Flu wave hits England’s busiest A&E

In England's busiest emergency department, every bed is occupied by midday.

When one patient leaves his room in the emergency department of Leicester Royal Infirmary, cleaners are waiting outside.

As soon as he leaves the room, the bed is stripped and bleach is sprayed. The next patient is already waiting in the wings.

Over the course of two days, the BBC was given access to the hospital to see first-hand how it was coping with an early surge in winter bug cases.

This year's flu season started a month earlier than usual.Experts warn that a more serious strain of the virus, mutated H3N2, appears to be circulating.

Hospitals across the country, such as this one in Leicester, are doing everything they can to avoid being completely overwhelmed.

But Royal Infirmary staff say the rising number of people coming to hospital with flu and other winter infections, as well as existing pressures, is hitting the hospital hard.

They are already worried about how they will survive this winter.

When 19-year-old Paige arrives at the hospital by ambulance, she is placed on a trolley while an intensive care bed is cleared. She has the flu, but she also has type 1 diabetes and dangerously high sugar levels. She was curled up in a ball, pale and shaking.

“There are patients in every cubicle,” says consultant Saad Javaid when Paige is brought in. “Another ambulance just arrived.”

We watch as he and his colleagues in the intensive care unit search for desperately needed beds.

“When beds are full, we have to move people around—sometimes that means moving people who can sit from beds to chairs,” he says.

Paige is given insulin and fluids to try to stabilize her sugar levels. Doctors hope her diabetes will be under control soon. Recovery from the flu will take longer.

The next day, Paige is in a side room in the emergency room.

“I have a really hard time in the winter,” she says. “Maybe I was here two or three weeks ago. The infections and stuff seem to be hitting harder than usual.”

The number of flu patients in hospital has reached record levels at this time of year in England, with NHS bosses warning the country is facing an unprecedented flu season.

Last winter, at its busiest times, the emergency department here in Leicester saw over 1,000 patients a day. On one of the days of our stay, 932 patients entered here. This number is expected to increase in the coming weeks.

Attendance levels this year are already about 8% higher than last year. The department lacks between 50 and 70 beds every day.

Around 64 beds at the Royal Infirmary are currently occupied by people with respiratory viruses, including influenza.

We meet one patient who has been waiting for a bed in the ward for 106 hours. Another, Gary, came in with a stomach problem and finally went to bed after 34 hours.

By evening, the children's waiting area is full. Parents stand rocking crying babies while all the seats are taken.

Respiratory illnesses such as influenza and bronchiolitis, a disease that affects the lungs of young patients, are also rapidly increasing here.

In just 30 minutes, 30 children arrive at the department.

At five months, this is Oscar's first winter and his first trip to the emergency room. His mother brought him in because he was wheezing and having trouble breathing. A few hours after arriving, he was finally examined by a doctor and told that he had bronchiolitis.

“These bugs are everywhere now – Oscar's older brother brought them home from school and now Oscar has them,” his mother says.

Richard Mitchell has been chief executive of University Hospitals of Leicester NHS Trust since 2021 and has witnessed first-hand how difficult it becomes to cope with each passing winter.

“We are already seeing very high levels of flu,” he tells us. He expects the numbers to rise in January. “This is one of the many things that worries me at the moment.

“At the moment, I feel like we are operating at the limit of our capabilities.”

The hospital has introduced a new system to manage the flow of patients into its emergency department as pressure on front-line services increases.

Receptionists, nurses, right down to consultants now sit at desks near the entrance, assessing patients as they arrive.

This speeds up triage, gets people away from the front door and ensures those most in need receive emergency care.

Staff say the range of cases is becoming increasingly polarized. Some of the most seriously ill patients are brought in by relatives due to long wait times for ambulances.

At the other end of the scale, people come in with minor complaints after struggling to see a GP. “Last week someone came in with herpes,” one nurse tells us.

Experienced staff can refer those who do not need urgent care, helping them make an appointment with a doctor or directing them to pharmacies and other services. One in 10 patients is now sent away from hospital, although staff admit this can be frustrating.

After one violent incident, security was beefed up, with glass partitions installed and 24-hour security installed.

Leicester Royal Infirmary introduces new measures every year to increase capacity and manage increasing demand. Winter pressure continues to rise and the calmer summer months are a thing of the past.

To reduce queues for ambulances, the prefabricated structure was converted into a permanent unit with 14 beds – all of which were full at the time of the BBC's visit. Without them, 14 ambulances would have been queuing for hours to unload patients.

Unlike many hospitals, Leicester's emergency department is not overcrowded with elderly patients. Frail patients are referred directly to specialist units, including a frailty unit, or receive support in the community to avoid long hospital stays.

Preston Lodge, a former care home bought by the trust, now provides 25 beds and a further 14 will open on December 15. Patients who no longer require acute care but still need rehabilitation or support are transferred there to await care packages.

“We're aiming to prepare people to return home and hopefully make them stronger and more independent so they don't end up returning to hospital as often during the winter,” says head of nursing Emma Roberts.

Looking ahead, Mr Mitchell expects waits and delays for patients to only get worse in the coming weeks.

In the first week of January – traditionally the busiest week of the year – the hospital plans to free up more emergency beds, but that means postponing other surgeries and procedures.

He says: “We will not be able to provide timely care to every patient this winter, but we will continue to do everything we can to ensure patients are treated with dignity and respect to ensure they receive safe care, and we will do everything we can to reduce waiting times.”

Hospital leaders here are trying to take proactive steps rather than simply react to every crisis. But staff and patients alike warn that hospitals across the country are caught in the middle of a system that many say is close to breaking point.

In a statement, the Department of Health and Social Care said it was “under no illusion that this winter will be a difficult one for our NHS”.

A spokesman said: “Cases of flu are rising so it is vital that patients can be protected. Nearly 17 million vaccines were delivered this fall, up 350,000 from last year.

“There is no shortage of flu vaccine in the country, and we encourage everyone who is eligible to be vaccinated to protect themselves and their loved ones.”

Get our top newsletter with all the headlines you need to start your day. Register here.