A senior emergency department consultant lifted the lid on pressures facing Wrexham Maelor hospital as fears were raised with First Minister Carwyn Jones.

Dr Robin Roop was among a total of 46 doctors from across Wales who signed a letter to Mr Jones highlighting problems they say are cropping up on a daily basis.

They acted following the release of Welsh Government figures which showed that during December 2017 the average number of A&E attendances per day was 2,656 – 5.4 per cent higher than the same month in 2016 and the highest number of attendances per day in any December since records began in 2006.

Furthermore, in December 2017, 3,741 patients spent 12 hours or more in A&E, from arrival until admission, transfer or discharge. This is an increase of 26 per cent compared to December 2016.

The letter cites a similar one sent to Prime Minister Theresa May last week on the issue of struggling emergency departments in England.

The group say emergency departments in Wales are no exception – in some ways being in a worse situation.

The letter says: “We feel compelled, as our colleagues in England did, to speak out in support of our hardworking and dedicated nursing, medical and allied health professional colleagues, and to share the very serious concerns we have for the safety of our patients.

“Safety is compromised in all of our departments to an unacceptable degree. This is despite the enormous efforts made by our staff to keep patients safe in extremely challenging circumstances.

“We do not dispute that great effort was put into winter planning for NHS Wales at both Welsh Government and Health Board level. Unfortunately, our experience from the clinical front line is that these plans have fallen well short of what was required to maintain adequate care for our patients.

“We acknowledge Health Boards are doing everything they can to create capacity and more beds in the short term, and we are grateful to them for their continued assistance in such a time of crisis.

“We also acknowledge the help and support given to the Emergency Departments by our colleagues in other specialties and disciplines across our hospitals.

“We appreciate the financial constraints under which the Welsh Government must operate. However, the current situation demonstrates that both the Welsh NHS and Welsh social care are severely and chronically under-resourced.

“We have neither sufficient staff, nor sufficient beds (in either acute hospitals or the community) to cope with the needs of our ageing population.

“As you know, a number of scientific publications have shown crowded Emergency Departments place patients at increased risk. This risk (in terms of both increased morbidity and mortality) increases in line with the amount of time patients spend in the ED after their initial treatment is complete.

“The letter sent to the PM mentioned how appalling the situation has become in many departments. The EDs in Wales are no exception – indeed, in some ways the situation is even worse. The
four-hour target figures for our best performing hospitals are similar to those from some of the worst performing hospitals in England."

They add: “Recruitment and retention of staff in Welsh EDs has been a particular challenge over the last few years. As a direct result of the relentless pressure our EDs are under, we are now seeing a worrying number of talented medical and nursing staff leaving a specialty they love to pursue careers in other areas of the NHS or overseas.

“We acknowledge the collaborative efforts made by the Royal College of Emergency Medicine, Wales Deanery and the Welsh Government to find a solution to address this problem. If we are unable to rectify this soon, then the situation will deteriorate further with every coming winter."

Dr Roop, also vice-president of the Royal College of Emergency Medicine Wales, added: “For staff, an Emergency Department feels like a battlefield. We are fighting to safely treat an increasing number of acutely unwell patients, we’re fighting to find enough staff to cover shifts 24/7 and we’re fighting to find hospital beds for sick patients when there simply aren’t enough.

“The fact of the matter is that, despite the best efforts of all NHS staff, patient safety is being compromised daily.

“It is not acceptable that an increasing number of patients are being left on a trolley in a corridor, without satisfactory care. This is unsafe, undignified and distressing for patients and their family.

“We are also seeing a high number of patients suffering from the flu this winter. This means that even more beds are made inaccessible to other unwell patients to, rightly, prevent the spread of this infectious disease.

“The perennial pressures on our Emergency Departments is not the fault of the patient or staff. We should be able to plan and care for our growing and ageing population, despite severe cases of influenza and other infectious illnesses.

“However, insufficient resources to match patient numbers all year round has resulted in compromised patient safety, declining four-hour performance, A&E crowding and ‘exit block’ across Wales.

“The College welcomed the Welsh Government’s winter resilience plans in November. Nevertheless, to provide safe and sustainable care for all patients we need more.

”We need more capacity in the entire health and social care systems which means more hospital beds, more nurses and more doctors. Our A&E Departments are severely stretched.”

He added: “The figures released today paint a stark picture of the unyielding pressures faced by A&E staff, day and night.

“Yet the figures should not come as a surprise. We warned that our health and social care services are under-resourced and under-staffed to meet the predicted demand.

“The college welcomed the announcement of an additional  £10m to help relieve winter pressures  this month. Nevertheless, this is too little, too late.

“To provide safe and high-quality care for all patients we need more capacity in the entire health and social care system. This means more hospital beds, more nurses, more doctors and more social care facilities, all year round.

“Let’s act now and plan for future demand so that patients receive the high-quality service that we all aspire to provide.”

Commenting on the NHS Wales performance statistics, cabinet secretary for health and social services Vaughan Gething said: “Despite the busiest December on record for our A&E Departments and the busiest ever month for the Welsh Ambulance Service, our NHS has continued to perform under exceptional pressure in delivering emergency and scheduled care.

“The ambulance target was comfortably achieved in December. Although there was a slight drop in the proportion of patients admitted or discharged within four hours of arrival at A&E, A&E performance for the whole year has improved with 82.5 per cent of patients seen in under four hours up from 81.2 per cent last year.

“I want to once again thank our NHS and social care staff for their commitment and hard work in delivering care during this extremely busy period.

“We have worked closely with health boards and partners since last winter to plan for this winter period and invested an additional £60m to help them deliver urgent and emergency care, and ensure planned care activity can continue during this time.

“During November, the number of patients waiting over 36 weeks stabilised, and while sadly some activity has to be postponed our investment has ensured operations and other procedures have continued through winter. 

“We expect to see reductions in waiting times up to the end of March 2018. 

“Delayed transfers of care in December were lower than they were the same time last year and for the whole of 2017 the lowest they’ve been since records began.

“Therapy waiting times have again improved over the month and more people were treated within target times for cancer than in any previous November.

“Over 90 per cent of urgent cancer patients were seen within the target times, the best performance since February 2014 and the target for non-urgent cancer patients was met.

“We still need to drive up performance in a number of areas but under severe pressure and record levels of demand our NHS has held up and continues to deliver high quality healthcare to patients.”