• Regulator criticises local chiefs’ response to extreme pressure
  • Bristol, North Somerset and South Gloucestershire declared a “critical incident status”
  • CCG says changes have been made

An NHS England/Improvement regional manager has reported “serious concern” about the handling of a “critical incident”, in which an entire health economy was subjected to extreme operational pressure, HSJ can reveal.

Correspondence seen by HSJ shows NHS managers in Bristol, North Somerset and South Gloucestershire were told they did not urgently address risks to patient safety caused by the pressure felt by the system.

The concern, flagged by Mark Cooke — the regulator’s director of strategy and transformation for the south west — has prompted several changes to the way leaders in the region escalate their response at times of intense pressure.

On 25 November, the health economy declared “critical incident status” and raised its response level to OPEL 4 (used when NHS organisations face extreme pressure to deliver services).

Three days later, Mr Cooke told a BNSSG chief executive and colleagues in NHSE/I’s regional team about his “serious concern” regarding the area’s “approach to OPEL 4 system response”, which he said was not managed in the nationally agreed way, including discussing it with the regional team.

The next day, on 29 November, the health economy downgraded its status from OPEL 4 to OPEL 3, which remains the status today.

Mr Cooke said a “gold command call” between local leaders showed them taking a “tactical if not operational approach” and that participants failed to “look strategically at the situation and urgently addressing (sic) any immediate risks of harm to patients”.

Examples included a lack of information about the number of beds needed by the region’s acute trusts that evening, the number of discharges needed, how many community beds could be made available, and how other services such as primary care and ambulances could be mobilised to help.

Mr Cooke also wrote: “There appears to be little structure and a distinct lack of vital information which would enable the system to de-escalate as soon as possible.”

He highlighted a lack of “perceivable senior presence” in the health system at the time. His message indicated that Andrea Young, chief executive of North Bristol Trust, and Julia Ross, chief officer of BNSSG Clinical Commissioning Group, were both away. The email was sent to Janet Rowse, chief executive of Sirona Care and Health, which is the region’s community services provider.

The CCG told HSJ today that following Mr Cooke’s email, it carried out a debrief of the BNSSG “system escalation response” which was shared with the region’s chief executives and accident and emergency delivery board.

A CCG spokesman said: “A number of changes to processes have been made with immediate effect and we have discussed these changes in detail with colleagues at NHSE/I.”

HSJ asked what the changes were but had not received a response at the time of publication.

Asked for a comment, an NHSE/I spokeswoman said the regulator has a responsibility to “support our systems to work together to maintain safe patient care, particularly in times of pressure”.

Sirona directed HSJ to the CCG’s response. 

October’s data on emergency department attendances showed North Bristol Trust achieved 80.4 per cent against the four-hour target while University Hospitals Bristol managed 82.5 per cent.

Elizabeth O’Mahony is regional director for the south west patch, which oversees the system.

  • Article updated at 10.02am on 11 December to correct a quote from Mr Cooke’s email. We initially reported “tactical not operational approach” - the correct quote was “tactical if not operational approach”.