‘WE are struggling with overcrowding, we physically do not have anywhere for patients to sit or lie’.

Those are the stark words of Andy Ennis, Royal Bolton Hospital’s chief operating officer as he laid bare the huge pressures facing the A&E department, especially in the evening when most people choose to turn up, leading to overcrowding.

On average 420 patients a day are coming through the doors, leading to delayed ambulance handovers, exhausted staff and long waits.

Yet many of those seeking emergency treatment do not need to be admitted to hospital.

So intense is the pressure facing the hospital, Fiona Noden, chief executive of Bolton NHS Foundation Trust, likened the situation to that normally seen in January as people are unusually contracting winter viruses now.

The hospital is facing a perfect storm of winter viruses in July, demand on A&E, and Covid putting huge pressure on beds.

‘Mr Ennis said: “Despite £12m-plus to develop the department we are overcrowded.

“It was notable with the rainstorms we were down in attendances. We are overcrowded in the evenings, we are struggling when they all turn up at the same time.

“We are regularly seeing over 100 people at midnight still in the department and it is not unusual to see 30, 40 children at midnight.

“We are struggling with overcrowding, ambulance handovers, because we physically have nowhere to put the patients. We recognise the importance of getting away ambulances, we physically do not have anywhere for them to sit or lie and it is putting a strain on the whole department.

“We know we have Covid and it is not going away and will remain through the year.

“Bronchiolitis is already with us, it is a disease in children we normally see in a short peak in November and December. Already we have children and transferred a child to ICU, our HDU is full, our wards have been full “Flu is expected to be worse and norovirus is expected to be worse.

“Norovirus is one of those viruses where immunity wanes if you are less exposed. With lockdown you have less exposure and we are already seeing nursing homes already affected seeing it in children.”

Mr Ennis added: “We are now in a planning mode for what is going to be a challenging summer, autumn and winter. We would normally think about winter, now we have to plan for the lot.”

He said he was confident that the hospital could cope “because of the attitude of Bolton, because our staff are brilliant” and innovative.

Surprisingly the growing demand on A&E is not as a result of the pandemic.

It is the young and working age population, rather than the elderly, who are attending the emergency department.

Nearly half of those who attend A&E live in the most deprived wards in the town.

Mr Ennis said: “The rise in attendance is not a pandemic issue it is a culture change — it is where people believe they should go and it is not primary care failing to see the patients, although undoubtedly fewer face to face is a factor but is not the factor why patients are choosing this.”

“So what we have perhaps is a differentiation between urgent wants and urgent needs, so our number of admissions to attendance conversion is saying that there is not that many sick people out there but they feel it needs sorting out now, ”said Mr Ennis. “This is about us being a primary care provider. Our hospital is in the heart of that community so they see us as the point of contact. I do not believe that GPs are not doing enough, I think they are overwhelmed.”

Mr Ennis said: “I think they (patients) are choosing wisely, they are thinking ‘I need a blood test and I think I need and X-ray and if I go to a GP I will be sent to the hospital so why don’t I just go to the hospital and cut out the middle man’.

“It it is no good telling them they need to go somewhere else so we build the services around where they need or want.

“If we do not get into our communities and help them to be well then the hamster wheel of our A&E and services is just going to run faster and faster. We have to work with our communities to support them to keep them well in their homes.”

The board discussed the possibility of a walk-in centre to relieve pressures within the area where people are more likely to use A&E.

Mr Ennis said: “The survey at the time was clear, when it closed it did not make a big difference to attendances but since then the world has changed. It would not be helpful unless it has diagnostics — that’s why (our) bid for the community diagnostic hub is relevant otherwise you have a very limited service and they would still come here.”

“The bid we have for the community diagnostic s will part of the answer to that.”

James Mawrey, executive director of workforce at the trust, said: “We have absolutely fantastic staff in Bolton and it has been 18 months of hard work, but the urgent care pressures are huge and the staff members are exhausted. They have worked so hard to care for the Bolton public.

“It has become absolutely clear that the winter wards we thought were there for short periods, the urgent care pressures are huge and the winter wards will stay open, we need more staff, we need more nurses, more support workers.”

A recruitment drive is underway as agency spend is “spiralling”due to urgent care pressures and elective recovery, which the trust is pressing ahead with in spite of the pressures faced.

Mr Ennis said:”It is really important that we get our elective activity through, we have patients waiting for a long period on a waiting list they are coming to harm potentially if they do not get their operations. “We need to get the balance right and we need to work as a system around that, that might be working with Wigan working with Christies to make sure our patients get treated, it is absolutely that we are not sacrificing one element of our care for another part.”

Ms Noden said: “It feels like the middle of winter in the first week of January to our staff.

“It does feel extremely bad at the moment it feels really tough for everybody I just want to say a massive thank you to all our staff for looking after our patients and secondly for looking after each other and keeping each other safe.

“The restrictions were lifted earlier this month and from our point of view we still need to continue to wearing masks and still continue with our visitor restrictions because the level of activity of Covid in the Bolton borough is still quite high.

“I was reminded of this when I was driving home last week, when I was listening to the radio and somebody in Harrogate saying they only had two patients in the organisation and I was thinking we have 55 in so there is a huge level of difference in different regions of the country and I think we are still in the eye of the storm. So it’s a thank you to our staff who are brilliant.”