The dark clouds gathered across the slate grey sky.  Another dawn arrived with a sliver of silver light, just above the horizon.

The street lamps were still glowing amber.

There were twelve Merc 515’s lined up on the runway, they’d been there all night.  Interior lights blazing.  Some engines ticking over.  Ambulances, on a nine hour wait, to get into A&E.  Over the last fortnight it was routine.  

Anne Milton had just taken over from Jeremy Hunt, the longest serving Health Secretary.  He’d been moved to the Foreign Office following Boris’ flouncing out of Cabinet and marching up Downing Street for the benefit of the cameras.

Milton was hurried into the board room, avoiding the waiting press.

Can’t you do something...’  was all she could say.

The chief executive leaned back in her chair and shot a glance to the medical director.

‘Secretary of State; we have cancelled all but emergency operations, we have mix-sex-wards all over the hospital.  Outpatient appointments cancelled.  We have amalgamated the paediatric ward with the Trust across town and are using ours for adults.

‘There are patients on trolleys in the corridors.  The boardroom and the waiting rooms in out-patients are temporarily wards.  Estates are turning two storage cupboards into rooms.  

‘We have 20 beds at the Travel Lodge across the road but they are asking us to leave as it is putting-off the other guests.  We will probably take over the entire hotel.  We are waiting to hear from their board by lunchtime.

‘The ambulance service are using taxi firms and thank goodness for the St John’s and Red Cross; they’re doing home visits.  We expect to have the leisure centre kitted out by tomorrow lunchtime.

‘We are beyond diverting patients.  There is nowhere to divert them to.

‘Our big problem is staff.  We only got to 42% coverage with the flu-jab before it got bad.  One in five of the staff are off sick.  Over the next ten days we anticipate the sickness rates to increase.  We have managers cleaning, working in the kitchens and the labs.  We have closed the general switchboard, hired every single person the local agencies could find.

‘We have consultants triaging A&E and sending all but the sickest back to their GP.  They are swamped.  Half of them seem to have the flu.

‘We are in discussions with the military for field hospital wards in the car-park… what else do you suggest?’

Milton knew, by lunch time she would announce, to the House, the closure of all cinemas, clubs and pubs and asking the public to keep travel to a minimum.  

The medical director finished with; ‘I can’t see us recovering the waiting list position any time in the next there years.  People will die waiting…’

Milton stared into her coffee cup.  Welcome to Whitehall.

Yes it’s just a story… but… as I write, fiction is becoming fact.

Yesterday, in three hours the London Ambulance Service took 1,000 calls.

If anyone told you the hospitals were on Black-Alert… they weren’t.  None of them are.

We don’t do the green, amber, red and black thing any more.  It’s OPEL;  Operational Pressures Escalation Levels.

Escalation protocols used to vary from area to area.  We don’t have districts or regions any more so we talk about ‘health economies’.  OPEL is designed to put some structure into a consistent approach, to help get a feel for what is going on nationally. 

It doesn’t make the NHS any less busy.  It just lets someone in Whitehall know the NHS is busy.  Not that they can do anything about it.  It’s just nice to know.

And, it doesn’t make it any easier to answer the question; how many Trusts are on OPEL 4 today?  By the look of social media, it’s easier to answer the question, which ones aren’t.

PHE publish a weekly bulletin.  Here’s the latest.  It doesn’t seem to reflect the crescendo on the ground?

Everywhere’s choc-a-bloc; frail elderly with breathing difficulties and dehydrated patients admitted with ugly D&V.

The horrible fact; it’s generally the end of January and early February that are the really bad months.

It ain’t over ’till the fat lady uses her last Kleenex and starts signing.  It might just be the case that it won’t get started until a new lady arrives and starts listening. 


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