Staff under pressure as winter surge starts early

Winter is the busiest time of the year for the already under-pressure NHS in London.

With more junior doctors strikes on the way, waiting lists to get through and the usual surge in winter illness, the pressure is on.

BBC London has been behind the scenes at Newham Hospital in east London where doctors, consultants and non-medical staff are preparing for a tough winter.

It's a wet and windy day when we arrive at Newham Hospital's car park. It's not easy to find a space - a clue perhaps as to how busy this place is.

Not yet in the depths of the NHS's usual winter pressures, there is already a posting on its website with a simple message. It reads: "Our emergency departments are extremely busy.

"Our teams continue to work hard to ensure patients are treated as quickly as possible, but wait times may be long and you might be seen quicker elsewhere."

Newham Hospital's website has a warning over how busy its emergency departments are

The emergency department is indeed busy.

As we make our way to the operations centre, a whiteboard there tells us they're expecting nearly 500 patients today.

It also tells us that many of those patients will be waiting longer than the four-hour target to get seen or treated.

Chantel Davies, deputy director of operations, said: "We're just in December, the NHS winter generally starts in January, so we are in the early stages of it.

"It's been tough so far... it's been incredibly tough."

Staff meet four times a day to discuss provisions for patients

Four times a day, about 30 staff from across the hospital arrive in the ops centre, an anonymous room off the main corridor on the first floor.

They're here from every ward, giving an up-to-date picture of every patient: who is ready to be discharged, what each patient needs, where the pressure points are, how demand is being managed - all are discussed.

It's been a decent morning; 11 patients are on their way home but 25 more are being lined up.

Dr Danny McGuiness, divisional director of acute and speciality medicine, says winter brings its own issues.

"Our patients increasingly have complex medical problems," he said.

"They're coming in sicker and many patients are waiting longer before they come to hospital and they are more unwell as a result when they do come in."

It can mean moving patients out of hospital is harder, so here they have a team dedicated to working with the local councils, charities and social care teams.

Hospital care these days is not just about care in the hospital.

Its Urgent Treatment Centre sees about 200 patients a day

We're taken along a yellow line painted from the entrance to the emergency department, around the corner to Newham's Urgent Treatment Centre - the UTC.

The reception is full of patients redirected from the emergency department. It's been decided they don't need to be admitted to hospital and can be treated in other ways.

Advanced clinical practitioner Blessing Uzoma is in charge today.

"We get to see over 200 patients every day," she said.

"Some of these patients get to be seen here by GPs, some are treated here and sent home, and others we refer to other specialists."

Strikes 'add to pressure'

Across the road, there's a new stand-alone building, the uninvitingly titled BHOC. It stands for Barts Health Orthopaedic Centre.

Stand alone, because this is where the trust that runs Newham does its planned orthopaedic surgery, so people waiting for knee or hip operations among other surgery, don't have to have procedures cancelled due to emergency cases.

This is part of their effort to tackle waiting lists. Currently across London, more than a million people are waiting for procedures.

But even here, progress will be hit by the continuing junior doctors' pay dispute; more strikes are planned in December and January.

It is another thing to add to growing winter pressures.

Dr Chris Streather, regional medical director for London, said: "We are well prepared, [we] have a playbook of things we do every winter.

"Our task is made more difficult by the impending junior doctors' action.

"I'm confident we'll keep people safe but it's hard work and I regret that it's happening. I hope both parties in the dispute will come to a negotiated settlement."

Patients have increasingly complex problems

This is a hope shared here at Newham, where staff are preparing for the even busier times ahead.

"It is undoubtedly more and more challenging as every month, week and year passes," says Ms Davies.

As we leave, three cars are waiting for our parking spot - and the ops centre team are preparing to meet again.