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The Norfolk & Norwich University Hospital, which was categorised in the latest Care Quality Commission inspection report (published 15 May 2019) as “requires improvement”, has since been so overwhelmed by patients that the senior doctors were told last week to make “the least unsafe decision” when treating patients.

The Guardian newspaper reported that they had seen the message which said “We would like you to know that the trust will support you in making difficult decisions that may be the least unsafe decision, and we would appreciate your cooperation over the coming days with this.”

The trust sent the message out because the hospital was so overcrowded, at the time there were no spare beds, a full accident and emergency department and 35 patients waiting on trolleys to be admitted. A major internal incident was therefore declared. The hospital added to it’s circular “We are facing our most challenging situation with our trust today.”

Pryers recently reported the national increase in A&E visitors and wait times, but this Norfolk and Norwich trust has seen their A&E waits in excess of four hours has more than doubled from just over 2,000 to nearly 5,000 in the past year.

Dr Julia Patterson, a spokeswoman for EveryDoctor, which campaigns to improve doctors’ working conditions, said the trust’s message meant “optimal care is unavailable now for some NHS patients [because] ‘the least unsafe option’ is the best we can offer”.

“When hospitals are so full that there are no intensive care beds, no hospital beds at all, and essential operations are being cancelled because there’s simply no one to do the surgery, then every option carries undue risk.”

Dr Sue Crossland, the president of the Society for Acute Medicine, said the message was worrying. “We would always support our members to make safe decisions, despite the pressures we face from all sides. We acknowledge the dire situation that we all find ourselves in, but we must always make safe decisions and give our patients the best care possible. Patients and their families deserve to know that trusts are providing the best and safest care.”

Over the weekend, staff at the East of England Ambulance Service (EEAST) received a text message asking for support to the A&E departments in NHS Norfolk, it said “Potentially looking for some staff this afternoon to care for patients in the ED departments across Norfolk & Waveney.”

One paramedic told their local press, that they might be asked or expected to occasionally help monitor a patient as they drop them off, but to be asked to come in and work in the A&E Department is a first. However, a spokesperson for Norfolk and Norwich University Hospital (NNUH) said “It is established practice for all trusts to make use of paramedic support in emergency departments as part of the overall winter plan.”

The Hospital has not yet needed to use additional resource from the Ambulance Service, but it must be looking at all options to ensure patient safety across what is proving to be an exceptionally busy time.

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