Leicestershire and Rutland is 'almost in critical incident territory' once again, the medical director of the health board has warned today. 

Leicester, Leicestershire and Rutland (LLR) Integrated Care Board's medical director Nilesh Sanganee gave the gloomy prediction at the regional health scrutiny meeting held at Leicestershire County Council's offices this morning. 

He said 'extreme pressure' across the Midlands was putting pressure on the region's ambulance service. 

Critical incidents are declared when a health system is so stretched that it is unable to provide services as normal and typically asks people to consider their options before attending hospital. 

He said: "We are experiencing extreme pressure across the Midlands, not just LLR. East Midlands Ambulance Service are under extreme pressure, with some record numbers of calls. So, we are literally almost in critical incident territory at the moment, in the way we are operating, because of the pressures on the ambulance service. And so we have decided to enact some of those additional winter interventions early to make sure we can support our ambulance service, but also our wider system" 

He also said there were currently 'huge' numbers of children attending the accident and emergency department at Leicester. 

The ICB and the University Hospitals trust jointly declared a 'critical incident' last month and at the meeting the medical director said that had largely been due to a rise in respiratory illnesses and norovirus which had led to an increase in people attending accident and emergency. 

The health boss and the chief operating officer at the University Hospitals of Leicester Jon Melbourne were given a tough grilling at the meeting, by the members of the scrutiny board – most of whom are councillors from across Rutland and Leicester. 

Cllr Zuffar Haq (Lib Dem), a Leicester City councillor who represents Evington, cited a number of recent incidents, including a woman who had broken her hip and lay waiting for an ambulance for nine hours. He also said he had recently witnessed 12 ambulances queuing outside the Leicester A and E because there was no space for the patient they were bringing in.  

He asked the medical director: "What is going on and why is the system so broken?" 

Mr Sanganee said: "Those situations are totally unacceptable. They're not something that we want any of our citizens to experience. We absolutely want to apologise for any poor experience or poor care because of the pressures they're experiencing. The pressures are not unique to Leicestershire and Rutland, it's across the whole of the midlands at the moment and we have many systems either close to or declaring critical incidents. The pressures are extremely high – and it goes beyond the Midlands as well. 

He added: "I really want to emphasize that we are doing everything we possibly can to get the right care to the right patient in the right way. We absolutely understand the experience of our patients at the moment across the urgent care pathway is sub optimal, and that's to say the least at times." 

East Midlands Ambulance Service is also facing increasing pressures. (Photo: EMAS)

Cllr Dan Harrison (Con), a Leicester County councillor for Ibstock, said it was obvious the winter planning done by the health system was 'nowhere near the game to be able to cope'. And Cllr Ross Hills (Con) Leicestershire County councillor for Hinckley, questioned why a critical incident had been called so early? 

He said: "I don't recall having a critical incident this early in the winter. I think it's been mild up until the last few weeks as well. So am I right to assume then that these are just going to become more standard, possibly common, critical incidents?" 

Mr Sanganee said there had been 'some sort of seasonal change' that is leading to earlier presentation of respiratory disease and the usual lull in the summer months was no longer happening. 

Mr Melbourne said: "We are seeing demands above what we had initially planned for this year. Every year we look at demand projections, but we are seeing dome demands, both in terms of attendances and admissions, that are above what we would expect, and this is why we are putting in place additional interventions. However, as Nila has also referenced, we have had financial challenges as well and we have to make sure we are using the best use of our money. There are times when the variability we see in urgent emergency care demand can lead to significant pressures and sadly, people waiting on ambulances, for example. I don't think it is a sign of weak winter planning, but what it is, is a sign of increase in demand in some areas where it is really challenging to cope with the level of demand." 

The health system in LLR is currently predicting a £80m overspend this year, which could likely increase when new finance reports are presented to the ICB board next month. 

Cllr Phil King (Con), who is Leicester County Councillor for Market Harborough, said: "What I'm concerned about is that nothing is being done to address the fundamentals of the issue, which to me seems to be that in Leicestershire and Leicester, you've got essentially a central A and E; that you've got limited access for people in the county to access their GPs. Out of hours the provision is complicated. They [residents] don't understand and so they go to route one and route one is to turn up to a and e in Leicester, because they know it's open 24/7 and they know that someone will be there and eventually they will get seen." 

He continued: "To me this seems to be a fundamental problem that is not or has not so far been addressed. I'm just wondering what is being done, because I'm not hearing as much about that as I used to and that's concerning. 

"Are we just, excuse the expression, kicking the can down the road, fire fighting, literally from month to month, week to week." 

The UHL chief operating officer said there were longer term plans, and a report would be brought to the next health scrutiny committee meeting. 

He said: "We are committed to thinking transformationally about how we design urgent emergency care to give the best care for patients in LLR  

He said: "Just dealing with x per cent more demand each year is not a sustainable solution."