【卫报】英国国民保健署危机丨第5期

A cancer specialist at an Essex trust said they had never seen so many cancer operations cancelled.

埃克塞斯信托机构的癌症专家说他们从来没有见过这么多癌症手术被取消。

More than 20 hospitals in England have had to declare a black alert this week after becoming so overcrowded that they could no longer guarantee patient safety and provide their full range of normal services.

本周，超过20家英国医院不得不发布黑色警报：过度拥挤的医疗环境使他们不能再保证病人的安全和提供全方位的常规服务。

Unprecedented numbers of patients requiring care has led to at least 23 hospital trusts declaring they cannot cope since Monday, inquiries by the Guardian have established.

经卫报调查证实，由于急需护理的病人数字空前巨大，自周一起至少23家医院信托机构宣称已不能正常运转。

Struggling hospitals have been forced to take highly unusual steps in order to manage a surge in demand for care. They include cancelling cancer operations, treating adults in children's wards and even closing a birthing centre to help cope with a sudden influx of patients who need to be admitted for treatment.

捉襟见肘的医院被迫采取及其特殊的措施去应对护理需求的飙升。其中包括取消癌症手术，把成年人安排在儿童病房甚至关闭妇产中心去应对由于需要住院治疗的病患的激增而引起的床位紧张问题。

Hospitals are expected to come under even greater strain over the next few days as unusually cold weather sweeps across much of the country, which doctors fear could prompt a spike in serious breathing problems, among other conditions.

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University hospitals of Leicester NHS trust was under so much strain on Tuesday that it declared a "system critical incident" - even higher than a black alert - and had to make patients wait in ambulances before being offloaded into the care of A&E staff.

星期二，NHS信托机构莱斯特大学医院不堪重负，进入“系统危机临界”状态——一个比黑色警报更高级别的警报，这意味着病患在得到急症室的工作人员照料之前只能留在救护车上。

The Royal Surrey hospital in Guildford, which is used by many of health secretary Jeremy Hunt's constituents, declared black escalation status on Monday because it had become "extremely challenged" by the sheer number of patients whom it needed to find a bed for. At one point that day it had 27 patients who needed a bed but nowhere to put them.

星期一，吉尔福德的皇家萨里医院，这座卫生部部长杰里米·亨特的许多选民所就医的医院，宣告了黑色升级预警：它需要安置的病人数量“极具挑战性”。就在那天出现了有27位无法安置床位的病患。

Lewisham hospital in south London became so full on Monday it had run out of beds and in an email to staff it described the situations as "critical" and "not safe". The hospital had nowhere to put the next patient brought in as an emergency by ambulance, it added.

星期一，伦敦南部的路易甚姆医院爆满，床位告罄。在一封给员工的电子邮件中，医院把当时的情形描述成“危急的”和“不安全的”。其中还补充道，医院已经无法容纳救护车送来的下一个紧急病人了。

Under guidance which NHS England issued to NHS acute trusts last October ahead of this winter, hospitals were told to declare what is called a black alert when they have become "unable to deliver comprehensive care [and] there is increased potential for patient care and safety to be compromised".

今年十月，NHS（英格兰）向它的急救医院下发指示：当医院进入“不能提供全面照顾并且有可能无法提供看护、损害患者安全”的状态时，医院应当发布黑色警报。

The NHS document outlining the operational pressures escalation levels (Opel) system explains that Opel 4 means that "decisive action must be taken  to recover capacity and ensure patient safety" in the face of "rising system pressure". That black alert is what most of the 23 trusts have gone onto this week, though some have described it as a "serious internal incident" or in similar terms.

这份概述了压力升级应对系统的NHS文件解释到：四级压力意味着当面对“上升的系统压力”时，医院“必须采取果断行动来恢复医院的正常运作并且确保病人的安全”。尽管有些医院使用了“内部严重事件”等类似用语描述了状况，23家医院信托机构中大部分事实上已经进入了黑色警报状态。

The Royal College of Emergency Medicine, which represents A&E doctors, warned that the already chaotic situation in the NHS could get even worse as the winter weather worsens and that the A&E system is at risk of breaking.

作为急救科医生代表的皇家急诊医学学院警告说，紧随着冬季天气的恶化，NHS医院的业已混乱的情况将会越发糟糕。并且，急救系统正面临着崩溃的危险。

"Emergency departments are overflowing with patients, internal major incidents are being declared around the country and staff in emergency departments are struggling to cope with the immense demand being placed on their services," said Dr Taj Hassan, president of the Royal College of Emergency medicine.

皇家急诊医学学院的负责人泰姬·哈桑博士称，急诊部门的病人不断增加，全国各地告急范围持续扩张，急诊部门的医生和护士们疲于应对巨大的急诊需求。

"These crowded environments are stretching the clinical workforce to their limits and, more importantly, at times are unsafe for patients."

在这些拥挤的医疗环境中，医护人员工作能力压榨到极限，更严重的是，有时甚至无法保证病人的安全。

He urged ministers and NHS leaders to draw up an urgent action plan to rescue A&E care to avoid the quality of care patients receive starting to deteriorate. "Without dedicated funding and planning, both patients and staff will increasingly suffer", he added. However, it is understood that reports of a package of emergency funding for A&E units are wide of the mark and that the Department of Health will not be producing any more money, despite mounting problems.

哈桑博士呼吁各个部长以及NHS的领导人制定一个紧急行动计划来援助急救科，避免病人所接受的看护质量开始下滑。他还说“如果没有专项的资金和专门的计划，病人和医生、护士都将会持续饱受折磨”。然而，人们都知道关于给急诊科拨应急款的报告都是空谈，即使问题越来越多，卫生部也不会投入任何资金。

On Tuesday the Royal United hospital in Bath closed its Paulton Birth Centre for two weeks, which is usually used by women having a low-risk pregnancy who want a natural birth, and began using it to house medical patients instead.

星期二，巴斯的皇家联合医院波尔顿生育中心歇业两个星期，开始用它来容纳其他类型病人。那里本来是为想要自然分娩的低风险孕妇而设的。

In an email to staff it explained: "This is because we are experiencing unprecedented bed pressure across the health community and the current bed spaces in Paulton are required to take care of medical patients in a safe environment." Mothers-to-be left disappointed by the temporary closure could have their babies at an unspecified location elsewhere, it added.

在一封给工作人员的电子邮件中，院方解释说：“这是因为我们整个医院系统正面临着前所未有的床位压力，而且我们需要波尔顿目前的床位来在安全的环境中照顾病患”。邮件中还写道，因生育中心的临时关闭而无法入院的准妈妈们可以去非指定的其他地方分娩。

Two days in a row Broomfield hospital, Essex, had to tell a patient with oesophageal cancer that they could not have their scheduled oesophagectomy - which could cure them - because it had no free intensive care bed in which to care for them after the procedure. One cancer specialist at the trust said: "I have never seen so many cancer operations cancelled."

由于没有术后用于康复的重症监护床位，位于埃克塞斯的布鲁姆菲尔德医院不得不连续两天告知食道癌患者，医院不能如期进行可以治愈他们的食管切除手术。医院的一位癌症专家表示，从未见过如此之多的癌症手术被取消。

NHS登上伦敦奥运会

A spokesman for the Leicester trust, which runs the city's two main hospitals, said: "The system critical incident, the top level alert, was put in place [on Tuesday] at 8am and we finished it at 1pm [on Wednesday]. This is an alert higher than Opel 4. It's essentially when this starts to impact part of your business or other businesses.

附属两家莱斯特城大医院的莱斯特信托机构发言人表示：自（周二）早8点起，截止（周三）下午1点，医院启动最高级别警报：系统危机临界。这次警报级别远远高于四级警报，这表明医院和其他行业开始受到影响。

"For us, [Tuesday's] situation impacted on the wider health system. We had to hold ambulances at our A&E as they couldn't offload patients. We were at system critical; that's the highest point."

“对我们而言，（周二）局势波及更广泛的医疗系统。由于紧急病患无法得到安置，救护车被滞留在急诊科。我们那时处于系统的危机临界，那是最高级别警报。”

Its main problem was its inability to discharge older patients, in order to free up beds, because local social care was inadequate, the trust added. It had also put more staff on to its frontline and cancelled elective surgery to help it cope.

信托机构进一步表示，主要问题是因当地社会医疗资源匮乏，医院不能让年老患者出院进而腾出空床位。他们还将更多人员调往前线，并取消非必需手术，以此帮助解决床位拥挤问题。

Caroline Landon, chief operating officer at the Epsom and St Helier trust in south London, told the Guardian: "For a short period last week we used our paediatric day case units to care for adult patients who urgently needed a hospital bed. We also used our adult day case unit and medical infusion suite for the same purpose."

埃普索姆和圣艾利耶信托机构位于伦敦南部，其首席运营官卡洛琳·兰登向《卫报》记者表示:“上星期，有过很短一段时间，我们把儿童的日间看护房和成人的日间看护房、输液套间临时用来照顾急需病床的成年人。”

A doctor at the Maidstone and Tunbridge Wells NHS trust said it had decided not to declare an internal emergency because its bosses did not want bad publicity. Things are so stretched there that she had seen a patient with urinary problems being given a bed bath in the middle of a corridor, with just a plastic sheet to shield her from the rest of the ward.

梅德斯通与坦布里奇韦尔斯的NHS信托机构的一名医生表示，因医院领导不想败坏医院形象，决定不发布内部紧急情况警报。那里的情况极其糟糕，她见到医护人员在病房过道给一名泌尿疾病的患者洗床浴，仅仅用一片塑料布将其与病房其他人隔离开来。

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审核丨白夜叉，阿妫

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