Pressure on hospitals is particularly high this winter, with more than a dozen declaring critical incidents in recent days.

Hospitals struggle every winter with additional pressures due to the impact of cold weather, but the early arrival of flu this season and high volume of cases meant Christmas and New Year’s weeks were even busier than usual.

There are currently at least 20 hospitals that have declared critical incidents in England, although this is a fast-moving picture, and some trusts will go into critical incident for as little as half an hour.

The latest NHS winter situation reports give a more detailed look at the level of pressure experienced by individual trusts, including those with the worst ambulance handover delays and highest levels of flu patients.

Ambulance handover delays

When a patient arrives at a hospital in an ambulance, clinical guidelines suggest that it should take no longer than 15 minutes to transfer them into emergency care.

It is now common for handovers to regularly exceed this timeframe, however, when emergency departments are overcrowded and lack the capacity to keep up with new patient arrivals.

This is risky for patients because it delays their assessment and treatment by clinicians, and also reduces the availability of ambulances to respond to new incidents.

The trust with the longest delays was University Hospitals Plymouth, with an average handover time of three hours and 33 minutes over the week – two hours and 40 minutes longer than the average for England. It also recorded the longest average handover times for a single day, at five hours and 14 minutes on New Year’s Day.

Use the table below to search for local ambulance handover times:

On 7 January, University Hospitals Plymouth declared a critical incident at Derriford Hospital due to “significant and rising demand for hospital care”, though this has since been stood down.

The Shrewsbury and Telford Hospital Trust had an average ambulance handover time of three hours and 15 minutes, increasing by more than an hour from one hour and 51 minutes the week before.

In Royal Cornwall Hospitals NHS Trust, 83% of handovers took more than 30 minutes, the highest share among areas dealing with more than five ambulance arrivals per day.

This area also recently declared and then stood down a critical incident.

In total across England, 43 trusts out of 127 had average handover times of more than an hour, while nine areas had average handover times of more than two hours.

Flu

This winter’s flu wave arrived earlier than usual and has hit health services hard.

Over New Year’s week, there were 5,407 flu patients in hospitals in England on average each day, more than three times higher than during the same week last year and increasing by 20% from the week before.

The worst impacted trusts were Northumbria Healthcare and University Hospitals Birmingham, with 15% and 13% of all available beds occupied by flu patients respectively in the latest week.

Wirral University Teaching Hospital NHS Foundation Trust had among the biggest increase in flu patients from the previous week, more than doubling from 18 to 42 patients per day on average.

Use the table below to search for local flu hospitalisations:

There are some indications that flu activity may have now peaked, with national flu surveillance showing a decrease in positive flu tests in the latest week, though activity remains at high levels.

Bed occupancy

Current NHS guidance is that a maximum of 92% of hospital beds should be occupied to reduce negative risks associated with overfilled beds.

These risks include the impact on patient flow resulting from it being more difficult to find beds for patients, and negative impacts on performance and waiting times, as well as being linked to increased infection rates.

In the week to 5 January, 92.8% of 102,546 open hospital beds were available each day on average, not far off the recommended level.

However, bed occupancy was very high in some trusts, with more than 95% of beds occupied in 43 trusts on average over the week.

The trust with the highest rate of bed occupancy was Wye Valley NHS Trust, with 99.9% of 332 beds occupied on average throughout the week.

There was only one day when beds weren’t fully occupied, on 3 January, when two beds of 322 were available.

Use the table below to search for local bed occupancy:

Kettering General Hospital NHS Trust recorded bed occupancy of 98.5% over the week. This trust declared a critical incident on 8 January.

Part of the problem for bed availability is prolonged hospital stays – also known as bed-blocking.

This is often linked to pressures in other parts of the health and social care system, for example when patients can’t be discharged to appropriate social care providers even though they are ready to leave hospital.

Just under half of beds occupied by patients in English hospitals last week were occupied by long-stay patients who had been there for seven or more days.

In seven trusts, at least three in five beds were occupied by long-stay patients, while in Barking, Havering and Redbridge University Hospitals NHS Trust the figure was more than four in five beds.

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Making Britain better off will be “at the forefront of the chancellor’s mind” during her visit to China, the Treasury has said amid controversy over the trip.

Rachel Reeves flew out on Friday after ignoring calls from opposition parties to cancel the long-planned venture because of market turmoil at home.

The past week has seen a drop in the pound and an increase in government borrowing costs, which has fuelled speculation of more spending cuts or tax rises.

The Tories have accused the chancellor of having “fled to China” rather than explain how she will fix the UK’s flatlining economy, while the Liberal Democrats say she should stay in Britain and announce a “plan B” to address market volatility.

However, during a visit to Beijing’s flagship store of UK bike maker Brompton, Ms Reeves said she would not alter her economic plans, with the October Budget designed to return the UK to economic stability.

“Growth is the number one mission of this government,” she said.

“The fiscal rules laid out in the budget are non-negotiable. Economic stability is the bedrock for economic growth and prosperity.”

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The chancellor is being accompanied by Bank of England governor Andrew Bailey and other senior executives.

She will meet with her counterpart, Vice Premier He Lifeng, in Beijing later on Saturday to discuss financial services, trade and investment.

She will also “raise difficult issues”, including Chinese firms supporting Russia’s invasion of Ukraine and concerns over constraints on rights and freedoms in Hong Kong, the Treasury said.

But it did not mention whether Ms Reeves would raise the treatment of the Uyghur community, which Downing Street said Foreign Secretary David Lammy would do during his visit last year.

On Friday, Culture Secretary Lisa Nandy defended the trip, telling Sky News that the climbing cost of government borrowing was a “global trend” that had affected many countries, “most notably the United States”.

“We are still on track to be the fastest growing economy, according to the OECD [Organisation for Economic Co-operation and Development] in Europe,” she told Anna Jones on Sky News Breakfast.

“China is the second-largest economy, and what China does has the biggest impact on people from Stockton to Sunderland, right across the UK, and it’s absolutely essential that we have a relationship with them.”

Read more – Ed Conway analysis: The chancellor’s gamble with China

However, former prime minister Boris Johnson said Ms Reeves had “been rumbled” and said she should “make her way to HR and collect her P45 – or stay in China”.

While in the country’s capital, Ms Reeves will also visit British bike brand Brompton’s flagship store, which relies heavily on exports to China, before heading to Shanghai for talks with representatives across British and Chinese businesses.

It is the first UK-China Economic and Financial Dialogue (EFD) since 2019, building on the Labour government’s plan for a “pragmatic” policy with the world’s second-largest economy.

Sir Keir Starmer was the first British prime minister to meet with China’s President Xi Jinping in six years at the G20 summit in Brazil last autumn.

Relations between the UK and China have become strained over the last decade as the Conservative government spoke out against human rights abuses and concerns grew over national security risks.

Navigating this has proved tricky given China is the UK’s fourth largest single trading partner, with a trade relationship worth almost £113bn and exports to China supporting over 455,000 jobs in the UK in 2020, according to the government.

During the Tories’ 14 years in office, the approach varied dramatically from the “golden era” under David Cameron to hawkish aggression under Liz Truss, while Rishi Sunak vowed to be “robust” but resisted pressure from his own party to brand China a threat.

The Treasury said a stable relationship with China would support economic growth and that “making working people across Britain secure and better off is at the forefront of the chancellor’s mind”.

Ahead of her visit, Ms Reeves said: “By finding common ground on trade and investment, while being candid about our differences and upholding national security as the first duty of this government, we can build a long-term economic relationship with China that works in the national interest.”

A coroner has warned about the effects of depression medication after the husband of the Prince and Princess Michael of Kent’s daughter took his own life.

Thomas Kingston, a 45-year-old financier, was found dead on 25 February last year at his parents’ home in the Cotswolds.

Katy Skerrett, senior coroner for Gloucestershire, has said action must be taken over the risk of suicide to patients after finding he was “suffering adverse effects of medication he had recently been prescribed”.

Mr Kingston married Lady Gabriella, 43, at Windsor Castle in 2019, with Queen Elizabeth II and the late Duke of Edinburgh among the guests.

The inquest into his death at Gloucestershire Coroner’s Court last year was told he had initially been given sertraline, a drug used to treat mental health problems, and zopiclone, a sleeping tablet, after complaining of trouble sleeping following stress at work.

But after they did not have the desired impact, a GP switched him from sertraline to citalopram. In the days leading up to his death, Mr Kingston stopped taking medication.

Read more:
Who was Thomas Kingston?

In a prevention of future deaths report, Ms Skerrett questioned whether there is adequate communication of the risks of suicide associated with such medication.

She also raised concerns about whether the current guidance to persist with selective serotonin reuptake inhibitor (SSRI) medications, or switch to an alternative SSRI medication, is appropriate when no benefit has been achieved – “especially when any adverse side effects are being experienced”.

The report was sent to the National Institute for Health and Care Excellence (NICE), the Medicines and Healthcare Products Regulatory Agency and the Royal College of General Practitioners, who have 56 days to respond.

The coroner’s concerns echo those of Mr Kingston’s wife, Lady Gabriella, who warned about the effects of the drugs during the inquest.

A statement by Lady Gabriella, read out by Ms Skerrett, said: “It seems highly likely to me that he had an adverse reaction to the pills that led him to take his life.”

“I believe anyone taking pills such as these need to be made more aware of the side effects to prevent any future deaths. If this could happen to Tom, this could happen to anyone,” she added.

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Recording a narrative conclusion in December, Ms Skerrett said: “The evidence of his wife, family and business partner all supports his lack of suicidal intent. He was suffering adverse effects of medication he had recently been prescribed.”

Giving evidence to the inquest, Dr David Healy, a psychiatric medical expert, said Mr Kingston’s complaints that sertraline was continuing to make him anxious was a sign SSRIs “did not suit him” and he should not have been prescribed the same thing again.

He said the guidelines and labels for SSRIs were not clear enough about going on the drugs in the first place or what the effect could be when moving from one to another.

A NICE spokesperson said: “We will consider the issues raised by the report and respond to the coroner directly.”

Anyone feeling emotionally distressed or suicidal can call Samaritans for help on 116 123 or email jo@samaritans.org in the UK. In the US, call the Samaritans branch in your area or 1 (800) 273-TALK