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Due to increased pressures across our sites (Royal Preston Hospital and Chorley and South Ribble Hospital), for the second time in recent weeks, Lancashire Teaching Hospitals NHS Foundation Trust has taken the decision to escalate to OPEL 4 – the highest level of internal escalation. This allows us to be able to take additional steps to maintain safe services for our patients and help us cope with the growing demands.

Operations Pressure Escalation Levels (OPEL) is a method used by the NHS to measure the stress, demand and pressure a hospital is under, with OPEL 4 representing the highest escalation level.

Declaring the highest level of alert enables us to bring all our partners in Lancashire and South Cumbria together to focus on one thing – the safe and timely care of all of our patients.

As always, patient safety must take priority and we need to take action to make sure that those who are more clinically urgent get the help they need as quickly as possible.

There are some immediate actions being taken by Trust teams and our partners, including:

• Increased use of Same Day Emergency Care (SDEC) and virtual wards
• Pharmacy colleagues supporting discharge lounge to enable faster transfer of patients from ward beds to create the capacity to decompress Emergency Departments
• Cancellation of non-essential meetings / activities in order to redirect clinician time to patient facing activities
• Speaking to patients and families about arranging their own transport to get home rather than waiting for an ambulance transfer.

What can you do to help?

You can help us manage these periods of high demand by ensuring you are seeking help from the most appropriate health services.

This winter, the NHS is encouraging people get the right care, in the right place, at the right time and to keep emergency services free for those who need them most. Choosing the right service for your needs helps ensure you may be seen more quickly and reduces pressure across the NHS. Local pharmacies, GP practices, NHS 111 online and urgent treatment centres may be able to help you faster.

To help us keep services running safely, please:

• Use A&E only for serious or life‑threatening emergencies.
• Support loved ones leaving hospital by collecting them as soon as they are ready to go home and ensuring they have what they need.
• Be prepared for longer waits if you do need to attend A&E. Our teams will always prioritise the most seriously ill patients first - thank you for treating our staff with patience and respect.
• If you must attend A&E due to a genuine emergency, please bring essential items such as a charged phone, payment method and warm clothing in case you need to wait.

Ways to access NHS services

Whether you're managing a long-term condition, caring for a loved one, or simply need advice for an unexpected health concern, there are more ways than ever to access NHS services quickly, easily, and on your terms.

1. Your local pharmacist can help with a wide range of minor health issues. They are trained to offer oral contraceptives, the emergency contraceptive pill, and prescription medicines, if needed, for seven common conditions the same day.
2. The NHS App puts essential services at your fingertips. You can order repeat prescriptions, manage appointments, receive reminders, and even check some
3. Some GP Practices now offer online contact forms, via the NHS App or by logging in through the practice website. This may be an easier route to get in contact with your practice, especially for non-urgent enquiries.  Submit your enquiry and your local surgery team will get back to you, either by phone, email or a message in the NHS App. 
4. NHS 111 is available 24/7 by phone, online, or via the NHS App. It offers trusted medical advice for urgent health needs and can direct you to the most appropriate local service including when your GP practice is closed, need dental treatment but are not registered with a dentist or have run out of medication.
5. Should you need mental health crisis support, you can call NHS 111 and select option 2 at any time of day or night to speak to a trained professional.
6. If you no longer need or are unable to make a health care appointment, make sure you cancel it so it can be reallocated to another patient. To cancel a hospital or community service appointment contact the number on your appointment letter, and for GP practice appointments cancel by ringing the practice or via the NHS App. 
7. If you are eligible for a covid-19, flu or RSV vaccine you can book an appointment. You can check If you're eligible for the winter COVID-19 vaccine via the NHS England website COVID-19 vaccine - NHS.  You do not need to wait for an invitation before booking an appointment. The last date you will be able to get your COVID-19 vaccine is 31 January 2026. Online booking will close on 30 January 2026. 
8. If you're eligible for an NHS flu vaccine, you can contact your GP surgery to book an appointment, book a free NHS flu vaccination appointment at a pharmacy online or in the NHS App (if you're aged 18 or over) or find a pharmacy that offers free NHS flu vaccination. 
9. The RSV vaccine helps protect against infection with RSV, a common virus that can make babies and older adults seriously ill. It's offered on the NHS if you're pregnant, aged 75 to 79, or turned 80 after 1 September 2024. More information about how to get your RSV vaccine is available here RSV vaccine - NHS.
10. A range of information is available as part of this year’s ‘Good Health Starts…’ campaign which is running throughout winter in Lancashire and South Cumbria on the ICB’s website.

Our teams continue to work exceptionally hard; and we would like to reassure our patients and the public that in spite of the challenges faced, essential services remain fully open for anyone who needs them so if you require urgent medical help, please continue to come forward.

Watch our video

Watch this short video from Dr Michael Stewart, Deputy Chief Medical Officer - recorded earlier in January, explaining more about what being in OPEL 4 means for patients and families, what we are doing to respond to this together as a Trust, and thanking colleagues for their hard work under pressure.

• Transcript

  Hello everyone.

  My name's Michael. I'm one of our Consultants in Emergency Medicine and Deputy Chief Medical Officers for the Trust.

  I want to take a few minutes today to update you on the current situation we're seeing across both the hospital sites.

  We're operating at OPEL 4 today, which is the highest level of escalation we use. It means that the demand for our services is significantly exceeding our capacity, and we're particularly seeing this across our Urgent and Emergency Care streams.

  And this does mean that some of our patients, and naturally their families, are seeing long waits for their assessment and treatment within the Emergency Departments and assessment areas. And we recognise how worrying and how distressing that can be for the patients we want to care for.

  We also recognise that this degree of pressure has an impact on our staff and that working in these conditions is stressful, it feels relentless, and we have to openly acknowledge that impact it's having on us.

  The situation we're in, the situation we're facing, is not through the lack of effort and the fact that the staff are finding it stressful and they're finding it distressing is actually a sign of the dedication, the compassion that we still feel we want to show for our patients. And we're seeing that professionalism and the hard work by all of our teams across the organisation every single day.

  We expect winter pressures. We expect it to be busy at this time of year, but what we're experiencing at the moment is exceptionally high and sustained levels of escalation. And that simply requires a high and exceptional and coordinated response from everyone in the Trust.

  We've stepped up our Executive-led Gold Command, so providing a very, very senior level of oversight, decision making coordination for everything that we're doing across the organisation. And in turn, we're asking that every team, clinical, corporate, support services, everyone who works within the Trust plays their part in reducing delays to the patients at every stage of their journey through an emergency stay.

  Specifically, we have some actions being taken at ward level, and we're asking our Matrons, Consultant Therapists and Service Managers to work closely alongside the ward Medical and Nursing teams to think about safe alternatives to inpatient care.

  We often default to assuming that being in hospital is the safest option for patients, but we know this isn't always the right choice either for the individual patient or for the overall pressures on our systems. So wherever it is appropriate, we need to be identifying the patient to suitable for community pathways. Think about use of our virtual wards, hot clinics, enhanced community services and other out of hospital solutions that help assist safely manage the patients who absolutely need to be in the hospital beds.