Life-saving oxygen is at risk of not getting to patients in hospital because of problems with how it is piped around wards, a safety watchdog is warning.
A Healthcare Safety Investigation Branch (HSIB) review said a number of hospitals in England faced difficulties during the winter Covid wave.
It said outdated systems used to pump oxygen around wards could not always cope with the surges in demand.
This is the case even if there is excess supply on site.
Investigators said it was vital that hospitals made adjustments to cope with future outbreaks.
HSIB director of investigations, Dr Stephen Drage, said the supply of oxygen was clearly a “critical” issue, adding: “If it fails the impact is significant.”
The problem particularly affects hospitals that use an older piping system, known as a radial system, which just pumps the oxygen one way.
Newer systems pump oxygen into the piping system at both ends – but the majority of hospitals are thought to use a radial system.
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“The supply of oxygen was clearly a “critical” issue. If it fails the impact is significant.”
The HSIB was set up to investigate safety issues in the NHS in England. It carried out an in-depth investigation into problems reported at one hospital where a major incident was declared when the oxygen supply to wards, including the high dependency unit, dropped.
The trust ended up diverting patients to nearby hospitals and cancelling non-emergency surgery.
The HSIB said the problems were not unique to this trust, which was not named, as it was aware of similar issues in at least a dozen hospitals.
It said long-term investment was needed to upgrade the supply systems – with experts who gave evidence describing the equipment being used in many parts of the NHS as “unbelievably old”.
But there were also steps that could be taken immediately, including getting doctors and engineers to work more closely to try to even out demand across the hospital site, as well as using cylinders to pump oxygen into the pipes at points where pressure is at risk of dropping.