DOCTORS were told to send patients home as soon as possible, free up beds and cancel planned operations after a shortage of nurses led to a 'code black' alert.

An NHS Grampian executive issued an urgent email to staff at Aberdeen Royal Infirmary earlier this month warning that "there are many more patients in the hospital than we have beds for", but said more wards could not be opened because there were not enough nurses to staff them.

Malcolm Metcalfe, NHS Grampian's acute sector associate medical director, urged staff to cancel any scheduled operations which could be delayed and to avoid arranging any new procedures unless it was an emergency.

He said: "We are now in an emergency situation as there are many more patients in the hospital than we have beds for. Surgery is in a particularly bad position. There is no easy answer to this as opening more beds cannot be matched by finding sufficient nursing staff to help. Can I please ask that colleagues urgently review their patients and discharge as many as possible within the shortest possible time."

The email on April 4 came after significant reductions in the number of planned knee and hip replacements at NHS Grampian due to a shortage of theatre nurses.

Surgeons have already previously warned that cuts in beds would harm patient care in the region. In 2014, they compiled a report warning that planned reductions in general and vascular surgery beds meant it would "not be possible to deliver an adequate service to any other than emergency patients".

However, between December 2013 and December 2016 the number of acute hospital beds in the region fell nearly 10 per cent, from 1,631 to 1,474.

A spokesman for NHS Grampian said: "We can confirm that Aberdeen Royal Infirmary experienced a higher than usual demand on services during Tuesday, April 4. As a result, the decision was taken in the afternoon to postpone some elective, non-clinically urgent procedures. We would like to reassure people that all emergency and urgent procedures were unaffected."