NGH response to extreme winter pressures

As a result of sustained extreme pressures on our emergency department and our bed capacity, we have decided to implement a number of measures to help us to continue our focus on the safe care of our most seriously unwell patients.

Our staff are doing an amazing job as they continue to prioritise care and as they continue to treat patients with dignity despite the obvious pressures on space. However we have increasing concerns relating to the fact that patients are waiting too long and the numbers of patients requiring our help remains very high.

We also want to be able to ensure that ambulances can continue to be offloaded quickly so that patients who need ambulances in the community can access them for life threatening conditions.

We have been planning for a difficult time this winter and those plans have all been put in place but the measures have not been sufficient and the pressures this winter are more extreme than in other years. We are admitting more older and more unwell patients who are needing to spend more time in hospital than in previous years and we are having more difficulty finding appropriate care for them once they no longer need an acute hospital bed

Placements in community care homes

We are very actively working with our partners in health and social care to arrange a number of temporary placements in local care homes for patients who are medically fit to leave hospital but are waiting for a care package in their own home or placement in a residential or nursing home.

We are doing this because we have many more people than usual coming to A&E for care and treatment, many of whom need admitting onto a ward for treatment. We also have people who are waiting on wards to move into a residential or nursing home or for a package of care in their own home but who no longer need the level of care a hospital provides.

This means that we are finding it difficult to admit patients onto ward areas in a timely manner to receive the care that they need. In the meantime, staying in hospital longer than necessary puts our patients, especially those who are elderly or have complex needs, at risk.

Once a patient has transferred to the care home, the home will assume responsibility for their care needs with GP support. Patients will still be able to exercise their right to choose a placement or care package of their choice while in their temporary care home.

We don’t as yet know how well this system will work or how may placements will be made available but we do know that to ensure that we can provide safe care for all the patients who need it we will need to double the number of patients with complex needs who are able to leave the hospital each day and we also know that the services they require after these temporary placements will need to be increased as well.

This measure will be funded from NHS additional winter funding announced in the government’s 2017/2018 budget.

Operations and appointments

In accordance with NHS England recommendations, we have reviewed our position regarding scheduled operations and procedures for the rest of January.

• Routine theatre operations scheduled for January will be cancelled with the exception of patients receiving treatment on the 52-week cancer pathway. Emergency and life-threatening operations will go ahead.
• Urgent cancer operations and procedures will go ahead
• The majority of outpatients and day case procedures and appointments will go ahead.

We had already planned to stop routine operating until the middle of January and we will now plan to cancel more operations during the final two weeks of January. As well as reducing pressure on our bed capacity, this will allow us to deploy theatre staff to support our emergency department and our wards.

We will give as much notice as possible to those patients whose appointments are being cancelled. We work hard to carry out operations as quickly as possible once our position has stabilised. In some cases we will run clinics and theatres outside usual hours, including weekends.

Patients with a scheduled appointment should attend as requested if we haven't been in touch to cancel.

In the meantime our senior clinical and managerial staff are supporting and overseeing the situation several times a day to ensure that we balance all the various risks and pressures and that we keep patient safety at the centre of all our endeavours. The entire hospital workforce – clinical and non-clinical - continue to support this approach and are aware of the issues we face.

Dr Sonia Swart
Chief Executive Officer
Northampton General Hospital NHS Trust

Deborah Needham
Chief Operating Officer/Deputy Chief Executive
Northampton General Hospital

POSTSCRIPT: NHS Providers blog

You may find the following of interest, a blog from Saffron Cordery, director of policy and deputy chief executive of NHS Providers, the trade association for NHS hospital, mental health, community and ambulance services in which she references Northampton.

You can find the online version here 

5 JANUARY 2018

Why has this winter hit the NHS so hard?

Some trust leaders say the pressures on urgent and emergency care are the worst they have ever seen.

It’s not as if we didn’t see it coming. Winter always hits the health service hard. Yet now, just a few days into the new year, some trust leaders are saying the pressures on urgent and emergency care are the worst they have ever seen. This is despite planning more meticulous and extensive than ever before. 

A time-lag in the official figures means it will take a while for the full picture to emerge, but trust leaders we have spoken to and social media posts show the service is struggling to keep up with demand. 

This message to us from a trust in the north of England was typical: “Really busy – seriously ill patients – flu starting to kick in – 111 overwhelmed – staff working so hard to do their best – norovirus doesn't help.” 

Many others speak of staff “pulling out all the stops”. A hospital trust chief executive tweeted: “I'm 34 years in and never seen anything like this. Relentless and staff have been brilliant.”

So why is the pressure this year so great? In part, it is down to demographic changes and advances in treatment, which result in more patients requiring complex care. But feedback from the frontline suggests there is more respiratory illness than expected, and rising levels of flu. There are fewer beds available than last year. Some are unavailable because of norovirus. Cuts to social care have made matters worse. In some places, the pressures on primary care – with GPs working at more than full stretch – spill over into A&E. 

Ambulance services are also bearing the brunt. One reported the “busiest ever Christmas”. Others have emphasised the priority given to life-threatening emergencies.

Trust leaders tell us they are doing everything they can to cope – organising extra beds, calling in staff to work extra shifts and delaying non-urgent work. Needs must. Trusts will always seek to ensure patient safety. And that is why the recommendations from the NHS National Emergency Pressures Panel – including the cancelling of non-urgent operations and a relaxation of the rules on mixed-sex wards – are realistic and sensible. 

These measures give trusts the best chance to provide the quality of care we would all want to see. It was also right to highlight the guidance for people seeking advice for non-emergencies, so staff in A&E can focus on the sickest patients, needing most help.

However for others, this will mean delays, uncertainty and frustration. We should not underestimate the impact on patients who will see their procedure or appointment rearranged. On top of that there will be a price to pay for trusts in delaying more routine work, such as knee and hip operations, in terms of lost income and an even greater challenge to meet waiting time targets. Clearly once the dust has settled, we need to make sure the impact of these measures is widely understood and taken account of. But despite this it is the right thing to do to safeguard patient safety

And, in amongst all this, we mustn‘t lose sight of the amazing work that is going on day-in day-out in such difficult circumstances. These include extraordinary acts of kindness and compassion. Staff on one of the wards at Northampton General Hospital NHS Trust decided to bring Christmas a day forward for a woman dying of cancer, providing a tree, decorations and presents. Then there was the paramedic from West Midlands Ambulance Service who camped out close to work in sub-zero temperatures to ensure he would be available for the morning shift. 

We need to ask ourselves why it has come to this: despite the NHS preparing better than ever before for winter, and the heroic response from many of its staff, it still faces such difficulties sustaining the performance people have a right to expect. We know the answers. We will always face these struggles until we fix the more fundamental problem of how we resource the NHS. How bad must it get before we take the fundamental steps needed to equip our health and care services for winter pressures in years to come?

Saffron Cordery, director of policy and deputy chief executive, NHS Providers