New challenges for Cambridgeshire hospitals as patient numbers rise and winter approaches

a&e08:07 Thursday 13th November 2014
BBC Radio Cambridgeshire

CHRIS MANN: A new initiative to help reducing waiting times at A&E has been launched today by Cambridgeshire’s NHS Clinical Commissioning Group. It comes as figures from our three major hospitals show they’ve seen big increases in the number of people coming to the emergency department. Our reporter Sue Marchant explains.
SUE MARCHANT: The hospital’s Chief Executive Keith McNeill has blamed the severe pressure from admissions, saying the knock-ons have resulted in postponed surgery. But as far as admissions, papers reveal concern over the number of staffed beds available to patients. Bosses have also admitted eHospital is also hampering efficiency. The roll-out of the new electronic patient record system has, in their words, prompted a dip in A&E performance.
CHRIS MANN: Sue Marchant there with the situation at Addenbrooke’s in Cambridge. Well joining me now live from Peterborough City Hospital’s A&E department is our reporter Johnny D. Morning Johnny.
JOHN DEVINE: Good morning there Chris.
CHRIS MANN: And last night they went on to ‘black alert’. Is that still the case this morning?
JOHN DEVINE: No it’s not Chris I’m glad to say. We’re going to find out a bit more about that in a moment. But I’ll just describe to you the scene here. It’s a large circular reception desk in front of me. There’s a member of staff busily tapping away on the computer keyboard Chris. It’s a relatively new building this, it’s light bright and spacious. And there’s about thirty seats in front of me for admissions and their relations. I’m pleased to say they’re all empty at the moment. There is a children’s area just on the other side of the room as well. And they have nearly 2,000 people a week coming through these doors with things like bruises, sprains and fractures. But it’s all quiet on the western front at the moment Chris, and I’m going to introduce our guest for you, Celia Kendrick.
CELIA KENDRICK: Good morning.
CHRIS MANN: Good morning Celia, Head of Nursing at Peterborough City Hospital. So we’ve heard that things are pretty busy, that there are some real strains. What’s it like in your view? How bad is it at the moment?

CELIA KENDRICK: It’s been difficult. It’s been a challenging few months for us. We have had some periods where we’ve been under pressure with the number of people coming through the door, and the number of people we need to find beds to admit to. So yes, it’s been challenging , but we’re still providing a good quality and standard of care to our patients.
CHRIS MANN: A good quality. Is that the same as the best quality?
CELIA KENDRICK: Yes. We absolutely strive every day to provide the best care we can to our patients. It’s challenging when we’re full, but that is absolutely our aim every day.
CHRIS MANN: Tell us what the obstacles are every day for you. What do you have to battle through?
CELIA KENDRICK: We have peaks in attendance times, so we have times in the day where more people turn up than we can accommodate quickly at any one time, and obviously that causes delays for the patients. And we’re very conscious that then those patients are waiting, and we don’t want to keep patients waiting. We want to have good flow through the department, and get everybody seen and treated and either discharged out of the building or admitted to the right hospital bed as soon as we can.
CHRIS MANN: And the message still is that some people are coming to A&E who shouldn’t be.
CELIA KENDRICK: We do see a proportion of patients who could be better cared for elsewhere within the health system. Our expertise obviously lies in dealing with the broken bones and the dislocated limbs, and saving lives and resuscitating patients who have acute emergency conditions. But we do see a proportion of patients who would be more appropriately treated by practice nurses, GPs, even self-care sometimes. So we’re not always the right choice for the patient. There are other choices out there that they could select.
CHRIS MANN: There’s been a lot of change in the NHS of course. I was talking earlier on to Andrew Lansley the former Health Secretary between 2010 and 2012, a Cambridgeshire MP of course. He says things are getting better. Do you agree?
CELIA KENDRICK: (DISTANT) …to predict really, based on the part of the NHS that I see. I wouldn’t want to comment about the whole of the NHS. We are certainly getting all the right resources in place that we need to enable us to cope with the increased pressures, and making sure that we resource our department effectively to be able to cope with the types of patients coming through, and taking part in initiatives like this helps us to try and make sure that patients do select where they go appropriately, so that we’re not trying to manage patients whose care could be better managed by somewhere else in the health system.
CHRIS MANN: I’m sure you understand that people’s sympathies are with nursing staff and doctors who people think are doing the best. I’ve never heard complaints about the staffing or the care. But the fact is that the figures show that at Addenbrooke’s and your hospital the accident and emergency units are failing by the standards that have been set, in terms of dealing with people.
CELIA KENDRICK: There are some quality indicator targets that we aren’t able to achieve at the moment, but that doesn’t mean that we don’t still give the right care to the patients while we’ve got them. It’s just difficult to provide that care in the timely manner that’s required of us, when we haven’t got the right flow through the building, or we’ve got more patients turning up than we can actually accommodate at that time.
CHRIS MANN: So who’s fault is this Celia?
CELIA KENDRICK: I don’t think you could say it’s any one service or any one individual’s fault. I think there are areas for improvement across the system, and obviously if we can get the patients to select the right care, so that they’re seen by the people they need to be seen by, then that would help us to keep the flow going across our services.
CHRIS MANN: So all the re-organisations that have happened in the NHS, all those protests and job losses and changes in budgets and targets set that you’ve had to work towards, you accept all that do you? You don’t think that’s been contributory?
CELIA KENDRICK: I think a number of things have been contributory, and I wouldn’t want to pinpoint any one thing. I think that we are seeing a distinct rise in attendances year on year, as all A&Es are, and obviously we have to try and match our resources to the demands put on us by the patients. But the absolute solution would be that we select the right patients to the right place at the right time.
CHRIS MANN: OK. So give us your advice to people today. I know we’ve done it before, but again, tell people who should be going to A&E and who should be going elsewhere.
CELIA KENDRICK: When patients come to A&E we don’t know those patients. The vast majority of our patients are new to us. When patients go to their general practitioners or to practice nurses, those services know those patients and they know their histories and they know the circumstances. So they are in a much better position to treat some of the longer term conditions and more minor illnesses. patients need to come to us when they have broken bones, dislocated limbs, nasty wounds, and/or are in need of immediate intervention to save life or relieve suffering. We’re different services. We need to deal with the emergency stuff, and the conditions that are already being well managed by primary care services should continue to be managed by the primary care services. They know their patients. When patients come to us, we start from scratch with them.
CHRIS MANN: And Celia, what do you think about this new world where people might start to have their treatment on the internet? They might even be given an iPad to take away with them. You’re laughing. Is that because you don’t think it will happen?
CELIA KENDRICK: No, I think it’s the vision of all these patients walking around with iPads.
CHRIS MANN: Well that’s what’s been told to us.
CELIA KENDRICK: Yes. It is. And I think there is a definite value to having information available online. Obviously like I just explained to you, when a patient comes to us we don’t know their history. We don’t know their background. We don’t know what their normal red flags are. We don’t know what drug treatment regimes the doctors have tried before with them. If the information’s online and we can access it, then obviously we’ve got a much better staring point for treating that patient appropriately.
CHRIS MANN: Celia, thank you so much. I know it’s a busy time. so really apppreciate your joining us this morning. Much obliged.
CELIA KENDRICK: You’re welcome.
CHRIS MANN: Celia Kendrick there, Head of Nursing at PCH for emergency and urgent care.