NHS Winter Campaign Tougher Than Expected

older17:19 Tuesday 7th January 2014
BBC Radio Cambridgeshire

[C]HRIS MANN: Cambridgeshire’s three main NHS hospitals face bed shortages this very evening. Hinchinbrooke and Addenbrookes say the situation is nearing critical. Peterborough City Hospital has been on Black Alert since Friday, meaning it’s experiencing a severe bed shortage. Khurram Iftikhar is a Consultant in Emergency Medicine at Addenbrookes. He says they’ve seen a big increase in the number of elderly people coming to A&E who subsequently need a hospital bed.
KHURRAM IFTIKHAR: We’ve had significant pressures over the last few months, and for similar reasons really we’ve had a 5% increase in walk-in presentations to the Emergency Department. On top of that, a 10% increase in patients arriving by ambulance, and the patients arriving by ambulance tend to be elderly, with more complex medical problems and complex comorbidities. And they’re the kind of patients that generally get admitted into the hospital. Our bed capacity varies, so being on Black Alert is a dynamic thing. You can be on Black Alert early on in the day, and that can change once patients are discharged. And then it can go on Black Alert again once you get the admissions through the door. But from an emergency medicine point of view, we all depend on flow, and if there’s no beds in the hospital to admit patients to, the Emergency Department very very quickly gets overcrowded, and that can pose challenges itself, working in the Emergency Department, for the staff and for the patients as well. The other minor contributory factor is Addenbrookes is now the major trauma centre, so we receive trauma patients from across the region. Patients are living longer now with complex comorbidities, and therefore requiring hospital admissions when they become acutely unwell. There are a few patients that probably do attend inappropriately.
CHRIS MANN: That’s Khurram Iftikhar from Addenbrookes. Now in just moment or two we’ll be going live to Peterborough City Hospital and talk to the Chief Operating Officer Angus Maitland for an update from them. But a short while ago I spoke to Jane Tombleson. She’s Head of Operations for Hinchinbrooke Hospital’s Emergency Care Department. And this is the update she gave me.
JANE TOMBLESON: We currently are seeing quite a surge in poorly patients coming through our door, following Christmas and New Year break. We have all of our escalation capacity open, as do our colleagues in Peterborough and Cambridge. We’re doing all we can with our clinicians and our community colleagues to make sure that we are looking after our patients safely, and to start discharging them in a timely way.
CHRIS MANN: And it’s got to a critical situation really, has it?
JANE TOMBLESON: Yesterday (we had) an internal Black Alert, which means we had absolutely no capacity left. So we’re working very closely with our clinicians to make sure that the patients who come through the doors are looked after in a safe and timely way. But we are seeing quite a surge in activity, which is proving difficult to manage.
CHRIS MANN: How do you cope? Because you’ve got a hospital full of people who are ill, and you’ve got more people arriving who are unwell and need to be cared for. You can’t just throw the ones who are ill already out on the street. How do you manage? What do you do?
JANE TOMBLESON: What we try and do is have some plans in place prior to winter. We all know it’s coming, and we all know the numbers that we are likely to see I think. So we do all that we can prior to the winter season to prepare, and to have escalation beds that we can go into, and to ensure that all our clinicians are engaged and working really hard to make sure that we treat the patients and move them through the hospital in a safe and timely way. We also work very closely with our community colleagues to make sure that there’s a package out there to care for people who need it in the community.
CHRIS MANN: So everybody will get seen.
CHRIS MANN: You used the word “timely” quite a lot. Define that. What does that mean?
JANE TOMBLESON: Obviously it’s the best thing and the right thing for the patient to receive the right care in the right place at the right time. So it’s making sure that we have the clinicians working together with our community colleagues to move the patients through the system in a safe and timely way. That’s the best .. normally the best thing for the patients,
CHRIS MANN: Now where are we going from here? Is the problem going to get worse? You said it’s already critical.
JANE TOMBLESON: I think, certainly at Hinchinbrooke we’re managing it, and we’re trying to support our colleagues as I say at Peterborough, if we can. I think it’s about planning, and ensuring that the public know to present at ED when they need to present at ED, to go to the GPs if they can during normal working hours., so that we’re seeing the people we need to see in the acute setting.
CHRIS MANN: That’s Jane Tombleson from Hinchinbrooke Hospital. So we’ve heard from Addenbrookes and from Hinchinbrooke. let’s now bring in the Chief Operating Officer at Peterborough City Hospital, Angus Maitland. Hello Angus.
ANGUS MAITLAND: Good evening.
CHRIS MANN: We spoke at this time yesterday, and you were telling us then that things were getting more serious. Twenty four hours on, what’s happening?
ANGUS MAITLAND: There’s a been a fantastic response from all of our health and social care partners in the last twenty four hours. So first of all I’d like to thank all of the people who’ve been able to help us. From a patient’s perspective they probably won’t have noticed a big deal of difference, in that we’ve still had to cancel I’m afraid pretty much all of our surgical operating today, in order to make sure that space is made available for emergency patients. But what we have seen is a slight easing of the waits in the Emergency Department. And a number of people who’ve been waiting for complicated packages of care in the community through a combination of health and social care has been able to go home today, which has helped a little bit.
CHRIS MANN: So obviously hard work from all of the professionals. But are you getting help from the public? Because last night you did stress that some people were coming to A&E who didn ‘t really need to. We’ve heard some shocking figures today actually nationally sometimes some people go to A&E as many as fifty times a year.
ANGUS MAITLAND: Yes you’re absolutely right. There is a small minority. But I would like to stress that the vast majority of the public do use their health services extremely responsibly. I think the message I’d like to put across is a slightly different one, which is I’ve been looking further at the mix of the patients who’ve been coming through the hospital in the last week, and we’ve seen a very high level of patients over the age of eighty. And indeed, in the last couple of weeks, an extremely high volume of patients over the age of ninety. So it’s fantastic to see the longevity of our patients locally. But what people can most do to help those patients is to make sure that their neighbours, relatives etcetera in that older age group are being well looked after. And I strongly echo the message you had from your earlier correspondent from Hinchinbrooke, saying that one of our main responsibilities as members of the public is to see what we can do to help our neighbours and older relatives to see a GP early, because they are very often the most expert person to look after people’s complex needs.
CHRIS MANN: You mentioned the over eighties and the over nineties. A fair point there. Things tend to be more serious at that age. But what about other people? Are they listening to your requests to go to GPs and to use other help lines, chemists .. ?
ANGUS MAITLAND: Yes, I think in the main people are making very responsible use of the services. And I can only echo and ask for people to keep doing that, and to remind people, just on a very local basis, we have a very good Minor Injuries and Illness unit run by some health service colleagues at the City care Centre in Peterborough who remain open eight am to eight pm every day. And that GP services remain available twenty four hours a day every day of the week.
CHRIS MANN: Now Angus, as you’ve said, this Black Alert continues. You’ve had to cancel operations. It happened last year, the previous winter. It’s a regular thing now. So it’s no longer Code Emergency is it? It’s almost the status quo. Should we not be preparing for this better?
ANGUS MAITLAND: I heard your questions to our colleagues in Hinchinbrooke. We have put in a lot of preparation for this this year. What we’ve seen compared to the similar fortnight last year is a rise of over 10% in admissions from people in the most acute and the oldest age groups, which I have to say is considerably above the level of planning we’d done, which assumed a maximum of probably 5% growth, year on year. So the spike we’ve had I would suggest reflects a particular acuity of illness this winter. And while one can do a lot of planning, we planned for up to sixty extra patients this winter, we’ve seen a much greater volume than that in the last two to three weeks.
CHRIS MANN: I know you’re not alone in this, having to cancel operations, but what’s the knock-on effect to the rest of the month, the rest of the year, and so on, when so many operations that people have waited for for a long time are being called off?
ANGUS MAITLAND: Well we have rearranged some operations for some patients in the independent sector, to make sure that they don’t wait an undue period. All I can say is that I understand completely the aggravation this will cause people, and in some cases a lot of distress, and for some people pain as well. So we’re working our way through as best we possibly can. And we’d ask all of our patients to bear with us as much as they possibly can.
CHRIS MANN: Angus, we appreciate you joining us. Thank you very much indeed.