Prime Minister commits to action over Hereford County Hospital

The Minister is expected to experience the pressures on bed capacity at the hospital at first hand and report back on how those pressures could be eased.

North Herefordshire MP Bill Wiggin has this morning (Thurs) confirmed the ministerial visit.

It comes after Mr Wiggin raised bed capacity at the County with the Prime Minister in the Commons earlier this month.

Then, the PM pledged to “look very carefully” at what could be done to help.

Now, the PM has written to Mr Wiggin promising to send a Minister to hospital, which went into special measures in October.

Bill Wiggin said that the County not only not more beds but the hutted wards to be replaced.

“With the added attention of the Prime Minister I am sure we will not have to wait for too long before our hospital gets the extra beds it needs,” he said.

The intervention of the PM follows the revelation by the Hereford Times last month that the County faces having to discharge between 40-50 patients staying overnight or longer  to cope with current admissions.

But Wye Valley NHS Trust (WVT) has been told by the NHS that extra beds may not be answer with alternatives found through new measures to manage patient flow.

Figures in a system resilience plan for the county’s health services  show the hospital now taking between 35-55 emergency admissions each day.

Around 23 per cent of these patients are discharged the same day, leaving between 30-45 non-elective overnight admissions.

A further 40-60 day case elective patients can be expected each week day and between 7 -11 elective patients overnight.

This means  that from its total bed base of 208, the hospital has to discharge between 40-50 patients who have been in hospital overnight or longer.

The plan breaks the discharge options down to between 7-11 elective patients and 33-40 non electives.

At weekends, when admissions are less, there is a need to discharge between 25-35 non elective patients who have been admitted for at least one night.

The figures make sobering reading for a hospital put into special measures by the Care Quality Commission, and facing another winter surge, while still coping with the impact of last winter on patient numbers and service demand.

On current assessment non-elective patients stay an average 6 days and elective patients 2 days.

With bed occupancy targeted at 95 per cent this gives an overnight requirement of between 220 to 240 beds dependent on the month of year - well above the actual operating  bedded state of the hospital and contributing to its difficulty in managing to the 95% 4 hour target in A&E.

The interpretation doesn’t currently include additional overnight elective patients transferred to the private sector  because the hospital does not have the physical capacity to deal with them without further  compromising urgent care capacity.

This is around  50 patients a month or, roughly, a further 6-8 elective beds each weekday.

Current bed occupancy at the hospital is 95 per cent and well above the national performance expectation of  around 85 per cent.

Advice WVT has received through the NHS emergency care intensive support programme suggests extra beds may not be the answer in the medium-term.

That advice cited a significant number of operational changes to patent flow management that could cut the average length of stay.

This, however, came before the upsurge in A&E attendances which, in part, has increased admissions as a result.

As previously reported, A&E is already working at well above the average 125 attendances a day it was designed for.

Operationally, the trust is only managing to deal with the required bed numbers using capacity set aside for Day Case surgical patients, and the Clinical Assessment Unit, which is should not really be used for patients requiring overnight admission.

This increases the costs for the trust in having to staff areas in addition to normal capacity overnight, and is seen as potentially compromises the quality of patient care.

For the past year, the county’s health community has emphasised alternatives to admission and how much more can be done to deliver those alternatives.

There is an acceptance that continual “fire-fighting” over patient numbers and pressure on moving patients through the system has become the norm rather than ensuring that systems are working effectively.

Against this background, the plan identifies priorities that include additional bedded capacity, better access to “clinically appropriate” care, improved “anticipatory” care, and earlier identification of patients able to be discharged in the day.

The resilience plan concedes that current health services across the county are complicated for patients, with too many entry points that direct patients to services more acute than their needs require.

Patients are often being returned into a more acute environment within the community rather than enabling them to return to their home with help and support.

A&E attendances have seen a year on year growth of 1,640 (3.6%) from 2012/13 to  2013/14. The majority of the increase since 2012/13 1,368 (83.4%) are over 65’s.

Activity at the Minor Injuries Units (MIUs) has reduced by more than the increased attendances at A&E.

Overall, MIU activity has been reducing significantly since October 2012 representing a 38 per cent reduction year on year.

The closure of MIUs in January this year is recognised as having an impact although the trend tips towards significant reduction.

A&E has also seen an increase GP and other provider’ referrals while the number of ambulance arrivals is up by 6 per cent from 2012/13 to 2013/14.

Delayed discharges have seen a five per cent growth.

Analysis has shown a significant decrease in Prime care Out of Hours (OOH) activity year on year due to the introduction of the NHS111 service, which came on line last year.

Prime care, however, is still recorded in the plan as taking around 2,500 (OOH) contacts a month.

The Hereford GP Walk in Centre (WIC) saw a drop in activity over 2013/14.

However, initial statistics for 2014/15 show a significant increase in such activity to a reported average of around 100 patients a day.

In terms of patient flow to A&E, WIC has reported an increase of 32 per cent year on year with an average of 30 patients per month in 13/14.

March saw a significant increase to 49 patients referred into A&E from the Walk in Centre.

During the last 4 months, the NHS111 data has shown an increasing trend towards ambulance, A&E and other services, confirming other data showing a rise in emergency activity.

The virtual wards implemented as a pilot across the 8 Hereford GP practices in October last year have supported early discharge for 174 patients, and kept around 135 from being short stay admissions.

A RAAC (Rapid Access to Assessment and Care) scheme  started in January this year had taken 51 patients out of WVT by June and another 32 supported through earlier discharge.

Taurus Healthcare is currently running three GP extended hours “hubs” in Hereford, Ross-on-Wye and Leominster open  open 8am-8pm Sat and Sun and 6.30pm-8pm Monday to  Friday.