NHS’s winter pressures: will GWH get some of the government’s new winter money?
It is now clear the government is petrified that the NHS may face unsustainable pressures in the coming months – especially in already over-busy A&E departments.
The HSJ says this new money will be announced within days. It will be on top of the £250 million already allocated and will go to help hospital trusts which, like the Great Western Hospitals Foundation Trust (GWH), got nothing from the original £250 million fund.
GWH applied with the Swindon Clinical Commissioning Group (CCG) for a share of the first £250 million. That money went to 53 CCG’s to support their local acute hospitals – the average amount was £4,170,000.
The money was allotted to trusts that had not coped well last winter or that are considered to be in such financial straits that they would not cope this winter. Some said the money was a reward for failure.
GWH got none of that £250 million and has been putting into place its winter planning using its own funds and financial assistance from CCGs.
During last winter GWH saw a ten per cent increase in people coming into its A&E department as well as a 6.7 per cent rise in emergency admissions. This winter’s pressures are already being felt at GWH’s A&E department.
GWH’s bid for extra funding included extra spending on community health services, on end of life care, increased staffing in A&E and support for the timely discharge of patients.
Working with Wiltshire and Swindon CCGs, GWH have already put in place a number of steps to alleviate this winter’s pressures on staff and facilities.
They have invested £3.2 million in extra medical beds and doctors. And have employed three extra emergency medicine consultants – bringing the total up to nine consultants. And they continue to recruit more nurses.
Wiltshire’s community health services – run by GWH – now have Care Coordinators in each locality to help patients live well at home for longer and reduce unnecessary and unwelcome stays in hospital.
GWH have also launched an incentive scheme for nursing staff, midwives and health professionals like physios. This will enable staff to earn extra pay for working extra shifts – reducing the use of agency staff who may not be familiar with the hospital or with patients.
A GWH spokesman explained: “Paying staff in this way is better value for money for the taxpayer as it’s more cost effective than using agency staff. Our staff work incredibly hard 24/7, 365 days a year, often in challenging circumstances and this is an extra thank you to those who are willing to help out at our busiest times.”
It’s not just the number of people arriving at the front door services like A&E that cause problems. It’s also pressures at hospitals’ back doors: patients who cannot be allowed leave hospital wards once their treatment is complete because they have nowhere appropriate to go.
These are called ‘Delayed Transfers of Care’ or DTOCs and they cost CCGs a great deal of money. They used to be called ‘bed blockers’ - as though it was the patient’s fault.
Reducing the time patients wait to leave hospital involves close coordination with local authorities’ social care services who have to ensure patients – often the frail and elderly – go to an appropriate nursing home or rehab ward or can be cared for safely in their own home.
Oxfordshire CCG, which has had one of the worst DTOCs record in the country, has allotted more than a fifth of its £10 million extra winter funding to Oxfordshire Council to help reduce its costly level of DTOCs.
It is worth noting that Oxfordshire CCG identified 23 temporary schemes to alleviate winter pressures at their hospitals. Some of these are to last six months.
Oxfordshire CCG aims to recruit skilled staff to fill more than 50 new full-time roles to work over the winter period – as well as an unspecified number of other extra nursing staff. Whether they will be able to recruit this number in time and within budget will doubtless feature on their risk register.
But the scale and cost of winter measures in Oxfordshire, underlines the seriousness with which the NHS is facing the approaching cold weather.
GWH’s A&E or as they call it ED for Emergency Department: Some days ago we published a story headlined “Twelve patients a day had to wait on A&E trolleys in great western hospital probe reveals.”
This was a report of story first published in the Daily Mail. MNO understands that GWH’s Freedom of Information response stated that “up to twelve patients” in a day had been waiting on trolleys in a corridor.
This, by some sleight of hand, was changed in the published story to read “12 patients a day have to wait on trolleys in corridors in A&E” – clearly implying it happened every day.
Having looked back at the wording of their FOI response, GWH have now issued another statement:
“The number of patients treated in ED can change greatly from one day to the next. We have never shut our doors and always do everything we can to treat and care for our patients using the space and resources we have at the time.”
“There are occasions when we have been extremely busy, this means we have asked patients to wait on a temporary trolley until a suitable bed is available. Any patient waiting on a trolley will have been assessed and will have a dedicated nurse caring for them and observing them until they are moved to a ward.”