Great Western Hospital's plan to meet Swindon's huge population growthAt the turn of the century when Great Western Hospital (GWH) was being built there was some surprise that it would have a smaller capacity than the Princess Margaret Hospital it was replacing. It was, after all, a time when Swindon's population was growing fast - as it still is.
Today GWH finds it impossible to meet the national target of treating patients in its emergency department (ED - otherwise known as A&E) within four hours and has bed occupancy considered too high to manage safely at its busiest times.
GWH was built to handle 48,000 ED patients a year. Sixteen years later, that figure has nearly doubled and they are treating about 90,000 ED cases a year.
Between January and June 2017, their ED was overcrowded sixty-five per cent of the time - leading to a less safe and acceptable experience for patients and putting an impossible strain on its hard-pressed staff. The scale of the problem was the same this year.
The scale of this flow of emergency patients also means that bed occupancy throughout the hospital becomes too high for safety and the efficient flow of patients. Hospital managers reckon they are currently short of sixty beds and, of course, the staff those beds would require.
GWH carried out a revamp of their ED in 2013. But that continuing population increase, the increasing complexity of the ageing population's medical conditions, the expectation for survival of the very, very young and the very old, and staff shortages, catches up on them.
In the words of a senior manager: "Capacity is one of our most pressing challenges - along with staff recruitment."
GWH are now putting forward a plan to restructure the hospital to have a more efficient and comprehensive 'front door' space for patients coming to ED, as well as those sent by their GPs and other treatment centres. This will bring services down from the third floor of the main hospital and provide a new home for its Urgent Care Centre (now run by GWH) - currently in temporary buildings.
However, GWH is also looking further into the future. Between 2001 and 2031 (when GWH's Private Finance Initiative funding contract ends), Swindon's population will have grown by 47 per cent. If they did nothing now about changing the hospital and providing more beds, analysis shows they would by then need another 232 beds.
They realise no one is likely to fund that sort of enlargement and they would be unlikely to be able to staff that number of extra beds. But with their changes to the 'front door' services and stronger community services, they believe the 2031 figure for extra beds should be between 60 and 80 - with the staff to support hem.
That level of expansion would be essential "...to maintain any sort of efficiency and standards of patient care and quality of service".
These plans have the blessing of the Sustainability and Transformation Partnership (STP - covering Wiltshire, Swindon and Bath & North-East Somerset). They are the STP's number one submission as part of their capital scheme.
GWH is working very closely with Swindon Council - but has also to work with all six local authorities that have patients treated at the Swindon hospital. These plans go for approval from the regional NHS England and NHS Improvement teams to their head offices - with a decision expected in about four months.
Seen from outside the NHS, it is a reflection on the strangely dysfunctional state of Britain's planning process and the lack of joined-up infrastructure policy, that none of the private developers for all Swindon's thousands of new homes has paid a penny towards the necessary investment in health services.
You do not need a doctorate in health planning to realise that more homes means more sick people. Long waiting times in ED or A&E are very largely the result of political decisions and lack of foresight by local as well as national politicians.