GWH gets a capital grant to help solve A&E crisis - but where can they find the staff?

Written by Tony Millett on .

Just before the notion of General Election 'purdah' apparently put a stop to everyday policy implementation - as opposed to everyday electioneering promises - Great Western Hospital was listed to get a share of the first £56million of capital money from NHS Improvement to help hospitals ease the nationwide A&E crisis.

GWH will receive £899,661 towards a scheme they put forward to make building alterations integrating their Emergency Department and their Urgent Care Centre.  The latter is now being run by GWH as part of its new responsibilities for Swindon's community health services - making these changes feasible.

This will have an impact on the flow of patients through the emergency department.  But the problems in meeting the national target for 95 per cent of patients to be admitted, transferred or discharged within four hours, have many other wider causes - causes that this novel 'bricks-and-mortar' plan cannot cure on its own.

So at a time of ritual claims and counter claims about the Government's treatment of the NHS, let us look at some facts.

In March 2017 the total number of emergency attendances at GWH's A&E was 6,893 - that was an increase of twelve per cent on February's figure and showed a decrease of 6.2 per cent against March 2016 - though February is, of course, a shorter month.  

With that slightly better news came more serious news:  there were 3,430 emergency admissions to GWH during March.  That was 15.5 per cent up on February, but also 7.3 per cent up on March 2016.

The 95 per cent A&E target was missed at GWH in March with 83.7 per cent of patients within the four hour target. The figure across 2016-17 was 86.6 per cent.  The main cause for these figures is simply that GWH - which has too few acute beds for the huge growth in the population it serves - has problems with the flow of patients through its wards.  Most of these problems are not of its own making.

We are back to 'Delayed Transfers of Care' (DTOCs) - known also as 'blocked beds'.  The number of bed days lost at GWH to DTOCs in March was 810 - up more than 30 per cent on February, but up by a whopping 36 per cent on March 2016.

Of those 810 bed days, 345 were Swindon patients (up 50 per cent on February) and 259 were Wiltshire patients (down marginally on February.) (The other 206 bed days lost were patients from outside the Swindon and Wiltshire areas.)

Additional beds have been made available at Savernake Hospital. But as patients are moved out of GWH's acute beds, blockages are occurring further down the line:  with community hospitals' beds blocked because patients cannot be moved back to home or to rehabilitation.

As the report to the GWH board meeting (May 4) says: "...Community services report that community hospital and intermediate care beds for GWH patients have been difficult to access due largely to placement and Help to Live at Home delays..."

One of the many ways GWH are seeking to minimise DTOCs is through their Home to Assess service.  This began in November as a pilot scheme funded by Swindon CCG.  Although somewhat undermined by staff shortages, it has had successes - saving about 111 bed days during the pilot.

Now the pilot is over, Swindon CCG are funding it month by month.  "But", the report to the board states, "certainty is required if the service is to reach its full potential."  To which GWH Director of Finance, Karen Johnson, added: "Swindon desire to make it work - but there is a gap in funding."

The building work must start soon as under the rules for this £899,661 it must be complete by October - before the 'winter pressures' kick in.  

NHS Improvement are demanding that recipients of this money reach the 95 per cent target by the end of the year. And GWH has to present a plan on how that will be achieved - as Karen Johnson told the board: "It's got to be a credible plan."

NHS Improvement may be able to magic-up cash, but they cannot magic-up staff.  The next hurdle will be for GWH to recruit staff - including GPs - to work in their newly integrated A&E service. But - as with recruitment - many of the problems around A&E waiting times and DTOCs lie outside GWH's remit.   

 It is not yet clear how - or even whether - shares of the government's £1bn to help local authorities meet their social services responsibilities that go to Wiltshire (said to be £5.8m) and to Swindon will help GWH get patients back home faster.  

Will, for instance, Wiltshire Council use part of this money to upgrade and fully staff its Help to Live at Home service to help with DTOCs?  That is something you can ask your new Wiltshire councillor.