How can GWH cope over the three years it will take to enlarge the hospital?Among its everyday problems with finances and staffing, Great Western Hospitals NHS Foundation Trust (GWH) is facing a serious three year challenge.
It has finally been acknowledged by those holding major NHS capital budgets that the hospital (which opened to patients in 2002) is too small for Swindon's ever and fast increasing population. The number of beds and the size of its emergency department (ED - also known as A&E) has simply not kept pace with the town's housing developments.
And Swindon's expansion goes on with a large new development just approved as part of the New Eastern Villages expansion programme.
GWH does now have the money and a plan - for sixty extra beds and a new and enlarged emergency department. It will, however, take three years to get both beds and emergency department ready for patients - and it is not just a matter of bricks-and-mortar and equipment, but also of staffing the new services.
And there lies the challenge: how to cope with the dramatically growing demand during those three years. In the words of one senior executive at the recent Board meeting: "There's the knotty problem of how to get through the next three years."
Their ED is 'half the size it should be' and April and May saw a fifteen per cent rise in people coming to it for treatment. "This", said Chief Executive Nerissa Vaughan, "is unprecedented and is not sustainable."
Those two months should have seen the end of the usual winter pressures on ED and on the hospital in general. But this level of people coming to ED seems to be 'the new norm'.
In May 2018 the GWH ED hit 90.3 per cent of patients being admitted, transferred or discharged within four hours - the target or standard is 95 per cent. And when other emergency centres in GWH's remit were included, they were just 0.9 per cent short of the target.
April 2019 was a different story entirely. The figure for GWH's ED was 69.7 per cent of those attending achieved the 4-hour target, with an overall figure of 82.8 per cent.
That overall figure included two minor injury units - much smaller facilities with smaller catchment areas and a narrower remit catering for less serious cases - each run by Wiltshire Health and Care rating 99.1 and 100 per cent.
And by all accounts the figures for May will be just as difficult.
A paper for their recent board meeting (June 6) made it clear that GWH is not alone in this continuing four-hour quagmire:
"Four hour performance over the last six weeks has remained a challenge for the South West with only one Trust [a district hospital] achieving the standard during this period and only ten Trusts achieving above 90 per cent and seven performing below 80 per cent" - of A&E patients admitted, transferred discharged within four hours.
"Great Western sat at 26 out of [the] 35 Trusts in the region during this period with a performance position of 82 per cent."
Why is there such intense and increasing pressure on A&E departments? A large part of it down to the ageing population who tend of have more complex conditions. Undxer recent changes they may be kept and treated at home for longer, but when they do need hospital treatment they become emergencies.
A further part of it is almost certainly due patients arriving for treatment at the wrong place. A recent spot check found that out of 14 ambulance deliveries to GWH, 12 should have gone to minor injury units.
GWH are looking closely at the number of patients referred to their ED by Swindon GP surgeries. Some surgeries are thought to shift too many patients too soon to ED.
And there may be other less obvious social reasons. Could the push to get people exercising more and playing more sports be leading to an increased number of falls, broken ankles and arms?
But working out the whys and wherefores of the increasing numbers arriving at GWH ED is difficult. Every patient has a unique set of symptoms, complexities, on going treatments and of support systems (or lack of them).
It is likely that the four hour target - or standard - will be changed to make it simpler to understand and to count. But GWH's 'knotty' three year challenge will remain. Watch this space...