How one woman's protest letter focused attention on a major NHS issue

Written by Tony Millett.

Great Western Hospitals have a capacity problem and it has to cope with a daily number of between 60 and 70 patients who are ready to leave its wards but cannot mainly because their care at home or in care homes is not available.

The hospitals' plight was highlighted recently by the case of 84-year-old Lady Fiona Hannon.  A resident of Bradford on Avon, she had a stroke in January and by April 4 was declared fit to be discharged from GWH's Chippenham Community Hospital.  

By May 5 Wiltshire Council had still failed to find her a care package so she could be discharged.  She was still in hospital when she wrote to Jeremy Hunt - who is still the Secretary of State for Health.

Her letter was sent to the media and picked up by the Sunday Express.  Faced with the publicity, Wiltshire Council suddenly found her an appropriate care package so she could go home to be with her disabled husband.

Marlborough.News understands that this was not the case with other people on her ward who signed her letter - another of whom had already waited a month for care so she could leave hospital.  This incident has rather blown a hole in Wiltshire Council's bullish claim that they were hardly ever responsible for blocking hospital beds.

One GWH executive has pointed out that coding of the reasons for delayed discharges of patients sometimes wrongly puts them into the NHS column rather than into the social services column.  This is because reasons for the delays are often complex and not due solely to NHS problems (like delays in prescribing drugs) or to Wiltshire or Swindon Councils' social service departments.

At the Wiltshire CCG the talk is of reducing the area's hospital capacity - as they cannot afford to pay for so much hospital treatment.  At the other end of the new NHS 'footprint', at GWH - which is mainly commissioned by the Swindon CCG - they are planning how to increase the number of beds.

Swindon is the third fastest growing town in Europe and GWH is simply too small to cope with the town's population. GWH has been struggling to meet some - but by no means all - its mandatory targets.  This is especially true of its Emergency Department (ED or A&E) - although the numbers dealt with within four hours has been improving.

Chief Executive Nerissa Vaughan told her board (June 2) that something had to be done as the situation was affecting staff ('Staff and safety are at risk') and the hospital's reputation: "We are massively over capacity.  I can't be Chief Exec and do nothing.  Going forward, I cannot see some of the things we see in this hospital.  Nursing patients in an ED is the most dangerous thing we can do."

GWH's Interim Chief Operating Officer, Adrian Griffiths presented a 'discussion document' putting forward the case to 'do something'.  This showed that year round, the Trust's hospitals were, on average, short at any one time of 43 acute care beds - with a peak in February of 78 and a winter average of 60 beds short.

Adrian Griffiths:  "The Trust has neither the time, nor the confidence, to wait for the whole system action plan to deliver the reduction of medically fit patient delays  [DTOCs or delayed transfers of care] that it seeks to achieve this year."

So he put forward seven options - some of them costed in detail - which could be taken up singly or simultaneously.  These ran from GWH commissioning its own care home places to taking over and redesigning a Swindon facility for beds for elderly patients to recommissioning a ward.

The board were prepared to go ahead with more detailed discussions and financial planning to improve the hospitals' capacity.

Lady Hannon and her husband had, her letter stated, 'so far' supported the government.  The Hannons spent much of their working lives bringing communities together in South Africa and Northern Ireland.   

She ended her letter with two sentences that did not make it into the Sunday Express.  She referred to the 'few leaders' they had worked with "...who had the vision and the courage to succeed in building a different and better future":

"One thing they all had in common - they recognised that to change the world, you have to change yourself.  Perhaps that time has come for you and indeed your whole party."