Hospital services

Our hospital wards show ‘little green shoots’ after pressures to breaking point

Leaders at Derby and Burton hospitals say ‘little green shoots’ are emerging after immense pressure pushed the health service to breaking point.

However, officials are clear that there is still a serious battle to be fought to get services back to where they need to be, before the pandemic-induced crisis.

There was also a warning against being overly optimistic about how long it will take to get services back to normal and de-escalating from full capacity or beyond full capacity.

A meeting of University Hospitals Derby and the Burton NHS Foundation Trust this week heard that major staffing shortages are leaving maternity wards understaffed, posing a potential heightened risk to mothers and babies.

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Staff are exhausted, trust officials say, and there is little they can be asked to do to help reduce the risk of waiting, with more staff needed to help fill shortcomings – but all of this takes time through training and recruitment.

However, the currently suspended home birth service could hopefully be operational again towards the end of April or early May.

Meanwhile, while waiting lists filled with thousands of people who have been waiting for more than a year for care are much lower than before, it will still potentially take three years to cancel them.

More than 5,000 people have been waiting for care for more than a year, when usually there wouldn’t be a single patient waiting that long – a key indicator of the seriousness of the task facing our health services .

There are also more than 400 people who have been waiting for more than two years for treatment – which is also unheard of before the pandemic.

The number of people being referred for a diagnosis of potential cancer has increased significantly, which the trust welcomes, which does not translate into more people with cancer.

However, far fewer people are diagnosed with cancer or given the green light within two weeks of an urgent referral to a GP.

Only 15 of 509 people who were referred for an urgent breast cancer referral in December were seen within two weeks, or 3%.

Last year, when the trust assessed cancer referral pressures, it gave one in four potential cancer patients a diagnosis or a green light within 28 days, with more than 800 patients missing the cut in May.

The latest data, from December, shows a worse assessment position of one in three potential cancer patients within two weeks, with 954 of 2,887 patients seen within 28 days.

Dr Magnus Harrison, acting chief executive of the hospital trust, said: “There are green shoots, little green shoots.

“Looking at our 12 hour waits in our emergency departments right now, in the last month we have only had one bad day, other than that there have been no breaches, generally, and maybe a 12 hour a day offense, and that’s a significant improvement from January and December.

In January, the trust recorded nearly 300 “12-hour cart violations” in which a patient was left in hospital after being deemed in need of care but without a hospital bed.

Before the pandemic, a single patient waiting longer than 12 hours was generally unheard of, so to count nearly 300 — an all-time high — is completely unprecedented.

On a positive note, Dr Harrison said: “We haven’t canceled as many procedures as we usually would and I think a lot of that is due to the activity we’ve been able to continue through the center of processing.”

Sharon Martin, the trust’s chief operating officer, said: ‘We are seeing some tiny green shoots

“We really struggled in January and had really high expectations, which is clearly not acceptable. I am happy to say that they are improving.

“Increased longer length of stay and release times have caused us some pretty significant operational pressures.

“We’ve had quite a few exit blocks in terms of offloading which are also starting to improve.

“With cancer, a big area of ​​concern was the breast department, where we had difficulty with staff from January to February.

“We have seen a 19% increase in referrals to the breast service, they are not translating to an increase in breast cancer, which is reassuring.

“We have seen the wait time, which is expected to be 14 days, continue to drop. We haven’t reached 14 days yet, we are currently around 22.5 days.

“We are starting to see improvements in our ambulance turnaround times. We are in no way in major delays like some of our neighboring trusts and we support a number of trusts in the West Midlands and take patients from other sites, in particular Burton.

The trust aims to cancel two-year waits by July this year, 18-month waits by April 2023, bring 62-day referrals back to pre-pandemic levels by March 2023 and have at least 75% of urgent referrals diagnosed with cancer. or given the green light within 28 days by March 2024.

Justin Shanahan, vice president of the trust, said: “I think we are overly optimistic about when we will achieve these new target scores. I don’t think we’ll be looking at this a year from now and we’ll have achieved those goals.

“I know it’s very NHS-ey to say we’re going to fix this in a drill, but I think a lot of it is not fixable in a drill, even if we had plenty of resources to report it – which we don’t.

“I think there’s an optimism bias and I think there’s a cultural and financial bias at play here.

“I urge you all to be a little more realistic, in all honesty, about when we think we’re going to fix it, because that will determine how long we need to deploy these resources.

“I think we’re kidding ourselves about how easily some of these problems can be solved.”

Dr. Harrison agreed with that.

Dr Kathy McLean, chair of the trust, said the organization needed to assess its maximum capacity and output “long before we say we’re going to send patients somewhere else or we’re going to build something else”.

On maternity issues, Patti Paine, director of midwifery at the trust, said: ‘What is suffocating us is the lack of midwives.

“We hope to be able to restore the home birth service by the end of April until May.

“Things are improving although the increase in the workforce is slow, but it is starting to increase. We are far from where we need to be.

“We are facing a fairly large shortage.

“The compromising factor is that we know we’re going to have additional births in the next two months and one of the conversations I had with one of the consultants today is ‘are we at the point where we need to really refuse reservations? ‘”

Kara Dent, the trust’s legal director for obstetrics and gynecology, said: ‘We have a very, very high unprecedented rate of illness among our trainees, we are running at 50-60% on some days. We have a very tired workforce.

“We’re still working in the delivery room with maybe eight midwives instead of 12. We really hope those two things will change in the future, but that’s our biggest challenge.”

Dr McLean said: ‘We know maternity is probably our highest risk area, it’s for every organization that runs obstetrics and maternity units.

“The challenge is to find the people. You find the people, but balancing that with people retiring is one of your biggest challenges.

Cathy Winfield, the trust’s executive chief nursing officer, told the Local Democracy Reporting Service, when asked about possible appointment cancellations, said: ‘We are hoping to get our home birth service back up and running as c is really important for women and for choice.

“I think it’s something we take month by month and keep the board regularly informed about it.

“It’s a fine line. The women we care for are as safe as possible.”

Ms Martin, when asked by the LDRS about patients likely to present to hospital with advanced stages of cancer, said: ‘In urology, some of our consultants checked references and at the height of the pandemic it was clear that people were showing up later, and I think that was probably a trend that was followed nationally because people were very focused on the pandemic.

“These were people who were referred in a timely manner, but much later in the course of their illness.

“What’s really good to see now is that we’re seeing more people showing up with two-week referrals, that’s really positive.

“It indicates that people are asking for help. We are not finding any more cancer from these references, which is good, it is a good indicator that there is not this latent cancer.

James Crampton, the trust’s acting executive medical director, told the LDRS: ‘Since 2019, we have seen a 25% increase in two-week (cancer) waiting referrals to UHDB, compared to an increase of 13 % In the region.

“However, the conversion of those patients waiting two weeks into actual cancer patients has dropped to 6% at UHDB, down from 10% in 2019.”

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