Bid for millions of pounds to ease unprecedented A&E demand

LOG JAM Ambulances waiting outside accident and emergency at at Queen Alexandra Hospital yesterday afternoon ''                Picture: Malcolm Wells (142589-1168)
LOG JAM Ambulances waiting outside accident and emergency at at Queen Alexandra Hospital yesterday afternoon '' Picture: Malcolm Wells (142589-1168)

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Queen Alexandra Hospital’s A&E department had to send patients to Southampton yesterday as it was too busy to cope.

On average the Cosham hospital sees around 10 patients an hour in A&E but during yesterday afternoon’s ‘unprecendented’ peak, 30 people an hour were turning up.

High demand led to ambulances queuing up outside QA, and the hospital said six patients were diverted to Southampton General.

It comes after MPs held a crisis meeting to talk about the situation and local GP commissioning groups, which are in charge of funding QA, have put in a bid for £4m to the government to ease the long-running problems.

Each time an ambulance is held up in A&E for more than 15 minutes, a fine is issued against Portsmouth Hospitals NHS Trust (PHT), which runs QA.

And failure to see, treat or discharge 95 per cent of patients in four hours means the hospital trust will again face a financial penalty.

A PHT spokesman said: ‘Our emergency department is facing unprecedented demand at the moment.

‘Yesterday we received a very high volume of patients being conveyed to the hospital on an hourly basis from 9am – peaking at 30 patients in one hour. We usually receive between 10 to 12 patients an hour. Between 3pm and 4pm, due to very high demand, we diverted six non-life-threatening cases to Southampton.

‘We are doing everything we can to make sure patients are safely managed and are working with colleagues within the healthcare system to ensure the demand on the emergency department is resolved.’

South Central Ambulance Service (Scas) said taking patients to Southampton is part of a ‘standard contingency plan’.

A spokesman said: ‘On the rare occasions when A&E is at capacity, Scas activates its standard contingency plans, in order that those patients with non-life-threatening conditions be diverted to the nearest hospital, while those in life-threatening conditions continue to be admitted to QA.’

Clinical Commissioning Groups (CCGs) control health budgets. QA is largely funded by Portsmouth CCG, South Eastern Hampshire CCG and the Fareham and Gosport CCG. The commissioners have put in a bid for up to £4m of government funding called the resilience funds.

Dr David Chilvers, lead for F&G CCG and the doctor who represented all three CCGs at the MPs’ meeting, said: ‘Although the most visible pressures on the health system tend to be seen in the emergency department, we need to look more widely than that – if one part of the local NHS is struggling, the whole local NHS will struggle, and so we are all involved in the effort to give patients good care, and good access to that care. The resilience funding has not yet been allocated, and so we are not yet able to finalise our plans.

‘However, we have agreed everything we do should prioritise the following four areas: ensuring patients are supported to leave hospital at the earliest appropriate time; increasing bed capacity in hospital and the community; ensuring patients are only admitted into hospitals if they genuinely need to be, and increasing the proportion of A&E patients who are cared for within the four-hour target.’

The bid includes creating an additional team to support early hospital leave, increasing community hospitals’ medical capacity, using extra beds in QA, and continue funding for an assessment lounge to see if a patient needs to be in A&E.

PHT, commissioners, NHS community providers Solent NHS Trust and Southern Health NHS Trust, and adult social care services run by the city council and the county council, met in Westminster.

It was hosted by MP Mark Hoban, along with Penny Mordaunt for Portsmouth North, Gosport’s Caroline Dinenage, George Hollingbery from the Meon Valley and East Hampshire’s Damian Hinds.

Fareham MP Mr Hoban said: ‘We were able to see where the problems were and set up a clear action plan. We need to work on the discharge process and make sure patients are getting on the right care plan if it’s clear someone doesn’t need to be in hospital.

‘We also need to make sure people are aware of the options that are out there, without having to go to QA.

‘There seems to be some determination in solving this, each member recognises they are part of the solution to the problem.’

Ms Mordaunt said: ‘QA has a lot of demand on its emergency department, and yesterday it wasn’t able to cope fully. As part of our ongoing plans to reduce waiting times at A&E, we will have weekly meetings to discuss performance.’

A&E problem is a long-standing issue for QA

HIGH demand for A&E services is not something new for Queen Alexandra Hospital.

For more than a year now, the Cosham hospital has been faced with scores of people turning up to the emergency department each day.

For QA, this is not a seasonal demand, but one that takes place throughout the year.

The problem first came to light in July last year, when figures showed QA was being fined thousands of pounds for failing to see patients within four hours and for holding up ambulances in A&E

As reported, promises were made to ensure things would improve.

When this didn’t happen, Clinical Commissioning Groups introduced the urgent care centre in late November last year.

This involves having GPs in A&E at key times such as weekends to target patients who don’t need urgent care.

In October, Rick Strang was brought in to troubleshoot problems.

But when there was no change, commissioners across south-east Hampshire wrote a scathing letter to hospital chief executive Ursula Ward.

Several new measures have been introduced to reduce the waiting times.

This has included increasing the number of beds available in the hospital, holding more daily meetings to identify which patients can be discharged, extending care given by the medical assessment unit and introducing a phoneline for GPs to call to get a second opinion before sending a patient to A&E.

Although initially it seemed to work, since mid-March weekly performances have been well below the target.

Regular progress meetings will take place

EACH organisation that sent a representative to the crisis meeting set up by MPs will have to report back regularly.

This team is being headed by Ursula Ward, chief executive of Portsmouth Hospitals NHS Trust, which runs Queen Alexandra Hospital.

Talks between MPs, health services and adult social care providers took place, in a bid to tackle A&E waiting time delays in QA.

The MPs at the meeting recognised this to be a ‘system-wide’ problem.

Penny Mordaunt, MP for Portsmouth North, said: ‘Although there’s been a lot of good work in and out of hospital, there are still some issues concerning MPs.

‘On the one hand there is a hospital delay in getting people treated in A&E, and on the other hand we need to look at the system and patients being discharged at the other end.

‘Patients shouldn’t be waiting around in hospital because they are waiting for the pharmacist to dispense medicine, or a care plan isn’t in place for them. We all need to work together.

‘Even though the A&E challenge is considerable, we are pleased there is a group looking at it, and we will be scrutinising this.’

MPs will meet with the various parties again in three months’ time, and will be given updates in the interim.

The MPs who all represent areas in and around Portsmouth, decided to hold talks with NHS leaders to find out what’s being done to solve the A&E waiting times problem.

The MPs got together to hold talks about the waiting times at Queen Alexandra Hospital, before setting up a meeting between themselves, health trusts and local councils.