Queen Alexandra Hospital hit with more fines for waiting times in accident and emergency department

QUEUES Ambulances waiting at the entrance to A&E at the Queen Alexandra Hospital in Cosham
QUEUES Ambulances waiting at the entrance to A&E at the Queen Alexandra Hospital in Cosham

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ACCIDENT and emergency waiting times have still not improved at Queen Alexandra Hospital despite months of work – and are costing the hospital hundreds of thousands of pounds.

The failure to get 90 per cent of patients either treated, admitted or discharged within the national guideline of four hours, has meant the hospital has incurred fines.

In the financial year ending in March, Portsmouth Hospitals NHS Trust (PHT), which runs QA, was given a £244,749 penalty for breaching this guideline – an increase on the previous year of £195,399.

This delay has had an impact on South Central Ambulance Service, which has also levied separate fines for keeping its crews waiting in A&E.

In 2012-13 the fine was £81,750, and in March this year it jumped up to £667,128.

PHT is largely funded by the Portsmouth, Fareham and Gosport, and South Eastern Hampshire Clinical Commissioning Groups (CCG), which issue the fines.

Dr Jim Hogan, chief clinical officer for the Portsmouth CCG, has said this is ‘disappointing’.

Speaking on behalf of all three CCGs, he said: ‘Achieving the four-hour target remains a big priority, so it’s disappointing all the efforts which have been made in recent months have yet to show a real improvement in terms of performance.

‘The Urgent Care Centre at QA is now well established and treating up to 30 patients a day at peak times, however that is clearly not the only answer.

‘The problem is complex and reaches far beyond A&E itself, but it’s clearly essential that patients can rely on an emergency care system which works well and is sustainable.

‘The three local CCGs, along with all the other elements of health and social care in this area, are committed to achieving that goal, and will continue to work on behalf of patients to ensure that urgent care waiting times come down.’

And Fareham MP Mark Hoban said more needs to be done to address the ‘huge gap’ in QA waiting times, compared to the national average.

Between January and March this year, 87.5 per cent of patients were seen within four hours – lower than the national average of 92.5 per cent. There was a minor improvement compared to this position last year, where 86 per cent of patients were seen in the time frame.

Mr Hoban said: ‘There’s still a huge gap in what the hospital trust is doing compared to the national average.

‘It’s disappointing to see A&E figures continue to lag, and we want to see a change.’

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‘More work is needed to clarify delay problems’: Read The News Comment on this issue

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Steve Taylor, manager of patient forum Healthwatch Hampshire, said that it is aware of ongoing problems.

He said: ‘We know there are pressures. Clinically patients are satisfied, but the waiting times need to be addressed.’

QA has put in several measures to try to improve the situation in the last year. It has a new computer system, and has started placing GPs in A&E to get more patients seen. Ben Lloyd, financial director for PHT, said that the fines are largely put back into the trust.

He said: ‘Most of the money has been reinvested into the trust, and we are having ongoing discussions with our commissioners.

‘We need to get to the bottom of significant inaccuracies in ambulance fines imposed at the end of 2013-14.

‘For instance if there are four ambulances waiting with four patients, one crew has been told to stay and look after all four and the other three crews can be released. However, those have still been recorded as four ambulances waiting.

‘But we know the emergency department is getting full, and if we aren’t moving patients out, then new patients can’t get in.

‘We have put in significant programmes of improvements, staff work hard and changes have been made and we want to see improvements in the first quarter of this year.’

Ambulance trust is working with hospital

FINES can be issued by the NHS if ambulances are left waiting too long in hospital A&E departments.

In 2012/13, Portsmouth Hospitals NHS Trust, which runs Queen Alexandra Hospital, was fined £81,750 by commissioners for ambulance hold-ups.

NHS guidelines state a patient coming into A&E ‘on blue lights’ should be transferred into the hospital’s care within 15 minutes.

If hospital trusts fail to meet that a penalty is issued.

Clinical Commissioning Groups (CCG), which came into being in April last year, pay for health services to be provided.

QA is served by many CCGs – predominantly Portsmouth, Fareham & Gosport and South Eastern Hampshire.

For each delay over 30 minutes, CCGs can place a fine of £200, and more than an hour can mean a fine of £1,000.

In the last financial year PHT incurred a fine of £667,128 – a figure that is being looked at.

South Central Ambulance Service said it is working closely with PHT to improve the situation.

Operations director Mark Ainsworth said: ‘We have been working closely with the management team at QA to look at ways of reducing handover delays.

‘The increasing patient attendances at A&E reduces capacity in the department and the knock-on effect will be that at peak times ambulance crews are unable to get their patients into A&E.

‘Life-threatening patients are never delayed and are taken to a separate area in A&E for immediate treatment.

‘Patients who are unable to be admitted immediately into the emergency department are held in a queue and cared for by hospital and ambulance staff until capacity becomes available.

‘This means there is also an impact on Scas’s ability to respond to 999 calls awaiting our attendance in the community.

‘We will continue to work with QA to improve the processes we have implemented.’

Scas can charge commissioners £2.44 per minute for handover time longer than 15 minutes.

Latest figures

week ending no of attendances four hours or less (more than four hours) national average

30-03-14 1,917 85.2 (14.8) 95.8

23-03-14 2,025 85.9 (14.1) 93.7

16-03-14 2,059 91.0 (9) 94.3

09-03-14 1,906 83.1 (16.9) 92.5

02-03-14 1,919 74.2 (25.8) 92.1

23-02-14 1,866 86.1 (13.9) 92.4

16-02-14 1,762 87.7 (12.3) 91.4

09-02-14 1,861 83.2 (16.8) 91.4

02-02-14 1,900 74.6 (25.4) 92.9

26-01-14 1,819 74.1 (25.9) 94.1

19-01-14 1,729 96.0 (4) 93.1

12-01-14 1,775 82.2 (17.8) 91.7

05-01-14 1,818 87.1 (12.9) 91.5

Jan-Mar 14 24,356 87.5 92.5

Jan-Mar 13 24,535 86 91.1