For the past two years Queen Alexandra Hospital’s A&E department has been in the spotlight for failing to reach national waiting time targets. Health reporter Priya Mistry looks at the plans to improve this.
Video shows Priya explaining the news that hundreds of patients have been left waiting more than 30 minutes to get into A&E in Portsmouth – compared to just six in Southampton - according to new figures
We are all aware people are living longer.
And with that comes an ageing population, which tends to mean more frail and ill people with complex medical needs.
We also know we’re only supposed to go to A&E – as the name suggests – in an accident or an emergency.
But with patients struggling to get an appointment with their GP, unsure about using the NHS 111 service, seeing a pharmacist or visiting a walk-in centre, many head for what they see as the safest bet. And that’s the A&E department.
Not only is it a recognised place to receive care and help, it fits in with the modern-day mentality of expecting services to be available 24 hours a day, seven days a week – but all this comes at a price.
Queen Alexandra Hospital, in Cosham, says it faces unprecedented demands on its A&E department.
The government set a target that 95 per cent of patients should be seen, treated, or discharged within four hours.
Figures from NHS England show that for the week ending January 18, 73.3 per cent of those who went to A&E were either seen, treated or discharged within four hours.
This is an increase on the previous week where the figure was 70.6 per cent, and 61.1 per cent before that.
And this is not just about figures – this translates to hundreds and hundreds of people having to wait for a long time to be seen.
The story is not unfamiliar – it’s a matter that has been going on for almost two years and doesn’t look like it will be slowing down any time soon.
Steve Taylor is the manager of patient watchdog group Healthwatch Hampshire. He says: ‘It’s good to see there have been slight improvements at QA, but there is still some way to go.
‘It’s encouraging to see it’s getting better, but we need to make sure patients are getting the best.’
In October last year the hospital was put on ‘black alert’ as it was struggling to cope with the number of people turning up.
And as today’s story shows, a busy A&E department has a major knock-on effect for other services.
Between November 3, 2014, and January 2015, 1,289 ambulances were left waiting more than 30 minutes to hand over patients to QA – an average of 19 a day.
This compares to only six at Southampton General Hospital.
But it’s not just a problem for QA to fix, as many other NHS organisations are connected to the hospital.
Portsmouth Hospitals NHS Trust runs QA, and gets most of its funding from Clinical Commissioning Groups.
There is the Portsmouth CCG, Fareham and Gosport CCG and the South Eastern Hampshire CCG.
Solent NHS Trust and Southern Health NHS Trust run community and mental health services.
There’s also adult social care services run by Portsmouth City Council and Hampshire County Council, South Central Ambulance Service and the out-of-hours GP service.
And all of these services need to work together to tackle the A&E crisis.
Last year a meeting between these groups was held in Westminster, overseen by Fareham MP Mark Hoban.
Also there was Penny Mordaunt for Portsmouth North, Gosport’s Caroline Dinenage, George Hollingbery from the Meon Valley and East Hampshire’s Damian Hinds.
Together a strategy was developed and is being implemented to bring down the number of people waiting more than four hours in A&E.
Mr Hoban met Ursula Ward, chief executive of PHT, to carry on discussions and ensure the plans made are being put into action.
He says: ‘Ms Ward recognises the continuing challenges that the trust is facing.
‘There also needs to be fundamental changes on how they work and tackle the underlying problems.
‘That does mean having people on-call and available seven days a week.
‘People are not ill to suit staffing hours.
‘But of course it’s not just about them, this is about an entire health system.
‘PHT is one element of this and knows its challenges.
‘All the other NHS trusts and local authorities involved must also do their part. This is something we will continue keeping an eye on.’
On these pages are eight panels on the organisations involved in the A&E system.
It gives details of what each will do in order to tackle the figures.
Portsmouth Hospitals NHS Trust
This is the trust that runs Queen Alexandra Hospital.
The target to see, treat or discharge 95 per cent of patients within four hours is measured at the hospital.
The trust has previously said patients need to ‘flow’ in and out of A&E to reduce waiting times.
This means patients should be seen quickly coming in, and discharged as soon as they are ready to be. As part of its action plan, the trust it will do the following:
- Extend the number of medicine discharge ward rounds at the weekend to increase number of discharge decision makers.
- Have more early assessment, diagnosis and treatment for frail elderly patients.
- Increase the use of the discharge lounge to release the number of beds available.
- Increase the consultant cover in A&E.
- Increase bed capacity by more than 40.
- Increase medical and nursing engagement in the A&E recovery plan.
Clinical Commissioning Groups
THESE groups pay for health services and locally there are three serving south-east Hampshire.
These are the Portsmouth CCG, Fareham and Gosport CCG and South Eastern Hampshire CCG.
All pay different health providers to run services and therefore the CCGs can hold different NHS providers to account if they do not meet targets or outcomes.
The groups work closely with different organisations and meet to ensure they are following their plans.
All three have said they will do the following:
- Reduce the number of people turning up at A&E who do not need to be there and can get help elsewhere.
- Support referrals to hospital from home visits earlier in the day in order to support patient flow.
- Monitor the progress of individuals.
- Meet the national target of seeing, treating or discharging 95 per cent of patients within four hours.
Southern Health NHS Trust
This is an NHS trust that provides community and mental health care for Hampshire.
This includes Fareham, Gosport, Havant and Waterlooville, but not Portsmouth.
It is responsible for providing care in the community setting, such as people’s homes or in centres.
It will be working on the following points in order to help free bed space in Queen Alexandra Hospital:
- Carry on with its six-month Enhanced Recovery at Home team which supports patients to live at home after a hospital stay.
- Open 15 additional beds
- Have enhanced therapy staff
- Expand its in-reach programme, which means more is done to identify patients who need to come home
- Integrate its discharge team with staff from Portsmouth City Council, Hampshire County Council and Solent NHS Trust.
- Increase medical capacity with community hospitals.
Solent NHS Trust
THIS is an NHS trust that provides community and mental health services predominantly in Portsmouth.
It is funded by the CCGs and works with Portsmouth City Council.
It aims to:
- Enhance the Portsmouth Rehabilitation and Reablement Team with Portsmouth City Council.
- Establish and implement with Portsmouth City Council, Hampshire County Council and Southern Health NHS Foundation Trust an integrated discharge team.
- Improve its in-reach capacity.
- Have extra therapy support.
- Increase the number of nurses and the physiotherapy at Jubilee House.
The Community Assessment Lounge was set up to see if it could identify patients that were ready to go home sooner. The trust aims to deliver the targets on this lounge.
- Add a social worker at Jubilee House, Spinnaker ward and The Limes.
Portsmouth Health LTD
This is a private company that provides the out-of-hours doctors service for Hampshire.
PHL has agreed to work with the urgent care centre to establish a primary care presence at Queen Alexandra Hospital.
The urgent care centre is a scheme which has doctors based in A&E to see patients who may not need emergency care.
If they do not, then they will be told to go to their own GP or another service.
South Central Ambulance Service
THIS is the trust that provides ambulance cover in Hampshire.
It is responsible for taking emergency calls, assessing whether a patient needs an ambulance, how quickly they need it, treating a patient and taking them to hospital if necessary.
The ambulance trust said it has faced a surge in demand with 999 calls, which has put a strain on the service.
Scas said between November 3, 2014, and January 11, 2015, it took 8,537 patients to Queen Alexandra Hospital’s A&E department – a 10 per cent increase on the year before. And of those, 1,289 – 15 per cent – were kept waiting at QA for more than 30 minutes. It means patients are left waiting in the back of ambulances and other patients waiting for help will receive a slower service.
It will be working on:
- Ensuring it keeps the Hospital Ambulance Liaison Officer support scheme to manage surges in activity at A&E.
- Increasing the number of patients who aren’t taken to hospital – instead working with primary care, ie doctors.
Hampshire County Council
THIS is the authority in charge of providing social care to older people in areas including Fareham, Gosport, Havant and Waterlooville.
It works with Southern Health NHS Trust, which provides community and mental health services for the same patch.
The Better Care scheme is looking to get the NHS to work much more closely with local authorities, so health and social care needs are being met.
The county council says it will:
- Establish and implement with Solent NHS Trust, Portsmouth City Council, and Southern Health NHS Trust, an integrated discharge team
- Work with Southern Health NHS Trust to support Enhance Recovery at Home Team.
- Work with Portsmouth Hospitals NHS Trust and Southern to increase the number of discharge-to-assess beds to 16.
- Enhance the equipment service to ensure there are no delays.
- Provide follow-up care packages.
- Add more qualified social workers.
Portsmouth City Council
THE local authority is in charge of social services in Portsmouth.
It is working with the Portsmouth Clinical Commissioning Group to bring in the £16m Better Care Fund. They will be pooling money together in order to provide better care for adult social services.
This means the NHS and the local authority would work closer together so patients are getting the best care. This is aimed at stopping the duplication of information.
As part of the A&E plans, the city council will:
- Establish and implement with Solent NHS Trust, Hampshire County Council, and Southern Health NHS Trust, an integrated discharge team.
- Recruit care navigators to support discharges.
- Improve the rehabilitation and reablement team - working with Solent.
- Enhanced in-reach capacity.
- Add a social worker to Jubilee House, Spinnaker ward and The Limes, pictured.