Queen Alexandra Hospital fails to meet A&E targets again

There is concern about waiting times at the accident and emergency department at Queen Alexandra Hospital in Cosham.
There is concern about waiting times at the accident and emergency department at Queen Alexandra Hospital in Cosham.
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SOMETHING must be done – and soon – about Queen Alexandra Hospital’s failure to hit A&E targets.

That’s the call from patient support group Healthwatch Portsmouth.

It comes after the revelation that despite 18 months of awareness campaigns, fines being levied on Portsmouth Hospitals NHS Trust and a raft of initiatives, waiting times at QA remain much longer than the national guidelines.

Between April and July this year the hospital failed to hit its target once of admitting or discharging 95 per cent of patients within four hours.

Head of Healthwatch Portsmouth Simon Haill said: ‘There’s a real public concern about QA only achieving around 85 per cent of its benchmark of 95 per cent for seeing, treating or discharging patients within four hours of arrival.

‘The shortage of staff within this area contributes significantly to the problem.

‘Clearly the situation is now unsustainable and something needs to be done urgently to resolve it.’

A CCG report says the problem is caused by a number of factors including seasonal demand and people attending A&E instead of their GP or a pharmacist.

Dr Jim Hogan, head of the Portsmouth Clinical Commissioning Group, which is in charge of funding medical services, commented on the issue in a report saying: ‘There remain ongoing problems associated with delivering the four-hour target within PHT.

‘Performance has been unacceptably poor for a considerable period, with the service standard not being met for the past five quarters.

‘Despite plans and resources being put in place, both within the trust and across the system, this has not had a material impact on the target.’

Former hospital chief executive Fiona Wise was hired for three months to look at the A&E department to see what worked and where improvements needed to be made.

She found the most significant problem was the lack of availability of beds and waiting for specialist opinion.

The urgent care centre, which was set up in November last year, introduced GPs into A&E to see if patients did need to be treated in hospital.

Ms Wise’s report urges this service to become a 24/7 model.

Dr Hogan said: ‘Our organisations have invested a lot of money and resources in a number of projects to try to improve waiting times at A&E.

‘But, despite our best efforts, these combined efforts have not made a significant impact to improve the situation.

‘This is not about me saying this is anyone’s fault because it is the responsibility of everyone in the local health system to work together to improve urgent care services for our patients.

‘That is why we all signed up to bringing in someone of high calibre to look at all the issues, identify what might be preventing us from making the necessary improvements and developing a recovery plan to deliver lasting improvements.

Dr Hogan said that areas for improvement had been identified and put in an Urgent Care Improvement Plan.

‘The recently-reconstituted Portsmouth and South East Hampshire Urgent Care Board will be charged with monitoring and implementing this,’ he said.

‘This group, comprising the most senior managers of all the organisations has already met.

‘This action will hopefully be welcomed by everyone as further evidence of our determination to all work together and to make the lasting performance improvements that we all want to see, both as the commissioners and providers of all our local health services.’

Portsmouth North MP Penny Mordaunt said that while a lot of things are happening in the hospital, the wider health economy needs to be looked at.

She said: ‘QA does a good job of treating the most ill and those in need of immediate attention well.

‘But it’s concerning to see these waiting times have not improved since different measures have been put in place.’

Between January and March this year, 87.5 per cent of patients were seen within four hours – below 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.

Previous failures

QUEEN Alexandra Hospital has been failing to meet A&E waiting targets for more than a year.

The problem first came to light in July last year, where 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.

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.

In it, commissioners expressed A&E as one of four areas they were concerned about in terms of performance and putting patient safety at risk.

New measures had 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.

Figures show that immediately after the changes were put in place, there was an improvement in waiting times in the emergency department.

Other changes added to the emergency department also involved:

n Setting up an area within the Medical Assessment Unit to monitor a patient for things such as fluids or making sure they had the right medication.

By setting up this area, patients get checked and if the progress is fine, avoid being admitted into hospital.

n GPs speak to consultants before they send them in to the emergency department.

On average, A&E gets about 50 referrals from GPs a day, but by ringing up and speaking to a consultant for a second opinion, referrals have been halved.

n Additional consultants have been taken on to work in the emergency department, medicine and at the weekends.

n An extra 50 beds were opened up for the winter and extra staff were brought in.

In January this year it seemed these changes had paid off with the green shoots of recovery coming in.

QA started to see 90 per cent of patients within four hours, and were also above the national average.

However this was short-lived, as the middle of March was the last time QA hit 90 per cent.

Since then, weekly performances have been well below this and also under the national average.

MPs join forces for crisis talks

A GROUP of MPs in the Portsmouth area are due to hold crisis talks with NHS leaders to find out what’s being done to solve the A&E waiting times problem.

As reported, the MPs got together to hold talks about the waiting times at Queen Alexandra Hospital.

Fareham MP Mark Hoban, Portsmouth North MP Penny Mordaunt, Gosport MP Caroline Dinenage, Meon Valley MP George Hollingbery, and East Hampshire MP Damian Hinds have all met to talk about the problem.

And now they are due to meet the leaders of the Portsmouth, Fareham and Gosport and South Eastern Hampshire Clinical Commissioning Groups, social services for Portsmouth City Council and Hampshire County Council, Ursula Ward, chief executive of the trust that runs QA, and community provider Southern Health NHS Foundation Trust.

The meeting is due to take place on September 5.

Mr Hoban said: ‘It’s clear to say this is a system-wide problem. It’s about what’s going on in GP practices, about social care and about community healthcare.

‘But that doesn’t absolve responsibilty for QA not meeting targets.

‘It’s disappointing things haven’t improved despite different initiatives, but it shows the scale of the challenge that lies ahead.

‘Until we have that meeting, we won’t know what the answer is.’