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18.12.14

Overwhelmed hospital trust declares ‘major incident’ and says ‘system is broken’

Hospitals in Gloucestershire declared a “major incident” this week when they were unable to find beds for 51 patients due to being over-capacity.

On Monday there were no beds to spare in Gloucestershire Royal Hospital or Cheltenham General Hospital, forcing chief executive of Gloucestershire Hospitals NHS Foundation Trust, Dr Frank Harsent, to take the drastic action.

The shortage was revealed during a crisis meeting between healthcare providers across Gloucestershire. They met to discuss the problem of patients admitted to the hospitals who could not be discharged because of the lack of suitable alternatives.

Dr Harsent publically criticised the county’s healthcare system for letting patients down. But, at the meeting of the county council's Health and Care Scrutiny Committee, councillors criticised Dr Harsent for airing his concerns through the media and criticised a breakdown in communication between partner agencies.

Dr Harsent defended his remarks. According to the Gloucester Citizen, he told the meeting: "If the system isn't broken, why did I have to declare a major incident for the first time in 20 years in the job? I have never had to do that before.

"We managed to get hold of agency staff and we made room to cope with it, but there was still a large number of people in A&E who needed beds. The reality is that we need to move away from people feeling angry and disappointed and instead recognise that the system is not working. There is a danger here that we are in denial."

The trust's chairman, Professor Clair Chilvers, said medically fit patients are not being discharged quickly enough from hospital. She was quoted by the Gloucester Citizen as saying: “We had gone through all the talking that we could and all the meetings. We can argue about whether to use the term broken but the system is not working and the evidence is that we had to call an emergency yesterday,” she said. "It is a problem. Things have changed. There is much greater demand. We have got to work better together to solve the problems.

"We want to give the best service we can. To do that the whole system has to work better together to ensure that happens so that we don't have the crisis that we have had in the last couple of days. But with current demand I wouldn't bet money on it not happening again."

Gloucestershire CCG chairman, Dr Helen Miller said: “The health and care community has a collective responsibility to work positively together in the interests of the patient. Entering into a blame game serves the interests of no-one.”

She outlined the steps being taken to reduce delays in patients leaving hospital, provide more care in the patient’s own home and improve the patient experience. 

These include:

  • Reviewing the timing of ward rounds by senior staff – including earlier in the day and at weekends
  • Additional investment in the Integrated Discharge Team. The team of nurses and social workers make sure everything is in place for patients to leave hospital in a safe and timely way
  • Investment in a short stay ward for patients who require a 24-48 hour hospital stay
  • Developing the Older People’s Assessment and Liaison service – reducing the need for admission to hospital
  • Working to ensure maximum bed availability at Community Hospitals, including Stroud, through the recruitment of nursing staff and a revised discharge policy
  • Investment of £3.9m in Integrated Community Teams – providing intensive support to patients in their own homes
  • Working with the Ambulance Service so more patients can receive care at home or in the community – including expert advice from GPs, mental health professionals and specialist community teams.

She added: "We will continue to monitor this closely with our partners, recognising that every patient deserves to receive timely care in the most appropriate place to meet their ongoing needs.”  

The major incident is just one more worrying sign of an NHS stretched too thin and unable to cope with demand. Earlier this week NHE reported that West Midlands Ambulance Trust and A&E units were struggling to cope as the ambulance trust deal with the fourth busiest day in its history, receiving nearly 150 calls an hour. Last Thursday Heartlands Hospital in Birmingham had to put patients on trolleys in corridors as they didn’t have enough beds, while on Friday morning Walsall Manor Hospital reported being completely full.

Former health minister Liam Byrne said health chiefs face an “NHS emergency” in Birmingham then the latest statistics revealed the cities hospitals are using 96% of available beds.

Last month Morriston hospital in Swansea became so busy that at one point 11 ambulances, each containing a patient, were forced to wait for up to three hours outside the A&E unit because there were too few beds available.

(Image: c. Tim Ireland/PA Wire)

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