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Struggling Lincolnshire trust to continue overnight closure at A&E unit

A struggling trust in Lincolnshire has announced that it has been forced to continue the overnight closure of the A&E unit at one of its hospitals.

Back in August 2016, hospital leaders made the decision to temporarily change the opening hours at Grantham and District Hospital to serve patients between 9am and 6.30pm, which was extended to 8am to 6.30pm in March this year. This will be reviewed again in three months’ time.

Though the hospital has said that the reduction in opening hours has allowed doctors to provide better and safer patient care, the trust which looks after the hospital, United Lincolnshire Hospitals NHS FT (ULHT), slipped back into special measures in April.

Trust leads have said the reason for the continuing overnight closure at the hospital is due to the national shortage in A&E doctors, adding that the hospital was increasingly forced to rely on agency doctors to fill gaps, something NHS Improvement CEO Jim Mackey has recently encouraged trusts to try and avoid.

“When the decision was taken last August to reduce the opening hours of Grantham A&E, a threshold of a minimum of 21 middle grade doctors is required to safely staff the three A&E departments at Lincoln, Pilgrim and Grantham,” said Dr Neill Hepburn, medical director at ULHT. “Even if we had 21 doctors, this is still below our ideal number of 28.”

And despite recent recruitment drives at the hospital, which have seen a gradual improvement to medical staffing levels, Dr Hepburn added that Grantham was currently at 18.6, and had not reached the minimum threshold to be able to open 24/7.

“The provision of emergency services, particularly at Lincoln County Hospital, continues to remain fragile and requires the support of A&E medical staff, from Grantham District Hospital, on grounds of patient safety,” he continued.

On top of that, the change to the taxation rules has also had an additional deleterious and previously unforeseen effect on A&E staffing, Dr Hepburn also explained.

“We understand the frustrations and concerns of Grantham people and that they want A&E to be open 24/7 but we will only do this once we can safely staff all our A&Es at least eight weeks into the future,” he concluded. “We are fully committed to opening A&E but only when it is safe to do so.”

A statement from the hospital also added that the trust had improved on its average number of substantive middle grade doctors based at Lincoln, going up from 2.6 in August up to 4.6 now, with one more expected to join in September.

It has also said that in order to attract more doctors at this level, the trust is offering ‘certificate of eligibility for specialist registration’ training posts with a financial incentive – giving the applicant the opportunity to work on secondments to become an emergency medicine consultant.

And before the next board review of Grantham opening hours in November, ULHT said it will work with CCGs to explore an interim service model for 24-hour emergency/out of hours service.

The overnight closure at Grantham has been challenged in the past, as a patient group launched a legal case against the change back in September last year.

Top Image: ULHT

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