Life-threatening conditions and broken fingernails at Hinchingbrooke’s A&E department as staff struggle with rising admissions

PUBLISHED: 07:33 20 February 2017

Sophie Ives, operations manager for emergency medicine, Shaheen Hosany, emergency department matron , Menchie Lynn, site manager.

Sophie Ives, operations manager for emergency medicine, Shaheen Hosany, emergency department matron , Menchie Lynn, site manager.

Archant

Hinchingbrooke Hospital’s A&E department has dealt with an unprecedented level of admissions in recent weeks. Clinicians and the management team are fighting against a lack of beds, staff shortages, and a significant number of patients who could have been treated more appropriately elsewhere.

When the A&E department at Hinchingbrooke Hospital opened in 1983 it was set up to cater for an average of 20 admissions per day.

Currently, it is designed and staffed to care for 80 patients a day, but on February 6 this year, 145 people sought treatment, and on a single day last month that figure reached 150.

Many of these patients were displaying potentially life-threatening symptoms, some, however, had minor ailments and injuries that could easily have been treated by a GP or pharmacist and, in many cases, at home. Highly trained staff working under enormous pressure spent precious clinical time advising patients who were complaining of earache, sore throats and even a woman who had broken a false fingernail and needed it removing before she went on holiday.

The hospital’s chief operating officer, Phil Walmsley, said: “Our A&E department is a precious resource and we ask people to use it wisely to ensure it continues to work well for them. This means only coming when you need urgent medical assistance.”

Tracy Dowling, chief officer for the Cambridgeshire and Peterborough Clinical Commissioning Group (CCG), said: “We have continue to see high numbers of people at our local A&E departments. Some of these are patients who have minor injuries or illnesses that could have easily been treated at home, or used an alternative service such as NHS 111 or a pharmacist. Our message to local residents is clear. A&E is for emergencies and life-threatening conditions. If you are unsure where you should go, then call NHS 111 who will help you find the right service for your illness or injury. By using the right service you can help to ensure A&E is kept available for those who really need it.”

According to A&E treatment time targets, laid down by the NHS, 95 per cent of patients should be seen within four hours. Hinchingbrooke’s figures for the last three months show: 80.01 per cent for November; 71.8 per cent in December and 71.9 per cent for January; nationally, the average figure was 79 per cent.

Hinchingbrooke chief executive, Lance McCarthy, said: “There is no single fix for the this complex issue which has seen all our local hospitals struggle to care for patients in a timely way. We are working across the local health system to see how we can work collectively to shorten A&E waiting times.”

The Royal College of Emergency Medicine (RCEM) believes when the four-hour figure falls below 75 per cent, it signals a “significant level of overcrowding” and potentially “puts patients at risk”.

Hinchingbrooke is, however, not alone, A&E performance across the NHS hit a record low this winter. The RCEM says emergency departments are a “barometer of pressure” in the wider health and social care system and are calling for more funding for emergency and social care.

As whether he thought the Hinchingbrooke or the wider NHS emergency care has reached crisis point, Mr McCarthy added: “It is fair to say that acute organisations across the country are under similar pressures to manage emergency care. It would make a real difference if we could find a way to ensure services were used appropriately. However that means providing better community and social care support to help people avoid needing a urgent trip to hospital. This is not a quick fix, but we are working with our healthcare partners to look at improving access to care outside of hospital.”

In recent days health secretary, Jeremy Hunt, has described waiting times in some A&E departments as “completely unacceptable”.

“There is no doubt that change is needed on many fronts, but there is no silver bullet and we need the public’s help,” he told the BBC.

The health and social care system across Cambridgeshire is creaking under the weight of sheer numbers and questions have been raised about whether alternatives to A&E are adequate.

Healthwatch Cambridgeshire, which campaigns and challenges health care decisions on behalf of the public, told The Hunts Post: “The focus for the hospital and our local health commissioners needs to be on clear consistent messages to patients about the alternatives, so it is easier for them to make informed choices,” said the body’s chief executive Sandie Smith.

“It’s no good saying to people, go to the walk-in centre when the only one is in St Neots, or to go the minor injuries unit when these aren’t always open or offering a full range of services.”

In October last year, Healthwatch visited the A&E department at Hinchingbrooke and carried out two ‘enter and view’ visits. Although the numbers were small, volunteers discovered more than 40 per cent of people in the waiting area had not considered other treatment options before attending A&E.

“We are not suggesting any of these people were attending inappropriately, many of them were probably exactly where they needed to be, but they just didn’t check before they turned up and it is the checking that is the crucial bit. We also have to look at the wider health and social care system and ask what can be done to improve it for patients,” added Mrs Smith.

During one of the ‘enter and view’ visits, Healthwatch volunteers discovered there were no empty beds available in the hospital so patients could not be admitted to the wards. Two patients were waiting in ambulances, which meant the crews had to stay with them until a formal hand-over with a nurse could take place, preventing them from attending other patients.

Tracy Dowling, chief officer of the Cambrigeshire and Peterborough Clinical Commissioning Group, has said the Cambridgeshire and Peterborough Sustainability and Transformation Programme (STP) would help to address some of the issues.

“We are looking at ways to develop and improve our urgent care services that will support people to keep well and help community, GP, ambulance, mental health and hospital services to work more closely together. We need to meet health needs of our population, deliver good quality services and outcomes, and do so within the resources we have available.”

PHARMACY: A pharmacy can provide confidential, expert advice and treatment for a range of common illnesses and complaints without having to wait for a GP appointment.

NHS 111: This service has been introduced to make it easier for people to access NHS healthcare services. NHS 111 is available 24 hours a day, 365 days a year. Calls are free.

GP: Trained professionals who can advise you. This is particularly important if you suffer from an underlying health condition. Dealing with illness early can prevent trips to hospital.

WALK-IN CENTRES: For minor injuries and ailments.

INFO: For expert advice, visit: www.nhs.uk/staywell.

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