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Trust plans night time A&E closure after reaching 'crisis point'

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United Lincolnshire Hospitals NHS Trust has set out plans to temporarily close Grantham Hospital’s emergency department at night time, because of staff shortages and patient safety concerns.

The trust said the “situation is now unsustainable”, with services at “crisis point” and that patients could be put at risk “if we don’t act”. A decision on the proposals will be finalised in the coming days, it said.

“Closing A&E at Grantham overnight is the best way to ensure that services for our patients remain as safe as possible”

Allan Kitt

It said a “severe shortage of doctors” meant it did not have enough to fill shifts in three departments 24 hours a day, seven days a week.

The trust is proposing to cut night time hours at Grantham and District Hospital, the smallest of its three sites, but has ruled out cutting hours back at its other two larger sites.

The plans are yet to be finalised and the precise hours of closure would be the subject of further discussions if the closure plans were approved, a trust spokeswoman told Nursing Times’ sister title Health Service Journal.

In a statement, the trust said: “Our A&E staff are concerned that if we don’t act, patients could be put at risk if we continue as we are. To ensure that we run safe services, we have looked at a number of options. These include reducing the opening hours of our A&Es.

United Lincolnshire Hospital NHS Trust

Four wards closed after hospital fire

Grantham and District Hospital

“We have ruled out reducing the opening hours at Lincoln County Hospital and Pilgrim Hospital, Boston,” it said. “This is because they both take patients more seriously ill patients and have a higher number of patients attending A&E and being admitted than Grantham and District Hospital does.

“Our safest option for the people of Lincolnshire is to look at reducing the opening hours at Grantham A&E,” added the statement.

The trust’s emergency departments were staffed with 15 consultants and 28 registrar or middle grade doctors. But, at present, the trust said it was “down to 14 consultants, of whom 10 are locums, and just 12 middle grades. This means we have only 43% of the middle grades we need”.

“Placing an ever increasing workload on overstretched staff can create a vicious circle”

Clifford Mann

Allan Kitt, chief officer for South West Lincolnshire Clinical Commissioning Group, said: “Any temporary emergency closure is very concerning, whilst we are disappointed that we may be forced to take this action, we do believe that closing A&E at Grantham overnight is the best way to ensure that services for our patients remain as safe as possible.

“We will be working closely with the trust, local GPs and our community services to develop a range of services to ensure that those people who have less serious illnesses but might currently use A&E can get a service locally during the temporary closure,” he added.

The Royal College of Emergency Medicine described the move as “disappointing, yet unsurprising”.

College president Clifford Mann said: “The great efforts made by doctors and nurses to help patients in under-resourced locations sometimes is not sustainable.

CEM

Dr Clifford Mann

Clifford Mann

“As well as potentially putting patient safety at risk, placing an ever increasing workload on overstretched staff can create a vicious circle in retention and recruitment with many overworked trainees simply choosing to leave the country or indeed the specialty altogether,” he said in a statement.

“The wider picture is there is a real crisis in emergency medicine as our workforce numbers are not growing fast enough to keep pace with rising numbers of patients attending A&E departments,” he added.

Dr Mann was unveiled earlier this week as clinical lead for developing NHS England’s new accident and emergency improvement plan, which aims to redesign urgent care services and improve A&E performance.

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