Winter is always a challenging time in the NHS. The amazing hard work and commitment of our 11,000 staff across our five hospitals means that we have continued to provide care despite the extra pressures, but this year is proving to be a real test, explains Janice Sigsworth.
On 1 January, one of our A&E departments had 130 ambulance attendances, compared with around 60 on a typical day. We have had to trigger our ‘full capacity’ protocol scores of times over the past couple of months.
I know it’s a similar story across the country. We have also had real pressure in providing critical care to post-operative patients as well as support to sick patients with respiratory conditions in our high dependency units.
Our ongoing urgent and emergency pathway improvements plus additional winter initiatives are helping us to cope with the unprecedented demand.
“Matrons, senior doctors, transport managers and others come together to make sure we identify and resolve potential problems as quickly as possible”
We have opened extra beds, increased ward rounds and expanded nurse and consultant staffing in our emergency departments.
We are providing an increasing number of urgent patients with same-day diagnostics and specialist review so that they can be assessed and treated without the need for A&E or hospital admission. We’ve also established closer working with social care and community health partners.
Operationally, we have cross-site situation report calls five times a day, reviewing emergency department activity, surgical admissions, bed capacity, staffing and discharges. Matrons, senior doctors, transport managers and others come together to make sure we identify and resolve potential problems as quickly as possible and look ahead to see what else we need to do.
Just after new year, NHS England recommended that all hospitals consider additional measures to ensure continued safe care. This involved reviewing all patients requiring surgery.
“Another big issue is making sure we have enough staff to look after our patients”
While time-critical operations, including cancer operations, and outpatient clinics are going ahead, we are postponing more non-urgent operations and procedures this month.
Decisions about which planned operations should be postponed are being made by senior clinicians, with as much notice to patients as possible. This is very distressing for patients and families and not something any of us want to do - but it has proved to be necessary.
We have also followed the recommendation to consider whether, under exceptional circumstances, we may need to admit a male patient to a female ward or vice versa.
The decision to do this would be made as a last resort, on a case-by-case basis, to ensure the safety and dignity of all of our patients. The decision would be made by senior clinicians.
Another big issue is making sure we have enough staff to look after our patients. Like many other trusts we have vacancies, and so our bank and agency nurses have really stepped up to try and fill the gaps.
Some nurses and midwives have also had to move to other wards and, on occasion, other sites to provide cover which brings its own pressures. The dedication of all our staff, and the extra hours and flexibility they have provided, has been critical.
I am grateful to all the team at Imperial College Healthcare for pulling together at this difficult time.
“Social care seems under even more pressure than the NHS, both primary care and community care are swamped”
We have yet to feel any major impact from flu but we are bracing ourselves for a potential increase in cases. We’ve almost doubled the proportion of our staff who have had the flu jab this year but there are many who haven’t taken up the opportunity to be vaccinated or who have said no.
That seems astonishing to me. The reasons are many - from “it will give me flu” to ”it doesn’t work” . More work for us to do on that, I think.
Winter brings extra pressures but increasing demand is an all-year-round issue now. We are seeing more patients, and sicker patients, which means more admissions to our wards.
We also have more patients who, once they have been treated, need extra support to be put in place before they can go home or to community-based care, which often causes a delay to discharge.
I have been reading and watching all the commentators on the state of the NHS over recent weeks and they are right to say something has to change. Social care seems under even more pressure than the NHS, both primary care and community care are swamped.
Greater productivity, efficiency and transformation is the medicine we all need to take apparently to make things better. I am not convinced that is the complete answer.
With people living longer, often with many health problems, the situation is only going to get worse. We cannot continue to rely on the goodwill and commitment of our staff who will simply become too exhausted.
A more radical review is needed.
Janice Sigsworth is the chief nurse of Imperial College Healthcare Trust in London