Number of Covid patients in our local hospitals near first peak of pandemic
THERE are nearly 200 patients with Covid-19 at Derby and Burton’s hospitals, with officials fearing that figures will soon hit the height of the first wave of the pandemic.
In a University Hospitals of Derby and Burton NHS Foundation Trust meeting on Tuesday, leaders gave an update on widespread pressures affecting health services.
Dr Magnus Harrison, interim chief executive at the trust, said: “Operational pressures are significant and we are being hampered by the number of Covid positive patients we are currently treating, across UHDB. As a rough guide, we have got approximately eight wards of patients right now, 195 patients to date, who have tested positive for Covid.
“If we all remember back to wave one in 2020 of Covid, we had up to 243 patients. My concern is that before the end of July we will be approaching that number.
“Obviously this has knock-on effects for operational delivery. It is busy beyond what we would expect at this time of year. The usual summer hiatus I am not seeing, and I don’t think we are seeing system wide either.”
Alongside the pressure caused by Covid, which includes growing staff sickness absences, are high demand on A&E, ambulance handover delays, a large proportion of “bed blocking” with people medically fit to leave hospital not able to be discharged, and waiting list backlogs.
On one of these fronts there is a welcome relief. Before the pandemic it would have been unheard of for there to be a patient who had been waiting more than two years for surgery or treatment.
However, due to the pandemic, at its peak in January, 500 people had been waiting more than two years. The trust has now managed to whittle this down to nine patients, all of whom have been consulted and have specific reasons why they cannot have their surgery right away, including personal choice.
Dr Harrison said: “Teams from across the trust have worked incredibly hard to treat all those patients who have waited more than 104 weeks – two years of their lives.
“This has been difficult as the teams have needed to balance the needs of those who require emergency treatment, those whose condition has deteriorated quickly and couldn’t wait, and those who have waited the longest.
“I know many more patients have waited less than two years but more than 12 months, and our commitment to those patients is that we are coming to you soon.”
There were 5,820 patients waiting more than a year for treatment in May, trust papers detail. Just like with the two-year waits, having one or more patients on this list was incredibly rare before the pandemic, and had peaked at 10,000.
There was also welcome relief at the start of July for expectant parents wanting to have their babies at home, with the restart of the home birth service after it had been suspended throughout the pandemic.
In the trust board meeting, Dr Harrison made clear that the service has already experienced challenges, saying: “Obviously it is dependent on having the right staff available and we have had to pull the service three days (out of nine operational days) already due to staff sickness.”
The level of staff is a widespread issue, with the trust board hearing that there have been midwifery chal
lenges for 18 months and that, despite efforts to recruit, “there is a view that there probably isn’t a projected improvement in the next two, possibly three years in terms of getting to more normalised establishment numbers”.
Board papers detail that 60 per cent of the trust’s savings are to be made by cutting “pay costs”, making clear that this is related to reducing the use of agency staff, as opposed to recruiting permanent staff.
The trust says its headcount and pay costs have been “increasing year on year, however this is simply unaffordable and is one of several factors driving our underlying deficit as an organisation”. It aims to “break this trend and will work to bring our pay costs down to an affordable level”.
Amanda Rawlings, chief people officer at UHDB, said: “To support staffing challenges during the pandemic, we used agency staff to enhance our workforce. We are actively recruiting to substantive and bank roles to expand and grow our team, which in turn will help us to save money.
“Our staff are at the heart of UHDB and I thank them for everything they are doing to provide exceptional care to our patients.”
Trust board papers detail that one in 10 beds at the trust are occupied by patients who are medically fit for discharge – so-called bed blocking – due to delays in arranging social care support to enable them to leave hospital. In this week’s board meeting, leaders said this had increased to one in eight beds, with Dr Harrison saying: “This continues to hamper our ability to manage flow effectively across the urgent and emergency care pathway and creates challenges within the emergency department, which in turn impacts on ambulance handovers.”
Papers detail that Royal Derby Hospital, since January, has regularly had 120 patients – four wards’ worth – who are medically fit for discharge but remain in beds, meaning these slots cannot be used by incoming patients in need of urgent help.
The regular number of beds filled by patients medically fit for discharge is 60 – two wards’ worth.
Maura Teager, the trust’s lead governor, told the board that one woman had waited an extra three days in hospital because she needed a two-person ambulance to transport her back home.
She said: “That’s just one example and I know there are many more.” Dr Kathy McLean, trust chair, said this incident was “just unacceptable”.
Sharon Martin, executive chief operating officer at the trust, said there had been problems with community transport over the past couple of months “which is a reflection on the overall demand for transport”.
She said she was not aware of an increase in patients “self-discharging” due to long waits to leave hospital.
Meanwhile, the trust’s emergency departments are currently seeing 108 per cent of the usual number of adults coming to A&E, with 130 per cent of the usual rate at paediatrics. This is placing immense pressure on an already strained system and causing patients to wait much longer than usual.
For example, the average wait in Royal Derby Hospital’s
A&E in May was around nine hours, with national targets to see patients in need of admission within five hours. In May, 13.8 per cent of Royal Derby’s A&E patients were waiting for 12 hours.
The trust details that nearly half of A&E patients are “self presenting” – arriving themselves without prior contact – and the vast majority of these patients are treated at Derby’s urgent treatment centre instead. Some hospital trusts have had to issue statements this week that they can only accept serious life-threatening patients at A&E due to limited capacity.
Dr Harrison told the Derby Telegraph that this is not something that has happened at the trust, or that has been considered. He said having the urgent treatment centre on the same site as the Royal Derby Hospital had helped alleviate this. Dr McLean said “if anything, we take diversions from others”.
Dr Harrison said: “The urgent and emergency system continues to be under significant pressure both nationally and locally. “With our partners, we have a clear plan for improving our performance on reducing long waits in our emergency departments and minimising handover delays between ambulance and hospital staff. This plan included the same day emergency care service at UHDB being extended to weekends so the service is now 12 hours a day, seven days a week, which reduces the time of the initial assessment. “We have further plans to develop our medical workforce and establish a frailty assessment area for elderly patients, as well as maximising the use of the urgent treatment centre, now seeing 150 patients a day, which discharges more than 80 per cent of patients.”
It is busy beyond what we would expect at this time of year.
Dr Magnus Harrison