Could 20 year old prediction on Norfolk’s health service come true, as NHS may face worst winter in recent history?
PUBLISHED: 11:02 05 September 2017 | UPDATED: 16:04 05 September 2017
It was 20 years ago a leading health researcher made a gloomy prophecy about the future of Norfolk’s busiest hospital.
Today, fears were raised that those visions of bed shortages and patient crisis could come true amid warnings the NHS may be facing its worst winter in recent history.
In 1997 Professor Allyson Pollock, who at the time worked at St George’s Hospital in London, was commissioned by the British Medical Association to study Private Finance Initiative hospital programmes nationwide.
At the time, looking at the Norfolk and Norwich University Hospital (NNUH) she said: “I wouldn’t like to be a pensioner in the winter in the Norwich of the future.”
Now director of the Institute of Health and Society at Newcastle University, Prof Pollock said she was not surprised NNUH had one of the highest average bed occupancy rates in the country last winter.
But she said her concerns would not be heeded even today, due to government policies. She said she was not listened to at the time because “the government were desperate to keep all public expenditure off the balance sheets,” a situation she felt was mirrored now.
However, a spokesman for NNUH said things had changed over two decades.
He added: “Good care in a modern hospital means being seen and diagnosed swiftly, often in an ambulatory clinic before going home again the same day” and that the hospital had seen admissions drop from 32pc to 25pc.
“Sometimes patients do need to be admitted and short stays where there is timely decision making and treatment are more beneficial to patients than longer stays. These changes, together with a focus on safely discharging patients with the right support from all the agencies is reducing our bed usage.”
It comes as health chiefs across Norfolk and Waveney have united in support of the cash boost called for by the trade association that represents hospital, mental health, community and ambulance service trusts in England.
NHS Providers called for an emergency cash injection of between £200 and £350 million to enable the NHS to manage patient safety risk in the winter months.
The organisation said failure to make the investment will lead to longer waiting times and will also put the safety of patients at risk.
Graham Wilde, chief operating officer at James Paget University Hospital in Gorleston, said: “Any funding to assist with the anticipated additional winter demand would be welcome.
“Patients in need of urgent and emergency care will receive the treatment they need, when they need it. However, increased pressures can mean those in less urgent need of care may experience longer waiting times as priority is given to those patients with the most pressing health needs.”
Jon Green, chief executive at the Queen Elizabeth Hospital, in King’s Lynn, said: “Additional funding to support patient care and hospitals during the often difficult winter months is of course always welcome. However, alongside our partners in West Norfolk CCG and backed by our regulators, we are developing robust plans across health and social care to support delivery during the winter months.”
An NNUH spokesman said additional funding was always welcomed, but new measures and workforce planning meant they were “in a good position to manage demand effectively throughout the winter”.
He added: “As a trust, our approach is to have year-round resilience and throughout the year we have been working to improve efficiencies, reduce delays and place downward pressure on emergency admissions by developing enhanced ambulatory facilities.”
For providers such as Norfolk Community Health and Care NHS Trust (NCHC), who provide many services in patients’ homes, plans include having access to 4x4 vehicles in poor weather.
A spokesman added: “NCHC has winter plans in place to keep our own services going during the cold season; we also have a joint plan with health colleagues to work together across Norfolk to provide support at home and speed up discharge processes. Wherever we can we want to prevent the need for admission to hospital and our community nurses treat people in their own homes, helping reduce admission rates.
“NCHC has winter plans in place to keep our own services going during the cold season; we also have a joint plan with health colleagues to work together across Norfolk to provide support at home and speed up discharge processes.”
And a Norfolk County Council spokesman added: “NCC Adult Social Care has really robust processes in place to work with health colleagues over the winter. We have put in place a number of arrangements to speed up discharge, with a focus on helping people to get back home wherever possible and we plan carefully for winter.”
The region’s mental health trust said planning was also underway to react to seasonal pressures, as they would also see an increase in admissions.
Debbie White, Norfolk and Suffolk NHS Foundation Trust (NSFT) director of operations in Norfolk said: “Increasingly, as other agencies are under pressure, we are seeing more delayed transfers of care – people who are well enough to be discharged from our beds, but require ongoing support from other agencies, such as social care, housing or sheltered accommodation.
“Initiatives that will help to ease winter pressures include our Flexible Assertive Community Treatment (FACT) model which has enabled us to support people who appear to be heading into crisis in the community. “
NHS Providers found the level of planning and support for this winter is considerably more developed than last year and emergency care performance has been given greater priority. But improvements are being outweighed by a combination of increasing risks.
It said trusts were not benefiting from the extra social care investment. And demand for emergency care is continuing its “inexorable rise”, key staff shortages are growing, and primary and social care capacity, as a whole, remains “very challenged”. NHS Providers also said trusts are under greater financial pressure than last year and therefore less able to afford the extra capacity they urgently need.
What happened last year?
The region’s NHS again faced challenging circumstances last winter, against a backdrop of more and more people attending A&E at the Norfolk and Norwich University Hopsital (NNUH), James Paget University Hopsital (JPUH) and the Queen Elizabeth Hospital (QEH) every year.
NNUH had one of the highest average bed occupancy rates in the country last winter, at 99.6pc, according to NHS England.
And analysis by this newspaper found in December last year record numbers of patients were stuck in the hospital, despite being ready to leave, in what is known as bed blocking.
Data from NHS England also showed JPUH, in Gorleston, was in the top ten for Norovirus bed closure rates.
In the meantime in 2016/17 there was a 30.7pc increase in delays in transferring patients from ambulances to emergency departments – the equivalent of 71,000 ambulances hours lost.
Why is winter so busy for our NHS?
It is the busiest time of the year for our NHS, as temperatures drop - and illnesses such as the flu take hold - many more people find themselves needing medical care than at other times of the year.
One of the main reasons for this is our aging population, as the frail and vulnerable tend to be worse affected by the changing weather and take longer to recover when they do get ill. However, coping with this increase is difficult for the health service when faced with general rising demand, workforce shortages, and financial pressures.
Challenges in primary and social care also cause problems. People may not be able to see their doctor so get more sick, so they eventually need hospital care. Or due to no appointments being available they may go to A&E as a first option. There are also instances of delayed transfers of care, where a patient is ready to leave hospital but cannot due to hold ups in social care.