Sunday 14 July 2024
16.8 C

Inside Nottingham’s A&E at Queen’s Medical Centre ahead of winter pressures

Queen’s Medical Centre agreed to access to the Emergency  Department on a busy midweek afternoon to show the scale of the problems facing the NHS in Nottinghamshire.

“Pressure like we’ve never seen before” is how one A&E consultant describes the situation on the ground at Nottingham Queen’s Medical Centre as winter approaches.

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There are hospital beds lining corridors, staff working under obvious pressure and emergency ambulance paramedics stood waiting with their patients until they can be accepted by the hospital.

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Doctors and nurses said until recently this situation would only be something seen in the middle of winter, when demand for healthcare always goes up. But now, they say, the packed corridors are the new normal.

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Consultant in paediatric emergency medicine Colin Gilhooley says the current situation in A&E is a “barometer” of the rest of the health service.

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Meanwhile, at the ‘back door’ of the hospital, 135 patients are medically fit to go home, but pressures in social care mean they have nowhere suitable to go to.

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The hospital trust says plans are in place to deal with the tough winter months – but staff and patients alike speak of a deep concern that the NHS is unable to cope.

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Nottingham’s A&E is one of the busiest in the country. Throughout October it saw 19,256 people, equating to roughly 687 a day. The department was originally built to look after just 350 a day.

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Nottingham University Hospitals Trust lets most ambulance patients straight into the building regardless of how busy A&E is – but paramedics must wait with the patients until they are officially ‘handed over’ and accepted by the hospital staff.

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Due to bed shortages, this means patients are often lining corridors, waiting for a bed on a ward.

Sixteen bed bay spaces are available for patients who have been seen in A&E and then need moving on to a ward – all of are them full on our Wednesday lunchtime visit. So normalised is the stacking system that the corridor patients have their own nurses and doctors.

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In October 2023, A&E at the QMC saw 19,256 patients, compared with 17,910 in October 2022.

Ben Holdaway, director of operations at East Midlands Ambulance Service, said paramedics have lost 1,500 hours of their time to hospital handover delays so far this month, meaning they cannot get back out on the road to respond to patients.

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Ben Holdaway

He said: “The pressure isn’t necessarily all here at the front door at ED, it’s enabling the patients to move through the hospital and out into the community in a timely fashion.

“It’s a worsening trend as we go through the year.

“We know we’re not responding to category two patients as fast as we would like and we’re very sorry for that.

“There is a lot of work going on to increase the number of staff we have available on ambulances to decrease the hours at hospitals.

“Patients want a fast response and when we can’t do that it’s disappointing for them.”

He added that the public should only attend A&E in a genuine emergency, and use other services such as urgent treatment centres and 111.

Caryn Beeley’s daughter Emily is one of those patients on a corridor bed. She has been waiting for 18 hours.

Ms Beeley, from Newark, works for the NHS.

She said: “She has been waiting for 18 hours and they don’t really know what’s wrong with her.

“She’s been sick for the last three days and can’t drink or eat anything.

“She was so dehydrated we had to bring her in.

“We’re just out in the open in the corridor. The chap next to us was examined with people walking past.

“They need more beds and more A&E staff.

“I think something needs to be done, but it needs to be across the board, not just at Nottingham.”

Consultant in paediatric emergency medicine Colin Gilhooley is one of the 500 members of staff working in A&E.

He said A&E is experiencing “pressure like we’ve never seen it before”.

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Colin Gilhooley

He said some staff have left the profession due to the pressures of the job.

He said: “Whether it’s the middle of the night or the afternoon, there are more patients than we’ve ever had with more complex conditions.

“It creates a huge moral injury for staff when they come to work knowing the care they want to provide just isn’t possible at the moment due to the crowding in the emergency department.

“Normally in years gone by we would see a reset once winter was finished where that pressure would reduce.

“Over the last few years, we’ve seen winter causing the pressures to be worse and then there’s no release after winter. It’s building and building year on year.

“I’ve seen the crowding situation just get worse and worse with each passing year.

“I’ve seen staff who were incredibly resilient, caring and compassionate getting into a situation they find increasingly hard to deal with.

“There’s a huge need for us to look at how we look after people in the community so they don’t get to the situation where they have to come to the emergency department.”

Innocent Muchemwa, Nurse in Charge at A&E, said there had been a “significant change” in the number of patients.

He said some patients arrive at A&E with a problem they have had for a year.

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Innocent Muchemwa, Nurse in Charge at A&E

He said: “The difficulty is providing the service that we would like to.

“The aim for us is to provide top quality care for the patients but that is being put under a lot of pressure due to the increasing number of patients coming in.

“It puts stress on staff including myself.

“Some of the patients we see in A&E could have called their GP, a pharmacy or 111 for advice.”

Meanwhile, at the ‘back door’ of the hospital, teams are working to discharge patients more quickly.

A new ‘discharge lounge’ opened in September 2023 – a 24/7 space with 20 beds and 20 chairs, aiming to discharge patients in one or two days.

They are currently able to discharge up to 40 patients a day.

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Jackie Odell, a Healthcare Assistant on the department, said: “The patients come down to us while they wait for their medicines or for family to come and pick them up.

“We give them tea, a hot dinner or a sandwich until they are able to leave.

“I think it’s making a difference because it is easing the bed space upstairs.

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Jackie Odell

“We’re very busy all the time.”

Patient Frances Bailey, 79, was waiting in the discharge lounge to go back to her Clifton home.

She had a stroke just over two weeks ago and was treated on a corridor before being moved onto a ward.

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Frances Bailey

She said: “There’s not enough beds, the staff couldn’t do any more.

“They’ve looked after me well on the discharge lounge. The staff are doing their best.”

Duane McLean, Acting Chief Operating Officer at the trust, said the trust has a “robust” winter plan.

He apologised to patients who were waiting in the corridors.

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Duane Mclean

He said: “Our emergency department is in a very overcrowded state with particular pressures for staff and long waits for patients.

“One of our key elements for winter is we have opened a new Same Day Emergency Care in QMC which aims to take some of our patients and see them and treat them quickly and get them home.

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“The aim is to avoid unnecessary admissions to our bed base.

“We’ve re-purposed some of our wards to focus on seasonal viruses.

“Every winter is a concern for NHS leaders and staff.”

The Department for Health has been contacted for further comment.

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