The acting chief executive of Nottingham’s hospitals has described the immense pressure facing the organisation this winter as it attempts to recover from a damning inspection report.
Rupert Egginton said an extra 32,369 patients have attended the emergency department at the Queen’s Medical Centre over the last 12 months compared with the previous 12 months.
There are also more than 200 patients waiting to be discharged back into the community that are taking up beds for other patients, some with cancer.
He said “difficult clinical decisions” will need to be made as the Trust supports Covid patients, the increase in numbers accessing emergency care, and sorts out the backlog of patient care created during the pandemic.
Mr Egginton has written to Nottingham City Council’s Health and Adult Social Care Scrutiny Committee ahead of a meeting on Thursday, November 11.
The committee is due to scrutinise the progress made by the Trust following a damning report by inspectors the Care Quality Commission (CQC).
The CQC visited both Queen’s Medical Centre and the City Hospital earlier this year where they found a “culture of bullying” and inadequate leadership at the organisation.
The report described how some bullying cases at Nottingham University Hospitals Trust (NUH) were found to be “directly attributable to racial discrimination”.
The CQC has handed the trust 28 points to improve on, including addressing the bullying “across the organisation” and addressing “the disconnect between the board and the wider organisation”.
In a separate probe, maternity services at the trust are also being investigated by the CQC following a number of baby deaths and children born with brain injuries.
Calls were made in October for the medical director and chair of the trust to resign by Nottinghamshire County Council’s health scrutiny committee.
Cllr Sue Saddington (Cons), chair of the committee, said she will write to Health Secretary Sajid Javid to voice concerns over the Trust’s leadership.
Now, Nottingham City Council’s Health and Adult Social Care Scrutiny Committee will meet hospital bosses on Thursday, November 11.
The committee is asked to scrutinise the actions being taken in response
to the findings of the recent inspection.
The acting chief executive, Mr Egginton, has written to the committee in advance explaining some of the work that has been achieved.
He said: “In our conversations with clinical and supporting teams, the issue of greatest concern being raised is about having sufficient workforce numbers available to allow us to do our jobs to the best of our ability.
“I want to have a real focus on recruitment, retention and absence so that we can maximise the workforce available to us over the next few months as we know the pressures on our services are going to be high.”
He added: “By far the strongest reactions have been around cultures of bullying, racism and issues with inclusion.
“We have heard staff concerns and are absolutely determined to tackle these head on. We want to be really clear: bullying, racism and barriers to inclusion will not be tolerated in any form.”
He said the service had seen “unprecedented levels of emergency
patients for this time of the year.”
Emergency attendances were recorded at 126,965 between April to October this year compared to 94,596 the previous year.
Emergency admissions also rose from 29,249 patients to 34,499 over the same period.
“With the ongoing pandemic and the winter months ahead, we will need to be creative in how we manage our capacity and workforce to deliver the very best we can for our patients”, he added.
“I am conscious that high volumes of emergency patients can not only stretch our teams ability to deliver care to the standard that we all want, but also compromise the capacity we have available for patients awaiting diagnosis and care on our urgent and elective pathways.
“I am also well aware of the impact it is having on staff, physically and emotionally.
“Throughout the summer our hospital services have been operating under the kind of sustained pressure that we would normally only see in the most difficult winter periods.
“We face a combination of managing Covid patients, an increase in the numbers of people accessing emergency care, and managing the backlogs of planned patients created during the pandemic.
“This means that we have to make very difficult clinical decisions on a daily basis to prioritise patients into limited capacity.”
He said on an average day “we have between three and five wards full of patients who no longer need hospital care and are waiting a discharge.”
“This means these beds are then not available for emergency, cancer or elective patients,” he stressed.
“Whilst our target is to have no more than 37 inpatients waiting for discharge; we currently have 222 patients awaiting discharge on November 3.”
He said a number of measures are under way to solve the problem including looking to provide services to patients in their “normal setting” to avoid
emergency admissions to hospital.
There is also a discharge working group, to support the discharge of patients as soon as they are ready to leave the hospitals.
The CQC is set to return on January 28, 2022, to ensure the Trust has made enough progress on the concerns highlighted.