Nottingham University Hospitals CEO Anthony May’s People First report sets out the problems and planned solutions to difficulties at the trust.

Flow

200,000 patients come through the doors of our emergency department each year.
The proportion of patients handed over to the trust from our colleagues in the ambulance service within 15 minutes has declined form 70% (Oct 2019) to 40% (Jan 2023)
The average time patients spend in our emergency department has increased from 240 minutes (Oct 2019) to 300 minutes (Jan 2023)
The time patients spend in our emergency department has increased from 240 minutes (Oct 2019) to 430 minutes (Jan 2023)
The total average number of patients who are medically safe for discharge but still occupy a hospital bed has increased from 58 (April 2020) to 238 (Jan 2023)
The proportion of patients receiving their first cancer treatment within 62 days of being referred to our hospitals has declined from 80% (Oct 2019) to 61.3% (Nov 2022)

The report states:

‘The challenges facing emergency care within the NHS in the recent past have been well documented.

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‘The impact of this situation can be seen across all parts of the NHS.

‘The issues are complex, and it will require input from all parts of the health and care sector to create services that our local people deserve.

‘In the current year, national plans have asked ICSs to create plans that cover 10 key areas, such as supporting 999 services, improving primary and community health services, as well as improving hospital flow and discharge.

‘More recently, all emergency care systems in the NHS have been asked to reduce the time it takes for ambulances to hand over patients to hospitals to maintain safe emergency services.

‘We have been working within our ICS across Nottingham and Nottinghamshire to improve the local situation.

‘We have held several summits to bring together health and care partners to develop plans for improvement, including working with primary care in our Accident and Emergency (A&E) department, improving the volume of same-day emergency care and creating an integrated discharge hub to move patients promptly from the hospital when their medical treatment is complete.

‘We are also working with our partners in the ICS to ensure that the recently announced increases to social care funding can be applied to maximum benefit for our population.

‘Despite this work, the impact of an overly pressurised emergency care system can be seen throughout the organisation, with its impacts reaching far beyond our overcrowded emergency department.

‘The number of patients whose care is complete but are awaiting discharge is at unsustainably high levels and peaked this autumn in excess of 200 patients (the equivalent of eight hospital wards.

‘While the numbers of patients attending our emergency department are broadly similar to the levels seen before the pandemic, the length of time patients are staying within our hospitals is increasing, creating further bed pressures. This compromises our ability to run the A&E department efficiently, with longer times to admit patients, longer times to offload ambulances, increased pressure on staff, and reduced capacity for our planned services, which also have growing waiting lists.

‘Although we have increased our bed capacity and introduced successful approaches to same-day emergency care, patients who require longer stays in hospital are remaining within our beds for even longer.

‘From our patients’ perspective, they often face long waiting times before they are assessed (at the very time they are at their most anxious), and then wait a long time often in an overcrowded accident and emergency department before admission to our wards.

‘As a result, while our patients are waiting to be either assessed or moved onto a ward, they are not in the right environment, and we know that this is not the level of care or experience that our staff want to deliver.

‘We know that we need to continue to work as a system to ensure that patients access the treatment they need at the right time and at the right place to enable our accident and emergency department to be responsive.

We know achieving this will enable us to deliver timely planned care to our patients as well. We must remember that emergency care and planned care are intrinsically linked, and both must be working at their optimum potential to achieve the best service for our patients.

‘The need to address these issues has been highlighted by the NHS’s national planning guidance for the 2023/24 financial year.

‘Within it, there is a clear focus on the need to recover core services and productivity, such as improving both the ambulance response time and accident and emergency waiting times, as well as reducing the time patients wait for planned care, cancer care or diagnostic care. By focusing on flow through our hospitals, we know we can have an impact on all these issues, emphasising its importance in our plan for the next year and beyond.

‘At NUH we are creating an emergency care strategy based on three key streams of work, the acute front door, acute patient flow, and discharge.’

‘This will form part of a wider plan to improve emergency care alongside our partners in the ICS. We will deliver our part of the emergency care strategy and report through our normal performance management mechanisms. We will continue to develop our partnerships within the ICS, which has also made emergency care one of its priorities. Playing our part to ensure that the wider health and care system can deliver the improvements set out in the NHS planning guidance and meet the needs of emergency care patients. Nonetheless, the key to our success will be improving patient flow throughout our hospitals.’

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