Beds crisis holds back good 2008 for hospital
It has been a turbulent year for health bosses in North Staffordshire, with mounting complaints over waiting times at A&E and ward closures because of a vomiting bug. But in other areas The University Hospital Of North Staffordshire has been making improvements. Health reporter Dave Blackhurst takes a look at the hospital's performance over the past year
THE seeds of the latest harrowing scenes at the emergency department of The University Hospital Of North Staffordshire were being set from the very start of 2008.
Even a cursory glance at the trust's performance reports that officials issue every month makes it obvious problems were being stoked up back then.
Sure enough, from September onwards, there has been a growing public outcry about marathon queues of desperately ill patients stuck on trolleys in corridors in A&E, waiting to be admitted to a scarce bed.
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But while the indicators in the reports reveal some things were veering out of control, they also show how other aspects of care have improved radically over the 12 months.
Levels of the hospital-acquired bugs, C-Diff and MRSA, have been slashed to record lows, waiting times for routine operations and cancer care have fallen dramatically to exceed national standards, and queues for specialist help for sexually transmitted diseases have been wiped out with the arrival of a new walk-in service.
Survival rates from cardiac operations are higher than average and deaths among old people who have broken their thighs have been halved in the past five years.
A major breakthrough has also been the transformation of delays for diagnosis of illnesses, with patients waiting weeks instead of years for investigations such as MRI scan hearing tests.
Even those caught up in the A&E jams have admitted that once they have reached the front of the queues, they have found the standard of treatment to be second to none at what is Britain's 13th biggest hospital. And next spring and summer, a new £60 million cancer and maternity unit will open on the City General site.
All that has not gone unnoticed by the Healthcare Commission, which improved the complex's annual ratings for quality of services from "fair" to "good", while its use of resources was deemed to be "fair" two years after that classification received a black mark of "weak".
Despite that, the trust's progress has been continually held back by the queues for emergency medicine, culminating in the resignation this month of senior official Val Doyle, who months earlier publicly staked her career on bringing improvements.
The biggest pointer to the crisis ahead came with rising number of delayed discharges – recovering patients whose treatment had ended but who could not be moved out of the hospital for a variety of reasons. They were left to block scarce beds badly needed by the new cases pouring in through the accident unit.
Throughout the year these have been running at many times at both the national average and the level tolerated by the commission.
So when another 130 beds were wiped out to new admissions by the norovirus outbreak a fortnight ago, it is no surprise the emergency care system teetered on the brink of meltdown.
Delayed discharges started the year at 8.8 per cent and, after easing slightly for several months, they shot up to record levels approaching 10 per cent in the late summer and autumn. Besides creating delays for patients desperately needing admission, the bottleneck meant hundreds of people had routine operations cancelled because the bed earmarked for their recovery was needed for an emergency case.
The performance reports show the rate of cancelled operations was running at more than double the Healthcare Commission's tolerated level throughout the year, with some of the inconvenienced patients not having the surgery re-scheduled within the 28-day deadline laid down by the Government.
The squeeze on the emergency system also meant the trust regularly fell short of the Whitehall directive that 98 per cent of everyone brought into the accident unit is treated and sent home or admitted to a bed within four hours of their arrival.
A health campaigner who challenges trust directors on the performance reports said despite the bleak picture on emergencies all year, there was still plenty to celebrate about other aspects of its care in 2008. Ian Syme, co-ordinator of Healthwatch, said: "The hospital is still reeling from losing 140 beds to pay its debts which built up three years ago. A community services programme to take up the slack lagged behind and a lot of initiatives to prevent what it is currently happening got put on hold. Some of those things are only now starting to be put in place.
"But the bed occupancy at the trust is 95 per cent compared with the 84 per cent national standard. It means there is no flexibility left in the system for contingencies like the norovirus or a surge of emergencies, and we have been hit by both of those things.
"In fact, the University Hospital is one of only four in the country with such high occupancy – and the other three have similarly-sized units nearby to call on.
"But the long delays for a bed are nothing new and the NHS is vastly improved on what it was a few years ago. There have been dramatic strides on the quality of the emergency care itself, reducing MRSA and C-Diff, shortening delays for tests to make a diagnosis and speeding up people's operations."
Trust chief executive Julia Bridgewater, pictured left, said: "This has been a challenging but successful year for the hospital.
"Over recent weeks we have seen an unprecedented demand on our services, and we are now in the middle of what is turning out to be one the most challenging winters we have faced.
"But our survival rates are some of the best in the country and we are reporting our lowest-ever infection rates. All of this is very important to maintaining public confidence in our hospital, and despite the pressure we have continued to provide excellent standards of care for our patients."