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GWH's blocked beds: Swindon Council's "immense" improvement - not so Wiltshire

As anyone who has had to go to A&E recently - or has watched BBC2's extraordinary HOSPITAL documentaries - will know, delays in getting patients out of hospital when they are fit enough are crucial to the safe and timely treatment for new patients.


A delayed transfer of care (DTOC in NHS parlance) in one part of GWH, can lead to unacceptable delays in A&E as patients wait for beds to be freed up.  GWH's board heard (May 3) that DTOC problems were being sorted out - and the number of lost bed days was being reduced.  Though many of the problems lie outside GWH's control - with Swindon Borough Council and Wiltshire Council.

The most frequent reasons for delayed transfers out of wards and out of hospital are the lack of empty reablement and recuperation beds in the community and the lack of care for patients in their homes - provided by local authority social services.

Chairing the board meeting, deputy chief executive Guy Rooney, said Swindon Borough Council's approach to the problem had "improved immensely". 

Chief Operating Office Jim O'Connell told the board: "Swindon local authority had done significant work into the causes of delays - especially reablement. It's really impressive - they've got their own house in order. We have a good partnership with them - working around our concerns with delays."

During March 2018 patients from Swindon at GWH were involved in 226 DTOC days - that's five per cent down on February and 34 per cent down on March 2017.

However, Mr O'Connell went on to say: "We've not the same level of response from Wiltshire." 

People resident in Wiltshire account for about a quarter of patients treated at GWH.  Mr O'Connell's report to the board stated: "There has been increased challenge for Wiltshire discharges in March, predominantly for those patients requiring ongoing NHS care or self funded packages of care at home - all of which could indicate a struggle with the availability of care at home across the county."

In March from Wiltshire being treated at GWH were involved with 320 DTOC days - an increase of 15 per cent on February and an increase of 24 per cent on March 2017. At least it was a reduction on the January DTOC figure for Wiltshire patients at GWH which nearly reached 500 lost days and was the highest for any month in the period since April 2015.

Mr O'Connell was asked whether this was a problem with systems.  Some of the problem, Mr O'Connell said, lies with Wiltshire Health and Care (WHC which has the contract for adult health care in the community) and some with social services. But to try and sort out the Wiltshire problem, GWH staff are doing 'more work at system level to work better with the local authority and with WHC'. 

Mr Rooney summed up saying simply that the DTOC problem was "Holding us back." 

In March 85 per cent of patients coming to GWH's emergency department were seen, admitted or discharged within four hours - against the national target of 95 per cent.

But then the department was built to see about 40,000 patients a year - and is now seeing about 85,000.  DTOC levels meant beds were not being freed up fast enough for patients needing to be admitted from the emergency department. 

In addition, bed occupancy in GWH wards in March was "...regularly over 100 per cent".  The safe level for occupancy is around 85 per cent.  It seems obvious that GWH is too small for Swindon's rapidly increasing population and for Wiltshire's rapidly ageing population.

Finances: 
GWH finished the financial year 2017-2018 with an overall deficit of £11,324,000 - against a forecast deficit of £4,960,000.  But it earned from NHS Improvement 'Sustainability and Transformation Funds' to reduce that deficit to a - provisional -figure of £7,770,000.

The management is having to reschedule some loans that are due for repayment.  And there could be a crunch point with their cash position in October.

The GWH Trust's auditors - KPMG - have carried out an exercise measuring GWH's financial position against their other Trust clients.  This showed that GWH was not in as bad position as they had thought - when the problems can get 'quite over-whelming': "It gave us a bit of comfort. We're definitely not alone."

The comparison found that GWH scored well on debtors, less well on creditors and their borrowing, which they had thought to be high, was lower the average.

Beds:

If you had ever thought running an NHS Foundation Trust Hospital like GWH was easy - think again.  A question to the board meeting centred on the hospital's new beds: what was happening to the old beds?  Here's the response:

"The beds have been purchased via a finance lease at an annual lease cost of £102k which will come from Trust capital programme.  Total cost of the beds if purchased from capital would have been £863k including VAT."

"The old beds are going to a variety of places- the supplier is taking the first tranche of 100 at a cost to us of £7.50 per bed, and we have a contractor removing 480 free of charge."

"We had hoped to sell at auction, but the market is flooded and the transport and storage costs proposed by the auctioneer would end up costing us more money."

"Note these beds do not comply with current safety standards, so cannot be sold onto the European market."



















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