UPDATED – Into the unknown – GWH prepares for winter

UPDATED: Great Western Hospital’s board was told this week about preparations being made by its staff to cope with the pressures that are bound to hit them this winter.  This planning started back in April.

 

Now sooner had this article been completed than the Department of Health & Social Care announced an extra £145million for hospitals’ preparations for winter – that may be about £1million a hospital. The Department says this will cover 900 extra beds across England and “upgrades to A&E departments”.  Questions have already been raised about where the extra staffing will come from.  It could mean a bumper winter for the agencies who provide temporary staff.

The Winter Scheme, overseen by Chief Operating Officer Jim O’Connell, faces two great unknowns.  How serious will any flu epidemic be and will the government give them any extra funding to help alleviate winter pressures.

Purely anecdotal evidence from Australia’s winter has it that this time around the flu virus will not cause such serious illness as last year’s did.  But a different virus might come our way.  And the money?  In 2017, just before Christmas, GWH got a last minute award of about £1.4million to help them through the winter.

Each of the GWH plan’s Key Action has named staff leading on it and putting it into operation.  Amidst a huge array of actions two stand out:  finding and staffing extra beds, and maintaining the flow of patients through the hospital.

 

On the first they are targeting about 40 extra beds in the community and about 30 more within the hospital.  Of the latter they have identified 20 and more work is needed to find how to achieve the other ten.

Last winter GWH was helped significantly by being able to use 26 additional care home beds in the community.  So far the Swindon Clinical Commissioning Group (CCG) has found 24 – and they hope the Wiltshire CCG will come up with the other 16.

Keeping the flow of patients going has been top of the agenda for many months as GWH’s emergency department (ED – otherwise known as A&E) has faced increasing pressures. During the very hot and very sunny July the numbers coming to ED were 1,500 higher than in July 2017. 

One of the main initiatives already in play and which will be intensified during the winter months, concerns the ‘MFFD’ count.  We’ve had ‘bed blockers’ (a silly term as it was generally not their fault), DTOCs (delayed transfers of care), and now we have Medically Fit for Discharge from hospital – or MFFDs.

The target is to keep the rate at which those who are MFFD free up their hospital beds as high as possible.  And they are seeking funding to enable the GWH integrated discharge unit to work over weekends and bank holidays.

GWH’s winter planning was praised by Non-executive Director Peter Hill, who was formerly Chief Executive of Salisbury Hospital, as being a practical scheme that was obviously being put into operation: “It’s a great piece of work. As you can imagine, I’ve seen a lot of these – some are just words on the page.   This is has good engagement internally and externally.” 

There’s one preparation all eligible and potential GWH patients can take – get the flu jab.  As yet local surgeries have not started to get their deliveries of the vaccine.

OTHER NEWS:  Dementia -  GWH now has 134 trained Dementia Champions.  And they have funding for a 2-year pilot project with two Dementia Specialist Nurses – both have been appointed and start next month.  This is important as at times 60 per cent of in-patients have some degree of dementia.

The Care Quality Commission’s latest inspection took place last month (14-16 August) and their inspectors could make unannounced visits to any GWH service until the end of September. 

 

Carillion fall out:  the collapse of Carillion which provided GWH’s cleaning and other essential services, and replacing them with Serco, cost GWH £191,000 in legal costs, executive time, etc.  This has been repaid by The Hospital Company which holds GWH’s private finance initiative (PFI) contract – under which GWH was built and is maintained and serviced. 

SafeCare technology which shows in real time how safe staffing numbers and mix of nursing levels change with the seriousness of the conditions (acuity) of a ward’s patients.  This is being heralded as a very useful tool to ensure patient safety.

One slight problem is that nurses need to carry mobile phone-sized digital tablets to enter changes in symptoms etc.   And some patients complain that these nurses are on their private mobiles all the time when they should be nursing!

Measles:  Meanwhile, with students about to go to universities and colleges – many for the first time – Wiltshire CCG is urging them to get their MMR jab if they have not already had it.  Cases of measles (which can be very dangerous) are increasing – and communal living often favours the spread of measles.