Below is a letter that was sent to me last week. In it, Averil Dongworth, the Chief Executive of Barking, Havering and Redbridge University Hospitals NHS Trust says that information regarding temporary closure of Queens and King George Hospitals to ambulances will not be published on the Trust website as it might confuse people. This argument is dubious, if A&E temporary closures were always published a month in arrears it seems difficult that: (a) a sick person is going to look this statistic up and: (b) it would stop them going to Queens/ KGH even if they did.
The public elect MPs and cllrs to monitor the performance of public services. How can people judge if King George A&E can be closed safely if this key information is withheld? Text of letter follows
Interim Chair: Mr George Wood
Chief Executive: Averil Dongworth
Chief Executive’s Office
Rom Valley Way
DDI: 01708 435444
22 December 2011
To: Members of the Scrutiny Committees and
Health and Wellbeing Boards for Outer North East London
Re: Emergency department performance
I wanted to update you on the pressure on the hospitals’ emergency departments,
particularly during December and ahead of January, often the busiest time of the year for
A&E and with greatest pressure on the availability of hospital beds.
We now publish full performance information on the BHRUT website on a monthly basis.
This can be viewed through the link: http://www.bhrhospitals.nhs.uk/aboutus/plans.php.
(There is a month’s time lag before the information can be collated, centrally validated and
displayed.) I am concerned that there are still too many occasions of delay, both in releasing
ambulances and in admitting patients through the Emergency department.
The Trust is committed to reducing ambulance delays and delays in treating or admitting
patients within four hours. With regard to ambulance delays, we have improved performance
in recent months by implementing new processes within the Emergency department. These
include risk assessing every patient as soon as they arrive at the hospital, offering them rapid
treatment where they need this urgently.
Further work is needed, in particular, to help us cope with surges in the number of
ambulances at the hospital – at times we have to deal with up to 12 ambulances on site at
once. We are developing plans to increase our capacity both for ambulances and for
seriously ill emergency patients as a whole, so that we can make sure every patient receives
rapid treatment in the best setting. We are preparing a business case for capital works to
expand capacity in the Queen’s Emergency department.
We have received questions about the procedure for closure of the Emergency department
at times when it is too busy and I would like to clarify that the department never closes, and
would only do so if there was an immediate risk to patient safety, for example, from a fire.
However, there are occasions when our resuscitation bays are all occupied, and at this time,
we liaise with NHS London and the London Ambulance Service.
Following established protocols, a divert for blue light ambulances may be agreed for a
limited time, taking into account capacity at neighbouring units. This time period is usually
less than two hours and is kept under regular review. The most common divert is for patients
who would have been taken to Queen’s to be diverted to King George, but consideration is
given to all the surrounding hospitals, their facilities and capacity. During a divert, the hospital
is still open to walk in patients, and there may be circumstances where paramedics override
the divert on the basis of an individual patient’s needs.
We do not publish details of diverts on the Trust’s website, because they operate for such a
limited period and are often lifted early. Patients using blue light ambulances are the only
group affected, and publishing details could cause confusion for other patients who would
still be able to access emergency services.
I think it is important to acknowledge that we have not resolved all the issues that we face in
delays in the emergency department, patient flow throughout the hospitals, and in reducing
the number of people attending hospital who could have benefited from out-of-hospital care.
We are working with our commissioners and GPs to reduce these problems, which are also
supported by the NHS Operating Framework. This framework contains rules meaning
hospitals are paid only 30% of tariff for ‘excess’ A&E attendances and not paid for
readmissions within 30 days. This allows commissioners to invest in out-of-hospital care,
admission avoidance schemes and re-ablement schemes to prevent the need for hospital
A&E attendances and readmissions remain high and we are in regular dialogue with our
commissioners and GPs about the further work that is needed. Some recent developments
include a system where A&E staff have the support of GPs to book patients a GP
appointment, if this would be more appropriate for their care. NHS ONEL is also launching a
public information campaign about alternatives to hospital care, with high profile advertising,
leaflets and information distributed throughout the community from the start of January 2012.
I would like to assure you that staff across the Trust have been briefed about the importance
of reducing delays for patients at every stage of hospital care, so that beds are available for
patients who need admission from the Emergency Department and cubicles are then
available for patients as they arrive. I would be very happy to discuss this with Committee
members and provide a further update in the New Year.
cc Alwen Williams, NHS Outer North East London