Staffing and discharge crisis piling “extreme” pressure on hospitals as winter looms
There 924 trolley waits of more than 12 hours reported at York and Scarborough's emergency departments
The trust which runs York Hospital remains under “extreme” pressure, with short staffing and the inability to discharge patients into the community the biggest concerns as winter looms.
Nearly a third of ambulance handovers to the York and Scarborough emergency departments took more than an hour in August, while 924 trolley waits of more than 12 hours were reported.
Trolley waits – the time between when a doctor decides that a patient needs to be admitted to hospital for further treatment and when the patient is actually admitted – were almost unheard of before the pandemic at this length.
At a board meeting of the York and Scarborough Teaching Hospitals NHS Foundation Trust on Wednesday, interim chief operating officer Melanie Liley explained that 30 beds at York Hospital were closing so the “fundamentals of care” could be delivered with the level of staffing available.
This was a requirement after the Care Quality Commission (CQC) raised concerns about the standard of care earlier this year.
Another inspection is expected before Christmas, but hospital board papers noted that staff’s “continued whistleblowing and enquiries do not instil confidence with the external regulator and may instigate a wider inspection”.
Eight whistleblowing concerns raised by staff this year – primarily about staffing at York Hospital – have been upheld by the trust itself.
But chair of the trust Alan Downey said improvements were being made.
“It does feel to me as if we’re seeing a significant measurable shift in some of the things that we needed to shift in order to convince the CQC that we’re making progress,” he said.
Regarding the flow of patients through the hospital, the meeting heard that York now had a 24/7 emergency assessment unit and that Yorkshire Ambulance Service had agreed to station paramedics inside the hospital to try to stop the buildup of ambulance queues while patients wait to be admitted.
Ms Liley said working with City of York Council and North Yorkshire County Council to find ongoing care for people who no longer need to be in hospital was still proving challenging.
The trust is even considering setting up its own domiciliary care service to look after people once they have left hospital.
Hospital chief executive Simon Morritt said the scale of delayed discharges was “huge”, with 120 people waiting to leave York Hospital.
Mr Morritt explained that the trust could hope to get £5m of the £500m announced by health secretary Therese Coffey last week to fund discharges for medically fit patients.
Chief nurse Heather McNair explained that shortages with nurses was one of the biggest staffing issues, with more than 100 vacancies. She said the prospect of full nurse staffing – boosted by international recruitment – was still a year away.
The latest futures shows the trust spent £20m in a year on agency staff – making it among the highest spenders on temporary staff in the region.
However, the trust has had success in recruiting healthcare assistants and patient service operatives in recent months.