Surge in summer A&E demand at Royal Preston Hospital
Around 2,000 more people visited the accident and emergency department at the Royal Preston Hospital over the last two months compared to the same period two years ago, the Local Democracy Reporting Service understands.
In the nine weeks up to 25th July, attendances leapt by 21 percent when measured against the numbers arriving at the city‘s hospital in 2019, pre-pandemic. Last year’s figures are not comparable because of the anomaly caused by Covid of fewer people seeking non-virus-related urgent medical help.
It comes as a leading emergency medicine consultant at the hospital appealed for “support” from members of the public when they are deciding whether or not to attend its A&E – while stressing that they should not hesitate if they are in need of the service.
Dr. Andrew Curran was speaking after Lancashire Teaching Hospitals NHS Foundation Trust revealed that it was experiencing “unprecedented” demand at one point on Tuesday – with services remaining extremely busy since.
And if the dilemma faced by patients is how to determine the most appropriate place to seek medical help, the dilemma for doctors is to ensure that their message about how stretched they are is not misinterpreted by those who need their assistance most.
“We’ll get elderly people who have chest pain or have fallen and broken something, but not want to disturb us – and they are obviously the people that need to come in,” Dr. Curran explained.
“If you’re having say a stroke, the right place to be is the emergency department and you must phone 999. We want to protect those frontline services for the people that really need them.
“Whilst we are really busy, we are really busy with sick people that need to be here.
“All frontline services remain open for patients who require them. However, we’re asking for support from people who might be able to source alternative care – whether it’s self care, the local pharmacist, the NHS website or NHS 111.”
Dr. Curran admits that the range of routes into the healthcare system for people in need of medical help can be confusing – even for someone like him who works in the NHS. He says that can result in people falling back on “what they know”.
Last year, the health service rolled out a system advising people to think “111 first” if they were not facing a medical emergency. That can see them given a time slot to come to A&E or being directed to a more suitable source of help.
Dr. Curran says that the online decision-making tool on the NHS website can also be a useful way of deciding what steps to take for those who are not in urgent need of assistance, while the 111 phoneline is a good “first port of call” in non-emergencies – particularly for parents worried about a sick child.
“When you first phone up and give the symptoms, if there are ‘red flags’, then 111 is able to transfer you straight through to 999. The operators who take that call are able to look for some of those red flags, such as if your child is drowsy and difficult to wake or if they have a non-blanching rash one that does not disappear when pressed under a glass.”
The number of children attending A&E at the Royal Preston has risen by 76 percent so far in July compared to the same month in 2019.
It is understood that some of the increase is being driven by respiratory syncytial virus (RSV), a condition that is usually most prevalent in early autumn, but has this year put in an earlier appearance, along with some other common childhood complaints.
Meanwhile, what Dr. Curran describes as a “small minority” of patients who come through the doors at Preston’s A&E are failing to wear a mask – something which remains a requirement at all NHS facilities – and they are politely reminded of the need to cover their face.
“We have the advantage within a clinical setting of knowing people’s past medical history and helping them to understand who’s exempt and who’s not. When you’re wearing a mask, you’re not just protecting yourself, you’re protecting other people,” says Dr. Curran, who also urges people to get their vaccine to help protect themselves against the ongoing threat from Covid.
The medic says that those arriving at the emergency department are experiencing “a little bit of everything” – including chest pain, strokes and the effects of the hot weather.
“Now that people are out and about, major trauma is also back up again. When we were all sat at home, there really wasn’t much major trauma happening at all.
“People are presenting with chest pain, because they’re having more exertion – and it may well be that they aren’t as fit and they go back to exercise regimes.
“The hot weather doesn’t help – so think about being careful when you’re exercising and making sure that you stay well hydrated and check up on people in the community to make sure they are hydrated in the hotter summer months.”
Dr. Curran acknowledges that the days of quieter summers in emergency departments had long gone even before the pandemic struck, but says that this year has been particularly tough for staff – who are continuing work under the cloud of Covid.
“I was completely exhausted and washed out after recent shifts with the numbers of people coming through. As well as caring for all these people, we’re trying to maintain social distancing and manage the isolation of Covid patients.
“As the annual leave period comes up, people are needing to take it over the school holidays – and it’s important to get that break in before winter, because we do expect September onwards to be even busier again.
“I’m always reluctant to say I’ve never seen it as busy, because I know it’s going to get busier again.”
Visiting band remains in place
Most adult inpatient visiting at the Royal Preston and Chorley and South Ribble Hospital is still not being allowed as part of an ongoing precaution put in place last month as Covid cases surged.
Dr. Curran says he has received calls from people who are “very upset” that they cannot visit relatives in A&E or on the wards.
“We do make exceptions including for people at the end of their lives and those in the maternity department – and I would want to be with my loved one if they were in hospital. However, I also wouldn’t want to put them at risk.
“If your relative has a mobile phone, they can use that freely in the hospital – gone are the days of people being banned from using phones,” said Dr. Curran, adding that adding that extra healthcare assistants have been deployed to provide patients with the kind of support that may have been given during visits from relatives in more normal times.
Primary care pressures
Dr Lindsey Dickinson, chair and clinical lead of Chorley and South Ribble’s clinical commissioning group said that “more people than ever” were needing support from primary care services such as GPs.
“GP practices are open and have been providing services throughout the Covid-19 pandemic, both face to face and through methods such as telephone and video consultations – and this work continues.
“The majority of common conditions can be assessed and diagnosed by a member of the primary care team in this way and they are experienced and skilled in doing this. Using technology like this helps protect you, your family and loved ones – and GP practice staff from the potential risk of the virus. It will also support you in accessing services in a timely and convenient way.
“We ask everyone across Central Lancashire to continue to access the most appropriate service for their health needs, and for many people this support can also be accessed through services such as NHS 111 online and by calling NHS 111. Local pharmacies are also able to support people to stay well and provide information and a range of over-the-counter medicines,” Dr. Dickinson added, thanking people for their support during an “incredibly busy time”.