Ref: TB5/56/12

Northern Heath and Social Care Trust

Subject: Nursing Workforce Update

Content: At the Trust Board meeting held on 24 November 2011, the
Director of Nursing advised of the review being undertaken on
the adequacy of nurse staffing levels. Mrs MacLeod provided
assurance on nurse staffing levels but advised of the reliance of
temporary, bank and agency staff and that posts required to be
filled on a permanent basis.

This review has now been completed across the acute
directorate and, as a result, the Trust has agreed to increase the
current staff establishment to achieve nurse to bed ratios of 1.3
in all acute surgical and medical wards.

The recruitment process has commenced to appoint 58.85 WTE
nursing posts (47.24 registered and 11.61 non registered).
Posts were advertised in the press on 17 January and it is
hoped that new appointments will commence by April 2012.

Author: Mrs Olive MacLeod
FOR NOTING

Patients waiting over 12 hours in A&E spend the equivalent of 282 days waiting inside A&E during the moth of January 2012

According to the most recent data released y the Northern Trust a total of 564 patients waited over 12 hours for treatment, admission or discharge from its Acute A&E’s at Antrim and Causeway hospitals. In total these patients spent a minimum of 6,768 hours waiting through the month of January, this is equal to 282 days.

Worst affected was Antrim A&E in where despite a reduction (332) in the amount of patients arriving at the A&E from January 2011, 446 patients waited over 12 hours, the equivalent of 223 days within the A&E department alone. The A&E at Antrim resembles an inpatient ward with meals being served to patients rather than an Accident & Emergency room.

Antrim:

• 1,559 patients waited 4-12 hours to be treated
• 446 patients waited 12 hours plus to be treated

Causeway:

• 550 patients waited 4-12 hours to be treated
• 118 patients waited over 12 hours to be treated

In the space of 4 weeks Save The Mid met; The Health Minister, CEO of the Northern Trust Sean Donaghy and Dr Brian Hunter from the Commissioning group, this circle has been travelled before but one the Health Minister sent the group upon due to his inability to look at fact based evidence provided to him proving that the current decision makers within the Northern Trust are the same people who have destroyed the Trust's medical capacity to deliver services to a population of 470,000 residents. It is time the Health Minister does what other Minsters within the Executive do and makes a decision, a decision that must immediately increase capacity within the Northern Trust.

If as residents we allow the Minister to think it is acceptable to wait in corridors, plastic seats and trolleys in Antrim it will not be long until he finds it acceptable for everyone around the country to wait in car parks, trolleys and porta-cabins in Belfast Hospitals after the removal of more life saving services in the Northern Trust.

Meeting with Save the Mid group

Braid Valley Training Centre 1 February, 11.00 am

 

Hugh McCloy and three members of the Save the Mid group, Sean Donaghy, CEO, NHSCT. In attendance Don Heaney, NHSCT

Group members stated that A&E at Antrim could not cope in the present circumstances and called for a return of A&E capability at Mid Ulster Hospital. Mr Donaghy reaffirmed the Trust position that this could not happen. Whilst accepting there were planning issues that impacted on the closures, decisions taken around A&E services at Mid Ulster and Whiteabbey were unavoidable in the interests of patient safety.

The issue of safety at Antrim currently was questioned. Mr Donaghy made the distinction between waiting for treatment and compromising safety. Antrim was not unique in its problems; he accepted, however, that improvement was needed. He added that the situation at Antrim continued to improve.  

Mr McCloy advised that the group had recently carried out a review of A&E patients at Antrim and said the responses were “absolutely disgraceful”. He added that the “stuff hitting the media was the tip of the iceberg”. Mr Donaghy did not accept these conclusions, citing the group’s position as a lobbyist. Mr McCloy acknowledged this and advised that the findings had been forwarded to the HSC Board as part of the Compton review.

Mr Donaghy went on to say that the Trust had plans in place and that he expected to see significant improvements by March this year. He accepted the point raised by Mr McCloy that this winter had been better than last year, but problems still persisted. Mr Donaghy responded that injuries due to weather were not the problem, rather there were higher numbers of older people and those with respiratory problems. He added that the core issue for A&E related to the numbers needing admission.

Mr Donaghy referred to the lack of space and the unsuitability of the area the unit had expanded in to over the years.

Mr McCloy questioned whether a “new A&E could handle things any better” in the light of future plans outlined in the Compton report. Mr Donaghy said he felt the report gave a good overview of the changes required but importantly it highlighted the need to look to local health economies to devise a service model, suitable to local need, subject to consultation.

Mr McCloy raised the issue of the future of the Mid Ulster hospital discussed at last Trust Board. He said it was clear that the Trust planned to rent space on the site to voluntary [sic] groups such as Citizens Advice Bureau and the Alzheimer’s Society. Mr Donaghy assured that the priority was to re-locate and centralise clinical teams working in the Magherafelt/ Cookstown area to Thomson House. He added that further renting additional space to groups working in the broader health and well-being arena would be considered appropriate.

Mr McCloy did not feel that was made clear and that people were confused; the impression had been given that space would be provided rent-free for these groups. Mr Donaghy assured that public resources could not be provided free. He said he would seek feedback from the meeting to help clear up any confusion. Concern was also raised that at the meeting reference was made to services for Magherafelt and did not include Cookstown or other towns in the area. Mr Donaghy assured that the base chosen for services did not prescribe the area served.

Mr McCloy referred to high numbers of people waiting more than 24 weeks for services provided at Mid Ulster. Mr Donaghy said that the Trust’s performance in planned care was equivalent to other trusts, and that the N Ireland waiting position had improved over time. There were acknowledged shortfalls in ENT and Dermatology capacity, with a short-term for improvement, and a longer term plan for investment in NHSCT services by the HSCB to increase capacity.

Mr McCloy raised the issue of what he felt to be shortcomings in the Deloitte report into emergency care published last year. He said there was a need for an extension to the minor injuries and out-of-hours services. Mr Donaghy pointed out that the report was commissioned by the Board and that he was not in a position to challenge it. He referred Mr McCloy to the HSC Board with any concerns.

Mr McCloy said he wished to take away something from the meeting regarding extending minor injuries hours of service and providing a service for under-5s. Mr Donaghy cautioned about challenging paediatric clinical advice. He also said that as part of future plans the Trust would envisage an expansion of GP out-of-hours to the Mid Ulster site. The Local Commissioning Group (LCG) would have a major input to the planning and development of future services and the Save the Mid group should refer to them.

Mr McCloy said that reducing services at Causeway Hospital would also have a bearing on services available to the mid Ulster area. Mr Donaghy acknowledged that there were specific issues

Northern Trust Acute A&E Failing Year On Year – Patients Waiting Over 12 hours for treatment in

Figures released by the DHSSPS Show:

·         Despite fewer attendance at Acute A&E’s within the Northern Trust more patients waited over 12 hours between 2010 & 2011, increase of 455 patients.

·         This quarter also seen a milder winter than 2010.

·         Patients who waited over 12 hours spent at least the equivalent of 405 days (over a year in terms of time) waiting in Antrim A&E between Oct-Dec 2011

·         Patients who waitned over 12 hours for treatment in Acute A&E in the Northern trust spent at least the equivalent of 554 days waiting to be treated between Oct-Dec 2011

Concerns for the future:

·         The pending Compton review will remove more acute services from the Northern Trust.

·         The extension for Antrim A&E will only be able to serve in the region of 70,000 patients; this will still not be big enough to serve its catchment area, even more so if services at the Causeway Hospital are reduced.

·         the extra 24 beds planned are technically already full

·         The performance of the ambulance service and turn over times at Antrim A&E are still going to be long

Despite the Health Minister know of the concerns in a meeting with Save The Mid on the 24th Jan 2012 he is still unwilling to look at the option of re-opening acute services at the Mid Ulster Hospital site, even as a interim measure to combat waiting times and help protect patients dignity, these ever failing performance are the worst recorded in history and despite claims that previous health ministers made mistakes Mr Poots is in charge now and these performance are under his watch.

Mid Ulster Hospital was closed based on health and safety concerns, how long will it take for Antrim to be recognised as an unsafe environment?

Raised at the meeting:

• Ambulance response times, under 50% of emergency calls answered below the Ministers Target of 8 minutes
• Tracker systems in ambulances leaving the Mid Ulster area devoid of ambulance cover for some time as Mid Ulster ambulances cannot get out of Antrim
  
• Waiting times at Antrim hospital including the short stay ward and clinical decision ward
• Chief consultant Oliva Dornan of the Northern Trust on her ability to manage the A&E and the fact that 2 consultants in the under staffed A&E are doing more administration work than medical work, this puts a strain on the remaining consultants to serve the A&E.
• The extension of the A&E at Antrim, it was recognised that this extension will still not be able to cope with the numbers that will have to go through it
• The extra 24 ward beds, it was recognised that these beds are already full up before they are built
• The intention of the Northern Trust to rent out the Mid Ulster Hospital to private charities, some being non-health related
• the 2006 risk assessment that stated the most dangerous decision health chiefs could of made was shut the Mid Ulster hospital in terms of maternity and A&E
• The ability for residents to now Trust the decision makers within the Northern Trust due to the mistakes made in the past
• The vast increase in patients waiting for out-patients waiting over 9 weeks for first appointment between 2010/11 (13,000%), in-patients and day case treatment waiting over 13 weeks for first appointment since 2010/11 (2,000%) and the danger of this leading to more people turning up at the A&E
  

Also at the meeting Save The Mid presented the Health Minister with a petition from Mid Ulster residents calling for the reinstatement of services at the Mid Ulster Hospital, in the region of 10,000 signatures were received by the Minister to show the scope and depth of feeling regarding the removal of the A&E and actue services. Along with this submitted before the meeting was 300 pages of research backing reopening services at Mid Ulster


While the Minister had no intention of restoring services at the Mid Ulster Hospital Save The Mid had before hand sent recommendations to the Health Minister, the same recommendations were also submitted to John Compton in the health review in 2011 that included:

• Opening ward two fro patients from Thompson house and overflow from Antrim Hospital
  
• Extension of opening times at the Minor Injury Unit in Mid Ulster

In the past the a report was launched to see if there was a need for extra Minor Injury opening hours, this report was inconsistent and not impartial as the Northern Trust were heavily involved in the conclusion not to give Mid Ulster extra opening hours and will now be revisited according to the Health Minister.

The Minister urged that MLA's and Save The Mid bring these issues to the Northern Trust, which beggar belief as to who is actually in control of our health system, it was said to the Minster with no reply that if it is acceptable to let patients wait on trolleys then why do we not shut down all the hospitals expect the Belfast ones and make people wait there. If it is not acceptable it is not acceptable and this must be corrected, it was also put to the Health Minster that he knew Chief consultant Oliva Dorna hid patients and ambulances were diverted from the Antrim Hospital when he visited it last year, in response the Health Minister said that there is a independent reviewer at the Antrim Hospital to monitor what is happening.


Save The Mid meet with Sean Donaghy CEO of the Northern Trust on the 1st February.