Agenda item

This report was requested by Members to update them on the impact of pressures of Accident and Emergency (A&E) at Medway Maritime Hospital.  The Chief Executive of Medway NHS Foundation Trust and Clinical Director for A&E will attend the meeting.

Discussion:

The Chief Executive, Medway NHS Foundation Trust introduced his report relating to Accident and Emergency (A&E) pressures and informed the Committee that Medway Maritime Hospital’s A&E department sees 90,000 patients every year, a third of whom arrive by ambulance.  In this regard the hospital was the busiest in Kent.

Members were informed that since early this year the Trust had been unable to meet its 95% target of waiting for treatment and the pressure appeared to be continuing through the summer.  There was also a rise in the acuity of presenting patients and a change in pattern in that more people seemed to be arriving later in the evening.  Flow through A&E had also been an ongoing problem.  It was clear that the A&E department had not been designed for the volume that was now coming into it and staff were struggling to work in a confined space.  Work had been started on plans to release some of congestion but some of these were temporary measures – a longer term redesign was also underway.

The Clinical Director, A&E from Medway Maritime Hospital explained some of the staffing changes, which had taken place and stated that the hospital did try to signpost people to other services where that was appropriate but many preferred to attend the hospital.  Visits had taken place to other A&E departments to ascertain good practice. 

The Committee were informed that a new Senior Treatment Access Route had been devised which had been helpful and in response to questions regarding cleanliness of toilets and other public areas in the hospital it was confirmed that these were also being addressed and a gradual refurbishment section by section had commenced.

A question was asked about how the hospital were keeping patients informed about the changes and challenges and it was confirmed that the public had been invited to a meeting last month on the topic and feedback on patient experience was valued.

Following further questioning the Chief Executive explained the staff rotas of consultants in A&E and stated that although, as in most hospitals,  it was not possible to provide a consultant in A&E 24 hours of every day that there would always be one on call.  The consultants were present from 8am until midnight during the week and from 9am to 5pm at weekends.  He also stated that diagnostic services were available 24 hours a day for urgent tests.  In relation to the start and finish time of the 4 hour target this commenced at the point of the person being seen by the navigation staff and ended when the patient left the hospital. 

As far as referrals from A&E were concerned it was stated that 7,500 visit the department each month of whom 18% go to MEDDOC, a quarter are admitted to hospital, the remainder are discharged.  It was also stated that at present Medway is achieving 88% against the target of 95%, which was acknowledged to be below an acceptable standard at near to the bottom of  performance nationally.

Tribute was paid to the nursing staff at the hospital and in response to a question about how the Committee could be of assistance, the Chief Executive requested Members’ help in alerting the public to the need for disruption and diversions while refurbishments were ongoing.

Discussion then took place around the distractions of having outpatients clinics in A&E and the fact that sometimes when the nurse calls patients to be seen they can not be heard.  The Clinical Director explained that the reason the nurse comes into the waiting room to call for a patient was to ensure they were able to detect any deterioration in patients rather than remaining in a room and calling names using a tannoy.

A question around the possible impact of Fair Access to Care was asked but it was stated that the hospital are not privy to the background of older people presenting at the hospital so would not be able to answer as to whether this could be because they were not eligible for support from adult social care.

Decision:

The Chief Executive and Clinical Director, A&E, from Medway NHS Foundation Trust were thanked for attending the meeting.