Swadlincote: "Serious uphill battle ahead to get hospital services back to where they need to be"

Derby and Burton hospital leaders say "small green shoots" are emerging after immense pressure pushed healthcare services to breaking point.

However, officials are clear that there is still a serious uphill battle ahead to get services back to where they need to be, before the pandemic-induced crisis.

There was also a warning against being overly optimistic about how long it will take to get services back to normal and de-escalating from full capacity or in excess of full capacity.

A University Hospitals of Derby and Burton NHS Foundation Trust meeting this week heard that significant workforce shortages are leaving maternity labour wards understaffed, presenting a heightened potential risk to mothers and babies.

Staff are exhausted, say trust officials, and there is only so much they can be asked to do to help cut waiting risks, with more employees needed to help plug the gaps – but this all takes time through training and recruitment.

However, the currently suspended homebirth service could be back up and running towards the end of April or in early May, it is hoped.

Meanwhile, while waiting lists filled with thousands of people who have been waiting more than a year for care are much lower than previously, it will still take potentially three years to quash.

In excess of 5,000 people have been waiting more than a year for care, while usually there would not be a single patient waiting that long – a key indicator of the severity of the task facing our healthcare services.

There are also more than 400 people who have been waiting more than two years for treatment – which is also unheard of before the pandemic.

The number of people being referred for potential cancer diagnosis has spiked significantly, which the trust welcomes, which is not resulting in more people being found to have cancer.

However, far fewer people are being diagnosed with cancer or given the all-clear within two weeks of an urgent GP referral.

Just 15 people out of 509 who were referred for an urgent breast cancer referral in December were seen within two weeks – three per cent.

Last year, when the trust assessed cancer referral pressures, it was giving one in every four potential cancer patients a diagnosis or an all-clear within 28 days, with more than 800 patients missing the cut in May.

The latest data, dating back to December, shows a worse position of assessing one in every three potential cancer patients within two weeks, with 954 patients out of 2,887 seen within 28 days.

Dr Magnus Harrison, interim chief executive of the hospital trust, said: "There are green shoots, small green shoots.

"Looking at our 12-hour waits in our emergency departments at the moment, over the last month, we have only had one bad day, other than that it has been zero, commonly, and maybe one 12-hour breach per day, and that is a significant improvement from January and December."

In January, the trust had nearly 300 "12-hour trolley breaches" in which a patient was left within the hospital after being deemed in need of care but without a hospital bed.

Before the pandemic, a single patient waiting more than 12 hours was typically unheard of, so to clock nearly 300 – an all-time-record – is completely unprecedented.

As a positive, Dr Harrison said: "We haven't cancelled anywhere near as many procedures as we would usually and I think this is largely due to the activity that we have been able to keep going through the treatment centre."

Sharon Martin, the trust's executive chief operating officer, said: "We are seeing a few tiny green shoots

"We really did struggle in January and had some really significant waits which clearly isn't acceptable. I am pleased to say that they are improving.

"The increase in the longer length of stay and delays to discharge caused us quite significant operational pressures.

"We had quite a bit of exit block in terms of discharge which is starting to improve as well.

"With cancer, a big area of concern has been the breast service, where we have had difficulties with staffing during January into February.

"We have seen a 19 per cent increase in referrals into the breast service, they are not manifesting into an increase in breast cancer, which is reassuring.

"We have seen the waiting time, which should be 14 days, continuing to fall. We have not hit the 14 days yet, we are around 22.5 days at the moment.

"We are starting to see improvements in our ambulance turnaround times. We are by no means in the significant delays as in some of our neighbouring trusts and we do support quite a few of the West Midlands trusts and take patients from other sites, particularly at Burton."

The trust has an aim to quash two-year waits by July this year, 18-month waits by April 2023, get 62-day referrals back to pre-pandemic levels by March 2023 and have at least 75 per cent of urgent cancer referrals diagnosed or given the all-clear within 28 days by March 2024.

Justin Shanahan, vice chair of the trust, said: "I think we are too optimistic about when we will hit these new target scores. I don't think we will be looking at this in a years' time and will have hit these target scores.

"I know it is very NHS-ey to say we are going to fix this in a financial year, but I think a lot of this is not fixable within a financial year, even if we had plenty of resources to point at this – which we don't.

"I think there is an optimism bias and I think there is a cultural and financial year bias playing out here.

"I would invite you all to be a bit more realistic, in all honesty, as to when we think we will fix it, because that will determine the length of time that we need to deploy these resources.

"I think we are kidding ourselves as to how easy some of this is to fix."

Dr Harrison agreed with this.

Dr Kathy McLean, chair of the trust, said the organisation needed to assess its maximum capacity and output "way before we say we are going to send patients elsewhere or we are going to build anything else".

On maternity issues, Patti Paine, the trust's director of midwifery, said: "What stifles us is the lack of midwives.

"We are hopeful that we will be able to reinstate the homebirth service by the end of April into May.

"Things are looking brighter although the increase in workforce is slow, but it is starting to increase. We are a long way off where we need to be.

"We are facing quite a significant shortage.

"The compromising factor is that we know we are going to have extra births in the next couple of months and one of the conversations I have had with one of the consultants today is 'are we at the point where we really have to refuse bookings?'"

Kara Dent, the trust's legal director for obstetrics and gynaecology, said: "We have a very, very high unprecedented sickness rate in our trainees, we are running at 50 to 60 per cent on some days. We have got a very tired workforce.

"We are still working on the labour ward with perhaps eight midwives instead of 12. We are really hopeful that both of these things are going to change going forward, but that is our major challenge."

Dr McLean said: "We know that maternity is probably our highest risk area, it is for every organisation that runs obstetrics and maternity units.

"The challenge is finding the people. You are finding the people, but balancing that against the people that are retiring is one of your biggest challenges."

Cathy Winfield, the trust's executive chief nurse, told the Local Democracy Reporting Service, when asked about potential appointment cancellations, said: "We are hoping to get our homebirth service back up and running because that is really important for women and for choice.

"I think it is something we take on a month by month view and keep the board regularly updated about it.

"It is a fine line. The women that we look after are as safe as they possibly can be."

Ms Martin, when asked by the LDRS about patients potentially presenting at hospital with later stages of cancer, said: "In urology some of our consultants audited referrals and at the height of the pandemic it was clear that people were presenting later, and I think that was probably a pattern that was followed nationally because people were very focused on the pandemic.

"That was people getting referred in in a timely way but much later in their disease progress.

"What is really good to see now is that we are seeing more people coming forward with two-week referrals, that is really positive.

"That indicates that people are seeking help. We are not finding more cancer from those referrals, which is good, it is a good indicator that there is not this latent cancer."

James Crampton, the trust's interim executive medical director, told the LDRS: "Since 2019 we have had an increase of 25 per cent in two week wait (cancer) referrals into UHDB compared to a 13 per cent increase over the region.

"However, the conversion of those two week wait patients into those who actually have a cancer has gone down to six per cent at UHDB, whereas it was 10 per cent in 2019."