Derby Royal’s Winter Plans

Royal Derby Hospital has laid out its plans to combat the winter influx of patients – but it is still left more than one hundred beds short of what it needs.

The University Hospitals of Derby and Burton NHS Foundation Trust has published its plans to prepare for winter in its papers for this month’s board meeting.

It shows that Royal Derby Hospital has 594 beds and will need 813 – leaving a gap of 219 beds.

However its “plan to close the gap” will reduce the shortfall – but will still leave it short 102 beds.

It says that it will free up extra space around the hospital to create room for more beds – previously saying that 59 beds could be placed in unused areas such as existing bathrooms and a “pre-operative assessment area” at a cost of £2 million.

On top of this, the construction of a new “modular” 28-bed unit at Queen’s Hospital in Burton will come into use and a temporary flat-pack ward build on Royal Derby’s short stay car park will be used again.

London Road Community Hospital in Derby will also help to share the load of extra capacity for beds to be found there too.

A report written by Sharon Martin, the chief operating officer at UHDB, says that the hospital trust expected increased demand of two to four per cent this winter season – but it has already seen eight to 10 per cent growth.
Ms Martin says that emergency attendances at Derby and Burton’s two A&Es are six to 10 per cent higher than last year.

She says that if activity rises by 13 per cent at Royal Derby, then elective (optional) operating may have to be reduced and beds for these patients used for medical patients instead.

Other key plans to prepare for winter include a new orthopaedic assessment unit at Royal Derby.  This relates to patients with bone, joint, tendon and muscle ailments – typically hips and knees.  It aims to promptly move patients from the emergency department to orthopaedic specialists.  GP referrals can also be seen in the unit – which are currently directed to the emergency department.

UHDB says that “whilst these patients are not in huge numbers each day, they can stay in the emergency department for long periods of time”. The facility will be open seven days a week, 12 hours a day.

Meanwhile, an outpatient antibiotic therapy service will be in action – delivering longer-term intravenous therapy at home or as an attender at London Road Community Hospital.

This will provide a facility for people to return to for antibiotics instead of taking up a valuable hospital bed.
The service has already saved around 500 bed days this year at the hospital trust.  It will close the bed gap at Derby by a “conservative estimate” of four.

The London Road service is new and a similar facility could be brought in at Queen’s Hospital in Burton next year.

UHDB says that “getting into hospital is very easy but discharging out of hospital can be difficult and complex”.

It says that staff will be “supporting a person to not be hospital any longer than is absolutely necessary – particularly reinforcing the harm, particularly to elderly people, that prolonged hospital stays can cause”.

A member of the public told the Local Democracy Reporting Service that a consultant at the King’s Treatment Centre on the Royal Derby Hospital site had a screen-saver on their computer reading “manage your beds”.

The hospital trust says it has an aim to reduce the overall number of patients staying 21 days or more by 40 per cent.

For UHDB its target is to get to 129 patients or less and it currently has 166 patients staying more than 21 days.

Gavin Boyle, the chief executive of UHDB, wrote in a report: “We have put in place a comprehensive winter plan together with our partners across Derbyshire and Staffordshire.
“We are creating some new beds across our hospitals to help reduce the time our patients wait in A&E or other emergency and urgent care areas.
“It will also help us to continue to offer planned surgery over winter, which is often disrupted by increased emergency admissions.
“Our main focus this winter will be on the prioritising of discharges and reducing delays in our own processes, as well as transforming our processes for those patients who have a long length of stay.
“There will be a role for our partners in supporting us, and EMAS are working to reduce ambulance conveyances to our hospitals.
“GPs, local authorities, community providers and NHS111 are also putting their plans in place to prepare for winter so that patients can either avoid attending A&E in the first place or have a care package for when they are discharged home or to the next place of care.”

Ms Martin said: “We have over 1,700 beds across our trust and during winter we work hard to increase the number of beds available as more patients require medical care.
“Increasing capacity within our hospitals is only one part of the systems approach to managing winter.
“We are also working with our health and social care partners to reduce the number of patients admitted to hospital and to ensure there is sufficient capacity in the community to discharge patients.
“The public can really support us by using the right service to help with their illness or injury. NHS 111 are able to give free advice on which services are available.”

Dr Paul Wood, clinical lead for urgent care at Derby and Derbyshire Clinical Commissioning Group said: “Health and social care partners in Derbyshire are working together to prepare the system for winter but we also need people to help us to help them.
“There are lots of ways to access help and advice about illnesses and injuries and we’re asking people to consider if they really need to go to A&E or if there are more suitable ways to get care.
“Patients can access advice on health and well-being at their local pharmacy without an appointment and can call NHS 111 for free, 24 hours a day, 7 days a week.
“NHS 111 is much more than a helpline – if you’re worried about an urgent medical concern you can call and speak to an advisor.
“Depending on the situation, the NHS 111 team can access a nurse, emergency dentist, or even a GP and if they think you need it, they’re able to arrange face-to-face appointments.”