APPENDIX 4
Memorandum submitted by Bridgend & District NHS
Trust
Thank you for the opportunity to submit evidence for the
forthcoming meeting of the Welsh Affairs Committee with Win Griffiths,
M.P, Minister responsible for the NHS in Wales. Attached you will
find our submission in bullet point form with some graphical evidence
to support.
P. M. Williams
Chief Executive
3 December
1997
Annex 1
EMERGENCY ADMISSIONS
Issues
- Ageing population, older and iller people.
- Improved ability/skills of clinicians to make people
better.
- Public expectation of hospital admission, second opinion.
- Pressure on primary, community and social care services.
- Concept of "extended family" to care is rapidly
diminishing.
- Increased respiratory disease-air pollution.
- Increased drug/alcohol related problems.
- Not just "medical" emergencies, includes Surgical
and Mental Health.
- Social factors eg unemployment, housing.
Implications
- Insatiable demand for secondary care.
- Insufficient bed capacity.
- Need to switch resources "on and off" at speed.
- Increased Accident & Emergency trolley waits.
- Reduction/cancellation elective activity, especially
during winter months.
- Delayed discharges due to Social Services funding shortfalls.
- Patients discharged/transferred prematurely with risk
of readmission.
- Patients outlying in wards of different speciality.
- Impact on quality of care and patient experience.
- Increasing use of Bank and Agency Nurses and associated
costs.
- Poor communications between health care professionals
and others (including patient/relatives).
- Lack of supporting clinical equipment.
- Difficulties in recruitment/retention of staff.
- Effect of pressure of work on staff (especially doctors
and nurses).
- Added financial pressure.
EVIDENCE
- Accident & Emergency attendances.
- Emergency/elective trends.
- Audit of delayed discharge (Iechyd Morgannwg Health).
ACTIONS
Those Taken
- Medical Assessment Unit and Pre-Discharge Ward commissioned
in 1995.
- 24 hour Bed Management Team.
- Trust Bed Management Group chaired by Executive Director.
- Redesignation of 12 gynaecology beds to medical beds
in October 1996.
- Admissions & Discharge Lounge.
- Improved response from Ambulance Trust to accelerate
discharge/transfer.
- CHKS Project commenced (capacity planning tool).
- Further 9 medical beds commissioned for 3 months in
June 1997.
- Relocation of Coronary Care Unit alongside Medical Assessment
Unit in October 1997.
- 28 Bed Winter Ward commissioned in October 1997 for
6 months.
- Work closely with Iechyd Morgannwg Health and Bro Taf
Task Forces on emergency admissions.
THOSE PLANNED
WITH ADDITIONAL
FUNDING MADE
AVAILABLE
Hospital Based
- Health Care Assistant staffing bank.
- Increased Paediatric Ward capacity.
- Increase capacity and nursing staff for times of peak
demand.
- Supplement discharge planning services.
- Enhanced Occupational Therapy services in Accident &
Emergency and Medical Admissions Unit.
- Increased Radiology service out of hours.
Community Based
- Extended "out of hours" District Nursing service
(linked to consortium and Age Concern).
- Night sitting service (linked to Marie Curie)
- Carers' training scheme in Maesteg.
- Equipment costs to support discharge.
- Community Nursing support to Nursing Homes.
- Increase Physiotherapy and Occupational Therapy home
vists.
Voluntary Sector
| - | Age Concern | -
| Home Support Worker Scheme. |
| | |
|
| - | Marie Curie | -
| Home Nursing and Staffing Service. |
| | |
|
| - | Ogwr Care/Repair | -
| Safety at Home Initiative. |
Social Services
- Extended community rehabilitation.
- Improved links and discharge procedures.
- Packages of care to patients discharged home.
- Reserve for additional schemes.
FURTHER ACTIONS
PROPOSED:
- Retain the additional capacity provided in the "Winter
Ward".
- Develop a joint Medical and Surgical admissions area.
- Develop joint Medical and Surgical pre-discharge and
rehabilitation areas.
- Use CHKS capacity planning tool to "flex"
capacity in response to elective and emergency demands.
- Increase "out of hours" support services,
eg Radiology.
- Provide computerised reporting of results to all acute
wards.
- Extend "out of hours" community nursing services.
- Introduce community based nurse practitioner service
aimed at reducing admissions from Nursing Homes.
- Extend Day Hospital services to seven days a week.
- Extend joint health and social services community rehabilitation
schemes.
- Work with voluntary services to improve hospital discharge
services, eg Age Concern.
- Use Day Hospital facilities for training of carers.
- Extend the hospital based Social Worker service to address
complex hospital discharge cases on Surgical Wards.
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