Cambridge University Hospitals Foundation Trust has uncovered a “perfect storm” of factors behind a sharp spike in its accident and emergency attendances after polling its patients.
The research by Ipsos MORI found that 20 per cent of attendees had come to the trust’s Addenbrooke’s Hospital despite living outside its traditional catchment area.
Surveyed patients said they had either opted to travel the extra distance themselves or had been brought to the hospital by ambulance. Most of those who said the hospital was not local for them came from nearby Bedford or the outskirts of north London. Some arrived from as far away as Norfolk and Suffolk.
The trust commissioned the poll to help understand why A&E admissions had risen from 8,500 a month at the beginning of 2014 to 10,000 in June.
Researchers said there was “no obvious single cause” for the high A&E attendances and were unable to explain why levels had rocketed more recently.
“There are very few differences in patterns of service use between January and May patients,” their report said.
Trust chief executive Keith McNeil told HSJ the trust was aware of “increasing ambulance flow” from surrounding areas and that it sat in one of England’s most financially challenged economies.
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He said: “Trusts around us are struggling to cope with their demands and we are seeing our catchment area expand into that area around the north London rim down around Harlow and Bedford.
“All of those have added up to a perfect storm. That has happened without [us] being able to expand our bed capacity or our staffing overnight, although we’re trying hard to do that.”
While the FT has persistently failed the national the four hour A&E target, it received a significant boost this month after Monitor said it was no longer in breach of its licence, a status held since November 2012.
It had fallen short on national targets for cancer care, referral to treatment and been criticised by the regulator for “poor financial management [and] multiple occurrences of preventable patient safety incidents”.
Trust chair Jane Ramsey said she was pleased with the progress but that further improvements - including measures to address A&E difficulties - required examining the Cambridgeshire system as a whole.
She said Dr McNeil had been appointed because of his experience working in an integrated way in his previous role as chief executive of Metro North Health Service in Brisbane, one of the largest health services in Australia.
Dr McNeil and Ms Ramsey attributed performance improvements to a range of changes, including a reshaping of its divisional structure away from a traditional medical group to one structured around patient pathways.
Dr McNeil gave the example of patients with abdominal problems now being able to attend a unit “staffed by specialist gastroenterologists, as well as specialist abdominal surgeons”.
“They work together now, unlike in the previous divisions. The same for the musculoskeletal pathway,” Dr McNeil said.
The trust has also changed its approach to frail elderly patients, a group representing a rapidly growing proportion of the Cambridgeshire population.
Dr McNeil said its new frail elderly unit allowed them to send home “around 30-40 per cent of patients” who would have previously been admitted.
The trust was also working much more closely with its local authority and clinical commissioning group to reduce delayed transfers of care.
The trust ditched the arrangement whereby it fines the council when patients remain in hospital because of a lack of social care capacity.
“We have taken the step to take away the fines from the council for our patients and we have asked them to re-invest that into providing better services,” Dr McNeil said.
“We are trying to work collaboratively as well as show system leadership. The only way we will get out of this is as a whole.”
Interview with trust