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There are certain emergency departments around the country which operate right on the edge. When pressures intensify everywhere, these EDs quickly become overrun.

Royal Preston Hospital is one of those departments, and staff are losing the will to carry on.

In a letter to executives at Lancashire Teaching Hospitals Foundation Trust, seen by HSJ, several managers in the department raise multiple concerns over staffing and patient safety.

The letter says: “Whilst we have documented our concerns previously the current situation is worse than it has ever been…Our situation is increasingly precarious…

“For the past few months we have on a regular basis had more than 50 patients waiting for a bed and that wait being in excess of 60 hours.

“This means that at most times there is limited or no space to accommodate newly acutely ill patients causing ambulance handover delays of over four hours and delay in treatment.”

They say there is a lack of support from the rest of the trust, and claim the ED has a “never-ending elasticity in the eyes of others”.

The trust is aware of the urgent need to expand the department and make it fit to hold the number of patients it receives, but it will take a couple of years at least to secure capital funding and complete the building work.

In the meantime, it can only hope current covid pressures (the trust has around 120 covid-positive patients) will subside as the second omicron wave burns out.

A less than optimum outcome

The traumatic death of someone living in an NHS facility is always going to be hard for their relatives who often want to understand what has happened and be given reassurance that it won’t happen to anyone else.

So for an independent investigation to remain unpublished seven years after a death is a sign something has gone badly wrong. Anthony Dawson’s horrific — and unnecessary — death in a unit run by Surrey and Borders Partnership FT was understandably distressing for his sister, Julia. The delay in the independent investigation has compounded her grief.

The investigation acknowledges failings in his care, especially around his physical healthcare. But much of it, according to Ms Dawson, misrepresents her brother — who had learning disabilities and autism — and does not address what she believes to be the true cause of the gastric ulcer which led to his death, the repeated use of NSAIDs (ibuprofen) without any attempts to protect his stomach.

Despite several draft reports, her concerns have not been fully addressed and now it appears a summary report only will be published with a statement saying she disagrees with it. That’s a less than optimum outcome after so long.

Also on today

Change is on the way for the NHS England board when it takes over NHS Improvement’s powers later this year. As part of this, Sir Andrew Morris will become NHSE joint deputy chair while Lord Ara Darzi will leave the board. There’s also been an appointment in the North West, where former Northern Care Alliance CEO Raj Jain has been named chair designate for Cheshire and Mersey Integrated Care Board. Meanwhile, NHS Supply Chain is bringing three major procurement categories in-house, as part of a major overhaul of its operating model.