North by North West: Hospitals face intervention on ambulance handovers

Hospitals in the North West are set to face renewed pressure to deal with ambulance handover delays, following action taken in Liverpool to stop crews being held outside accident and emergency. 

Last month, directors at the Royal Liverpool Hospital ordered staff to receive new ambulance patients “in all instances” – in other words, even when the A&E and wards are deemed to be full to capacity.

This followed nasty clashes between hospital staff and paramedics at the newly opened hospital, around the number of ambulance patients that could be brought into the corridors.

NxNW expects there to be a push this month to force other hospitals to follow suit.

This will be targeted particularly at the worst offenders for holding patients outside, where ambulance crews are routinely prevented from responding to new emergencies.

Board papers published last week by North West Ambulance Service Trust suggest attentions will be heavily focussed on Greater Manchester, which had three of the five worst offending hospitals in October.

There were 430 ambulance hours lost at North Manchester, 496 at Fairfield General (where one patient died in the back of a queued ambulance), and a massive 817 at the Royal Oldham, compared to 394 at the Royal Liverpool (recorded before the new instructions from directors).

Manchester University Foundation Trust and the Northern Care Alliance, which run the three GM hospitals, ignored questions on this from NxNW, but the numbers suggest a Liverpool-style intervention is needed.

The main excuse trusts cite for handover delays is they lack bed capacity due to difficulties in discharging patients, but new winter sitrep data suggests plenty of providers with high numbers of blocked beds are doing just fine on handovers.

Ambulance crews I’ve spoken to believe the culture of the hospital is just as important; do they understand and appreciate the risks posed to NWAS and 999 patients in the community when ambulances are queued? Are they willing to take on more risk themselves?

The GM trusts should be urged to learn from the likes of the Royal Blackburn Hospital, which runs one of the busiest emergency departments in the country, and Leighton Hospital in Crewe, which often has a high proportion of blocked beds. Both hospitals are among the best performers on ambulance handovers nationally.

Sizing up ICBs

The last edition of NxNW pointed out the need to cut staffing numbers in the region’s integrated care boards, and it soon emerged Lancashire and South Cumbria is targeting a 20 per cent reduction to its staffing bill.

L&SC is the most financially challenged system in the North West, although it already appears to employ a below average number of staff for its population (less than 40 staff per 100k).

This suggests similar cuts are on the way for Greater Manchester’s ICB, which employs a much higher number (61 per 100k), but chief executive Mark Fisher said no specific targets have yet been set.

He said in an interview: “If there are announcements or decisions to be made about that, you’d understand why I’d want to tell my own team first before I told HSJ.”

Elsewhere in that interview, Mr Fisher called for ICBs to be given more responsibility to manage the performance of trusts in their systems, suggesting there is still much confusion about their role versus NHS England’s regional teams.

This got a hostile reaction from some readers, but he is surely correct that ICBs’ role needs further clarification, with responsibilities better defined.

What’s the priority?

Meanwhile, Mr Fisher said Greater Manchester is not currently planning to replicate the work being done in Coventry and Warwickshire, where leaders are testing software that can factor in health inequalities when prioritising patients for elective care.

He stressed he is worried about data which suggests patients from ethnic minorities or deprived communities wait longer for their care, and this needs to be addressed. But he added: “If rigorous assessment shows that is a sensible a reasonable thing to do, then I’m sure we should consider something like that, but at the moment that’s not in our plan.

“I’m more interested at the moment in simply getting those numbers down generally and allowing the clinicians to really reach a rational view of the risks every single individual on those waiting lists are actually running, and prioritising the waiting list accordingly.”

Interestingly, this struck a different tone to Owen Williams, Northern Care Alliance CEO, who is leading this work in GM.

Vote of confidence

Lastly, one of the key priorities for the GM system is to support and oversee Greater Manchester Mental Health FT amid multiple investigations into the abuse scandal at the Edenfield Centre in Bury.

Trust chair Rupert Nichols quit last month, but CEO Neil Thwaite remains in post.

Asked about Mr Thwaite’s position, Mr Fisher said: “There’s obviously a slew of investigations and inquiries ongoing, and we’ll have to see how that all pans out.

“The chief executive at the trust needs the confidence of his board and the confidence of the wider system, as well as the ICB. Neil has our confidence as the leader at the moment dealing with really really tricky and difficult issues.”