North by North West: The omicron damage

The speed and scale of the rise in covid admissions in the North West over the last three weeks has been more severe than the NHS expected, with the surge in omicron cases coming even faster than it did in London.

The number of covid-positive patients occupying hospital beds stood at just 800 on Christmas Day, but by 10 January had risen to more than 2,900, which is almost as high as the peaks of the first and second waves.

During the pandemic we’ve all become used to projections of covid demand being undercut by the reality, but the admission numbers for North West hospitals ended up being higher than the NHS had expected (according to a letter to system leaders last week). So, the modellers do get it wrong both ways.

Thankfully though, case rates in the community have started falling rapidly, as omicron runs out of young people to infect.

The surge in admissions slowed significantly over the last week, and the demand on hospitals looks like it’s reached a peak in Greater Manchester and Cheshire and Merseyside. In a crucial departure from previous waves, the demand on critical care has remained relatively low and stable throughout.

Staff absence rates have also now dropped; having hit 12 per cent at the start of January, they fell back to around 10 per cent at the end of last week (still the highest level in England, however).

Overwhelmed

Services have again coped as best they could, avoiding any sort of dramatic collapse.

But there’s no doubt hospitals have been overwhelmed, and many people will have suffered horrific delays, poor care, and harm as a result.

Significant amounts of elective care have been scaled back, postponing treatment for thousands of patients, many of whom will already have waited too long.

In the first two weeks of January, the region’s A&Es have reported a daily average of around 100 breaches of the 12-hour standard, for sick patients waiting for a bed after a decision to admit. Ten years ago, the whole of the English NHS consistently reported fewer breaches than this in any given month.

Many of these breaches involve mental health patients, with Lancashire and South Cumbria still having terrible problems on this front. A report to its system leaders last week noted the “extreme waits” being experienced by some.

At some hospitals, such as Bolton, Wigan and Blackpool, ambulance handovers breached the 30-minute standard in around a third of cases, a proportion that would have been unthinkable until recently.

Meanwhile, mortality data due out later this month will show a significant rise in ‘excess deaths’, which had already been running at an average of 200 per week in the North West since the start of August.

All of this comes alongside the unmeasurable impact on already exhausted staff. Despite working flat out, many will have seen patients suffering, and will fear risky gaps in staffing rotas becoming normalised. God knows what the long-term implications of this experience will be.

Discharge trouble

The main efforts at mitigation have focused on hospital discharges, which has the tantalising potential to free up hundreds of hospital beds and staff – thereby cutting the ambulance and A&E delays, and ensuring the more urgent elective cases (like cancer) can be protected.

Hospital leaders have been bombarded with guidance and targets in recent weeks, around reducing the number of inpatients who no longer meet ‘criteria to reside’.

Last Monday, NHSE’s regional team made a further push, saying hospitals needed to reduce the number of these patients by 30 per cent by the end of the week.

That would have meant cutting the numbers from an average of around 1,900 in the first week of January, to around 1,300 by the end of last week. But according to internal data seen by NxNW the average last week actually increased to more than 2,000.

Some exasperated trust leaders said there is little they can do on delayed discharges, with so many hospital and social care staff absent from work, and dozens of care homes closed to new admissions.

At one point last week, almost 60 care homes in Liverpool were closed to new admissions (two-thirds of the total), according to the council.

The NHS has tried for years to sort out delayed discharges, without much success, so any dramatic improvement over such a short space of time (and without any huge fall in non-covid demand, as per the first wave) seems fanciful.

Something radical needs to change in the social care sector, and workforce, to make real progress on discharges, but until then hospitals will remain blocked up and many patients will continue to suffer long delays.

Trust avoids CQC prosecution

Blackpool Teaching Hospitals Foundation Trust had some better news before Christmas, with the Care Quality Commission deciding not to pursue a criminal prosecution against the trust in relation to multiple offences which are alleged to have occurred on its stroke unit.

In November 2018, police began investigating alleged neglect and mistreatment, including the suspected ‘poisoning’ of patients, on the stroke unit.

Enquiries led to the identification of other suspected offences, including the murder of a 75-year-old woman, and alleged sexual offences against patients and staff.

Some arrests and charges have been made against healthcare professionals this year, although police continue to investigate the murder case.

Alongside the police probes, the CQC has been considering whether to bring criminal charges against the trust, which it can do if it believes they were liable for breaches of fundamental standards of care.

But Ann Ford, deputy chief inspector of hospitals, told HSJ in a statement: “We confirm that the CQC has conducted and now concluded an investigation into concerns raised at Blackpool Victoria Hospital around the care and treatment on the stroke ward. All the families affected have been contacted and we appreciate they will be disappointed that the CQC has been unable to pursue a prosecution.

“However, we remain in regular contact with the police who continue to investigate. CQC will continue to monitor the trust closely to ensure patients are receiving safe care and treatment.”