• Consultants raise concerns over staff burnout and patient safety issues
  • Trust’s main A&E departments have been among the worst performing in England
  • Trust leaders outline various improvement measures being taken

Consultants have written a letter to a teaching trust’s executives and taken to social media to raise concerns about its struggling emergency services, which have been among the worst performing in England against the four-hour target.

Some Lancashire Teaching Hospitals Foundation Trust clinicians went public with their concerns on Twitter, suggesting managers had blamed them for the issues. The letter was sent to divisional managers by the emergency department’s consultant team at Royal Preston Hospital.

Stuart Durham, an emergency medicine consultant, posted on Twitter on Friday: “Absolutely ashamed of our exec! Despite repeated attempts to tell them how bad it is in the ED they don’t understand. We warned them again in a letter today and again they blame us!”

He later posted: “The 4 hour standard is just a metric but what concerns me more are the patient safety issues, poor clinical standards, public perception, staff stress, burn out… all as a consequence of keeping the risk in the ED.”

Another emergency medicine consultant, Ayman Jundi, replied to the post: “Really fed up and frustrated by the total indifference shown by our exec team towards the continuing challenge to patient safety in ED, caused by lack of flow and lack of support – and to add insult to injury, team ED …gets the blame!”

The consultants have both been employed substantively by the trust, although it is unclear whether this remains the case or if they now work as locums.

In the final three months of 2018-19, the trust’s type 1 accident and emergency departments reported performance of 52 per cent against the headline four-hour waiting standard – the worst in the country. However, the trust said the figures had been skewed since the start of 2019, because all patients with minor illness and injury at Preston have been streamed directly to the urgent care centre, so no longer feature in the type 1 reporting.

When including attendances at walk-in centres and urgent care centres, the trust’s performance against the four-hour standard was 80 per cent, which was around the 40th worst performance in England.

There were also around 200 “trolley waits” of at least 12 hours for patients who needed to be admitted to a ward, which was among the highest figures.

HSJ understands there has been frustration among some clinicians at delays in bringing forward plans for reconfiguration of emergency services between Royal Preston Hospital and Chorley and South Ribble Hospital, which are 12 miles apart and both run type 1 A&E services. The trust has struggled in recent years to safely staff both departments.

Karen Partington, the trust’s chief executive, told HSJ in a statement: “We fully recognise the challenges that our ED team is experiencing when faced with constantly rising demand and high bed occupancy.

“Over the past 18 months, the executive team and other senior leaders have been working with our emergency department and other colleagues to resolve a range of issues that broadly relate to challenged patient flow within our hospitals and the wider health and social care system.”

She said £1.9m has been invested since last year to improve the facilities and increase capacity, with another £526k allowing nursing and support staff numbers to increase by 19 whole time equivalents.

Since January, patients with ailments designated as minor have been streamed directly to the co-located urgent care centre, reducing the overall number of patients attending the ED by around 70 a day.

She added: “It will take time for all of these improvement programmes to have the impact we need, but we remain fully committed to making the necessary changes, and will continue to do all we can to maintain safe and effective care in difficult circumstances.

“Members of the executive team have been meeting weekly with ED leaders for some months to provide progress updates and listen and respond to any concerns, and we will continue to work together to make improvements.”