• Royal Surrey aims to learn from this winter
  • Increasing community capacity could reduce demand for acute beds
  • Increasing emergency attendances and admissions put pressure on trust

A trust is proposing an extended moratorium on elective care over Christmas 2019 and Easter 2020 and pre-booking outsourcing to private providers in an attempt to shore up emergency care performance and cut cancellations. 

Royal Surrey County Hospital Foundation Trust saw elective cancellations because of bed shortages creep up in 2019-20 and, accident and emergency performance against the four-hour target slide to between 84 and 88 per cent, compared with 81 to 96 the previous year.

For next winter it is considering scaling back elective work around Christmas earlier than it did in 2018, stopping elective work other than urgent and cancer cases during Easter, and outsourcing some lists to the private sector during peak times. This would involve block booking space in advance rather than on an ad hoc basis and could involve orthopaedics, urology and benign gynaecology.

Bob Peet, chief operating officer at the trust, said: “We are looking at some of the learning from last year. We planned well and engaged with the teams but the reality was more challenging than our assumptions.”

At this stage he could not put numbers on the operations which would be outsourced as the trust still had to talk to private providers who might be able to help.

The trust had followed guidance on when to reduce elective work around Christmas and the first two to three weeks of January, he said, but there was a question over when it was best to return to normal working. “We are reflecting on whether we need to make that longer,” he added. “Our planning will focus on at what point to return to more normal operating in January.”

Another focus will be providing more out-of-hospital care, including more domiciliary services to get people back home, additional community hospitals beds and a “proactive care hub” to stop admissions. These measures would reduce demand for non-elective acute beds by around 30, said the trust.  

An analysis of last winter showed the trust saw 5.5 per cent more A&E attendances than the year before but a significant spike in January when demand was up 11.4 per cent in January 2018. Emergency admissions grew by 6.7 per cent, meaning the trust had to find an extra five beds each day. This was despite a much milder flu season than the year before and fewer delayed transfers of care.

The trust saw some interventions making a significant difference – more “home first” capacity, placing patients who might qualify for continuing healthcare funding in a care home while assessments took place, and a “Hoppa” bus to take discharged patients home in the early evening thus avoiding a night in hospital. But some initiatives proved hard to staff such as some escalation beds and additional pharmacy and junior doctor shifts.