Chorley A&E reopening plan revealed - but this is what has to happen first

A final ‘go or no-go’ decision on the reopening of Chorley and South Ribble A&E will be made towards the end of September, it has been revealed.

Tuesday, 11th August 2020, 7:58 pm
Updated Tuesday, 11th August 2020, 8:23 pm

A recruitment drive is currently underway for the extra staff who will be needed to operate the unit while keeping it Covid-secure.

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Chorley A&E consultation could begin by autumn

The facility closed at the end of March, concentrating Central Lancashire’s response to the coronavirus pandemic on the Royal Preston - and increasing the critical care capacity available across the area.

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The aim is for Chorley A&E to reopen by the end of September

It was announced last month that hospital bosses were “working towards” reopening the unit in September, provided that Lancashire did not experience a significant spike in Covid infections beforehand.

Papers presented to a meeting of the Lancashire Teaching Hospitals NHS Foundation Trust (LTH) board, which will make the final decision, reveal that there will also be a review of available staffing levels before it does so.

However, members heard that managers were “absolutely motivated” to being able to bring patients back through the doors by the end of next month.

“It is not without its risk – and it would be unwise to say that it’s a done deal and that we are able to open with no problems,” explained LTH chief executive Karen Partington.

“There is a huge amount of work [to be done] and a significant number of people working with us to try and make this happen.

“We have recruited some substantive staff and have got plans to bring in agency staff. We will be able to make offers to some senior clinicians, but…individuals currently in roles [elsewhere] will have to give notice in order to be able to join us.

“[There are] a couple of senior medical staff who, if they were to be appointed, couldn’t join us until December, so we would need to find an alternative solution [in the meantime],” Ms. Partington added.

In order to staff the Covid and non-Covid zones, the A&E department at the Euxton Lane site will require an extra three registered nurses and three healthcare assistants per shift – bringing the totals of each to seven and four respectively.

However the bigger challenge may be the need to recruit an additional dozen middle-grade doctors to cover both Chorley and the Royal Preston safely. It was a shortage of these roles which forced Chorley A&E to close completely for much of 2016 – and has been the primary reason cited for its part-time status ever since.

The Lancashire Post understands that five offers have been made to middle-grade medics and recruitment efforts – including the use of agencies – are continuing to find the remaining seven required.

Chorley MP Sir Lindsay Hoyle – a longstanding critic of LTH management – said he hoped that the trust was not “preparing people for bad news”.

“If they struggle to find staff this time as they have in the past, they have to ask themselves why they’ve got a recruitment problem.

“However, there is a lot of hope and anticipation, because they’ve had months to get it reopen, so there shouldn’t be an issue,” Sir Lindsay added.

South MP Katherine Fletcher said she was "reassured" that there was now a clear timeframe for the reopening of the facility.

"I will be quite happy to play my part in the search to find people to take up these new jobs," Ms. Fletcher added

Interviews for several of the available roles are expected to take place later this month.

Karen Partington told the board meeting that the recent return of respiratory and critical care services to Chorley - after they were also temporarily stood down - demonstrated that the trust was “serious” about reinstating facilities on the site.

Director of nursing and midwifery, Sarah Cullen, said that the Covid-secure measures that will be introduced amount to effectively “running two emergency departments on one site” – as has been the case at the Royal Preston since March.

“The running of Chorley [during the peak of the pandemic] would have resulted in the equivalent of running four A&Es. With the increasing activity, that became something which we thought we’d be unable to manage in the circumstances,” Ms. Cullen explained.

One of the reasons for creating the green and red zones is because of the heightened risk of coronavirus transmission posed when a Covid-positive patient undergoes an “aerosol-generating procedure” such as intubation, which can disperse the virus through the air.

Members were told that the emergence of rapid Covid-testing kits – including one which also tests for flu – could make it easier to operate the A&E departments on both the Chorley and Preston sites as winter approaches. The trust currently has access to fewer than a dozen of the Covid tests per day, but is hoping that numbers will increase as they become more widely available.

As and when the Chorley unit does reopen, it will return to its previous part-time hours of 8am until 8pm, seven days a week. The urgent care facility on the Chorley site will continue to operate around the clock.

'IF IT CAN REOPEN DURING A PANDEMIC, IT CAN STAY OPEN FOR GOOD'

Campaigners who have spent over four years calling for a round-the-clock reopening of Chorley and South Ribble A&E said it was “excellent news” that a timetable for its part-time reinstatement had been drawn up.

However, they also sent a blunt message to hospital bosses - if medics can be found to run an expanded department for the duration of the pandemic, there is no reason why sufficient staff cannot be recruited to secure the long-term future of the unit.

Back in January, the Lancashire Post revealed that four groups of clinicians from within Lancashire and further afield had concluded that the A&E - in both 12-hour and 24-hour form - was “not clinically viable”, largely because of concerns over a lack of available staff.

A now delayed public consultation into its future was due to recommend that the facility be replaced with one of two versions of an urgent treatment centre.

Jenny Hurley, from the Chorley & South Ribble Hospital Campaign, said that such reasoning would have to be reassessed if the recruitment required for a September reopening proved successful.

“There are obvious concerns over how they’re going to find the extra nurses and healthcare assistants that are needed to meet Covid standards across the two sites. After all, if they haven’t been able recruit the necessary staff to keep our A&E open for even 12 hours after over four years, then how are they going to be able to recruit these staff now?

“That said, if they do pull it off, then the four reports [published earlier this year] will be null and void. If they suddenly acquire [the staff needed] then the reports will be inaccurate and a new assessment and a completely new business plan will need to be made.

“We fully understand that we need staff to have our A&E. We’ll be following their progress to reach each of the requirements to open late next month - it’s why we’ve been stood outside the hospital for 232 weeks now every Saturday morning,” Ms. Hurley added.

However, last month, the man leading an overhaul of health and social care services in Central Lancashire told the Post that the move towards a September reopening did not “fundamentally alter” the clinicians’ earlier conclusions.

Jason Pawluk, delivery director for the Our Health Our Care programme said: “We still need to have an honest conversation with the public about the best long-term solution for A&E and critical care hospital services.

“We’re keen to avoid anybody forming a view that this is the first step towards a 24/7 A&E or restoring a type 1 A&E facility [the most extensive] at Chorley.

“There are still real questions to answer about long-term viability and the most appropriate care model,” Mr. Pawluk added.

The public consultation into the future of Chorley A&E is provisionally pencilled in for later this year - and could start within weeks of its reopening.

CHORLEY A&E LAYOUT

GREEN ZONE

'Resus' cubicles

'Majors' treatment area

'Minors' treatment area

Triage

RED ZONE

'Resus' cubicle

Isolation cubicles

'Majors' treatment area

'Minors' treatment area

STAFFING

Pre-Covid - 4 registered nurses & 1 healthcare assistant per shift

Post-Covid - 7 registered nurses & 4 healthcare assistants per shift

- 12 extra middle-grade doctors across both Chorley and Preston