Plan to reduce Royal Preston's waiting times hampered by continued Covid pressure - and how new Chorley Hospital theatres could help
One whole ward and a third of intensive care beds at the Royal Preston Hospital remain occupied with Covid patients – and local NHS bosses are planning for a worst case scenario where that situation does not change for the foreseeable future.
The Post can reveal that Lancashire Teaching Hospitals NHS Foundation Trust (LTH) is preparing to increase its intensive care capacity to what is known as “super surge” level – because of the impact that virus-stricken patients are having on attempts to clear the backlog of routine work which built up during the pandemic.
LTH has not been at its base level of 28 intensive care unit (ICU) beds since before Covid struck. It is currently operating at a surge capacity of 34, but is aiming to have 38 beds open within the next couple of weeks.
It is part of a plan to restore many so-called “elective” – or pre-planned – procedures to pre-pandemic levels in the coming months.
That process will also see the opening of a new suite of theatres at Chorley and South Ribble Hospital in October, bringing the total on that site to 13. While they will be used to treat patients of all priorities, it is hoped that the new facilities will enable the trust to focus particularly on people – from right across Central Lancashire – who have been waiting over a year for routine treatment.
Figures for July show that there were around 6,600 LTH patients whose wait had exceeded 52 weeks – down from well over 7,000 earlier in the year – but still a stark statistic when put in the context of the fact that there were no patients in that position immediately prior to the pandemic.
Speaking to the Post after a recent LTH board meeting at which she described the elective recovery programme as becoming “trickier”, the trust’s chief operating officer, Faith Button, says that Covid patients are putting “sustained pressure” on other services.
“We thought it might have been a consequence of the lockdown easing back in May, but…the occupancy of critical care is currently still running very high – it puts a strain on staff and puts at risk each day the elective [procedures].
“If a patient is coming in for an operation and we know they need a critical care bed [afterwards], then if the unit is full of emergencies and Covid [patients], we can’t go ahead with it, as it’s too risky.
“So that’s why we want to get up to 38 ICU beds, because it [enables us to carry out] those elective cases – particularly cancer cases – that we want to get in each day as well. Before Covid, 28 beds used to allow us to deal with both emergencies and the elective programme," explains Ms. Button, adding that the current level of Covid bed occupancy means the trust has lost much of its "spare capacity".
She says that many Covid inpatients are now amongst the younger age groups and stresses the importance of them getting double jabbed. Whilst that is no guarantee that they will not end up in intensive care, it does give them the best chance of recovery.
However, the vaccination programme’s impact on the time the most seriously ill Covid patients spend in hospital has given the trust a new – albeit welcome – problem. Fewer patients who end up in intensive care are dying – but that does mean they are staying longer before being fit to be discharged.
“If I say to someone that a third of our ICU capacity [is occupied by Covid patients], people are quite shocked – but if I say it’s 11 people, then they think that’s nothing.
“But ICUs aren’t huge, they are very specialist and an intensive resource – and ours was already one of the biggest.”
As LTH attempts – along with trusts around the country – to get back to something akin to a pre-Covid state, the challenge at the Royal Preston is made all the tougher by the fact that the site is the the major trauma centre and specialist, so-called “tertiary”, facility for the whole of Lancashire and South Cumbria. That means that the most seriously unwell patients arrive at its door – and also that there are many operations that can only be carried out in Preston for patients from across the county.
Nevertheless, Ms. Button says that the extra theatre space becoming available at Chorley during the autumn has enabled LTH to set a “trajectory” for improving its waiting times.
The trust expects to start making inroads into the lower clinical priority cases that are currently the source of the inflated list of patients waiting more than 52 weeks for treatment – although she admits that some will remain by the end of the financial year next March.
As has been the case throughout the pandemic, patients on the waiting list are being checked up on to ensure that their conditions have not deteriorated – and to ensure that they do not need to be moved to a higher clinical priority status. This will also soon be done for patients waiting for diagnostic tests.
The trust is also aiming to return to the national waiting standard for the most common of those diagnostic tests being carried out within six weeks – currently around 39 percent of LTH patients are waiting longer than that. It is hoped that waits for CT scans will be back within that timeframe in the coming months and for MRI scans by January.
However, endoscopies will take longer to return to normal waiting times, because of the need to prioritise that procedure for cancer investigations.
The trust is currently meeting the national standard that states at least 93 percent of patients should see a specialist within two weeks of being referred for suspected cancer – LTH achieved 94.3 percent in July.
Just over 63 percent of patients began their first definitive treatment for cancer within 62 days of referral – against a national target of 85 percent. The trust says this was due to backlogs caused by Covid, but those backlogs are no longer growing and it aims to return to the pre-Covid standard by next March.
‘DON’T FORGET YOUR GP’
The Royal Preston is continuing to experience high demand for A&E services – something which Faith Button describes as winter-style pressures being felt during summer.
However, unlike past periods of pressure on its emergency department, it is not the result of people turning up at the facility when they do not require it. The vast majority of cases do need urgent attention – but Ms. Button says that outcome can often be avoided if action is taken early enough.
“What we want patients to do is go to their GP if they feel unwell, because it’s really important that they don’t get unwell at home and then end up in A&E when they could have gone to see their GP a few days [earlier].
“We also need patients to access NHS 111 services and get advice early on.
“The acuity of our A&E patients is high – if they were inappropriate [attendances] we would be able to stream them to the urgent care centre [on the same site],” Ms. Button explained.
She added that mental health referrals to A&E were also up by half compared to this time last year.
In July, 79.5 percent of patients attending A&E were admitted, transferred or discharged within the four-hour national standard – roughly in line with recent performance across England.