Preston and Chorley hospitals postpone some non-urgent ops - and stop booking any new ones
The trust which runs the Royal Preston and Chorley and South Ribble Hospital has temporarily stopped scheduling all new, non-urgent, pre-planned surgery because of pressure caused by the pandemic.
The Post understands that Lancashire Teaching Hospitals NHS Foundation Trust (LTH) has also been forced to postpone some non-urgent procedures that had already been booked in - although others are still going ahead.
Cancer-related care and other urgent operations are also continuing and are being prioritised along with Covid patients and those needing emergency treatment.
Some existing outpatient appointments have also been postponed, with certain clinics not currently making any new bookings either.
The trust is in the process of writing to all affected patients and will also advise them of what to do if they have any concerns, so there is no need for patients to contact the hospitals speculatively.
It is understood that the decision has been taken to enable LTH to open additional critical care beds and redeploy the necessary staff to care for those in them - which include patients from elsewhere in Lancashire and South Cumbria.
That is part of an established system of so-called “mutual aid” which enables trusts from across the wider region to support each other.
The Post has seen internal NHS data reflecting the intense pressure that the system as a whole is currently under in Lancashire - and which has led to the implementation of a transfer service to facilitate the safe movement of patients between trusts within the county when necessary.
According to a document distributed earlier this week, critical care capacity across Lancashire and South Cumbria has recently been increased by 85 percent, with 150 beds now available.
Yet even with that escalated number of beds open, critical care was still running at an average 90 percent occupancy over the seven days to 20th January.
That figure reflects both Covid and non-Covid patients - but it is virus-stricken individuals who make up the overwhelming majority in critical care, with numbers ranging between 90 and 103 across that week.
The document reveals that all trusts in Lancashire and South Cumbria have so-called “super surge” critical care beds open at the moment - but Blackpool Teaching Hospitals NHS Foundation Trust and East Lancashire Hospitals NHS Trust both have what is described as “super, super surge” facilities in operation.
Kevin McGee, the chief executive of the two organisations, admitted earlier this week that their intensive care, high dependency, critical care and enhanced care units "are at bursting point".
In that context, it is perhaps unsurprising that LTH is currently providing region-wide assistance. The trust - along with those covering East Lancashire and Lancaster and Morecambe Bay - has also opened additional “enhanced respiratory care” beds, which are used to relieve the strain on critical care units.
There have been embryonic signs of the start of a drop in Covid patients in critical care since the start of this week.
However, the total number of Covid patients across all hospital beds in Lancashire and South Cumbria was still heading in the wrong direction at that point. An internal NHS graph seen by the Post showed the overall figure hovering at around the 775 mark, but with a slower upward trajectory than was the case earlier in the month.
Meanwhile, the proportion of deaths linked to Covid-19 continues to rise in Lancashire - last week, 36 percent of the 491 deaths registered in the county were coronavirus related.
The current strain on the NHS in Lancashire appears to be a reflection of the surging rates of infection which had taken hold in the county until recent days. The case rate per 100,000 people peaked at 567 in the week to 8th January - the highest since the pandemic began - but had fallen to 501 by the seven days to 16th January.
When approached by the Post, LTH confirmed the situation regarding the postponement of some non-urgent procedures and outpatient clinics and its pausing of all new non-urgent, elective surgery and some outpatient appointments, but did not provide any further comment.
Lancashire and South Cumbria’s integrated care system (ICS), the regional partnership of health and social care organisations, referred to a statement it issued last month on expected winter pressures, in which Dr. Amanda Doyle - its chief officer - said:
“Winter is always a challenging time for the NHS and wider social care services. This year, as we continue to respond to Covid-19, it will be harder than ever.
“In response to this, all hospitals within Lancashire and South Cumbria continue to work together and have plans in place to manage increased demand on our services.
“Anyone with concerns should continue to come forward for help and treatment. It is important that unless you are contacted, you should continue to attend appointments as planned,” Dr. Doyle added.
The Patients’ Association says that the best way of securing NHS care for all patients is to keep Covid infection levels down.
"To prevent the NHS from being overwhelmed to the point where it has to cancel routine services en masse, decisive early steps must be taken whenever infection rates start to increase – acting later will be more costly, and less effective,” the organisation's position statement on patient care during Covid-19 reads.
"When planned treatment does have to be cancelled because of rising numbers of Covid-19 cases, the NHS must understand the impact on all patients, and act in response.
“This means clear communication to patients whose treatment is cancelled or postponed, and giving clear expectations about what might happen next. Extra support to help people remain as well as possible in their own homes should be provided when possible.”
YEAR-LONG WAITS RISE
Even before being forced to make Covid-related postponements and put the booking of some new appointments on hold, the pressure of the pandemic on Lancashire Teaching Hospitals’ non-virus work - like that of the wider NHS - was already apparent.
Data obtained by the Health Service Journal shows that 4,825 patients had been waiting 12 months or more for routine treatment as of 3rd January this year.
Published NHS figures show that in January 2020 - before the effect of the pandemic began to be felt - there was just one LTH patient who was in that position.
LTH now has a greater proportion of patients on its waiting list who have been there for a year than any other trust in the North West - 10.7 percent.
The trust’s total waiting list as of November 2020 stood at 42,160 - up from 35,610 in January that year, a rise of 18 percent.
However, LTH is far from alone in the challenge it will face to clear a mounting backlog when the strain caused by coronavirus finally begins to ease.
Across England, the overall waiting list stood at 4.46 million at the end of November 2020 - the highest figure since records began in 2008. More than 192,000 of those patients had been waiting a year.
Professor Stephen Powis, NHS England's national medical director, said the figures were a stark reminder of the “exceptionally tough challenge” facing the health service.
He added: “Despite 2020 being the year of Covid, nearly 20 million people received emergency care in England’s A&E departments, while in November alone - as Covid-19 was spreading more rapidly - patients still benefited from four million important elective treatments and essential checks on the NHS.”
However, Professor Neil Mortensen, president of the Royal College of Surgeons, said the data showed the “calamitous impact” of the “hidden waiting list building up under lockdown”.
“For thousands of people in this country, a corrective operation is the best way to relieve debilitating pain and get them back up on their feet, back to work and enjoying life again.
“Many of us were complaining about the pain of the lockdown restrictions in November. However, we should remember all those people waiting for an operation who had their physical pain to deal with, on top of the pain of lockdown.
“When we eventually emerge from this crisis, we will need sustained investment to treat all those who have been waiting patiently for treatment.”