29 October 2021

Statement from Nigel Lee, Chief Operating Officer at The Shrewsbury and Telford Hospital NHS Trust

“We are acutely aware of the ongoing impacts the lengthy delays in ambulance handover times are having for some of our patients and would like to apologise to those affected. Both within our hospitals, and alongside the wider local health and care system, we have already taken a number of actions to look to address these, with a number of others in train and planned.

“Given the effects for some of our patients, and the focus on this area following the letter sent from NHS England and Improvement to all hospital Trusts, we wanted to set out in a little more detail the issues that sit behind the current delays and what we are doing to try and address them. We want to reassure you that we are continuing to do everything we can, alongside partners, to deal with the delays and my colleagues are working exceptionally hard to ensure that we offer the high-level of care we want to provide for all those who use our services.”

Issues

  • Demand for urgent care is at unprecedented levels and has been running at these kind of levels for several months
  • Bed capacity/space within our hospitals is extremely stretched, partly due to sustained levels of COVID-19 patients, with any available space already given over to urgent and emergency care
  • The space inside the hospitals (in A&E, and on wards) is also segregated to provide separate COVID-19 assessment spaces in A&E and COVID-19 wards, as well as other space and wards for non-COVID-19 patients. This reduces flexibility between and on both sites
  • Our ability to discharge patients who are fit to leave our hospitals is severely impacted by constraints in local social and home care capacity; length of stay in our hospitals for patients needing additional support at home or in a care home is higher than this time last year – this ripples back through to the space available in the Emergency Departments for new admissions and is therefore a major contributor to the current delays we are seeing with ambulance handover times

Actions taken & planned

  • Joint work with West Midlands Ambulance Service and community partners to reduce conveyances of some patients to hospital, as clinically appropriate, and providing alternate treatment and care whilst at home or in the community
  • Opened a new Same Day Emergency Centre (SDEC) for medicine at the Royal Shrewsbury to divert patients, as clinically appropriate, away from A&E.  We have also expanded the Surgical SDEC capacity at the Royal Shrewsbury for the same reason.  All SDEC units receive ambulances directly for suitable patients
  • Provided booked slots for 111 patients to be seen and treated in SDECs and Urgent Treatment Centres to avoid times of peak demand
  • Joint work with the ambulance service to understand and assess the clinical risk of all ambulance patients at the A&Es and ensure that patients are offloaded in clinical priority order, followed by longest wait
  • Action taken internally to improve patient ‘flow’ through the hospital to enable earlier/more timely discharge of patients to create bed space
  • Working closely with health and care system partners to look at additional community and social care capacity to support timely discharge and create bed space to take patients from A&E
  • Used all possible additional escalation capacity on both sites, including using part of the Day Surgery Unit Princess Royal for inpatient medical patients
  • Construction underway on a new modular ward to add additional capacity at the Royal Shrewsbury site – 32 additional beds by Spring 2022
  • Undertaking a £9.3m upgrade of our Emergency Department at the Royal Shrewsbury Hospital to increase capacity and upgrade facilities within A&E, adding 11 additional cubicles – phase one of this work has finished, the larger clinical areas will be complete by Christmas, and all areas finished by early Spring 2022
  • Longer-term, the Hospital Transformation Programme, which will reconfigure the delivery of our services, including A&E, is explicitly designed to address the kind of pressures we are currently experiencing by creating a new, dedicated and larger emergency care site

Notes to Editors

We would urge everyone, if they are considering attending A&E, to ask themselves if the emergency department is the right place to go for the care they need. A&E is for genuinely life-threatening emergencies – for example chest pains or severe bleeding or burns – with a whole range of other options across the NHS and healthcare system for medical matters that fall outside these.

GPs’ surgeries are open; the 111 service – including online and via the NHS app – is available to help if you have an urgent medical problem and aren’t sure what to do; pharmacies – which are staffed by trained medical professionals – can assist with a wide range of issues; and urgent treatment or minor injury centres are available across the region.