By Ian Dipple Friday 13 September 2013 Updated: 13/09 12:32
HEALTH chiefs have insisted they can avoid a repeat of the crisis which gripped the county’s A&E departments last winter, despite concerns the system is under prepared.
Worcestershire Acute Hospitals NHS Trust has asked commissioners and NHS England to stress test the county’s winter plan, as they remain to be convinced measures being put in place will reduce demand on emergency departments and control admissions to hospital, which spike during colder weather.
More than 3,300 extra patients were admitted through the county’s A&E departments last year and admissions have increased by 35 per cent over the last decade, although they are lower than the national average.
The pressure the system was under last winter led to the Trust failing to hit the four-hour A&E waiting target for six months in a row, patients queueing in corridors waiting to be treated and a warning from a senior A&E consultant at the Alex that safe care could no longer be guaranteed without drastic action.
But despite a raft of measures being put in place Trust bosses are still unconvinced, particularly as they have more than 40 winter beds already open. Delays in the wider health and social care system mean they continue to struggle to move people out of hospital when they no longer need acute care.
Chief executive Penny Venables said they had to take a cynical stance until they were reassured by commissioners.
“We really need some more evidence these schemes will work because we do have to keep the door open every day.”
Stewart Messer, chief operating officer at the Trust, added: “If they were successful in doing this it will be bucking the trend on the last few years and through the breadth of the country.”
But commissioners say the measures they have put in place are already working to reduce demand.
Last year over £1million was invested in 13 schemes which reduced A&E attendances by 1,447 people – there were 1,345 fewer unplanned hospital admissions and 16,667 bed days saved.
The schemes have now been commissioned to run either throughout the year or to be reintroduced for this winter.
A&E attendances at the Alexandra Hospital are down over five per cent between April and September 9 from 24,781 in 2012/13 to 23,523 compared to the same period in 13/14, and admissions have fallen by almost seven per cent.
An extra 60 beds have been put into the system and Redditch and Bromsgrove CCG is planning to invest an additional £225,000 in admission prevention schemes.
In a statement Redditch and Bromsgrove CCG, said: “The plan is robust and requires all the local health and social care partners to work together to deliver it.
“NHS Redditch and Bromsgrove CCG is confident the CCGs winter plan will help hospitals cope with a seasonal surge in demand. In recent months WAHT has done really well and improved A&E performance substantially.”
HERE are some of the schemes Redditch and Bromsgrove CCG is introducing to reduce demand on the county's A&E departments.
GPs in ambulances: The scheme sees doctors work with paramedics to look after patients in their own homes instead of taking them to hospital if it is not necessary. Between last October and this August 300 GP in ambulances attendances in Redditch and Bromsgrove, resulting in at least 150 people avoiding being taken to hospital.
The scheme is being expanded for this winter with GPs attending in ambulances more of the time and at the busiest periods.
Virtual Ward: This replicates hospital wards in the local community and is split into red, amber and green wards.
Red ward patients are those who are acutely ill but are managed in a community setting rather than being taken to the Alex or Worcestershire Royal. Amber ward patients are those with increased needs such as physiotherapy and rehabilitation and Green ward patients are those who are known to be at risk of being admitted to hospital and measures are put in place to manage their condition effectively to prevent that occurring in the future. The scheme is being expanded to provide dedicated medical cover to support people through their red ward experience and enhanced medical support to look after them at home. If they require a hospital stay doctors will follow them through their journey to the Cottage Ward at the Princess of Wales Community Hospital, supporting the discharge process.
Advanced Nurse Practitioner: Having an ANP in A&E at busy times will allow patients to be treated who need primary care rather than a hospital service or to divert them to the Out of Hours GP service.
It is estimated this could reduce A&E admissions by 20 per cent or 164 patients.
Care Homes: All care homes in Redditch and Bromsgrove are aligned to a GP practice that provides regular visits and reviews to residents. It is has been extended to provide medical cover to people temporarily placed in care homes by the social care system and who are outside the boundary covered by their registered GP. Patients are registered on a temporary basis and are reviewed to assess their needs, provide enhanced support and avoid readmission to hospital.
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