The “internal major incident” which was declared at Mayday Hospital’s Accident and Emergency department earlier this month was caused by the coincidence of the worst winter for flu-type illnesses since 2009, people not making use of GP surgeries over the Christmas holidays, and a 25 per cent fall in the number of nurses training in London in the past year.
The analysis of the difficulties faced by the borough’s largest A&E was laid out yesterday by John Goulston, the chief executive of Croydon University Hospital, to a meeting of the council’s scrutiny committee.
The internal major incident was declared on January 6 when there were more patients arriving and awaiting urgent treatment than the hospital could cope with. Croydon’s hospital was one of several around the country which appeared to be struggling with patient demand.
Goulston told councillors that respiratory illnesses were worse this winter than at any time since the swine flu outbreak in 2009-2010, with 2015 seeing many cases of child bronchitis and adult respiratory illness.
These illnesses meant Mayday’s A&E was already under strain when the Christmas holidays arrived – with Christmas day falling on a Thursday and setting up the first of two long weekends, patients tended to go straight to A&E, rather than visiting their GPs, even though many local surgeries had arranged for special holiday opening times. GPs reported that their surgeries were quite quiet over the holidays, Goulston told the meeting, while the number of registrars working at the hospital’s A&E was down to two, from six.
“Staffing numbers were flaky,” Goulston said, referring not only to the number of doctors available, but also to the number of nurses, with “multiple vacancies”.
Mayday has long had problems in recruiting permanent staff. Its Thornton Heath location means that the management is unable to offer inner London waiting wage rates to nursing staff. With resulting staff shortfalls, the management has to resort to hiring agency nurses, at greater cost, putting more pressure on the hospital’s creaking budgets.
So with people presenting at A&E, instead of at their GPs, and with a shortage of staff to deal with them, by early January, a crisis was approaching.
On Monday, January 5, there were 13 patients in A&E awaiting admission to the hospital. Within 24 hours, according to Goulston’s report, that number had risen to 28, with another nine patients in the emergency department’s observation ward awaiting beds.
The Emergency Department “was unable to off-load ambulance arrivals in timely fashion”, Goulston reported. “The chief operation officer took the decision to declare an internal major incident. This was in order to mobilise the correct resources at the earliest time of the day to maintain safety and return the Trust to business as usual.”
Goulston went on to suggest that that decision was meant to be an internal one, but the matter was leaked to the press.
Government targets require NHS A&Es to have 95 per cent of patients to be seen within four hours of arrival. On January 5, Mayday was seeing to just 67.7 per cent of patients within the four-hour target. On January 6, that was 88.5 per cent. After a week in “business continuity” after the major incident was declared, there was a reduction in the number of patients attending the emergency department, and the 95 per cent target had been achieved and maintained since.
The emergency in the emergency department is unlikely to help ease the pressure on Goulston and his hospital managers. As we reported earlier this month, Croydon University Hospital is among the country’s bottom 50 performing hospitals.
And Goulston has been criticised directly for spending Trust funds on a legal action over the unfair dismissal of a consultant, Kevin Beatt, who los his job because he acted as a whistleblower over conditions at Mayday.
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There is a fascinating edition of File on 4, the BBC Radio 4 analysis programme, on the Radio 4 website which gives a more complete explanation of the shortage of nurses in hospitals across the country.
It mentions Croydon by name on more than one occasion and reveals specific figures. It also lays the blame for the latest health crisis firmly on the shoulders of hospital managers, whom it claims, instructed universities to reduce the number of nurses in training four years ago as an aid to balancing the books and thereby allowing various hospitals, including Croydon, to apply for Foundation Trust status; then a must-have fashion accessory for every hospital.
Apparently, there was no attempt by these highly paid administrators to assess the future need for nurses; just a calculation of how much money they could save.
Now the chickens have come home to roost. We are spending a fortune on agency nurses and on importing qualified staff from countries like Portugal. It will take an estimated decade to put right this crass piece of mismanagement for which nobody is to blame, it seems, because nobody has lost his or her well-paid job.
The story doesn’t completely square up. True, more people were showing up at A&E rather than their GPs but then we are told there was a backlog of people waiting to be admitted onto a ward. Even if some of those had been seen by their GPs first they would still have been sent to hospital urgently and ended up in A&E waiting for a bed. The problem, as described, appears to be a lack of beds in the hospital causing a backlog into A&E, rather than any capacity shortfall in A&E itself. And as I understand it much of the problem on the wards is caused by the difficulty in discharging people who need continuing care at home: that has evaporated thanks to the cuts in social care provision, or has been spread so thin as to be not enough for the patients’ needs.