SPECIAL REPORT: The challenge facing Northampton General Hospital to cope with winter

Northampton General Hospital Billing Road entrance. ENGNNL00120121206174934
Northampton General Hospital Billing Road entrance. ENGNNL00120121206174934

Northampton General Hospital has introduced a number of measures to reduce the pressures over winter...but will it be enough?

Weather-wise this Christmas could be among the best ever.

Northampton General Hospital South entrance. ENGNNL00120121206174720

Northampton General Hospital South entrance. ENGNNL00120121206174720

But that doesn’t mean the forecast for Northamptonshire’s hospitals will be particularly cheery. In fact many experts predict the NHS will have its worst winter in 30 years in terms of numbers of patients needing treatment.

Why? Well, the weather may be nice and mild now, but over the course of the whole season, dipping temperatures lead to trips and falls, flu, hypothermia and other myriad complications.

The fact that numbers of elderly patients with complex conditions keep relentlessly rising regardless of the month, means staff are fearing the worst.

But that is not to say our NHS bosses are simply waiting for the tidal wave.

One of the best ways to stop a crisis before it gets to hospital ward level is to make sure people with the likes of bugs and muscle strains are advised to see it out at home.

With the frontline of the NHS now the 111 call centres, bosses have taken steps to overstaff the rotas.

Call takers have had leave cancelled between mid December and mid-January and some have even been primed to work from home.

And, in the event of heavy snow, four wheel drive vehicles are on standby to ferry workers to their stations.

If the focus is on stopping people jamming the waiting rooms with non-life threatening injuries, one of the best places to intercept people is near Northampton’s Bridge Street.

The volume of medical problems increases with the amount of drink consumed, not all of it serious. For that reason, East Midlands Ambulance Service is setting up its ‘field hospital’ service outside All Saints Church on the busiest nights, guaranteeing shorter waits than emergency departments while freeing paramedics for serious calls.

Yet it is guaranteed that however hard the ambulance service or 111 tries, huge numbers will turn up at hospital anyway, in many cases justifiably so.

Between 2010 and last year, numbers of genuinely urgent NGH cases rose by over a


Hospital bosses have opened 31 extra beds in ‘escalation areas’, essentially specialist outpatient departments intended for a narrow band of patients, stretching the site to its very limits.

Even this is unlikely to be enough to allow doctors and nurses much comfort, however.

The extra areas have this year been open since September but the sight of patients waiting in accident and emergency for a bed has been far from rare.

“Based on current estimates,” says Carolyn Fox, director of nursing, in her winter report, “NGH will require an additional 60 beds to cope with the expected pressures over the winter months.

“These will have to be sourced externally as there is no further capacity internally for inpatient escalation areas.”

And this is where we near the point where the machine begins to stall.

Yes, people are taken out of the system over the phone and outside All Saints Church.

And, yes , NGH can ‘expand’ to squeeze extra patients in.

The patients who get in even get the expected level of care.

But getting those patients home again is the biggest problem of all.

Care homes, community health staff, private ambulances – all the essential cogs in the discharge machine –were never set up to be whirring at all hours every day of the week.

And now they have to be ramped to the level of a huge NHS juggernaut.

Here is where the plan has fallen down time and again over the last few years, partly because the level of intensity in a large acute hospital is not the same as community health. Some, like NGH chief Dr Sonia Swart have suggested that joint ‘bed-blocking’ targets – instead of one for the hospital alone – may help.

And this year’s Winter Plan admits that, in 2014, some organisation struggled to cope with the influx “while others were not necessarily at the same stage of escalation.”

In simple terms, the NHS and social care in Northamptonshire have to work together, escalating and de-escalating at the same time, not in relay.

That is far easier said than done, with such a fragmented social care system made of many private companies overseen by financially crippled county council.

But if a perfect storm not seen in decades is to be avoided, this is where the plans must be perfect in communication and execution.

If health bosses can deliver that, they will make sure our NHS has happy new year and not a winter of discontent.