The United Lincolnshire Hospitals NHS Trust (ULHT) say they cannot confirm that Grantham Hospital will continue to admit patients 24 hours a day, under proposals for it to become an urgent care centre.
Both the current situation at the hospital and plans for its future formed part of a presentation by ULHT managers to a full meeting of South Kesteven District Council.
After explaining that eight to 10 consultants per 24-hour A&E site is the standard expected by The Royal College of Emergency Medicine, ULHT’s medical director Dr Suneil Kapadia said: “At Grantham we have two consultants, both are locums, and that’s been the case for the last five years. And they are trying to provide a 24-hour service, seven days a week. That’s really not a viable composition, and it never has been.”
As part of the ongoing Lincolnshire Health and Care (LHAC) consultation between all of healthcare providers in the county, being undertaken due to the prospect that in five years they will see a £350 million deficit if nothing changes, it has been proposed that Grantham Hospital is designated an urgent care centre, treating only minor illnesses and injuries.
The current national recommendation is that an urgent care centre would be open for a minimum of 16 hours a day, with the potential for some to remain 24/7. When asked if Grantham Hospital would remain open 24 hours, a spokesman said: “It is too early to say.”
During the presentation to SKDC, Dr Kapadia said: “The numbers coming into Grantham’s A&E are very small, representing just a handful per day.”
Furthermore, it is projected that the numbers of A&E attendees at the hospital will decrease by 13.9 per cent from 28,657 in 2014-15, to 24,668 in 2018. However, this was challenged in light of plans for Grantham’s population to increase by 30 per cent, to 60,000 by 2026.
Mayor of Grantham Coun Jacky Smith asked: “Have the projections that you have made have taken into account the planned growth of Grantham and the considerable increase in the population that we’re expecting over the next five, 10 years and even further?”
In response, Dr Kapadia said: “It has to be balanced by the work being done by the clinical commissioning groups (CCGs) to increase care closer to home, in trying to provide alternatives to an emergency department. There’s a lot done in an emergency department that doesn’t need to be done there.
“The other thing to reflect is, as seen with the ambulance crews where there is a 50/50 chance of needing treatment elsewhere, rather than having two journeys we are actually going to the desired A&E department first time round.”
Both Dr Kapadia and ULHT’s acting chief executive Kevin Turner highlighted the issue of ‘bed blocking’, stating that at any one time 1 in 10 patients at Lincoln, Boston and Grantham are ‘medically fit for discharge’.
The consequent lack of beds has seen the number of operations cancelled on the day, or the day before, in the first quarter of this year nearly double from the year before, to 930.
Mr Turner said: “I hold the view that this will only work if we can have in our beds at any one time only those patients who need to be receiving acute and specialised hospital care, which is why we are working very hard with our county council colleagues, and other providers, to reduce the number of ‘bed blockers’.”
However, it was also pointed out by councillors that Lincolnshire County Council is having to make savings in adult social care.
Coun Charmaine Morgan, chair of SOS Grantham Hospital, asked how ULHT can say it has best served people’s interests when “after a succession of managerial reviews have successively degraded the services at Grantham Hospital, resulting in lower numbers of patients, the loss of the maternity unit, issues around staffing and retention of staff”.
She added: “Can you tell people how the hospital trust has best served their interests and provided quality and provision of care, especially when we consider that blue light ambulance crews are telling us that the journey time to Lincoln Hospital in peak time can exceed one-and-a-half hours, and in fact we would be better off not putting our faith in Lincolnshire but moving our services to Nottingham?”
To this Mr Turner said: “Journey times are a particular challenge for Lincolnshire given our rurality and our geographical footprint, but we always consider journey times in the context of what the national specialisations tell us about the appropriate amount of time.”
They also say that they are looking to substantially increase elective, or planned, care, at Grantham, and went on to stress that no final decisions have been made. Recommendations are subject to ratification by the ULHT board and LHAC partners, while also being overseen by NHS England. Proposals go out for consultation in February.