Health boss warns of system under 'immense pressure' and highlights efforts to tackle problems

The comments come from Nick White, the Chief Medical Officer for NHS Shropshire, Telford and Wrekin, who was responding after the Shropshire Star's report into the strains facing the NHS in the county – and across the country.

He has spoken of the steps being taken to tackle the problems – in an effort to free up GPs and ambulances, to cut delays at accident and emergency units, and improve the discharge of medically fit patients into the community.

All areas have faced massive pressure and a resulting decline in performance, with workers describing the current situation for staff and patients as the worst at any stage in their career.

Mr White said all of the county's health organisations are working together in a bid to address the issues – and specifically thanked staff, and patients across Shropshire for their support.

The chief medical officer described how services were being hit by a combination of issues.

He said: "This winter is one of the toughest on record with Covid-19 case still presenting, flu circulating in the community, industrial action and long ambulance waits and handover times. On this basis I would like to thank staff across the health and care system and the public and patients for their continued support.

"It’s not just one part of the health and care system that is affected, all elements are under immense pressure – primary, secondary and social care. This impacts on everyone from our care workers delivering domiciliary care in people’s homes, our GPs, community services through to our hospitals.

“All partners are working together to address these whole-system issues that affect winter pressures to ensure patients are kept safe and can access care when and where they need it."

Mr White said they had taken measures to address the pressure, highlighting an increase in the number of appointments across primary care.

Shrewsbury & Telford Hospital NHS Trust (SaTH), which manages both Royal Shrewsbury Hospital and Princess Royal Hospital in Telford, is one of the worst performing in the country when it comes to A&E waiting times.

The trust bosses are awaiting permission to start on long-awaited £312m plans to reorganise the hospitals which they say could transform care.

Mr White has highlighted that despite the wait for approval on the 'Future Fit' Hospitals Transformation Process, a number of initiatives and new units have been brought in to try and improve performance at SaTH, and relieve pressure.

One of those measures is the creation of an 'Acute Assessment Floor'. It has recently opened at the Royal Shrewsbury Hospital (RSH) and provides an expanded medical assessment area, where the trust is able to receive direct GP admissions – meaning the patients no longer have to go to A&E.

The ongoing issue of ambulance handovers has been a major problem at both hospitals – with some of the worst delays across the West Midlands, and some patients even waiting more than 30 hours in the back of an ambulance outside hospital.

Mr White referenced special 'Ambulance Decision Areas' set up at both PRH and RSH to try and relieve the problem.

The areas are staffed by paramedics and emergency department workers who look after patients within the hospitals rather than on ambulances, to free up paramedics to respond to new emergency calls.

Mr White said that joint work was also taking place with ambulance services to "understand and assess the clinical risk of all ambulance patients" at the A&Es to make sure that the most urgent patients are dealt with in priority order, followed by longest wait.

He added that ambulance and community partners were working together to provide the "appropriate care in the right setting" via Rapid Response teams, helping to prevent unnecessary hospital admissions.

Work has also been carried out at RSH and PRH to allow more patients at A&E, as well as in wards at Shrewsbury, while action has been taken internally to improve patient ‘flow’ through RSH and PRH to enable earlier or more timely discharge of patients – helping create bed space for patients needing admission from the Emergency Department and assessment areas.

Other measures include diverting patients, as clinically appropriate, to Same Day Emergency Centres (SDECs) and Urgent Treatment Centres – and providing booked slots for 111 patients to be seen and treated in SDECs and Urgent Treatment Centres to avoid times of peak demand.

Measures to keep people out of hospital include a virtual ward allowing patients to get the care they need at home safely and conveniently, rather than being in hospital, and nursing and therapy in-reach teams to care homes to facilitate additional discharge.

A Winter Control Room has also been set up which uses multi-agency data to respond to pressures across the county as health and social care services.

Mr White also said that specific measures were being implemented to address the discharge of patients who are fit to leave hospital.

He said: “In addition, a great deal of cross-system work is being done to improve the discharge of medically fit patients from the hospitals into the wider care system, to create much-needed capacity within the hospitals, which will positively impact handover delays.

“Our focus is across the three pillars of our improvement work: Community-based initiatives to better support people in their own homes; Changes to processes and systems that improve the patient journey through hospital; Discharge out of hospital and community/social care support.

“Addressing these three areas together will enable us to help more people stay well in their own homes for longer, and ensure that those who do need acute care can access it in a timely fashion.”