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Winter Pressures – Questions and Answers

1) Why are our hospital emergency departments so busy?

Emergency Departments across the UK and Ireland are all facing significant pressures. This reflects an ever rising level of demand for Emergency Department (ED) care.

In the last five years, the overall number of ED attendances in N Ireland has increased by 24%. Significantly, in this same period, there has been a 78% increase in the most seriously ill patients attending (patients triaged in categories 1&2).

This year alone, there was a 15% in category 1&2 patients at our EDs, compared to last year, over the period from Christmas Eve to New Year’s Day.

These are often frail and elderly patients, who can require longer in-patient stays and then more complex social care packages when they are ready to leave hospital. These increases are on top of an already very busy system, and responding to spikes in pressures is increasingly more difficult.

The prevalence of seasonal flu and other respiratory conditions, as well as norovirus at this time of year, has also presented challenges to the system, as has staff sickness. Closely linked to the pressures at the front door of Emergency Departments are the challenges faced in helping patients to return home after a hospital stay. All Health and Social Care (HSC) organisations are working very closely to ensure that the sickest patients are admitted to a bed as quickly as possible, and those who are assessed as clinically fit can leave hospital in a timely way and receive the care they need at home or in a community setting.

2) Does the Health and Social Care service not plan ahead for this?

Considerable preparation has gone into planning for the winter months and this work starts in the summer period. The Department of Health made an additional £7 million available to support Health and Social Care Trusts to put in place additional measures to help alleviate some of the winter pressures in HSC this year.  The plans have included increasing staffing levels and, where possible, opening extra hospital and community based beds.

In addition, extra funding of £1.4 million was allocated this winter to help meet the demand. This has allowed GPs to provide around 75,000 additional appointments (in hours) between December 2017 and March 2018. A further £850,000 was allocated to GP Out of Hours (OOH) providers to help continue to maintain a safe and effective service over the winter months.

Even with this careful planning, the pressures of the busy holiday period resulted in increased demand on top of an already very busy system. Also the level of complex and serious conditions, particularly amongst the growing frail and elderly population; the prevalence of flu, other respiratory conditions and also norovirus at this time of year, staff sickness; and the challenges of helping patients to return home after a hospital stay; meant that some patients have had to wait longer than we would have liked and the HSC would apologise to them for this.

3) Is the answer more hospital beds and more funding?

Whilst we have seen pressures on hospital beds in recent weeks, there have been many patients in hospital, assessed as clinically fit, awaiting to return home or to a community setting. Unfortunately, they have been unable to do so for a variety of reasons, including the pressures currently facing the community and domiciliary care sector, which has impacted on the availability of care home placements and care packages. Also, the growing complex health and social care needs, particularly amongst the frail elderly, has meant that more specialist care is required when a person returns home which often can take longer to organise.

Therefore, there is a need to continue with our transformational plans for HSC in Northern Ireland. Inevitably this will mean reconfiguring services, investing in workforce, providing additional beds in key areas, and developing and enhancing community capacity all of which will require additional funding.

Whilst the number of beds is kept under constant review, increasing permanent beds to deal with seasonal pressures does not always represent the best use of resources or best meet patients’ needs. Patients, who are supported to return to a community or a home setting in a timely way once they are medically fit to leave hospital, will receive the ongoing care they require in the most appropriate place. They will also regain a level of  independence quicker. This will help ensure those patients requiring a hospital bed can access it more quickly.

4) Is it going to get better?

It is anticipated that Emergency Departments and other urgent care services will continue to face pressures in the weeks ahead. This is expected at this time of year and is a similar position to the rest of the UK and Ireland.

Health and Social Care colleagues across Trusts, the Health and Social Care Board (HSCB), Public Health Agency, Northern Ireland Ambulance Service and GP Services are working very closely together to address pressures, and staff continue to prioritise the most clinically urgent patients. Regrettably, those with less urgent conditions will have to wait longer.

5) What needs to happen?

Our core focus is to assist people in avoiding hospital in the first place through helping them stay well. We are also working hard to ensure people, if they require hospital treatment, move quickly and safely through the hospital system and back into the community when their treatment in hospital has been completed.

The public are reminded that they should only attend hospital Emergency Departments for urgent and life threatening conditions. There are a range of alternative services that people can access if they do not need emergency care.  These include using the online A-Z symptom checker, seeking advice from a pharmacist, going to a Minor Injury Unit, or contacting a GP or the GP Out of Hours services (if their medical condition can’t wait until the GP surgery reopens).  People can also check the average waiting times in their local Emergency Department

In the longer term, it is vital we continue to transform Health and Social Care services. We have made a good start in introducing new ways to care for people closer to home (for example hospital at home initiatives), but we need to continue to reform the system in 2018 at pace and scale. This requires continued support from communities and politicians.