Non-urgent operations cancelled to reduce A&E times

Wrightington, Wigan And Leigh NHS Foundation Trust axed elective surgery during March, unless it pushed patients’ waiting times past 18 weeks.

It is one of the things being done to improve the performance of the A&E department and free up beds.

A&E at Wigan Infirmary failed to meet the target of seeing 95 per cent of patients within four hours every month since October 2015.

And provisional figures now published show it was also missed in February - although the 83.89 per cent performance was an improvement on 79.59 per cent the month before.

Jon Rouse, chief officer of Greater Manchester Health And Social Care Partnership, wrote to all A&Es to ask how they planned to return to above 90 per cent.

A response detailing the plans was sent by Trish Anderson, chief officer of NHS Wigan Borough Clinical Commissioning Group, and Dr Sanjay Arya, the trust’s medical director.

They wrote: “As you would expect, the aspiration of Wigan locality is to treat every patient within four hours of attendance at A&E given the well documented links with poor patient outcomes and long waiting times in A&E.

“We acknowledge we have not always been able to provide the level of care we would wish for all patients and, as such, senior representatives from the Wigan A&E Delivery Board met to agree an improvement plan with clear actions and priorities to improve performance during March which can be sustained into 2017/18.”

They are looking at ways to reduce attendances, such as working with the ambulance service to find out why some patients are discharged from A&E without treatment and directing people who go to A&E regularly to community services instead.

Work will be done with nursing and residential homes and the integrated community service could be extended to reduce admissions.

Bed closures have had a big impact in the past four months “due to a series of infection outbreaks”, with one 14-bed ward closed due to norovirus at the time the letter was written.

The trust has 457 beds in total, with 348 of those at Wigan Infirmary and the rest at Wrightington Hospital and Leigh Infirmary.

Bed occupancy at Wigan Infirmary “remains at a constant 98 per cent”, the letter says. Before the ward closure, the average performance for the week was 92 per cent, compared to 87.4 per cent nationally, and the trust had the 36th best performing A&E in the country.

Steps are being taken to “bring the hospital back to safe operating levels and improve A&E performance”.

This included cancelling non-urgent elective surgery at Wigan Infirmary, but the trust’s other sites were not affected.

Other action involved discussing every acute admission through A&E with a consultant before they are admitted and ring-fencing assessment areas.

Earlier this month, we reported that 208 operations were cancelled at the last minute by the trust between October and December. And 23 of those patients - 11 per cent - were not treated within 28 days of that cancellation.

Andrew Foster, chief executive of the hospital trust, said: “The acute site, Royal Albert Edward Infirmary, has been under intense pressure during March and indeed throughout the whole of 2017 so far. This has led to an increase in demand for acute and emergency beds.

“During these high demand months, a decision was taken to defer the majority of routine elective cases which required an overnight stay.

“In taking this proactive step we have been able to reduce the need to cancel operations on the day, but more importantly, we have been able to provide beds for all patients needing cancer and emergency care.

“We understand the upset, frustration and inconvenience that cancellations and re-prioritisation of operations must cause for our patients and their loved ones. The decision to cancel or defer operations is always a last resort and a decision taken with patient safety at the forefront. It is our intention to prioritise those patients, who have had their operations cancelled, in line with NHS standards.

“It is difficult to anticipate how long the pressures will last for. We are planning and preparing for ‘normal’ service to resume in April. However, we must remain responsive to changes in demand to safeguard those in most urgent need continue to receive the care and treatment required.”

Dr Tim Dalton, chairman of NHS Wigan Borough CCG, said: “We fully supported the hospital’s difficult and very rare decision to cancel routine non-urgent surgery for March. Surgery was performed in all emergency cases, for those with serious illnesses like cancer, and for those patients whose wait for treatment was approaching the maximum amount of time (18 weeks from GP referral).

“It has been well publicised that A&E has been under a great deal of pressure in recent months and we needed to make sure that patient care continued to be safe and of a high quality. Cancelling some operations for a short period of time released staff and beds to support A&E and concentrate on caring for those most in need.

“Obviously, cancelling operations is not a long-term solution to relieve the pressure at A&E.

“It is therefore one of a number of other changes made which have started to reduce the pressures in the last couple of weeks.

“We have been working closely with the hospital and other NHS and council teams to work out a long-term fix that include ways to reduce the number of people attending A&E and reduce the length of time people stay in hospital. Over the coming year we will all be working hard to implement our joint plans and transform local services.

“I would like to add my personal thanks to all our staff, both in the accident and emergency department and also across the broader health and care system.

“They have all somehow worked even harder whilst still showing tremendous compassion at a difficult time.

“I ask our public to support them by seeking help if they become poorly in the most appropriate way possible and by avoiding attending going to the accident and emergency department unless they have a life-threatening or serious illness or injury.”