WARRINGTON & Halton Hospitals £4.3m allocation from the national ‘winter’ pot has provided a “huge boost” to expanding the Emergency Department at Warrington Hospital as patient numbers return to pre-COVID-19 levels.
More than 270 patients attended the ED at Warrington on Monday, August 17, the highest number for over six months and a real indicator that things are returning to pre-COVID levels when it comes to emergency work.
Warrington & Halton (WHH) was allocated £4.3m of a £300m national pot to expand and redevelop the Emergency Department and a bigger Assessment Unit/Plaza. Allocations ranged from £9m to £200K for 117 acute trusts; with WHH receiving the 13th largest allocation nationally and the most in Cheshire and Merseyside, recognition that the Emergency Department is too small to manage the number of patients they routinely look after, especially in the COVID-19 era when the separation of flows and spacing of patients is at the core of good infection control.
WHH Chief Executive professor Simon Constable said: ” This is a huge boost to expanding our Emergency Department and the creation of an enhanced assessment unit in Appleton Wing which will enable us to bring together a range of clinical specialists to provide 24/7 access to diagnostics and assessments for patients.
“As well as being able to upgrade our hospital facilities, this will help to alleviate the pressures on our emergency department and ensure that strict infection control and social distancing measures can be put in place to ensure our urgent care services continue to provide a safe environment for both patients and staff throughout the winter period.
“While there is still much work to be done, plans are already advanced and we hope to start work as soon as possible on the expansion works – all part of our strategy of making the best of what we have got until the long term plan for our hospital development is worked through.”
It is one of a number of initiatives taking place at the Trust which has been selected as one of the first NHS111 First Mover sites.
NHS111 First – Early Mover site
NHS 111 First is a national programme which will encourage the use of the NHS 111 service to access a range of urgent care services including, for the first time, direct booking of slots in A&E (ED).
NHS 111 First aims to ensure that patients can access the clinical service they need, first time, both in and outside of hospital, with the convenience of a booked appointment or time slot for ED or an Urgent Care Centre. Importantly, it will help to reduce the risk of transmission of COVID-19 for patients and NHS staff by reducing crowding in waiting areas across services.
This a new initiative and each region had to select ‘first mover’ sites to roll out NHS 111 to ED, following a request from NHS England in mid-July. First mover sites in the North West will be Blackpool, scheduled for 25 August, and Warrington, scheduled for 8 September. A number of ‘fast follower’ sites have also been identified to roll out NHS 111 First between 10 October and 23 November with a national target to have slots for ED and urgent care bookable by NHS 111 First implemented across all areas by 1 December 2020.
From 8 September NHS 111 First will encourage patients in Warrington and Halton to call NHS 111 in the first instance if they need urgent, but not emergency, NHS care. Patients will still be encouraged to dial 999 in life-threatening emergencies and contact their GP practice directly online (via eConsult on their surgery website) or via phone if they need to access services at their surgery. If appropriate, NHS 111 can book time slots for patients at local urgent care centres, the emergency department at Warrington Hospital and other NHS services.
Patients who do attend urgent care centres or Warrington Hospital ED without a booked time slot will NEVER be turned away. Local processes will be developed over time to help manage the flow of patients by appropriately streaming patients to other health services in addition to urgent care.
NHS 111 First has many patient benefits including:
·Reducing the risk of infection in crowded waiting rooms
·Greater convenience for patients by being directed to the right care, in the right place
·Booked time slots will reduce waiting times for patients and in many cases, patients will be able to access care closer to home
·By managing attendances in the ED during the winter months, NHS 111 First will help reduce pressures on the system and support our ability to cope with increased demand
·It supports the move to Urgent Treatment Centres – following a public consultation exercise, NHS Widnes Urgent Care Centre and NHS Runcorn Urgent Care Centre will move to become UTCs on 1 October 2020. Part of this change involves patients being able to access booked time slots at UTCs via NHS 111.
A wide-ranging local communications campaign will launch in September to support the changes. It will involve promotion on NHS and partner websites and social media, press releases, posters, leaflets and advertising. There will also be wider regional communications from NHS England to detail the approach across the North West and from November it is expected there will be a national communications campaign as more sites go live.
NHS 111 First is a whole system project that is being co-ordinated by NHS Warrington Clinical Commissioning Group, NHS Halton Clinical Commissioning Group, Warrington and Halton Teaching Hospitals NHS Foundation Trust, North West Ambulance Service NHS Trust, who deliver the NHS 111 service, NHS England, Bridgewater Community Healthcare NHS Foundation Trust, GPs and other local healthcare providers. Although Whiston Hospital is not part of the first mover programme, St Helens and Knowsley Teaching Hospitals NHS is set to go live with NHS 111 First before the end of the year.
Car Parking – improving experience for patients, visitors and staff
In March 2020 the Trust suspended all car parking charges for patients and staff. There are no immediate plans to reinstate charging for either patients or staff.
However, as patients begin to return for appointments and treatments the Trust is seeing a resurgence of the significant pre-COVID parking issues yet activity is not fully restored and almost all visiting is still suspended. The situation is especially critical at Warrington although Halton is beginning to experience the same concerns as they move more and more elective activity to the ‘COVID-secure site’.
There was an 11.6% year on year increase in total vehicle movements on the Warrington site in 2019 with 1.47m vehicle movements. On the busiest days there are circa 1900 cars on site at anyone time, with space for only 1400. In a post-COVID world another increase like this will see the site become at risk. In addition, environmental concerns about vehicle use has a much stronger platform post-lockdown.
Professor Constable added: “We need to act now to resolve these long standing parking issues which generate such angst and negative feedback from patients, visitors and staff and affect everyone’s experience and perceptions of our hospitals. To this end, we are launching a Trust-wide exercise throughout September to involve our staff in helping suggest and shortlist permanent solutions to our car parking situation. We will then take the shortlist further to our patients, public and stakeholders for further input.
“To reiterate, this engagement work is about SPACES not CHARGES.”
Green Pathways and ‘COVID-secure’ sites
Patients need to be able to have confidence that it is safe to come into hospital for surgery and it is key that the Trust has the processes and pathways in place to instill this confidence. They started a ‘green’ pathway on B18 for urgent elective cancer patients at Warrington by creating a designated ‘green’ theatre and recovery area. Since May, 150 patients have been cared for via this ‘green’ pathway.
Work has begun to mirror this pathway at the CMTC at Halton (the soon to be renamed Captain Sir Tom Moore Building – or TMB for short) for patients who require Trauma & Orthopaedic and Breast surgery. Confidence in the system has been demonstrated by patients themselves and the surgical teams caring for them. Patient and public involvement will be factored in to ensure that the Trust is optimising the patient experience as they develop the Halton elective programme further.
Professor Constable said: “We are working at pace through our recovery programme using these ‘green’ pathways and so far Endoscopy, trauma & orthopaedic ambulatory, trauma & orthopaedic elective and outpatients are all up and running, as are general surgery outpatients, oral surgery, orthodontic surgery, audiology and ophthalmology services. There is also the commencement of elective surgery for urology and ENT patients at CMTC, and the restart of paediatric elective surgery, the chronic pain service and gynaecological surgery.
“We are currently developing a 4-bed Post-Anaesthesia Care Unit (PACU) at CMTC/TMB which will provide higher level enhanced care enabling patients with a higher anaesthetic risk to have their surgery there – moving more surgeries from Warrington and freeing beds up for unplanned, emergency care.”
Spotlight on Safeguarding
The Trust’s Safeguarding Team has led a targeted ‘Spotlight on Safeguarding’ campaign during August with virtual learning sets each day and the launch of a domestic violence awareness campaign. The Silence hides Violence campaign closes three weeks of thought-provoking and powerful awareness and education sessions reflecting the unintended and often unseen consequences of the COVID-19 lockdown. It is estimated lockdown containment measures have resulted in a 77% increase in reports of domestic violence nationally. Tragically, in the first three weeks of the UK’s lockdown, 16 women and children were killed in their own homes, 11 more than the same period last year.
Safeguarding almost always requires a multi-agency response and the Trust is working with partner agencies, including the national NHS Safeguarding team, to raise awareness of the impact of COVID-19 pandemic on domestic violence, alcohol abuse, fabricated induced illness and the additional support that families will need to cope as they face the future.
While children have not been affected by the virus to the same extent as adults, the lockdown restrictions will have significant impact on their learning, development and wellbeing which will become apparent when they return to school in September. The Trust is already experiencing a rise in the number of complex adult patients requiring safeguarding support admitted into the hospital. Spotlight on Safeguarding has been an opportunity to share learning and best practice with staff and partner agencies as well all prepare for further challenging times.
The Trust has launched a toilet-door poster campaign at its hospitals with helpline information available for those who may be experiencing domestic violence provided by the Warrington Independent Domestic Violence Abuse (IDVA) and the National Domestic Abuse Helpline, highlighting the support for those who need it as well as reassurance that they ‘are not alone’.
Project Wingman leaves a Legacy at Warrington Hospital
Project Wingman – Aircrew supporting the wellbeing of NHS Staff – landed right on schedule at Warrington Hospital’s Kendrick Wing as they worked through the Covid-19 pandemic and has had over 15K staff visits since the lounge opened in May 2020.
Wingman is a national programme and was established at over 80 hospitals around the UK with Warrington Hospital being the first to open in the Cheshire and Merseyside region. Airline crew from every UK airline that are furloughed, grounded or made redundant due to the Covid-19 pandemic have come together, united by their profession to serve NHS staff during this crisis. The crew provide a space to unwind, decompress and de-stress before, during and after hospital shifts.
The Wingman Foundation is now winding up its support project as the worst of the pandemic is behind us (fingers and toes crossed!) and the airline industry begins to pick itself up again. However, PW would like to leave a legacy behind and has selected Warrington Lounge as one of just 7 Wingman Legacy Lounges, the only one in the North of England. This means staff will continue to enjoy a ‘first class lounge’ experience permanently, although with reduced hours in future. The ability to retain a permanent facility is thanks to the willingness of the Warrington Wingmen Volunteers to continue to support the hospital, despite their own very challenging situations, and the WHH Charity Community Hub which is working tirelessly to keep the lounge stocked for staff to enjoy.
Project Wingman Founder and CEO Captain Emma Henderson said “We have all noted the value to NHS staff of the Wingman lounges and will never be able to know how many people have avoided the need for further wellbeing support as a result of being able to come in to a lounge for old fashioned ‘tea and empathy’. We do know however, that everyone needs a Wingman from time to time and we would like to be there in your hospital to support this if you are keen to jump on board as one of our legacy lounges.” WHH has jumped aboard!
Notice of Annual Members’ Meeting
The Trust will hold its Annual Members Meeting on Wednesday 30th September 2020 at 4-5.30pm. Due to ongoing restrictions on visitors to our hospitals due to Covid-19 this meeting will be held on line by Microsoft Teams Live (MS Teams Live). The link to join this meeting will be posted on the Trust’s website at this link nearer to the time https://whh.nhs.uk/about-us/how-we-work-our-board-and-governors/council-meetings-minutes-and-agendas. The agenda will be published to this page and there will be an opportunity for members of the public to submit questions in advance and also during the MS Teams Live Event through the chat board. The Trust’s annual report for 2019-20 is available here:https://whh.nhs.uk/about-us/corporate-publications-and-statutory-information/annual-reports-plans-and-quality-accounts. If you would like to join this meeting by any other platform, such as ZOOM, please contact the Trust Secretary on [email protected] to arrange.
