North Mid struggling amid ‘busiest summer ever’

Record numbers seen at A&E as hospital requests help to tackle its massive cancer treatment backlog, reports James Cracknell

North Middlesex Hospital
North Middlesex University Hospital in Sterling Way, Edmonton

North Middlesex Hospital is likely experiencing its “busiest summer ever” as it continues to struggle with a growing waiting list and soaring A&E attendances.

At a board meeting this morning (Thursday), senior managers at North Mid explained the challenges the Edmonton hospital continues to face in the wake of the pandemic, since when the NHS trust has fallen a long way behind in a number of key performance measures.

May this year was the busiest-ever month for the accident and emergency (A&E) department at North Mid, with 610 patients being seen every day, while June was the second-busiest month ever seen. The A&E staff team is designed to cope with not more than 535 patients per day, leading to exceptionally long waits for treatment.

The main NHS performance target for A&E departments is for 95% of patients to be discharged, admitted or transferred within four hours of arrival – but the percentage at North Mid in June was only 65.8%.

Mark Lam, board chair of North Middlesex University Hospital NHS Trust, told today’s meeting: “I want to acknowledge the tremendous operational pressure we are experiencing and, although that is not unusual, this is among the busiest – if not the busiest – summers we have seen.

“I want to thank colleagues for their ongoing focus and professionalism.”

Dr Surendra Deo, a non-executive director at North Mid, said the exceptionally high A&E attendance numbers were being driven by the current difficulty in patients being able to access GP appointments, leading many to seek help at A&E instead.

“There is an access problem in primary care,” Dr Deo said. “What are we doing as a trust, as a partnership, to address this? Because it is not going away. I don’t think it is sustainable – it might well get worse.”

Mark Lam responded: “We need to be open to a radical rethinking of the care system. The whole point of setting up integrated care boards is to push for that.”

Other performance metrics are also causing significant concern at North Mid. They include the overall waiting list, which has now reached 18,711 patients, up from 14,374 at this time last year. Of these, 121 have been waiting longer than a year.

The percentage of patients waiting under 18 weeks to be treated – described as the ‘referral to treatment’ (RTT) time – is currently 79.3%, below the 92% target and also the 85% level seen at this time last year.

The situation is particularly dire regarding cancer treatment, where just 32.6% of patients are currently starting their first course of treatment within two months (62 days) of a referral, far below the 85% target. Before the pandemic North Mid had been exceeding the target, but by this time last year the number had fallen to 64.1%.

This poor performance has led to the NHS trust moving to a ‘recovery’ position on cancer treatment, establishing a cancer oversight group to focus on ways to resolve the current capacity problem.

Shola Adegoroye, North Mid’s chief operating officer, told today’s board meeting that the hospital had sought outside help to tackle the cancer backlog. She said: “The key areas we need to work on are where there is a capacity gap. We have reached out for support from NCL [North Central London Clinical Commissioning Group]. We need to recognise where we are at the limit of our capacity.

“The most important thing to say is we have a supportive environment. There is a recognition that if we cannot find that support within NCL we will look elsewhere. That request for support has been made.”

A report presented to the board meeting went into more detail and said: “The trust was compliant against two out of the nine cancer performance standards. The largest patient backlogs exist in colorectal, urology, and gynaecology […] overall, it is expected that improved performance will manifest once the backlog of patients in a 62-day breach position have been treated.”

One major factor in the hospital’s struggles is bed occupancy. When “core beds” are all in use, the hospital instead utilises “escalation” beds. The report revealed that when measuring bed occupancy as a percentage of core beds, the occupancy rate as of May was 105.8%.

Mark Vaughan, North Mid’s director of human resources and organisational development, said the pressures were taking a toll on staff. He said: “There are a lot of staff who are pretty deflated and knackered and just see a relentless pressure.

“The way we motivate people is with empowerment, which gives them satisfaction when they come to work, knowing they have that control.”

Mark Lam added: “The report does reflect the extraordinary pressures we are under, but also the hard work of our team in managing that pressure.

“With the level of pressures we are experiencing, they no longer feel extraordinary. Previously these were seasonal, but now it is a perpetual state. When extraordinary pressures feel normal, one of the effects is that people feel numb to it. It has a huge impact.”

North Mid was one of the worst-hit hospitals during the Covid-19 pandemic, but there is now a new public health emergency that has been declared by the World Health Organisation, in relation to the recent monkeypox outbreak. So far, 32 patients have been treated for monkeypox at North Mid, but only three have required admission for symptomatic care and all of those have recovered fully.