Record numbers at North Mid A&E as long winter expected

Edmonton hospital records busiest-ever day for emergency admissions, reports Simon Allin, Local Democracy Reporter

North Middlesex University Hospital
North Middlesex University Hospital

North Middlesex Hospital is taking steps to cope with a surge in demand this winter after a record number of patients visited its emergency department.

The £3million winter plan drawn up by North Middlesex University Hospital NHS Trust sets out a range of schemes designed to boost capacity and minimise disruption to planned procedures at the Edmonton hospital as a report warned that failing to take action could lead to a shortage of up to 65 beds.

On 5th December, 768 people attended North Mid’s emergency department – the highest number ever recorded by the hospital on a single day. In particular, the trust is seeing a higher-than-usual number of children attending A&E, largely because of concerns over strep A and scarlet fever.

It came after NHS national medical director Professor Sir Stephen Powis warned the health service was facing a “perfect storm” this winter amid rapidly increasing virus cases, ongoing pressures in emergency care and “hugely constrained” bed capacity.

A report presented to a meeting of the NHS trust’s board earlier this month warns that the period up to 7th March is “likely to place exceptional demands on our clinical and operational staff as we aim to maintain safe access to care through our constitutional standards”. It adds that failing to take action to deal with a “surge of patient demand” would lead to “a deficit of up to 65 beds”.

Plans to boost capacity during winter for urgent and emergency care include providing an extra 30 beds within existing wards. A front-of-house GP hub at the hospital will enable doctors to manage patients who should be seen by primary care but who arrive at the emergency department.

In addition, a ‘clinical decision unit’ will allow patients who do not require admission to be managed by emergency department consultant staff while they wait for test results or confirmation that treatments begun in A&E are working. Faster discharges from elderly care and medical wards are also being planned to free-up beds.

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The plan assumes that additional ‘virtual’ ward capacity will be made available to allow patients who would otherwise be in hospital beds to be cared for within the community. Virtual wards allow medics to use technology to monitor patients remotely, and the trust has allocated extra funding for the initiatives.

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A separate report reveals that in October only 63.8% of North Mid’s emergency department patients were being seen, treated and either admitted or discharged within the health service’s four-hour A&E waiting time target. Although this is below the 95% NHS standard, the report notes the trust’s performance was “equivalent to that seen across other trusts in NCL [north central London] and also reflected nationally”.

Figures for October also show 273 patients waited 60 minutes or more to be handed over from an ambulance to A&E, against a target time of 15 minutes. In addition, 495 patients spent more than twelve hours in A&E from the time that a decision was made that they required admission to them leaving the department. The percentage of patients waiting under 18 weeks to be treated – described as the ‘referral to treatment’ (RTT) time – was 72.3% compared to a target of 92%.

North Mid chief executive Dr Nnenna Osuji said the hospital’s emergency department sees some of the highest patient numbers in London, adding that a combination of factors – including weather, circulating viruses, and patients with multiple conditions who require complex care – can add to demand for emergency and inpatient care.

Dr Osuji continued: “Every NHS organisation undertakes planning for fluctuations in both numbers of patients, and what they need care and treatment for, and North Mid is no exception. We have been working with our partners across north central London to plan for winter and our comprehensive plan for 1st December to 31st March is the result of detailed preparation for various situations that might present over the coming months. This helps us ensure that we are ready to maintain safe and responsive services for our local community.

“Our preparations include being ready to open more clinical areas, which are staffed and supported properly, and arrangements to assess, treat, and care for patients in ways that minimise disruption for planned procedures wherever possible.

“Many of our staff are working above and beyond in challenging circumstances, and I would like to put on record my thanks to every member of team North Mid for their ongoing dedication.

“I would also like to thank local people for their ongoing support of North Mid, and for playing such an important role in keeping our services available for people who need them. Getting vaccinated against flu and Covid, and using services like local pharmacists and for situations that aren’t life-threatening, are all tangible ways that individuals and families can contribute to keeping our emergency department for emergencies – help us help you.”

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