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Even top NHS trusts are ‘nervous’ about winter

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A director of one of England’s best-performing hospitals has said he is “nervous” about winter, despite planning more extensively than ever.

West Suffolk NHS Foundation Trust is rated “outstanding” and is in the top 15 hospitals in the country when judged against a key A&E performance target, seeing close to 95% of patients within four hours.

Sky News spent two days at the hospital speaking to doctors, patients and administrators, as well as GPs and ambulance staff.

We found that even after months of planning and greater co-operation with other services and social care than ever, winter still brings major challenges, and a sense of trepidation among staff working harder than ever to keep up with rising demand.

The hospital occupies ageing real estate on the edge of the market town of Bury St Edmunds.

It has an emergency department that was built in 1974 to see 30,000 patients a year but today has to cope with 70,000.

West Suffolk NHS Foundation Trust - the waiting room at A and E
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The demand is always there at West Suffolk NHS Foundation Trust

Pressure on the hospital is largely determined by the impact of winter on an ageing population.

The county has the second-oldest demographic in the country, with one in five people aged over 65, a proportion forecast to increase to one-in-four by 2021 and one-in-three by 2037.

Winter brings an increase in respiratory illness and cardiac issues, and many patients have more than one serious condition.

West Suffolk NHS Foundation Trust
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Suffolk has the second-oldest demographic in the country, with one in five people aged over-65

“We’re nervous,” says medical director Dr Nick Jenkins, during one of his regular consultant shifts in the emergency department.

“I can’t believe there is anyone working in the NHS who isn’t nervous about winter.

“We are prepared, we are as well prepared as we have ever been. We have got plans in place for extra beds to be available, we have got as many nurses and doctors as we can recruit, but that’s a real challenge.

“We will never have the number of nurses in our hospital for this winter that we need, but we will be working really hard to keep the patients that we have got safe, and the planning that’s gone into it will, we hope, pay off.”

Medical director Dr Nick Jenkins of West Suffolk NHS Foundation Trust
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Medical director Dr Nick Jenkins says everyone is worried about winter

The hospital is predicting an increase in admissions of at least 4%, and preparations for this year include spending £13m on a new Acute Assessment Unit, designed and built in 11 months and intended to divert patients away from the bottleneck of the emergency department, as well as dealing with referrals from local GPs.

Chief executive Steve Dunn said planning began before last winter had even finished.

“We were rated outstanding last January but we didn’t feel outstanding, so we started planning for this year. We have built the acute assessment unit in time for winter.

“We are also running services in the community, including a ward in a care home. Now we have to staff that extra capacity, but if we can’t find the staff to run it safely we won’t open that capacity, and that will put pressure on us, but we will have to do our best.”

Chief executive Steve Dunn at West Suffolk NHS Foundation Trust
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Chief executive Steve Dunn says winter planning began before last winter was over

The apprehension at West Suffolk is echoed nationwide by a chorus of health experts and representative bodies who have warned that this winter may be the worst-ever in the modern NHS.

Performance figures and situation reports released this week reveal a system already under huge strain and close to capacity.

Bed occupancy in the first week of December was 94.2 % across England, close to last winter’s post-Christmas peak of 95%, and a third of trusts were at 97%.

West Suffolk NHS Foundation Trust
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West Suffolk NHS Foundation Trust’s ambulance crews are also very busy

There were 97,500 ambulance arrivals at hospitals during the week, more than any other week last winter bar Christmas week, and 11% of them suffered handover delays of more than half an hour, with 2,000 delayed for more than an hour.

And monthly figures for November showed while hospitals were dealing with 1,000 more people every day within the four-hour A&E target than last year, the proportion of the total attendances seen in that time fell to 87.6%, down on last year and well short of the 95% national target.

The NHS Confederation called the figures “deeply troubling”, while NHS Providers’ chief executive Chris Hopson said “the reality is that trusts can’t keep up with three per cent increases in year-on-year attendances”.

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