United Lincolnshire Hospitals NHS Trust has agreed to extend opening hours of Grantham A&E by an hour, but says it has not been successful in recruiting enough emergency doctors to re-open it through the night.
In August the trust made the decision to reduce opening times at the Grantham Hospital A&E department to 9am to 6.30pm due to a severe shortage of middle grade doctors at Lincoln and Boston A&Es, requiring the Grantham doctors to help cover those units.
The trust now anticipates the new opening hours will come into effect on March 27, provided that the staffing numbers don’t fall before then.
The trust says there is a national shortage of A&E doctors, and ULHT is very much affected by this, being reliant on short and long term agency doctors to fill staff rotas.
The trust says reducing the opening hours of Grantham A&E has allowed it to provide better patient care in Lincoln - where the most serious cases from across the county go to. Grantham A&E doctors have provided up to an additional 85 hours of middle grade and consultant support per week at Lincoln. Though not ideal, the trust says this was the safest option for the provision of emergency care for the people of Lincolnshire including those who live in the Grantham and Sleaford area.
Dr Suneil Kapadia, medical director at ULHT says: “I recognise people want Grantham A&E to reopen 24/7 and will be disappointed with our decision, but before we can reopen the A&E overnight, we need to be confident that we can staff the doctors’ rotas consistently for at least eight weeks in the future. To ensure we provide a safe service for Grantham people and those throughout Lincolnshire, it’s important we aren’t in a situation where we reopen A&E one day and then need to close again the next week due to doctors leaving. We need services to be safe and sustainable. ULHT remains committed to fully reopening Grantham A&E but only when safe to do so.
“We are making steady progress in recruiting doctors. We now have three more middle grade doctors working regularly for us than in August - one at Lincoln and two at Pilgrim – and have secured the commitment of another five doctors, who we hope will be with us for three months.
“We currently have 17.6 middle grades for all our A&Es at Lincoln, Pilgrim and Grantham. Although the numbers are higher than in August, they are still below the required number of 21 to have all three departments open 24/7. Even if we had 21 doctors, this is still below our ideal number of 28. The numbers of senior medical staff can vary from month to month and we already know that two doctors will be leaving the Trust in the near future.”
At February’s Board meeting, ULHT reviewed the opening hours of Grantham A&E and considered the views of 10 of the most senior medical consultants, A&E medical and nursing staff, stakeholders and the public in making this decision. The trust claims its data shows that the healthcare system is coping with the overnight closure of Grantham A&E and that on the whole the impact has been small in the number of attendances and admissions at other A&Es.
This is despite concerns expressed by police and ambulance services about increased waiting times for patient hand overs tying up ambulances causing delays in ambulances reaching patients, while police officers had been left with no alternative but to ferry in some patients themselves.
The hospital trust says its clinical management board (the committee made up of its most senior doctors) supports this decision. They recommend that A&E remains closed overnight but to extend opening hours to cover 8am to 9am if safe to do so. The clinical commissioners also support the continued overnight closure of A&E.
The trust states that while it is working hard to recruit doctors to work longer contracts, the reality is agency staff have the pick of places to work and often can leave a placement at short notice. The trust says it agreed on the threshold of having a minimum of 21 middle grade doctors before it will reopen Grantham A&E with the commissioners and regulators, as the level required to staff three A&E rotas 24/7 consistently and safely.
The recruitment drive will continue. They are still advertising in the UK and abroad and are working with UK and international recruitment agencies to ensure they recruit enough doctors. The trust will review the opening hours in three months, at its board meeting in May.
Campaigners are set to hold another protest march in Grantham later this month against the continued overnight closure of the A&E.