Winter plan anxiety for NHS chief

Twm Owen Local Democracy Reporter

A health chief has admitted to being “anxious” about full hospitals in the run up to the winter peak. 

Nicola Prygodzicz, the chief executive of the Aneurin Bevan University Health Board, said it needs the number of patients in its beds, who could be returned home or to a care home, to reduce before demand spikes in January. 

She told the board’s November 26 meeting: “The reality is we’re six weeks away from the peak. We need those discharge numbers reduced by at least 50 over the next six weeks. 

“We are already full today.”

Anxiety

Ms Prygodzicz said her “anxiety” is around how quickly the board can make changes to reduce people “lying in our beds today so there is capacity for the people who come in”. 

The NHS is expected to work in partnership with Gwent’s five local authorities that are responsible for social care and do so through a regional partnership board that has had to draw up a plan for reducing those staying in hospital longer than necessary under a 50 day challenge set by the Welsh Government. 

Flu and pneumonia modelling scenarios predict peak national daily admissions between 63 to 132 for winter 2024/25. Covid-19 is also expected to lead to increased strain on hospitals. 

Across Gwent the Aneurin Bevan board had 1,529 beds, as of November 14, and predicts bed occupancy to peak during the second week in January 2025 at 1,579, with a range of 1,505 to 1,613 – potentially leaving it 50 beds short of what’s needed. It also has to account for the possibility beds will be closed due to infection controls as well as being unavailable due to emergency surgical demands and surgery to meet waiting time targets. 

Hannah Evans, the board’s planning director, said the “answer is not to put in an additional 130 beds.” 

Instead plans include using clinics rather than patients arriving at the Grange University Hospital emergency department and boosting vaccination rates for at risk groups, those over 65 and children aged two and three.

Better use of beds in smaller hospitals will free up demand at the Grange, in Cwmbran, while plans are also being put in place to better deal with patients arriving there by ambulance, and from out of hours referrals and discharge patients at weekends and the Christmas holidays. 

There is also a streamlined decision-making process with an integrated discharge board and regular meetings with council decision makers.

Data tracking

The health board will be tracking data including public and staff vaccination rates, how long patients are staying in hospital and occupancy rates, delayed pathways of care that are commonly known as bed blocking, demand on the emergency department and staff absence. 

Based on September figures it’s thought a 25 per cent reduction in delayed pathways of care, that is the care in the community needed for someone to leave hospital, could free up 58 beds. 

There is a contingency plan to expand to 84 ICU beds at the Grange in the event of a “full surge”. 

The board’s special advisor Phil Robson questioned the prepardness of the local authorities. The former Powys council social services chief said: “I’m not impressed with some of the partnership stuff it seems a bit woolly. There’s lots of detail about the health board are going to do but not so much about what the partners will do.” 

However the health board’s chief operating officer Leanne Watkins told him: “I would ask, so what? We are responsible for providing health care. We are trying to get our own house in order in the first instance.” 

Plans have been tested at hospitals during November. 

The plan has already been allocated £2m in health board funding and it has been agreed £500,000 of unspent funds from the regional partnership board will be added to the pot, although there is no confirmation as yet of any additional winter funding from the Welsh Government.