Doncaster hospital ready for winter after major boost to emergency department staffing levels

Doncaster and Bassetlaw Hospital Trust Chief executive Richard Parker
Doncaster and Bassetlaw Hospital Trust Chief executive Richard Parker

Winter is coming - but bosses running Doncaster's main hospitals trust believe they better prepared than they have been in years.

Officials say they have as close to full staffing in their emergency departments as they have been for a long time, despite a climate of recruitment problems across the NHS.

Chief executive Richard Parker, himself a qualified nurse with years of service under his belt, is pleased with the improvement in terms of boots on the ground, but admits it would only take a bad winter to cause problems.

After a wave of recruitment, the Doncaster and Bassetlaw Teaching Hospitals Trust, which runs the Doncaster Royal Infirmary, Mexborough Montagu Hospital, and Bassetlaw Hospital, is going into the winter with seven of its 11 Emergency Department consultant posts filled. Two years ago the figure was just three.

In terms of nurses in the same department, they have a vacancy figure of less than two per cent. This compares with around 10 per cent two years ago and a national average of 11 per cent.

In an interview with the Free Press, Mr Parker said he believes that is a major boost for the hospital going into what is traditionally a busy period of high pressure.

The hospital has also been carrying out work to train up doctors internally as emergency department specialists.

The improvements come against a backdrop which has seen the hospital, like most, failing to meet four hour waiting time targets for accident and emergency departments.

But Mr Parker says the hospital is still in the top 75 per cent for those targets.

He said: "The workforce is the biggest challenge at the moment. If we have not got the staff in post then we have to use bank and agency staff, and that has additional costs.

"The challenge has not gone away. The workforce makes up 60 per cent of the hospital's financial outgoings.

"There has historically been pressure on the 24/7 services, and demands on them have been going up 3.5 per cent per year, while fewer people choose to work there. Emergency consultants and doctors are an issue across the country.

"It is also difficult to recruit in small specialties like pediatricians and children's services. The numbers are quite small in terms of people training, and demand for those services is also increasing, There are gaps that are difficult to resolve. For the first time since records have been kept we've had to go to the second round of recruitment because posts were not filled."

However, bosses feel the hospital has benefited from becoming a teaching hospital last year in terms of recruitment, with it making Doncaster a more attractive place to come in that it means they may get to do research work

"We have had applications from candidates we would not have seen a year ago, and we will begin to see that with doctors and other professions like physiotherapists and dieticians as well. said Mr Parker.

Despite what he sees as an improving position in the emergency department, Mr Parker said a bad winter could still cause major problems.

A bad winter could cause difficulties for many reasons, and admissions in winter often stay in the hospital for longer.

A cold winter can mean more injuries such as fractures due to ice, more illness due to 'flu, and associated respiratory disease, and if it changes from cold to warm to cold, can lead to more likelihood of winter vomiting viruses, which can potentially close wards.

It can also mean more staff absence due to such illness.

He said: "Emergency departments are unpredictable, and you don't have appointments. It is complex but this year it is made better in that we're in a position where we are better off in terms of medical staff than last year, going into winter with a relatively low number of vacancies, and that is better for managing peaks and pressures.

Vacacies have also halved in acute medicine which includes fields such as cardiology and gastroenterology. Last year saw 60 vacancies. This year it around 30.

Mr Parker said the trust was looking to keep staff morale high to encourage staff to stay, so that they would have fewer new faces to recruit.

"We are trying to make Doncaster an attractive place to work," he said. "We are doing things like providing training opportunities and good appraisals. I won't say we've bottomed staff numbers yet, but we are working on it. Retention is as important as recruitment and we need to make sure this is a place people want to work."

Deficit set at £17 million

Hospital bosses have had to draw up strict savings plans to deal with a major deficit which was at one stage as high as £45 million.

Since concerns were first raised over under reporting of the deficit , plans have been put in place to tackle the financial shortfall, which last year was down to £6.2 million.

However that figure was achieved through receiving extra cash from the Government as a bonus for its work towards savings, and for meeting certain clinical targets that it has been set.

That figure reduced the figure from what would otherwise have been £17million, which is also the forecast for next year.

Mr Parker said: "When I first came to Doncaster, finances were felt to be stable, and we were looking to achieve improvements in the quality of service. We have made great inroads on that. For instance we used to have 150 severe pressure ulcers. Last year there were 32.

"Last year we set a £27 million deficit budget. Because we took measures to remove costs that was revised mid year to £24million, and then £17 million.

"This year we cannot guarantee the bonus payments so we have set a deficit budget of £17 million.

"We are working towards a break-even figure."

The highest deficit was in 2014-15.

Work aimed to cut the deficit has included bringing in more partnership working with external organisations such as Doncaster Council. Efforts are being made to reduce the number of agency staff, which are costlier than health staff working directly for the trust. The trust is also to get people back to their homes rather than them staying in hospital beds when they do not need to.

Other options may be to re-organise some types of surgery. For instance, machinery used for cataract eye operations has to be put on a particular side depending on which eye is being operated on. One suggestion is that a run of operations on left eyes should be done, so the machine does not have to be moved, then the machine moved once, and then several operations carried out on right eyes.

Mr Parker said the cost of heath has increased since he first went into nursing, with more complex equipment, like MRI scanners, and more intensive care beds.

He said: "It is how we deliver services at a time of financial constraint that is a challenge."