I am always mindful of reflecting the reality of life within the Trust as accurately and openly as possible for colleagues, partners and our patients and their families but with just seven days between blogs I’m conscious of not repeating myself on issues that inevitably linger for more than a week too.
Towards the end of the year this always feels much more difficult and there is always that moment, for me, where we herald the ‘first blog of winter’. If you haven’t already guessed, this is it. The clocks go back, the nights draw in and, blink, we’re in the thick of it in every conceivable way.
The first thing to note is that in recent years our services have been extremely pressurised all year round with very feint lines emerging between the traditional seasons and colleagues have had very little, if any, downtime at all.
But there are weeks where we move unfathomably beyond even what we’d normally face and this has been one of them. It’s hard on colleagues, as well as patients and their families who find themselves needing help in the midst of very high demand.
It always manifests itself most obviously through our urgent and emergency care pathways, including A&E at Blackburn, the urgent care centre in Burnley and the minor injuries unit in Accrington. For those who value statistics, so far it has been the busiest November for four years and we’ve recorded the highest number of people attending for treatment and support per day for five years. For this reason we have enacted our escalation protocol which involves the acute medical units (AMUs) and wards. Thank you to everyone for their ongoing support.
It’s been really, really tough, even for the conditioned standards of Team ELHT. And I do mean the whole team, across all settings and services, who are simply doing a magnificent job.
In addition, the acuity of people we’re seeing is more enhanced and the number of people needing to be admitted with Covid or flu is increasing, albeit still in relatively low numbers of 36 and 18 respectively today.
All of these factors, on top of a national shortage of clinical staff, our determination to reduce the backlog of people waiting for elective procedures and the cost of living crisis which is impacting on everyone, is making our commitment to providing safe, personal and effective care a very difficult challenge indeed.
The impact this has on colleagues and the experience of our patients and their families is both a worry and a fear for me, all of the time. We know there are long waits in A&E to even be seen and for some that need our help they can find themselves waiting, often on a trolley in a corridor, for many more hours than we’d like. This isn’t something that any of us will ever accept, no matter the pressure and demand, and supporting our patients will forever remain our number one goal. I recognise, however, that if you’re among those waiting that might not feel like the case but please know we are doing our very best and we couldn’t be working any harder.
These delays in admitting people for treatment are down to the volume of patients coming in but also the number of people who have been admitted onto our wards previously, been treated and are medically able to go home but can’t.
This might be because they need social care, although I am very proud that together with the wider community teams and health and social care colleagues we generally have comparably low numbers of people in hospital who shouldn’t be. It’s right that we get those who are medically fit to leave back to their homes and families as quickly as we can too, it’s good for their mental and physical health and enables us to create space on our wards for the next person who needs care.
This cycle of patients incoming, being treated or admitted and then discharged involves thousands and thousands of people every year and logistics that would make your eyes water. I am not being dramatic when I say that we cannot take our eyes and minds off it for a moment.
The second challenge is a very human one that I’m sure everyone will recognise – when people are stressed out and tired, tempers flare and patience wears more quickly than usual. At its simplest you might observe a moment where a colleague walks by someone in distress when you know they would normally stop with a kind word and a cup of tea. It can escalate to more obvious and direct incivility between colleagues or patients or both and, yes, this in a place where I am confident kindness and compassion usually prevail.
In the most challenging situations those behaviours deteriorate further from a sharp word or impatience to violence and aggression, either implied or actual in the worst of times. This has happened this week towards a colleague and it upsets me when I hear anyone has faced abuse at work.
We have zero tolerance to verbal or physical aggression across all our sites and services and we actively promote this policy, but unfortunately it doesn’t mean that colleagues aren’t assaulted or treated poorly by patients and their families at times.
I understand too that people might be in pain, anxious and worried about what is happening to them or their family or even grieving for a loved one they have lost, but please remember everyone in the Trust is doing their best and no one could be working any harder in these difficult circumstances.
Know also that ELHT has a thriving culture of continuous learning and improvement and is constantly working on how we could make our services better for everyone. We know we’re not perfect and we’re open to feedback, suggestions and complaints where our standards have failed.
I was pleased to see that this week, as pressures intensified, colleagues have come together, encircling the problems and challenges to work out how we could do things better. This involves people from every team right across the organisation and throughout our communities doing whatever they can. I like to think we have thought of – and subsequently tried – everything but I never cease to be amazed as new and innovative ideas are born and created each and every day.
As testimony to this, I wanted to share that we received a note from colleagues at the North West Ambulance Service (NWAS) this week in recognition of our consistent performance in supporting timely ambulance handovers, which allow crew to get back out on the road to the next call.
The message said: “Your ED is the biggest (by far) in the North West for NWAS, which is all the more remarkable. I hope the wider East Lancs teams are aware of just how much they are protecting their surrounding communities.”
I’m proud we’re in the top 12 Trusts for ambulance handovers in England and that we’re supporting colleagues in NWAS, but it is the last sentence and its sentiment around protecting our communities which is at the heart of this work, so it is brilliant it is paying off. Well done and thanks to everyone involved.
Over the coming days and weeks I have no doubt I will return to winter pressures and the very fine balance between treating everyone as we would want to be treated and managing very large numbers who need help.
One thing you can do to support this effort is to be informed about your choices and options for health care – knowing that coming to A&E isn’t always the best place for you depending on your condition and, actually, as we prioritise those according to clinical need, it could result in a very long wait to be seen.
You can find out more here and – put simply – our urgent and emergency pathways are very much what you see on the tin where it says ‘urgent’ and ‘emergency’.
The Trust and wider healthcare system across Lancashire and South Cumbria knows that only by working together will we get through one of the most difficult winters we ever expect to see.
Let me extend that directly to you. Help us not only to support those who need it most with quality and timely health care, but to also ensure all colleagues are able to operate effectively and do what we do best – and that is to look after you.
Martin