With 11,000 patients waiting more than a year for treatment and another Covid wave coming, Joel Adams speaks to the man in charge of the region’s biggest hospital.
Sam Higginson’s in-tray is growing.
The Norfolk and Norwich University Hospital, which he has led since 2019, is currently expanding its emergency department, building a new orthopaedic centre, treating Covid patients through “virtual wards” and taking over part of a care home.
The hope is that all these projects will tackle the biggest challenge the NHS faces - massive waiting lists which exploded during the pandemic.
Before coronavirus arrived, hardly any patients had to wait more than a year for treatment.
Now 11,000 have been waiting at the NNUH for at least 52 weeks and almost 4,000 of those have been held up for more than two years.
“I have far too many patients waiting far too long,” Mr Higginson admitted. “But we are prioritising the most clinically urgent patients.”
He warned, however, that meant those with less urgent conditions could be waiting for two years in pain as many of the solutions the hospital is putting forward will take time.
In the short-term, Mr Higginson has been asking his staff to work weekends and put on extra clinics to clear the backlog.
They hope to have treated all patients currently waiting more than two years by March next year. Already that number has reduced from 5,000 in October to 3,900 in November.
But Mr Higginson said it would take several years to treat everyone waiting more than a year.
“You can’t switch it around overnight,” he said. “Realistically we are going to be talking about this for a number of years.”
Orthopaedics is one of their biggest challenges. The NNUH has the fifth largest orthopaedics waiting list in England, with 10,000 patients currently on it.
This newspaper has told the stories of many patients waiting in agony and the huge impact it has on their lives.
But Mr Higginson points to a new £11m orthopaedic unit which hopes to start admitting patients next summer. It will not only increase capacity but will mean if there is another Covid wave, the unit can keep running all year, separately from the hospital.
A new hospital for Norfolk?
All our hospitals are under huge strain and need more capacity, but asked if the county needed a new one, he said the NNUH had opened 100 new beds last year and two new paediatric theatres.
“I’m not far off having built a good chunk of a new hospital in the last 18 months,” he said.
But where work is needed is east and west Norfolk, he argued.
Both the James Paget University Hospital in Gorleston and the Queen Elizabeth in King’s Lynn are at the end of their working lives. The QEH’s roof is being held up with dozens of metal poles, but despite campaigning from locals, politicians and this newspaper, the government has made no commitments to replacing it.
Mr Higginson said this needed to happen urgently. “We need to work very hard as a county to lobby for that,” he said.
Staff praised - and attacked
However many shiny new hospital buildings Norfolk can get, they are nothing without their staff.
“The staff at my hospital have been working incredibly hard, well outside of their working hours for a considerable period of time,” Mr Higginson said. “Because of that people are tired and facing up to what is going to be a long, tough winter.”
But he added: “I think there is still a really good sense of team.” He said that team spirit, along with 700 volunteers had helped the hospital manage the pandemic.
Despite an outpouring of support for NHS workers last year, he said they are now increasingly seeing frustrated patients and on rare occasions that has spilled over into abuse.
“We need help from the public,” he said. “I recognise people are frustrated at times, but we’ve had a couple of incidents in the last couple of weeks with violence towards staff and racism towards staff and I think that it is really important that we stick together.”
Care homes
While the hospital is dealing with far fewer Covid patients this winter - just 28 last week, 10 of whom are being treated at home - more and more beds are taken up by elderly people ready to leave but with no care to go to.
“You have to think about it a bit like a conveyor belt,” Mr Higginson said “If you’ve got a blockage in one place it disrupts everything else. The massive issue we’ve got at the moment is a lack of capacity in the care sector.”
He said pre-Covid they would have on average around 70 patients waiting to be taken into the care sector. Now they have 170 - around a quarter of all hospital beds.
He said this was down to a staff crisis in the care sector driven by Brexit and wages rising in other industries.
There is little the hospital can do to fix the care sector, but he said 20 patients are being treated in “virtual wards” where they receive medical care at home rather than in a hospital bed. There are plans to expand that to 80.
Meanwhile, the hospital has also taken over 15 beds in a local care home where patients ready to leave can be placed while they wait for local council care.
“We are trying to be creative but it is going to be a massive issue for us - I don’t have a magic bullet for it,” he said.
The impact on ambulances
With people struggling to leave the hospital, it means longer delays for those coming in the front door.
Dozens of ambulances queuing outside A&E have become a common sight and last month a patient suffered a cardiac arrest while waiting in the back of an ambulance. They were taken into the resuscitation ward but died.
However, Mr Higginson defended the hospital’s use of ambulances.
“In an ideal world everyone would be in a hospital bed rather than the back of an ambulance,” he said.
“But as long as you are clinically triaging those patients in the back of the ambulance appropriately, which is what happened, arguably that is a safe place to be, better than being stuck at home.”
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