Daily Insight: Ordered to collaborate

Most trusts are struggling to keep on top of demand at their emergency departments, but the issues at University Hospitals Plymouth Trust are likely to be at the extreme end of the intensity.

When CQC inspectors visited the trust’s ED in September, they found six patients being treated “on the floor” while another was being assessed and triaged in a “storeroom”, according to their report.

Among the inspectors’ findings was the trust’s inability to “ensure the safety of all patients”, adding to the growing list of trusts whose safety failings have been admitted in public.

But the problems at UHP are not new and are difficult to solve.

The ED is simply too small to meet the current levels of demand, and although the trust has secured funding to expand the department – its progress on this is controlled by the government’s New Hospitals Programme, which holds the purse strings.

Physical infrastructure aside, there are also the common issues of a buckling care home sector where staff are leaving for other industries (such as tourism or hospitality, in Plymouth’s case), and a shortage of medical staff across the integrated care system.

In a sign of the times, the CQC itself said UHP could not solve its challenges alone, and – in an unusual move – imposed a condition on the trust’s registration requiring UHP to “take action with the health and social care system to improve patient safety and experience”.

For Devon’s NHS chiefs, whose history of collaborative working has been criticised before, the question is what more can be tried that hasn’t already been done?

An unenviable record

The NHS is on course to break a pandemic record for hospital acquired covid infections, amid pressure on officials to relax infection control guidance.

The proportion of patients who likely caught covid-19 in hospital wards after being admitted for other illnesses was around 20 per cent of all hospital covid cases in the first two weeks of January.

If this trend continues, it would be the highest proportion of hospital-acquired covid on record.

The proportion of probable hospital-caught covid cases is also reaching record levels at many individual trusts – most notably at Mid Cheshire Hospitals Foundation Trust, where 56 per cent of its cases were likely hospital acquired in the first nine days of January.

It comes amid a surge in the number of patients catching covid in hospital after the omicron variant pushed community transmission rates to record levels.