Tim Almond on the challenges of delivering emergency care in our existing hospitals

Operational Management Lead for the New Hospitals Programme at Lancashire Teaching Hospitals NHS Foundation Trust, Tim has a background in NHS management, with a focus on urgent and emergency care.

In your management role, what have you noticed about the change in demand for our hospitals over the past few years?

In my work across Lancashire and South Cumbria, I have witnessed phenomenal care and dedication from the doctors, nurses and associated staff. We are extremely lucky in this region to have such motivated teams, working constantly to provide the best possible service to our local people.

At the same time, I have seen demand on the Emergency Departments (A&E) at Royal Lancaster Infirmary and Royal Preston Hospital rise year on year, thanks in part to new housing developments and a steady increase in people moving to the area. We also have an ageing population, which means older people with complex health problems increasingly need our help.

Peaks in demand over the winter have long been a phenomenon for the NHS, but increasingly these are extending, with the busiest period now lasting far beyond winter to become a year-round challenge.

Recent changes on the Preston site to bring together expertise in major trauma, neurosurgery and vascular surgery to provide a regional service, have also resulted in higher numbers of the most seriously ill patients being brought to the hospital.

How are our hospital buildings responding to the increased demand on NHS services?

All this increased demand is being channelled through existing buildings, which are many decades old and were simply not designed to cope with the high levels of attendance and admissions that we are now experiencing.

On top of the sheer volume of patients and the lack of space to allow our sites to grow, the condition of many buildings is now a serious cause for concern. We are seeing unexpected events, such as flooding as a result of leaks, causing serious disruption, despite the best efforts of the estates team to anticipate and prevent this.

The Covid-19 pandemic has really brought home how inflexible our current buildings are, making the necessary changes to accommodate the need for social distancing extremely difficult.

If you could, what changes would you make to our hospital facilities?

Due to the way the buildings have developed over time, many of the diagnostic tests and scans that are necessary for patients in emergency admissions must take place in another part of the hospital. This means the patient has to be taken across the site by a porter or member of the nursing team, and then brought back, taking up valuable time.

In an ideal world, such facilities would be located in departments next door to each other, allowing much better joint working, speeding up diagnosis, freeing up clinical expertise and providing a much smoother service for patients. The New Hospitals Programme offers us a chance to look at how we would redesign our buildings with the flexibility to adapt, as well as ensuring key services are more easily accessible to make patient flows – the movement between their necessary tests, consultations and treatments – seamless and quick.

Tackling this issue and coming up with a plan is fundamental to our ability to continue to provide high quality services. The existing hospitals are under serious pressure and doing nothing is not an option.

It is not just a case of tackling the problems of today. It is about taking the longer view and looking at what might be needed in the next 20 years and beyond in terms of demand, as well as the changing face of technology and the opportunity to bring the latest treatments and equipment to the region.

This is a chance to work with all our partners to look at what currently takes place in hospital and whether more could be done in the community, particularly for minor procedures and appointments, which could take place closer to the patient’s home.

New hospital buildings can serve as a beacon, both to reassure our local communities that the most modern healthcare services are available close to their homes, and also to help attract the next generation of clinical staff to come and work in Lancashire and South Cumbria.

Together we need to seize this opportunity and secure our future.