Agenda item

To inform the Brent Health and Wellbeing Board of the plans to increase acute medical unit bedded capacity on the Northwick Park Hospital site for winter 2024 by building a new 32 bedded ward.

Jason Antrobus (Deputy Chief Operating Officer, LNWUHT) introduced the report, informing the Health and Wellbeing Board of the bid the Trust had made to NHSE to increase acute bedded capacity ahead of winter. He advised the Board that all Trusts nationally had been asked to put these bids forward following the challenges of the previous winter, recovering from various waves of the pandemic and other pressures. The Board was being asked to support the bid for 32 beds in an additional acute medical unit for patients coming through from A&E. The unit would act as a ‘short stay admission’ before the patient was placed in a specialist ward or went home to use community services. From a build point of view, the Trust planned to place the unit on top of the existing A&E building so the physical footprint on the ground floor was not increased due to current space restrictions. The Trust did not envisage any operational impact on A&E or wider services as the build was completed. The unit was planned to be in place by January/ February 2023, and the Trust had also made a commitment to NHSE that from 1 October 2023 it would ramp up additional beds across the 3 hospitals to start seeing the increased capacity when winter starts. In introducing the report, Jason Antrobus highlighted that the report demonstrated that Northwick Park Hospital now had one of the busiest A&E sites in the country. The department was completely full on a daily basis and patients were waiting for beds. The modular would help to increase safety, reduce waiting times in A&E and reduce the waiting times for ambulance services. Due to the timescale to have this in place by January, there was a planning application submitted to Brent Council and it was expected the outcome of that would be known in September, but work had already started on the modular.

In considering the report, the following issues were raised:

·         The Board noted that Simon Crawford (Deputy Chief Executive, LNWUHT) had reported to the Board on several occasions the challenges in supporting users with acute mental health needs in A&E, and asked what collaborative working was going on across mental health and acute providers to reduce waiting times. Jason Antrobus highlighted that mental health patients were in A&E cubicles every day and may have security, 1 to 1 nursing or an additional mental health nurse supporting them. This disrupted the flow in A&E and they were a cohort that needed to be managed on a daily basis. There was a good partnership relationship with both Central and North West London NHS Foundation Trust (CNWL) and West London NHS Trust for the Northwick Park and Ealing site where the majority of mental health patients presented. Northwick Park Hospital had the highest number of mental health patients attending out of the whole of NWL and would sometimes have double or triple the number of mental health patients of other sites. The escalation process was in place every day to work through the flow and capacity. As a result of building the modular, some of the side rooms could be built to be more mental health appropriate. Although they would not be fully suitable mental health beds, it was recognised that often 30% of patients in A&E were mental health patients waiting for next steps. With the addition of the modular, patients could be spread more safely across the site so that they were not condensed in one area, which was a contributing factor to ambulance handover delays.

·         A member of the Board asked whether all wards in Northwick Park Hospital were fully occupied and operational or whether there were any vacant wards the beds could be placed instead. Jason Antrobus explained that on a daily basis Northwick Park Hospital was almost 100% occupied. The Trust and NHSE would expect a much lower occupancy so that more patients could be admitted. Due to the occupancy level, Northwick Park Hospital was cohorting patients, taking them off ambulances and putting them in corridors before they could be treated in A&E. Each morning, patients were being moved out of A&E or the acute medical unit and being ‘plus one’d’ so that once discharges were made throughout the day they could be moved into those bays. There were a few escalation beds but the hospital was full. He added that a ward block had been demolished in the last 12 months because it was a condemned building and no longer safe for clinical care purposes. Part of the long-term plan for the hospital was for that critical care rebuild but that was a number of years away.

RESOLVED: to support the process as the Trust continues to mobilise additional bed capacity and support the Trust’s bid to NHSE for additional beds.