Nationally, 3,500 more people are going to A&E every day,compared to 2010. This is very much in line with the increase indemand we are seeing in Plymouth.

The number of patients needing emergency care is higher thanit has ever been. For example, three years ago, in September2011, 7,237 patients came in to our Emergency Department. Inthe same month in 2014, this had risen to 7,873. Theaverdage daily attendance is creeping up towards270 patients in the department every day. Youcan see the rise over time in the graph below.

There is no one reason why this is happening.We think it is multi-factorial - a combination ofolder, sicker patients and an out-of-hours caresystem that patients find difficult to navigate.

Wider impact Our data also shows that patients, both those cominginto the minor injuries area, as well as those with majorinjuries and illness are having more investigations, such as x-rays, blood tests or scans.

This demand for these services means our EmergencyDepartment at Derriford Hospital is, at times, overcrowdedwithout a spare surface for new patients arriving. As a resultambulances have to queue outside the hospital with patientswaiting. As more patients are then admitted from the Emergency

Department onto wards, beds get taken up. We have just shortof 1,000 beds but often we don’t have beds available for thosepatients coming in for planned operations and therefore we haveto cancel their surgery. This is unacceptable for patients andour staff find it distressing unable to treat patients as planned.

Taking actionWe are doing everything we can. We are working with

comissioners and other healthcare providers to try toreduce the number of patients needing to be treated

by Emergency Department staff. One example ofthis work is that GPs are working alongside hospitalcolleagues , seeing those patients coming in withmore minor conditions.

We are also doing everything we can to supportpatients being discharged home or to an alternative

place of safety as soon as they no longer need medicalcare. This means our beds and other facilities are free for

those needing planned operations, investigations or emergencytreatment.

Inside our own hospital, we have invested in more staff, morebeds and are ensuring patients are seen and treated quickly.We are also running a big flu campaign to ensure our staff arevaccinated, protecting themselves and patients.

Despite all of this, though, we are preparing for a tough andbusy winter.

November 2014

In-Touch with Plymouth Hospitals NHS Trust

Big rise inemergency

patients

Our Emergency Departmentsees two types of patients.

Minor patientsThose needing treatment forconditions, such as suspectedbreaks, sprains and strains,bites and stings, infectedwounds and minor headinjuries, are treated for minorinjury or illness.

Major patientsPatients suffering stokes, heartattacks, major trauma followinga collision, fall or serious illnessare all examples of patientstreated as ‘majors’. They arepatients facing life-threateningor life-changing conditions.

Derriford Hospital will have a new helipad in operation by nextsummer. Funding of just under £2m has been agreed to build thenew helipad close to the Emergency Department entrance.The helipad will be able to receive Search and Rescuehelicopters as well as the night flights which Devon and CornwallAir Ambulances will soon be running.

Derriford Hospital does not currently have a recognised helipad.The hospital has a small grassed-over area adjacent to theEmergency Department which has been used for some years as

a set-down area for air ambulances. This area is recognisedunder ‘grandfather rights’, it is not a helipad, it is unsuitable forlarger helicopters and has no lighting. Larger helicopters suchas those from the Military and Search and Rescue have had toland at nearby Marjons, with patients then being transferred tohospital by land ambulance. No flights, even from smallerhelicopters, have been able to land at Derriford at night.

But thanks to the HELP Appeal (Helicopter Emergency LandingPads), which is contributing £850,000 alongside £900,000 capitalfunding from the hospital Trust, work on the new £1.7m helipadwill start within weeks. It is expected to be complete by summer.

Chief Executive Ann James said: “Our patients need anapproved helipad and we’re really delighted that with the supportof the HELP Appeal, we have been able to make this happen.We are the designated Major Trauma Centre for the peninsulaand we receive around 400 patients per year as emergenciesneeding transfer by air.

“It’s right that these patients can land as close as possible to ourEmergency Department at all times of day and night. Being ableto receive patients 24 hours a day will allow patients to betransferred for specialist care quickly, negating the need forlengthy ambulance transfers and potentially improving outcomesfor them. A quick transfer can be vital in major trauma cases.”

Preparations well underwayAlthough the risk of Ebola in this area remains low, we take itextremely seriously. We are following national guidance andmaking plans in line with Public Health England and Departmentof Health advice. We are developing local procedures formanaging any patient who is unwell returning from abroad andwe are specifically refining those for any patient who may be atrisk of ebola. Our plans include:

Designating appropriate isolation facilities.•Ensuring staff receive the relevant training about how to deal•with suspected cases and what protective clothing to wear.A designated negative pressure room being identified for•anyone suspected of having ebola to be treated in.If a patient tests positive for Ebola we would contact the•Royal Free Hospital in London and take advice from them.The expectation is that the patient would then be transferredto the Royal Free in London for care there.

Listening to cancer patients Nearly nine out of ten people with cancer treated at DerrifordHospital rate their care as ‘excellent’ or ‘good’. This is the findingof the latest National Cancer Patient Experience survey. Morethan 700 patients treated at Derriford Hospital responded to thesurvey.

Staff at Derriford Hospital pride themselves on being a centre ofexcellence for cancer care and the specialist cancer care teamsare really pleased that the vast majority of their patients (88%)remain very satisfied with their care. Of those rated ‘excellent’and ‘very good’, our UGI cancer and Urological cancer teamswere rated in the top 20% of all Trusts, scoring 94%.

We have made a short video with some of our patients givingtheir thoughts on their care and this is available on our YouTubechannel: www.youtube.com/phntnhs

New helipad at Derriford gets off the ground

Sexual health doctors in Plymouth have been successful insecuring more than £21,000 to launch a brand new service forhome HIV testing.

Dr Rachel Challenor and Dr Zoe Warwick, Consultants in Genito-Urinary Medicine (GUM), will use the money from NHS England’sRegional Innovation Fund, to run a trial over one to two years fromthe GU clinic at Plymouth’s Derriford Hospital. This is the first trialof its kind. No other organisation is currently providing this type oftesting.

Patients will be able to request a home HIV testing oral kit to beposted out to them via a link on the clinic’s website. The aim of thisis to reach people who have not tested before, which will result inprevention of transmission to others and also prevention of latediagnosis, both resulting in better patient care and huge costsavings for the trust.

Home testing has been shown to appeal to those who have nottested for HIV before. The new service will be available in time fornational HIV Testing Week – 22 – 30 November 2014.

Dr Challenor said: “We believe that offering a free web basedservice for home HIV testing using oral sampling will improvetesting in people who have not wanted to access traditional testingservices. Home testing has been piloted and is acceptable to manypatients and it helps to reach an at-risk population. Oral samplingkits are available for people to buy, but at a cost, making regulartesting, as recommended in some groups, unaffordable for many.”

The GU clinic already provide traditional access to HIV testinglocally and have a website that people interested in HIV testingmight want to access.

Dr Warwick said: “By providing the tests we are able to supportpeople through the testing process and understanding their results.We care for patients diagnosed with HIV so are able to ensureappropriate access to care if tests are positive and further adviceif tests are negative.

“We also have close working relationships with other organisationscurrently providing HIV testing in alternative settings, such as TheEddystone Trust."

First in country to offer free HIV home testing

Leading in research“Best conference I’ve ever been to!” – one ofthe comments made by a delegate at thisyear’s Research and DevelopmentConference.

In its fourth year, the conference was held atthe Postgraduate Medical Centre on Friday26 September.

More than 175 healthcare professionals andacademic researchers from across the southwest heard various research teams atPlymouth Hospitals NHS Trust and itsresearch partners.

Facts about research at Plymouth HospitalsThe Research and Development has•been supporting research in PlymouthHospitals since 1997.90 studies have been opened this year•to date (from 1st January 2014).59 studies have opened in this financial year (from 1st April 2014).•So far this financial year, PHNT has recruited more patients to NIHR badged interventional studies than any other Trust in the•Peninsula.There are more than 500 active research studies going on in the Trust.•There are 52 Research Nurses working in the Trust.•

PlymouthHospitalsNHSTrust

Find us at www.plymouthhospitals.nhs.uk or on

@PHNT_NHS youtube.com/phntnhs

How we are performing

Providing timely access and treatment

Indicator Target Current (Sept)

Accident & Emergency - Percentage within 4 hours 95% 92%

‘Admitted patients’ - Percentage within 18 weeks 90% 83.6%

‘Non-admitted’ patients - Percentage within 18 weeks 95% 88.7%

‘Incomplete pathways’ - Percentage within 18 weeks 92% 89.1%

Diagnostic tests - Percentage waiting more than 6 weeks <1% 8.5%

Providing timely cancer services

Indicator Target Current (Sept)

31 days from ‘decision to treat’ 96% 97.8%

62 days from urgent GP referral 85% 89.2%

62 days from screening referral to treat 90% 90.9%

62 days from consultant upgrade to treat 85% 75%

31 days from decision to treat to subsequent surgery 94% 98.3%

31 days from decision to treat to subsequent drugs 98% 100%

31 days from decision to treat to subsequent radiotherapy 94% 96%

2 weeks for breast symptom referral 93% 91.2%

2 weeks for urgent GP referral 93% 93.4%

Providing safe care

Standard Target Year to date

Number of ‘never events’ in the current financial year 0 0

Providing a positive patient experience

Standard Target Current (Sept)

Complaints reponded to withing agreed timeframe 80% 92%

Friends & Family Test Response Rate - A&E 15% 24.6%

Friends & Family Test Response Rate - Maternity 15% 39.1%

Friends & Family Test Response Rate - Inpatient 15% 45.7%

Cancelled operations - Percentage of activity 0.8% 2.3%

Providing a clean environment

Standard Target Year to date

Clostridium Difficile infections 15 4

MRSA infections 0 0