Health Minister responds on hospital concerns

I’ve received a response to a query I sent to Chief Minister Howard Quayle about alleged concerns reported on social media about Nobles (link):

https://www.facebook.com/Mannin-Branch-Celtic-League-805941286121301/tim...

I’ve received a reply from Health Minister David Ashford MHK that sets out in considerable detail a rebuttal of the points raised.

I’m grateful to the Health Minister and his team for the detailed response and to the Chief Minister for facilitating it.

I suggest if anyone does not accept any of the points made because they have information to the contrary they take it up directly with him. He seems candid enough which is no bad quality in a politician.

“Dear Bernard,
Thank you for your e-mail to the Chief Minister, he asked me to respond on his behalf as Minister for Health and Social Care.
Like yourself, I tend to when possible follow the Crown Dependency News Facebook site as it normally is fairly factual. Unfortunately, in this instance that is not the case and there is no basis whatsoever for any of the claims made in the article.
Dealing with each of the claims in turn:

Claim 1: Standing room only at Nobles Hospital!
Bed capacity is monitored carefully at 07:30 each morning; a report is produced advising the number of medical beds available across the Noble’s Hospital site. This is subsequently reported at the 08:00 daily hospital assurance meeting. Bed capacity at Ramsey and District Cottage Hospital is monitored similarly. For clarity these are not “virtual beds” these are actual physically vacant beds after taking into account any planned admissions.
I can confirm that since the 14th April 2018, when we commenced daily reporting and further to the decommissioning of Ward 5, the average number of empty medical beds available at 07:30 is 9 beds per day.
I can further confirm that medical bed availability at the commencement of each day during week of the 30th July 2018 was as follows, an average of 5 empty beds per day.

Date
Medical Beds Available at Noble’s at 07:30
30-Jul
4
31-Jul
2
01-Aug
8
02-Aug
5
03-Aug
8
04-Aug
6
05-Aug
5

Avg. for Week
5

Furthermore, I can confirm that no elective surgery was cancelled due to the lack of beds during the same period
Claim 2: DHSC have continued with Kate’s plan for further Ward closures. Ward 5 has now been closed with a further loss of 21 beds.
Ward 5 was decommissioned at end March 2018 resulting in a reduction of 21 beds at Noble’s Hospital. To compensate, the number of beds at Ramsey DCH was increased from 21 to 31. Reduction in the average Length of Stay by two-days across the Medical admissions delivers an efficiency that is equivalent of 11 hospital beds. Improved working relationships between the hospital and Adult Social Care has already resulted in improved flow from hospital and has contributed to the fact that we have seen empty medical beds at Noble’s at the start of each day since 14thApril 2018 (as per the statistics quoted above).
Claim 3: The Hospital says it’s not needed so they’re turning it into Chemo unit and have got rid of beds and staff.
No staff have been ‘got rid of’. All staff that had previously worked on Ward 5 are now deployed to other wards across Noble’s Hospital. Ward 5 is to be re-commissioned as the Day Oncology Unit and will re-provide the current unit which is located adjacent to the main hospital building. Bringing the unit back on to the main site provides greater assurance to patients that should they require medical (doctor) input during their treatment, the doctor is in close proximity and can be summoned without delay. The ‘new’ oncology unit will also provide additional capacity for us to provide more treatments as demand grows in the future. Associated oncology workforce will also increase in line with the treatment capacity plan.
Claim 4: A local trust is considering giving the money to turn the Ward into a chemo unit and get rid of beds.
We have been in discussions with a Charitable Trust and as such our plans for re-commissioning Ward 5 as a Day Oncology Unit are progressing, for clarity the proposals would be going ahead regardless of whether the trust is involved or not. As stated above we are not disposing of “much needed bed capacity”. There is already spare bed capacity in the hospital and the number of beds in Ramsey has increased by 10, the equivalent of half a ward.
Claim 5: Once they do that it’ll make a situation which is very bad for patients already so much worse.
As shown above the evidence on the ground does not support that claim in anyway whatsoever. It is completely baseless.
Claim 6: Staff report that It’s chaos up there and toxic with neither nursing staff or consultants being allowed to offer an opinion.
Again this has no basis, staff were fully engaged in the planning of the changes and continue to be consulted with.
Claim 7: It is said by staff that one of the terms the management have used in their reports is that Nobles have a number of virtual beds free each day- these are beds that should be free, but, aren’t because often patients who are recovered but for various personal reasons are unable to go home often don’t and there’s no current legislation to ensure they do so.
In relation to this claim there appears to be a misunderstanding as to what the term “virtual bed” is. The term ‘virtual bed’ is used when a patient no longer requires admission to an acute hospital but may require contact by the hospital – a virtual bed is not a physical bed but the term is used as an aide memoire to hospital colleagues to ensure that contact with the patient remains. Patients that have recovered from their acute health care episode and considered well enough to go home are described as either ‘Medically Optimised’ or ‘Medically Fit Discharge Ready’. Often these patients may require additional support at home to be arranged by community colleagues before a safe discharge can be achieved. On occasion some families refuse to assist in the discharge planning process resulting in those patients being delayed in hospital longer than necessary. This is taken into account in any bed capacity planning, as stated and explained in the answer to claim 1.
Claim 8: One patient has been in one of these beds for eight years.
Completely and utterly untrue. As at today’s date (11th August 2018) the longest length of stay is 136 days (just over 4 months).
Claim 9: This is ok unless you’re sick and need to lie down on one of these virtual beds and it’s not there.
Please see the previous responses to claims 1 & 7.
Claim 10: Sick patients are now left waiting in A & E for many hours.
I can confirm that the mean average waiting time in Noble’s A&E for YTD 2018/19 is 158 minutes (2 hours 38 minutes) compared to an average waiting time of 156 minutes (2 hours 36 minutes) in the previous two financial year (2016/17 and 2017/18).

It is important to note however that these sustained average waiting times have been achieved despite a year on year increase in the numbers of patients attending the Noble’s A&E Department. In 2016/17, 35,596 patients attended. Attendances increased to 37,281 in 2017/18 and based on the first four months of this year attendances in 2018/19 are forecast to increase to 43,530.

I have specifically reviewed A&E activity performance for the period 30th July 2018 to 5th August 2018, the average waiting time in A&E during this period was 178 minutes (2 hours 58 minutes). As previously advised, during this period the average number of empty medical beds across the Noble’s site at 07:30 was 5 empty beds indicating that the number of available beds in the hospital did not contribute to delays to patient awaiting admission from the A&E Department.
Claim 11: Nobles now have 42 acute medical beds left on 2 wards after the closure... for an ageing population of 80,000!!
Again, not true. Noble’s Hospital has 21 acute medical beds on the Acute Medical Unit (AMU), a further 21 acute medical beds on Ward 8 and 21 acute medical beds on Ward 9. There are a further 15 medical beds on the Stroke Unit (Ward 7), 5 acute cardiology beds on the Coronary Care Unit (CCU). A further 31 medical step down beds offering rehabilitation are available at Ramsey and District Cottage Hospital. This is a total of 124 beds – 83 of which are at Noble’s Hospital.
Claim 12: A local trust is considering giving the money to turn the Ward into a chemo unit and get rid of beds. Once they do that it’ll make a situation which is very bad for patients already so much worse.
Once again not true. Ward 5 was decommissioned in March, there are no plans for the decommissioning of any further beds. As stated earlier the plans for the re-commissioning of Ward 5 as a Day Oncology Unit are progressing and would continue to progress with or without external financial support. It is the correct thing to do from a patient safety point of view and will enhance the treatment for those requiring chemotherapy and ensure that in the unlikely event a medical emergency occurs patients can received the swift and effective intervention that they should rightly expect.
I’m sorry for the rather lengthy reply but I wanted to go into a bit of detail to provide as much information as possible. If I can be of further assistance please let me know.

Hon. David Ashford MHK
Minister for Health & Social Care
MHK for Douglas North
Legislative Buildings
Finch Road
Douglas
Isle of Man
IM1 3PW
British Isles”

Bernard Moffatt