Winter surge will make it difficult to provide all planned services, says Western Trust

The health authority warned of increased pressures as it announced details of its 2024/25 Winter Preparedness Plan.

Maximising ambulance capacity, reducing time spent by patients in emergency departments (EDs) and timely hospital discharge will be key priorities this winter, it said.

“While our services experience pressures throughout the year, we know that the winter months are a particularly demanding time across primary care and hospital and community services,” it stated.

Its annual Winter Plan sets out arrangements to manage the predicted increase in demand for services, particularly at EDs.

“During the coming months, we may find it difficult to provide all of our planned services whilst also managing the expected increase in demand for unscheduled or critical care.

"Our plan includes steps we will take to minimise any impact as much as possible, such as focusing on delivering our Service Delivery Plan targets and ensuring we make best use of capacity in our dedicated elective care centre in Omagh and the elective overnight stay centre at South West Acute Hospital.

“Patient safety will always be our priority, whilst we balance these risks,” the Trust declared.

A key plank in the Trust’s winter planning is the management of pressure on the Altnagelvin ED.

It is aiming to ‘maximise existing pathways and rapid access arrangements – minor injuries unit, acute medical model, paediatric pathway, early pregnancy, gynaecology pathways, ENT rapid access clinic, eye casualty’ and to ensure the ‘best use of ambulatory and same day emergency care opportunities’ including via Altnagelvin’s enhanced Ambulatory Care Unit, cardiology and respiratory hubs and paediatric assessment unit.

Co-ordination hubs and enhanced oversight arrangements are also being put in place to effectively manage patient flow and capacity in Western Trust hospitals.

The Trust says it is taking action to ensure access to mental health expertise in EDs to allow timely joint assessment by medical and mental health teams.

Timely hospital discharge is another crucial component of its winter preparedness proposals.

The Trust says it will be engaging with and supporting patients, carers and families to promote safe and timely discharge and taking a co-ordinated approach to safe and appropriate patient discharge arrangements.

This will include the creation of ‘a discharge co-ordination team, making best use of the discharge lounge and continued implementation of the trusted assessor role to support timely allocation of care home placements’.

The health authority is aiming to ‘maximise our domiciliary care capacity through the continued roll-out of the Trust’s rota optimisation project and review of packages of care to ensure they remain suitable by the early review and assessment team and enhanced care panel’.

To maximise ambulance capacity it will be working with the Ambulance Service (NIAS) to support timely ambulance handovers at EDs and smoother transfer of patients.

The Trust also wants to pilot mental health staff presence in ambulance control room at weekends.

It hopes a fully operational Minor Injuries Unit at Altnagelvin providing rapid access for assessment and treatment of minor injuries will also free ambulance capacity.

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The Department of Health’s own Winter Preparedness Plan says the Western Trust’s discharge coordination team will ensure placement of the right patient to the right place at the right time.

"The Trust has improved access to Elderly Mentally Infirm (EMI) placements by redesignating seven general residential beds as EMI residential beds.

"In addition, the Trust will open 11 EMI beds and eight general nursing home beds. The Trust will also increase palliative care provision through opening an additional four beds in Omagh,” it adds.

Health Minister Mike Nesbitt said he expects another pressurised winter.

He said: “There is no doubt that the Health and Social Care system is again facing a very difficult winter period. While there are ongoing pressures across the system all year, it is clear that more people become sicker, for longer, over the winter months. This is particularly true of our older population.

“The planning process for winter gets underway in springtime, to ensure that we can mitigate, as far as possible, the additional pressures that we know we will face.

"For this winter, this includes measures to keep the population well in the community, including the use of community pharmacy, and measures to protect primary care, hospital care and social care.

“We can all play our part again this winter to look after ourselves and support the health service. This can include getting vaccinated if you are eligible, taking sensible steps to stay well, and co-operating with hospital discharge processes if you or a family member are well enough to leave hospital.

97,738 inpatient admissions in the Western Trust, 21.3 per cent of all admissions in North

“Timely hospital discharges are essential to ensure patient flow through hospitals, freeing up capacity in EDs and the Ambulance Service.”

The initiatives across primary, secondary and social care detailed in the Winter Preparedness Plan include:

A Pharmacy First Sore Throat Service available from pharmacies. Starting from December 1 for everyone aged five and over, this service will offer advice, clinical assessment and treatment for sore throats, without having to wait for a GP appointment.

Vaccination programmes for COVID-19 and influenza are operational. In addition, a Respiratory Syncytial Virus (RSV) vaccine is now available for older adults and pregnant women from 28 weeks gestation.

An extra £3.4m is being made available to help GP services meet additional winter demand. A further £4.6m has also been provided to assist the delivery of proactive support and care to those in nursing and residential care homes.

Phone First services are available in all geographic Trusts.

An additional investment of £5m has been allocated to the Health Trusts for 2024/2025 to enhance independent sector provision of care packages for the over-65 population.

To make best use of available home care capacity, Trusts have been provided with £697,000 in recurrent funding to establish early review teams.

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