Grange Hospital 'needs expansion' amid long A&E wait

Wales' newest hospital is already in need of expansion because demand has been a third higher than anticipated, a medical director has said.

Dr James Calvert said the extra pressure on the Grange Hospital in Cwmbran has been caused by pent up demand as a result of the pandemic and the severity of people's health needs.

He apologised for "the overcrowding and long waits".

People were warned of 14-hour waits at its "extremely busy" A&E.

The Conservatives said Labour had to "get a grip" on the NHS while Plaid Cymru blamed centralisation for leaving staff at breaking point.

First Minister Mark Drakeford said Covid had put the service under significant strain.

The 471-bed hospital opened in November 2020, costing £358m to build.

Aneurin Bevan health board took measures to enable staff to divert ambulances away from the hospital as well as potentially cancelling routine surgery and outpatient appointments on Tuesday.

Dr Calvert said patients "can be assured they are getting a very high standard of care, but I recognise the experience of care is very poor".

In response an "ambulatory care centre" will open in the summer, where patients are treated without the need to be admitted.

The waiting areas at the hospital have also been remodelled.

Dr Calvert also acknowledged staff were still being spread too thinly across the health board's four hospitals - something that has again been raised by the Royal College of Physicians (RCP).

In October, BBC Wales reported that some trainee doctors and consultants at the health board were "scared to come to work" according to a report by the RCP.

Six months on from its visit, RCP Wales vice president Dr Olwen Williams said encouraging progress had been made, but "issues of retention, morale, patient demand, staff capacity, workload and burnout still exist".

It comes as a health board in west Wales said its hospitals were under "an unprecedented amount of pressure".

Hywel Dda University Health Board has asked patients to help by "using the right level of service to meet your need.

"We are dealing with a combination of high numbers of attendances, particularly in our emergency departments, and challenges in health professional staffing due to Covid-19," said director of operations Andrew Carruthers.

He added that there were also staffing problems in social care leading to "difficulties" in discharging some patients.

"This means we have very limited beds available... waits in our emergency departments are hours long and far in excess of what we would strive to deliver."

Dr Parisa Torabi, an internal medicine trainee, based at Grange and Royal Gwent hospitals, as well as an associate college tutor for the RCP, said things had improved with additional staffing, but challenges remained around care for elderly and frail patients.

"We've got an ageing population and with that we do need to have hospitals that can provide care to those vulnerable patients," she said.

"At the moment at the Grange we are not providing services that will focus on the needs of that population," though she added she was aware of plans for a new frailty assessment team.

Critical care and specialist services at the Royal Gwent and Nevill Hall hospitals, in Newport and Abergavenny respectively, were centralised at the Grange in 2020.

It has meant junior doctors have to move between sites to fulfil their training requirements, which can be difficult when staffing is stretched.

"A lot of trainees are concerned they're not going to be able to meet the requirements of their portfolio to be able to pass the year," said Dr Torabi.

Dr Calvert said the health board was investing in medical staffing on wards to free up time for trainees.

In October, he explained a shortfall of 21 junior doctors had been identified.

Shortly after, eight doctors were appointed, with an additional 27 being interviewed this week after a second recruitment round in January.

Those posts will be spread across the health board, "in particular addressing concerns at Nevill Hall where we want to bolster our staffing", he said.

"I do not anticipate that the model we are delivering at the moment will be the model that we are delivering a year from now because our staff are spread too thinly."

He explained the original plan did not include acute patients being seen across four hospitals, but Covid had forced their hand.

"As we begin to recover from Covid then we will have opportunities to simplify the model of care, spreading staff less thinly and providing a much better experience for patients," he said.

The health board advised people to avoid the A&E unit unless they had "a life-threatening illness or serious injury".

They also advised people to visit the website NHS Wales 111 and attend the minor injuries unit in Newport.

Meanwhile, the Welsh Ambulance Service also advised people to make their own way to hospital unless they had life-threatening injuries due to demand on Tuesday evening.

The health board tweeted: "Despite actions to try to stabilise our services, today we've had to declare a state of 'business continuity' due to sustained pressure.

"Our Emergency Department at The Grange University Hospital is extremely busy and waits to see a doctor are greater than 14 hours in some cases."

Three hours later, the ambulance service tweeted: "Please only call 999 for life threatening injuries or illness and make alternative arrangements to get to hospital to keep our emergency vehicles free for those who desperately need us."

Welsh Conservative health spokesman Russell George said: "For a major hospital to declare a black alert on a weekday night shows the NHS is ill-prepared to help those who need it most, with hard-working staff doing all they can being let down time and time again by the Labour government.

"We know Covid had a detrimental effect on the delivery of healthcare, but Labour ministers have had months to prepare the NHS for recovering from the pandemic but seem to be missing in action."

Plaid Cymru South Wales East MS Delyth Jewell said: "When other hospitals like the Miners in Caerphilly closed, patients were promised they'd not see a disruption to care, but over centralisation of services is leading to just that.

"So we have staff who are near breaking point, and patients who aren't getting the care they need."

First Minister Mark Drakeford urged people to use the most appropriate part of the NHS for their needs, saying a rapid rise in coronavirus patients in recent weeks had put the service under "very significant strain".

"The Grange hospital was designed to be a specialist hospital providing the most serious forms of intervention that are needed," he said, during a press conference on Wednesday.

"There are other ways in which people are able to get help from the health service; from their community pharmacy, right through primary care, using the 111 service that's now available in every part of Wales."