Recommendations on stabilising
hospital services presented to Trust
By Ryan Sands
A GROUP tasked with helping to stabilise services at Daisy Hill Hospital has presented its final report containing key recommendations to the Southern Trust.
The Daisy Hill Hospital Expert Panel was established last summer with the remit of working with the Trust to ‘implement the ongoing stabilisation plans for acute inpatient medical services at Daisy Hill Hospital, and to support the development of a longer-term plan for the future of the Newry hospital’.
The nine-member group’s chair, former Trust chief executive Mairead McAlinden, submitted her last report on its work to the current chief executive, Dr Maria O’Kane, for consideration on 21 February, and this was published online last Thursday.
The document highlighted that elements of the hospital’s stability plan relating to its High Dependency Unit (HDU) and the medical model/medical workforce challenges were ‘key areas of focus’.
In relation to Daisy Hill’s HDU, it was stated that a plan to relocate its beds to a ward base had been ‘a source of significant concern to staff and external stakeholders’.
The report recommended that the provision of a unit to provide Level 2 high dependency care, as defined within intensive care guidelines, ‘cannot be justified on the basis of historic or current workload’, and that ‘an area to care for those patients needing enhanced care (defined as Level 1.5) should be provided on the Daisy Hill Hospital site’.
It added that ‘the term “High Dependency Unit” should not be used’ in relation to this, and, instead, referred to it as a High Acuity Unit (HAU).
‘The HAU should be situated in the same location as the current Daisy Hill Hospital “HDU”, given the quality of the infrastructure in that area,’ the report read.
‘The remit of the HAU will be to provide a level of care not normally available on the general ward, for patients who require additional intervention or nursing care (known as Level 1.5, enhanced or augmented care) – but excluding patients who require Level 2 (high dependency) care.’
It is highlighted that these recommendations were endorsed by the panel on the basis that ‘patients who deteriorate and may require escalation of care to Level 2 or Level 3 (intensive care) should be referred to the Trust’s critical care service based in Craigavon Area Hospital’, and that, in Daisy Hill, ‘on-site support and assistance, as part of the required resuscitation, stabilisation and ultimate transfer process, is provided in conjunction with the emergency anaesthetic team, who are available 24 hours on site’.
Staff were consulted ‘on the most appropriate name for this unit (HAU), and there is a proposal that this be called the “Enhanced Care Unit”’.
‘The panel are assured that the above model, informed by evidence, clinical leadership and independent clinical advice and support, will stabilise and optimise the purpose and function of the renamed Enhanced Care Unit in Daisy Hill Hospital and is supported by staff,’ the document added.
On the hospital’s medical model, the report recommended ‘one general medicine service’ across the Trust’s two acute sites, namely Daisy Hill and Craigavon Area hospitals.
The core of the model would be ‘acute medicine focused on “same day emergency care” with a focus on extending ambulatory care and short stay inpatient beds’, to be complemented by the emergency department’s Clinical Decision Unit and ongoing development of Hospital at Home.
The document recommended utilising ‘the general internal medicine doctors from the Trust’s international medical recruitment to develop this acute medicine model at pace, prioritising the development of the service at Daisy Hill Hospital’.
The Trust was also advised to ‘develop at pace a Trust-wide service for sub-specialty care to cover both Daisy Hill Hospital and Craigavon Area Hospital’, with the priorities being cardiology, respiratory, diabetes and endocrine, and gastroenterology.
‘Other medical specialties, which have a more outpatient focus (neurology, rheumatology, dermatology), should continue to be supported to provide a Trust-wide service, which delivers an appropriate level of input to Daisy Hill Hospital,’ the report added.
The panel also discussed the further expansion of paediatrics and other specialties at the Newry hospital, and increasing the pace of delivery of these was ‘strongly encouraged’ in the document.
Dr O’Kane thanked the panel for “their commitment to this strategic project”.
“The aim of this process has been to find a sustainable way forward for Daisy Hill Hospital, its patients and staff,” she said.
“Ensuring patient safety and supporting our staff have been our priorities.
“We sincerely thank Mairead as chair, and all of the panel members for their expertise, commitment and diligence in finding workable solutions to the challenges that have faced Daisy Hill Hospital.
“Whilst there has been positive progress in stabilising medical staffing and acute inpatient medicine at Daisy Hill, rising demand for services, workforce and finance remain as very serious challenges across the Southern Trust and health and social care regionally.”
The chief executive welcomed the recommendations, adding that the Trust is looking forward to “developing this work at Craigavon Area Hospital also, in the next phase of this project, aiming to improve our acute hospital network as a whole”.
“The Trust is contributing to the regional hospital configuration blueprint project led by the Department of Health, and we have also started the journey of developing our new long-term corporate vision and strategy for the organisation,” she concluded.
“We continue to develop and promote Daisy Hill as a key acute hospital throughout this process.”
Visit HYPERLINK “https://southerntrust.hscni.net/download/694/dhh/17457/daisy-hill-hospital-expert-panel-chairs-report.pdf”southerntrust.hscni.net/download/694/dhh/17457/daisy-hill-hospital-expert-panel-chairs-report.pdf to read the report.
