THE seemingly inexorable increase in the number of patients attending Gwent hospital emergency departments has continued through what has proved to be a difficult 2019.

By the end of August, 116,477 attendances had been recorded at A&E (the Royal Gwent and Nevill Hall Hospitals), the Ysbyty Ystrad Fawr emergency department, and the minor injuries unit at Ysbyty Aneurin Bevan in Ebbw Vale, combined.

That is a 4.7 per cent increase on the first eight months of 2018, and if A&E attendances only are counted, the increase is slightly higher, at 4.8 per cent.

During only one month - June - did combined and A&E attendances this year fall, compared to last year.

Most months have seen record attendances, or at least the highest for many years, and the monthly combined attendance topped 16,000 (16,309) for the first time in July.

The continued increases are a concern for Aneurin Bevan University Health Board with what promises to be yet another very busy winter approaching, and a number of factors have combined to make coping with them difficult.

The complexity and acuity, or level of sickness, of patients has been on the rise, and has coincided this summer with the health board having to reduce capacity at Nevill Hall due to nursing vacancies.

Added to this is the fact, director of operations Claire Birchall told board members, that the emergency department at the Royal Gwent, "is not big enough for the volume and pattern of attendances".

"We know we have had some unacceptably long waits for patients (and) we know we have had incidents where ambulances cannot get to patients in an acceptable timescale," she said.

A number of initiatives have been introduced to try to help, including additional triage nurses at the Royal Gwent, to try to ensure patients are triaged inside the 15-minute target.

This is ringfenced support, so staff do not get called to support the rest of the department.

An ambulance service liaison role is also being tried out, to help focus on the issue of the safe retention of patients in ambulances at the hospital, if trolleys are not available.

"The emergency department (at the Royal Gwent) gets unacceptably congested, and we are working with the Welsh Ambulance Services NHS Trust and the department team to create a handover area, to safely manage handovers, supported by qualified ambulance staff," said Ms Birchall.

She added that there has been "fantastic" feedback from patients about the department's ambulatory care area - which enables some emergency patients to be assessed more quickly to reduce waiting times - and that the aim is to try to double its capacity.