The Grange a saviour for overrun health board departments

The £360 million hospital opened on November 17 last year, just weeks before the second wave of coronavirus peaked in Wales.

Nicola Prygodzicz, director of planning, IT and digital at Aneurin Bevan University Health Board, sat down with the Argus to discuss moving all critical care and emergency treatment under one roof and the progress made in the past twelve months.

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“It’s hard to believe that it’s 12 months ago that we started transferring patients in two days before we actually opened the main emergency department,” she said.

“We were worried about whether we were going to get in quick enough before the second wave was really going to hit us because the numbers had started rising.

“We felt that the local lockdowns that Wales had put in place had given us a little bit of headroom to make sure the rates stabilised to enable us to get in.

“It was probably only about three to four weeks later that we’ve seen some of our peaks in the second wave in the middle of December, so we had to settle in very quickly to be able to respond.

“It was just all hands on deck.

“The actual move itself was an even greater success than we anticipated because we moved 110 patients from our other sites.

A single bed critical care room at the Grange.

“There's no doubt in our view that the hospital has enabled us to much better respond to the pandemic than if we didn't have it.

“It has been a saviour for us really, albeit that it hasn’t been able to fully open in the way we wanted to if we had opened in normal circumstances.”

Ms Prygodzicz highlighted several departments as being in a stronger position as a result of the move to the Grange, with staff from some – including paediatric and women’s services – saying they wouldn’t have coped had the move not taken place.

Staff moving equipment into the neonatal ward at the Grange. Picture: Aneurin Bevan University Health Board.

“We now have sustainable services for our children and our women’s services, our critical care department is in a much stronger position to respond to the demands that Covid continues to bring us,” said Ms Prygodzicz.

“Our infection prevention control rates for Covid spread is low in the Grange and the extra space that gave us in the Gwent and Nevill Hall enabled us to spread out if we did have an outbreak and enabled us to manage it effectively.

“Our urgent care system is under significant pressure, like it is everywhere in the UK. We are seeing increased numbers of people presenting to both the emergency department at the Grange and the minor injury units.

“The peaks in particular are much higher than we've ever seen before. One day in June, at the same time 2019 we’d seen 400 people across the system. This year we saw 700 on the same day.

“Our A&Es at the Royal Gwent and Nevill Hall weren’t coping before – one of the reasons for the new hospital is they just weren't big enough to deal with the demand, and demand is growing again.

“It is our view that if we hadn’t have opened the Grange, we would be under even more pressure than we are now.”

Ambulances queued up outside the Grange University Hospital.

That demand is meaning that a significant criticism of the health board since the Grange opened has been the long waits in ambulances outside the hospital, and in A&E for treatment. One common question is why the old A&E departments are not reopened to help with demand.

“In order to open those [A&E departments] back up, you need the staff to put in those sites, but it isn’t just about the A&E department,” said Ms Prygodzicz. “If you open up your A&E department you need a critical care unit on site, you need emergency theatres on site.

“We were struggling to run all of those teams across the two sites.

“What we can do is making sure the people that can go to the Royal Gwent or Nevill Hall do and are seen effectively and quickly.

“Ambulance waits outside the hospital but more importantly ambulance waits in the community where you’re sitting at home waiting for an ambulance in an emergency is a huge concern for all of us and something that is a top priority for us in terms of trying to address.

“We have a flow centre where we have clinicians sat in the flow centre and help prioritise where patients can go. We also try to encourage people to contact 111 where appropriate so that we absolutely prioritise those that need an ambulance.

“What we have to try and do is make sure we get patients moved out of the A&E department very quickly so that they’ve got room to keep bringing in patients.

“The biggest challenge we’ve had has been around the workforce. Our absence of staff is still around eight per cent where we always used to run around under five per cent.

“Social care have got a huge crisis around their own workforce and capacity to get people out of hospital.

“We’ve got an average of around 250 patients in our beds that are ready to go out of hospital but are waiting for some kind of social care. And if you can’t get them out that end, it backs up all the way to the front and leads to ambulance waits and people waiting in the community.

“We are working with our local authority partners in terms of how we address this as a whole system, because workforce is our biggest challenge across the whole piece.”

Another issue involved people being unable to contact their loved ones who had been taken to the Grange.

“Because we opened early, we didn’t have time to put the full mobile signal in, and at a time where we weren’t allowed visitors into hospital,” said Ms Prygodzicz. “It was a huge issue.

“We did put in place the patient liaison officers where there was a contact number people could ring to get information from the wards.

Nurses at the Grange ahead of its opening in November 2020.

“We have also worked with each ward individually to find out what their challenges were. Lots of them just had a fixed phone next to the nurses desk, which they miss if they’re out and about. So we changed lots of them to handheld phones.

“We had a dedicated IT person going round each wards with tablets so people could FaceTime, and we also brought in ward assistants so you didn’t have qualified nurses having to be taken away from clinical tasks to do pastoral support for patients.

“We still continue to learn and listen to develop that further.”