Health board Q&A on Grange hospital, Covid and delays

In the middle of the pandemic, Gwent's Aneurin Bevan University Health Board opened its new major hospital, the Grange, which was hailed as an important weapon to tackle Covid.

But accounts of long waits at the hospital doors, and queues of ambulances outside, have led some Argus readers to question whether everything was running smoothly at the Grange.

We sat down with Nicola Prygodzicz, the health board's interim deputy chief executive, to find out about the pressures currently facing the NHS in Gwent and to ask how the new hospital was faring.

'Huge benefits' of opening Grange during pandemic

The Grange opened in November 2020, four months ahead of schedule and just as a series of local lockdowns hit Gwent and the rest of Wales. And as patients were transferred to the new site, major accident and emergency (A&E) departments closed elsewhere - at Newport's Royal Gwent Hospital and at Abergavenny's Nevill Hall.

Mrs Prygodzicz said this was "always the plan" since the Grange project began 15 years ago, and "all the clinical evidence" supported a "centralised, specialist acute hospital for our sickest patients".

Opening during a global pandemic was not part of the original plan, however, but the Grange gave the health board more space and better facilities to separate Covid and non-Covid patients, minimising the spread of the virus.

"We took a clinically risk-assessed decision that is was better to open it early than to go through the winter, and there were huge benefits in us doing that," Mrs Prygodzicz said.

She explained how the move "freed up capacity" in Newport and Abergavenny, and Covid patients at the Grange could be treated in single rooms as opposed to open wards.

Mark Drakeford officially opened the Grange last August but it started treating patients in November 2020. Picture: Welsh Government

Mrs Prygodzicz said "I don’t know how we would have managed" without the Grange during the pandemic, because Covid was engulfing wards at other hospitals.

"Obstetrics, paediatrics, they believe they would not have been able to survive the winter of 2020 if we hadn’t opened the hospital, because we were already struggling… we just didn’t have enough space to provide paediatric care," she said. "Critical care went into a brand-new facility and we contained it all."

Patient flow problems are causing bottlenecks and delays

The Argus has reported multiple times on long queues of ambulances outside the Grange, and some patients waiting much longer than the four-hour target for triage at A&E.

Mrs Prygodzicz said "all of us are really unhappy" about such waits, which are not unique to the Grange nor to Gwent. Improving A&E waits is a "top priority", she added.

But the problem is less to do with the new site itself and more to do with wider issues around patient flow and discharge from hospitals.

"We’ve sometimes got 10-20 patients sitting in the emergency department who are waiting to go to a ward, but the wards are all full," Mrs Prygodzicz explained.

"We’re waiting for people to go from the Grange to a community hospital, or to the Royal Gwent or Nevill Hall, but they are full. Their beds are full of people waiting to be discharged, and social care hasn’t got the staff there to do the packages of care, or the care homes are in outbreak.

"We’ve got on average 300 patients at any one time who are medically fit to leave hospital, that we can’t get out. Then it’s like a domino effect, it backs all the way up."

Last month a Senedd committee rapped the Welsh Government over patient flow bottlenecks, and ministers have pledged to tackle what is a national problem.

Locally, Mrs Prygodzicz acknowledged long stays in hospital can "decondition" people and it was better to get them home or into a community setting. She said the health board was working closely with councils and social care agencies "because we know this is a blockage that is impacting on the waits at the front of the system".

Health board may improve the layout at the Grange

There are other practical steps which can be taken at the Grange to improve patient flow, and the health board is considering proposals to expand the waiting area to prevent long queues outside.

One of the things the health board didn't expect was for so many people to arrive at the Grange by car - originally, the plan was for the hospital to only accept ambulance patients. As a result, the numbers of people arriving for treatment can be larger and more unpredictable than anticipated.

The Grange University Hospital. Picture: South Wales Argus Camera Club member Paul Joy

The opening of a same-day emergency care unit will treat patients who need diagnostic tests, too. Set to open in August, it could take "a couple of months" to hit full speed but "should take the congestion away from the front door", Mrs Prygodzicz said.

Other pandemic measures have also played a part - the Grange had to open a second A&E assessment area for non-Covid patients, and testing stations for the virus also take up space. It is hoped that when these measures are no longer necessary, it will free up even more room in the hospital.

Covid still taking a huge toll on healthcare

The NHS remains under "significant" pressure and "as things seem to be settling, we’re hit with a new wave", Mrs Prygodzicz said.

This is having a major impact on staff absence, and a Covid outbreak in a department can sometimes take a quarter of all workers out of action at the same time.

"We have to be a bit stricter with our isolation and our testing regimes to make sure people come back to work safely, when they’re in contact with so many patients," Mrs Prygodzicz explained.

Even though national restrictions have been dropped for several months, she said Covid was still having "a huge impact on our ability to keep services running", and effects on staffing were also being seen in the ambulance service and in social care.

Nicola Prygodzicz, interim deputy chief executive at Aneurin Bevan University Health Board. Picture: ABUHB

This comes at a time when demand on NHS services is at record levels, mainly because many treatments were paused during the pandemic and staff are now working to clear significant backlogs.

An indirect consequence of Covid and lockdowns was that people put off seeing a doctor, meaning their health problems may now be more complex.

"We’ve got a lot of patients on our wards who need enhanced care – more than we’ve ever seen before need that one-to-one care," Mrs Prygodzicz said. "We’re definitely seeing a higher dependency of patients who are coming into us."

Some patients attending wrong hospital

Another problem at the front door of the Grange has been around communication. The Grange is Gwent's only major A&E hospital and is not intended to treat minor injuries, but since it opened the health board has had to "redirect" many people who turn up at the wrong place for treatment.

This has led to queues and frustrations, especially for patients who spend hours waiting in A&E to be told they should have gone to one of Gwent's minor injuries units.

Improved communication will help with patient flow and cut waits, Mrs Prygodzicz said, and "make sure the people who come to the Grange are absolutely only those need to be at the Grange".

"We’ve got four minor injury units, three that are 24/7 (the Royal Gwent, Nevill Hall, and Ysbyty Ystrad Fawr - while Ysbyty Aneurin Bevan has limited hours) and they see about 8,00 patients a month between them, and 90 per cent of them get turned around in four hours," she added.

"We don’t want, and what is not acceptable is people waiting a long time and we then say you need to go somewhere else."

In recent months, the number of "redirections" has improved, Mrs Prygodzicz said, adding: "We do feel the message is getting out there and people are starting to understand it better, but we know there’s still a lot of work we need to do."

• More information about choosing the right hospital can be found here. If you're in doubt whether you should attend a minor injuries unit, call 111 for advice.