Half in Exeter intensive care are ‘out of area’ Covid patients

Half the patients in Intensive Therapy Unit beds at the Royal Devon and Exeter hospital are ‘out-of-area’ patients, hospital trust board members have been told.

Daniel Clark www.devonlive.com

The documents presented to Wednesday’s morning’s meeting confirm that the Trust has been taking in patients from elsewhere in the country to help relieve pressures within their hospitals where they have been struggling with extreme demand for critical care beds due to the Covid-19 pandemic.

At the latest count on January 19, 6 of the 12 COVID patients in ITU were out-of-area patients, the documents state.

The meeting heard that while the hospital had suffered a ‘tough December’, it is in a better position that forecast in January and ‘are in a good position to give mutual aid to others across Devon and the surrounding counties’.

The report of Suzanne Tracey, Chief Executive of the RD&E, said: “The current clinical capacity at Nightingale Exeter has been able to support mutual aid requests from outside Devon and Cornwall.

“These requests have been coordinated by the System Medical and CEO group to assess the appropriate system priorities and management of the COVID response, and have been implemented by clinical and managerial leaders from across the system.”

At the meeting, she added: “We had a tough December, but based on our forecasted number for January, we have fared better in the number of patients we had, and given we are in a better position in terms of numbers and staffing, we are in a good position to give mutual aid to others across Devon and the surrounding counties.

“That is reassuring given the position across the country and we are playing our role to provide aid to other parts of the country harder pressed.

“The position remains tight as alongside those supporting from Covid, but have pressures from non-covid emergencies as well, but we are managing to do that ok, but it is a constantly moving position that requires constant oversight.”

With the support of the other local acute trusts and recent deployment of 25 medical assistants and 20 general duties military personnel, the Exeter Nightingale has activated plans to increase its capacity to 70 of its 116 beds, her report added, saying: “The current clinical capacity at Nightingale Exeter has been able to support mutual aid requests from outside Devon and Cornwall.”

The Nightingale Exeter is also working alongside the RDE to substantively recruit Healthcare Assistants, with approximately 26 expected into place over the next 2-3 weeks and further recruitment continuing.

“This will help facilitate a further increase in bed capacity to 94 beds which are likely to be available if required in the first week in February,” the documents says, adding that the oversight of the capacity increase has been system-led and ‘capacity has been utilised Plymouth, Torbay, Exeter and North Devon’.

She added: “We have been lucky to be allocated a deployment of military personnel so we can increased the number of beds across that to staff it. That has allowed us to take a further increase of bed capacity at the Nightingale to around 70 to 80 beds, with the ultimate capacity of around 116 and we are managing demand and capacity carefully on a daily basis.”

An NHS England spokesman said: “The NHS has tried and tested plans in place to manage significant pressure and this has always included mutual aid practices whereby hospitals work together to provide the very best care for patients. Devon has played its part, where capacity allows and at UHP we are caring for a very small number of patients from other areas.”

And Dr Adrian Harris, medical director at Royal Devon and Exeter Foundation Trust told the board that the situation inside the hospital was ‘enormously encouraging’ and that they were in an extremely strong position in terms of hospital acquired infections.

He said: “We haven’t seen a definite case for at least ten days, so we are in a good position compared to other trusts. The situation at the RD&E is enormously encouraging at the moment but is not a cause for complacency.”

The information follows on from what Devon County Council’s Health and Wellbeing Board had last Thursday heard.

The meeting heard that while there were more patients in hospital in the county than during the first peak, they do have the capacity to manage the demand and it is not impacting on urgent non-Covid healthcare.

And the board heard that while there was pressure in the system, Devon hospitals were in a position where they have been able to take patients in from elsewhere in the South West and the South East to help healthcare colleagues in those areas.

Dr Paul Johnson, clinical chair of the Devon Clinical Commissioning Group, said that if their modelling is correct, then the next week should see the peak of admissions and occupancy in hospital before plateauing and dropping, and if so, then Devon will have the capacity to care for those who need it.

Speaking at the meeting, Dr Johnson, when asked how hospitals were managing, said: “In general we are seeing more people in hospital than the previous peaks and around 10 per cent are needing intensive care, around the same as first peak, and we are using the Nightingale to utilise extra bed capacity.

“It does mean that as things stand, we have the capacity to manage the number of cases we are getting, and if the modelling is right, then over next couple of weeks we should see the peak and then plateau and drop, then we should have the capacity to care for those in hospital

“One impact of that though is that all hospitals are operating at ‘green surge’, so things that can be deferred safely like routine operations are so that staff and spaces can be used to provide some more critical care and general medical beds during this time. But it is not impacting on those urgent non-Covid things we need to be doing.

“We are in a better place than our neighbours, both north and south of us, and we are looking at how we can mutually support them, and we are looking to care for some of the patients from outside of Devon. We have taken some from elsewhere in the South West and some from the South East to support healthcare colleagues across the county.”

And as a percentage of total acute beds available, 2% of beds in North Devon are occupied with Covid patients, 5% in Torbay, 12% in Plymouth, and 16% in Exeter, with only Derriford having seen a rise in the past week.

North Devon and Torbay have the lowest percentage occupancy rates anywhere in England, while at a partnership level, Devon is the lowest with Cornwall second lowest.