STAFF at Royal Bournemouth Hospital have spoken openly about the immense challenges and pressures faced every day as demand increases exponentially.

The Daily Echo spent a morning with consultants from emergency departments and patients to discuss why the hospital was facing such difficulty.

Throughout the night, patients faced waits of up to two hours in the back of ambulances before entering the hospital – brushing shoulders with A&E walk-ins and those waiting in beds situated in corridors.

Despite adversities faced, the mood around RBH was decidedly positive on Thursday morning (December 9).

The calm atmosphere is largely attributable to the team we visited first – the Clinical Site team, who are described as the “eyes and ears” of the hospital.

Bournemouth Echo: Clinical Site team at Royal Bournemouth HospitalClinical Site team at Royal Bournemouth Hospital

The team of clinically trained site managers are in charge of operating the deployment of beds, liaising with ambulance services and making “impossible choices” such as what patient will be given priority care over others.

The team was informed that there would be between 50 to 60 new admissions in the morning, however just 16 discharges were expected.

Following a FLOW meeting, which is described as “oiling the cogs of the machine”, site manager Chris Trent said: “When you’re in this mode, you’re looking at breaking down individual patients as to what’s stopping them leaving hospital.

“We’re not kicking people out, we’re looking for justifiable reasons why this patient isn’t going home once they’re medically ready.

“Long waits to be seen aren’t necessarily an indication of how departments are doing first thing in the morning. You could have someone with tooth ache who wants to be seen by a doctor. While important to the patient, it’s just not a clinical priority compared to someone coming in with a stroke or heart attack.

“We often find ourselves debating whether we’re going to treat someone’s hip after waiting for hours, versus someone’s heart attack – that’s when you make some very difficult, sometimes impossible, decisions.”

Site managers Kelly Henderson and Sarah Lee both went on maternity leave in early 2020. Returning one year into the pandemic, they said everything “completely changed”.

While talking with the team, it became apparent how many variables prevented patients from leaving hospital despite being treated.

Examples were given of vulnerable patients with no means of travelling home and those with mental health problems – the hospital’s duty of care means they must liaise with other organisations, be it care or social, to make arrangements. This process takes time, causing less bed availability for new patients.

RBH operates on an Operational Pressures Escalation Levels (OPEL) framework – a system which manages pressure on a four level basis.

OPEL level four is the highest form of pressure a hospital can face. For staff at RBH, level four has become “routine”. Sarah Lee said: “People in the trust used to be like ‘oh my God’ when it was level four, now it’s routine.”

The ripple effect begins in the home. One patient, a 60-year-old woman, phoned 999 at around 9pm on Wednesday for a rapidly increasing heart rate. Arriving at RBH at around 1am, the patient waited in the ambulance for just under two hours.

Bournemouth Echo: Corridor beds inside Royal Bournemouth HospitalCorridor beds inside Royal Bournemouth Hospital (Image: Stock image)

Upon entry, she received a Covid test, a blood pressure check and an ECG before being taken to one of four corridor beds. She was eventually moved into an observation booth at 4.15am, being seen by a consultant at around 10.30am.

She said: “I think they did incredibly well. They were clearly inundated but everybody was thoughtful, kind and apologetic.

“You can see the pressure they’re under but I never felt they were in a hurry to get rid of me. They made it as comfortable as possible and deserve so much credit.”

Consultant Dr Chris Dale oversaw the emergency department on Thursday. She said: “Everyone talks about the winter crisis last year, but we don’t feel like we’ve got out of it at any point.

“When a patient is here, they’re obviously very worried about themselves. There has been a bit of an uptick in aggression towards staff but overall I’d say people have been incredibly patient.

“We feel desperately sorry for them having to wait eight or 10 hours before seeing a doctor. That’s not the service we want to provide. We want everyone to be seen early, but we physically cannot do it.

“Our priority is to make sure we don’t miss that one person who’s really sick – that’s our biggest fear. If we miss those, that can have significant repercussions.”

The Acute Medical Unit (AMU) is a “halfway point” at RBH. It houses 52 beds and aims to treat all patients by 72 hours before triaging them to speciality wards or for discharge.

Acute medicine consultant Dr Michael Wheble said: “We live or die by flow and once one department falls, the others follow.

“Covid is a factor but it’s not alone. We’re seeing Brexit impact staffing amid 10 years of staffing challenges anyway so it’s a perfect storm – Covid, Brexit and staffing problems.

“I suspect this is going to be a challenge until at least February.

“We just get on with it and I’m very proud of my unit here. [Everyone] is getting stuck in and pulling in the right direction – from our medical directors to our porters and cleaners.”