WYE Valley NHS Trust heads into winter facing a “perfect storm” with a budget deficit of more than £5 million, unprecedented emergency demand and the loss of its chief operating officer.

Significant pressures on A&E and bed availability at Hereford County Hospital already far exceed those this time last year as high attendances and, in particular, high levels of emergency medical admissions continue.

Over a single day last month 57 emergency admissions were handled by the hospital over a 24 hour period, which represents just under one third of its total adult bed base.

Work continues across the county’s health and social care economy on a resilience plan for winter that can also improve the trust’s performance towards key NHS targets.

Those key targets not met over August include four hour waits in A&E, ambulance handovers, and cancelled operations.

The resilience plan has gone to NHS England and the NHS Trust Development Authority (TDA) for scrutiny and approval.

Amongst its initiatives were:

• The creation of additional winter contingency beds at Hereford County Hospital and Bromyard Community Hospital.

• The establishment of additional rapid access, ‘discharge to assess’ beds in the community, to assess care needs for patients no longer needing hospital beds.

• Continuing the deployment of GPs to late shifts within A&E.

Additional actions being taken by the trust but not in the plan include:

• The creation of a Frailty Assessment Unit within the current Acute Admissions Unit.

• The recruitment of an additional acute medicine physicians.

• The deployment of the NHS England Area Teams Medical Director in the Trust for 2 days a week to assist with the urgent care improvements.

Against this background, the trust’s chief operating officer (COO) Neil Doverty, who has overseen improvements to clinical services so far, is leaving to become COO to Peterborough and  Stamford NHS Foundation Trust.

The search for both a substantive COO and an interim appointment to ensure continuity as the trust moves into winter mode is underway.

With A&E attendance and emergency activity demand staying significantly above planned contracted levels, the impact on elective services is said to be “profound”.

 This impact is demonstrated in a repeat marginal fail against the 18 week referral to treatment target, high levels of planned surgery cancellations and high number of bed days lost in surgery.

The trust has arranged for additional day case elective beds at the County next month to bring down the number of surgical patients experiencing late cancellations because of “excessively high” emergency referrals.

Nor is the trust’s financial position getting any easier.

The reported month 5 budget deficit was £5.38 million - £1.38 million behind plan.

To the trust, this position primarily reflects the “significant and on-going” operational pressures it is under.

There is now a “significant likelihood” that the trust will not be able to deliver the £9m deficit that was agreed in the financial plan.

Talks between the trust and the TDA over options to address the deficit are underway.