Some staff at Harrogate District Hospital are selling their annual leave and applying for further financial help in a desperate bid to make ends meet.
The hospital is allowing NHS workers to trade time off for extra payments until the end of the year, while a hardship fund has also been set up to help with the soaring costs of energy, fuel and food.
This comes at a time when staff are set to vote on strike action over a below-inflation pay offer which unions have described as another real-terms pay cut.
Jonathan Coulter, chief executive of Harrogate and District NHS Foundation Trust, told a board meeting today that he had “always been against” staff selling annual leave, but the cost of living crisis now meant that providing support was “absolutely vital”.
He said:
“My justification for this is that the financial position of some staff is putting them under more stress than the benefit of having a holiday.”
A total of 17 staff have so far applied for extra payments instead of time off, while 271 applications have been made to the hospital’s hardship fund, which is offering grants of up to £500.
Read more:
- Harrogate hospital plans new £14m operating theatres
- Hospital ‘not anticipating’ service cuts due to energy price surge
Wallace Sampson, hospital trust board member and chief executive of Harrogate Borough Council, said he had “mixed feelings” about staff being able to sell annual leave as he believes it is “very much needed” to help with their wellbeing.
In response, Mr Coulter said he agreed but this was the preference of some workers and that a five-day limit on the amount of time off that can be traded would ensure staff do get some down time.
He said:
“There is an absolute maximum of five days, so staff can’t sell all of their annual leave.
“We have agreed the policy for this year as a one-off, partly recognising that people have a lot of annual leave because of covid.
“We will need to review the initiatives, but at the moment they are absolutely vital.”
Winter strike possible
His comments come as strike action could span across several months this winter after the Royal College of Midwives union notified hospital bosses that it will ballot its members over pay.
Other unions including GMB and Unison are also said to be making preparations for a vote.
The prospect of staff striking at what is always a busy time for under-strain services in winter has been described as “worrying” by senior officials at Harrogate District Hospital, which has begun making contingency plans.
Around 100 of the hospital’s lowest-paid staff will see an uplift from a rise in the legal minimum wage to £10.90 in October.
However, Dr Suzanne Tyler, executive director at the RCM union, said the government needed to go further and give all workers a better pay rise after its members rejected a 4% increase offer.
Dr Tyler said in a statement:
Harrogate hospital plans new £14m operating theatres“Our members have spoken and just like us they believe a below inflation pay award is not good enough, they deserve more.
“The results and turnout speaks volumes about the feelings of a fragile, exhausted, and undervalued workforce, because taking industrial action is always the very last resort for midwives and maternity staff.
“They obviously now see no other alternative to getting a fair and just pay award from their governments.”
Harrogate District Hospital is planning a £14 million project to create two new operating theatres in an effort to tackle waiting times for treatment.
The scheme would see two additional operating theatres, two procedure rooms and a 12-bed ward for patients who require extended stays in care built on the site.
The hospital currently has six operating theatres, including general and emergency surgery.
Officials at Harrogate and District NHS Foundation Trust said the move would help to increase capacity for operations and reduce waiting times for both planned and emergency surgery.
The project forms part of a national funding scheme to help hospitals tackle long waiting lists.
A spokesperson for the hospital trust told the Stray Ferret:
“The number of theatres currently at our trust/Harrogate District Hospital limits the number of operations we can undertake on a weekly basis.
“Additional theatres will enable us to treat more patients each week, which will reduce waits for both planned and emergency operations.”
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- Harrogate care costs climb to £54,000 a year as ‘colossal’ price rises bite
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The trust added that the project will also help to “future proof” the hospital for a growth in population and changes in demographic in the district.
The scheme has been submitted to senior NHS officials and is currently being reviewed.
Trust officials said they expected a response on grant funding within the next four weeks. However, the project would also require planning permission before it goes ahead.
25,500 patients waiting
It comes as Harrogate hospital is currently tackling a long waiting list for patients awaiting treatment.
According to the trust’s own board papers, there were 25,564 patients waiting for an operation at the end of August.
Of that number, 1,297 had been waiting more than 52 weeks.
While the overall number of patients waiting is down by 65 on July, it is an increase of 3,396 on the same time last year.
In a report to the board, Jonathan Coulter, chief executive at the trust, said:
Most Harrogate hospital operations to go ahead on Monday“We have had a difficult summer and we are now moving towards winter knowing that the current level of acute pressures and community services workload are already significant.
“Combined with the need to reduce our elective care backlog, the challenges that we are managing are significant.”
The majority of planned operations at Harrogate District Hospital are set to go ahead on Monday.
Staff at Harrogate and District NHS Foundation Trust have been contacting patients after the funeral of Queen Elizabeth II was made an official bank holiday.
The trust said that of 35 operations due to go ahead on Monday, 33 were still due to proceed.
Two non-urgent operations have been cancelled. The hospital said one was rescheduled on request of the patient.
The trust said in a statement:
“We are working hard to deliver as many of the appointments and operations that have been booked to take place on Monday, September 19, as possible.
“By the end of this week, we will contact anyone who has an appointment, endoscopy or operation on that date to let them know if it is going ahead as planned or not.
“We would ask anyone who might be affected to please wait for the call from out teams.”
Read more:
- Covid infections in Harrogate district lowest for 15 months
- Hospital ‘not anticipating’ service cuts due to energy price surge
It comes as hospitals across the country have been told to contact patients ahead of the bank holiday to inform them of whether their appointments are going ahead.
In a letter to all English hospital trusts, Dr Ursula Montgomery, director of primary care at NHS England, said:
Hospital ‘not anticipating’ service cuts due to energy price surge“For patients with planned appointments that are affected by the bank holiday, please ensure they are informed in advance of any changes by utilising direct patient communications.
“Where planned appointments are going ahead it is important this is also confirmed with patients.”
Harrogate District Hospital has said it does not expect to cut back on vital health services because of soaring energy bills after revealing its costs have more than doubled from last year.
The hospital’s gas and electricity costs shot up by 132% between April and June when compared to the same period last year, but bosses have insisted the price rises “are being managed”.
This comes amid warnings that some NHS trusts will have to find as much as £2 million extra a month this winter due to the fuel price surge.
The NHS Confederation – which represents trust bosses across the UK – told the BMJ that the energy crisis coupled with higher than expected inflation was already “wiping out large parts of the NHS budget”.
A spokesperson for Harrogate District Hospital said that as part of its own budget planning it would do its “utmost” to take into account further rises, adding:
“Inflation costs above those included in the budget are being actively managed through the trust’s efficiency programme so that we can provide the best possible value for the taxpayer.
“It is important that our community has the best possible healthcare system to turn to when they need it and we are not anticipating that the current fuel rises will impact on the vital services we provide.”
Energy bills for non-domestic customers such as hospitals are not subject to the energy price cap and have therefore been even more vulnerable to surging prices.
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Under Liz Truss’s energy plan, household bills will be frozen at an average of £2,500 for two years and the new prime minister said businesses, charities and public sector organisations would also be offered an “equivalent guarantee” – but only for six months.
Harrogate District Hospital was last year awarded £14 million to reduce its carbon footprint and energy bills as part of its drive to become a “greener, more environmentally friendly organisation”.
The funding is being used for works to install new insulation and glazing across the hospital site.
A hospital spokesperson added:
Harrogate hospital officials ‘confident’ A&E streaming can tackle waiting times“Another exciting project currently underway is the drilling of a borehole, from which the heat energy will be extracted from the water, put through a heat exchanger and into our heating system to help reduce our reliance on gas and other fossil fuels.
“We also have a number of other projects that are currently being progressed or will start shortly, including replacing air handling units to increase efficiency and extract heat energy, and installing photovoltaic arrays to generate electricity on the site.
“Through this work we are already seeing big efficiency gains and further projects will continue in the years ahead.”
Hospital bosses in Harrogate have said they are confident a new streaming service will help tackle waiting times in A&E.
Harrogate and District NHS Foundation Trust revealed in June that it was to spend £900,000 setting up a service to assess patients at its emergency department.
As part of the plan, those who have a less serious illness or injury will be transferred to another part of the hospital which will have its own designated clinical practitioners.
Officials have now confirmed that the streaming service will be in full operation seven days a week from November this year.
Hospital bosses have so far been running the service four days a week when staff are available.
While there are no formal figures on how many patients the service has seen in that time, the hospital estimates that up to 50 people a day can be triaged through streaming.
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Currently, between 130 and 150 patients attend the hospital’s emergency department daily.
The Stray Ferret asked the hospital whether it was confident that the measure will help to cut down waiting times at A&E.
A spokesperson for Harrogate and District NHS Foundation Trust said:
“The streaming model will have a significant impact on waiting times in the ED [emergency department] – ensuring those walk in patients are seen promptly and allowing the sickest patients to have the focus of senior clinicians.”
Waiting time targets
Latest figures show that Harrogate District Hospital had 5,663 attendances to its emergency department in July 2022.
The national standard for emergency department waiting times is to admit, transfer or discharge 95% of patients within four hours.
According to NHS England figures, 71% of patients were seen within that timeframe at Harrogate hospital.
The move to create an A&E streaming service comes as other hospital trusts across the UK have introduced similar measures.
In 2018, United Lincolnshire Hospitals Trust spent £500,000 on expanding Boston Pilgrim Hospital’s emergency unit in order to introduce a streaming service.
At the time, ULHT said it felt there were too many patients attending the emergency department who could be seen by a general practitioner instead.
Harrogate hospital introduces yellow socks for fall victimsHarrogate District Hospital has started issuing yellow socks to victims of falls.
The scheme, which has been introduced by other hospitals, allows staff and visitors to identify patients who require extra assistance with their mobility.
Under the scheme, if a Harrogate and District NHS Foundation Trust patient is admitted having previously fallen, they will be automatically given a pair of non-slip yellow socks.
Katie Butterworth, falls specialist and corporate nurse at the trust, said:
“The bright colour of the socks let both staff and visitors know that a patient who is wearing them may need assistance when walking and could be a potential fall risk.
“We would like all staff to see (yellow socks), think (extra assistance) and then act (review falls risk assessment).”
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Hospital ‘under greater pressure than winter’ as staff struggle to free up beds
The chief executive of Harrogate hospital has warned it is under greater pressure than in winter as staff struggle to free up beds occupied by covid patients and those waiting for social care.
Jonathan Coulter said the recent rise in covid cases and a lack of available care services meant patients were staying in hospital longer than they should.
He added this was having an impact on A&E waiting times which “remain below the standard we would want”, with over a quarter of patients waiting more than four hours to be seen.
Mr Coulter said in a report:
“We are now in mid-July, and the acute pressures, the bed occupancy, the community services workload are all greater than you would often experience in mid-January.
“During the month of June and into July, we have experienced a significant spike in people in hospital who are covid positive.
“We have currently over 35 people in hospital with covid, and whilst the severity of the illness is reduced due to vaccine uptake, the infection control measures that we have had in place result in flow through the hospital being more difficult.”
Read more:
- Positive covid patients at Harrogate hospital doubles in three weeks
- Harrogate hospital records increase in heat-related illnesses
- More than 130 Harrogate hospital staff absent due to covid in June
Mr Coulter said covid was also having an impact on staffing levels, with around 80 staff currently off work after absences climbed above 130 in June.
He described the pressures on the wider health and care system as “enormous” and said the problem of bed blocking – where patients are medically fit to be discharged from hospital but have no care packages available – needed to be addressed.
He said:
“We continue to have a significant number of patients who are medically fit within hospital, our length of stay has increased, and we have many times more patients in hospital over 14 days and 21 days than we ever had before the pandemic.
“This reflects the pressure in care services out of hospital, and we are discussing across the system how we can reduce this risk.
“We know that if people stay in hospital for a significant time that outcomes deteriorate, and we are currently at risk of worsening care for our population as a result of some of the urgent care pathway pressures being felt across all organisations.”
Mr Coulter added the hospital was continuing to take ambulance patients from outside the Harrogate district and that while this was creating added pressure, it was “absolutely the right response”.
He said:
More than 130 Harrogate hospital staff absent due to covid in June“Despite the pressures locally, we continue to offer significant support to colleagues in other parts of our system, in particular York Trust.
“During June, in line with previous months, we had numerous ambulances diverted to the Harrogate site, which resulted in on average around 15 additional beds occupied by patients admitted as a result.
“This is absolutely the right response to system support, but we need to recognise the impact upon our colleagues who have to organise and arrange this care.”
More than 130 Harrogate hospital staff were absent due to covid last month.
A report from Jonathan Coulter, acting chief executive of Harrogate and District NHS Foundation Trust, has revealed that the increase in spread in the community had led to staff being off sick.
The figure peaked at more than 130 in June amid the spread of the more transmissible Omicron variant.
Currently, 80 hospital staff are absent due to covid.
Mr Coulter said in a report, which will be presented to the trust board on Wednesday, that the spread of covid has put “additional pressure” on staff.
He added that “a small number of staff” would now be affected due to sick pay changes, as the virus is treated like “any other sickness”.
Mr Coulter said:
“The guidance in respect of sick pay for people off with covid has now changed, and covid sickness is now treated and managed in the same way as any other sickness.
“This will have an impact upon a small number of colleagues who continue to suffer with long covid, and who will now move into our usual sickness management arrangements with the risk that after a defined period of time, their pay is reduced or ultimately ceases altogether.
“We are in dialogue with all colleagues affected by this change, but we need to recognise that this will be a difficult time for some.”
Read more:
- Positive covid patients at Harrogate hospital doubles in three weeks
- Harrogate hospital records increase in heat-related illnesses
Meanwhile, Mr Coulter confirmed that the trust is currently treating 35 patients who have tested positive for covid.
He added that while the severity of the disease remains low due to vaccine uptake, it has had an impact on flow through the hospital.
He said:
Harrogate hospital records increase in heat-related illnesses“During the month of June and into July, we have experienced a significant spike in people in hospital who are covid positive.
“We have currently over 35 people in hospital with CoVid, and whilst the severity of the illness is reduced due to vaccine uptake, the infection control measures that we have had in place result in flow through the hospital being more difficult.”
Harrogate District Hospital recorded an increase in heat-related illnesses during this week’s record-breaking temperatures as it also warned of extra pressures from a further rise in covid patients.
The hospital saw a 10% increase in visitors with conditions such as heat exhaustion or heat stroke, while covid patient numbers have tripled to 33 since the end of June.
Dr Matt Shepherd, deputy chief operating officer at Harrogate and District NHS Foundation Trust, said demand on services was “higher than we would typically expect” for summer and that there is “no doubt” much of this was due to the pandemic.
He added:
“Extreme weather, such as heatwaves, also adds additional pressure on hospital services.
“We need to ensure that the people in our care and our staff are not unduly affected by increasing temperatures and we have severe weather plans in place to address any issues.
“Waiting times to be seen during these times can also be longer than usual due to demand.”
Temperatures are easing today after approaching 40 degrees in the district yesterday when North Yorkshire Fire and Rescue Service declared a ‘major incident’ on the hottest day ever recorded in the county. It said today it had ‘stood down’ this status.
Gosh it was a hot one yesterday! ☀️ As you know we, like most other fire services around the country, declared a major incident due to the level of demand. The good news is we have now stood down this status and have returned to expected levels of demand.
— North Yorkshire Fire & Rescue Service (@NorthYorksFire) July 20, 2022
As well as causing a surge in demand for emergency services, the heatwave also led to cancellations for train services and forced some schools to shut.
The forecast for today is still warm, but cooler on Thursday and Friday with highs of 19C in Harrogate.
Covid pressures
Covid infections and hospital admissions have been creeping up since the end of spring and after the emergence of the BA.4 and BA.5 sub-variants of Omicron.
Dr Shepherd said while most patients are not falling seriously ill with the virus, it was still causing pressure for the hospital which is battling long backlogs.
He said:
“Since we emerged from lockdown, our priority has been to reduce the backlog for operations and treatment.
“The increased number of planned operations being performed has added to the pressures, but it has meant we have been able to reduce our waiting lists and no longer have any patients who have been waiting over two years for treatment.”
Read more:
- Positive covid patients at Harrogate hospital doubles in three weeks
- Yorkshire Ambulance Service declares ‘critical incident’ status
The Harrogate district’s weekly infection rate has been climbing steadily over the last few months and currently stands at 288 cases per 100,000 people.
The latest figure is up from 52 in May, but well below the previous peak of 1,007 in March.
The increase comes as the government has announced that everyone aged 50 and over will be offered a booster vaccine this autumn to top up their immunity.
Younger people at high risk from covid, as well as health and social care staff, will also get the booster.
Dr Shepherd added:
Hospitals, schools and care homes braced for record temperatures in Harrogate district“Covid vaccinations have been extremely successful in reducing the severity of the virus, however, the highly infectious nature of the new variants is having an impact at our hospital.
“Thankfully, most patients who have tested positive are here for other medical issues or surgical procedures rather than having acute covid symptoms.
“However, in most cases it does mean that their treatment cannot be progressed until they test negative, which increases the time they need to stay in hospital and reduces the number of beds we have available.
“Whilst we are much better prepared at treating covid than we were two years ago, this virus has not gone away and it still has a significant impact on the hospital and is still a threat to people’s health – particularly vulnerable or unvaccinated patients.”
Schools, care homes and public services across the Harrogate district are putting in place measures to protect vulnerable people from the extreme temperatures expected today and tomorrow.
With the Met Office forecasting highs of 38C and red warnings in place, there is a risk to health, especially for the elderly, very young and people with existing medical conditions.
Ice creams for hospital patients
Measures are being put in place to help patients and staff keep cool at Harrogate District Hospital and Ripon Community Hospital.
On the wards and in outpatient areas, temperatures will be monitored and air conditioning units are available if needed. High risk patients will be watched closely and ice creams and lollies will be available to help people cool down.
A spokesperson for Harrogate District NHS Foundation Trust said staff have been given advice on ways to keep cool while working during the heatwave, including wearing light-weight scrubs.
Some appointments where physical exertion is needed, such as physio appointments, may be postponed until the weather is cooler.
The spokesperson said:
“Our emergency department is always busy and under pressure during severe weather due to an increased number of people visiting our hospital – some with heat related illnesses such as heat exhaustion or heat stroke.
“Waiting times to be seen during these times can be longer than usual due to demand.”
Anyone considering going to the emergency department is asked to call NHS 111 first or visit the 111 service online, unless it is a severe or life-threatening situation.
The service can offer advice and even book people in to be seen quickly on arrival if a hospital visit is needed.
Anyone arriving without an appointment will still be seen, with the most urgent cases being dealt with first.
Council bin collections to start earlier
Harrogate Borough Council has made some adjustments to its services in order to keep staff safe.
A spokesperson said:
“Waste and recycling collection rounds will be starting earlier in the morning to enable rounds to be completed earlier and limit work time in the hottest part of the day.
“In relation to our Brimhams Active health and wellbeing services, all staff cover heat exhaustion as part of their staff training, they will be reminded of what to look for and how to treat any incidences.
“At our community wellbeing hubs we have plans in place to increase breaks and water at all sessions.
“We are using the government guidance for vulnerable adults and will err on the side of caution and cancel when/if appropriate.”
Risk assessments have been completed for extreme heat and adjustments made, including for staff working outdoors. The spokesperson said there may be some changes to services if required to protect staff and vulnerable residents.
Read more:
- Harrogate district prepares for heatwave as red weather warning issued
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Extra checks on vulnerable residents
As the public health authority for the Harrogate district, North Yorkshire County Council has issued advice about keeping homes cool, including:
- closing curtains and windows in rooms facing the sun
- turning off unneeded electrical appliances
- finding shade outside, which may be cooler than indoors
- not leaving anyone, including children, the elderly and animals, inside a closed, parked vehicle
- storing medication according to packet instructions
- ensuring fridges, freezers and fans are working properly
The council’s director of public health, Louise Wallace, said:
“Those in our communities who may be more vulnerable will be receiving increased checks on them throughout hot spells.
“However, we would appeal to those who are able to take the time to check whether friends, relatives and neighbours need help and to call for assistance if necessary.
“Public buildings operated by the county council will also be kept as cool as possible while temperatures remain high, but we would advise people to avoid making unnecessary journeys while the weather remains hot.
Care homes focus on hydration
Jill Young, operations director at Vida Healthcare, said its homes have plans in place ready to be activated in the event of a heatwave and some measures began to be introduced last week.
She said hydration was a particular focus, as well as adapted menus with cold foods to reduce use of ovens in the kitchen, adding:
“During hot weather, we also introduce extra fluid measures. Our chefs make jelly sweets that contain 20ml of water per sweet – our residents love them and it can be a straightforward way of giving them a little extra fluid.
“Our freezers are kept stocked with ice creams and ice lollies for both staff and residents which are available at all times, and our residents also have access to jugs of juice and water in their rooms and the communal areas.
“We’re very lucky that all three of our homes have access to secure outdoor spaces with shaded areas that our residents can enjoy.
“If a resident is keen to go outside, our staff will make sure they’re wearing a hat and suncream, and will encourage them to sit in the shade to keep safe from the sun.”
At Emmaus House, opposite Harrogate’s Valley Gardens, manager Chrissie Steel said extra jugs of cold squash will be placed around the home.
“For people with dementia, they may not be able to recognise they are thirsty, or to tell us they need a drink, but they can often point to a jug if they see one.
“We’re very fortunate to be close to the Valley Gardens to get outside when it’s cool enough – and many of our residents who have spent time in Africa earlier in life absolutely love this heat!”
Schools relax uniform policy
Some schools have relaxed uniform policies for Monday and Tuesday, allowing students to attend in light-weight clothing.
Many have said they will keep children indoors during the hottest part of the day and will be ensuring they drink more water than usual.
NYCC public health director Louise Wallace said:
“Staff in schools are aware of the potential risks created by a heatwave and school children should aim to have sun cream applied before attending school next week, and ensure they have a refillable water bottle with them.”
Warning over power supplies
Northern Powergrid has warned the high temperatures could cause disruption to power supplies.
It has asked people to report power cuts via its website or by calling 105.
Anyone who could need more assistance in a power cut, such as people with medical conditions or disabilities, or families with very young children, can sign up for priority services membership and will be kept updated during any disruption.
A spokesperson for Northern Powergrid said:
“Our customer support vehicles are also prepped and ready to go out into local communities, where possible.
“We have also taken action to remind our people of the importance of staying hydrated and protected so they can continue to work safely during the hot weather.”