Case Study - Whittington Hospital NHS Trust

Cross over site cover out of hours

The Whittington Hospital NHS Trust aimed to identify solutions that could be used in other trusts by exploring the feasibility of cross over site cover out of hours.

The final report of its European Working Time Directive (EWTD) pilot states the project encountered both internal and external difficulties, admitting that the project would’ve been approached differently in hindsight.

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Internally this included the secondment of the project manager to another team, plus changing the emphasis of resources when the hospital applied to become a foundation trust (FT). External issues included the arrangements for commissioning and funding NHS services, the impact of both Whittington and Homerton University Hospital NHS Foundation Trust's applications on collaborative behaviour, plus the implications of the Next Stage Review. Celia Ingham-Clark, medical director of the Whittington Hospital trust, said: "We have got to solve the problem of the EWTD. People cannot close their eyes to the issue and hope it will go away, it won't. "It needs a dedicated project manager who has the vision to see it through as well as handling the practicalities of ensuring meetings actually happen. Everybody else has a day job and with so many competing pressures, the most immediate ones tend to take precedence."

We have got to solve the problem of the EWTD. People cannot close their eyes to the issue and hope it will go away, it won’t.
Celia Ingham-Clark, medical director, The Whittington Hospital NHS Trust

The original plan included two options for general surgery to combine the consultant on call rotas. They were either to operate alternate nights on call between the two hospitals with the 'hot' hospital providing the on call consultant, available to give advice to the 'cold' hospital, or for one of the two hospitals to undertake all the out of hours emergency surgery.

In that case general surgery consultants from both hospitals would contribute to a combined on call rota to support the service.

But the trust encountered difficulties. Celia Ingham-Clark said that although London Ambulance Service was 'sympathetic' to their plans, the systems were not in place to make it possible.

"Although similar schemes have been running elsewhere in the UK, the situation in London is more complex and includes ambulance crews coming in from surrounding counties. There would need to be in place more detailed supervisory systems, the last thing anyone wants is for a patient to be taken to the wrong hospital."

The final report states that if out of hours emergency surgery was to be focused on one of the two sites, the other might be perceived to be less able to deliver emergency care at other times. It states 'each site felt it would be vulnerable without a middle grade surgeon on site 24/7 since surgical emergencies can commonly arise in medical inpatients or in post operative elective surgical patients'.

The report also acknowledged that in 'the current competitive environment of the health service' no trust can afford to show any potential weakness that might threaten its commercial viability www.healthcareworkforce.nhs.uk/pilotprojects.

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