Opinion

While some other hospitals were turning away patients and putting up the shutters, the team at Darlington managed to keep on admitting very sick, mainly elderly, patients.

Janet Probert, a former nurse who is now the smartly-suited winter pressures manager at the hospital in Woodland Road, says the answer is in forward planning.

"These days we expect to be very busy all the time which means that there is always an issue about how we are going to manage over the much busier Christmas period. That is when the planning comes in. We learned a lot from planning for the millennium because we had to do everything in such detail," she says.

"We know we have contingency plans, we know we will use beds on surgical wards for medical patients. Last year it wasn't 'Oh my God what are we going to do?', it was planned."

A member of the County Durham and Darlington Health Authority winter planning team which has continued to sit all year, Janet is pleased at the progress made since last winter and the extra millions that have allowed hospitals to increase beds and staffing and social services teams to spend more on nursing home places for patients who would otherwise become "bedblockers".

Most of all, she is hoping that lightning will not strike twice. "We had 'flu last year and we survived and the hope is that we don't have such bad 'flu again. We had very high numbers of very sick people last year and we managed throughout that and we managed to keep most elective, planned surgery running. We didn't close to medical admissions which I think is a credit to everybody."

Over at Bishop Auckland General Hospital, Darlington's partner in the South Durham Health Care NHS Trust, the shutters came down briefly but Janet says this was largely due to capacity problems at a smaller hospital.

This winter, with pressure on the Government to do something to prevent another winter of hysterical headlines about "winter crises", facilities have been strengthened across the region.

At South Durham, this has translated into 12 extra medical beds, together with diagnostic services which can weed out people who need to remain in-patients and those who can safely be allowed home.

Both developments are "a big improvement", says Janet.

The extra beds will double the size of Darlington hospital's medical and surgical emergency admissions unit, introduced for the first time last winter.

The unit allows medical staff to assess and treat medical emergencies promptly and efficiently. If patients need further hospital treatment, they can be moved to an appropriate ward but if they are well enough to return home or need some other type of care, this can be arranged quickly.

Admitting patients to this dedicated ward reduces disruption to other patients elsewhere in the hospital.

"The medical admissions unit made a real difference last year. We can now say to patients 'it is not as bad as you thought' and in some cases send them home on the same day," explains Janet. "This frees up much-needed beds and means the right people stay in and the right people go home."

In the last two years there has also been a very significant change.

So-called Immediate Response Teams made up of trained nurses and support staff can now go into patients' homes up to four times a day to provide health or social care. Jointly funded by the Darlington Primary Care Group and Darlington Social Services they work in a way which abolishes the old distinctions between social and health care.

"They will go in and, according to what the patient needs, provide them with a bit of lunch or a bit of physiotherapy. The good thing is that they can provide both social care and health care, you don't have to decide what kind of care the patient needs, you just have to decide it is better for the patient to be cared for at home," says Janet.

Closer links between social services and the health service means that Janet can pick up the phone and try to find a nursing home place for a patient who cannot return home but plainly does not need to be in a high-tech acute hospital, occupying a bed which may desperately be needed by a seriously ill patient.

"I actually had a patient in this week who really needed to be in a nursing home so I rang social services and asked if they could help," says Janet.

While there is always a waiting list for the most popular private nursing homes, patients are consulted before they are discharged into a home.

While Janet is mostly preoccupied with ensuring there is adequate capacity for more medical admissions - by cutting back on planned non-urgent surgery as the holiday period approaches - she is also keen to get the message out to people that the accident and emergency department is not the right place to go if you have a runny nose.

"The accident and emergency department is there for accidents and emergencies. If you have a chest pain it's almost certain you need to be there - but not if all you have is a bad cold."