Clevedon Hospital

The hospital was established in 1875 by a local beneficiary Sir John Hallam Elton. He had become aware of a hospital at Warminster and realised that Clevedon needed a similar hospital. The hospital was initially established in 2 cottages in Old Street. They were subsequently adapted. A resident matron was appointed. There were 6 beds initially and this was later increased to 10.

The population of Clevedon is about 23,000. However the hospital also serves the large population in the surrounding area. Since its inception the medical input has been provided largely by local general practitioners initially working voluntarily. At one time the hospital was under the overall umbrella of Southmead. It then became part of the North Bristol NHS Trust. Two years ago it was taken over by the North Somerset Primary Care Trust.

I had an hour long interview with Gwen Hobbs who is Matron at Clevedon Hospital. She has worked there since 1988. The hospital does not produce an Annual Report but Gwen Hobbs was able to provide all the essential information.

Twenty-one beds on 2 levels in the old cottage accommodation. The in-patient accommodation was not purpose-built. There is a lack of space - the beds are close together and the corridors are narrow. Previous Trusts had not invested in up-grading the building. A lot of time and money needs to be spent on it to bring it up to an acceptable of accommodation. There are 6 beds downstairs for people who are reasonably mobile.

The bed occupancy rate was about 84% last year.

Most, but not all, patients are elderly. There are some younger patients who are in hospital for terminal care. The general practitioners are the only people who can admit patients to Clevedon Hospital. The patients may come from home or from one of the acute hospitals (e.g. following heart or hip surgery).

There are very few stroke patients. There are many people with chest infections. Other problems include cellulitis, leg ulcers, and heart failure.

The hospital does not deal with fractures these are referred to acute hospitals.

Straightforward x-rays Service offered 9-5.

Ultrasound and echo (No radiologist on site)

Intravenous therapy and blood transfusions Nurse cannulation.

Suturing In the Casualty Department.

Telemedicine There is a telemedicine facility with Frenchay

A&E. It is not very much used but Gwen Hobbs says that it can be very useful.

There is a nurse-run Casualty Department where simple problems can be managed. Major injuries, including fractures, are referred on to acute hospitals.

During the last 4 years there has been a huge increase in the number of consultants visiting. The following specialities are represented the number of clinics per month is given in brackets:-

Paediatrics (1)

General Medicine (nil)

Geriatrics (4)

General surgery (3)

Cardiology (4)

Vascular surgery (1)

Gynaecology (2)

Urology (1)

Rheumatology (1)

Orthopaedics (1)

Family planning (4)

ENT (1)

Respiratory medicine (3)

In addition there are a number of clinics run by specialist GPs. There is a musculo-skeletal clinic 16 clinics per month. There is also a gastroscopy and sigmoidoscopy clinic run by a GP specialist. There is now a weekly session but the waiting list is growing and there is little OP space for more clinics.

No major surgical procedures are undertaken. However varicose veins are injected.

Recruiting catering and domestic staff can be very difficult. Recruiting trained staff including nurses was at one time relatively easy but has become more difficult recently.

The dependency of in-patients is high using the Telford scale. The average length of stay in hospital is 17 days. There are the inevitable problems with \"bed-blockers\". There is a General Practitioner Management Committee (one from each practice plus Matron). There is a very active League of Friends. They have purchased a great deal of equipment. and have supported the hospital in many ways. They welcome and appreciate guidance from professional staff. The hospital was greatly extended in 1999 when a new block was built incorporating out-patient suites, x-ray, physiotherapy, occupational therapy, and podiatry.

In working hours the patients general practitioner will normally cover. There is also a general practitioner on-call for the hospital if the patients GP cannot be contacted. Out of hours there is a general practitioner on-call all the time until 11.00 p.m. Thereafter Prime Care provide cover until 7.00 a.m.

Medical emergencies The On-Call GP is contacted initially. For anything that cannot be dealt with locally the 999 services are contacted and the patient transferred to an acute hospital. The hospital does not use streptokinase. All the nurses are trained in defibrillation.

Gwen Hobbs outlined the following particular problems:-

The in-patient accommodation - This is really not up to modern standards.

Bed blocking - This remains a constant problem. There was a need for at least 3-4 extra beds.

Time - There is an increase in the amount of clerical type work involved with collecting data and audit/governance.

There is a need for improved palliative care facilities particularly accommodation for relatives.

Gwen Hobbs very kindly showed me around the hospital.

Space is at a premium. The wards are clearly cramped and not really suitable for current purposes. Virtually all non-ward rooms are used for 3 or 4 separate purposes by several different people.

I was impressed with the equipment. Virtually all the beds have piped oxygen. There is a roof-attached hoist serving the beds in the main ward. Examination couches can be pumped up and down.

The new out-patient block is pleasant and well laid-out. However, it, also, is clearly too small.

There is quite a large car park but there are inevitable problems with this.

I was really impressed with this hospital. A huge amount of work is going on and the hospital is well-supported by the local community. In-patient accommodation needs to be rebuilt. I was particularly noted the large number of consultants who come down to do out-patient clinics and to see ward referrals. It seemed to me that this is a good example of a local hospital that is providing an excellent service, with limited facilities, for the local community. I would strongly recommend that the South Bristol PCT, who are currently involved with planning a new hospital for South Bristol, should visit Clevedon Hospital.

My final memory is of a photograph, on the wall of the OP block, of a scantily clad John Harvey about to jump off Clevedon pier in order to raise funds for the hospital..

RLH

March 2004.