Agenda item

(To receive a report from Ruth Cumbers (Urgent Care Programme Director and Senior Responsible Officer, STP Urgent Care Programme) and Simon Evans (Director of Operations, United Lincolnshire Hospitals NHS Trust) which provides the Committee with an update on the system resilience during Winter 2017/18)

The Chairman welcomed to the meeting Ruth Cumbers, Urgent Care Programme Director and Mark Brassington, Chief Operating Officer, United Lincolnshire Hospitals NHS Trust.

The purpose of the report was to update the Committee on system resilience during the Winter 2017/18.

The Urgent Care Programme Director advised that the 2017/18 winter had been difficult, both locally and nationally.  Causes of the pressures in Lincolnshire were as a result of a higher level of respiratory illness than expected; higher levels of flu than expected with more people having to be hospitalised; and the loss of bed capacity due to norovirus.

Details of the actions of the Winter Plan for Lincolnshire's health and care system were shown on page 149 of the report presented; along with details of the significant steps taken at national level to improve NHS resilience.

It was noted that despite the preparations there had been a number of continuing difficulties and pressures which had put pressure on the system's ability to cope.  This had included the flu strain; funding pressures; lack of beds; workforce pressures and underlying performance pressures. 

It was highlighted with the acute trusts seeing more people in both worse and frailer conditions, and the National Emergency Planning Panel had recommended to all acute trusts that non urgent operation should be cancelled during January 2018.  It was highlighted that although this was enacted in Lincolnshire it was regularly reviewed; and not all operations were cancelled.  The cancelled operations obviously resulted in less income for the trusts, which was an additional challenge for Lincolnshire which was already under significant pressure to deliver savings; and recover financial targets and assure their sustainability.

The Committee was advised that the normal operating for the Lincolnshire system was Operational Pressures Escalation Level (OPEL) 2; information provided on page 151 of the report showed Lincolnshire as being above average and operating at (OPEL) 3 for the duration of December and January.  It was noted that Level 4 was reported on only 2 occasions (days) this winter during the severe weather conditions in February and March.  The Committee was advised that when the systems were at Level 4, the system was able to manage the threshold and de-escalate.

It was reported that ambulance conveyances on all sites had remained consistent during the winter.  The United Lincolnshire Hospitals NHS Trust had been among the top five poorest performers nationally for the percentage of ambulances delayed over the 30 minute arrival to clear target, in December 2017.  It was noted that additional changes had been made to the patient cohort process.

During discussion, the Committee raised the following points:-

·         A question was asked as to whether the Trust was confident in meeting the Lincolnshire Four Hour Standard Trajectory for 2018/19.  It was reported that a realistic improvement trajectory for 18/19 had been developed and agreed across the urgent and emergency care systems.  The plan was however dependent on a number of system wide actions to improve hospital flow and reduce Delayed Transfers of Care (DTOC).  There were also historic factors such as recruitment which could have an influence on progress;

·         What could be done further to help maintain low DTOC figures?  The Committee noted that the DTOC standard was fewer than 3.5% of available beds days would be lost due to delays.  The Table on page 155 of the report highlighted that the percentage had risen above 3.5% from October 2017 onwards.  The Committee was advised that there was confidence that the percentage would improve for June/July 2018.  Confirmation was also given that the County Council was fully engaged within the hospitals; and in the overall discharge process;

·         Handover times - There was a recognition that the handover times were unacceptable and EMAS and Trust staff were working very hard to address the matter.  It was felt that there would be improvement for June/July;

·         Dedication of staff over the severe weather period.  One member asked whether there was a rota for staff in circumstances such as severe weather conditions.  The Committee was advised that the Trust was able to offer accommodation and meals etc. to meet staff needs.  It was highlighted that the all Lincolnshire Community Health Service had completed all visits they undertook, which had been a major achievement.  The support from the armed forces and volunteers with 4x4 vehicles had been fantastic.  One of the biggest challenges had been for patients leaving hospital, the Committee was advised that the armed forces had done a wonderful job ferrying patients home.  The Committee was advised further that the rotas for holidays were reviewed each year; and that consideration would now be taken to those staff with children, who had been unable to come in; due to school closures, as a result of the bad weather, which had then caused them problems with their child care arrangements.  The Committee was advised that no charges were imposed on staff who remained on the hospital site over the severe weather period;

·         Confirmation was given that the 2017/18 flu vaccine had included immunisation against the flu strain that had caused patients issues.  It was highlighted that the flu peaks for Lincolnshire had not been any higher than other areas;

·         The effect of rising fuel costs.  It was confirmed that inflationary rises did impact on health, but it was no different to any other sector.  The main focus for the Trust would be concerning procurement;

·         Patients accessing doctors surgeries – The Committee was advised that GP surgeries were as affected as the acute hospital.  It was highlighted that the CCGs had continuity plans in place to cover these circumstances;

·         Cost of damage to ambulances from potholes – No comments was able to be made with regard to the point raised as this was a matter for the East Midlands Ambulance Service;

·         Rise in the number of ebola cases, a question was asked as to whether any lessons had been learnt from the previous ebola outbreak.  Confirmation was given that following the last ebola outbreak, plans had been put in place;

·         Some support was extended to the urgent care streaming currently been undertaken at the hospitals; and

·         Confirmation was given that there was an Urgent Care Strategy which had all year round plans aligned to it which covered delivery.

The Committee was reminded that planning for winter resilience 2018/19 had already started and, that the Lincolnshire Health and Wellbeing Board would be considering a report at its meeting due to be held on 5 June 2018.  The Committee were invited to highlight any issues they might have to the Lincolnshire Health and Wellbeing Board.

The Committee requested a progress report concerning winter resilience for 2018/19.

RESOLVED

1.    That the Winter Resilience Review 2017/18 report be received.

2.    That a further report concerning winter resilience plans for 2018/19 be received by the Health Scrutiny Committee for Lincolnshire later in the year.