Agenda item

(To receive a report from Lincolnshire Community Health Services NHS Trust (LCHS), which provides the Committee with an update on LCHS's urgent care services.  Maz Fosh, (Chief Executive, Lincolnshire Community Health Services NHS Trust) and Tracy Pilcher, (Director of Nursing and Deputy Chief Executive, Lincolnshire Community Health Services NHS Trust) will be in attendance for this item)

The Chairman invited Maz Fosh, Chief Executive, Lincolnshire Community Health Services NHS Trust (LCHS) and Tracy Pilcher, Director of Nursing and Deputy Chief Executive, LCHS to present the report, which provided the Committee with an update on LCHC's urgent care services.  The report as detailed on pages 29 to 36 focussed on the Clinical Assessment Service (CAS), the urgent treatment centres (UTCs), and minor injuries units (MIUs) provided by LCHS.

The Committee was provided with an overview of the latest position in relation to Covid-19 second surge.  It was noted that as of Tuesday 10 November 2020, United Lincolnshire Hospitals NHS Trust (ULHT) had 117 Covid-19 positive in-patients in their acute hospitals; and LCHS had 13 Covid-19 positive in-patients in their community hospitals.  It was noted further that LCHS were also caring for 532 patients in the community.

It was also highlighted that Covid-19 was having an impact on workforce availability, and that currently ULHT had 272 staff absences as a result of Covid-19.  This figure included staff who were self-isolating, or waiting for test results.  The Committee was advised that out of the 98 absences LCHS had, 34 were as a result of Covid-19.

It was reported that LCHS were taking all the necessary steps to meet the requirements of the government's guidance and as a result patients were being encouraged to ring 111; and that 'Talk Before You Walk', was being promoted to protect patients and staff.

The Committee were reminded that urgent care included services where treatment required was not life threatening, but was required on the same day for patient wellbeing, satisfaction and quality of life.  It was highlighted that urgent care differed from emergency care, where the need was more acute or life-threatening and this was provided by accident and emergency departments.

It was reported that when Lincolnshire patients called NHS 111, and their call was categorised as being suitable for LCHS services, the calls were transferred to the Clinical Assessment Service (CAS).  It was noted that the CAS was well established and operated 24/7, 365 days a year, providing phone-based clinical advice and guidance.

Pages 30 and 31 of the report provided the Committee with details of the number of cases handled, call-back times, cases closed by CAS, and monthly performance information. 

It was noted that between 1 February 2020 and 20 October 2020 a total of 83,757 cases had been handled, representing an average of 9,306 cases per month, which had peaked at 11,018 in March 2020.

The Committee was advised that the average call-back wait time in the past 30 days had reduced to 19 minutes for interim cases and 17 minutes for emergency cases.

The Committee was advised further that the figure for the number of cases closed by the CAS had increased to 67%, with no referral to any other service.  It was also noted that the proportion of cases closed without being referred to emergency care remained at 90%.

It was reported that since July 2020, there had been a further 32,588 attendances at UTCs during August, September and October 2020.  It was highlighted that during this period 98.89% of patients had been seen within four hours.

Pages 32 and 36 of the report pack provided the Committee with UTC/MIU attendance and performance information relating to all sites; a site by site summary of the services provided by LCHS, and the changes made at those sites during the Covid-19 pandemic; and activity profiles by site for 2019 and 2020.

During discussion, the Committee raised the following points:

·       Assurance was sought regarding the temporary arrangements at Grantham Hospital.  The Committee was advised that the decision for the temporary arrangements at Grantham Hospital had been taken by the ULHT Board, and that LCHS were providing that temporary service until 31 March 2021, unless Grantham Hospital ceased operating as a 'green site;'

·       Clarification was sought as to staffing required for 24/7 UTC provision against 24/7 A & E provision.  The Committee noted that there was a fundamental difference between UTCs and A & Es, with A & Es required to operate in accordance with the Royal College of Emergency Medical Standards, which meant that the skill set of staff needed were more specialist, and completely different to that of a UTC, which was primarily a GP led service.  An A & E's role was to deal with the most acute and life threatening needs; and a UTC's role was to deal with non-life threatening health issues, that could be deal with on the same day;

·       The need for the use of digital technology in the future was stressed to continually enhance services being provided;

·       The effect of increasing Covid-19 cases on the 'green site'.  The Committee noted that if the number of Covid-19 cases were to exceed the agreed threshold, it would be up to ULHT to determine whether and when to rescind the temporary arrangements and revert to an A & E service at Grantham Hospital;

·       Some concern was expressed to the lack of UTC provision in the south east of the county.  Particular reference was made to Spalding MIU.  It was reported that activity at Spalding MIU had seen a reduction of 82% during the Covid-19 peak.  Reassurance was given that patients were still able to access a full range of services.  A request was made for a more detailed report on the potential for UTC provision in the south east of the county.  The Committee noted that Lincolnshire Clinical Commissioning Group was responsible for commissioning services across Lincolnshire, and that this was not the responsibility of LCHS;

·       Thanks were extended to LCHS staff for the excellent service provided at Grantham Hospital;

·       Concern was expressed at the lack of overnight UTC provision at Skegness and along the east coast.  Some members felt that there was an inequality of provision along the coast and a reduced provision was having a negative effect.  A further question was asked as to how many home visits were being undertaken.  Reassurance was given to the Committee that the reduction in 24/7 operation at the Skegness UTC had been as a result of a reduction in attendances at the UTC.  The Committee was advised that between 10pm and 8am patients continued to be triaged via NHS 111 and signposted to ensure that appropriate care was provided.  The Committee also noted that home visits were being made from a number of bases across the county.  The Committee was advised that LCHS services were responding to a pandemic, and as such steps had been put in place to protect patients and staff to keep them safe in accordance with national guidelines.  Reassurance was also given that Skegness Hospital, including its UTC was a key NHS service, meeting the needs of the local community;

·       Some concern was also expressed to the lack of confidence in NHS 111.  A further question was asked as to how many patients were being displaced as a result of reduced services at UTC's.  The Committee was advised that postcode analysis was obtained to identify where patients were accessing treatment; and that this was continually monitored.  The Committee was advised that patients were encouraged to ring NHS 111 rather than just walking into a UTC; as this then protected others in the population; with a booked appointment being safer; and for those unable to attend a UTC, a home visit would be arranged;

·       Reasons for the reduction in attendances at UTCs and MIUs.  The Committee noted that some patients were now choosing to use digital platforms for consultations, guidance and prescriptions.  Reassurance was given that all activity would continue to be monitored.  There was also appreciation that some patients were still reluctant to make contact and that national campaigns were underway to encourage patients to make contact if they had any health concerns;

·       Clarification was sought whether the 'temporary' closure of Skegness and Louth UTC's overnight actually meant 'temporary' or was it a repeat of what had happened at Grantham Hospital.  Again, the Committee were advised that the aim was to maintain these hospitals as vibrant hubs; there was a commitment to community hospitals, for example apprenticeships were currently being offered to build in resilience for the future staffing provision. Reassurance was given that the current measures were temporary to help protect patients and staff and reduce the transmission of Covid-19;

·       Staff were also commended at the Skegness UTC for the services provided and for their professionalism;

·       Some concern was expressed to the decision of East Lindsey District Council to extend the caravan park season; and whether this was likely to have an impact on the number of people needing access to urgent care; and whether this factor would be taken into consideration with extending the overnight closures.  It was reported that the situation was being monitored and if there was an increase in activity, the service would be reviewed; and

·       A request was also made for list of locations for community hubs.

The Chairman on behalf of the Committee extended thanks to the presenters for their update.

RESOLVED

1.      That the Committee's support and thanks to all staff providing urgent care in Lincolnshire be recorded.

2.      That the Trust be supported and commended on the opening of the Gainsborough Urgent Treatment Centre on a walk in basis, from 8am to 8pm from 2 November 2020.

3.      That the Committee's view be confirmed that the changes to the opening times at Louth and Skegness Urgent Treatment Centres should only be a temporary measure during the Covid-19 pandemic, and that there should be an aim to re-open these two centres in the longer term on a 24/7 'walk-in' basis, as set out in the Healthy Conversation engagement exercise of 2019.