Agenda item

(To receive a report from Sarah Furley (Urgent Care Programme Director – Lincolnshire East Clinical Commissioning Group) which provides the Committee with an update on urgent care in Lincolnshire.  Gary James (Accountable Officer – Lincolnshire East Clinical Commissioning Group) will be in attendance for this item)

A report by Sarah Furley (Urgent Care Programme Director – Lincolnshire East Clinical Commissioning Group) was considered which provided an update on urgent care in Lincolnshire.

Gary James (Accountable Officer – Lincolnshire East Clinical Commissioning Group) was in attendance for this item of business.

The Committee was advised that the NHS Constitution set out a minimum target of 95% for the "four hour A&E standard" for patients attending an A&E Department in England.  The CCGs had seen the worst month since the implementation of the target in 2004, reaching 88.7% although it was suggested that this was also the picture nationally.

The local context was provided for the Committee:-

·       The standard had continued to fall since the winter of 2014/15.  Lincolnshire experienced 10% increase in A&E attendance during March 2016, which mirrored the national picture.  A&E attendances throughout 2015/16 had, however, increased by only 2.7% overall which was equivalent to approximately 4500 additional attendances in 2015/16 compared against 2014/15.

·       Emergency admissions had reduced by nearly 1.5% in Lincolnshire which equated to approximately 900 less people being admitted to hospital in 2015/16 compared to 2014/15.

·       It was acknowledged that bed occupancy rates of higher than 90% could increase the risk of problems such as infections and quality of care.  This also continued to be high in ULHT and, since January 2016, bed occupancy rates had been between 92% and 95%.  The actual numbers of beds available in acute hospitals varied daily as a result of beds opening and closing to meet surge in demand, staffing levels and infection control.  In February 2016, ULHT had an average of 1010 beds open throughout that month;

·       Delayed Transfers of Care (DTOC) continued to have a negative impact on patients being delayed as this may result in significant implications for their independence.  This also impacted on wider service delivery and performance across the whole health and care system. 

·       The national target for DTOC was 3.5% of available bed days lost to delays.  In January 2016, Lincolnshire Community Health Services reported 929 lost bed days (16.75%) which reduced to 600 in January 2016.  ULHT reported a loss of 50 beds in February 2016 from an average of 1010 open beds that month.  The Committee was asked to note that the way in which each organisation measured these figures was different and could not, therefore, be compared;

·       The NHS 111 contract, effective from 1 October 2016, had been awarded to a joint provision between East Midlands Ambulance Service (EMAS) and Derbyshire Health United (DHU) with the call centre based at the EMAS Call Centre in Bracebridge Heath, Lincoln.  This was a welcome development as work continued to merge the 111 and 999 services; and

·       The Walk-In Centre, Urgent Care Centres and Minor Injury Units consistently achieved in excess of 95% for the four hour standard to see, treat and admit or discharge in under four hours.

The urgent care recovery plan had been focussed on two distinct areas – a 30 day rolling programme of actions for Pilgrim Hospital and five priority areas agreed with the Emergency Care Improvement Programme (ECIP).  In February 2016, a concordat was agreed by leaders from each part of the Lincolnshire system and the regional tripartite to demonstrate the overall commitment to the five priorities:-

·       Emergency Care Flow;

·       Implementation of Safe Care Bundle & 'No Waits' process on five wards per month (including community);

·       Therapy Review/Improvement;

·       Amalgamation of existing discharge portals into a home first/Discharge to Assess model (Transitional Care); and

·       Perfect Week Programme;

Increased demand was not driving the Lincolnshire urgent care system as A&E attendances had only risen with population growth and emergency admissions were reducing.  All performance measures had been considered when identifying a recovery trajectory for the Lincolnshire acute hospital four hour A&E standard of 95% although there was an emerging national view that not all NHS trusts would achieve that target in 2016/17.

The Committee was advised that the current trajectory for Lincolnshire was to achieve 85% consistently through Quarter 1 2016/17 and 89% in Quarter 4 2016/17.  Other system measures would also be monitored and this would include achieving 3.2% DTOC by October 2016.

Northumbria Healthcare NHS Trust had been visited and, in particular, the newly opened Emergency Care Hospital.  It was thought to be an impressive model and one which could be further considered for Lincolnshire as the county of Northumberland was similar to Lincolnshire.  It was reported that the base sites were managed by Nurse Practitioners with back up consultants based at the emergency hospital. 

Members were given the opportunity to ask questions, during which the following points were noted:-

·       The Committee was advised that a condition of being given £16m funding from the Sustainability and Transformation Fund, was that ULHT was contractually obligated to meet the 89% target for the four hour A&E standard;

·       It was suggested that consideration be given to reinstating convalescent homes as it was thought that hospitals were being used for this purpose rather than their intended function;

·       The NHS 111 figures did not include GP out-of-hours figures although those could be sought and presented to the Committee.  It was confirmed, however, that 'hot transfers' did take place where calls were passed directly through from the NHS 111 service to the GP out-of-hours as necessary;

·       Although healthcare provision was changing as a result of continued budget reductions, it was agreed that changes would still be required to ensure that services become better and more efficient;

·       The Committee requested that an update report be added to the Work Programme for September 2016;     

·       It was also asked that the figures noted in the table on page 26 of the report relating to A&E attendance be broken down further to show performance of the three sites within ULHT;

At 12.35pm, Councillors T Boston and B Keimach left and did not return.

RESOLVED

1.    That the report and comments be noted; and

2.    That an update report be added to the Committee's Work Programme for consideration in September 2016.