Agenda item

The University Hospitals of Leicester submits a report to appraise the Public

Health and Health Integration Scrutiny Commission on the current pressures

faced across the urgent and emergency care pathway, covering NHS and Local Government commissioned services.

The Chief Operating Officer of the Integrated Care Board presented the item noting the full system winter plan that had been discussed at the Commission previously and the winter pressures that have been seen across all health services over recent months and likely to continue. The following comments were made:

·       The local health system planned to focus on three areas, including the in flow of patients to all health and social care services, the flow through those services and flow out. The agenda included key highlights of what the system intended to put into place and updates on those measures and comparisons to the previous winter.

·       Despite mitigations put into place following learning from the previous winter, pressures continue to persist in the health services due to increased demand across health and social care.

·       Pressures on health services were attributed to the general winter and festive break. Unforeseen pressures such at Storm Henk and extreme weather conditions also impacted patients requiring respiratory health support as well as two periods of five-day industrial action. Modelling accounted for a 5% increase in demand based on public health data and population growth, but this was exceeded by 8% and therefore admissions and discharges increased by 13%. Patients waiting for discharge into local authority funded care also increased by around 80 patients over winter compared with the previous year.

·       The system recognises it is not where it would want to be in terms of performance statistics with an increase in time for an ambulance to respond to a Category 2 call, an increase in handover times that system had previously worked hard to reduce, and an increase in medically fit for discharge patients waiting in beds.

·       Despite challenges, on performance metrics, the system has been doing better this winter compared with the previous year and will continue to work in partnership to continue to improve over coming weeks.

·       Key plans for 2024/25 have been identified, including raising admission rates through the emergency department and working with the Local Authority where necessary to improve discharge of patients.

In response to Members comments and questions it was noted that:

·       Virtual wards are better from a quality perspective for patients to be discharged from hospitals and return home. This was introduced during the pandemic and an initiative continuing to be used. Current analysis indicates that it is cheaper to operate virtual wards, but further analysis is required on understanding the correlation with virtual wards and preventing admissions.

·       Community based urgent care appointments has increased with 111 operators utilising appointments when liaising with patients to manage the flow at the emergency department.

·       Data is collected for ambulance handover at 30minutes, one-hour, two-hours and four-hours intervals. The number of patients waiting over two hours between summer and winter of 2023 was very low but has increased with increased pressures over recent weeks. Data is monitored to ensure quality care and it was agreed that further information would be shared on ambulance handover times as well as number of deaths due to delayed handover.

·       Virtual wards are used to treat patients at home for pathways where appropriate and it was agreed further information or a report for details discussion could be provided. The target is to reach 80% and currently at 79%.

·       Patient safety is paramount and at the centre of services provided and as the health sector experiences pressures unfortunately some patients with less serious problems may need to wait longer to ensure patients are receiving the right care at the right time for their condition.

·       Pressures are being seen across the region and nationally, particularly with increased demand, impacting performance statistics and it is important for the local system to benchmark itself to understand its position. The health sector is looking to ensure residents know the correct place to seek help to get the right care at the right time. Pharmacy First is an example of an initiative launched recently to encourage residents to seek advice from pharmacies where appropriate for less severe problems.

·       The emergency department four-hour performance target is 76% but has been 73% over winter. The target for responding to Category 2 calls is 18-minutes and work achieved this recently, but ongoing pressures has resulted in times increasing to 60-minutes over winter with a target to achieve 30-minutes currently.

·       Ambulance conveyance rates nationally sit between fifty and thirty percent so 39% for EMAS and most days c30% which is good.

·       Delayed discharges at UHL is around 22% and the top quartile would expect to be between 11-15%. The Integrated Crisis Response Service was piloted in the city and learning is being used to develop a consistent model across Leicester, Leicestershire & Rutland.

·       The number of city residents clinically ready for discharge and waiting local authority care is generally good compared with the wider area. Figures on the day illustrated of 1,800 beds, 12 city residents awaiting discharge and within top quartile of the country. It was agreed further information could be circulated regarding numbers of city residents awaiting discharge.

·       There has been a shift in discharge pathways this winter with an increase in patients clinically ready to leave hospital but require further care support under Pathway 2 compared with Pathway 1.

The Chair highlighted that following the critical incident being declared at Leicester’s hospitals he visited the emergency department at the Leicester Royal Infirmary which was extremely busy and Merlyn Vaz Urgent Care Centre which was very quiet and requested whether processes could be reviewed to ensure better utilisation of health services.
The Chief Operating Officer of the Integrated Care Board thanked the Chair for his feedback and assured the Commission that discussions have taken place with Derbyshire Health United that run the Centre to improve access which will be monitored and consideration of how to further utilise the Centre. It was noted that the Centre continues to see the same number of patients but the ‘Talk before you Walk’ initiative encourages patients to call 111 and attend for booked appointments as opposed to patients waiting. It was further noted that patients attending the emergency department are being assessed and rediverted to booked appointments at Centres where appropriate which has received positive feedback.

The Deputy Director of Public Health provided the Commission with an update in relation to Covid-19 and flu, in which it was noted that:

·       Flu rates have increased gradually over recent weeks.

·       Hospital admissions and deaths from Covid-19 are key indicator measures for identifying trends as testing is not reported as it was previously in the community. Hospital admissions reduced but was remained flat and number of deaths had been relatively low.

·       Leicester had a low uptake of over 65’s receiving the Covid-booster vaccination at 48.5% compared nationally with 68.3%. Uptake was also lower than comparator authorities. The vaccination campaign has concluded but work was targeted in areas with lower uptake and will be focussed in future campaigns.

·       Flu vaccine rates vary in the city, but uptake was higher than Covid-19. 69% of over 65s are vaccinated and 36% under 65 at risk which is better than previous years with targeted work.

In response to Members comments and questions it was noted that:

·       Data is available for ethnicity of residents in areas of the city but not for religion. It is important to work with community organisations in areas of low uptake to understand vaccine hesitancy. Targeted work with communities is ongoing and will continue to be a focus to improve uptake.

·       There is no absolute certainty around the correlation between residents who do not engage with health services and those who are unvaccinated but targeting over 65’s would expect individuals to be in contact with health services. ‘Making every contact count’ is an initiative health providers use to promote the importance at vaccinations where possible and practices have been encouraging triple vaccine appointments but pressures on capacity and increased demand can impact the offer.

The Chair requested an update on the measle situation and highlighted the opportunity to share materials in different languages. The Public Health Consultant noted twelve cases had been reported in the city and work was continuing to promote the uptake of the MMR vaccine, including targeted work in areas of the city with low uptake and sessions in local schools.
The Deputy City Mayor for Health, Social Care and Community Safety assured the Commission that messaging continues to be shared through Health Champions, VCSE organisation, faith leaders and social media. It was further noted that whilst many communities speak a vast range of different languages in the city, not all read in a different language, and the ability to share messaging quickly that can be translated electronically is favoured.

The Chair invited a youth representative to make comments in which it was noted in response that data is not readily available for vaccination uptake for disabled residents on an ongoing basis, but targeted work allows data to be collected, for example uptake of vaccines for residents with learning disabilities.

The Deputy Director of Public Health presented information about Leicester Energy Action, in which it was noted that:

·       The programme is a two-year funded initiative by public health and the NHS focussed on prevention. It enables residents struggling with fuel poverty to access support with the aim of preventing and protecting health conditions.

·       The overall number of cases is lower than the target set but this did not account for the complexity of needs and support that is being provided when the programme was initiated.

·       The programme is performing well with people reached far exceeding targets by attending events and training officers to promote access to welfare support as well as tips for keeping homes warm.

·       The success of the programme and impact it has on residents’ lives is illustrated through a case-study outlined within the agenda pack.

The Chief Operating Officer of the Integrated Care Board thanked VCSE organisations for their support with the programme and echoed the success and importance of the initiative for prevention. It was highlighted that further work is underway to identify patients with respiratory conditions that would benefit from the rollout of the programme.

The Deputy City Mayor for Health, Social Care and Community Safety commended the programme and associated work streams highlighting the importance on preventing health conditions that require medical support and improving peoples lives. It was noted that the Commission may wish to look at the item in more detail.

In response to Members comments and questions it was noted that funding is not predicated on targets which were set by the Local Authority although negotiations are underway with the contractor, National Energy Action, to review the targets given the complexity of cases officers.

AGREED:

·       The Commission noted the reports.

·       Members comments be considered.

·       Additional information requested be circulated.

·       Virtual wards be added to the work programme.

·       Vaccination uptake/hesitancy to be added to the work programme.

·       Leicester Energy Action to be added to the work programme.