Members of the Committee to receive a report providing an overview of the urgent and emergency care system through the peak winter months, highlighting summary actions from the LLR winter plan.
Members of the Committee received a report providing an overview of the urgent and emergency care system through the peak winter months.
Rachna Vyas Chief Operating Officer presented details of key actions from the Leicester, Leicestershire, and Rutland winter plan as well as outlining preparation for 23/24 and lessons learnt to inform one-year and five-year plans across LLR.
Attention was drawn to the following points:
· System Control Centre (SCC) was launched on 1 December 2022 as per national directive, this would act as a single point of contact for health partners to manage the flow of patients through the system on a daily basis as well as providing for escalation, operational support and reporting purposes.
· Whilst demand had stabilised through the start of Q4, all parts of the system remained busy in terms of acuity and demand.
· Primary care continued to be under pressure and an unprecedented number of walk-in presentations in emergency dept. had been seen. Steps were taken to address that with an additional 1,577 appointments provided during December to minimise overcrowding ED and streaming patients presenting with specific conditions to an offsite primary care provider. The impact of that had been significant.
· There had also been a focus on providing respiratory support for adults and children with the trial of Acute Respiratory Hubs that had provided almost 9.5k appointments. Feedback showed these were easily accessible and people were not having to seek support elsewhere.
· The Unscheduled Care Coordination Hub was a positive step to taking patients who were appropriate to be seen elsewhere off ambulance queues leading to a reduction of between 20-40 people on a daily basis.
· Virtual wards had been introduced across 10 specialities and this was giving people ability to be cared for in their own home with support as needed.
· Delayed discharges were at the 2nd lowest in the country and an integrated discharge function across health and care services had launched in February 2023 to support and facilitate patients being discharged.
Members discussed the report which included the following comments:
· The government short term funding had been received at the beginning of the year which enabled the service to plan better however health partners welcomed any support from members to get sustainable income going forward.
· As regards the Virtual Ward, it was necessary for the person to have internet, however a full assessment was made with the patient and their carer to ensure that they had the right equipment, if they did not have a network link it did not necessarily exclude them, but the team were working patient by patient to ensure the right needs were met.
· In terms of the risk of virtual care leading to isolation, contact was maintained with the patient on a daily basis, and they could also phone and speak to a nurse for advice and assurance.
· Regarding patient vulnerabilities and people at risk, there would be an appropriate conversation as part of the assessment to determine suitability for virtual wards, and it was recognised that virtual wards were not for everyone. A series of short videos were available explaining what a virtual ward was and showing several case studies of people from varied backgrounds.
· In relation to risks posed by industrial action, there was always some impact however lessons had been learnt from previous action and it was about assigning resources to the right place at the right time. Initiatives such as the Unscheduled Care Coordination Hub that helped reduce ambulance waiting had had a huge impact enabling resources to be where they need to be to ensure patients get the right care.
Members discussed the pressures on nursing staff and concerns were raised about the risks to patients as a result and the need to ensure patient dignity. Members also felt it was important to recognise nursing staff and medical professionals and to do more to stop qualified staff leaving. Feedback on patient care was welcomed and it was acknowledged that it had been a difficult winter with pressures on all services, it had also been necessary to open wards in environments where perhaps they would not normally want to but there had also been investment to improve things and recruitment was ongoing to increase medical staff.
The Assistant City Mayor referred to the recent Health & Wellbeing Board meeting which focused on winter preparedness and commented on the work being done by health partners and noted the partnership building with adult social care and the positive effects of that work upon delayed discharges. The work being done in the emergency dept was also recognised and the initiative to stream to offsite primary care was commended as too were the steps taken to redirect people calling 999 for ambulances who could be seen by other services.
Whilst members welcomed the initiatives reported it was suggested there was more that could be done to improve people’s perceptions about health services and there should be wider communication about new initiatives e.g., the virtual wards as it was likely the majority of people in the city had no idea what that was. Members also felt it was important that new pathways created, and the way things were done should be translated into better communication to build peoples trust in those services.
Members noted that in terms of planning ahead, each year health partners began to plan around August however this year’s winter plan was already written taking on board the learning from winter 2022-23 and so health partners were in a position to put some of the services used this year into a more sustainable position and ensure the basics would be ready for next winter.
The Chair thanked officers for the presentation, noting the very positive outlook and asked for a report to be provided to a future meeting to see progression.
1. That the contents of the report be noted,
2. That a letter of representation be sent to the Secretary of State in relation to sustainable funding and to include concerns about medical staff morale and to request more support,
3. That consideration be given to including a future piece of work around NHS Cultural Change on the committee work programme or as a Member Briefing.