Minutes:
Given the concerns around this issue, the Chair requested that the agenda order be altered, and the Critical Incident item was therefore taken first of the main agenda items.
The Chief Operating Officer of University Hospitals Leicester gave a verbal update on the critical incident which was declared by University Hospitals Leicester on 9th October 2024. It was noted that:
· The incident was a called due to an increased demand on the emergency care pathways, operational delays and long waits for care.
· The incident was stood down after 30 hours.
· A critical incident has not been a common occurrence, one was declared at the start of 2024 and one in each of the previous 2 years.
· 904 patients attended the Emergency Department on 8th October.
· The focus of the organisation was for a significant number of discharges to ensure the patient flow and that patients were in the appropriate place for their onward care. Also increased discharges from system partners.
· Increased pressures have been felt across many areas including urgent and emergency care pathways and this has impacted the length of time it has taken to access emergency care.
· The winter plan for this year has been revisited. As a result of the incident, there has been further initiatives rolled out. This has included increased urgent treatment capacity. These will have pressures due to financial constraints however.
· In the longer-term, emergency care needs to be done differently to deliver better care for patients.
· The Chief Operating Officer sincerely apologised to those who have experienced delays. It can be evidenced that improvement is happening but recognise that more needs to be done.
In response to questions and comments from Members, it was noted that:
· It was early in the year for a critical incident.
· The flow through the hospitals seems to have been a significant issue. More information on where the bottlenecks have occurred and how they are dealt with would be useful. The discharge figures will be shared with Members.
· The Winter Plan came in September to the Commission, it has been built on since. A more detailed plan was submitted in October in line with national guidance which is to be shared with Members.
· The critical incident allowed new initiatives to be trialled which helped to de-escalate the situation and further discussion with ICB is to occur.
· Leicester has one of the busiest emergency departments in the country and has faced challenges due to being the only emergency department in the city centre. 904 patients attended the emergency department on the 8th October. This is not particularly extraordinary, but means capacity needs to allow for these levels.
· Work is being done to promote alternatives to the emergency department for treatment, including other centres and the Pharmacy First scheme.
· There was no specific winter plan funding for the NHS. Funding has been moved to the start of the year and there are very careful discussions around additional expenditure.
· Additional funding was made available in November/ December for cradle to grave schemes. The delivery of all initiatives funded by this are to be tracked to assess impact and ensure they have delivered, or the funding will be diverted.
· Additional initiatives are planned for the winter, such as cardiology, as know there will be surges.
· The wider context of emergency care has relevance to the demand as there has been an increased complexity in the cases presented, with patients having multiple conditions and occurrence in younger populations. This has resulted in it taking longer to move the patient through the pathways.
· More community measures are needed as many patients have adverse results in a hospital.
· There is a sustained pressure across all services throughout the year and there have been significant efforts made to address this.
· More needs to be done to inform residents in the city of the correct pathways to help alleviate the demand on emergency pathways.
Agreed:
· The item to be brought back in January for a further update.
· Full winter plan to be shared with Members, including approved spending.
· 111 improvements plan to be shared.