Agenda item

University Hospitals Leicester (UHL) will give the Commission a verbal update on the current position.

The Chief Medical Officer and Deputy Chief Operating Officers gave a verbal update to the Commission on the current winter pressures. The following was noted:

·       An early surge in flu had been identified which had not been anticipated nationally and had taken trusts by surprise. Partners across acute, primary care and EMAS had worked together to identify additional actions and ensure plans remained effective.

·       The focus included improving ambulance response times, quicker handovers and ensuring ambulances arriving at the Leicester Royal Infirmary could transfer patients safely and promptly to release vehicles back into the community.

·       Work continued to improve A&E performance with an emphasis on increasing the number of patients seen within 4 hours and improving care for children. A paediatric surge had been experienced and a paediatric hub had opened at Groby Road Medical Practice for all children across LLR to be directed appropriately. This had begun operating during the week.

·       A first respiratory surge had also been highlighted, alongside the ongoing challenges with long A&E wait times, including waits of over 12 hours for patients needing a mental health bed. Work continued to reduce these times and improve patient flow through the hospital. Ensuring timely discharge for patients who were ready to leave was identified as essential to maintaining capacity and protecting staff and patients.

·       Work undertaken since the Emergency Care Action Plan and the winter plan was outlined. This included reviewing how to reduce demand, improve flow through services and strengthen discharge processes.

·       Same day emergency care services had been expanded, including direct access to surgical and medical reviews and clinics. Productivity within existing services was being improved, particularly for patients needing diagnostics.

·       Patients continued to be redirected to the most appropriate setting including hubs and urgent care centres. Improvements to discharge processes were being monitored against specific criteria and timeframes.

·       Additional capacity had come online for winter, including LOROS beds and new wards at the General Hospital and Preston Lodge community setting. The first floor had opened and the second floor was due to open in January.

·       It was noted that 6th January was historically the busiest day for health services and preparations were underway to manage expected pressures. Work also continued on supporting and deploying the workforce during the Christmas period, recognising limited staffing flexibility.

·       An update on primary care and pharmacy was provided, confirming that additional practice activity was underway to ensure patients were directed to the most appropriate services rather than attending A&E unnecessarily.

In discussions with members, the following was noted:

• Questions were raised about the KPIs shown in the winter planning slides, with a request for these to be shared in more detail at a future meeting to show performance against them. A progress update on the indicators was also requested, including how they were being monitored over winter.
• Clarification was sought on the additional LOROS beds supporting discharge and whether these were funded by the NHS. It was confirmed that four additional beds had been identified, with two now operational and two more due to go live next month.
• Concerns were expressed about flu and Covid vaccination uptake. One member reported that some GP practices had told patients they could not book vaccinations in person, which was contributing to lower uptake. This had been raised with the ICB, as the information was not correct.
• Work was taking place to address variation across practices, including weekly discussions on redirection at the door policies and the impact of national contract changes introduced on 1st October. Data was being reviewed weekly and trends were emerging in particular practices. Further support was being provided to practices and PCNs, including GP webinars to promote more effective referral routes.
• A query was raised regarding how many practices were experiencing access issues of this kind. It was reported that eight practices were currently being worked with closely out of a total of one hundred and twenty. Broader concerns were also shared about the ability to access out of hours care after 10pm and the recurring pattern of winter pressures. Members questioned why improvements were not more visible given the level of planning undertaken each year.
• There was support for receiving a post winter comparison to understand what improvements had occurred and what gaps remained. It was acknowledged that some improvements had been made, although these were not always evident during peak pressure periods. Percentage improvements in waiting times had been observed, although ambulance delays continued to pose a significant challenge and demand across the system had increased.
• The importance of accessible primary care was highlighted, noting that eight practices experiencing difficulties could equate to approximately one hundred and twenty thousand affected patients.
• Public concerns were shared about ambulance and A&E waiting times, with some reports of patients waiting up to fourteen or sixteen hours and not being seen within four hours. Questions were raised about what constituted an acceptable waiting time for ambulances and for patients in waiting rooms, as well as when meaningful improvement could realistically be expected. It was noted that public confidence in NHS services was being impacted, particularly during winter when delays were greatest.
• It was reported that demand continued to grow due to an ageing population and rising numbers of patients with multiple long term conditions. Attendances at A&E were reaching record highs, with up to one thousand patients presenting in a single day. National standards remained four hours for A and E waits and forty five minutes for ambulance handovers, although the preferred ambition was fifteen minutes.
• Continued pressures across primary care, pharmacy and community services were also noted. The system was operating at the highest escalation levels more frequently and remained focused on ensuring patients were redirected appropriately while prioritisation was maintained. Capacity had increased although workforce challenges persisted. Productivity improvements continued to be required across the system, with benchmarking showing some progress against regional and national performance.
• Further questions were raised about why some new wards would not open until January despite high demand. It was explained that the Leicester General ward was opening in phases due to building work only recently being completed and workforce for the first stage now in place. Additional capacity had been introduced for paediatrics, including the paediatric hub at Groby Road, although demand remained extremely high. Leicester continued to be one of the busiest areas in the UK for paediatric attendances. Additional support was being provided for families and young people during the respiratory surge period, which typically ran from mid-November to January, with capacity planned to remain in place until the end of March.
• Clarification was sought again about the LOROS beds and whether four additional beds were available. It was confirmed that these were bespoke winter beds intended to support system pressure differently. If successful, the initiative could potentially continue longer term, which would also support LOROS financially given the wider range of community services they provided.

AGREED:

1.    That the verbal update be noted.

2.    That a special meeting would take place with all health partners for the City in January and an update to follow at the next Joint Health Meeting in February.