Minutes:
The Chair stated that he had agreed to take an item of any other urgent business on the Urgent Care System.
Urgent Care System
The Chair invited the Managing Director of Leicester City Clinical Commissioning Group to comment upon the recent publication of the report by Dr Ian Sturgess following his six month review of the Urgent Care System within Leicester, Leicestershire and Rutland.
It was noted that:-
· Dr Sturgess had been commissioned by the CCG to undertake the review and had spent nearly four months in a hospital setting and the remaining time looking at primary and community care elements.
· The report contained over 180 recommendations.
· An initial report was submitted to the Wider Urgent Care Board after his work in the hospital setting and a number of the recommendations have already been considered and work was progressing on them.
· Following the publication of the full integrated report on both the in and out of hospital services, the Local Urgent Care Plan has already been updated to accommodate the highest priority level of his recommendations.
· The remaining recommendations will be considered in the near future. The more strategic recommendations will be fed into the Better Care Together Programme, particularly around those involving the change of culture. Those more immediate operational actions would be brought into the Urgent Care Plan.
· The recommendations focussed on issues relating to the following main themes:-
o Admission avoidance – ensuring that people receive care in the setting best suited to their needs rather than the Emergency Department.
o Preventative care – putting more emphasis on helping people to stay well with particular support to those with known long term conditions or complex needs.
o Improving processes within Leicester’s Hospitals – improving the Emergency Department and patient flow within the hospitals to improve patient experience and ensure there is capacity in all areas.
o Discharge processes across the whole system – ensuring there are simple discharge pathways with swift and efficient transfers of care.
· The report stressed that the 4 hour target for a patient to be seen in the emergency department was not an indicator of how the emergency department was working but was essentially a measure of the effectiveness of the whole system’s management of the urgent and emergency care pathway.
· A further key message was that the system should focus on getting people home rather than finding them a bed in hospital as an interim measure, as there was a tendency for people to decondition and become less able to look after themselves once they had been admitted into hospital. The key was getting a good rapid assessment and accessing good community services to help the person to remain at home.
The Interim Director of Adult Social Care stated that social care performed well in the City and the requirement to for patients to be discharged from hospitals as soon as possible was understood. More work was needed to prevent admissions to hospitals but this required an infrastructure with more support from GPs, district nurses, and domiciliary support to maintain people in their home environment for longer. The challenge for primary care support would be to continue to support people if there was a significant rise in the rate of hospital discharges. These aspects were currently being looked at in more detail but social care also needed the input from health services to contribute to that process.
The Managing Director, Leicester City CCG, commented that there was emerging evidence that if people were discharged sooner, they could be discharged with less intensive care packages for both the health and social care systems. It was also acknowledged that, with intention to support people with more social care packages, the consequential impact upon carers would need to be recognised and supported.