Agenda item

To receive a presentation on recent delays in patient handovers from East Midlands Ambulance Service to University Hospitals of Leicester Trust. 

The Commission received a presentation on recent delays in patient handovers from East Midlands Ambulance Service (EMAS) to University Hospitals of Leicester NHS Trust (UHL). Dr Richard Mitchell (Deputy Chief Executive/Chief Operating Officer,UHL), Dr Bob Winter (Medical Director EMAS) and Mr Will Legge (Director of Strategy and Information, EMAS) attended the meeting to address the Commission and answer questions on the presentation.

Dr Mitchell commented that hand-over times at the Leicester Royal Infirmary (LRI) were acknowledged as a long standing issue for reasons which have been widely stated before.  The A&E unit at the Leicester Royal was the busiest single site A&E unit in the Country and had large numbers conveyed to it by ambulances.  The building of the new emergency care centre due to open in November 2016, would address the current limitations imposed by the physical estate constraints and restrictions.  Staff were also confident that the issues currently arising from the patient processes that contributed to some parts of the delays would be addressed before the new emergency centre opened.        

The following points were noted during the presentation:-

a)         The recent increase in lost hours over the 15 minutes target handover time and the 1hr + delays in September had both exceeded the levels experienced in December 2014.  There were 1,400 lost hours in December 2014 compared to 1,700 in recent weeks. 

b)         The EMAS rate of non-conveyance to hospital in Leicestershire was 48%-50% which was the highest in the EMAS area of operation.  Other areas had non-conveyance rates of 15%-20%.

c)         The current pressures were seen as a consequence of the unprecedented levels of demand placed upon the Emergency Department and the LRI. 

d)         Action taken to date to address these issues were:-

·         Continued focus on community pathways and non-conveyance where it right to do so.  EMAS were currently providing a Hear and Treat service to 15%-16% of 999 callers and were looking to increase this where it was safe to do so.

·         Processes had been reviewed and communications streamlined between UHL and EMAS staff through implementing new technology whereby staff from both services could enter simultaneous PINs to verify patient handover details.

·         EMAS Emergency Care Practitioners had also worked as part of the UHL clinical team at times of peak demand.

e)         Further planned actions included combined working on greater management of GP urgent flows, assess options for future ‘surge’ support from EMAS and other partners, complete data alignment of new handovers screens, assess the potential for increasing non-conveyance rates by possible support from GPs through the extended evening and weekend working arrangements currently being put in place.

f)          Unipart had been engaged to undertake an 8 week appraisal, analysis and re-design of process to achieve greater efficiencies, following their initial 5 day interim work on process mapping exercises and gathering data.  This had the support of the Trust Development Agency and was designed to achieve rapid improvements in systems, internal capacity and skill sets to achieve sustainable working practices in the future.    

Following discussions and questions from Members, it was noted:-

a)         The delays impacted upon the EMAS performance for responding to 75% of RED calls in 8 minutes.  The current performance was 67%.

b)         During October EMAS had conveyed 4,887 patients to the LRI compared to 5,017 to the Queens Medical Centre (QMC) at Nottingham.  It was noted that the number of ‘walk-in patients’ to the A&E unit was considerably far higher in Leicester than Nottingham. 

c)         The estate footprint for the A&E unit at the QMC was 30% - 40% larger than the LRI and had been purpose built to accommodate patient flows through the hospital.

d)         Whilst 1,650 hours had been lost at the LRI in October, only 570 hours had been lost at the QMC.  The number of delays over 2 hours during October had been 103 occurrences at the LRI compared to 2 at the QMC.

e)         The design of the QMC allowed for non-acute patients to be treated on trolleys at times of high demand which was not an option at the LRI.  This meant that ambulances could return to service sooner at the QMC, whilst at the LRI this resulted in non-acute patients being assessed and held in ambulances until they could be transferred over to LRI staff.

f)          Ambulances were not designed as platforms for treating a patient over a long period.

g)         EMAS would always prioritise responses to Red category calls.  At times when ambulances were experiencing long delays in handovers at the LRI, patients within the Green 1 and Green 2 category response times were disproportionately affected, as the remaining available ambulances were responding to Red category responses.

h)        Ambulance crews also experienced additional emotional pressures as communications to all ambulances were open channel broadcasts and they would be aware that there were Red category calls that they could not respond to whilst waiting to hand patients over to hospital staff.

i)          EMAS were highly focused on quality patient care and the call centre operatives carried out regular welfare checks and gave reassurance to patients when delays were being experienced.  Where required, the status of the call could be upgraded if a patient’s condition required this.  EMAS were not aware of large numbers of patients being put a risk as a result of delays, but there were a number of patients in a healthcare setting that experience longer waiting times to be transferred. 

j)          The LRI was not the only hospital in the EMAS area of operation that was experience the problem of delayed handover times.

k)         Whilst the work being undertaken by Unipart was designed to improve efficiencies, it would not itself address the challenges faced during the winter care period if there continued to be excessively high levels of attendances with resultant delays in discharges and transfer to social care.   

AGREED:

1)    That the representatives of UHL and EMAS be thanked for their presentation and reassurances on the work being undertaken to address the issues of delays in patient handover times.

2)    The proposed re-modelling of the procedures and systems to make them more efficient were welcomed and it was hoped that a key element of this would also focused on improving the patient experience.

3)    That both organisations should provide a glossary of abbreviations in future, or state them in full when making a presentation to non-NHS staff.

4)    That a further presentation be submitted to the Commission in January providing an update on the outcomes of the Unipart initiative and the measures that have been put in place to reduce the impact upon patients.      

Councillor Singh Johal left the meeting part way through this item.