Agenda item

To receive a report from the University Hospitals of Leicester providing an update on the current state of play since the move to the new Emergency Department.

John Adler, Chief Executive, University Hospitals of Leicester NHS Trust provided an update on the current state of play since the move to the new Emergency Department.

The Chair commented that she had attended the preview tour of the new Emergency Department and had been impressed with the facilities it provided.

In presenting the update, the following comments and statement were noted:-

a)         The new emergency department had transformed privacy and dignity for patients, particularly for the frail and elderly.

b)         There used to be all year round pressures but now the unit had sufficient space to accommodate big surges in attendance.    There had been positive feedback on the design, quality and the build of the new facility. 

c)         The Trust was not consistently improving performance against the 4 hour target and as performance was still somewhat erratic.  The goal was now to achieve 90% of patients being seen within the 4 hour target compared to the previous target of 95%.  Overall all A&E departments in the country were performing at around 87%.

d)         Approximately 35 initiatives had recently been implemented in an attempt to bring about a more consistent improvement and these were outlined in the report.

e)         The Emergency Department was now one of biggest in the country seeing 600-800 patients a day.  One initiative had been to provide improved access to consultants for a trial period during the night so that junior doctors could get guidance on treatment of patients with minimal delay.  More porters had been provided and processes changed to allow quicker access to tests for patients.  This had made improvements and a medium term plan was being developed to provide sufficient medical resources during the evening and overnight periods.  Last week the Trust had been rated as the 107^th performing Trust when previously they had been rated the worst. 

f)          The Trust has been ‘buddied’ with Luton and Dunstable NHS Trust which was one of the top performing trusts in the country.  Although they were smaller in size, their system of operation was the key factor in providing efficiencies and long term improvements.  Staff from Luton had visited Leicester to observe the relationship between specialties departments and the Emergency Department.  UHL Trust were now looking to change practices and embed Luton’s culture in the Emergency Department.   This involved providing additional staff resources in the Emergency Department and changing downstream working and responsibility in departments.

g)         Currently UHL aimed to assess patients within an hour of arrival, devise a treatment plan within 2 hours and determine whether a patient needed to be admitted within 3 hours, and then locate a bed and move the patient to a ward within 4 hours.  The Luton model assessed the patient in the Emergency Department and located a bed within the first hour.  UHL were looking at an electronic bed management process to improve patient flows.

h)        Phase 2 of the Emergency Floor would see the co-location of the specialised assessment units next to the new Emergency Department. This would bring together the Emergency Department and the bulk of where medical patients would need to be treated.  The GP Ambulatory Unit would also move to a dedicate space within the emergency floor.  This unit assessed patients who had been referred by GPs but were not considered to require an admission.  These patients would now bypass the Emergency Department and go directly to the Ambulatory Unit.   It was planned to open this unit in December so that it was in place for the winter ‘surge’ period.  The remainder of Phase 2 was on target and within budget and would be fully operation in the spring of 2018.

In response to Members’ comments and questions, the following responses were received:-

a)         Key concerns in relation to the Winter Care Plan were having sufficient staff in the event of a flu epidemic.  Staffing recruitment was now more acute than they were pre Brexit; as the number of EU nurses employed by the Trust had fallen from 400 to 200 and the Trust currently had 500 vacancies.   The Trust could not open more beds as there were not enough trained staff to attend to them. 

b)         The Red to Green system was contributing to making improvements in patient flows as it reduced the time patients were in hospital waiting for investigations and tests.

c)         The Trust would shortly be issuing a tender for a partner to provide the Trust with GPs.

d)         The Trust were working with local GPs and the CCG to reduce the number of people coming to the Blue Zone (the assessment area for walk-in patients) so that inappropriate referrals could be re-directed to the hubs within the City and County.  The GPs working in the Blue Zone provided a valuable primary care service to those patients that really needed it.  The Trust was also looking to provide some primary care support at the Emergency Department reception to help to deflect patients to alternative care providers.

e)         Patients requiring the facilities to be provided in Phase 2 would use a separate access through the Emergency Department.  There would be no walk-in access to these services.

f)          There were up 200 ambulance arrivals per day at the Emergency Department and 1 in 3 patients at the Department arrived by ambulance.

g)         UHL offered A&E consultants a varied work experience package which made recruitment easier and consultants trained by the Trust had a tendency to stay with the Trust longer than in other Trusts.  This was important as there was a national shortage of ED consultants.

h)        The 4 hour target, although a much criticised target, was a good proxy of how the whole system from arrival to discharge was working.  If it all worked well there was no problem.  There was a national debate in relation to the target being a blunt instrument that distracted from the sickest patients receiving timely treatment; because it related to all patients that attended an A&E department.

I)          The number of patients attending the ED had plateaued for first time in some years and admissions seemed to be stabilising as well.  The less unwell patients attending the ED were considered to be manageable as long as there was a process of streamlining at the front desk. There were some initial indications that the patient flows seemed to be more manageable now. 

m)        The Trust were looking to find a sustainable way to have senior decision makers (consultants or senior registrars) in the ED in the afternoons and nights to provide a more efficient patient throughput.  Rotas were being designed for them to be in ED which would reduce admissions as they were more confident to find community services when appropriate.

AGREED:-

(1)       That Mr Adler be thanked for presenting the report and for openly responding to Members’ questions.

(2)       That a further update be submitted in the spring of 2018 following the full implementation of Phase 2 of the Emergency Floor.