Tamsin Hooton, Director of Urgent and Emergency Care and Jennifer Smith, Head of Operational Resilience and Emergency Planning, West Leicestershire Clinical Commissioning Group will present the Leicester, Leicestershire & Rutland Health and Social Care Economy Winter Care Plan 2017-2018
Tamsin Hooton and Jennifer Smith attended the meeting to present the LLR Winter Plan 2017-2018.
It was noted that the Plan was overseen by NHS England and had been submitted to them on 8 September 2017. The Plan had been assured by the Local NHS Team and was currently awaiting a formal assurance from the National NHS England Team. The purpose of the Plan was to co-ordinate the health systems ability to response to increased demand for services from the public in seasonal winter periods and particularly to spikes in demand arising during that period.
The Plan was overseen locally by the A&E Delivery Board Chaired by John Adler assisted by a Winter Plan Sub-Group that brought together the different agencies involved. As part of the planning process in preparing the lessons learned from the experiences of the previous winter period were reviewed to improve the resilience of the service for this winter.
The opening of the new Emergency Department was showing improved ambulance handover times. The lost hours through ambulance crews waiting for patient handover had been reduced by over 80% which enabled the ambulance service to recycle those resources back into the system to enable EMAS to respond more rapidly to calls for assistance.
Changes had also been made in the community based urgent care services with a view to providing an enhanced clinical navigation process in conjunction with NHS 111 to introduced an enhance care triage assessment to signpost to book non-urgent patients into an alternative treatment in non-acute services settings. Approximately 80% of patients seen by EMAS with a none emergency ambulance response were now receiving a different outcome from being conveyed to the acute hospital setting as a result of clinical navigation. In addition 6—65% of ED referrals were also being treated in a different way as well. Demand was beginning to be moderated and attendances at the A&E Department were already showing a 2% reduction compared to the same period last year. This was also being supported by the 4 Health Care Hubs in the City and patients were being booked into these through the clinical navigation process where appropriate.
Work was continuing to build and develop elements of the Plan. These included:-
· The development of a flu and infectious disease plan across city.
· Refining and refreshing the arrangements in relation to the need for a surgeon escalation within the plan co-ordinated by the CCG Team, so that there were clear actions at each level of pressure and that all partners were aware of the these actions at each level of escalation.
· The Plan also helped to manage the surge in demands and smooth out the peaks of demand for services. There was a spike in demand for service on Mondays throughout the year and also after 2 days of Christmas and Bank Holidays which were exacerbated by the additional winter pressures.
· A Passport Scheme, whereby patients identified as being at high risk of either attendance or admission to hospital, had a fast track into alternative services including home visiting service and telephone support.
· UHL’s ‘Red to Green’ initiative had already been beneficial in reducing the number of delays in discharging patients from hospital and further initiatives were being introduced to improve patient flows through the hospital.
Members commented that:-
a) That it would be useful to have feedback to future Board meetings on performance during the winter period. A general operational dashboard would be useful to monitor this and to provide a baseline with which to compare performance in future years.
b) The importance of the coordinated escalated responses at times of pressure were essential and important when the system was under pressure. The new Emergency Department was also seeing different patterns of patients attending and it would be important to understand these new patient patterns in order to address them, particularly in relation to the recent spikes on Mondays.
c) Future reports would benefit from having some narrative of the issue and how the service was performing in responding to them. Some further clarity around the data provided and the need to establish the baseline was required.
d) All partners were collectively signed up to improving the delayed transfer of care which was currently performing om a trajectory slower than the national targets.
e) The arrangement for the surgeon escalation could also impact on other issues during the winter such as delayed and cancelled elective surgeries, and this could be useful indicator to be include in the proposed monitoring dashboard. It was noted that there was an expectation within the health services that elective surgeries would be ‘phased’ over Christmas/ New Year period to reduce the pressures on hospital beds over this period and to avoid unplanned cancellations of elective surgery.
f) The regional moderation approach to the BCF Plan was a suggestion and recommendation that the plan went forward for approval, with conditions, that would have no caused no significant problems from a local authority perspective in terms of transfer monies that came through the NHS. The area had submitted a trajectory that was felt to be achievable by March but this had been rejected at national level by NHS England along with the rejection of plans of 18 other areas. The LLR was now being asked to submit trajectory that was not felt to be achievable, which local authorities felt was an unrealistic approach by NHS England. This could result in the Council being potentially punished by NHS England potential withholding funding of up £10m as a penalty that were essential to delivery baseline services. There was a view that the LLR was effectively being punished for good performance particularly in relation to reducing social care detox. The CCG had been informed that NHS England would be writing to them and 29 other leads of BCF plans offering the opportunity to consider our position, following formal feedback and provide a further opportunity to resubmit proposals by 16 October.
1) That the report be received and that pressures being placed upon the local health system be noted resulting in the current turmoil within the system be recognised.
2) That the Board receive further reports on performance monitoring during the winter period as requested in the comments above.