Agenda item

The Director of Urgent Care Performance, West Leicestershire Clinical Commissioning Group, submits a report that provides an update on winter pressures, the response of the local health and care system to winter pressures and the effectiveness of winter plans.  The Commission is asked to note and comment as it sees fit.

The Scrutiny Commission received an update from the West Leicestershire Clinical Commission Group (WLCCG) on the Winter Plan 2017/18. Tamsin Hooton; Director of Urgent and Emergency Care, WLCCG and Eileen Doyle, Chief Operating Officer, University Hospitals Leicester (UHL) were in attendance to present the report.

The Chair expressed concerns about reports of the norovirus, surgery cancellations and ambulance waiting times point which indicated that the NHS was not working effectively, albeit that it was recognised that staff were working extremely hard under considerable pressures.

Ms Hooton explained that the WLCCG had been given £4.2m for winter care; some of which had been used to increase capacity.  The Christmas and New Year period had been the most challenging that they had experienced. Discharging patients from hospital at Christmas time was problematical because care workers wanted to take time off to be with their families. The hospitals had been nearly full at Christmas, though that was not due to a lack of effort or blockages in the discharge process.  There had been an approximate 12 hour wait at New Year; a very unusual situation which impacted on ambulance hand over time.  Ms Hooton explained that over the last 12 months, waiting times had been generally good and it was rare to exceed a two hour wait.

Ms Doyle updated the Commission on issues around cancelled operations. Members heard that she had been the Chief Operating Officer at the UHL since 2 January 2018.  Ms Doyle said that it was fairly unprecedented that so many operations for cancer patients had to be cancelled. This was due to the fact that most of the patients required big operations and would have needed to be admitted into the Intensive Care Unit ITU) afterwards, but the ITU beds had been fully occupied by patients, some of whom had been critically ill with flu. The patients whose operations had been cancelled had been re-booked as quickly as possible; this was not something that UHL would ever want to do, but carrying out the operation and not taking the patient to ITU would have put them at a bigger risk than not having the operation.

In response to a question, Ms Doyle said that there was a duty to report on cancelled urgent operations. If there was any risk that the patient would have a cancelled operation, the aim was to talk to the patient at least the evening before. Staff stayed in touch, the situation was tracked and monitored very closely.  The Commission heard that the situation was improving but it was a slow process and other operations had to be postponed.

In response to a question as to what was being done to prevent a similar occurrence next year, Members heard that planning had already started and efforts were being made to recruit as many nurses as possible. There were however 550 nursing vacancies in the UHL. In relation to the numbers of people with flu, Members heard that although there had not been a flu epidemic, the problems had arisen due to the people with the flu who were very ill.

A Member referred to the delayed discharges from hospital and it was noted that Leicester City Council was highly focussed in tackling this issue and in December had no delayed discharge cases. The Director of Adult Social Care explained that in the city, there was a relatively stable home care market and approximately 60% of discharges were worked on prior to the formal notification from UHL. Members heard that the county had a different procedure for dealing with hospital discharges.

There was some discussion relating to staff from care homes coming into hospitals to assess patients to see whether their care home might be suitable for the patient. Ms Hooton stated that it could take up to a week for this to be arranged; some patients required a type of care that only certain care homes could provide. A member commented that she knew of a manager in a care home who would be very agreeable to coming out at short notice in order to accommodate a patient. The Commission heard that the WLCCG had put forward a business case for an assessor who could carry out the assessment on behalf of the care home to speed up the process.

In response to a question about transferring patients to community hospitals, the Commission heard that the community hospitals were also busy.  Ms Hooton explained that patients had a choice and sometimes a dialogue was needed to explain to the patient that as they no longer needed intensive nursing, a community hospital was more appropriate.

A Member referred to the term ‘stranded patient’ and queried its meaning. Ms Doyle explained that by definition, the term referred to a patient who had been in hospital seven days or more. This might be because they were very sick or because an appropriate alternative could not be found. Ms Doyle added that patients were monitored weekly. Concerns were expressed that the term had negative connotations and the Chair stated that she would raise this with Jon Ashworth M.P., the Shadow Secretary for Health. 

Concerns were also expressed that additional pressures were being put on the NHS because families had rejected alternative placements and wanted their family member to remain in hospital, perhaps delaying the discharge by several weeks. Members heard that in some circumstances, an eviction notice might be appropriate. Ms Doyle suggested that it might be necessary to find a solution to the problem at a national level. 

Concerns were expressed that the Sustainability Transformation Plan (STP) might result in fewer beds but this would be counter intuitive in the light of the difficulties experienced this winter. Members heard that there had been no reduction in bed spaces this year.

The Chair summarised the discussion and stated that there had clearly been various issues resulting in delays in treating and discharging patients, but it was clear that there were very caring staff who had done all they could. She believed that a more robust response to dealing with patient choice was needed.  The Chair added that she would like an update on lessons learned from the winter period and planning going forward, to be brought to a future meeting along with a report on the performance for patients with cancer. In addition the minutes of the discussion on the update on the Winter Plan to be shared with the Chair of the Health and Wellbeing Board.

AGREED:

1)    that the update on the Winter Care Plan be received and noted;

2)    that an update on lessons learned on the Winter Care Plan and planning going forward; be brought to a future meeting of the Health and Wellbeing Scrutiny Commission;

3)    that a report on patients with cancer be brought to a future meeting of the Health and Wellbeing Scrutiny Commission; and

4)    the minutes of the Health and Wellbeing Scrutiny Commission’s discussion on the Winter Plan 2017/18 be shared with the Chair of the Health and Wellbeing Board.