Agenda item

To receive a presentation providing an overview of practical winter planning arrangements and health care winter planning arrangements by the Leicestershire, Leicester City, and Rutland (LLR) health and social care system including plans for frail & multi-morbidity patients.

The Board received a presentation providing an overview of practical winter planning arrangements and health care winter planning arrangements by the Leicestershire, Leicester City, and Rutland (LLR) health and social care system, including plans for frail & multi-morbidity patients.

Mr Mike Ryan, Director of Urgent and Emergency Care, LLR, Phil Coyne, Strategic Director, City Development and Neighbourhoods, Rachna Vyas, UHL and Mark Pierce Leicester City CCG all contributed to the presentation.   

The presentation outlined Leicestershire, Leicester City, and Rutland (LLR) health and social care system approach to focusing efforts toward building greater and sustainable resilience across urgent and emergency care of patients and covered the following topics:

–     What system performance looked like last winter;

–     Our assessment of the major causes for pressure that we experienced;

–     The lessons that were learnt as a result;

–     The actions to avoid similar issues; and

–     Our assessment of our readiness for this coming winter

The presentation had been circulated with the agenda for the meeting and provided details of the following:-

·         The increasing pressures being faced by health and social care services during the winter period resulting from:-

o   80% of the hospital beds being occupied by patients over 75 years of age (20% of the population) who required more care and longer stays in hospital.

o   Emergency surgical cases had exceeded normal levels.

o   The length of stay for medical patients at UHL had increase by nearly 2 days from January to March 2018.

o   Norovirus and flu had resulted in bed closures at both UHL and LPT, and higher levels of staff sickness/absence during the peak periods of demand.

o   High levels of elective surgery cancellations than previous years following national instructions to all acute Trusts.

o   30% increase in calls to NSH111.

o   Ambulances service regularly at higher escalation levels and patient handover times higher than expected.

·         The lesson learned from 2017/18.

·         The actions to avoid similar issues by:-

o   A focused review and revision of the system wide Escalation Plan.

o   Improved patient assessment areas following the second part of the A&E development following the opening of the full emergency floor in June 2018.

o   A realignment of UHL’s bed capacity and creating additional  capacity equivalent to 3 wards to meet the expected increase in medical patient demand.

o   Improving access to IT systems enabling clinicians to see the patient’s clinical record.

o   Improved protocols between UHL and EMAS.

o   Improved communications systems between consultants and GPs.

o   Introduction of a Red Bag scheme in care homes which has proved successful elsewhere.

o   Supporting more patients to understand and manage their own conditions, especially those with respiratory conditions.

o   Improved discharge pathways.

o   Designing a new pathway for frail patients based on local needs national standards and utilising other interventions to reduce social isolation and engage carers and voluntary organisations.

o   The Flu & Immunisation programme for the forthcoming winter.

o   Introduction of a LLR programme to identify frail and multimorbid patients and assess their needs and wishes and provide a response based upon on a comprehensive assessment of need involving medical, cognitive, functional, social and environmental.

·         The ongoing arrangements for implementing actions will be constantly monitored by the A&E Delivery Board and any learning will be fed into updated versions of the plans to achieve constant improvement. 

Board members commented that:-

·         Utilising and supporting pharmacies in raising awareness of the services they can provide and health promotions to provide preventative measures and treat minor conditions and reduce pressures on hospital admissions by patients presenting at A&E conditions that could have been treated elsewhere.

·         NHS 111 had an important role to play in where they referred callers for treatment.

·         The frailty initiative had reduced admissions but there were still considerable numbers of patients with frailty conditions being admitted onto the system.

·         UHL’s performance in patient handovers had improved from being the worst in the EMAS area to being average for the last two months.

·         Although extra beds could be provided, this was still dependent upon the ability to provide sufficient nursing staff to operate them.

RESOLVED:-

That everyone be thanked for contributing to the presentation and that front line staff be thanked for their work in delivering the strategy.