Agenda item

Emergency Care Update.

Minutes:

The Committee considered a report from West Leicestershire and East Leicestershire and Rutland Clinical Commissioning Groups (WLCCG and ELRCCG) which provided an update on performance of the local urgent and emergency care system, in particular the University Hospitals of Leicester NHS Trust’s (UHL) performance against the four hour standard for Accident and Emergency (A&E) waiting times and the actions taken by the local health economy to address the underlying issues affecting the emergency pathway and its impact on A&E performance.  A copy of the report marked ‘Agenda Item 10’ is filed with these minutes.

 

Written comments had been received from Healthwatch Leicestershire and a copy is filed with these minutes. 

 

The Chairman welcomed Dr Dave Briggs, Managing Director of ELRCCG and Jane Taylor, Director of Emergency Care across Leicester, Leicestershire and Rutland, to the meeting for this item.

 

In his introduction to the item, Dr Briggs observed that a lot of good work had been carried out but that this had not translated to a sustained improvement in performance.  The patient experience had been improved through a number of quality and safety metrics including a patient census which tracked every patient through the system and enabled partners to identify where to focus resources.  It was hoped that this would result in a significant improvement in performance in the near future.

 

Arising from discussion the following points were raised:-

 

(i)        The challenge in achieving the four hour waiting time target for A&E was the daily variation in performance.  A sustained improvement in the flow through the hospital was also a significant challenge and key area of focus.  In particular, improvements were being made to the discharge process.

 

(ii)       UHL had received £10m from the Government to help deal with winter pressures.  This had already been overcommitted to help improve A&E performance.  The recent announcement of a further £150m from the Government would not be made available to UHL as they had received funding earlier in the programme.

 

(iii)      It was acknowledged that achieving the four hour waiting time target in A&E had always been a challenge.  This was because the local health economy had not transformed quickly enough over a number of years.  This had worsened the crisis and meant that a number of significant improvements were required to meet the challenge.  The improvements included the expansion of the Emergency Department which was felt to be a necessary investment in order for UHL to meet the target.  Commissioners were of the view that the local emergency care system was now catching up rapidly with other areas.

 

(iv)      The non-emergency telephone number, 111, had been introduced in Leicester, Leicestershire and Rutland after the national roll out to enable lessons to be learnt from issues that had arisen elsewhere in the country.  Prior to its introduction, UHL had implemented the single front door which meant that 111 had not had an adverse impact on UHL’s Emergency Department.         

 

(v)       Work was on-going to establish a single template for patient data across health and social care.  There was also an ambition to develop a single data system that worked across partners’ IT systems.  In the meantime, improvements had been made to enable partners to share information more efficiently and an integrated discharge team had been established.

 

(vi)      The integration of health and social care was a priority across the local health and care system.  Areas that would initially be focussed on included IT and the frail elderly.  The ‘silver book’, which had recently been launched and outlined care standards for older people over the first 24 hours of an urgent care episode, could be used to support work on improving care for frail elderly people.  Members suggested that creating a ‘silver e-book’ could be a useful project.

 

(vii)     Concern was expressed regarding the number of hospital admissions from care homes.  It was recognised that this was a cultural problem, particularly with regard to end of life care and the CCGs had a significant programme of work aimed at supporting care homes to reduce admissions.  This included giving care homes confidence in the Out of Hours service, proactively reviewing data on a weekly basis to address issues quickly and working with the East Midlands Ambulance Service.  A workshop would be hosted by the CCGs for care homes’ staff next week to identify how they could best be supported.

 

RESOLVED:

 

(a)       That the performance of the local urgent and emergency care system and actions taken to address the underlying issues affecting the emergency pathway be noted;

 

(b)       That a report on hospital admissions from Care Homes be submitted to a future meeting of the Health Overview and Scrutiny Committee.

 

Supporting documents: