Agenda item

The Committee considered a joint report of West Leicestershire, East Leicestershire and Rutland and Leicester City Clinical Commissioning Groups (CCGs) which provided an update on the progress and actions taken across the health system to support the delivery of seven day working.  A copy of the report marked ‘Agenda Item 10’ is filed with these minutes.

The Chairman welcomed Tim Sacks, Chief Operating Officer from East Leicestershire and Rutland CCG (ELRCCG) and Ian Potter, Head of Primary Care Delivery from West Leicestershire CCG (WLCCG) to the meeting for this item.

Arising from discussion the following points were raised:-

(i)     It was acknowledged that urgent and emergency services, along with some services provided in acute hospitals, were already available seven days a week and that an out of hours service was already in place. Members were advised that seven day services would not include routine outpatient appointments. The aim was to make services available for the 2.5 percent of complex patients that evidence had shown would benefit from a seven day service.  It was hoped that this would prevent unnecessary hospital admissions for this group of patients;

(ii)    It was acknowledged that an increase in primary and community care services would only be affordable if funding was transferred out of acute services.  In addition, there was a significant amount of duplication in out of hours services which could be reduced if services became more integrated.  The Urgent Care Vanguard project across Leicester, Leicestershire and Rutland, which had been the subject of a successful national bid, would include an integrated approach to seven day working;

(iii)   Concern was expressed over the effectiveness of the Urgent Care Centre in Oadby. Anecdotal evidence indicated that waiting times at the weekend could be up to three and a half hours and that patients did not always get to see a GP. The Committee was advised that a GP was present at the Centre at all times and patients were triaged to see either the GP or a nurse. The Centre had a target of a maximum wait of two hours, which was only met in 92 percent of cases. Regular contract meetings were taking place to address these issues and the staff rota was being reorganised so that more staff were available during busy periods. Members were also advised that there was a high level of demand for the service, including a significant number of patients from Leicester City. It was hoped that the four new healthcare hubs recently set up in Leicester would make demand for the service more manageable;

(iv)   Members were pleased to note the success of the Acute Visiting Service (AVS) pilot scheme in the West Leicestershire area which provided a rapid way of seeing patients in their own homes, including care homes, and was staffed by Emergency Care Practitioners in tandem with GPs.  The evaluation had been positive and the service would be extended to weekends from December.  The Committee was also pleased to note that some pilot seven day working schemes which had not had an impact were not being continued;

(v)    Members welcomed the work undertaken by UHL to support seven day discharge but expressed concern that the services in the community were not able to respond to this.  It was confirmed that the CCGs supported seven day discharge through the provision of community and virtual beds, although there could be difficulties in providing nursing care at weekends and overnight.  County Council social care staff also worked on the UHL site during the weekend in order to commission care packages to support seven day discharge.  A range of social care services were available seven days a week, such as domiciliary care services, reablement and crisis support.  However, there were some practical difficulties to commissioning a new care package at the weekend; 

(vi)   It was clarified that only nursing homes had nursing oversight; residential care homes were not allowed to provide nursing care.  Community nurses provided nursing oversight to residents in residential care homes.  There was a joint health and social care oversight group for care homes which provided assurance that services were appropriate and co-ordinated any input into the homes; 

(vii) The Committee was of the view that training provided to care workers needed to be of an adequate standard and that there should be a clear pathway for career progression.  Members were advised that the skills and status of care workers was a national issue. National initiatives were in place to address this such as the Care Certificate which aimed to improve the level of training provided to carers.  Within Leicester, Leicestershire and Rutland, a workforce strategy was being developed and subsidised training was also offered.  The County Council’s Member Reference Panel on Quality and Safeguarding in Residential Care Homes also provided assurance that service users received an appropriate standard of care.  It was recognised that there was more work to do in this area, particularly as the need for carer staff was expected to increase in the coming years.

RESOLVED:

That the update on the progress and actions taken across the health system to support delivery of seven day working be noted.