Agenda item

The Committee considered a joint report of West Leicestershire Clinical Commissioning Group (WLCCG), University Hospitals of Leicester NHS Trust (UHL) and East Midland Ambulance Service (EMAS) providing an update on the winter performance of the Urgent and Emergency Care System and briefing the Committee on the progress of the Urgent and Emergency Care Vanguard. A copy of the report marked ‘Agenda item 9’ is filed with these minutes.

The Chairman welcomed Toby Sanders, Managing Director, West Leicestershire Clinical Commissioning Group, John Adler, Chief Executive UHL, and Tim Hargrave Locality Manager, Leicester, Leicestershire and Rutland (LLR) EMAS to the meeting for this item.

In introducing the report John Adler gave an account of improvements in response to the Care Quality Commission’s (CQC) conditions imposed following its unannounced visit at Leicester Royal Infirmary (LRI) on 30 November 2015.  UHL acknowledged the seriousness of the situation, as the CQC had imposed conditions on UHL’s registration and failure to comply was a criminal offence. The issues identified by CQC and UHL’s response was as follows:-

·         The need to ensure that the skill mix of staff in the Emergency Department (ED) was sufficient for patient safety; particularly with regard to the numbers of senior nurses.  UHL provided a weekly report to CQC regarding both nursing and medical staff and no major problems had yet been identified;

·         The need to assess every patient within 15 minutes of arrival at the ED.  This was an extremely challenging standard, as observations and getting a case history could take time.  However, the Committee was advised that performance had improved in this area and a system put in place whereby ambulance crews assessed patients in transit and shared this on arrival so that the sickest patients could be prioritised during busy periods.  It was acknowledged that this presented a risk in that some patients would have longer waits;

·         The need to improve the management of sepsis.  A new pathway had been implemented and the last data set indicated full compliance.  However, the pathway required six specific actions to be implemented within one hour of the patient’s arrival at ED and performance relating to each action was mixed.

The Committee was advised that the most recent CQC report and feedback on the Trust’s progress had not been received yet, though it was hoped that the improvements listed above would be sufficient to comply with the conditions imposed.

Arising from discussion members were advised as follows:-

(i)     The single front door and the co-location of the ED and the Urgent Care Centre (UCC) allowed for effective triage of patients to ensure that they were treated in the most appropriate setting and had resulted in 68 percent of the patients walking into urgent care at the LRI not needing to go to the ED at all. The Committee was advised that patients who did not know which service was most appropriate for them should be using the 111 non-emergency number. The benefits of using the 111 number in non-emergency situations included advice on all local services available, including social care services and pharmacies. In addition, members were advised that part of the Vanguard project was intended to provide a more consistent urgent care service and increase the role of the NHS 111 number to act as the ‘portal’ for all points of access to health and social care in Leicester, Leicestershire and Rutland;

(ii)    The UCC was now managed by UHL and so was more integrated with the ED.  Clinicians in the ED felt that the referrals made to them by the UCC were appropriate.  It was intended that the UCC would be expanded to include an observation unit which would allow even more patients to be treated there rather than in the ED.  EMAS also diverted patients away from the ED through its ‘see and treat’ and ‘hear and treat’ services;

(iii)   The delays in ambulance handovers to LRI remained the most problematic issue for the local health and care system. In order to tackle this, work was being undertaken to ensure that handovers were as slick as possible and that flow was maintained within the hospital. If beds were not available in the main hospital, patient needing to be admitted were not able to leave the ED. This in turn resulted in a lack of capacity in the ED.  Members were, however, assured that UHL and EMAS worked together to proactively manage the patient flow. An escalation plan was in place which meant that delays of over two hours were referred to the Chief Executive of UHL.  This escalation process was effective as it ensured all possible actions had been undertaken;

(iv)   Members were advised that each 999 call was triaged and the fast response car was dispatched to all immediate life threatening conditions and cardiac arrests with a target response time of 8 minutes, in line with national standards. The same target for immediate but not life threatening emergency was 19 minutes. The Committee was also advised that the patients were normally taken to the closest hospital available, but that the patients would be taken to LRI if their patient history was already there;

(v)    The LLR Vanguard aimed to improve urgent and emergency care; focused on simplifying the points of access for these services and improving the ‘front door’ at the LRI.  The new ED floor, the first phase of which would be completed by the end of 2016, would provide an opportunity to look at how services could work together and be more integrated.

RESOLVED:

(a)  That the update on the winter performance of the Urgent and Emergency Care System and the progress of the Urgent and Emergency Care Vanguard be noted;

(b)  That the detailed plans for delivery of the Urgent and Emergency Care Vanguard be circulated to all members of the Committee for information.