Agenda item

The Committee received a report of Leicester, Leicestershire and Rutland Clinical Commissioning Groups which provided an update on winter pressures, the response of the local health and care system to winter pressures and the effectiveness of winter plans. A copy of the report, marked ‘Agenda Item 9’, is filed with these minutes.

The Committee welcomed Tamsin Hooton, Director of Urgent and Emergency Care, Leicester, Leicestershire and Rutland CCGs to the meeting to present the report. Mark Wightman, Director of Communications and External Relations, University Hospitals Leicester (UHL), and Richard Lyne, General Manager for LLR and Northants, East Midlands Ambulance Service were also present for this item.

Arising from discussions the following points were noted:

(i)        In previous winters there had been an increase in discharge rates immediately prior to Christmas which had meant beds were available come the post Christmas influx however this had not occurred in 2017. The main cause for the number of patients in hospital around the Christmas period was an increase in respiratory type illnesses.

(ii)       Concerns were raised that the dominant Flu strain B was not covered by the triple vaccine which was being administered by GPs and it was noted that it was the decision of individual GP Practices as to which vaccine they provided. The quadruple Flu vaccine was more expensive however it could be argued that it was more cost effective overall as it prevented the spread of Flu strain B.

(iii)      There had been a National Directive from NHS England to cancel elective procedures in order to prioritise urgent treatment. UHL deemed this to be essential due to the high bed occupancy rates and issues caused by flu. If the directive had not been issued it was likely that those procedures would still have been cancelled. It was clarified that the backlog created by the directive meant that UHL was unlikely to get back on schedule with regards to elective procedures and therefore would not meet the 18 week target for referral to treatment. NHS England recognised that this target was unachievable and therefore had set a target that the performance in March 2019 must be at least at the same level as performance in March 2018. 

(iv)      The Committee was advised that the cost to UHL of the cancelled operations during January was in the region of £10 million. This was because patients on an emergency pathway cost more than UHL were paid to look after them. The Trust could only make a profit through elective work.

(v)       Concerns were raised by a Member that on some occasions when an operation had been cancelled the pre-operation appointment had not been cancelled, and it was questioned whether better communication was required between different teams at UHL. In response reassurance was given that careful consideration was given before a decision was made to cancel operations and in those particular incidents it may have been that there had originally been a chance that the operation would go ahead.

(vi)      In previous years a survey of NHS frontline staff had taken place to gain feedback on areas for improvement with regard to the Winter Plan and feedback would again be sought this year however roadshows would not be taking place.

(vii)    The demand for Ambulance Services normally decreased in the new year period, however in 2018 demand had increased. Whilst there had been a spike in Ambulance handover delays in February 2018 this was not as protracted as the previous year. In the December 2016 to February 2017 period 5,000 hours had been lost due to ambulance delays whereas for the December 2017 to February 2018 period 3,500 hours had been lost. EMAS were implementing a new process where the appropriate grades of officers were allocated to incidents depending on the nature of the medical condition.

RESOLVED:

That the update on winter pressures, the response of the local health and care system to winter pressures and the effectiveness of winter plans, be noted.