Agenda item

The Committee considered a joint report of University Hospitals of Leicester NHS Trust (UHL) and the Leicester, Leicestershire and Rutland (LLR) Integrated Care System which provided an update on the performance of the Urgent and Emergency Care System including the findings of a Care Quality Commission (CQC) report into the system dated 8 July 2022. A copy of the report, marked ‘Agenda Item 8’, is filed with these minutes.

The Committee welcomed to the meeting for this item Rachna Vyas, Chief Operating Officer, NHS Leicester, Leicestershire and Rutland Integrated Care Board, Chris West, Deputy Chief Nurse, NHS Leicester, Leicestershire and Rutland Integrated Care Board, and Jon Melbourne, Chief Operating Officer, University Hospitals of Leicester NHS Trust.

Arising from discussions the following points were noted:

(i)          Some of the problems with the performance of the Urgent and Emergency Care System were a result of the Covid-19 pandemic, however there were also longstanding issues which needed to be addressed. The ambulance handover delays were a symptom of a much wider problem with flow through the system.

(ii)         LLR had the lowest EMAS conveyance rate which was believed to be because patients were being seen in other services and did not require acute care. However, LLR also had the highest referral rate in the region for urgent community response in patients own homes.

(iii)       Traditionally the Leicester Royal Infirmary Emergency Department experienced one of the highest rates of unheralded attendances in the region, though due to work which had taken place to tackle this problem the LRI Emergency Department now had one of the lowest rates. However, there were still significant numbers of patients presenting at the Emergency Department who could have been treated at other venues locally. Urgent Treatment Centres had additional capacity which was not being used. Members raised concerns about mixed messaging in relation to Urgent Treatment Centres and their opening hours which left the public unclear about where they should go for treatment and at what times.

(iv)       NHS England had set the LLR System and Leicester Royal Infirmary Emergency Department a challenge of zero handovers over 30 minutes by 1 September 2022. Whilst significant progress had been made towards this objective, the challenge would not be met by 1 September and whilst a trajectory had been agreed with NHS England it was difficult to estimate when the challenge would be met.

(v)        A member raised concerns about the lack of a clear strategy for improvement and questioned whether the high turnover of senior management at UHL over the previous years could have contributed to the lack of improvement in performance. Members also noted that the report to the Committee contained no action plan for how the issues with the Urgent and Emergency Care system would be addressed nor timescales for when improvements would be made. In response UHL acknowledged that sustainability in leadership was important and provided reassurance that the right leadership team was now in place. It was explained that managers across the Urgent and Emergency Care System were talking to each other more than ever and it was being ensured that they were all working towards the same aim rather than the aims of each individual organisation. An action plan was in place which set out how the demand and flow would be managed and metrics were in place to monitor performance. The action plan would be provided to members after the meeting.

(vi)       Additional capacity in the system was being created and a new care home was opening in Leicestershire which it was hoped would alleviate some of the problems with regards to discharging patients from hospital.

(vii)      In response to concerns raised by members that UHL did not have the required numbers of staff with the appropriate expertise, reassurance was given that recruitment and retention was a priority for UHL and work was ongoing to improve recruitment from all types of professions and make UHL a more attractive employer, for example improving pay and car parking. The staffing and recruitment issues did not just relate to UHL but to the whole Urgent and Emergency Care System. It was agreed that data regarding the number of vacancies would be provided to members after the meeting.

(viii)    The Integrated Falls Response service had just been launched which treated patients that had experienced falls in their own home and brought in lifting equipment where necessary. It was a pilot run by Derbyshire Health United and in response to a request it was agreed that the results of the pilot would be reported to the Committee at a future date.

(ix)       The Urgent and Emergency Care System took on board best practice from systems elsewhere in the country. Officers attended seminars and met with regional and national colleagues to share learning. Successful methods from elsewhere could not always be copied exactly in Leicestershire due to unique circumstances locally however where possible the learning was implemented locally. 

(x)        A multi-agency Patient Safety Risk Summit was taking place in September 2022. Currently no representatives from the County Council were scheduled to attend but they were welcome and consideration would be given to who would be the most appropriate attendees from the County Council.

RESOLVED:

(a)        That the update relating to the Urgent and Emergency Care System in Leicestershire and the Care Quality Commission report of 8 July 2022 be noted with concern.

(b)        That officers be requested to provide a further update to the Committee in the new year regarding the performance of the Urgent and Emergency Care System.