Agenda item

The Committee received a presentation from University Hospitals of Leicester NHS Trust (UHL) and the Integrated Care Board (ICB) regarding winter pressures across the Leicester, Leicestershire and Rutland Health and Care System. A copy of the presentation slides, marked ‘Agenda Item 8’, is filed with these minutes.

The Committee welcomed to the meeting for this item Jon Melbourne, Chief Operating Officer, UHL, Nilesh Sanganee, Chief Medical Officer, ICB, and Rachel Dewar, Assistant Director of Urgent and Emergency Care, ICB.

Arising from discussions the following points were noted:

(i)           UHL had declared a critical incident on 30 December 2022 due to high patient attendances but were able to stand the incident down on 1 January 2023. UHL understood that every other hospital trust in the East Midlands had also declared a critical incident around the same time. Members welcomed the quality and extent of the communications which were disseminated to the public when the critical incident was declared. The messaging to patients was to only come to the Emergency Department if they really needed to be at the Emergency Department.

(ii)         The respiratory pathways had been facing particular pressure over the winter but there had been recent improvements. Acute respiratory infection hubs had been launched to help manage viruses.

(iii)        Members welcomed the improvement in handover times at the Leicester Royal Infirmary Emergency Department.

(iv)       Clinical navigation systems were in place so that patients that had called for an ambulance could be taken directly to the most appropriate place for their needs and not automatically taken to the Emergency Department. Some patients could be treated in the community. This approach was reducing the numbers of patients arriving at the Emergency Department.

(v)         There was now a Minor Injuries and Minor Illness Unit at Leicester Royal Infirmary though the unit did not have a walk-in service. It was expected that the unit was having some impact on reducing attendances at the Emergency Department but it was hard to tell the extent of the impact.

(vi)       As the condition of some patients could deteriorate when in a hospital bed rather than when being more active at home, virtual wards were being used to monitor patients in their own homes.

(vii)      The actions on the slides at page 16 were rag rated so the ones in green had been completed, and the one in red (implement 300 virtual ward beds) had not yet been achieved.

(viii)    Work was ongoing to improve patients’ access to Primary care and the Enhanced Access Scheme would mean that primary care appointments were available 8.00am to 8.00pm Monday to Friday and 9.00am to 5.00pm on Saturdays. There was a target of 75% of primary care patients being seen face to face and the majority of GP Practices in Leicestershire were meeting this target.

(ix)       In response to a question about staff retention and the health and wellbeing of the workforce reassurance was given that staff morale was a priority, and it was being demonstrated to staff that the current difficulties were only temporary and plans were in place for improvement. Staff were being made aware of career opportunities in order to encourage them to stay. It was hoped to move to a position where agency staff did not have to be relied on.

(x)         The threat of industrial action was an issue facing the health and care system and there had been ambulance strikes on 21 December 2022 and 11 January 2023. However, the strikes had been managed well which was demonstrated by the ambulance handover times for those days which were good compared to other days. This had been achieved by putting in place additional services for those days, increasing the number of appointments available outside of the Emergency Department (which had come at additional cost) and using private ambulance crews.

(xi)       Partnership working had been important in tackling winter pressures particularly working with local authorities.  It was too early to assess the full impact of the new Integrated Care System but the first 6 months had gone well and integrated working was key.

RESOLVED:

That the contents of the presentation be welcomed.