Agenda item

The Committee considered a joint report of the Chief Executive and the Integrated Care System Performance Service which provided an update on health and care system performance based on the available data in January 2023 and focused in particular on cancer performance and recovery. A copy of the report, marked ‘Agenda Item 9’, is filed with these minutes.

 

The Committee welcomed to the meeting for this item Hannah Hutchinson, Assistant Director of Performance & Quality Improvement, Leicester, Leicestershire and Rutland Integrated Care Board (ICB), Helen Mather, Associate Director of Elective Care, Cancer and Diagnostics at the ICB, Jon Melbourne, Chief Operating Officer, University Hospitals of Leicester NHS Trust (UHL), and Alison Buteux, Senior Performance Manager, Midlands and Lancashire Commissioning Support Unit.

 

Arising from discussions the following points were noted:

 

(i)           The number of patients waiting over 104 weeks for elective treatment had reduced steadily each month for the previous six consecutive months. The peak of 1,063 patients in January 2022 decreased so that at the end of December 2022 there were 67 Leicestershire and Rutland patients waiting over 104 weeks, at a number of different Acute providers. There was a target that the number of 104 week waiters would be zero by the end of March 2023 and the number of 65 week waiters would be zero by March 2024.

 

(ii)         The dementia diagnosis rate was currently 60.7% and the target was 66.7%.

 

(iii)        Accident & Emergency Departments had a target to admit, transfer or discharge patients within 4 hours of their arrival. As of January 2023 57% of patients arriving at Leicester Royal Infirmary met this target and the national target for 2023/24 was to reach 76% compliance.

 

(iv)       At the end of December 2022 10,836 patients were waiting over 52 weeks from referral to treatment. There was a target that this figure be zero by March 2025.

 

(v)         In December 2022 45% of patients referred for cancer treatment were seen within 62 days. A trajectory had been set that fewer than 517 patients would be seen after more than 62 days by the end of March 2023 and in 2024 this would improve further with a target currently being agreed.

 

(vi)       With regards to patients that were seen within two weeks of an urgent GP referral for suspected cancer the position as of November 2022 was 88.3%. Of those patients 90% were found not to have cancer but this still meant that they had a medical problem of some kind that needed dealing with.

 

(vii)      Whilst some Trusts were able to achieve their performance targets earlier than the national trajectory it was not expected that this would be the case in Leicestershire due to the challenges faced.

 

(viii)    There was a new cancer leadership team both within the system and within UHL. The Trust was working with the national improvement support team to improve the processes and practices around cancer.

 

(ix)       It was important to get the governance of the cancer system right and some of the recent improvements had been as a result of improvements in governance.

 

(x)         There were concerns that during the Covid-19 pandemic patients had not been seeking medical advice when ordinarily they would have and this meant cancers were not detected early and as a result patients that were now being seen were more likely to have stage 4 cancers than stage 1 or 2 therefore requiring more invasive treatment. More data and modelling was required to fully understand the scale of this issue.

 

(xi)       Members raised concerns that historically cancer referral rates rose approximately 25% every three years and noted that this was partly due to an ageing population. It was questioned how this increase in demand was going to be met. In response it was explained that cancer patients needed to be dealt with in different ways from the traditional acute hospital model and there needed to be more use of diagnosis in the community. For example, GP Practices were now able to carry out tests that they could not in the past and make direct referrals. Bowel cancer screening known as Faecal Immunochemical Tests (FIT) was taking place amongst the over 60s. The Integrated Care Board had received national government funding of approximately £14.5 million to build a new Community Diagnostic Centre on the Hinckley and District Hospital (Mount Road) site. Cancer patients would also receive treatment closer to home and small operations could be carried out at community hospitals. Minor procedures would be able to be carried out at Hinckley Community Diagnostic Centre. Independent providers were also being used for cancer treatment.

 

(xii)      In response to members’ concerns about the mental health of patients waiting for a cancer diagnosis or treatment it was explained that a psychosocial support service for people with cancer was being set up and members welcomed this. There had also been funding secured to invest in Improving Access to Psychological Therapies (IAPTs).

 

(xiii)    In response to a question as to whether the breast screening service would be returning to Coalville it was explained that the service was returning to normal after the Covid-19 pandemic and agreed that further information in relation to Coalville would be provided to members after the meeting.

 

(xiv)    In response to a question from a member about vaccination uptake particularly in the North West Leicestershire area it was agreed that data on this would be provided to members after the meeting.

 

(xv)     In response to a question from a member about the infection control measures which were put in place in outpatient services during the Covid-19 pandemic and the consequent reduction in capacity it was confirmed that there were no longer any constraints due to infection control.

 

(xvi)    The following updates to the Better Care Fund data provided in the report were provided:

 

·              With regards to the effectiveness of reablement the proportion of older people still at home 91 days after discharge from hospital into reablement or rehabilitation was now 88%.

·              The percentage of people who were discharged from acute hospital to their normal place of residence was now 92.2% against a target of 92.7% which meant that performance was 0.5% below the target.

·              The number of unplanned admissions for chronic, ambulatory, care-sensitive conditions was 180.9 per 100,000 admissions against a target of 162 so performance was 18.9% above the target.

·              The number of older adults whose long-term care needs were being met by admission to residential or nursing care per 100,000 population was now 519.5. It was noted that the Better Care Fund metrics classed older people as aged 65 and over and questioned whether this should be increased to 66 and over given that the pension age was now 66. In response it was explained that the wording of the metric was set by government and were it to be changed it would make comparison with previous years difficult, but it was acknowledged that this was something which needed to be considered in the future.

 

(xvii)  With regards to the Public Health and Prevention indicators, indicator B16 - Utilisation of outdoor space for exercise health reasons the available data was from March 2015 to February 2016. A member questioned the relevance of this data given the amount of time that had elapsed since it was collected and it was agreed that were more up to date data to be published it would be provided to members.

 

RESOLVED:

 

(a)        That the update on public health and health system performance in Leicestershire be noted;

 

(b)        That the performance for the cancer wait metrics be noted with concern but the work taking place to reduce the backlog be welcomed;

 

(c)         That officers be requested to provide a report for the next meeting of the Committee regarding workforce challenges across the health and care system, and recruitment and retention issues.