Dr Nil Sanganee, Chief
Medical Officer, Leicester, Leicestershire and Rutland Integrated Care Board
will give a verbal update.
Minutes:
The Committee received a verbal update from Dr Nil Sanganee, Chief Medical Officer, Integrated Care Board regarding a Critical Incident declared at University Hospitals of Leicester NHS Trust (UHL) on 9 October 2024. The Committee also welcomed to the meeting for this agenda item Jon Melbourne, Chief Operating Officer, UHL and Tracy Ward Assistant Director – Integration, Access and Prevention, Leicestershire County Council.
Arising from discussions the following points were noted:
(i) The Critical Incident was stood down 30 hours later on the morning of 10 October 2024. UHL had not declared a Critical Incident since and on average UHL declared a Critical Incident approximately once a year.
(ii) The Critical Incident had to be declared due to significant pressures facing UHL. The pressures were mainly caused by an increase in respiratory illnesses amongst children and more significantly adults, and a general increase in the complexity of problems that patients were suffering from. UHL was not alone in facing these pressures; similar pressures were being seen at hospitals across the midlands.
(iii) A member questioned the definition of a critical incident and whether the factors UHL faced in October 2024 were sufficient for a Critical Incident to be declared. Members raised concerns that a Critical Incident had to be declared so early in the 2024/25 winter. In response it was explained that the respiratory illnesses had presented earlier in the winter than they usually did. It was also explained that the pressures across the year had generally been higher which meant that it took less of an increase over winter to push the system into critical territory.
(iv) Every year an Emergency and Urgent Care Plan was put in place for Leicester, Leicestershire and Rutland (LLR) and additionally specific plans had been put in place to manage the winter 2024/25 pressures across the health and care system. Additional interventions were being put in place including additional funding for GP appointments, Urgent Treatment Centre appointments, additional beds, and measures to avoid the ambulance service having to convey patients to the Emergency Department. In response to a query from members as to whether the plans had been inadequate, UHL stated that in their opinion the plans were not deficient, but the demand faced by UHL had exceeded that which had been planned for.
(v) A member raised concerns about severe ambulance delays in LLR which on one occasion had seen a patient wait 16 hours. Members emphasised that there was no criticism of the ambulance staff themselves but the measures in place to manage the demand were questioned. In response UHL and the ICB acknowledged that the ambulance service was under extreme pressure and some of the patient experiences referred to were unacceptable. However, work was taking place to address these problems and to ensure a rapid handover at the Emergency Department and improve flow through the hospital. Category 3-5 ambulance calls were now getting a community response rather than conveying the patient to the Emergency Department. Community nursing teams were dealing with some patients that called 999 and Derbyshire Health United also provided out of hours urgent care in LLR. Patients were being directly booked into Urgent Treatment Centres to ease the pressures on the Emergency Department. Patients whose condition was not serious enough to require an ambulance could be given telephone advice by a paramedic under the ‘hear and treat’ service.
(vi) Over the years messages had been disseminated to the public advising them not to attend the Emergency Department unless it was essential. Members queried whether this messaging had less impact on the public now and whether the declaring of a critical incident helped deter people from attending the Emergency Department. In response it was submitted that the messaging did still have an impact on the public and as critical incidents were declared at UHL infrequently, when they were declared they sent a strong message about the severity of the situation. It was also emphasised that it was important not to deter those people from attending the Emergency Department that really needed the care provided there.
(vii) The health and care system had a deficit forecast outturn of £80.0m in line with the final agreed plan for the year and an £18.8m adverse variance to that plan.
(viii) There were strong links between planned care waiting lists and Urgent and Emergency Care and it was important to reduce waiting times of both to ease the pressures on each other. Some of the patients on planned care waiting lists would end up requiring urgent care if they did not receive timely treatment. Given the rate at which demand was increasing a change of strategy was needed to enable the system to cope. UHL agreed to provide a report for a future meeting of the Committee regarding the long-term plans to manage demand.
RESOLVED:
That the update regarding the Critical Incident be noted with concern.