Agenda item

Chris Edwards, Rotherham Clinical Commissioning Group, to report

Chris Edwards, Rotherham Clinical Commissioning Group, presented a summary of performance across Urgent Health Care Services in Rotherham identifying poor performance and setting out remedial actions as follows:-

 

Accident and Emergency

-          There had been a consistent increase in attendances each month in 2014/15 compared to 2012/13 and 2013/14 – 5.2% increase

-          From August to November, 2014, A&E had failed to achieve the 95% target for patients who had been waiting for treatment

-          It was clear that a contributing factor was the increase in demand at A&E as well as increased acuity of patients and difficulties in the recruiting of doctors

-          Performance was currently around 94%

-          Second best performing Trust out of the 4 in South Yorkshire

-          National pressure on A&E

 

Walk-In Centre

-          The maximum activity target for the Service was 1,000 per week – attendances had fallen just below this form July, 2014

-          The fall in referrals was the result of a range of demand management initiatives that had been introduced by Care UK with the support of Rotherham Clinical Commissioning Group

-          Rotherham Clinical Commissioning group had also recently realigned the contract removing incentives for Care UK to generate additional activity

 

NHS111

-          The number of calls had increased by 37% probably due to the transfer of GP Out-of-Hours calls to NHS 11 that took place in 2014

-          The proportion of calls transferred to a clinical adviser dropped by 1.7%

-          Proportion of call backs within 10 minutes had reduced by 7.6%

-          Proportion of calls being diverted to A&E or 999 had reduced by 1.4% compared to 2013/14

-          A larger proportion of calls were being diverted to the GP Out-of-Hours Service

 

Yorkshire Ambulance Service

-          Continued struggle with performance on Red call-outs

-          Good Governance Institute recently conducted a review of performance detailing a number of recommendations for both Commissioners and the Service:-

·           Commissioners should design a 3 year service model for urgent and emergency care

·           Commissioners needed to clarify the lines of accountability for the Service and indicate whether and in what circumstances a locality approach should be taken outside of the overall Yorkshire and Humber approach

·           The Service needed to consolidate senior leadership team and appoint a Director of Operations to strengthen leadership

·           The Service was to understand a thorough review of middle management arrangements

·           A large scale cost and efficiency approach should be considered to support future service models

·           Develop a sustainable workforce strategy that addressed the sickness rate and overtime costs

-          A Recovery Plan recently implemented aimed at reversing the trajectory on Red calls

-          Despite this the Ambulance Service unlikely to achieve the 75% required performance for 2014/15

-          Compares relatively favourably with other ambulance services

-          Nation-wide issue

-          Rotherham Clinical Commissioning Group had requested assistance from NHS England

 

Care Co-ordination Centre

-          The number of patients managed by the Service continues to rise

 

Summary of Remedial Actions agreed by the System Resilience Group to improve performance on A&E waiting times and Yorkshire Ambulance Service 999 response times

 

A&E Waiting Times

-          Targeted work with GP practices who have high rates of A&E attendance

-          Extend opening hours for GP practices during the Winter period

-          Ensure that clinical reviews of patients at A&E are carried out by senior doctors before decision to admit

-          Explore strategies for joint working with the Walk-in Centre and GP Out-of-Hours Service

-          Implement supported discharge care pathways to improve patient flow

-          Introduce regular MDT meetings for medical wards and long stay patients

 

Yorkshire Ambulance Service 999 Response Times

-          Introduction of an urgent Care Practitioner Service in Rotherham during the Winter period

-          Increased clinician support for NHS 111 to reduce the number of calls transferred to the 999 Service

-          Effective case management of high intensity users of the 999 Service

-          Development of the Yorkshire Ambulance Service Pathfinder Programme which is successfully diverting patients from A&E

 

Discussion ensued with the following issues raised/clarified:-

 

·           The current category 8 target (very serious cases – seen within 8 minutes) was 75% - Rotherham’s performance was in the very low 60s.  There was analysis which showed that every minute after the 8 minutes the majority were seen within 15 minutes.  There was assurance that patient harm had not been increased as a result of the performance targets

 

·           In the last 3 months there had been more elderly people and people with Dementia going to A&E

 

·           The Trust had put a huge amount of effort in during the last 4 weeks to manage the through flow at the hospital.  There was a consistent story that they were elderly dependent multi-condition patients that the hospital struggled to discharge which then had a knock on effect onto A&E.  This was a reflection of how successful services had been in keeping people alive longer during the periods of ill health who then returned to hospital 2/3 times and was a demographic pressure that was not being kept up with

 

·           The Trust needed to plan for next year’s additional burden rather than just meeting the current year’s demand.  There was more joined up care to be done particularly with Social Services and Intermediate Care, not actually focussing on the patient but more on the needs of the system to get patients out of hospital as well as co-ordination and personalisation

 

·           Creative solutions needed to be considered and discussions held with voluntary sector organisations as there were some really effective discharge schemes.  It was about looking at wider partner involvement and working with the Trust to support people when they got home and putting that initial support in which was not medical related but something that if it was not done it would affect their medical condition

 

·           There was no planning from the moment a patient comes into hospital when there should be a clear idea of where the patient would be going once their condition had been treated

 

·            Concern regarding the Ambulance Service’s performance and the demands on the Police Service in transporting people to hospital on a regular basis

 

·           Issues regarding people being discharged from hospital, early help and prevention, stopping people from getting into hospital experienced in Rotherham may be worth contributing to the national debate.  The Local Government Association had been very critical about cuts in Adult Social Care and was now starting to see the impact of such

 

·           The Government had announced funding for Social Care and Discharge from Hospitals for 68 authorities but Rotherham had not been contacted so it was felt unlikely it would be receiving any of the money.  Those local authorities that had significant issues regarding delayed discharges had been selected which was an area Rotherham was performing relatively well in

 

·           Wakefield was the lead commissioner for the 23 Clinical Commissioning Groups.  The Care Quality Commission had had a review of the Ambulance Service and Rotherham had commissioned the Good Governance Institute which had given a partial reassurance that the Service would fulfil the action plan  It was believed that the plan was fit for purpose but no assurance that Rotherham would meet the 75% target as would nowhere else in the country.  It was not known whether nationally the target figures would be redefined as they were not fit for purpose or change the tariff.  There were also issues with the Trade Unions to resolve.  The significant industrial action over the last 6 months had harmed performance

 

·           The Board could assist in communicating to the public about accessing the Ambulance Service appropriately

 

Resolved:-  That the report be noted.