Agenda item

To consider an update from TRFT regarding the delivery of urgent and emergency care.

Consideration was given to a presentation by the Deputy CEO and  in respect of provision of Urgent and Emergency Care. The presentation included descriptions of NHS England Field Test Standards for the pilot site, an update on recent operational pressures, a comparison of ambulance handovers with geographically neighbouring hospital, discharges and length of stay, a COVID-19 and flu update, and waiting times in the urgent and emergency care centre (UECC). The presentation covered recent actions taken, effects of industrial action, and workforce challenges and proactive actions to support the workforce. The conclusion noted a very difficult winter so far with higher demand than previous years, as well as infection, prevention and control challenges to manage and increased staff sickness. A number of actions had been taken to improve patient care and waiting times, focussed on managing the greatest clinical risk. Focus had also been given to tangible changes which will improve the health and wellbeing of staff.

In discussion of discharge and length of stay, Members sought clarification of “zero length of stay” activity. The response from the Deputy CEO noted that this meant treating people the same day, or getting the patient back home the same day if safe to do so.

Members expressed concerns regarding the impact on patients who were waiting a long time, if their treatments were delayed and requested further details around how the queue was prioritised. The response from the Director of Operations noted that whereas some neighbouring Trusts have a larger department which funnelled into areas to cohort. At Rotherham, the Trust managed the patients who were outside. The clinicians went outside to make sure the sickest patients were seen first. To do that, the clinicians found out how ill the patients were. It was acknowledged that long waits in ambulance can adversely impact on length of stay in hospital. Measures were in place to increase observation on patients to look after comfort and basic needs in the waiting room. More instances of aggression or violence had been observed associated with long waits.

In regard to workforce challenges, Members expressed a desire to know whether the bank staff had been updated. The Trust employed NHS professionals like most organisations across South Yorkshire and other parts of the country. There were some unfilled hours, but Incentives were in place linked to the pool ward, which were getting traction. Agency use and spending was noted, 50% of which was in medics. The Deputy CEO provided details of recent recruitment, retention, workforce numbers and vacancies. It was noted that the bank was responsive and tried to provide the cover if needed, although sometimes this could not be provided.

Members sought more information regarding the people who attend UECC who are redirected, specifically, what were the reasons for mistakenly attending UECC. The response described that a process was in place whereby the ICB (Rotherham Place) were looking into this, and which GPs the patients are presenting from, so that trends can be analysed. Most patients are acutely unwell. RSV had been high in children. Media stories regarding Strep A had resulted in more children presenting.

Members expressed interest in information around waiting times where children are the patients. The response noted that this data was collected as the Trust was sensitive to the waits of young children. The requested information would be provided.

Regarding children’s safety, Members noted the possibility of loss of confidence in the hospital and requested if any immediate changes had been made as a result. The response from the Deputy CEO provided a timeline for actions being taken in response. An independent investigation had been commissioned by NHS England which would be undertaken by a private sector organisation and would take three months to undertake, with expected conclusion around April. Within the paediatric service, there was cover in line with rotas. Steps had also been taken to ensure communications are recorded with families. Three new consultants had been recruited in urgent and emergency care. It was acknowledged that patient experience was impacted by high volumes of patients; however, in the last two weeks, improvement had been observed.

Members sought a further elaboration of what the Trust would do to improve the situation if there were no constraints. The response from the Deputy CEO noted that the main constraint consisted of challenges around flow, which included getting the patient into the right environment for discharge. Community partners were working with people to find alternatives to attending A&E.

Members requested further information regarding action taken by the Trust to increase participation in the staff survey and suggested that the next update include the newest data from the staff survey. The response from the Deputy CEO noted that 61% was one of the highest response rates in the country. The sector average was 48% and the highest is 68%. The paper-based survey had been given to people individually, along with a voucher for a coffee so that respondents could have a coffee at the same time as they completed the 97-question survey. The results would give insights into where the Trust had performed better than the sector average or worse than the sector average, and recommendations would follow from these insights.

Members requested more information around the developments coming online with regard to discharge to assess. The response explained that discharge to assess focussed on what people need in their own home. This involved patients having all of their assessments at home which included therapy assessments and anyone needing a care act assessment. National models were considered to care manage to support people in their own home, rather than prescribing high levels of care packages. Members requested to hear more about these developments in the next update.

Resolved:-

1.    That the update be noted.

2.    That an update on the Acute Care Transformation Programme be added to the work programme for 2023/24.