Minutes:
The Committee received a presentation from the Chief Executive of County Durham and Darlington NHS Foundation Trust and Chair of the Local A&E Delivery Board that gave an update on the winter plan and managing pressures (for copy see file of Minutes).
The presentation highlighted:-
· Winter Planning and Actions
· ECIST (Emergency Care Intensive Support Team) Recommendations
· LADB Leadership – developing system leadership and actions
· Assess to Admit – recommendations, plan and progress
· Today’s work today – recommendations, plan and progress
· Discharge to Assess – interface with Health and Social Care – discharge management – Darlington Update
· Discharge to Assess – interface with Health and Social Care – discharge management – Durham Update
· Performance Overview –
· Regional picture: Operational Pressures Escalation Framework (OPEL)
· A&E Performance (all types)
· CDDFT Summary Data
· Ambulance – Handover Delays Regional Picture
· CDDFT Summary
· Ambulance Handover Action Plans
· Recap – Service Change – 1 April 2017
· Use of MIU and Out of Hours GP Hubs – Action from previous meeting
· Patient Engagement
The next steps included further engagement talking to patients and people who use the service, a full engagement report would be produced and options considered by DDES executive. The CCG would engage with the current providers of the services and would come back to scrutiny with proposals in May 2018.
Councillor Bell asked how we could get people to present to the right place at the right time as the basic level of understanding seemed to be lacking. The Director of Commissioning, DDES CCG said that there was more that could be done in this area and it was about getting the message out as widely as possible. The Chief Executive of County Durham and Darlington NHS Foundation Trust added that every contact counted and a lot of patients were existing patients. She hoped that the teams around the patient would help to support people and educate them from the beginning. In order to combat people being booked in at a GP surgery by a receptionist without knowing what their problem was, the Director of Primary Care and Engagement, DDES CCG advised that they were embarking on a “care navigation” system whereby patients would be offered a choice. This would be a formal approach taken across County Durham.
Councillor Smith commented that there were good initiatives that had been proposed and asked if there were enough resources and staff in order to deliver them. She was concerned that vulnerable patients could not always speak up and she had recently experienced poor patient care herself so understood how pushed the staff were. She asked for re-assurance that posts were not being deliberately left unfilled in order to save funding. The Director of Commissioning explained that the board look at safe levels of nursing for each ward based on national criteria and assured the Committee that there had never been any significant concerns. She confirmed that they were not keeping posts unfilled and that were actively recruiting. They also ran a staff bank whereby nurses could work additional shifts, or for those nurses who wanted flexible working.
Councillor Patterson expressed concerns about the number of people who had responded to the DDES CCG Urgent Care Review engagement process as she felt that 133 responses was not a true representative sample, and she asked if there was an acceptable number to receive. The Director of Commissioning explained that the consultation was still open and that was the number received to date. There were still a number of meeting and events planned with a focus on those people who used the service. She would check with colleagues about what was an acceptable number of responses.
Referring to patients discharged from hospital, Mrs Hassoon asked that if someone was discharged without a full assessment would they be at risk. She was informed that a risk assessment was carried out for very patient and that services would be wrapped around them to provide support at home if required. She was also informed that as a patient would be assessed on admission a discharge date would be discussed at the time and medical needs would be put in place to continue support at home should the patient not need to be in a hospital bed. A patient would not be discharged to home until modifications were put in place.
Councillor Temple said that as this was a long presentation that included a lot of detail he would have preferred to have received it in advance of the meeting in order to prepare any questions. Referring to the local trust being below the regional average he asked what the target was in terms of the trusts place within the regional pattern. The Chief Executive of County Durham and Darlington NHS Foundation Trust replied that the target was against 4 hours. She added that quarters 1 and 2 had exceeded the target with quarter 3 just under the target of 95%. Quarter 4 was a target associated to the performance in March and she added that each trust would have a different target.
Further to a question from Councillor Temple, the Chief Executive explained that a plan was produced and signed off locally that would deliver improvements and achievable targets. The locally agreed target was set by the commissioners.
Councillor Grant agreed with Councillor Temple that there was a lot of information to take in and would prefer to receive this before the meeting. She asked why the trust were behind target and if this was partly to do with the size of the County and the rurality. The Chief Executive explained that the biggest reason for Dirham was that the A&E department was built for 30,000 people and were now seeing 65,000 patients a year. Plans were underway to build a new Accident and Emergency department at UHND.
Councillor Crute asked if when comparing statistics regionally and nationally would this take into account geographical areas and was advised that this was the case. In DDES and North Durham CCG levels of deprivation and women at childbearing age could be compared as there was a lot of national information available.
A member of the public commented that the primary case for admission contributing to winter pressures was influenza, and asked if this was an excuse. The Chief Executive explained that people may not have presented to hospital with the flu but they were being tested if they had shown any signs of it. If diagnosed this was adding to a patients length of stay and this had had an impact on the service.
Resolved:
That the presentation be noted.