Agenda item
Health Services: Winter Provisions
The Health Partnerships Overview and Scrutiny committee may remember that last winter (2012/13) North West London Hospitals Trust’s Accident and Emergency Departments struggled to cope with the additional pressures traditionally felt during the winter months. Brent CCG and NWLHT have therefore both been asked to provide the committee with details of their plans to cope with the forthcoming winter pressures.
Minutes:
The committee considered reports from the Brent Clinical Commissioning Group (CCG) and the North West London Hospitals Trust (NWLHT) on their plans to cope with the anticipated pressure on services over the winter period. The reports were presented by Jo Ohlson (Chief Operating Officer, Brent CCG) and Tina Benson (Director of Operations, NWLHT) respectively.
In summarising her report, Jo Ohlson clarified that Brent CCG was responsible for ensuring that there were sufficient services to meet demand over the winter but did not commission General Practitioner (GP) services; this latter task lay with the National Health Service England (NHSE). A briefing had been provided by NHSE on the relevant activity undertaken by the organisation and this would be circulated to the committee.
Outlining the work of Brent CCG, Jo Ohlson explained that £6.4m funding had been secured via winter bid plans to support a range of schemes across the local Brent-Harrow health economy, with a further £6.6m provided by Brent CCG. Schemes included the Short Term Assessment, Reablement and Rehabilitation Services (STARRS), an Integrated Care Pilot aimed at those most at risk of hospital admission, and increasing access to GPs via extended opening hours, including Saturday appointments. With reference to this latter project, it was noted that there was a need to promote these expanded opening times and work was being undertaken to explore possibilities of direct appointment bookings via the 111 service. Members’ attention was drawn to the table setting out the creation of additional bed capacity across several sites and an update was provided. In addition to those reported, a further 6 mental health beds would be provided on the Northwick Park Hospital (NPH) site. Members were advised that NWLHT was using capacity at both NPH and Central Middlesex Hospital (CMH) to ensure all available beds were used for suitable patients. It was anticipated that from December onwards there would be sufficient beds in the system. However, risks of a surge in demand on services remained.
Jo Ohlson set out the planned work to reduce Delayed Transfers of Care (DTOCs) from hospital to community settings. Principal causes of DTOC included patients awaiting either health or social care assessments or appropriate residential or nursing home placements, and a lack of appropriate / accurate information on potential discharges. A series of actions had been agreed to address these issues including increasing capacity within the NWLHT discharge team and creating a further 6 reablement beds. An escalation process had also been established to ensure appropriate overview of the process.
Tina Benson outlined the actions being taken by the NWLHT to address anticipated difficulties, such as excessive patient waiting times in Accident and Emergency (A&E) departments, during the winter period. These actions sought to increase bed capacity, improve flow through the emergency pathways and embed seven-day working. The report also set out performance against the four-hour emergency target, which required that those attending A&E must be seen, treated, admitted or discharged in under four hours. It was emphasised that the pressures on Northwick Park Hospital (NPH) were largely related to admissions rather than attendances, which in fact were fairly stable, lending greater importance to the Brent CCG work focussing on admission avoidance. Tina Benson explained that a capacity gap of up to 89 beds had been identified but there was insufficient space to accommodate the required number of beds at NPH. 40 additional beds had been installed at NPH and Brent CCG had funded in excess of 50 beds within the community. There was also potential for further external capacity of 22 beds. It was emphasised that patients were being informed that their care could be provided across a network of sites. Members were advised that the additional beds were not reflected in the table setting out performance trajectory in relation to the four-hour emergency target. This trajectory gave a year end performance of 94.4 per cent against the national target of 95 per cent. Performance against this target would continue to be reviewed, with a focus on understanding the impact of the additional beds provided. Breaches of the target also related to access to specialist teams, termed ‘speciality breaches’. Staffing had been expanded across these teams to address this problem. Tina Benson concluded her presentation by noting that a self-management target had been set to keep breaches of the four hour target to under 5 per day.
During members’ subsequent discussion several queries and issues were raised by the committee. A member noted the impressive achievements of STARRS and further information was sought about its operation. The Committee queried the contribution of GPs to meeting the pressure on services over the winter period and asked how this was monitored. Details were requested of the number of home visits undertaken and whether, per practice, there was a correlation between levels of home visits and A&E attendances. Members queried the number of calls received by 111 via the out of hours GP services by provider, how these were dealt with and the resulting number of home visits undertaken.
The Committee also sought clarification regarding the action implemented by NWLHT to provide additional consultant emergency surgeons for critical care outreach. An update was requested on whether seven-day working had been successfully implemented. Members asked the Health representatives to outline services provided to nursing homes. Confirmation was sought that there were no ‘mothballed’ or unused wards at NPH and queries were raised on the co-ordination of bed capacity between NPH and CMH. A member asked how many bed days had been lost due to patients awaiting assessment. The committee queried the plans in place to work co-operatively with neighbouring hospital trusts in the event of excessive service demand.
Responding to the queries raised, Jo Ohlson explained that the STARRS scheme in Northwick Park Hospital (NPH) was funded by Brent CCG and Harrow CCG. STARRS provided a range of services with teams comprising different health professionals including specialist nurses, consultants and occupational therapists. It aimed to support patients in hospital and after discharge by providing concentrated rehabilitation support and continuing their care at home or at ‘step down’ facilities such as those provided at Willesden Hospital. David Cheeseman advised that a presentation on STARRS could be provided at a future meeting of the committee.
Addressing members’ queries regarding GP services, Jo Ohlson explained that all GPs were required to offer home visits subject to clinical need but that this would not be monitored by NHSE. Similarly, data on use and outcomes of out-of-hours services could only be gathered by Brent CCG for the 14 out of 67 GP practices in Brent for which it retained this responsibility. The majority of GP practices had contracted their out of hours services with Harmoni and the remainder with London Central and West Unscheduled Care Collaborative (LCW UCC). To access these services, people could call either their GP’s telephone number or 111. Calls would be triaged and based on an assessment of clinical need could result in a home visit or the option to see a GP. Brent Residents accessing out of hours services provided by Harmoni would be able to attend either NPH or Hillingdon Hospital; those with LCW UCC would attend St Charles Hospital. It was emphasised that many patients would not be aware that there were three different services offered in Brent. At present, residents in nursing homes would simply be registered with a GP. There was some exploration of how this service might be commissioned with a provider to ensure greater visibility and more effective support and community care.
Tina Benson explained that the critical care outreach referred to in relation to the provision of additional consultant surgeons, encompassed specialist support to teams within the hospital site. Members were further advised that 7 day working had been successfully embedded and an increasing number of the London equality standards, many of which applied measures over 7 days, were being met as a result. This allowed greater opportunity for benchmarking performance.
Tina Benson confirmed that there were no mothballed wards at NPH and advised that patients attending NPH would be transferred to CMH where appropriate as all medical beds were treated the same across both sites. It was anticipated that there were sufficient beds to meet demand over winter but it was considered that further work was required to minimise length of stay. Improvements were expected in this area however, as a number of community strategies were implemented. Jo Ohlson advised that there had been 172 bed days lost over a period of 3 weeks as a result of patients awaiting assessment. Rob Larkman (Chief Officer, Brent, Ealing Harrow and Hillingdon CCGs) informed members that discussions were underway with colleagues across North West London to ensure that appropriate contingency plans were in place to ensure that neighbouring services supported each other in responding to surges in demand.
The Chair invited Tracey Jepson (London Ambulance Service) to comment on the winter pressures. Tracey Jepson advised that the action plan was due to ‘go live’ on Monday 5 January and would work alongside other relevant plans. It would be a live document and would be subject to regular review. A breakdown for the last three months of the number of ambulance conveyances to NPH and CMH for A&E, Urgent Care Centres and transfers was requested by the committee. Tracey Jepson advised that she did not have the information to hand but would provide the data for circulation to the committee.
Members thanked the representatives for their reports and advised that written summaries of the information presented to the meeting would be of assistance to the committee. The Committee also requested that any figures provided be broken down to show both the overall figure and a Brent only figure. Further to this, members’ emphasised the importance of respect for patients and asked that this be reflected in any reports.
RESOLVED:
That the reports presented to the committee from the Brent Clinical Commissioning Group (CCG) and the North West London Hospitals Trust (NWLHT) on their plans to cope with the anticipated pressure on services over the winter period be noted.
Supporting documents:
- winter-provision-report, item 4. PDF 53 KB
- winter-planning-update, item 4. PDF 241 KB
- winter-preparedenss-A&E-performance, item 4. PDF 222 KB
- A&E-performance, item 4. PDF 573 KB
- recovery-and-improvement-action-plan, item 4. PDF 422 KB