Agenda item

Briefing Notes of the Scrutiny Co-ordinator and the Executive Director of People

Presentations from Coventry and Rugby Clinical Commissioning Group (CCG) and University Hospitals Coventry and Warwickshire (UHCW) 

The following representatives have been invited to attend for the consideration of this item:

Councillor Maggie O’Rourke, Chair, Adult Social Care and Health Overview and Scrutiny Committee, Warwickshire County Council

Sue Davies, Head of Partnerships, Coventry and Rugby CCG 

David Eltringham, Chief Operating Officer, UHCW

Rebecca Southall, Director of Corporate Affairs, UHCW

The Scrutiny Board considered briefing notes of the Scrutiny Co-ordinator and the Executive Director of People on the social care responses to winter pressures during 2014/15. The Board also received a presentation from David Eltringham, University Hospitals Coventry and Warwickshire (UHCW). The Board had also been provided with background information from the Local Medical Committee concerning winter pressures on General Practice. Councillor Maggie O’Rourke, Chair of the Adult Social Care and Health Overview and Scrutiny Committee, Warwickshire County Council, Sue Davies, Coventry and Rugby CCG and Josie Spencer, Coventry and Warwickshire Partnership Trust (CWPT), attended the meeting for the consideration of this issue. Councillor Gingell, Cabinet Member for Health and Adult Services also attended.

The presentation detailed the winter challenge for the hospital providing performance data on the four hour target for A and E; weekly and monthly A and E attendances; and details on monthly hospital discharges including performance information on delayed transfer of care patients. An analysis of the data revealed:

·  An increase in attendances to A and E to March 2014 and sustained at this level

·  An associated rise in admissions

·  An increase in ambulance conveyances and a recent increase of over 65s to A and E and admissions implying an increase in frailty dependency, complexity and acuity

·  A steady decline in discharges over time

·  A significant rise in delayed transfer of care

·  A significant rise in patients outlying their base ward.

The Board were informed that there had been no twelve hour trolley waits and no major incidents declared. Further information was provided on the actions being taken to reduce the attendance to admission rate and to increase the number of patients being discharged so reducing the delayed transfer of care cases.

The briefing note of the Executive Director of People set out the plans to address the local challenges which had been jointly developed across the partner agencies. Not all of the schemes would have an immediate impact. The Board noted that the City Council had been awarded a grant allocation of £325,000 to implement actions to reduce delayed transfers of care.

The Board questioned the officer and representatives on a number of issues and responses were provided. Matters raised included:

·  Clarification and further information about the performance statistics provided in the presentation

·  The importance of partnership working between local authorities and the health organisations supporting both Coventry and Warwickshire

·  The room in the system to be able to cope with a growing and aging population

·  The importance of being proactive rather than reactive

·  The patient capacity at the hospital and the potential for expansion

·  Were the partner organisations managing as well as possible to get patients out of hospital and back into the community and were there any boundary issues which caused problems

·  The importance of liaising with families prior to the discharge of patients with complex care packages

·  The impact of 111 referrals and the inability to get GP appointments on the number of patients attending A and E

·  Measures to address preventable health issues

·  Details behind the newspaper headlines concerning bed blocking at the hospital

·  Concerns about the ability to be able to cope with increasing numbers of elderly patients in future years in light of the large number of delayed transfers of care

·  Concerns that the delayed discharges were a result of the Government reductions in local authority finance

·  A concern about inappropriate referrals from the Walk-in Centre to A and E

·  Further details about the care packages available in light of reduced resources and proposals to work with the voluntary sector including the issue of sustainability

·  The need for partnership working and new models of community support     

RESOLVED that:

(1) The presentation be noted.

(2) Officers be requested to give further consideration of funding transfer to social care settings and primary care to discourage hospital admissions and to encourage patient discharge from hospital.

(3) Further detailed information to be sent to all Board members on the following:

(i) The total annual patient capacity at University Hospital Coventry

(ii) The number of patients currently in hospital who are fit for discharge including the local authority area they live in.

(iii) The number of monthly calls to NHS111 including the number of referrals to A and E and the ambulance service.