Agenda item

Joint presentation

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

Simon Gilby, Coventry and Warwickshire Partnership Trust (CWPT)

Steve Jarman-Davies, Coventry and Rugby Clinical Commissioning Group (CCG)

Emma Livesley, University Hospitals Coventry and Warwickshire (UHCW)

The Board received a joint presentation on the initial assessment of the urgent care performance over the winter period at University Hospitals Coventry and Warwickshire (UHCW) with particular reference to the delivery of the A and E 95% standard for the four hour wait target. Steven Jarman-Davies, Coventry and Rugby Clinical Commissioning Group (CCG), Emma Livesley, UHCW, Simon Gilby and Tracey Wrench Warwickshire Partnership Trust (CWPT), and Simon Brake, Coventry and Rugby GP Alliance attended the meeting for the consideration of this item. 

The presentation drew attention to the wide scale reporting in the national media around the winter pressures facing the NHS this year and the ability of Health and Social Care systems to be able to cope with these pressures. Information was provided on the national and local A and E four hour performance over Christmas and New Year with UHCW delivering at around 82%. A comparison was provided with the A and E performance of Trusts within the West Midlands region.

The Board were informed about the pressures on A and E Departments nationally, with patient numbers being the highest levels ever recorded and the numbers of ambulances arriving at hospital and calls made to the ambulance service being the highest ever. Locally over the Christmas and New Year calls to the ambulance service were consistently 8-10% above contracted levels and the previous year. Further information was provided on the national trend for A and E attendances and the percentage of attendances which led to admission to hospital. The Board were informed that it was going to take a real change in behaviour by patients if A and E attendances were going to stop continuing to rise both locally and nationally. This year UHCW had seen a 3% growth in attendances.

The presentation referred to the national system of reporting levels which ranged from Opel 1 to Opel 4. Levels 3 and 4 required specific daily briefings on actions being taken, that were discussed on regional and national teleconferences as to the level of support and intervention to be given to systems. The Board were informed that although New Year A and E performance by Trusts in Coventry and Warwickshire was well below the 95% national standard, they were towards the top end of performance across the West Midlands. Opel level 3 was reached by the local system on 3^rd January but returned to level 2 within 2 days. 

Further information was provided on additional local pressures on A and E Departments which included the norovirus. All hospitals within Coventry and Warwickshire utilised planned escalation capacity to deal with demand which saw up to 62 extra beds being used at UHCW. This impacted on the Trust’s ability to undertake elective work. As a system the hospital met the national requirement to clear beds as much as possible before Christmas to get to below 85% bed occupancy for 24^th December. Bed occupancy then increased day by day across the system.

The presentation provided additional information on key issues at UHCW which were taken from daily national reporting system by Trusts in comparison to national trends.  

Further information was provided on NHS 111 during the Christmas period. There had been a 35% increase in ambulance dispatches in the West Midlands through NHS 111 over the holiday week. This was equivalent to 12 ambulances per day at UHCW.       

The Board questioned the representatives present on a number of issues and responses were provided, matters raised included:

·  Clarification about the increase in ambulances at UHCW over Christmas and New Year period

·  Clarification about the capacity being put in place to deal with escalation and the implications for other areas of the hospital of having additional beds

·  Whether operations were cancelled at the very last minute because of a lack of intensive care beds/ beds

·  The difficulties of finding a balance between the necessary levels of emergency and elective surgery

·  Clarification about what comprised the four hour target at A and E, ie when the time commenced

·  Further information about the guidance given by NHS 111 when advising patients to call an ambulance or attend A and E and how risk adverse was NHS 111

·  Concerns about a recent patient experience at A and E and clarification about an A4 information sheet that was being placed at the end of patients beds/ trolleys

·  Concerns about the capacity in the service to cope with the increasing numbers of  elderly patients and how many attendances at A and E were alcohol related

·  How was it determined to discharge patients before Christmas and details about the information sent to Trusts from NHS England recommending hospitals reduce their bed occupancy to 85% by Christmas

·  Clarification about closed waiting lists and how this related to the 18 week waiting time target

·  What were the NHS reasons for recent delayed transfers of care

·  Concerns about the inclusion in the STP of reduced attendances at A and E, was this a realistic expectation in light of the current situation.

RESOLVED that:

(1) The presentation be noted

(2) The representatives from UHCW and Coventry and Rugby CCG be requested to provide additional information for members on:

i) The numbers of operations cancelled because beds were not available, including details about emergency and elective surgeries

ii) Information about the numbers at A and E who had been advised to attend by NHS 111 including details about inappropriate referrals

iii) Further details about the introduction of the A4 sheet of information which was being placed at the end of patient’s beds/trolleys

iv) Information regarding the number of services which have closed waiting lists and how this relates to the 18 week waiting time target.

(3) A copy of the letter from NHS England requesting hospitals reduce their bed occupancy by 85% by Christmas be circulated to members.