Minutes:
The Sub-Committee received a presentation from Dr Angela Bhan, Chief Officer, Bromley Clinical Commissioning Group, Paul Donohoe, Deputy Medical Director, Princess Royal University Hospital (PRUH) and Sally Lingard, Director of Communications, King's College Hospital NHS Foundation Trust providing an update on the PRUH Improvement Plan and the Emergency Care Pathway.
The need for key agencies to work together to transform the way that urgent and emergency care services were provided towards a more community-based system had been identified. This would be delivered through the Emergency Care Pathway Programme which took a whole system approach to help patients get the right care in the right way. To support this, there had been a significant investment in the Bromley urgent care system over the last twelve months, and although the Accident and Emergency four hour 95% target had not been consistently met, there had been a steady improvement in performance throughout 2015/16.
Improvements made across hospital provision during 2015/16 included the recruitment of additional senior staff in Accident and Emergency, more paediatric beds and a pilot in-reach service to identify patients suitable for community care and support them to return home. Better inpatient management and an enhanced therapy service had been put in place, and there had been investment to support seven day working. A range of winter initiatives had been introduced including mental health liaison, work with the urgent care centres and enhanced radiography support.
Non-hospital services improvement during 2015/16 included the development of out-of-hospital care systems and services, and the Transfer of Care Bureau which had been established to facilitate timely discharges and had already reduced the average length of stay by two days. The Primary Care Innovation Fund had been used to invest in local practice initiatives that improved quality of care and reduced Accident and Emergency and Urgent Care Centre attendances and admissions, and an In-reach Team had been established at the PRUH to therapeutically assess people and direct them to alternate community care options where appropriate. To build additional capacity over the winter period, additional GP capacity had been made available through two primary care access hubs. Case management support had also been offered to practices in managing vulnerable patients and additional community support had been made available through the Medical Response Team. Winter health promotion campaigns included ‘Stay Well this Winter’, and ‘Use your Pharmacist’, and the Health Help Now mobile and digital app.
With regard to next steps, an evaluation of the Transfer of Care Bureau was underway and would be completed by April 2016, and Bromley Clinical Commissioning Group would also be hosting a stakeholder event to assess all winter work streams and programmes in April 2016. Bromley Clinical Commissioning Group was finalising a programme plan to support the implementation of three Integrated Care Networks for Bromley which would align health and care services across the Borough around groups of GP practices and support high risk patients who require integrated case management. The Sustainability and Transformation Plan for South East London was being developed and would be completed by July 2016, and would include an outline summary of the plan for Bromley which would be provided to Members when available.
In considering the presentation, the Chairman noted the age profile of nurses working in Bromley which could cause future staffing difficulties, and underlined the importance of ensuring there was a clear route for former nurses to move back into nursing. Sally Lingard reported that work was being undertaken on future staffing provision and further information would be provided to Members when available.
A Member was concerned at the increase in attendances at Accident and Emergency during 2015/16, which potentially reflected a change in the way some Bromley residents chose to access primary care services. There was a need to publicise the range of community health services that were available across Bromley to support people to access appropriate provision.
In response to a question from a Member around long staying patients who required support to move into care settings, Dr Angela Bhan confirmed that work continued to reduce the length of hospital stay for all patients, and that the Transfer of Care Bureau was working with neighbouring boroughs to support out-of-Borough patients to move into suitable care settings. The LBB Assistant Director: Adult Social Care advised Members that Local Authority case managers arranged the necessary reablement services and equipment to support patients to return home, and also acted as advocates to support more vulnerable patients into an appropriate care setting where needed.
Work was still being undertaken to contain the Norovirus outbreak at the PRUH which had blocked 190 beds with a number of patients and staff affected. All infection control measures had been taken and staff had worked hard to limit the spread of the infection.
The Chairman led Members in thanking Dr Angela Bhan, Paul Donohoe, and Sally Lingard for their excellent presentation.
RESOLVED that the update be noted.