Agenda item

Report ACH20-036

The Board considered a report providing an analysis of performance across the Bromley Urgent and Emergency Care system as compared to last year. This took into account the COVID-19 pandemic, which had impacted on the system dramatically at the end of 2019/20 winter period.

The report also provided an overview of the schemes delivered throughout winter 2019/20 from the Better Care Fund (BCF) winter pressures monies. These schemes were identified by the Bromley A&E Delivery Board and were presented for the Board’s information. Funding for this year’s Winter Resilience Schemes was £646k for Bromley CCG and £1,027k for the London Borough of Bromley, and were delivered under budget.

The Urgent Care Lead – SEL CCG noted that due to the COVID-19 pandemic, there had not been a formal review of the Bromley winter plan this year, as resources had been focussed on mobilising the pandemic response in Bromley. However, the report provided insight into how the Bromley System Winter Plan’s successful partnership working across the system had enabled successful mobilisation of the pandemic response locally.

In relation to the PRUH A&E, All Type performance between October 2019 and March 2020 had decreased slightly when compared to the previous year from an average of 75% to 72%. Type 1 performance had been particularly low in December 2019 until mid-January 2020. The Trust had carried out deeper analysis, which had shown that during this period there had been a 9% increase in Type 1 attendances and a 6.7% increase in Type 3, which had contributed significantly to the performance challenges.

Although overall emergency admissions for all ages were relatively stagnant as compared to the previous year, there had been a significant increase in attendances of over 85’s (7.7%), and also an increase in over 85’s being admitted to hospital (6%). These patients had a significantly longer length of stay (circa 8.3 days, versus 7 days for 65-84 years and just 3 days for 0-65 years) impacting on bed management and a consequentially negative impact on 4 hour performance. However it was noted that there had been an improvement in Type 1 and All Type performance in February and March 2020. A Board Member suggested that even more emphasis would need to be put on reducing delays to ensure that performance did not slip.

The Trust had made improvements to the flow of the department, and a new Transfer of Care Bureau Lead and Nursing Head of Quality were working on patient discharge. They had initiated ‘point prevalence’ reviews of every patient on the wards who had a length of stay of over 21 days. This had been a good example of the partnership working undertaken, with these reviews being carried out by trust and community health and social care staff, and had led to a significant drop of 278 patients in the period of December to January as compared to 321 for the previous year. It was noted that the voluntary sector should be praised for the key support they offered to patients on discharge, including care navigation of complex cases, joint visits with equipment providers to ensure access to house / key safe and the usual handyman and take home and settle services.

Up until February 2020, when NHS England paused the recording of statistics to focus outputs on supporting COVID-19 capacity, Delayed Transfers of Care (DToCs) remained significantly below the 2019/20 national target, as Bromley remained one of the best performing boroughs in London. This had put the Trust in a good position when the COVID-19 pandemic began to significantly impact A&E, as the Trust, Bromley Healthcare, the CCG and Local Authority were quickly able to build on the work carried out during winter, to mobilise the Bromley Single Point of Access (SPA) for hospital discharge.

In response to a question, the Borough Based Director – SEL CCG said that the PRUH had one of the most improved A&E performances compared to pre-COVID. Performance against the 4 hour performance target had been consistently above the 95% target in April, May and June 2020. All Type performance in April and May 2020 had averaged at 92% compared to 77% the previous year. It was noted that as patients returned to the ED, they wanted to maintain this high level of performance.

The Urgent Care Lead – SEL CCG informed Board Members that part of the recovery planning included dedicated winter planning, which would commence shortly. The Chairman noted that flu immunisation would be even more important this year, and highlighted that the programme would be started earlier. The Borough Based Director – SEL CCG said that there was a desire not to return to having packed Emergency Departments (ED), in which it was extremely difficulty to socially distance, and as such London would be piloting arrangements where patients dialled 111 to book a slot to attend. The hospital ED’s would not be shut, and attendees could still walk in, but people were advised to book in if they could. The feasibility of this system was currently being considered for the PRUH. It was agreed that further information on the ‘Help Us, Help You’ pilot would be presented to the meeting of the Health Scrutiny Sub-Committee on 16^th July 2020.

RESOLVED that the Bromley Winter Assurance Plan Update report be noted.