Agenda item

Sarah Cottingham (SEL ICB) presented this item to the Committee. The following key points were noted:

9.1. The national expectation with regards to performance standards specifically in terms of A&E waiting times is that there is a target to achieve by March 2024 of 76% of patients who attend A&E are to be seen and discharged within 4 hours of arrival.

9.2. There has been a huge emphasis on hospital handover with the London Ambulance Services (LAS). A handover protocol regarding a maximum wait for ambulances of 45 minutes had been implemented as a pilot and is now business as usual. This has helped improve overall turnaround times.

9.3. A lot of work had been done on overstay and discharge with investments made through the better care fund. There has also been ongoing development and expansion of community services, for example, virtual wards.

9.4. The ICS had been working on alternatives to admission within hospitals with a programme on expanding pathways for same day/emergency care units; supporting discharge rather than admittance to hospital.

9.5. There has been a lot of focus on how to support an improved Mental Health crisis offer to help reduce pressure on emergency departments. Since autumn 2023, there has been a roll out of an NHS 111 service/route for specific Mental Health concerns as well as increased bed capacity with more beds coming online for March 2024.

9.6. Despite those efforts the system remains in a challenged position. There were positive improvements in quarter 1 within UEC which was followed with more challenges and deterioration in performance which then stablished. It was reported the system is currently some way off where they want to be in terms of UEC performance. Real push in coming weeks to get as close to the 76% target at year end as possible. An improvement in January had been seen compared to December.

9.7. There had been lot of periods of industrial action- which had impacted on continuity –with priority being given to safeguarding UEC during industrial action.

9.8. In terms of discharge it was reported that a percentage of patients that are ready for discharge remain in beds while medically fit for discharge; it was explained that there are challenges which can vary day to day. On average the system are discharging 50% of people on the day they are determined to be medically fit which highlights the challenges with flow but also the opportunities for improvement.

9.9. There was a discharge summit which agreed a number of objectives including agreement on investment to support improvement in discharge processes and more funding into transfer of care hubs. There has also been additional money into capacity of intermediate care or nursing home beds. The ICS are trying to make sure use they use money wisely and have more sophisticated approaches to demand and capacity planning.

9.10. A number of discharge improvement initiatives had been agreed which were Borough related initiatives – each borough will have their own nuances. The ICS run a SEL discharge group so they have an overview of what is happening- to share best practice and learning; they are also part of regional groups.

The Committee proceed to make the following comments and queries, which are summarised below:

9.11. It was commented that there are challenges in discharge funding in the boroughs going forward and that some pathways have had to be paired back as in Bexley. In terms of funding and planning for 2024/25 it was reported that some additional discharge funding is expected nationally but it will be difficult to keep up with demand.

9.12. Concern was expressed about wait times, and about repeat attendees; it was thought more work could be done with such patients who are often mental health patients or those with Special educational needs and/or disabilities. Concern was also expressed about lost bed capacity in some boroughs for mental health patients. It was reported that regular attendees are tracked to identify and offer ongoing support packages but it was recognised that here are ongoing challenges. It was reported that there would be 26 extra mental health beds being provided this quarter and more beds are being commissioned.

9.13. It was commented that earlier discharges during the day are needed as there have been issues with late discharge and having their home ready for them which can affect flow.

9.14. In terms of emergency care, clarity was sought on how the NHS are working with on-site facilities for primary care to capture people who should be going to primary care but are attending A&E. It was noted that NHS111 does redirect people back into primary care or UTCs; it was noted that UTCs also have GPS doing GP sessions. It was recognised that there are challenges for people in accessing urgent and same day access.

RESOLVED: That the report be noted.