Agenda item

Report of the Vice-Chairman of the Joint City and County Health Scrutiny Committee

Caroline Shaw, Chief Operating Officer, Nottingham University Hospitals (NUH) Trust and Nikki Pownall, Programme Director, Urgent Care, Nottingham City Clinical Commissioning Group (CCG) introduced a report and presentation, updating the Committee on the delivery of urgent care services by NUH during the winter of 2015/16. Ms Shaw and Ms Pownall made the following points:

(a)  Performance in quarters 3 and 4 fell away, in part down to high levels of staff changes and departures, an increase in admission of over-85s and an outbreak of Norovirus in 4 out of 5 community facilities. There is no one cause for the increase, and no single solution;

(b)  In managing winter pressures, 38 extra beds had been located at both Queen’s Medical Centre and the City Hospital and £1.1 million invested. In order to strike a balance between emergency, cancer and planned operations in the busiest winter months, elective surgeries were reduced;

(c)  There has been a reduction in the number of vacancies recorded across the service. There are currently 8.7 whole time equivalent (WTE) registered nursing vacancies as opposed to 18.8 WTE vacancies recorded in March 2015. This demonstrates a stabilising staffing situation;

(d)  The Committee commended both the clear and comprehensive information provided, and the positive approach commissioners and providers demonstrated to find solutions in a challenging environment.

A number of points were raised during the discussion which followed:

(e)  Ms Pownall advised that tracking mental health patients in the Emergency Department (ED) was a key and ongoing work strand within the Urgent and Emergency Care Vanguard;

(f)  The involvement of GPs in the Urgent Care and Emergency Care Vanguard had proved effective in Nottingham, though less in driving down response times and more in providing better quality care and patient experience. The Urgent Care Centre was a valuable GP/nurse-led facility where walk-in patients could be assessed initially;

(g)  The Committee asked that the evaluation of the Urgent and Emergency Care Vanguard, with a focus on the GP element of the process, be put on the Committee’s work programme;

(h)  It was explained that fewer and fewer trusts are able to achieve the national target of 95% of ED patients being treated within 4 hours, and that administering safe and appropriate care was the overriding priority. There are indications of a national move towards a more achievable target of 85%;

(i)  A roof collapse at the City Hospital was in an empty emergency ‘decamp’ ward held in reserve as part of the NUH Estates Strategy, and was not in public use;

(j)  Divisional nurse leads were in place for each division to help drive performance and ensure, for example, that scripts were written up in a timely way by junior doctors to minimise delays for patients;

(k)  It was acknowledged that more work was needed in changing Occupational health models and in reducing numbers of elderly frail patients presenting at ED;

(l)  Staffing issues were becoming less acute. There were no vacancies at the consultancy level, and the Advanced Nurse Practitioner role will enable better nurse retention;

(m)  Ms Pownall reported improvements in performance at the interface/exchange of patients from the East Midlands Ambulance Service, and Nottingham did not have incidents of ambulance ‘stacking’ outside EDs seen elsewhere in the NHS.

RESOLVED to

(1)  thank Ms Shaw and Ms Pownall for their presentation and involvement in the subsequent discussion;

(2)  add ‘Evaluation of the Urgent and Emergency Care Vanguard, with a focus on the GP involvement in its delivery’ and ‘primary care at the front door’ to the Committee’s work programme;

(3)  to request an update on the service at the Committee’s April 2017 meeting.