Report of the Head of Democratic Services (Nottingham City Council)
Dara Coppel, Unplanned Care Programme Manager from Nottingham City Clinical Commissioning Group provided an update to Members on the work of the board, including how urgent and emergency services in Nottingham have dealt with winter pressures.
There have been a number of sub-groups which have been set up since the last update in September:-
· Local System Resilience Planning Group – To develop plans that help support health and social care services to meet fluctuating service pressures whilst maintaining service quality.
· Primary Care Access Planning Group – To better understand variation in primary care access across South Nottinghamshire and to identify how to best optimise access and reduce demand on A&E.
· Frail Older People Planning Group – To oversee development of services for older people; to improve provision, quality of care, and outcomes for patients across the local population whilst ensuring best value for commissioners.
· Provider Planning Group – To develop and maintain relationships and collaborative working across providers to ensure the safe and timely transfer of patients from NUH into community services.
Underneath all of these sub-groups is the Performance Oversight Planning Group which determines indicators and interface standards to fully understand and monitor changes in performance.
Despite ongoing investments and actions, performance in recent weeks against the 4 hour target standard (patients being seen and discharged within 4 hours) has been poor, but attendance in A & E has mainly remained the same apart from a recent decrease. The number in admissions is also very similar to last year’s figures. The number of admissions of people over the age of 80 is still going up.
To address the recent poor performance, the CCG’s (Clinical Commissioning Groups) are working closely with NUH to implement a recovery plan for both the hospital and community providers who support the urgent care pathway.
To help try and improve the situation a number of developments have been put in place to improve emergency care:-
· Transfer to access – If a patient is medically fit, try to get them transferred to a community care home within 24 hours of being discharged.
· Choice Policy – This is drafted by NUH, this will help the unblocking of beds, and waiting for a care home can take up to several weeks. It explains that medically fit patients have to be placed in an interim care home.
· GP Aspirations – To set standards for all GP practices across South Nottinghamshire
· Recruitment of key staff
· Redirection of patients from ED with primary care needs.
· Enhance and develop ambulatory care pathways.
· Winter Planning (recovery plan) – The two key groups who are responsible for overseeing the implementation of the Recovery Plan and Improvement Plan are the Collaborative Commissioning Congress and the Urgent Care Working Group.
· Walking the walk (the frail elderly persons pathway – getting visits organised (Joint Health Members received and took up this offer in the summer of 2013).
In summary the Care Board is taking good strides but is still struggling to hit 95% target. Transformation agenda will have great impact along with the Bruce Keogh report.
Following questions from the Committee, the following additional information was provided:
a) The longest possible stay at an interim placement for a patient would be up to 3 weeks when they are medically fit.
b) The data regarding the number of admissions comes from NUH. The findings this year are different to previous years.
c) NUH have advertised for the past 12 months for acute positions, there is a pressure on resources regarding GP’s especially with regards to 7 days a week working.
d) There was some funding which was received in early December. The Care Board did not qualify for winter pressure money this year, but there is pressure on where to spend the money they did get. Still struggle to hit the 95% target even when not in winter. Looking at why that is and work streams have been set up for this.
e) Both the County Council and City Council are involved in plans to help with the problems regarding the lack of beds. Much harder decisions will have to be made in the future regarding this issue.
f) The introduction of the 111 service could be a factor to the recent decrease in attendance, more patients ringing up to book appointments rather than coming into hospital. Also recent campaigns could have been a factor.
The Chair thanked Ms Coppel for her update and the committee agreed to bring the Urgent Care Board back on the agenda in 6 months’ time