Officers representing BHRUT and the local Clinical Commissioning Groups felt that the key issue impacting on plans for dealing with winter pressures on health services was workforce issues. This was not an issue of money but NHS bodies wished to work with Council to attract people to work in both health and social care.
Planning was already under way for 2019/20 although patient demand was also present throughput the year. An important objective was to increase the take up rates for flu vaccines and meetings had been held with GP practices with the highest urgent care demand in order to understand the reasons for this. Flu vaccination programmes would be better organised in order to avoid the national shortages that had occurred in 2018/19.
All local Councils and NHS organisations were involved in the A & E Delivery Group and a multi-agency A & E Delivery Board also met on a monthly basis. Workstreams covered ambulance demand, hospital flow and mental health issued which were now more clearly recorded in A & E.
Performance at BHRUT in meeting the target had improved in the last year, despite rising demand for A & E services. This contrasted with a 4% fall in A & E performance at Whipps Cross Hospital in the same period. Numbers of ambulance conveyances had increased slightly, mainly at King George Hospital.
The GP-led Urgent Treatment Centre at Queen’s would be open on a 24:7 basis from July 2018 and the Urgent Care Centre at King George had seen a 13% rise in patients. It was clarified that both facilities were managed by the Partnership of East London Co-Operatives rather than BHRUT directly.
Investment had been made in intensive rehabilitation services in order to seek to reduce demand on health services. It was emphasised however that all winter pressures money in 2018/19 went to Local Authorities rather than the NHS.
The Red2Green initiative had been introduced to improve patient flows through the hospital and reduce length of stay this producing better outcomes for patients. A new Rapid Assessment and Fast Treatment area had been opened at Queen’s which had reduced turnaround time for patients brought by ambulance to A & E.
Decisions would be needed shortly for critical recruitment to support the next round of winter pressures and a bid had also been made for national funding to support a 24 hour Enhanced Mental Health Care Liaison team in A & E. Plans were also being developed to reduce demand for children’s A & E services and to develop an integrated model of assessment for frail older people, again to avoid hospital admissions where possible.
The failure by the Trust at times to meet the 95% 4 hour target fir A & E treatment was part of a national pattern. This was caused by a number of issues including lack of capital and recruitment difficulties. BHRUT currently had around 1,000 vacancies including consultant posts. The use of the four hour target was currently being reviewed at a national level but BHRIT officers accepted that the Trust would fail to meet the target in the coming winter.
An annual readmission audit was undertaken by the Trust and data on this could be supplied to the Joint Committee. A Member felt that there was a long-term trend of deteriorating performance at the Trust and officers conceded that problems with meeting the four hour A & E target did need to be investigated. A recent review by an Intensive Support Team had concluded that BHRUT was doing everything it could to address this.
It was acknowledged that issues such as workforce gaps, having sufficient spacer to treat people in A & E and primary care needed to improve but there were no quick solutions. Members appreciated this and felt that a dialogue could be had to work through what issues impacted on performance. BHRUT offices emphasised that the simple addition of beds was not the answer and the Trust did not have the staff, space or capital to support this in any case. The answer lay in strengthening patient care and having a better patient flow through the system. Work on the Trust’s Clinical Strategy, which sought to address these issues, was due to complete by the end of 2019.
It was clarified that nursing recruitment at the Trust was relatively successful but consultant and other medical recruitment remained challenging. Plans to develop nursing careers over a 10 year period at the Trust would help with retention as would the introduction of a nurse mentoring scheme. Around 50 nursing associates had been recruited many of which it was hoped would progress to become full nurses in due course.