Report by Alan Steward and Joy Hollister
Minutes:
The CCG Chief Operating Officer explained that the 95% target for meeting the ‘four hour rule’ at Queen’s Hospital A&E would not be met every week but that local health economy was improving. The pattern of performance was varied and it was noted that there was not a direct correlation between performance and levels of attendance at A&E.
Large numbers of patients were now treated by the Community Treatment Team and Intensive Rehabilitation Service rather than at A&E. The GP Federation access hub also worked to move demand away from A&E. Seventy per cent of available appointment slots at the access hubs were now being used and appointments were now available at weekends as well as in early evenings.
There was now more demand for the Urgent Care Centre at Queen’s and a triage system had been introduced at the front of A&E and had proved successful in allocating patients to the correct stream for treatment. It was clarified that it was not optional for doctors to work in triage and that there were enough staff available to provide this service. The Community Treatment Team also had a hub in A&E (in addition to teams working in the community) and had also proved successful in reducing demand from A&E.
The majority of the problems related to the admitted side of A&E attendances when for example hospital beds were not available. The A&E assessment unit was often used prior to admission to wards and it was accepted that at night there was an element of keeping older patients in A&E for observation. BHRUT was working to bring forward discharges to earlier in the day and to address issues with where the hospital pharmacy may be delaying discharge. Patients were often able to wait in the discharge lounge, freeing up beds at an earlier stage.
The CCG had also purchased more community beds to create temporary capacity and allow more discharges from hospital. The Joint Assessment and Discharge Team had lowered the number of delayed transfers of care of which there currently a total of eight cases. This was an example of better working with partners taking place.
There were approximately 100 simple discharges (where people could return to their own home without any additional support) at Queen’s each day but these needed to take place earlier in the day. The scheme aligning GPs to care homes was also working to reduce the number of hospital admissions.
The A&E position had improved overall with better operational links between services and better management of demand. Patient flow was improving but earlier discharge was still needed. The new leadership at BHRUT had been cooperative and a new medical director and ED consultant had recently been appointed. There remained significant challenges for the hospital but the Trust was focussed on the key issues. It was noted that the hospital would be receiving an inspection from the Care Quality Commission (CQC) in three weeks and that this was taking the attention of the management team. Healthwatch Havering had been asked by the CQC to look at different aspects of BHRUT services.
Issues such as how the ambulatory care service could be utilised more could be addressed by the Programme Board. It was felt community pharmacies could be used in order to speed up discharge. Pharmacies could also be used more for minor ailments although the chief operating officer felt that pharmacies made a relatively minor contribution to the overall issues. The Chair of the Local Pharmaceutical Committee also wished pharmacies to be used for minor ailments more but it was to ensure value for money for any investment in pharmacies. The Chairman felt that discussions should also be held with other representatives of pharmacies. The Chair of Healthwatch Havering added that the issue of discharge medication in the hospital needed to be organised better. It was also now easier to obtain drugs out of hours from e.g. supermarket pharmacies. The Chairman added that too many drugs were also thrown away in care homes.
It was agreed that communications such as the ‘Don’t go to A&E’ campaign should continue in order that people were aware of where they needed to go for the appropriate treatment. Newspapers, pharmacy bags, buses and posters had all been used for the current campaign. Alternatives to A&E were also promoted digitally via an App and website and through the CCG Twitter account, A digital service guide was also available for NHS staff. Leaflets had been targeted towards parents of young children and a booklet had also been produced for older people that had been sent to GP surgeries, libraries etc. It was suggested that the Council e-mail database could also be used to advertise this.
It was clarified that the advertised phone number for advising which GP surgeries were open at the weekend related to the non-GP Federation weekend hub.
The Chairman explained that it was hoped to have weekly articles in the Romford Recorder and that this could also be used to publicise the ‘Don’t Go to A&E’ campaign. It was AGREED that Councillor Kelly would take this forward.
The Chairman thanked the CCG Chief Operating Officer for a comprehensive report.