Agenda item

This report is provided by Imperial College Healthcare NHS Trust and covers the performance and activity of the Accident & Emergency service during the winter period November 2016 to March 2017.

Councillor Vaughan welcomed Dr William Oldfield, Deputy Medical Director

Claire Braithwaite, Divisional Director of Operations, Medicine and Integrated Care, Mick Fisher, Head of Public Affairs, from Imperial College Healthcare NHS Trust.  The Trust managed a number of A& E services that included emergency departments (ED), urgent care centres (UCC) and specialist emergency centres, located at St Marys and Charing Cross hospitals.  This had been a challenging winter period nationally but a month on month improvement had occurred through the period December 2016 to March 2017, with a new acute service commencing at Charing Cross.  It was noted that a new UCC had become operational at St Marys in April 2016, operated by Vocare.  Dr Oldfield explained that they were remodelling critical care facilities and that they were signs of improved quality of services.  The following key points of the discussion were noted:

• This had been a challenging winter, with target of seeing 95% of patients being seen within fours not being met.  On average, 87% of patients were seen within four-hour, however, there was demonstrable trajectory of improvement from December onwards;
• With reference to figure 5, in paragraph 4.2 of the report, it was noted that during 2017, the position showed much improvement, when compared with Feb-March of the previous year;
• In terms of key challenges, it was recognised that contrary to media reports, most patients presenting at A&E sites need to be there.  There were increasing numbers arriving by ambulance, which also presented significant operational challenges;
• Remodelling of care at St Marys UCC had experienced short terms operational difficulties, with the result that that the streaming services (to either UCC or ED) experienced difficulty with managing extended wait times, delivering consistent streamlining services and maintaining adequate staff levels, particularly overnight;
• There had been significant changes to improve UCC with an extending programme of work to improve resilience targeting not only A&E, but the range of service provision from when a patient first presents to discharge.  Regular weekly meetings now monitored projects and required actions, with scrutiny and support from senior officers;
• The Trust acknowledged that they had not met the required standard but there was improvement;
• Dr Oldfield referred to a funnel affect, with large numbers of patients accessing service through single point.  Remodelling to maximise available space, calculating demand and resources, particularly staff, accordingly would see this become more streamlined.  Emergency medicine was hard, with staff requiring significant experience – taking up to 15 years to train an emergency consultant - in what was a highly pressurised, challenging environment;
• Difficulty in accessing other services could indicate a causal link to increased A&E attendance, particularly with some waiting periods of up to 18 weeks recorded for Referral to Treatment.  Members of the Committee highlighted the point that vulnerable and elderly residents struggle to access GPs and how easy was it for people to access primary care in the community.   Although it was noted that this was outside of the Trusts remit, it was understood that despite the wait, a patient who presented through an A&E service would eventually be seen within 14 hours by a consultant and receive a senior opinion on their condition; and
• Hospital based Social Workers were now accompanying consultants on their rounds, offering joined up patient care pathways, with discharge plans being formulated far early and sufficiently in advance of discharge to avoid delay.

An increase of Type 1 cases at Charing Cross was cause for concern, however, the Committee acknowledged that the level of demand caused significant pressure on the service, with the Trust unable to meet the national standard to see, treat and discharge 95% of patients that present to an urgent or emergency care setting within 4 hours. 

Members of the Committee highlighted additional concerns around the length of waiting time, particularly at Western Eye Hospital, where waiting times of up to five hours had been experienced.  The Committee would welcome closer analysis of public health education provision, which might potentially address this, together with a better understanding of how to achieve greater efficiencies around triage and initial assessments.

The Committee was disappointed that the waiting time targets had not been met.  However, it welcomed the fact that the Trust had plans in place to improve its performance, particularly at the Charing Cross A&E.  And members of the Committee commended the work of staff working in emergency care settings, understanding that the service had faced high levels of demand during this period.  The Committee will be interested in receiving a further report on A&E waiting times later in 2017 to see what impact these changes have made.