Agenda item

To receive a verbal update from a representative of UHNS on performance at the new Accident and Emergency Department.

The Chairman welcomed Liz Rix and Mark Mould from UHNS to the meeting following which they made a presentation providing an update on performance at the new Accident and Emergency Department including the impact of reduced A&E Services at Mid Staffordshire Foundation Trust since December 2011.

A summary report prepared by UHNS was circulated at the meeting and key achievements for 2011/12 were outlined as follows:-

·        All key national targets being met by the Trust except A&E 4 hour access.

·        Significant reductions achieved in hospital acquired infections and significant improvements made in Venous Thromboembolism (VTE) risk assessment.

·        Improvement in harm free care through implementation of Safety Express.

·        Moved the vast majority of clinical services safely into new state of the art facilities.

·        Improved efficiency through reduced length of stay, bed reductions and workforce reductions.

·        The Trust was designated as a Major Trauma Centre in 2011/12, with the national launch by Andrew Lansley, Secretary of State and David Nicholson, NHS Chief Executive, hosted from the new hospital on 3 April 2012.

·        Support provided for Mid Staffordshire Foundation Trust (FT) and their patients in Emergency Services following the closure of their A&E overnight.

·        Continued improvements to patient safety and quality culture which has been maintained through a period of unprecedented change.  Full compliance with Care Quality Commission (CQC) regulations.

·        Successfully moved the vast majority of clinical services safely to the single site by March 2012.

·        New model of leadership embedded and supported by significant investment in leadership and Board development.

·        Provision of emergency contingency to assist Mid Staffordshire FT overnight closure of A&E from December 2011.

·        Key substantive appointments to the Chairman and Director of Finance roles providing continuity of leadership going into 2012/13.

In addition to the above, the Trust’s key objectives for 2012/13 were summarised as follows:-

·        Deliver safe appropriate and effective patient care with no harm to patients.

·        Activity and capacity to deliver all access targets in order to provide resilience to performance.

·        Increase elective activity through networks and repatriation.

·        Reduce non-elective activity through care closer to home.

·        Ensure our financial viability by preventing any significant drops in activity income.

·        Deliver the Tripartite Formal Agreement milestones to become a Foundation Trust (FT).

·        Develop further strong strategic partnership working for tertiary services through alliances and clinical networks.

·        Develop stronger commercial relationships with Mid Staffordshire FT with a clarity of purpose.

It was indicated that delivery of the A&E 4 hour access target had proved challenging for a number of key reasons and had resulted in inviting the National Emergency Care Intensive Support Team into the Trust in February 2012, followed up by a whole economy diagnostic in recognition that flow out from the organisation is the biggest issue for impacting on delivery.  A number of actions were being taken across all organisations within the Health Economy to assist including West Midlands Ambulance Service, Staffordshire and Stoke-on-Trent Partnership Trust, Combined Health Care Trust and Clinical Commissioning Groups.  Through an analysis of the data, issues included:-

1.         Change in attendance and admissions

·        Overall for 2011/12, there was a 2% increase in patient attendances to A&E; however, February 2012 saw an 8% increase and March, post ED moves, there was a 14% increase.  Average daily attendances have increased from 280 to 320.

·        Admissions are at higher levels than same time last year.  Admission rate to inpatient beds has remained static at 21% but as attendances are higher, there is an increase demand for inpatient beds.  There was a 7% increase in PBR and 24% increase in non?PBR non-elective admissions against the 11/12 contract.

·        For 8 months the Emergency Department has consistently achieved 4 hours for non-admitted patients (95^th percentile at 226 minutes).

·        The Emergency Department has not achieved the 4 hours target for admitted patients all year and performance has deteriorated from October going into the winter period (95^th percentile at 618 minutes)..  Capacity and flow is the main constraint to delivery of the target.

2.         Capacity constraints through a smaller bed base

·        Significant progress had been made within the Trust in line with efficiency targets, resulting in 200n less beds across the Trust closing to date, with a reduction in length of stay and occupied bed stays.

·        The bed closure programme focused on reducing 300 beds by internal efficiency, admissions avoidance and community efficiency.  All areas of the programme have made progress but have not delivered at the same pace and not all programmes are fully realised.  As a result of the increase in demand, there has been a review of the bed requirements.

3.         High occupancy, increase in acuity and length of stay for emergency patients over winter

·        Historically the Trust has always run at a high occupancy.  There was a need to reduce occupancy to support flow and therefore more beds were required, particularly over the winter period.

4.         Imbalance between admissions and discharges, in particular weekend flow

·        With the change in attendances and admissions, there was an average daily demand of 70 medical inpatient beds per day.  The discharge rate in Medicine is on average 60 per day with 31% of patients being discharged before 1pm.  Earlier in the day discharge is key and rectifying the imbalance between admissions and discharge.  Weekend discharges reduce to half these levels despite consultant led rounds on all medical wards.

The actions being taken were being monitored by the Trust Board and Strategic Health Authority and performance was expected to improve by quarter 2.

Mid Staffordshire Foundation Trust closed their A&E overnight from December 2011 and four organisations assisting in taking patients, with UHNS being one.  The average daily numbers were predicted to be 10 patients brought to UHNS by ambulance.  However, since December the average has been 5 per night bought in by ambulance with an average of 2 patient walk-ins.  The maximum daily numbers has been 14 ambulance patients.

To address the increase in demand, the following measures were put in place and remain in place:

·        Extra SHO from 1800 to 0200 and 2200 to 0800 7 nights in A&E.

·        Minor injuries department opening times extended to midnight Monday to Thursday and 0200 Thursday to Sunday.

·        Additional medical beds.

·        Treat and transfer policy in place to ensure patients are safely transferred back to Stafford when medically stable.

Patient safety and experience in A&E remains a top priority and data on complaints and adverse incidents are reviewed on a weekly basis.  Complaints per 100 attendances are lower than last year and adverse incidents remain on a downward trend.  Patient experience surveys have been conducted in October, February and April.  Over 1000 patients responded and overall improvements have been reported; particularly in relation to pain management, discharge information, cleanliness visibility and overall service experience.  320 comments were received and most were positive.

The summary report prepared by UHNS concluded by indicating that the Trust was committed to ensuring the emergency pathway for patients supports the 4 hour A&E standard.

In conclusion, Councillor Becket sought answers to a number of questions relating to the A&E Department, to which Liz Rix offered to supply answers in time for consideration at the next meeting.

Resolved:-   (a)       That Liz and Mark be thanked for their presentation and that the information be received.

                        (b)       That UHNS be congratulated on the improvement in the figures for unexpected deaths and in securing the Major Trauma contract for Wales.

                        (c)        That the responses to the questions tabled at the meeting be placed on the agenda for the next meeting.