Agenda item

Report of Newcastle Gateshead Clinical Commissioning Group (CCG)

The Committee received a report and presentation from Marc Hopkinson from the Newcastle Gateshead Clinical Commissioning Group (CCG) which summarised the impact of the 2015/16 winter period on the Gateshead health economy.

The Committee were advised that whilst winter 2015/16 can be described as being ‘mild’ due to minimal disruptive weather (such as snow and ice) and without the level of norovirus outbreaks that have been experienced in previous years, all providers, in all settings and services experienced sustained pressures throughout  the whole of the winter period.

This caused the whole system to be less operationally resilient than planned, particularly in the Emergency Care Centre (ECC) at the Queen Elizabeth Hospital, due to a number of determinants which impacted on the whole systems ability to effectively manage the level of demand placed upon it. This included patients’ lack of rapid access to GPs, emergency beds, community and social care capacities; delayed discharges and demand for ambulances (with the North East Ambulance Service capacity and response significantly affected by handover delays at various hospitals across the region).

Whilst it must be acknowledged that there was a significant increase in the number of locally registered patients presenting to the EEC and Blaydon Walk in Centre which placed a strain on these services, increased and sustained pressures were also created by other Foundation Trusts across the region that were simply unable to effectively managed their own patient flow and therefore became reliant on Gateshead Health NHA Foundation Trust to assist them in meeting their demand for urgent care.

Several of these Foundation Trusts frequently had cause to divert patients away from their own hospital sites to Gateshead who despite being under significant, sustained pressure still provided mutual aid to these ‘out of area patients’.

In the interest of patient safety, NEAS often felt it clinically necessary to transport patients away from their local or nearest hospital because of delays in handing over patients from ambulance crews to A&E staff. This caused not only increased demand on the Queen Elizabeth Hospital but then created repatriation problems when patients were later medically fit for discharge as NEAS struggled to provide a transfer or their local hospital was not able to provide a bed.

The number of Delayed Transfers of Care, that is adult inpatients in the Queen Elizabeth Hospital (children are excluded from this definition) who are ready to go home or move to a less acute stage of care but are prevented from doing so, also increased during this time for both Gateshead and out of area patients due to the volume of patients needing support and complexity. Sometimes referred to in the media as ‘bed-blocking’, delayed transfers of care are a problem for the NHS as they reduce the number of beds available to other patients who need them, as well as causing unnecessary  long stays in hospital for patients.

The Committee were advised that within the NHS there are three main indicators which are used to measure performance of the urgent and emergency healthcare system. These are:

1. The 4 hour A&E Standard

This standard is part of the NHS Constitution and is considered a crucial indicator of the overall success in the delivery of high quality health services to NHS patients. It is a requirement that 95% of all patients who present to the Accident and Emergency Department/Walk in Centres are seen, treated and discharged or admitted within 4 hours of arrival.

Gateshead Health NHS Foundation Trust struggled to achieve this target during the winter months in 2015/16. Analysis of annual activity has indicated that whilst there was a decrease in the overall number of ambulance arrivals in 2015/16 (although there was some increase in patients being conveyed from Count Durham and Northumberland) there was a 7.6% increase in patients self-presenting to Gateshead urgent and emergency care services in 2015/16 (6,397 patients). Whilst two thirds of this growth was Gateshead residents (4098), there was a marked increase in patients presenting from South Tyneside (43%).

2. Ambulance Service – Category A Calls

The number of Category A calls – life threatening – resulting in an emergency response arriving at the scene of the incident within 8 minutes. There is a national target of 75% for ambulance services.

North East Ambulance Service (NEAS) managed to respond to 68% of these calls in 2015/16 within the specified timeframe.

3. Delayed Transfers of Care (DToC)

The number of days delayed involving Gateshead patients during 2015/16 was 24.5% above the trajectory of 3,330 days and 4% higher than 2014/15. The number of days delayed increased sharply in the second half of the year.

The Committee were advised that an evaluation event was held in early April which resulted in positive feedback on the schemes and ways of working, feeling that all had worked fairly well and were deemed to have made a material positive contribution to managing and assisting with pressures.

However, a number of issues were also highlighted which significantly impacted on the system. These include:

·         Higher proportion of elderly attendances than in previous years.

·         Acuity of patients severely impacted patient flows.

·         Increased attendances added more pressure to the system not just A&E.

·         Bed capacity, availability and access.

·         Patient Transport Service capacity, delays and availability – due to high demand impacted on discharge flow.

·         Out of area patients – issues with diverts to A&E and repatriation to other Foundation Trusts once medically fit for discharge caused delays and capacity issues.

·         Access to step down beds caused significant flow problems.

·         Patient expectation impacted on flow – particularly the choice agenda.

·         Delays with complex discharged impacted on patient flow.

The outcomes of this evaluation process will influence the planning process as well as the reform programme for Urgent Care during 2016/17 which is currently being discussed with providers and the Gateshead System Resilience Group.