Agenda item

Purpose: To inform the Board about the Urgent Care System.

Cathy Winfield gave a presentation to the Board on Urgent Care and the Berkshire West system. In summary:

• The national review of urgent care focused on five main elements, in particular how urgent care services could connect together and work in a cohesive way.
• There was a national standard for 95% of Accident and Emergency attendances to be seen, treated, admitted or discharged within four hours. It was anticipated that more reasonable measures would be introduced in time.
• Regarding the ambulance service, a swift handover of 15 minutes between ambulance staff and the Accident and Emergency department was vital so that the ambulance service could accept a new call. If this took longer than 30 minutes an Accident and Emergency department could be fined.
• The Berkshire West urgent care system was very complex and consisted of many different components. It was expected that the complexity of the system was the reason why the public visited their Accident and Emergency department in the first instance.
• The Accident and Emergency department became the barometer of the system. Consistency was required and a system that directed people to the same places.
• The acute medical unit was for those people with more complex issues. It needed to be ensured that when entering the unit people were looked after in the most suitable part of the hospital and by the best consultant for their needs. This resulted in the best outcomes for the patient.
• There was a new service specification for NHS 111. Due to the problems with the service experienced nationally, Berkshire West opted for a phased approach to its introduction. There was realisation that members of the public were still not as aware of the 111 service as they should be. There was aspiration to have a renewed effort at raising awareness.
• There was ambition for a single health and social care hub that provided ease of access to all out of hospital services.
• The urgent care system had come under scrutiny by Monitor and NHS England and a system recovery plan would need to be implemented.
• There were a number of reasons why targets were breached including the internal discharge planning process.  As a result seven day cover was being increased to help prevent patients not being discharged until after the weekend.
• Regarding what had been achieved, this included transparent whole system data, which formed an Urgent Care dashboard.
• Performance was gradually improving across the Urgent Care system. It could be seen from graphs that after a period of poor performance, recovery rates were very positive.
• Focus needed to remain on increasing discharge rates at weekends.
• Work was taking place with ECIST to help identify issues across the system. Length of stay reviews had been carried out to investigate why a bottle neck situation occurred.
• The Health and Wellbeing Board had a role to play which included taking oversight and ensuring all parts of the Urgent Care system were working to optimise flow through the system and by ensuring hr Better Care Fund was applied to develop services that would support people with urgent care needs.

Councillor Marcus Franks questioned if 999 calls made by care workers were reported on. Cathy Winfield confirmed that reports were received regarding calls from care homes however not primary carers. This was acknowledged as a useful point and further thought was required regarding communication points for carers and where they should make contact if they had concerns.

Rachael Wardell reported that the use of 111 was important when managing care pathways. If a person had real concerns then they should go to their local Accident and Emergency service, even if sound clinical advice advised them to wait until Monday.

Cathy Winfield confirmed that work also needed to take place with the voluntary sector and Children’s Centres regarding the 111 service. Adrian Barker stated that this was an area where Healthwatch would be able to assist.

RESOLVED that the Health and Wellbeing Board noted Cathy Winfield’s presentation on the Urgent Care System.