Agenda item

To consider the mid-year 2017-2018 performance of the Blackpool Clinical Commissioning Group for April 2017 - September 2017.

Mr David Bonson, Chief Operating Officer, Blackpool Clinical Commissioning Group presented the Clinical Commissioning Group’s mid-year performance for 2017-2018 (April 2017 - Septmeber2017). Mr Roy Fisher, Chair, Blackpool Clinical Commissioning Group and Ms Kate Newton, Performance and Quality Manager, Midlands and Lancashire Commissioning Support Unit were also in attendance.

Mr Bonson explained that there were ongoing urgent care and winter pressure issues. These included: a shortage of beds; people waiting inappropriately on trolleys; Accident and Emergency waiting times; ambulance response times; and cancer assessments and treatment time. He added that pressures from earlier in the year and the previous winter were still having a consequential effect throughout the year. These were accumulating in current winter pressures. issues such as flu (38 cases) required isolation reducing space and bed capacity although residents and staff were encouraged to have flu jabs.

Mr Bonson reported various plans were in place with frequent high-level partnership meetings including across Lancashire and South Cumbria. The Chair queried how effective the plans were given the previous year’s winter pressures and current pressures. Assurance was given that lessons were learnt and implemented each year but increasing demand on services created tougher challenges. A ‘whole system’ response and planning was required, e.g. involving North West Ambulance Service and Adult Social Care.

Mr Bonson reported that actions included creating physical facilities (to reduce Accident and Emergency pressures) using GP primary care screening, a dedicated mental health area, a discharge lounge (with social workers) and joined-up staff in the same place.

The Chair referred to local press articles. He acknowledged that figures might not mirror those held by the Clinical Commissioning Group but sought assurance of appropriate action. He cited that Accident and Emergency performance relating to waits being no more than 4 hours had been stated as just over 40% but needed to be 95% (the Government had temporarily relaxed this to 90%).

Mr Bonson explained that the 40% represented cases that genuinely required Accident and Emergency against an overall performance of 84%.  He added that new primary care screening had been developed to re-route people not requiring Accident and Emergency.

Members requested that both targets were shown next time with clear explanations. They also suggested that the screening for genuine Accident and Emergency need should be more effective at source, i.e. avoid emergency ambulances.

The Chair referred to press reports that 1 in 7 trolley waits nationally were from Blackpool. Mr Bonson acknowledged the issue but added that the figure represented a small number of exceptional days. Usually more patients were discharged in the run-up to Christmas which had not happened leading to a shortage of beds thereby placing additional pressure on use of trolleys. Members also noted that trolley delays still involved paperwork (getting prescriptions from on-site chemists). This had been mentioned at the last performance report.  Mr Bonson acknowledged bed numbers had reduced over time and delays were a challenge for patient/bed flow (and could involve Adult Social Care pressures).

Members queried the effectiveness of awareness campaigns (to avoid unnecessary trips to Accident and Emergency) and the community based neighbourhood hubs which aimed to reduce Accident and Emergency pressures. They were informed that all these initiatives were helping including the four hubs but this was taking time and service demand was still increasing. Blackpool Teaching Hospitals had not turned any patients away but other neighbouring hospitals had had to. Blackpool Teaching Hospitals also dealt with a high numbers of people visiting Blackpool (costs could be claimed back but not for emergencies) creating additional demand pressures.

The Clinical Commissioning Group representatives added that patient / bed flow (and involving Adult Social Care) needed to be effective. There was no national target for bed numbers / resident population but benchmarking with comparable areas could be undertaken. They believed that there was no known research on inequalities and bed shortages. The King’s Fund was suggested as a source of potential research information.

Members were informed that new national standards and targets were due on ambulance response times. December 2017 figures for the North West Ambulance Service would be provided by the Committee’s next meeting on 14 March 2018.

A public attendee referred to the NHS’ non-emergency 111 service sending out an ambulance unnecessarily. Mr Bonson explained that, as breathing difficulties were involved in this case, the checklist algorithm chose what was deemed to be the most appropriate response.

Members queried the level of financial sanction (maximum of just over £3m) that could be imposed upon Blackpool Teaching Hospitals for missed targets. The Clinical Commissioning Group had agreed with Blackpool Teaching Hospitals to not simply to move money around the health sector with fines but instead to work with them to ensure quality performance.

Some Members reported good personal experiences and thanked the Hospital and staff in working through winter pressures. The feedback was welcomed by the Clinical Commissioning Group who added that patients also seemed to acknowledge the pressures.

The Committee agreed:

1.   That both Accident and Emergency targets, with clear explanations, should be shown in future performance reports.

2.   That December 2017 performance figures for the North West Ambulance Service would be provided by the Committee’s next meeting on 14 March 2018.