Agenda item

To consider the performance of the Blackpool Clinical Commissioning Group for April 2017 to March 2018.

Mr David Bonson, Chief Operating Officer, Blackpool Clinical Commissioning Group presented the Clinical Commissioning Group’s end-year performance for 2017-2018 (April 2017 - March 2018). 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.

The Chairman referred to 266 incidents of patients having to wait over four hours on a trolley (target now retitled to ‘decision to admit’) whilst in Accident and Emergency. The high number was much worse than the previous year. This was particularly concerning given that the target was actually zero and Members had raised the issue on previous occasions and been given assurance that matters would improve.

Mr Bonson explained that the issue was mirrored nationally and was not specifically due to Accident and Emergency patient numbers but wider system pressures concerning patient flows throughout the hospital. In particular, availability of beds was an issue. Optimum bed occupancy would be between 85-90% allowing some spare capacity for ad-hoc demand. However, winter pressures had resulted in full bed occupancy and it had become an all-year challenge to reduce the bed pressures.

He clarified that the ‘decision to admit’ [to Accident and Emergency] target had been breached numerous times on a few days leading to the high number, i.e. a slightly skewed figure. Analysis had been undertaken to better understand the issues. A key element was the lack of available beds meaning that patients were being queued up with the knock-on effect impacting upon other areas, e.g. the 18 week target for GP referral to treatment. He added that the beds issue was not solely due to the Hospital, e.g. patients had been seen in Accident and Emergency and were awaiting mental health assessments but at times the Lancashire Care Foundation Trust had no available beds at its Harbour facility.

Mr Bonson re-iterated that the issues were due to ‘whole system’ pressures and that these had been escalated for consideration. NHS Improvement was involved with looking at what support was needed to tackle the beds issue.

Members queried whether effective use had been made of recent Council loans to the Hospitals Trust to help tackle pressures such as bed shortages. Mr Bonson advised that the loans had been made directly to the Trust who would be best placed to explain how the monies had been spent.

Members queried why waiting times for first cancer treatment following urgent GP referral and NHS health screening were so high. They expressed concern that some patients were cancelling cancer treatment appointments so they could maintain planned holidays.

Ms Newton explained that there were various reasons for delays including patient choice. The aim was to confirm a prompt appointment with patients as soon as possible but flexibility was required. Cases could involve various treatment options and complex pathways of care. However, delays due to patient choice were also referred back to their GPs for further influence highlighting the health issues and potential implications of unnecessary delay. She added that the NHS Health Screening Service was a ‘one-stop shop’ for checking various health indicators but there was a capacity issue with follow-up actions and various options were being considered to reduce delays.

Members expressed concerns that some people did not need to be in Accident and Emergency impacting upon demand and that those people needed to be filtered out early. Mr Bonson explained that there were plans to tackle delays such as trying to increase health screening and other primary care screening taking place in good time to deflect people to more appropriate care options than Accident and Emergency.

He cited that approximately 30% of patients had been deflected from the hospital ‘front door’ to routes such as minor treatment. Primary care screening took place at limited times so could be increased and better use made of good local provision such as round-the-clock pharmacists. Some alternative treatment centres to Accident and Emergency were well known such as the ‘walk-in’ Whitegate Drive Health Centre but awareness campaigns and messages including ‘self-care’ could be re-iterated to people. He added that sometimes people would just turn up at Accident and Emergency and be reluctant to then be sent elsewhere.

Members referred to the 96 cancelled operations (target of zero) due to the winter period and sought assurance that cancellations wouldn’t be repeated and the back-log would be cleared before the next winter season.

Ms Newton explained that the cancelled operations were elective treatment not emergencies but where it had not been possible to agree another appointment within 28 days of the cancellation. Winter pressures such as bed shortages had had an impact and cancellations led to knock-on effects elsewhere such as cancer referrals to treatment, i.e. whole system all-year pressures with efforts to ‘catch-up’. Improving patient flow throughout the hospital was essential.

Mr Bonson added that some ‘outsourcing’ of elective care was required to help manage appointments, e.g. to the private Spire Hospital, and free up space to ensure that accidents and emergencies were covered.

The Chairman referred to the new national performance framework for ambulance service response times. The average time targets for Category A (immediate response required) and Category B (urgent / rapid response) had not been met by the North West Ambulance Service. Mr Bonson advised that nationally all ambulance trusts were struggling with the new performance targets, although national investment funding of £36million was being offered to invest in new vehicles.

Mr Bonson reported that the North West Ambulance Service had developed a performance improvement plan focusing on what was within its own control. He re-iterated that winter pressures were a factor but also that the new targets for each category required logistical changes in different types of vehicles and appropriate staffing on vehicles, e.g. rapid response vehicles might need two paramedics on board rather than just one. In response to a query, he clarified that ambulances always had two trained staff on board but there might only be one if the vehicle was transferring between shifts.

Some Members reported good personal experiences of the Ambulance Service with no handover delays at hospital and praised the professionalism of the paramedic staff.

In response to a suggestion that an existing dormant building on the Blackpool Victoria Hospital site could be converted into additional bed space, Members were informed that the relevant building was owned by the Lancashire Foundation Care Trust but in its current state was not ‘fit for purpose’. However, the principle of developing a building appropriately to create additional bed space was sound.

The Chairman advised that, in view of constant struggling performance and the reported system wide pressures, the Committee was keen to undertake short focused reviews on 1) delayed transfers of care and bed shortages, and 2) Accident and Emergency waiting times and ambulance handovers.

Members were advised that it was envisaged that these reviews would be single meetings with health partners and Adult Social Care invited aiming to identify and recommend some key improvements and actions.

The proposed reviews would be discussed with lead officers to establish current issues and actions and any planned work to ensure that reviews were focused on adding real value. In principle, the lead officers welcomed the proposed reviews.

The Committee agreed, subject to discussions with lead officers, to undertake short reviews (single meetings) on 1) delayed transfers of care and bed shortages, and 2) Accident and Emergency waiting times and ambulance handovers.