Agenda item

To consider the end of year performance for Blackpool Clinical Commissioning Group (BCCG) (April 2018 – March 2019) and to review the outstanding performance related recommendations for the Fylde Coast system following the Adult Social Care and Health Scrutiny Committee meeting on 28 November 2018.

Ms Kate Newton, Performance and Quality Manager, Blackpool Clinical Commissioning Group (BCCG) presented the BCCG report on end of year performance for 2018-2019.

The Committee drew attention to the continued poor performance for the percentage of patients being seen within two weeks of referral for breast cancer symptoms, noting that the target was being substantially underachieved, with a target of 93% and performance of 34%. Ms Newton advised that the deterioration in performance had been attributed to physical capacity constraints in terms of both imaging and clinic space. Members noted that the reason for poor performance had changed and that the last time the Committee had considered the performance for the target the reason for the poor performance then had been cited as a lack of consultant radiographers. Ms Newton advised that the previous issues had been resolved and that a plan was in place to ensure targets were met by the end of July 2019, highlighting that new equipment had been purchased. Further concern was raised regarding the length of time it had taken to resolve the issues and the number of women that had been put at risk as a result and Members were advised that the BCCG was reviewing the situation on a weekly basis and was involved in the process to recover the target as quickly as possible.

Concern was also raised regarding the number of 12 hour trolley waits in the emergency department, noting that there had been 300 in 2018-2019, of these 212 were mental health related. Ms Groves, Interim Director of Operations for Unscheduled Care, Blackpool Teaching Hospitals NHS Foundation Trust (BTH) highlighted that the indicator had been a focus of attention for BTH. The Psynergy pilot scheme had been introduced to alleviate the number of inappropriate mental health attendances at the emergency department and it was hoped the scheme would have a positive impact on the number of mental health patients waiting for more than 12 hours.

Mr Mark Lewis, Operations Manager, North West Ambulance Service (NWAS) advised that the Psynergy vehicle was currently in operation from 4pm until midnight, however, it was hoped the timeframe could be expanded if additional funding could be identified. The pilot commenced in November 2018 and had attended 950 patients. Of those patients, 11% had been transferred to the emergency department, a reduction from the 100% that an ambulance would have transported. The patients transferred to the hospital by the Psynergy vehicle had already received a mental health assessment before attendance at the emergency department, which therefore also speeded up their admission. It was considered that the Psynergy vehicle would have a positive long term impact and NWAS aimed to roll out the scheme to other areas in the North West.

Ms Groves also highlighted that the emergency department regularly coped with 200 attendances per day without any delay, however, on a number of days attendances could be between 230 and 260, which did cause significant delays in the speed in which patients could be seen. The links between discharge of patients and patient flow were highlighted and it was noted that all the measures in place to improve discharge would have a positive impact on emergency department wait time, however, it was recognised that it was unacceptable that any patient should have to wait for more than 12 hours.

The handover time from ambulances to the emergency department was also considered and Ms Maxine Power, Director of Quality, Innovation and Improvement, NWAS highlighted the importance of handover times on improving response times. She highlighted that there was robust monitoring in place to ensure that standards were met. In response to questions, Ms Power advised that there was not a consistent pattern of demand within Blackpool due to surges in peak tourist season and the large number of events that took place.

Members noted the national shortage of doctors and nurses and queried if the ambulance service also struggled to recruit. In response, Mr Ian Walmsley, Sector Manager NWAS reported that there was not currently a shortage, however, the bursary for student paramedics was no longer in place and the impact of its removal upon applications was not yet known. NWAS was working with the NHS to develop a robust workforce plan.

The Chairman highlighted the indicators relating to incomplete pathways and noted that performance had decreased. Ms Beth Goodman, Head of Acute Commissioning, BCCG reported that all partners were working as a system in order to find different solutions to improve performance. She advised that work was ongoing to create a single Fylde Coast waiting list to ensure no patient was disadvantaged by the treatment choice they had made and was confident that the next time the Committee considered the performance of the indicator that improvements would have been made.

The Committee discussed the targets to be met for each indicator, suggesting that all indicators should have a 100% target. Whilst agreeing with the Committee, Ms Newton advised that the indicators had national targets to be met, however, all organisations would agree that they were looking to achieve perfection.

Anecdotal evidence was also provided by a number of Members relating to hospital stays and in particular the comfort of the chairs provided for patients waiting to be seen in the emergency department was raised. Ms Groves agreed to investigate the facilities and set up provided to determine any improvements that could be made.

The Committee went on to consider the updates to recommendations made by Members when the performance of the CCG was last reviewed and discussed the recommendations identified as incomplete in detail. It was noted that the developers of the patient access app had advised that including signposting to extended access appointments was not under the scope of the app at this time. However, the CCG had recognised the value in the Committee’s recommendation and would continue to work with the developers to amend the app in the future, when possible. Subject to the CCG retaining the recommendation on its action plan, the Committee agreed the recommendation as completed.

With regards to succession planning, Mr Roy Fisher, Chairman, BCCG reported that the issue was ongoing. A new GP recruitment programme aimed at providing an interesting role to GPs to both recruit and ensure their retention would commence in September 2019. The Integrated Care System was also considering how resources could be shared in order to future proof service provision. It was agreed that a further update on succession planning would be provided to the Committee at the next meeting as part of the report on the Integrated Care Partnership (ICP).

The Committee agreed:

1.      That the provision of facilities including the comfort of chairs provided to patients waiting in the emergency department be considered.

2.      That BCCG add the inclusion of extended access appointments to the Patient Access App to their action plan.

3.      To receive a further update on succession planning to the next meeting of the Committee as part of the report on the Integrated Care Partnership.