Agenda item

To consider the performance of the Blackpool Clinical Commissioning Group for 2016-2017 (April 2016 - March 2017).

Mr David Bonson, Chief Operating Officer, Blackpool Clinical Commissioning Group presented the Clinical Commissioning Group’s end-year performance for 2016-2017 (April 2016 - March 2017).

The Chairman noted that the target of 92% had been missed for treating patients within eighteen weeks. Those patients had been referred for treatment as they had on been on ‘incomplete’ pathways of care. Mr Bonson explained that the target had just been missed. Local Trust performance had been on track but the overall results had been affected by issues at the Lancashire Teaching Hospitals NHS Foundation Trust’s Preston site. Those issues had been escalated to specialist commissioners and an action plan developed. He gave assurance that Blackpool residents had not been adversely affected.  

Members noted that eight out of nine cancer treatment targets had been met. However, performance had been 82.1% for first definitive cancer treatment within two months of GP referral. The target was 85%. Mr Bonson gave assurance that Blackpool Teaching Hospitals was on track but other factors meant the target was missed. The factors included delays due to patient choice and complex conditions.

The Chairman referred to the ‘Category A’ (third tier of response time) missed target for ambulances being at an incident within 19 minutes of a call. Performance had been 90.5% against the 95% target. Mr Bonson had previously explained that Blackpool Clinical Commissioning Group acted as the regional commissioner for the North West Ambulance Service. He confirmed that the figures in the report represented performance within Blackpool.

Mr Bonson noted that ambulance response targets were usually achieved as Blackpool was a relatively small urban area in contrast to more rural areas, such as Fylde and Wyre. He explained that service demand pressures had been much higher than predicted and added that all urgent services had been under pressure during the winter period. Usually post-winter pressures eased but this year had been proving more challenging. Related pressures included the patient handover at hospitals with delays resulting in fewer ambulances actively on the road.  Modernisation initiatives were being pursued with the Ambulance Service, e.g. more carefully identifying during calls whether other options were more appropriate than an ambulance and where possible treating people at the scene.  Improvements were being made and performance had been gradually heading in the right direction.

Members noted that often people were inappropriately attending Accident and Emergency. This had resulted in 87.9% of people receiving appropriate treatment or response within four hours of arrival against a target of 95%. Mr Bonson explained that the Department for Health recognised current extreme pressures so an interim target of 90% by September 2017 had been set although the 95% longer-term target remained.

Members enquired how attendance was being tackled and people prioritised.  They added that alternatives such as the Whitegate Health Centre existed. Mr Bonson explained that more focus had been given to managing ‘front door’ services, e.g. for minor ailments directing people towards primary care where GPs and nurses were increasingly treating minor ailments. Minor treatment which could be managed at GP practices amounted to 25% of Accident and Emergency incidents. He added that hospitals were not the ideal environments to aid people’s health and wellbeing but people genuinely needing hospital treatment would be supported. People generally still prescribed to Accident and Emergency always being available so awareness-raising campaigns such as ‘Think Accident and Emergency’ had been promoted, including ringing the NHS 111 non-emergency advice line first rather than going straight to Accident and Emergency. 

Mr Roy Fisher, Chair, Blackpool Clinical Commissioning Group, re-iterated that many people genuinely needed to access Accident and Emergency. Issues included ‘delayed discharges of care’ (from health services to social care) due to shortage of beds unable to meet demand.  However, the Council’s Social Care managers met regularly with Blackpool Teaching Hospital’s Discharge Team to manage patient flow and local Accident and Emergency performance was above the national average.  He added that evolving initiatives included new neighbour hubs which, from September 2017, would bring GPs, other health staff and social workers together. The hubs would also aim to offer people another option to Accident and Emergency.

Members referred to the number of people in Accident and Emergency who had spent over twelve hours on a trolley whilst waiting for a bed. The target was zero incidences of such long trolley durations but thirty-three incidences had occurred. Members noted that patients should be admitted in good time with access to beds. They were aware that delays often occurred for non-treatment reasons such as completion of paperwork or waiting for prescriptions. This meant that patients who were fit to go home had to wait, delaying the availability of beds for other patients.

Mr Bonson explained that the incidents had occurred over small periods of time, i.e. over a few days of exceptional winter demand pressures. He gave assurance that all incidents were recorded and investigated leading to improvement actions taken and lessons learnt. He added that the trolleys were modern, with a range of features including being adjustable but agreed that the situation was not ideal. He explained that there needed to be timely hospital discharges so that the system flowed smoothly. Experts with experience in developing effective discharge systems had been appointed to help create more effective systems. Mr Bonson confirmed that there were clear recorded timelines for each stage of the process, e.g. ambulance arrival through to discharge. He added that there were no additional beds so that managing patient flows better was imperative.