Agenda item

To inform the Health Scrutiny Committee of the specific activities undertaken around winter health planning across the Blackpool Health Economy and Fylde Coast area (involving local health service commissioners and providers of services).

Mr David Bonson, Chief Operating Officer, Blackpool Clinical Commissioning Group; Graham Curry, Sector Manager, North West Ambulance Service; and Neil Upson, Deputy Director of Operations, Blackpool Teaching Hospitals presented an update on specific activities undertaken around winter health planning across the Blackpool Health Economy and Fylde Coast area (involving local health service commissioners and providers of services).

David Bonson explained that a wide range of planning work had been undertaken recognising that demand pressures on acute and emergency services increased significantly during the winter period. Some regular services closed during the holiday period but demand needed to be managed and had increased in 2016.

He explained that planning followed national guidance which created standard local systems, structures and processes.  An Accident and Emergency Delivery Board, had been created for the Fylde Coast area incorporating Blackpool with a full range of executive decision-makers from health and social care commissioners and service providers. The Board was supported by an Emergency System Resilience Group which met weekly to review the previous and plan ahead. The Board would take more of a lead role as pressures increased.

David Bonson highlighted one of the key new elements being a structured approach to operational levels. There were four operation pressures escalation levels: a basic level one for day-to-day operations at an ordinary level of demand and management; level two for a slight increase in pressures requiring additional action; level three reflecting major pressures and level four where there were severe risks of unmanageable pressures. Each level was underpinned by the need for ensuring patient safety and sufficient resources to manage demand. 

He added that operations were currently at level two and outlined some new areas of planning. Primary care services (GPs) were more involved with enhanced opening times over the Christmas period and ability to take on non-routine appointments. The walk-in Whitegate Health Centre was offering standard and emergency slots. Pharmacists were ensuring their opening times allowed access to at least one pharmacist at any given time. Dentists were providing greater access through a ‘single point of contact’ dental helpline.  

Graham Curry profiled the pressures that the North West Ambulance Service was under. Call rates were up 10% totalling around 3,900 calls daily of which around 12% were managed through the NHS 111 advice line. To help manage the increased demand and support emergency responses more, resources were being pooled from different areas of the Ambulance Service. These included Urgent Care, NHS 111 and the Patient Transport Services.

He explained that one particular recent change had been simplifying the wide range of incident codes for telephone calls received from over 221 ‘red one’ codes (fastest response times required) to 16 codes. The streamlining made it easier and quicker for operators to process calls and allocate resources for these life threatening incidents.  He added that an Integrated Virtual Hub had been developed for managing a wide range of advice calls for the public and staff in the Urgent Care Service. Paramedics also reviewed incidents so that 48% of 999 emergency calls did not need to go to hospital but instead more appropriate routes such as GPs.  Other initiatives included paramedics and occupational therapists visiting vulnerable people at home to help prevent falls leading to a reduction of 70% less people going to hospital due to a fall. Mental health nurses worked closely with people at home.

Neil Upson referred to the 95% target for accident and emergencies to be dealt within four hours of arrival were not being met. There were seasonal variations with hospital attendances for same day treatment increasing in the summer based on visitor numbers but admissions for hospital stays did not go up. During summer both attendances and admissions had gone up.  Usually in winter attendances reduced but admissions increased.

He referred to a range of initiatives to reallocate resources including eighteen beds from scheduled care to emergency cases and release pressures at the acute care sites. The acuity (severe) care service had reduced discharges to the same day from previously one to three days. The frailty service had also been speeded up to reduce discharges to the same day freeing up five beds for emergencies. Twelve unused beds at the Clifton unit had been brought back into use. The therapy service also aimed for same day discharges. Reference had been made earlier to opening times increased for the walk-in Whitegate Drive Health Centre. The acute services were also working closely with the Council’s Social Services to develop fifteen extra packages of care and more integrated health and social care planning including ten beds being made at the Arc facility. Reducing outpatient clinics meant that key clinical staff would be more focused on emergencies.  

The Chairman noted that the winter health planning report was not very reader-friendly with a range of acronyms. He asked what would be the response if a (severe) operational escalation of level four was required. Neil Upson acknowledged that level four was rare but extremely challenging. The senior executive team would take responsibility for deciding actions which could include cancelling non-critical work and operations (after careful consideration was given), making sure all key staff were on-call and all staff briefed. Patients would be appropriately discharged.

In response to Committee comments that it might seem an unseemly rush to get people out of hospital, Neil Upson gave an assurance that people would only be discharged if appropriate and that being in hospital did not fully support people’s recovery. Community care was better although there were resources pressures across hospital and community care. The Committee enquired if records were kept of patients discharged who were readmitted not long after.  Natalie Davidson, Assistant Director (Resilience Management) explained that data was analysed for patients who returned within thirty days to identify the cause/s and whether early discharge had been a factor. Experienced staff communicating well with patients ensured that readmissions had reduced but there were still resource issues.

In relation to resource pressures, Members enquired if the voluntary and private sectors were called upon. Graham Curry confirmed that St Johns Ambulance was used particularly at peak times such as New Years’ Eve. He added that private ambulances did offer a significant but very expensive resource so were not a first port of call.

The Committee enquired about the impact of ‘repeat’ callers who constantly rang the 999 emergency line. Graham Curry explained that the issue was well known and there were structured processes to manage the issue. Often people had mental health issues or were lonely so situations had to be dealt with sensitively and social services were often involved to offer support. In extreme cases, the police and courts became involved with anti-social behaviour orders imposed.

In response to Members’ concerns on ambulance handover times at hospitals, Graham Curry confirmed that the issue was a strain on patients waiting for an ambulance and also volunteer and rapid response crews who needed to wait for experienced paramedics. However, Blackpool’s ambulance response and waiting times were better than comparable neighbours. He added that hospitals only admitted people who were genuinely ill so that ensured some demand management.

The Committee noted the report and thanked the health representatives for their efforts.