Agenda item

To consider a presentation from the Chief Executive and Director of Operations, Stockport NHS Foundation Trust.

Following on from the presentation made to the Scrutiny Committee in July 2013, this presentation will provide an update to the Committee on the actions taken by the Trust to address performance against the 4 hour target for unplanned admissions.

Details of the previous meeting at which this matter was considered can be found at http://democracy.stockport.gov.uk/ieListDocuments.aspx?CId=153&MId=5322&Ver=4

Ann Barnes (Chief Executive) and James Sumner (Chief Operating Officer), Stockport NHS Foundation Trust, attended the meeting and provided an update on progress with implementing the Trust’s action plan to address performance against the 4-hour target for unplanned hospital admissions. A copy of a briefing report was also submitted (copies of which were circulated).

The update provided background information to the reduction in performance in the previous year that had prompted the involvement of Monitor, the NHS Regulator, and highlighted actions taken by the Trust since the last update made to the Scrutiny Committee in July 2013.

The following issues were highlighted:-

·         Performance against the 95% target had improved and the Trust had achieved the standard for the preceding two months and was currently above the target level for October up to the date of the meeting.

·         The eight point plan agreed with Monitor had been delivered, with the exception of the recruitment of Emergency Department (ED) consultants where repeated attempts had proven unsuccessful. Recruitment of these consultants, as well as middle grade doctors, remained a challenge.

·         New services had been introduced including the Ambulatory Care Unit, a pathfinder project with the North West Ambulance Service, and IV Therapy Pilot, put in place to ensure those who did not need to be admitted were kept out of hospital.

·         The additional Winter Pressures resources would be targeted to those areas of highest need in collaboration with the Clinical Commissioning Group (CCG).

The following comments were made/ issues raised:-

·         Difficulties in recruitment reflected a national trend. Plans were in place to recruit to other posts/levels to support and supplement the expertise already in place. Expanding the number of Nurse Practioners through training of existing staff was being undertaken.

·         The allocation of the £1.5m of extra, non-recurrent A&E monies was to support projects that would realise savings elsewhere in the system. Many of these projects were genuinely innovative. One of the projects was to provide additional support to target repeat attendance caused by or related to alcohol.

·         Addressing dangerous alcohol consumption was complex and required changing ingrained patterns of behaviour. This was not necessarily most appropriately done in a hospital setting.

·         There was an excessive dependence on hospital care in Stockport and this would have to change in the future as it was unsustainable and unaffordable. Greater emphasis on prevention and community delivery was needed. Encouraging the public to use the most appropriate services was continuing.

·         There was a danger of patients becoming lonely and isolated if more care was provided at home. This was being considered as part of the work on health and social care integration and Stockport One.

·         The project with the North West Ambulance Service, to try to ensure only emergencies were brought to hospital, had been very successful so far although further work was needed to verify the data. It was not yet possible to identify how many patients may later have been admitted. The pilot demonstrated the efficacy of the work of the Ambulance Service in deflecting non-emergencies but also highlighted the willingness of the public to call an ambulance for GP-manageable conditions or even for inappropriate issues.

·         Out of hours care was key to the overall approach to reducing hospital admissions and A&E attendances, but patients often felt unsure about the treatment so were not able to make the right choices when they needed assistance. The cost of the alternatives to this service meant that it had to be given the opportunity to succeed.

·         Phase 2 of the work to address unplanned admissions was to try to quantify the number of admissions could have been more appropriately dealt with in other ways, outside of the hospital setting, to ensure the right care was provided.

RESOLVED – (1) That Ann Barnes and James Sumner be thanked for their attendance and presentation.

(2) That the Chief Executive, Stockport NHS Foundation Trust be invited to provide a further update on performance in relation to unplanned admissions to a future meeting of the Health & Wellbeing Scrutiny Committee in the New Year.