Agenda item

Ann Barnes (Chief Executive) and James Sumner (Director of Operations), Stockport NHS Foundation Trust have been invited to the meeting to provide an update to the Scrutiny Committee on unscheduled admissions to Stepping Hill Hospital.

Details of the previous meeting at which this matter was considered can be found at http://democracy.stockport.gov.uk/ieIssueDetails.aspx?IId=13559&Opt=3

Ann Barnes (Chief Executive) and James Sumner (Director of Operations), Stockport NHS Foundation Trust, attended the meeting to make a presentation to the Scrutiny Committee in relation to the Trust’s performance against the 4-hour Emergency Department (ED) Target and their ongoing efforts to address increased attendances at ED.

Mark Chidgey (Director of Quality & Provider Management), Stockport Clinical Commissioning Group (CCG) and Terry Dafter (Director of Adult Social Care), Stockport Council, also attended the meeting to provide input into the discussion from the perspective of their respective organisations.

The presentation covered the following issues:-

·         In November 2014, the Hospital were continuing to implement the measures set out in the Trust’s Action Plan to address unscheduled care, and performance was fairly consistently above or just below the 95% target.

·         From the second week in December the Hospital experienced unprecedented pressure. This pressure was not related to increased attendances at ED, nor because of significant increases in inappropriate attendances but was due to the increase demand from frail, elderly patients with respiratory conditions. Many of these patients also had complex needs requiring social care support (between 40-50%, up from the usual 20%).

·         The challenge for the hospital and other parts of the economy was to create sufficient capacity to allow for patients to be appropriately discharged. The problems with waiting times encountered by the ED, reported in the national press, were largely a consequence of the lack of ability to discharge to other appropriate care.

·         The hospital responded to the pressure by making provision to accommodate additional medical patients using winter resources and with additional areas, as well as additional staff being used to meet the demand.

·         The Trust ensured daily monitoring was in place to maintain safety and review provision. A conscious choice was made to prioritise the safety of patients over the performance target.

·         The Trust, CCG and the Council collaborated to address discharge challenges to create capacity and ease the pressure on the Hospital and ED.

·         Although the immediate pressure had subsided for the Hospital and for primary care, there remained risk for the remaining months of winter should the weather worsen or in the event of a flu outbreak.

·         Given the nature of the problem, the Trust and partners had coped well with the additional, unprecedented pressure.

Terry Dafter echoed the points made in the presentation, in particular the unprecedented nature of the pressure. He emphasised that the medical needs of the patients, the average age of whom was 90, meant that they could not be deflected from hospital to other services. Adult Social Care Services had also experienced severe pressures as a result of the respiratory illness affecting its service users.

Mark Chidgey stated that the pressures experienced by the Hospital had been reflected across the local health system with significant additional pressure on primary care and GPs. The CCG had worked with the Trust to ensure quality and safety were maintained and that the Trust’s contingency plans had been implemented and were fit for purpose.

Councillors asked questions and made comments on the presentation and issues around ED and the pressures on admission. These included:-

·         Given the national pressures on hospitals and EDs, why was performance at Stepping Hill the worst nationally? In response it was stated that as part of the ongoing work to address unscheduled care, improving discharge had been identified for action under phase 3 of this project. Because this issue had not been systematically addressed prior to this winter Stepping Hill Hospital faired proportionately worse than other hospitals. The Trust nevertheless stood by its approach of prioritising safety over achieving the 4 hour target as this was in the best interests of patient safety.

·         Was consideration given to declaring a major incident as other NHS trusts/ hospitals had done in response to the particular illness/ pressure? In response it was stated that actions taken by the Trust in terms of staffing levels etc., had the same effect as declaring a major incident so such an action was not warranted.

·         Given the problems with discharge, was there sufficient capacity in the social care/ care home system? In response it was stated that overall there was, although there were some specialist care placements that may need greater capacity. A positive effect of the recent pressure was that new providers had been sought and entered the local market. Further consideration would be needed to ensure that fee levels were appropriate and this would be subject to consultation with providers.

·         In relation to the impact on budgets, it was stated that discussion would take place between the Council and CCG in order to identify where reimbursement was appropriate, but that there was inevitably some additional costs to be borne by all parties. The Government had also announced additional money to support those local authorities worst affected by these pressures, although it remained unclear whether Stockport would benefit.

·         In relation to queries about the impact on other hospital services, it was stated that approximately 100-120 surgeries had been postponed to accommodate the additional medical patients, but that surgical patients had been offered alternative dates or providers wherever appropriate. Disruption to other hospital services had been kept to a minimum as many were needed to ensure people were prevented from needing hospitalisation.

·         It was suggested that trying to understand the geographical distribution of those attending/ being admitted would be useful in identifying what, if any, preventative community services were being used effectively and those that were not as successful.

·         It was commented that there was value in seeking to understand and address the recent problems through looking at the whole system. A balance needed to be struck between providing redundant capacity in the system and preventing this then being filled with lower need that might not otherwise use it and would be more appropriately be dealt with elsewhere.

The Chair summarised the discussions and highlighted the following:-

·         the Scrutiny Committee had previously accepted that safety and quality should take priority over meeting performance targets and accepted that this had been the case during December 2014/January 2015;

·         that despite the high demand the health and social care system as a whole had coped well in response, given the high average age and the fact that there were high numbers of very poorly patients with complex needs;

·         the target was ambitious for the Trust to meet and that risk remained in the event of a flu outbreak or very cold weather.

RESOLVED – (1) That Ann Barnes, James Sumner, Mark Chidgey and Terry Dafter be thanked for their attendance and presentation.

(2) That the Chief Executive of Stockport NHS Foundation Trust be invited to report back to the Scrutiny Committee in the new municipal year on performance in relation to the 4-hour admission target and the Trust’s experience following the end of the winter period.