Agenda item

The Chief Executive of the Stockport NHS Foundation Trust will attend the meeting to discuss ongoing efforts to reduce unplanned admissions and reduce A&E waiting times.

The Chief Executive (Ann Barnes) and the Acting Director of Operations & Performance (James Sumner) from Stockport NHS Foundation Trust attended the meeting to update the Scrutiny Committee on efforts to improve performance in relation to the healthcare standard requiring 95% of patients be admitted or treated and discharged within 4 hours of attendance to the Emergency Department of the hospital.

Stepping Hill Hospital had approximately 7,500 patients attend its Emergency Department each month, of which approximately 25% would be admitted. In the year to date attendance had increased by 3.9% and an increase in admissions of 7.6%, peaking during the winter period at 30-40% admissions. This pressure had required additional bed capacity to be found.

A hospital which had two successive quarters of not meeting this standard would trigger intervention by the NHS regulator Monitor. In the case of Stepping Hill Hospital, performance had been below this target for three consecutive quarters and had resulted in Monitor notifying the Trust at the end of January that it was in breach of its Authorisation. Leading up to this and since the notice was issued, the Trust had been having regular meetings with Monitor as part of the delivery of a rectification plan to address both the below target performance and to address more long term pressures on unscheduled care.

The Plan that had been agreed anticipated compliance with the 95% target by September of this year. The Plan was based on the assumption that the winter pressure on admissions would continue, therefore it was hoped that because of the prudence built into the Plan’s assumptions, compliance could be achieved earlier.

The Trust had been subject to a range of external reviews in addition to those by Monitor, all of which had found that the Trust’s Plans were sound and that appropriate progress was being made.

The following comments were made/ issues raised:-

·         In response to questions about failing to fully implement the Plan, it was stated that for each measure contained within it there were a range of contingencies to ensure that compliance would be achieved. The Plan had also been developed to ensure that the measures within it would have a long term impact, be sustainable and that improvements would result from the measures, not simply because of changing levels of demand. The difficulties being experienced by the Trust should be seen in the context of a national trend of worsening performance.

·         The Plan had been developed with the assumption that levels of demand would remain high, and had not factored in any of the other actions being taken by the Trust or the Clinical Commissioning Group to address unplanned admissions, such as the Stockport One project. Members welcomed the focus on reducing demand and prevention rather than reactive care, although it was recognised that it would take time to overcome a public culture of prioritising hospital care.

·         There was no clear pattern to Emergency Department admissions and as such no ‘quick fix’. GPs were provided with feedback as to the distribution of people presenting. The Trust was confident, supported by the opinions of other bodies, that they had correctly identified the causes for reduced performance and the remedy.

·         The difficulty of being seen to ‘turn people away’ to more appropriate care opportunities, such as GPs and pharmacies, was recognised. Careful management and working closely with other providers was important to ensure appropriate care was provided but also that the public were not using this as a bypass to a GP appointment. The Trust’s involvement in community care meant that it was better placed to prevent avoidable escalations for those with existing conditions.

·         In response to questions, it was stated that the three most important practical actions the Trust was taking were: (i) improving discharge from hospital and ensuring a senior doctor take responsibility for moving patients through their care pathway; (ii) increasing in-reach capacity; and (iii) recruiting additional Acute Physicians.

·         It was accepted that improving ambulatory care would be a significant step in improving unplanned admission rates, but due to the complexities of developing these services, time was needed to ensure appropriate pathways were put in place.

·         The cost of delivering the Plan and other changes discussed would be less than the cost of increasing capacity for admissions. It was hoped that once implemented, the Plan would help deliver both savings and improvements to the wider health economy.

·         The Trust Board were fully committed to the implementation of the Plan, and although some front-line staff had concerns, all staff recognised the need for change.

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

(2) That the actions of the Stockport NHS Foundation Trust in addressing performance in relation to unplanned admission times be noted, and that the Chief Executive be requested to provide an update to the Scrutiny Committee on progress with the implementation of the Rectification Plan to the meeting on 23 July 2013 and that the Scrutiny Committee would welcome being kept informed of developments prior to that meeting.