Issue - meetings

6.1       The Committee considered a report providing an update on the work being undertaken to reduce Hospital Handover times between South East Coast Ambulance NHS Foundation Trust’s (SECAmb) ambulances and the EDs of the three hospital trusts that provide services to East Sussex residents.

6.2       The Committee asked how communication could be improved between EDs and the 111 service to prevent reserved time slots being given out at times of higher demand in the ED.

6.3       Ray Savage, SECAmb Head of Strategic Partnerships and System Engagement answered that it was possible to indicate times of pressure for specific service pathways to 111 call handlers, as well as remove the option to book appointment slots at peak times, on the Directory of Services. Ray agreed to check whether this was the same process for booking appointment slots at EDs.

6.4       The Committee asked why the report showed average response times increasing as of May 2023 and how those increases were being mitigated.

6.5       Ray Savage noted that hotter weather led to an increase in demand for health services generally, so the sustained period of hotter weather during May and June had caused the increase. Matt Webb, SECAmb Associate Director Strategic Partnerships and System Engagement also noted there had been an increase in the daily average number of calls since January, but that despite the increase, average ambulance response times remained within defined tolerances of targets.

6.6       The Committee asked why the Pembury hospital had a fewer number of delays and what learning could be applied from this to other hospital sites.

6.7       Ray Savage commented that handover delays where often a consequence of other challenges at a hospital site, and that Maidstone and Tunbridge Wells NHS Trust (MTW) had done a significant amount of work to improve patient flow through the hospital. Laura O’Mahony, MTW Deputy General Manager Emergency Medicine added that having a dedicated member of staff on duty to assist ambulance crews with administration had helped in reducing delays. Hospital avoidance work was also important, such as by using virtual wards and 111 integration to direct patients to Urgent Treatment Centres rather than EDs.

6.8       The Committee asked what was causing the high level of sickness among staff and what was being done to address it.

6.9       Laura O’Mahony explained that a lot of the problems with sickness was due to staff burnout and low moral across the workforce after a difficult few years in the health service. At MTW sickness levels were decreasing and the Trust continued to monitor the situation and was putting a lot of work into supporting staff wellbeing.

6.10     The Committee asked if there was detailed information of any differences in average ambulance response times in different areas of the county.

6.11     Ray Savage confirmed that SECAmb had to report its data across its whole operational footprint, so this was not broken down by specific areas. SECAmb did monitor its own local performance to understand how responses differed between urban and  ...  view the full minutes text for item 6

13.1.    The Committee considered a report providing an update on the work being undertaken to reduce Hospital Handover times between South East Coast Ambulance NHS Foundation Trust’s (SECAmb) ambulances and the Emergency Departments (ED) of the three hospital trusts that provide services to East Sussex residents.

13.2.    The Committee asked why performance at the Royal Sussex County Hospital (RSCH) was an outlier compared to other hospital trusts, particularly given conveyances to the hospital had not increased recently, and asked whether enough was being done to improve the service when compared to the number of actions being taken elsewhere.

13.3.    Harvey McEnroe, Managing Director for University Hospitals Sussex NHS Foundation Trust (UHS), said UHS accepts that the RSCH continues to be an outlier in its handover performance, despite improvements in other hospitals owned by UHS. There are three reasons for this:

1.    the challenges with the estate restricting the flow of patients through the ED, made worse by COVID-19 infection prevention measures restricting how the corridors are managed;

2.    the increasing acuity of patients presenting at the ED via ambulance makes it more complicated to manage them, having a knock-on effect to admissions, despite the Urgent Treatment Centre (UTC) and Same Day Emergency Care (SDEC) streaming off lower acuity capacity; and

3.    the flow of admissions through and out of the hospital, including delays in discharging patients, has a knock on effect on the flow of patients from ambulances into the ED. The hospitals improvement programme is aiming to improve the flow of patients within the hospital, but there is a wider system issue with the number of Medically Fit for Discharge (MFD) patients waiting for discharge, which has not improved as much as other UHS-run hospitals.

13.4.    There is an additional issue of the fatigue of staff following an extremely difficult winter and summer and the lingering effects of COVID-19. This limits the extent to which staff can respond to changes in the ED. He clarified they are being helped as much as possible through the process. 

13.5.    Harvey McEnroe explained that the Trust is developing an Urgent and Emergency Care Improvement Plan for RSCH that will set out plans to improve patient flow. The top priority for UHS is to eradicate the 60-minute handover delays and then prioritise 30-minute handovers. The relationship between the ED Team and SECAmb has dramatically improved over the past 6-8 months, in part driven by the implementation of Fit 2 Sit and the Full Capacity Protocol (which moves people out of ED to prioritise the ambulance crews), and by replacing the culture of seeing the ambulance queue as an extension of the ED and treating them as a priority. Ray Savage confirmed SECAmb is working incredibly hard with UHS to expedite handovers at the RSCH, including embedding a member of staff in the department during busy periods to assist ED teams. He added that handovers are a system wide issue and often delays in the ED are caused by the delays in  ...  view the full minutes text for item 13

32.1     The Committee considered a report on hospital handovers, introduced by Ray Savage and Julie-Marie Allsopp-West from SECAmb and Richard Milner, Director of Strategy, Inequalities & Partnerships at East Sussex Healthcare NHS Trust (ESHT). It is recognised by SECAmb, ESHT and the CCG that delays in hospital handovers can cause patient harm. Much work has been undertaken to reduce delays over 60 minutes and the current focus is on achieving patient handover in under 30 minutes and meeting the national target of 15 minutes. Work is undertaken to support ambulance crews with handovers and hospitals are alerted whilst on route if an ambulance has a critically unwell patient. ESHT is working on this with SECAmb with a new set of targets for Emergency Department handovers and initiatives like “fit to sit”, ambulance awareness week, and dedicating 2 bays for handovers.

32.2     The Committee asked if there was a difference in handover times between the Conquest and Eastbourne DGH hospitals.

32.3     Ray Savage responded that performance between the two hospitals fluctuates, with a low point around September 2021. Separate charts showing the different hospital performance can be provided to HOSC in future.

32.4     The Committee welcomed the collaborative approach between SECAmb and ESHT to reduce handover times with initiatives like “fit to sit” and ambulance awareness week and asked why the handover time figures at the Royal Sussex Hospital were so high with 207 delays over 60 minutes in December.

32.5     Ashley Scarff responded that work is also taking place with colleagues in Brighton to reduce delays as a matter of priority. There is an acknowledgement that handover delays are symptomatic of wider system pressures and delays in patients flows through hospitals. The CCG is working closely with the Royal Sussex Hospital and the Brighton and Sussex University Hospitals NHS Trust (BSUH) on a refreshed hospital handover improvement plan, which will include sharing any learning from colleagues. It should be noted that the Royal Sussex has tertiary service pressures and estates constraints, but there is some work that can be done to reduce demand and improve patient flows and discharge.

32.6     The Committee asked if patients can be taken directly to ambulatory and emergency day care or do they have to go through A&E.

32.7     Julie-Marie Allsopp-West responded that there are some pathways to take patients directly to the right part of the hospital such as maternity and surgical, but not ambulatory care yet.

32.8     The Committee asked if stroke patients are included in the figures in the report.

32.9     Julie-Marie Allsopp-West confirmed that stroke patients are included in the figures. For stroke patients the receiving hospital is pre-alerted, and the patient is handed over to the team waiting for them within 15 minutes.

32.10   Ray Savage commented that admissions avoidance and the focus on alternative pathways (e.g. direct access bookings) is part of the current work. Work is also being undertaken to provide easy access to specific pathways that avoid A&E and identify suitable alternative pathways (e.g. a  ...  view the full minutes text for item 32