Issue - meetings

25.1     The Committee considered a report by the Assistant Chief Executive providing information on South East Coast Ambulance NHS Foundation Trust’s (SECAmb) planning for 2015/16 winter pressures and other issues.

25.2     Paul Sutton, Chief Executive, and Geraint Davies, Director of Commissioning, provided HOSC with a PowerPoint presentation and, in response to questions from the Committee, provided the following additional information:

Winter period

·         SECAmb considers that the key focus period during winter takes place between 1 December and 12 January – even though the worst winter weather may come after that period – because it is during that time when the availability of NHS staff is at its lowest. After 12 January, the system begins to get back to its normal availability.

Handover times

·         There is a national standard for handover time of 15 minutes after arrival at hospital. However, because three-hour delays are a routine occurrence in some hospitals in the South East, this target is nowhere near to being met.

·         SECAmb considers it to be inappropriate from both a clinical and patient experience perspective that patients often have to wait for hours at a time on an ambulance trolley. As a result, the Trust continues to point out to Monitor, NHS England, and the NHS Trust Development Authority (TDA), that the 15 minute handover time is being ignored. 

·         It is the policy of SECAmb to tolerate a certain amount of delay in the handover time between ambulance crew and the hospital staff and the Trust tries to support the situation by both keeping its ambulance crews on site for as long as it can, and employing a Hospital Ambulance Liaison Officer (HALO) to try to help coordinate and speed up the process of handover.

·         SECAmb now has in place an Immediate Handover Policy that is used when there is a very serious incident that necessitates the immediate withdrawal of ambulance crews who are waiting to handover patients at a hospital, for example, when there is a cardiac arrest in the community that requires an immediate response and there are no free ambulance crews to attend to it. The ambulance crew inform the HALO and hand over their patient to the care of hospital medical staff. 

·         If the national standard for handover times was enforced, it is arguable that acute trusts would recognise that responsibility for the cohort of patients in the hospital rested firmly with them and would do more to achieve the handover time, for example, by employing handover nurses who fulfil the role currently performed by ambulance staff. ESHT and BSUH have carried out initiatives that have improved handover times at the Royal Sussex County Hospital in Brighton, EDGH, and Conquest Hospital. The Sussex-wide Urgent Care Network is meeting on 16 December to discuss handover times.

111 patient triage

·         During the winter period 2014/15, 111 activity was at its peak and there was low confidence within the organisation of the accuracy of the categorisation of those 111 calls. In response, the Trust Board developed a pilot programme  ...  view the full minutes text for item 25

26.1     The Committee considered a report by the Assistant Chief Executive providing an update on the planning across the local health economy to deal with seasonal demand surges, extreme weather, and other issues associated with the winter months.

26.2     Wendy Carberry, Chief Officer, HWLH CCG; and Dr Susan Rae, Clinical lead for urgent care and health inequalities, Hastings and Rother Clinical Commissioning Group (HR CCG); provided the Committee with a presentation on System Resilience Planning - which is used to prepare for and manage periods of increased demand such as winter, and other periods, throughout the year.

26.3     In response to questions from HOSC, Wendy Carberry, Dr Susan Rae, and Nicky Young, Whole Systems Programme Manager, provided the following additional information:

·         The CCGs have invested £4.1m to address additional patient flow to ESHT during winter – this is additional money provided by the Government specifically for investing in services that mitigate against winter pressures. Some of that funding is to support additional wards opened up in either acute or community hospital sites called “escalation areas”. The funds have also been spent on additional social workers and therapists to support the flow out of these beds both in the community and in A&E departments. The CCGs are also investing in out of hours services, for example, to ensure that there is a prescribing pharmacist to deal with repeat prescriptions over the weekend to free up GP capacity.

·         As part of the System Resilience Planning, CCG project managers work across the healthcare system to assess the number of beds that will be needed, and where best they should be located, for example, an extra 12 step-down beds were identified as being needed in the Eastbourne area. The CCGs then discuss with the private sector home care and care home providers about their available bed capacity to meet this demand, for example, Milton Grange is providing these step down beds. This system resilience work also provides the CCGs with the opportunity to test and evaluate commissioning strategies that, if successful and popular, could be rolled out across East Sussex.

26.4     The Committee RESOLVED that it had considered and commented on the report, its appendices, and the presentation.