Agenda item

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 blocked catheter could be actioned by a community nurse). Alternative end points for ambulance crews such as more access to same day emergency care is also being explored.

32.11   The Committee noted that not all ambulance journeys have the same urgency and asked if there is some clinical prioritisation for handovers.

32.12   Julie-Marie Allsopp-West outlined that the more critically ill patients will have a pre-alert and non-critical patients will be taken into hospital based on their clinical need. If all patients arriving at the same time have the same level of clinical need, then the one that has been waiting the longest would be taken in first. Ambulance crews review observations whilst waiting and can escalate patients if they become more unwell or unstable to ensure the  patients with the greatest clinical need are seen first.

32.13   The Committee asked if the NHS and local government are getting together to work on this issue.

32.14   Mark Stainton, Director of Adult Social Care commented that working together is part of the answer. The delays in hospital handovers are a symptom of a whole system pressure and as such is a whole system priority which includes Adult Social Care. There is a need to ensure that only patients that need to be conveyed to hospitals are transported to them. There is an increase in activity that all parts of the system, and there are challenges with staff recruitment and retention across the system. There is work to be done on systems and processes that contribute to hospital admission and to enable discharge. There are challenges with patient flows through hospitals and as a local authority East Sussex County Council (ESCC) is block booking home care and residential care to facilitate discharges. It is also working with the independent care sector on staff recruitment and retention. Richard Milner added that there are challenges around patient flow through hospitals and discharges. This is where working as a system on discharges helps to achieve a balance between admissions and discharges.

32.15   The Committee asked if the Joint Community Rehabilitation (JCR) service also operates at the Royal Sussex Hospital where patients from the Newhaven and Seaford areas might be taken.

32.16   Mark Stainton confirmed that the JCR is a countywide service and there are also staff based in the Royal Sussex hospital where East Sussex residents may be taken.

32.17   The Committee RESOLVED to:

1) Note the report; and

2) Request a further update report in six months time at the September Committee meeting, including the actions being taken at the Royal Sussex and Pembury hospitals to reduce hospital handover times.