Agenda item

25.1     The Committee considered a report updating the HOSC on hospital handover delays at the Royal Sussex County Hospital (RSCH) and ongoing work between University Hospitals Sussex NHS Foundation Trust (UHSx) and South East Coast Ambulance NHS Foundation Trust (SECAmb) to reduce them.

25.2     The Committee asked whether it was a challenge working with three different social care authorities in discharging patients and ensuring patient flow.

25.3     Ali Robinson, UHSx Deputy Divisional Director of Operations, Medicine, said that it was a challenge working with three social care authorities, particularly at RSCH as it was the regional tertiary hospital. Proportionally there were more patients with No Criteria to Reside (NCtR) that were East Sussex residents. At RSCH there was a Transfer of Care Hub that worked across care providers and systems to match patient need as appropriate.

25.4     The Committee asked whether there would be a separate area in ED for patients with severe mental health issues.

25.5     Ali Robinson noted that this had been an area of sustained difficulty at the RSCH, and more recently UHSx had been working closely with SPFT to address estate issues. A section of the RSCH ED had been allocated to accommodate mental health patients, however this involved a trade-off with other physical health beds on the site which was another area of pressure. This area was staffed by a specific group of staff, separate from the main ED. The ICB was exploring whether there was scope to commission a specialist facility within Brighton & Hove that would ensure better support for patients in acute mental health crisis.

25.6     The Committee asked what learning had been taken from better performing hospital trusts with fewer delays.

25.7     Ali Robinson noted that UHSx and SECAmb had explored with a number of hospital sites about effective improvements and initiatives that had been implemented to reduce handover delays. The continuous flow model had been taken from another hospital.

25.8     The Committee asked what equipment ambulances carried to support patients with respiratory issues.

25.9     Paul Fisher responded that when an emergency call was received it would be triaged and SECAmb would aim to send the most appropriate resource. All ambulances carried oxygen and nebulisation was also available, although not all staff were authorised to deliver nebulised therapy. Critical care paramedics had advanced airway equipment and could attend emergency scenes as required, however in most circumstances a general response paramedic ambulance was able to support a patient with respiratory illness.

25.10   Cllr Turner requested follow up information on whether all emergency response ambulances carried CPAP equipment.

25.11   The Committee asked for clarification to whether the continuous flow model had gone live for the Surgical and Specialist divisions.

25.12   Ali Robinson confirmed that they had now gone live in the first week of December and had begun to have a marginal impact, with an expectation that they would further develop in time.

25.13   The Committee asked when the continuous flow model was expected to deliver an increase in total discharges.

25.14   Ali Robinson explained that the continuous flow model had resulted in some patients being moved within the hospital to move some pressure from ED to wards. By moving some of the risk and pressure to the wards, it was hoped that this would accelerate some discharges to the community of NCtR patients stuck on wards. Despite this method of risk management having been implemented, the hospital had not yet adjusted to the level of risk that was being placed upon the wards rather than ED.

25.15   The Committee asked what proportion of hospital handovers at RSCH met the national target of under 15 minutes.

25.16   Ali Robinson explained that he did not have that data available but that could be provided outside of the meeting. Nationally trusts were struggling to meeting the handover performance compliance standard due to the pressures in EDs. Despite this the collaborative work between SECAmb and UHSx had led to the implementation of a number of initiatives that would in time deliver a reduction in delays. Paul Fisher added that these initiatives were already starting to deliver results, particularly in reducing the number of delays lasting over 60 minutes. By way of comparison, in the first 10 days in December 2024 9% of handovers had lasted over 60 minutes, compared with 17% at the same time in 2023. Delays between 30-60 minutes had not reduced significantly, however.

25.17   The Committee asked whether UHSx had communications plans to reduce admissions to ED at RSCH.

25.18   Theo Cronin, UHSx Head of External Affairs, explained that there was a comprehensive system-wide communications plan to address winter pressures in the health system. Each provider was developing local communications to address localised challenges and reduce the number of attendances at ED.

25.19   The Committee RESOLVED to:

1) note the report; and

2) receive an update in June 2025 as part of the update on the Winter Plan.