Agenda item

The Sub-Committee is provided with an update on the performance of urgent and emergency care at Croydon University Hospital with a view to informing a discussion on the information contained.

The Committee considered a report which provided an overview on the current performance of the urgent and emergency care department at Croydon University Hospital. The report was introduced by the Chief Operating Officer for Croydon Health Services NHS Trust (CHS), Lee McPhail. During the introduction the following was noted.

• The report provided an overview of the outcomes from a high impact Improvement Programme that originally commenced twelve months ago and was targeted towards improving the responsiveness of urgent and emergency care for patients from the front door and throughout the service,
• The programme had been developed in response to a particularly difficult January and February 2019 and had seen month on month improvement in most areas throughout the summer and autumn, while also highlighting key areas of weakness such as the length of stay for patients.
• As a result, performance on the number of patients having to stay in hospital longer than 3 weeks had notably improved, with the service at one point being the most improved in London for this indicator.
• CHS had been successful in its bid for the AEC Accelerator Programme which would deliver further improvement for same day emergency care, with an increased number of patients being treated in an ambulatory environment rather than in the emergency department. 
• The winter period had seen some of the progress made go backwards, with a difficult December and January. This was in part to pressures at other hospitals having a knock on effect on Croydon University Hospital. As a result the additional bed capacity available at the hospital had been opened for an extended period.
• Initial data for February indicated that progress was starting to be made again, with the length of patients stays improving.
• It had been indicated by the Government that the target waiting time of four hours for emergency care was likely to remain in place, along with other targets focused on the quality of care to patients.
• Two of the key areas going forward were to ensure that the hospital was in a position to meet the new clinical standards and continuing to drive down the length of patient stay. Another part of the national mandate was for hospitals in normal circumstances to be operating at 92% capacity.

Following up from the introduction the Sub-Committee questioned how whether the capacity target was achievable. It was acknowledged that this would be a challenge for most hospitals, with Croydon University Hospital’s own capacity often nearer to 98%.

Regarding the performance data provided on London Ambulance Service handover times of over 30 minutes, which were currently above 20%, it was questioned whether the 5% target was achievable. It was advised that for the majority of the past year the figures were closer to the 5% target with the performance at Croydon University Hospital one of the most improved in London. However during the winter period there had been issues with congestion in the emergency unit and also spikes in attendance that had increased handover times.

A key area of focus was the whole pathway through the healthcare system as a means of alleviating pressure on urgent and emergency care. For instance the uptake of GPs appointments available on Sundays had increased from 20% to approximately 60%. Other initiatives such as having paramedics working in the emergency department were being trialled, with the possibility of having physio therapists available as well being explored.

The Sub-Committee noted from the information provided that there seemed to be a constant level of pressure on services throughout the year, with it confirmed that this was the case, although the acuity profile of patients changed throughout the year with sicker patients in the winter bringing different pressures.

Although the number of seasonal flu case had been lower, it had still been challenging as these patients tended to slow the emergency pathway due to the need to mitigate against the risk of infection. The use of rapid screening had improved over the past year, with the best course of action being to treat the patient at the hospital and for them to recover at home.

In response to a question about hospital staff taking up the flu vaccination, it was confirmed that the current rate was 79% against an 80% target. The number of staff having the vaccination earlier in the flu season had increased this year which helped to make a difference. The ongoing work to encourage people to take up the flu vaccination was welcomed by the Sub-Committee, particularly as statistics showed that 26,000 people died from the virus last year.

It was highlighted that anecdotally there seemed to have been a number of instances where patients had their regular appointments cancelled and it was questioned whether this had been planned to increase capacity at the hospital. It was confirmed that there was not a policy in place at the moment, however this could change should there be a need to create additional capacity to deal with emergency pressures.

In summarising the item, the Chair acknowledged that the improvement work being delivered at the hospital was reassuring, but felt that the new clinical guidance would provide additional challenges.  It was recognised that the ongoing integration programme would also lead to improvements and as such it would be important to revisit the performance of urgent and emergency care at Croydon University Hospital later in the year.

At the conclusion of the item the Chair thanked the officers for their attendance at the meeting.

Conclusions

Following discussion of the report, the Sub-Committee reached the following conclusions:-

1. The Sub-Committee welcomed the update on the provision of urgent and emergency care, in particular the outcomes from the improvement programme that were making a difference to the level of care provided to patients.
2. The Sub-Committee recognised that it would significant challenge to meet the 92% capacity target, in light of the fact that the hospital had been operating at nearer to 98% of its capacity.
3. The Sub-Committee agreed that it would continue to review the performance of urgent and emergency care periodically to ensure that the improvement programme continued to deliver improved services and to monitor the impact from the Integration Programme.
4. The Sub-Committee also agreed that a review of the extended length of stay for patients and health pathways would be considered for inclusion in their work programme for 2020-21.