Minutes of Luton System Resilience Group

Transcription

1 ITEM 2 Minutes of Luton System Resilience Group Date: Wednesday 23 March 2016 Time: 1:00 3:00pm Venue: Meeting Room 1 First Floor, The Lodge, 4 George St West, Luton, LU1 2BJ Name Initial Title Organisation Nicky Poulain NPo (Chair) & Director of Commissioning & Luton Clinical Commissioning Group Integration Caroline Capell CC Assistant Director of Unplanned Care Luton Clinical Commissioning Group Adrian Cullen AC Commissioning Project Manager Luton Clinical Commissioning Group Linda Sharkey LS Service Director Cambridgeshire Community Services Lynn Fanning LF Service Manager Children s Community Cambridgeshire Community Services Nursing Noeleen McLoughlin NM Project Support Manager Urgent Care Luton Clinical Commissioning Group Reena Silvester RS Business Development Manager East of England Ambulance Service (EEAST) Bernie Naughton BN Director of Operations Local Healthcare Solutions (LHS) Jane Moakes JK Head of Commissioning Central Bedfordshire Council Michael Mullender-Francis MMF Chief Operating Officer Healthwatch Marilyn George MG Integrated Operations Manager L&D / LBC Mark Morton MM Commissioning Project Manager Luton Clinical Commissioning Group Natasha Bartlett NB General Manager Bucks Urgent Care/Luton & South Beds OOH Healthcare Care UK Jane Moakes JM Head of Commissioning Central Bedfordshire Council Eugene Jones EJ Director of Mental Health and Wellbeing East London Foundation Trust (ELFT) Service Anne Adams AA Head of Intermediate Care Virgin Care Limitied Collette McKeaveney CM Director Age Concern Limited No Actions 1. Introductions: NPo chaired the meeting and introductions were made. Apologies: Anthony Prior, Marion Collict, Dr Masoud Amini, Maud O Leary, Mahmood Aziz Dr Nina Pearson, Iain Pickles, Marie Louise Smith, Julia Mead, Bridget Cameron, Emma Hunt- Smith 2. Minutes and actions from last meeting Wednesday 24 February 2016: The Minutes were reviewed and the following amendments were made: System Resilience Winter Schemes Update: EEAST, Hospital Ambulance Liaison Officer (HALO)/Private Ambulance Service (PAS),Page 2, Paragraph 4 - NPo queried why funding for the Street Triage vehicle is on this SRG update. NPo updated the group regarding a business case that has been supported by Luton CCG in relation to the Street Triage Service. NPo informed the group that governance in relation to the Street Triage service is via the Crisis Care Concordat Steering Group. JW informed the group that BCCG have also agreed to support his service. JW provided the group with an overview of the service. NPo will seek that an update from the Crisis Care Concordat Steering Group comes back to this group. JW advised that he will make sure that SRG receive a 6 month review. Action 1 - NM to circulate final amended minutes (Moorland Beds), Page 3, Paragraph 2, MG informed the group that Marisa Rose previously managed the data regarding Moorland Beds. NPO advised the group that current provision is adequate and no additional step down DST beds where used in January. 4.2 UEC Consultation, page 5, Paragraph 6, CC reviewed the key stages of the strategy with the group. JW requested a meeting with CC regarding the procurement of the Integrated Care Advice Service. (Formerly known as 111 out of hours).

2 Actions from and were then reviewed as follows: Carried Forward: Action 6 - NPo drew the group s attention to the fact that MG was representing two organisations during the meeting and SRG will support where they can however note that as this action impacted on one of the High Impact Interventions it will need to be carried forward and escalated. Action 6 MC carried forward to next month Action 1 was noted completed and closed. Action 2 & 5 related to processes between EEAST and the L&D regarding inaccurate recording at A&E and handover delays which should be progressed outside of this meeting with a solution being fed back to this group. AC advised that these actions are also being discussed within the SRG Ambulance Operational Group and IP has been invited to join these meetings. NPo queried if IP was still managing A&E. MG to check and update CC and AC. Action 2 MG to confirm new GM for ED to progress outstanding actions. Action 3 CC reminded the group that this action relates to the UEC Consultation Plan which was discussed at the last SRG and it makes reference to Clinical Hubs and how health care professionals will be able to access the hub which will be centralised. CC advised that this will be part of the Integrated Model. Action closed. Action 4 was noted as completed and closed. Action 6 It was noted that Steve Malusky will progress and feedback to this group. To be added to a future SRG agenda. Action closed Action 7 NPo queried if this teleconference took place. NPo reminded the group that this call was requested in order to discuss overlaps between L&D and CCS and the CCG facilitated the call. AC informed the group that teleconference took place. LS advised that this will be discussed further during the Primary Care workshop and Paul Lindars will be involved. Agreed action closed. Action 8 AC/SH taking this forward as part of the wider Ambulance / HALO work and updated group regarding CaMs developments. Agreed action closed. Action 9 AC informed the group that he has checked access to the CaMs system is only available to health care providers. Agreed action closed. Action 10, 11, and 12 - MM advised that with regards to DTOC he is working with system partners and colleagues in Hertfordshire and Bedfordshire to identify beds across both systems in order to allow patient discharge from L&D. MM reported that as a system we are looking for some quick wins and stated that discussions have taken place and suggestions have been made to have a lift and shift ward at St Mary s. MG explained to the group that the L&D have lots of contingency wards open at the moment and this is impacting on nursing care. MG stated that the suggestion of moving a ward out in to the community and a suggestion of utilising a whole floor of a facility such as St Marys and to supply nursing staff to support the ward has been made because of all the building work going on at the hospital. Agreed action closed. LS raised concerns regarding L&D moving a ward out in to the Community. LS advised that due to current working arrangements at the hospital she has raised numerous health and safety issues with David Carter, Marion Collict and Sarah Wilde. LS advised that she respects the position the L&D are in however would not support moving a large amount of staff out in to the community due to health and safety issues. Agreed action closed. MG reminded the group that numbers for Bedfordshire and Hertfordshire DTOC are increasing. MM advised that this week lots of good work has taken place to allow for 11 complex patients be discharged. Agreed action closed as now part of business as usual. Agreed action closed. Action 13, 14, 15, and 16 were noted completed and closed. Action 17- Eugene Jones will progress on behalf of ELFT. Action discussed and action closed. Action 18 - Closed as part of the Agenda. 3. System Resilience Final SRG Minutes - 23 March

3 3.1 Winter Schemes Update EEAST (HALO/Private Ambulance Service) RS provided an overview of the report to the group she advised that the report has 3 months of activity and noted handover to clear delays have improved however handover delays to L&D has increased. CC queried the reason for the increase. RS queried if HALO is working well as L&D. MG queried if it is just the amount of activity. MG to check with Martin Jagdeo, ED Matron. MG advised that she had previously discussed with IP and all seemed to be working well. RS advised that there is a Business Case which includes KPI s with the Acute Trust. NPo clarified that AC attends the regional sector meetings were it has been agreed that HALO should be used during periods of surge. NPo asked RS for her view of the HALO. NPo queried how as part of the core service the system can make this model work. RS stated that the Trust needs to agree it as a priority. CC queried if it is a priority for L&D and without MC in the room this cannot be clarified. It was noted that if HALO becomes business as usual the L&D need to have the ability to shape. NPo stated that there is a disconnect at moment. CC reminded the group that a job description for the HALO had been developed however the pathway didn t work for the L&D. RS explained that EEAST covers 17 CCG s across the patch and developed a single fit Job Description and business case to be implemented locally. CC requested a Winter feedback report for SRG in April LDH (Ambulatory Care/ ED Consultant/ Hospital at Home) MG drew the groups attention to the update and stated that the L&D has been extremely busy and without the additional support at the front door they would not have coped over Winter. MG advised that maintaining flow is crucial and raised concerns as the Winter funding finishes at the end of March. CC informed the group that the April SRG will focus on Winter feedback and requested a report from L&D which should also include plans for next year Virgin (Therapy Services) AA referred the group to the Virgin update and advised that their Winter scheme has been effective however raised concerns that the funding will come to an end at the end of March. CC requested a report for the Winter session in April and advised that it should also include plans for next Winter. NPo queried if the Therapy services would have been able to do urgent same day visits without the additional funding. AA confirmed that the service could absorb urgent same day visits however without the additional support other areas would have been affected. Action 3 - RS to prepare a Winter feedback report to include plans for next Winter for SRG in April. Action 4 - MC to prepare a Winter feedback report to include L&D plans for next Winter for SRG in April. Action 5 - AA to prepare a Winter feedback report to include plans for next Winter for SRG in April LBC (Moorland Beds) NPo informed the group that current provision is adequate and no spot purchase beds where used in February. MG agreed however advised that over the last week a couple of spot purchase beds have been required. 3.2 System Wide Indicators CC drew the group s attention to the System Wide Indicators presentation and advised the group that the data reflects the January period. CC noted that slide 2 shows that activity for A&E and UGPC remained stable. CC noted that streaming has had a slight increase for January and noted that streaming remains to be over 50% at weekends and over 40% during the week. CC explained that slide 4 reflects a decrease in admissions for patients 90 and over. CC highlighted that slide 5 highlights that the total emergency admissions and admissions under 48hours have both decreased slightly for January compared to December. CC reported that slide 6 summarises the key urgent care activity for Luton patients over the last quarter. CC noted that 111, Out of Hours, UGPC and A&E saw an increase in January and the Walk in Centre saw a decrease. CC drew the group s attention to slide 7 and noted that See Treat & Convey has decreased, See & Treat slightly increased. Final SRG Minutes - 23 March

4 CC explained that slide 8 EEAST handover delays have increased compared to last month. Discussion took place regarding Load Levelling which is when ambulances are stacking up at hospitals and ambulance services utilise their knowledge of the system to complete diverts. CC advised that there are regional discussions happening regarding this. RS informed the group that L&D has refused to be part of this and due to their location do not cause a problem. CC advised that slide 9 highlights that 111 calls answered continue to be poor as are calls abandoned. CC reported that there is a significant shortage of 111 call handlers available. CC noted that slide 10 highlights that the highest proportion of calls triaged in 111 is for primary and community care. CC advised that slide 11 shows that activity has increased across the whole of 111 and that call outcomes remain relatively stable month on month. NPo informed the group that 999 are saying that they cannot cope with 111 traffic. CC clarified that EEAST have confirmed that although they are receiving more traffic, less patients are being conveyed. CC noted that this activity will link Clinical Hubs where there will be more clinical intervention prior to convey and this work will feed into the SRG Ambulance sub group. CC explained that slide 12 refers to Out of Hours activity which has increased since January however face to face consultations have decreased. CC referred the group to slide 13 and noted that Luton remains below the national target for DTOC however stated that there has been a significant increase in the number of non-luton patients. NPo reminded the group that Better Together measure DTOC. BN informed the group that EHS has established an operational DTOC group across Bedfordshire. ACTION: AC to link in with this. Action 6 AC to link with EHS re Bedfordshire DTOC group. CC explained that slide 15 highlights the cancer waiting times showing a decrease in the monthly target compared to December and noted that the L&D continue to meet their 62-day referral to treatment target. 3.3 Risk Register CC presented the Risk Register to the group noting that at the moment there are 6 key system wide risks recorded. CC reminded the group that all system wide risks that you believe should be on the risk register are to be sent to NM who will update this and share with members on a monthly basis. 4. Paediatrics MM provided an overview of his presentation to the group and advised that the data included in the presentation related to Luton only patients. MM explained that there has been a 5% increase in A&E attendances in 2015/16 compared with 2014/15 and noted that 23% of paediatric attendances attend more than once and 1.2% attend 5 or more times in 12 months. LS advised that CCS support 0-3 cohort through Early Years and CCS are linking with system partners providing integrated health promotion helping parents to manage minor ailments. LF informed the group that she works directly with early year s settings, children s settings and nurseries. LS explained to the group that CCS took a snapshot of A&E data for 0-5 year olds and rang parents to survey why they attended A&E for interventions. LS noted that they are still processing the data however initial findings from the survey suggest that Primary Care access, lack of confidence to manage their own child, GP practice not being child friendly and word of mouth that if attend hospital seen within 4 hours. LS stated that this telephone survey and report of findings is available. ACTION: LS to share survey findings with MM. LS explained that majority of children within the snapshot were from Marsh Farm and CCS are working with Early Years and LBC regarding interventions to target this area. NPo informed the group that an audit of paediatric attendance at A&E has been agreed and this should highlight some of the issues and reasons for high usage. Once this has been completed the outcomes will be shared with colleagues. Action 7 - LS to share survey findings with MM. Action 8 -MM to analyse usage of A+E by practice. LS noted that there are a significant proportion of attendances that leave without treatment and Final SRG Minutes - 23 March

5 suggested that this may be an area where parents can be supported and given confidence to selfcare for children, thus reducing the need to access primary and secondary care services. MM advised that there has been a small increase in children admitted to hospital in 2015/16 compared to 2014/15 and 77% of these are admitted for 0-1 day. LF advised that children aged between 0 1 automatically go to PAU. NPo requested if LF could be a point of contact regarding the A&E audit which will look at wellbeing and health outcomes. MM advised that on completion of the audit and additional analysis a working group should be convened to identify a work plan that will be owned jointly by multi-agencies to improve healthcare provision and increase appropriate use of health care services for parents and children in Luton. ACTION: MM to co-ordinate this piece of work 5. Healthwatch Work Plan MMF presented the Healthwatch Work Plan to the group and outlined some of the key priorities for this year which include: Repeat Prescriptions, GP Access, CCG Commissioned Services, 0-5 paediatrics which is enormous, linking with Flying start, social prescription and its effectiveness, homelessness and how easy or difficult for these patients to access services. Action 9 - MM to convene working group. MMF advised that regarding GP Access Healthwatch are working with student groups to hear their views. CC suggested that MMF ask this cohort what they would expect to see GP s for which could feed into future shaping of these services. NPo reminded the group that communication is key and SRG sees Healthwatch as a system partner and in the interest of integrated working if system partners could work together regarding approaching different groups as there will be crossover and if you are interested in working with Healthwatch regarding any of their projects please contact MMF directly. ACTION: NM to circulate workplan to the group. 6. Patient Transport Due to unforeseen circumstances MSL were unable to attend. The presentation was shared and agreed to defer discussions to May SRG. 7. Urgent & Emergency Care Networks (UEC) Feedback CC explained there were three UEC Network events focusing on different areas of the Urgent and Emergency Care System. Action 10 NM to circulate Healthwatch workplan to group. Action 11 NM to add to May SRG agenda and request updated presentation. CC attended the event on 29 th February and explained this focused on the Integrated Urgent Care CM attended the event on 17 March and advised that the session had a huge agenda, and was well attended. CM noted that apart from the Older People and Paediatrics session the remainder of the time could have been better used as it is extremely busy in our system at the moment. NPo noted that networking during these sessions can be helpful and that her feedback is very helpful. 8. Any other business 8.1 APMS Consultation update CC explained to the group that NHSE and the CCG were out to public consultation on four APMS practices: Moakes, Whipperley Medical Centre, Sundon Park Health Centre whose consultation closes on the 6 May. The Town Centre GP Surgery including WIC closes on the 4 th June. 8.2 CQUINS CC explained the national CQUINs had now been published and the CCG were working with providers to develop these alongside local CQUINs. 8.3 Easter on call pack NM provided a list of the outstanding information for the on call pack and asked that final information was provided. CC confirmed the next SRG will be a Winter learning event. Action 12 JM, MG, EJ, Outstanding information to be sent to NM asap. Date of Next Meeting: Wednesday 27 April 2016, 1:00-3:00pm Meeting Room 1, The Lodge, Luton. Final SRG Minutes - 23 March