Report of the Deputy Chief Executive, London North West University Healthcare NHS Trust
Members received a report from the Deputy Chief Executive of London North West Healthcare NHS Trust. Mr Simon Crawford. The report and supporting appendix set out the progress made in preparation of the Trust’s winter plans in recognition of the on-going emergency demand and pressures faced by acute Trust hospitals.
Members asked the following questions:
A Member asked if there was a follow up after the patient was directed to the community as detailed on page 16 of the agenda. It was explained that there was collaborative working in place with partners in community or social services to confirm that care was in place before a patient was discharged. There were home visits arranged once a patient is discharged and an advance package of care for them to go back into the community.
A Member questioned about what would happen if the patient was alone. It was explained that an assessment of a patient’s dependencies would be made in advance, by health and social services and if house visits were required, they would be arranged in advance so there was a service in place which could give additional care and support.
The chair commented that it would be interesting to review the data at some point for future purposes. It was explained that in Northwick Park in a week, 65 to 100 patients were discharged everyday over the different discharge pathways:
· Pathway 0, - would be those who could go home without a package of care,
· Pathway 1 - Community Package of care in their own home
· Pathway 2 - a typical low-level care - care homes or social services provision
· Pathway 3 – this was more complex.
There were discharge meetings with the local authority, with community providers as well as the patient and families to discuss the appropriate package of care needed, so there was a robust process in terms of engagement, assessments, chasing up care homes to assess a patient in terms of whether they could take them, given their clinical care criteria. All this was done through daily escalated discharge calls between health, social care and discharge statistics could be shared with the Committee perhaps in future.
It was agreed that a review of system plans would be beneficial.
Another Member asked about reports that patients were being discharged after 10 pm. The Member was concerned about the impact on elderly patients. It was explained that it was not a policy or the intention to discharge patients late at night. Though there were exceptional cases, where patients had been discharged between 8 and 10 pm. Efforts were made to discharge most patients by 5pm at the latest. In some cases, patients could still be waiting for transport. It was the practice to avoid discharges after 5 pm wherever possible.
A member questioned about waiting times at the A&E and clarity was provided. It was confirmed that the standard waiting time was 4 hours to be seen and to be admitted from A+E within 12 hours. It was explained that patients were on times waiting longer than the 12-hour standard because the hospital was under continued pressure and admission to a bed was often dependent on other patients being discharged on a timely basis. Pre-covid such a wait over 12 hours would only have been for a bed for a patient requiring mental health bed.
A member raised concerns about a particular case where a stroke patient was negatively impacted after driving themselves to the A&E due to the lateness of the ambulance and was subjected to a long wait that meant they missed their heart medication. Simon stated he was not aware of the case but commented there were cases of long waits for ambulances at peak periods and offered to make the necessary enquires if further details on the patient could be provided as this was not the performance the health service was striving to provide.
A member concern was raised about lack of waiting places for patients receiving Chemotherapy to recover. Simon explained that there was limited space in the Urgent Treatment Centre (UTC). They would be exploring options such as limiting number of relatives to try and create space, but it was challenging at peak periods.
A Member questioned about reason for the significant growth in patient walks in at Northwick Park Hospital over the last three months as stated on page 22 of the agenda and what the situation was in other boroughs. It was explained that Northwick Park has often the busiest A+E department in London and attendances had gone up because of the introduction of same day emergency care and new pathways for frailty and diabetes and a direct booking referral system to divert patients from the UTC to alternative pathways. This was also being done across other boroughs in North West London.
A Member questioned and explanations were provided about the Trust’s system and processes for demand and performance monitoring against targets as detailed on page 23 of the agenda.
The chair questioned about the reports of residents finding it difficult to get GP appointments as not all surgeries were operating extended hours. It was explained that CCG was responsible for GP contracts and monitoring performance against service standards including access to GP appointments. The same issue was being experienced at the Urgent Treatment Centre that relied on GPs to run the service. There were capacity constraints, and it could be due to staffing issues. The report from the emergency care board was that there was good utilisation of the available GP appointments especially on Saturdays.
A Member commented that from her experience, Northwick Park Hospital was better than Ealing Hospital. It was explained that Ealing Hospital was a smaller A+E department, with less staffing capacity and a constrained department size so it could on times feel more pressurised quickly but there were efforts not to overload the hospital and maintain a balance across the Trusts 2 A+E departments.
The Chair questioned about the efforts that were being made to reduce non-emergency walks in and was enough being done to engage newly arrived communities to increase use of primary care rather than walking into the A&E which they may do in the communities they come from abroad. It was explained that more could be done to encourage GP registration and reduce fear of attending and communicate that registration was not necessary to access services. A lot had been done through communication in the communities.
A Member asked what plans were there to increase hospital staffing and could fuller use not be made of pharmacies. It was agreed that pharmacies were a good resource, and the Communities Team were best placed to discuss this. Simon explained that staff were willing to do extra shifts due to goodwill and there had been success recruiting into new and innovative roles within the Trust.
The Chair asked if there was enough robust evidence that the remote emergency access co-ordination hub reach model would not place vulnerable individuals at greater risk and what risk mitigating measures would be in place if this was going to be trialled? It was explained that this was a consultant led patient assessment service and other risks would be mitigated by applying lessons learned from where the model had been successfully implemented such as in Bath, from the implementation of similar services and monitoring patients ‘review’ and feedback of the service.
The Chair thanked the Deputy Chief Executive of London North West Healthcare NHS Trust, Mr Simon Crawford for his report and answers.
RESOLVED: That the progress made in preparation and delivery of the Trust’s Winter Plans be noted.