Agenda item

To receive a presentation on Urgent and Emergency Care Improvements and Winter Preparedness from the Director of Planning, NHS Shropshire, Telford & Wrekin CCG.

The Board received a report on Urgent and Emergency Care Improvements and Winter Preparedness from the Director of Planning, NHS Shropshire, Telford & Wrekin Clinical Commissioning Group (STWCCG). They outlined that health and social care across Telford & Wrekin faced a unique set of challenges. There had been longstanding issues regarding workforce, financial resources and service quality that continued to play a role as they entered winter. This was in addition to managing the ongoing Covid impact.

The Board heard that work had been done to make improvements, but it was emphasised that urgent and emergency care performance was dependent on primary care and other areas of the system. Accident and Emergency (A&E) faced ambulance challenges and further flow and capacity post discharge was needed to meet demand. The Director for Planning provided further context stating that there had been a 9% increase in those using A&E in comparison to pre-pandemic, a 14.5% increase in walk-ins and high numbers of self-presenters who hadn't contact 111 or their GP prior to attending. Of these a high percentage were discharged without care. There was a requirement to focus on people accessing the right services through a set of improvements at pre-Hospital level and through hospital flow and discharge.

At the pre-Hospital stage the board heard that funding had been allocated to increase same day capacity in Primary Care, which resulted in over 10,000 additional GP and allied health professional appointments between October and March. Additionally, they had implemented measures to increase use of 111 bookable appointments, but it was noted that recognitions and use of this was not where it needed to be. Flow through the Hospital to discharge into the community was managed through HALOs but seated discharge facilities have been created so that patients were moved out of the wards in order to free up beds. The Director for Planning assured the Board that SaTH had been reviewing regularly to ascertain and further improvements.

The Director of Planning informed the Board that their approach to winter preparedness had involved working with additional partners to examine existing arrangements and whether they were fit for purpose, with particular focus on the resurgence of flu. Using that information they had focused resources into enhancing voluntary sector support, respiratory work, care homes and community beds. These schemes were to be implemented until March/April 2022 with regular monitoring and adjustments where needed. The Board also heard that they would be running to create dialogue with the public. The Director of Planning thanked the Council for their input on a recent joint letter to the public and for the continued collaborative work.

Members thanked the Director of Planning for their comprehensive presentation. During the debate Members expressed concerns that pressures were already happening and that many features detailed in the reported are expected services. It was recognised that limiting factors such as availability of beds did exist and offered no short term fix, but the Board would like to know the parameters against which they were measured and quantative data of their effectiveness. The Interim Accountable Officer Shropshire, Telford & Wrekin CCG responded stating that this was an issue, particularly within domiciliary care as a result of the wage framework hindering their ability to provide staffed beds. Ongoing monitoring and modelling of A&E and hospital admissions had suggested that there was a requirement to be clearer on the alternatives available from the outset. Members agreed that there was often confusion around how to access the correct services and would like to see this become clearer. The Interim Accountable Officer Shropshire, Telford & Wrekin CCG advised the Board that he was happy to discuss in more detail at a later meeting.