Agenda item

To follow

Attending for this Item were:

NHS Herefordshire and Worcestershire Clinical Commissioning Group (HWCCG)

Mari Gay, Managing Director and Lead Executive for Quality and Performance

Worcestershire Acute Hospitals NHS Trust (WAHT)

Paula Gardner, Chief Nursing Officer

Herefordshire and Worcestershire Health and Care NHS Trust (HWHCT)

Rob Cunningham, Associate Director Integrated Community Services

Worcestershire County Council (the Council)

Mark Fitton, Interim Strategic Director of People

Rebecca Wassell, Assistant Director of Commissioning

Adrian Hardman, Cabinet Member with Responsibility for Adult Social Care

Karen May, Cabinet Member with Responsibility for Health and Well being

The Chairman explained that the Strategy and Engagement Director from West Midlands Ambulance Service University NHS Foundation Trust (WMAS) was unexpectedly unable to attend the meeting, however, had provided a summary for the attention of HOSC Members.  WMAS was taking fewer patients to the two acute hospitals in Worcestershire, however, delays in hospital handovers remained a significant concern.

The summary discussion of the progress made against the recommendations from the Scrutiny Task Group Report included the following key points:

·       The Health and Care System continued to be extremely challenged.  WAHT Emergency Departments (EDs) were seeing many more walk in patients with more complex clinical needs, COVID-19 continued to be prevalent although there were signs that cases were beginning to fall.  Workforce continued to be of national concern, with high rates of vacancies across the health and social care sector

·       The System had recognised that ED capacity at the Worcestershire Royal Hospital site (the Royal) was not right.  The new ED was anticipated to be open in December 2022, however, the enhanced Medical Assessment Unit (MAU), which would provide an additional 21/22 beds, had been delayed due to water sampling issues

·       Since 25 April 2022, the System had adopted a different approach to patient flow, working through a Rapid Improvement Cell, which had Executive Leadership.  The focus was on earlier discharges and identifying patients who could be discharged before 10am, known as ‘golden’ discharges.  It was reported that on Friday 6 May, 50% of patients were discharged before midday and 90% before 6pm.  This pace was commended but needed to be embedded and become usual practice

·       Same Day Emergency Care was being delivered in key services and signposting to appropriate services, such as Minor Injury Units, was being undertaken

·       Patients waiting in ambulances were checked on a regular basis, however, it was acknowledged that it often caused patient distress

·       Performance in discharge to Home was very good and discharge to Community Hospital had increased, with the HWHCT opening an additional 20 beds.  As a consequence, Staffing levels had been stretched

·       Workforce across the health and social care sector continued to be of concern, both locally and nationally

·       The situation continued to be run as an Incident and would run as such throughout the Summer until sustainable patient flow could be achieved.

Members were invited to ask questions and in the ensuing discussion, the following key points were made:

·       A Member asked why workforce issues had not been resolved given it had been of concern for some time.  In response, it was reported that lack of Doctors was the biggest factor and was a nationwide issue.  Locum Doctors were available but were an expensive option.  WAHT had recruited a new Chief Medical Officer in November and was pleased to report that 2 Respiratory Consultants had been appointed since.  It was agreed to provide the HOSC with the number of Doctor vacancies at present

·       For the period December 2020 to December 2021, there had been 200 Nursing vacancies.  At the time of the meeting, the figure was 99.  WAHT had successfully recruited, mainly from India, Nurses who were also training across HWHCT and the Council.  This rotational approach was positive for the System.  Separately, there was a number of Healthcare Assistant vacancies, mainly due to attrition.  It was reported that Retailers often paid a better hourly rate than was available with the NHS

·       When WHAT opened an additional Ward, Staff were brought in to provide a stable workforce with their substantive positions being covered on a temporary basis

·       HWHCT acknowledged that their workforce was aging.  There were options to promote increased flexibility to retain experience in the organisation, such as offering a flexible retirement.  In addition, as the work was community based and as shift patterns were not a main driver this allowed for a more flexible workforce.  That said, the complexity of patient need was increasing resulting in the requirement for highly skilled nurses.  It was noted that there had been success in overseas recruitment

·       Additional investment by HWCCG in the Neighbourhood Teams had resulted in the equivalent of 70 whole time posts being recruited to, which was 90% of the requirement, with 30 vacancies remaining

·       HWCCG acknowledged the workforce examples given and reported that it was of national concern.  The People Director had recently been appointed to the Integrated Care Board and it was hoped that the links with the new University of Worcester Medical School would be beneficial in the future

·       When asked how Partners would know when the system was working, Members were informed of the NHS Constitution Standards which required good access and good patient flow.  In addition, Senior Leaders would look at numbers and types of complaints and incidents which would inform decision making.  Each organisation also had a performance framework which was discussed at respective Executive Boards on a regular basis

·       Referring to the performance on early discharges, it was reported that levels were often around 15-20% before midday, sometimes as low as 8-9%.  The rapid improvement since 25 April was commended, however, it would need to be embedded and become sustainable.  8 discharge support workers, who had been COVID-19 vaccinators, had contributed to the improvement

·       A Member requested that future HOSC reports included performance data and information on what impact any change was having.  It was agreed that performance information could be shared with HOSC Members after the meeting

·       In response to a question about how organisations planned for recruitment for those Staff nearing retirement age, the HOSC was assured that organisations did not delay the process and adverts were placed when vacancies were known.  Exit interviews were undertaken to determine why staff were leaving, although it was reported that turnover of staff was normally around 12%

·       Social care recruitment and retention was no different to the NHS and was also affecting the independent sector.  Central Government was trying to make the sector an attractive career path, however, when the retail sector was able to pay a higher rate of pay, this was a huge barrier

·       A Member asked about progress with the Fire Authority’s offer to assist with patient transportation, to be informed that the offer was no longer viable.  However, Fire Authority Reservists and people employed as part of the COVID-19 vaccination programme were now involved in the hospital system, including ED transportation

·       There had been a significant increase in the number of patients utilising the Urgent (2 hour) Community Response via WMAS.  This was a positive step; however, it was noted that Minor Injury Unit numbers were not increasing at the same rate

·       The ED at the Alexandra Hospital in Redditch received fewer ambulances as specialist services were based at the Royal and ambulance crews were aware of this.  It had been previously reported that the ED at the Alexandra worked more efficiently and where possible ambulance were diverted to the Alexandra.  The more complex cases, however, were directed to the Royal

·       A Member referred to the Report, specifically the 1,074 ambulance handovers which had exceeded 60 minutes during March 2022, 876 of which were at the Royal.  April figures were similar and 6 hospitals across the West Midlands were reporting similar performance

·       Members were reminded that COVID-19 was still prevalent and the figures quoted coincided with the latest wave.  It was agreed to provide HOSC Members with more COVID-19 inpatient data, however, at the time of the meeting, there were 75 inpatients across both acute hospitals, which was nearly 3 Wards.  At the January 2021 peak, the figure was over 200

·       It was confirmed that the role of a Discharge Lounge, was for medically fit inpatients to leave the Ward, go to the Lounge and wait for onward transport. It was noted that the Discharge Lounge was relocating to a more convenient location where hospital transport would not be needed

·       The Medical Assessment Unit opening had been delayed, not due to building work, rather water testing samples which had failed.  If it had opened, as expected, in March, an additional 28 beds would have been available.  The Royal had freed up 21 beds to support the Discharge Pathway 

·       In response to a Member question as to why change had not occurred before now, HWCCG recognised that expert advice had previously been sought, however, the system was now working in a much more integrated way and an increased number of senior leaders were focussed on improvements.  There was general acknowledgment that improvement was needed at the Royal, however, Worcestershire was out-performing other Trusts in the region for Pathway 1 discharges

·       There was general acknowledgement that rapid improvement was not a quick fix, but it was hoped that over the next 2 to 3 years stability and continuous improvement would occur

·       The Cabinet Member with Responsibility for Health and Wellbeing and the Cabinet Member with Responsibility for Adult Social Care added to the discussion commenting that there was a need to change public perception of the health and social care sector.  They were also concerned about workforce pressures and hoped that all partners would be proactive in attracting students from the University of Worcester to stay within the County  

·       An example of collaborative working was given, whereby regionally Stroke Services was under recent pressure.  Through regional joint working, Consultant cover was secured and WAHT had subsequently been able to attract 2 Consultants after they experienced the working practice in Worcestershire

·       System wide, it was hoped that there was a potential to attract a new workforce, including those involved in the COVID-19 vaccination programme who were perhaps on furlough from other employment and would wish to stay working within the sector.

The Managing Director of Healthwatch Worcestershire was invited to comment on the discussion and echoed the concern over workforce pressures, which had also been highlighted as a national concern.  In addition, Healthwatch was pleased to learn that the new Chief Medical Officer was supportive of WAHT undertaking research, which should be attractive to future clinicians.

The HOSC Chairman thanked everyone for an informative discussion and asked for all partners to report back at the 8 July 2022 HOSC.

The Meeting adjourned for 5 minutes.