Representatives from Trafford CCG and UHSM will be in attendance to provide an update to the Joint Committee on progress. This will include

·         The impact of the New Health Deal for residents of Manchester and Trafford

·         Progress in dealing with winter pressures

·         Progress report from the Senior Management Team of UHSM on developments at the Trust

·         Progress report on the A & E capital investment

An update on the University Hospital of South Manchester NHS Foundation Trust is attached.

The Committee welcomed Attila Vegh, CEO, University Hospital of South Manchester (UHSM) NHS Foundation Trust; Silas Nicholls, Chief Operating Officer, UHSM NHS Foundation Trust; Dr Nigel Guest, Chief Clinical Officer, Trafford Clinical Commissioning Group (CCG); Gina Lawrence, Director of Commissioning and Operations, Trafford CCG and Jessica Williams, NHS England.

Mr Nicholls informed the Committee that UHSM narrowly missed the 95% Accident and Emergency (A&E) target in Quarter 3 of the 2014/2015 year, achieving 91.95%. He advised that the levels of patients from Trafford attending UHSM are in line with expectations, but admissions were higher than expected. At UHSM there has been a 20% increase in those attending in the higher illness category amongst over 75 year olds, and a 24% increase of those attending with respiratory problems. The Committee noted the information and asked if the figures are available regarding the number of readmissions. Mr Nicholls advised these figures are collated and they can be made available for members of the Committee.

Mr Nicholls further advised that the Trust had identified key areas to improve and manage patient flow; these include Internal Processes within the Trust, Increased Intermediate Care Support and increased Social Care Capacity. Mr Nicholls advised that to address the issue of Delayed Transfer of Care for those patients who are medically fit but require care packages to be in pace to allow them to safely return home, Trafford CCG and Social Services have addressed this by allocating a dedicated Social Worker in the Hospital and they have developed a more flexible approach to buying care packages.

In response to a question from a member regarding the increase in presentations of chronic respiratory problems amongst the over 75 year olds Mr Nicholls advised that work is ongoing to address this. He stated that proactive work is being undertaken with both nursing and residential care homes so that those residents who are identified as being at risk receive the correct care and management of their condition to prevent it from escalating. Ms Lawrence informed the Committee that this is one aspect of the work undertaken as part of the proactive Geriatric Outreach Service. This service had been designed so that nurses can monitor residents of both residential and care homes to identify issues and then liaise with GPs and Consultants where necessary to effectively manage their condition. Dr Guest stated that this co-ordinated approach of the Geriatric Outreach Service is very important and will include the co-operation of GP’s, Pharmacists and Physiotherapists.

Ms Lawrence advised the Committee that there is an issue regarding Nursing Homes in the Trafford area. She stated that whilst there are enough beds in Trafford they are significantly more expensive than neighbouring areas. To address this, the CCG are seeking to attract more quality providers into the area to help increase competition and offer a more competitive cost. She further advised that whilst Trafford had experienced an increase in demand for care packages, this has been compounded due to the lack of providers able to administer this care. Ms Lawrence advised that funding is available for the care and work is ongoing to commission care providers to address this pressure.

A Member commented that the winter had been relatively mild and enquired what capacity UHSM had to deal with an episode of severe winter weather. Mr Nicholls responded by advising that UHSM would open additional bed space to accommodate any increased demand on services. He stated that measures that can be taken include conversion of surgical wards to an acute ward to create additional bed space. He informed the Committee that this activity is funded through the one off winter pressure monies. Other less favourable options can include the diversion of activity to other hospitals and in extreme cases; hospitals can declare a major incident, whereby all elective work and staff leave is cancelled.

Mr Nicholls further explained to the Committee that in addition to this, work needs to be undertaken to address those patients who attend UHSM A&E Department for whom appropriate care can be provided by alternative provision. He described that on a daily basis of those 250 patients attending, 130 could be treated elsewhere. Members of the Committee followed this observation by commenting that the Urgent Care Centre (UCC) in Trafford remains under utilised by residents. Ms Lawrence advised that work is being undertaken to understand why residents are choosing not to use the UCC despite this facility offering a very quick and efficient service. Dr Guest responded to a question from the Committee stating that a leaflet is to be delivered to households in the catchment area and work is being undertaken to promote this offer with local GPs.  Dr Guest further stated that work needs to be undertaken at a national level to educate the general public with regard to when to attend A&E and when it is appropriate to access alternative sources of advice and care.

The Chair commented that the issue of GP access is an issue of concern for, and closely monitored by the Manchester Health Scrutiny Committee. He advised that despite the work undertaken the service offered remains inconsistent and a lot more work needs to be done to improve access to GPs. Dr Guest acknowledged that improving GP access is a significant factor in alleviating the pressures experienced by A&E Departments. He stated that it is important that GPs move away from outdated and inefficient ways of operating and that an appropriate level of fit for purpose, value for money GP access is achieved.

Ms Williams acknowledged that there are inconsistencies with regard to the provision of GP access and that work is being undertaken to address this by both NHS England and CCGs. A member commented that she welcomed the decision of the Care Quality Commission (CQC) to inspect GP practices.

The Chair commented that the pressures experienced by the A&E Department at UHSM can also be attributed to the closure of the Walk In Centres (WIC) in Withington and Wythenshawe Forum, a decision that was strongly resisted by the Manchester Health Scrutiny Committee. The Chair enquired if the WIC that had been co-located to UHSM still existed as a distinct and separate service. Mr Nicholls advised that the provision at UHSM functions primarily as an A&E Department. However GPs work to assist with the triage of patients.

Mr Nicholls described to the Committee developments with regard to the extension of the A&E Department at UHSM. He stated that the final design had been signed off, work is due to commence May 2015 and implementation is in several stages with a completion date of July 2016.

Mr Nicholls stated that in addition to increasing the size of the Department it will also see the establishment of a purpose built Clinical Decisions Unit. He informed the Committee that evidence indicated that the establishment of such a unit is beneficial for both patients and clinicians as it creates a dedicated space for clinicians to assess, diagnose and make informed decisions regarding the most appropriate patient care pathway. He advised that the ambition is to provide the same level of Consultant and specialist cover at weekends as is available throughout the week; however there are issues surrounding resources and recruitment that need to be addressed. The Chair requested that information be provided to the Committee regarding the capacity levels to be achieved at each stage of this expansion.

Decision

1. The Committee thank all colleagues and partners for attending and contributing to the meeting.

2. The Committee reiterates its view that some of the increased activity at A&E at UHSM is a consequence of the downgrading of Trafford General Hospital.

3. The Committee acknowledges the importance of maintaining cooperation between UHSM, Trafford and and South Manchester CCGs, Trafford and Manchester Councils and NHS England Greater Manchester Area Team to help tackle the increased pressures on UHSM.

4. The Committee note that the pressures exist following a mild winter period and have concerns that this may worsen if we experience a more severe winter.

5. The Committee request that further information relating to rates of re-admission within 28 days is circulated to members of the Committee.

6. The Committee welcomes the £12M capital investment in the A&E Department at UHSM and notes the timetable of works. The Committee further requests that information regarding the additional capacity linked to the timetable of works be circulated to members.

7. The Committee request that all updated publicity information relating to the Urgent Care Centre in Trafford be circulated to members as and when this is produced.