Report of the Director of Performance and Quality Improvement and the Director of Integrated Commissioning and Chair of the Manchester / Trafford Urgent and Emergency Care Board

This report provides an overview of urgent care winter pressures for 2018/19. It contains information on the joint system-wide planning taken across the Manchester urgent care system, the surge and escalation approach taken in order to manage periods of pressure and the resulting impact on the 4 hour performance target in A&E.

The Committee considered the report of the Director of Performance and Quality Improvement and the Integrated Commissioning and Chair of the Manchester / Trafford Urgent and Emergency Care Board that provided an overview of urgent care winter pressures for 2018/19.

Matthew Swanborough, Director of Corporate Resilience, MFT referred to the main points of the report which were: -

·                Information on the joint system-wide planning taken across the Manchester urgent care system;

·                The surge and escalation approach taken in order to manage periods of pressure; and

·                The resulting impact on the 4 hour performance target in Accident and Emergency Departments (A&E).

Members noted that the report did not contain any comparative data which made it very difficult to assess any improvements in performance. Paul Thomas, Urgent Care System Resilience Manager, MHCC stated that in line with national reporting the performance against targets was reducing. He further informed the Committee that a full analysis of the 10 key interventions that had been agreed across the health and social care system for winter would be undertaken.

Dr Rosemary Morton, Emergency Medical Consultant, MFT stated that there had been a 7% increase in the number of attendees at A&E, stating that those patients attending A&E had higher medical needs. She described that patients would be assessed and treatment provided was based on the patients clinical need, which made the 4 hour performance target to a certain extent meaningless.

Dr Morton explained that the majority of problems experienced in hospitals could be attributed to patient flow throughout the whole hospital. She said that work was ongoing to address this, stating that a discharge lounge had been established to facilitate patient discharge in the mornings to free up bed space. She commented that improved patient flow improved the overall efficiency of a hospital.

Dr Morton addressed a question from a Member regarding the number of patients attending A&E for non emergency issues. She said that whilst this was always subjective, initial analysis of the available data indicated that many people attended A&E as they were unable to secure an appointment with their GP. She said more needed to be done to make people aware of other sources of non emergency health advice and care, such as pharmacies.  

Mark Edwards, Chief Operating Officer, Manchester Local Care Organisation (LCO) stated that the continued development and delivery of the LCO would significantly support the pressures experienced by A&E Departments, especially for frail and elderly patients who presented. He said that the emerging model of care, delivered in neighbourhoods would identify care needs and deliver support and care for people to help them remain in their own home and community, supported by a range of appropriate, multi-disciplinary health and social care teams. 

Marie Rowland, Associate Director of Performance stated that improvements had been made in regard to the treatment of patients presenting at A&E with mental health issues. She said that feedback from patients, families and carers had been very positive. She said that the delivery of an improved patient care pathway demonstrated the commitment to responding to mental health in the same way as physical health.

Matthew Swanborough, Director of Corporate Resilience, MFT responded to a question regarding the number of readmissions following discharge by stating that this was actively monitored and the rates of readmissions across the MFT site were low. He further replied to a question by confirming that the winter period was defined as December to April.

The Executive Member for Adult Health and Wellbeing stated that the continued commitment to delivering a seven day GP service would help divert people away from attending A&E unnecessarily, noting that the pressures experienced at hospitals were not confined to a four month period but were experienced all year. She also stated that work was ongoing to address the issue of recruiting and retaining staff by promoting the profession and the place as an attractive career option. She described that work was being delivered at a GM level to address this national issue and made reference to the ‘Be a Greater Manchester Nurse’ campaign.

Decisions

1. The Committee notes the report.

2. Requests that an update report is submitted in a years time and that the report contains comparative performance data against previous years.