Agenda item

Purpose of the report: Scrutiny of Services 

The Wellbeing and Health Scrutiny Board requested a further update from North West Surrey system health partners, on the steps taken in the wake of the 2014/15 challenges to minimise the future need to declare an internal Major Incident at Ashford & St. Peter’s. The Board also requested an outline of the actions taken to reinforce resilience of the urgent care system in North West Surrey.

Declarations of interest:

None

Witnesses:

Julia Ross, Chief Executive, North West SurreyClinical Commissioning Group

Suzanne Rankin, Chief Executive, Ashford & St Peter’s Hospitals NHS FT

Shelley Head, Area Director, Adult Social Care

James Kraft, Managing Director, Virgin Care

James Thomas, Head of Urgent & Emergency Care

Key points raised during the discussions:

1.     The Head of Urgent & Emergency Careintroduced the item to the Board by stating additional resources would be applied this winter and that would include additional GP and Care Home provision. It was added that the CCG has invested £320K in a Care Home Support Team to support care homes in the upcoming winter period. It was questioned whether North West Surrey can provide the resources required, including additional Care Home services and paramedic practitioners, as the demand for skilled staff is so high. The Area Director advised the Board that funding is needed for different types of training and that a campaign to promote and incentivise caring careers in conjunction with Virgin Care had been devised. The Area Director also advised the Board that Adult Social Care were working with the CCG to challenge traditional methods around discharge to assess

2.     The Board inquired when the results of the system’s actions would be revealed. The witnesses stated that the preparation for winter 2015 is on target and that health and social care providers were in a better position than last year to meet demand. They were able to identify future demand spikes because of an IT system that provided real-time data and allowed for information to be shared between system leaders.

3.     Clarification was sought on the Intelligence Based Information System ‘IBIS’ a patient records system supported by the Ambulance Trust to allow their crews to have patient care records on the ground. Additionally, the Board were advised that a new system - Almanac  - that collects outcome data in one place and could show delayed processes across the whole system for example. By using this system it was seen as integrated and developed as leaders could intervene collectively to surges in demand. This system was developed for under pressure systems and is currently being used in Brighton as well.

4.     The Vice-Chairman queried whether the system’s goal for this winter was to avoid a major incident. It was stated that their intention was to stop system failing in terms of quality and safety and if they had to, leaders would be prepared to declare a major incident again even though that is undesirable. The CCG Chief Executive highlighted to the Board that the system was better at identifying future demand and that the big challenge was quality of serviceover public holidays. In 2014 pressure fell mostly on hospital and ambulance services, the difference in 2015 was the organisation were partners and have a agreed new process for extreme situations: ‘beyond black’ this allows the four system leaders to create one command centre to manage the system.

5.     The Chief Executive of Ashford & St. Peter’s NHS Hospitals advised the Board that there is a strategic shortfall in the supply of clinicians and nursing. The Trust had been recruiting successfully abroad and there was recognition of the quality of Philippine nurses in particular where the Trust had recruited 58 new nurses. However, this route was now unavailable due to Home Office rules on visas. The Board questioned the Chief Executive about the supply from European Union countries and were told that the Trust did recruit from Portugal but 40% returned home. Epsom General Hospital had recruited nurses from Portugal and Spain however they soon left for more specialised roles in London Hospitals. This is similar to staff from Poland and Romania each Trust faced the same problem of diminished supply.

6.     The Chief Executive of the CCG advised the Board that caring for frail/elderly residents was the biggest challenge in 2014 and the response was the Locality Hub model for the over-75s which is a proactive service wrapping around the patient. The Trust Chief Executive felt it was important to encourage everyone to have the ‘flu vaccination and that the Trust was taking the opportunity to opportunistically vaccinate.

7.     The Chair of the Surrey Coalition of Disabled People commented that the Red Cross filled a number of gaps in 2014 and that there was pressure on the wheelchair service. The role of the voluntary sector was recognised by the witnesses and praised for responsive transport service in the period of pressure. It was highlighted that the wheelchair service was being jointly reviewed by Surrey County Council and the CCGs and they were to procure a new integrated community equipment store.

Recommendations:

·         The Board commends the system leaders for their efforts in analysing the causes of the pressures in 2014 and the actions taken to ensure the quality and safety of care provided in winter 2015 and beyond.

Board next steps:

·         To discuss workforce issues especially the rules around the recruitment of nursing staff from outside the European Union and what action can be taken at its next business meeting. 

·         Post Meeting Note: The Government has relaxed Work Permit rules for Nurses from outside the EU.