Agenda item

Purpose of the item: to inform the Committee of improvement delivered in the delivery of Emergency Department (ED aka A&E) at Frimley Park Hospital in Surrey.

Witnesses:

Mark Nuti - Cabinet Member for Adults and Health (In person)

Philip Kelley, Director of Improvement & Workforce (Primary Care) Development / Acting Director of UEC access, NHS Frimley. Frimley Health and Care ICS (attended remotely)

Dr. Stephen Dunn, Director of System Flow & Delivery, NHS Frimley (attended remotely)

Key points raised in the discussion:

1.    The Chair referred to how the pilot was terminated by NHSE and as a result, whether difficulties had been created for the Trust, and how much notice was provided. The Director of System Flow & Delivery, NHS Frimley explained that there had been discussions over several months concerning the likelihood to move away from the four-hour Accident and Emergency performance. Formal confirmation was provided to them at the beginning of January 2022 which meant there was effectively three or four months to work through the actions that were needed to return to the standard. It was considered a good notice period however, as changes and dynamics on how patients were processed needed to be embraced regarding new clinical reference standards. Staff embraced this challenge and sought to improve performance.

2.    A Member asked about the Bracknell and the Brants Bridge site concerning the publicity surrounding them and how they are making effective use of that publicity. The Member also questioned how many people have arrived at emergency departments that could have been seen at the Bracknell site. The Director of System Flow & Delivery, NHS Frimley explained that they have recently seen eight hundred and eighty people attend both Frimley Park and Wexham hospitals, both sites had an excess of four-hundred attendees. There may be opportunities to divert people attending to Accident and Emergency to use the urgent treatment centre at Brants Bridge. They had identified opportunities to potentially treat patients at alternative locations, reflective of the discussions around primary care access. They had the highest numbers of virtual ward emissions per hundred thousand by an Integrated Care Board in the country, and the highest number of same day appointments within two-weeks in the region. The Director of Improvement & Workforce (Primary Care) Development / Acting Director of UEC access, NHS Frimley and Frimley Health and Care ICS explained there are several services operating from the Bracknell site such as cancer care and dialysis services and there was a good use of the capacity provided. NHS Frimley had around 5,000 people attending that site with 2,600 for the walk-in site and around 2,300 appointments. On average 96% of patients are seen within 4-hours at that facility.

3.    A Member clarified that the question was regarding the publicity for the site. In particular what publicity is there and are they making effective use of that publicity considering not everybody is online or aware that there is somewhere they can walk into in Bracknell. The Director of System Flow & Delivery, NHS Frimley thanked the Member for clarifying this question and explained that they have a detailed communications plan around ensuring their services are being used wisely which is delivered by use of social media and press-releases, and engagement for local authority newsletters. Community and voluntary groups and practices are utilised to relay messaging of alternatives to emergency departments. It was suggested it would be beneficial to for them to capture further information on this area of work as an action, with any support to help with publicity perhaps with the utilisation of county council newsletters around this messaging, welcome.

4.    A Member acknowledged the positive news concerning the reduction in waiting lists in emergency departments having fallen to less than 2.5% in August, September 2023 was different. The Member asked what is being done to ensure that winter pressures did not increase the waiting lists again and those exceeding the twelve-hour waits are not revisited. The Director of System Flow & Delivery, NHS Frimley explained that the Moorhouse work, and engagement undertaken on their regional strategy sets out a comprehensive overview of their urgent and emergency care system and the Surrey Heartlands plan. The delivery of 100,000 appointments is estimated over this winter with an expectation to create capacity for a further two hundred and two daily appointments to address those two hundred and forty patients across both Wexham and Frimley Park, diverting people away from Accident and Emergency. They are investing additional monies into the Surrey Heath system which will increase primary care appointments by another twenty-three thousand over the whole year.  Performance figures show 97% of patients using the urgent care response service are seen within two-hours. They intend to roll-out remote-monitoring, with over 5,500 patients being actively monitored with two-thirds of practices being actively enrolled. The connected care analytical service at Frimley shows that remote-monitoring has been reducing attendances by around 31%, admissions by 33% and general practitioner appointments by 21%. It will continue to be rolled-out throughout the winter period to help to reduce the number of people needing to be admitted at both hospitals. They have the highest number of virtual ward admissions and beds in the country, and the business case for expansion has been approved for the number of beds at the Integrated Care System. 90% of referrals to virtual wards are pre-admission and 10% are post-admission. Virtual wards are being used to help avoid admissions and step-up care and monitoring, rather than safety-netting discharges. The use of virtual wards which is connected to remote-monitoring are making a difference. As a system they are concentrating on getting their medically optimised numbers down and since December they have seen a 15% increase in the numbers of discharges from their place-based teams including the Surrey Heath teams.

5.    The Chair suggested a continuation of their campaigns, including email and SMS engagement for this winter’s flu and Covid-19 vaccination programmes would be recommended ensuring everybody eligible is made aware of the vaccinations, to increase uptake and keep the winter pressures down. The Director of System Flow & Delivery, NHS Frimley endorsed that recommendation which would help support the NHS to cope with a challenging winter.

6.    The Committee advised witnesses they were supportive of the Trust’s efforts to deal with the Reinforced Autoclaved Aerated Concrete (RAAC) present in the hospital. The Director of System Flow & Delivery, NHS Frimley suggested that the Committee’s support of the redevelopment for the new hospital site would be positive for the community.

RESOLVED:

The Committee recommended that:

1. Both Surrey Heartlands and Frimley ICBs continue their campaigns, including by email and SMS reminders with targeted engagement for this winter’s flu and Covid-19 vaccination programmes ensuring that those eligible are made aware of the vaccination and increase uptake of the vaccines.

2. The Committee gave their support for redevelopment of the Frimley Park hospital site and would continue to conduct overview of the plans and delivery of the work.