The committee to receive a presentation.
28.1 The committee received a detailed presentation from the Senior Commissioning Manager, Urgent Care, Gloucestershire Clinical Commissioning Group (GCCG). (For information the presentation slides were uploaded to the council website.) The committee was informed that the development of this plan built on experience from previous winters and from the NHS Improvement (NHSI) publication on national priorities for acute hospitals: ‘Good practice guide: Focus on improving patient flow’ (July 2017). The system wide requirements for Gloucestershire were:
Ø To achieve the national 4 hour standard for A & E
Ø To maintain elective and non-elective flow within the acute trust
Ø To maintain high quality care for all patients accessing Gloucestershire services
Ø To provide robust staffing by supporting staff to stay well alongside securing required staffing levels
28.2 Last year elective activity in the acute trust was significantly impacted by non-elective flow. To improve this position trauma and orthopaedic non-elective surgery would be managed at Gloucestershire Royal Hospital (GRH) with elective surgery at Cheltenham General Hospital (CGH). It was important to note that this was a pilot not a service change. The pilot would be evaluated and any future action discussed with the committee. Members were informed that one week after implementation the data was already showing an improvement in patient experience.
28.3 Members agreed that it was clear that this was a system wide plan – no one partner could deliver this on their own. NHS England has informed the Gloucestershire Clinical Commissioning Group that in its view this was a strong plan.
28.4 The committee was informed that a lot of work has been undertaken to improve the discharge process for patients.
28.5 With regard to trauma and orthopaedic some members expressed concern informing the meeting that they had been contacted by paramedics who had indicated that they were not aware of the change and had attempted to drop off patients at Cheltenham General Hospital (CGH). It was also stated by some members that they had also been contacted by staff who said that they had not been informed of the change until very late in the process. The Chief Executive, Gloucestershire Hospitals NHS Foundation Trust (GHNHSFT), informed the committee that she was concerned to hear this, and had also heard similar information from other sources. She has spoken with staff who had assured her that they had been informed in advance and some had been involved in the project. She acknowledged that the Trust could have better communicated the change with the South Western Ambulance Service NHS Foundation Trust (SWASFT).
28.6 Committee members were aware that managing people presenting with a mental illness took up a lot of time and put pressure on the system. It was questioned whether the winter plan would be able to withstand these pressures. It was also questioned whether there was any progress on identifying a specific space at CGH to manage these patients. Members were also aware of the national shortage of mental health professionals and questioned the situation in Gloucestershire.
28.7 The committee was informed that the GHNHSFT had not yet been able to secure the capital funding for to provide a dedicated mental health space at CGH ED but would continue to pursue this matter. The committee was also informed that all services worked together to support people with a mental health crisis; that there was a wraparound service in place. It was also explained that there was work in place to attract mental health professionals to Gloucestershire. The committee was informed that any workforce vacancies were being appropriately managed so as to not adversely impact on patients.
28.8 A member questioned as to whether the achieving the 4 hour A & E target was a suitable indicator as to whether the whole system was in fact improving. It was explained that this was a good indicator to monitor; if the system was not working this was where it would show. Members were also informed that each scheme within the winter plan has clear benefit realisations attached; if they were not producing the required success factors there should be dis-investment in that scheme.
28.9 The committee was informed that with regard to Nursing staff, GHNHSFT was in a very good position this year. 60 nursing students had come out of training, vacancies were dropping, and spending on agency staff was reducing.
28.10 In response to a question regarding the number of ED Consultants currently working at GHNHSFT it was reiterated that the issues relating to the changes to A & E (2013) was not about the number of consultants but rather the number of middle grade doctors.
28.11 The Chairman indicated that the committee would need to closely monitor performance data through the winter period to ascertain if the expected outcomes from the winter plan were being achieved, and that the escalation management actions had worked effectively.