A verbal report will be made.

Contact Dr Caron Morton, Accountable Officer Shropshire CCG, Tel 01743 253704.

85.1    A summary report of an informal Health and Wellbeing Board meeting (14 January 2015) that was held to discuss Urgent Care in Shropshire was circulated (copy attached to the signed minutes).  This gave a synopsis of the local health economy in Shropshire, an analysis of current system performance and detailed LHE urgent care recovery programmes being undertaken. 

85.2    A verbal update was also given by Dr C Morton, Accountable Officer, Shropshire Clinical Commissioning Group (CCG) on the position.  In doing so, she gave a synopsis on the Urgent Care System in Shropshire, and highlighted that locally, as well as reflected nationally, that our urgent care system was struggling, and confirmed that eleven 12 hour trolley breaches had been noted in Shropshire.  She assured the Board that the CCG was doing its utmost to remedy this.

85.3    A debate ensued.  Briefly, the following points were made;

o   The role of the Care Quality Commission (CQC), and the NHS Trust Development Agency (TDA) were discussed.  It was noted that a report regarding the recent inspection of SaTH had been published on 20^th January.  This report highlighted areas for improvement; one such area was the Trust’s response to shortfalls and improvement planning to address such shortfalls.  The Board discussed the importance of updating the regulators, with its concerns as highlighted in the summary report.

o   Twelve hour Trolley Breaches, as highlighted in the summary report and the CCG presentation, copy attached to the report, were discussed.  The Board was concerned that learning was not being identified through the reporting mechanisms and therefore it was not clear what actions were being taken by the Hospital Trust to ensure that future trolley breaches did not occur.

o   In understanding the metric of 12 hours, it was explained that the clock started from when a person was formally admitted to hospital through A&E, not when a person initially arrived at the A&E department, and as such they could actually be waiting a much longer time than 12 hours on a trolley before being provided care on a ward; it was noted that there was a strong evidence base for why individuals should not be waiting longer than 12 hours on a hospital trolley.  In cases where they did, concerns for safety and welfare needed to be raised.

o   The concern was raised that with the number of trolley breaches and little identification of learning from each breach, the Hospital Trust was ‘normalising the abnormal’.  The Board highlighted this as a potential marker of poor quality at SaTH.

o   The Board noted the difference between ‘Fit For Transfer’ and ‘Delayed Transfer of Care’.  The Board was keen to see the Health Economy as a whole taken into account as part of any improvement programme.

o   It was noted that the Integrated Community Service (ICS) programme had been successfully rolled out to the Shrewsbury and Atcham area the previous winter and further rolled out across Shropshire in autumn 2014.  ICS was able to support the urgent care system by supporting individuals with intermediate care packages when they left hospital.  The Board was keen to understand more about how this service could help the urgent care escalation levels at SaTH.

o   It was noted that the CCG has appointed an external body to undertake a review of the Accident & Emergency Departments in Shropshire.  It was also highlighted that because Shropshire has two relatively small A&E teams on two different sites this could also lead to delays.

o   Whilst it was acknowledged that Future Fit would address many of the key issues for acute care in 5 to 10 years’ time, it could not address the issues that were currently happening and a solution to the issues highlighted had to be sought.

o   The Board discussed the role of the SaTH Board and was keen to open a dialogue with the SaTH Board to understand its position and expectations for improvement.

o   The Director of Public Health noted the hard work of the health and care staff and clinicians at all levels to support the hospital’s urgent care.  He spoke about different layers of learning and the need to take stock of this learning in order to improve issues around escalation and quality in the future.

o   Concern was expressed by the Health and Wellbeing Board that despite efforts across the Health and Care economy it was not clear that lessons were being learnt for next time.  The Board wanted to see an assurance from SaTH that efforts were being made to reduce escalation levels and in particular to reduce 12 hour Trolley Breaches.

o   It was agreed that the next steps were critical.

85.4    RESOLVED:

a.     That SaTH be written to by the Chairman, on behalf of the Health and Wellbeing Board, and that a meeting be arranged between the H&WB Chairman, Karen Calder and the Chairman of the Trust, Professor Peter Latchford, OBE, to discuss matters further.

b.     That the System Resilience Group (SRG) be requested to look at learning and what had been achieved to date, and that a report be made back to the Health and Wellbeing Board at their 20 February 2015 meeting.

c.     That the NHS Trust Development Authority (TDA), the CQC and NHS England be informed of discussions to date at the Health and Wellbeing Board.

d.     That the Chief Executive at SATH, Mr Peter Herring also be written to by the Chairman, on behalf of the Health and Wellbeing Board, in order to understand what had been done to reduce escalation and 12 hour trolley breaches and to request an urgent meeting.