Agenda item

The Panel received a presentation from the Chief Officer of Doncaster and Bassetlaw Teaching Hospitals, which outlined the following areas;

·         Urgent and Emergency Care

·         Ambulance Data

·         Transfer of Care

·         Elective, Cancer and Diagnostics

·         Finance in Month Five

·         Winter Planning

·         Health and Wellbeing

·         Estates and Infrastructure

There was a discussion held and the following areas were highlighted;

Treatment of Carers in Hospital – Members expressed an interest in hearing about the treatment of carers in Hospitals, when there for the person they were caring for.  It was noted that the Carers Action Plan had been considered at a recent meeting.

The Chief Executive had explained that it had been challenging to support the role of carers during the pandemic but acknowledged the value of carers and the support they provide to patients.  It was continued that the D&BHFT was supportive of the Carers Statement 22-25 and would do their best to implement it.  It was commented that the role carers had in taking burden of caring staff and contribution they make was recognised.

It was viewed that at present, it was about maintaining the right balance and minimising the number of people in ward and department areas to maximise the ventilation and space whilst also prioritising carers.  Reference was made to the role of the Deputy Chief Nurse as lead in this area, who would also help and support carers and families, as well as addressing challenges.   Mention was made of the PALS service, which served as a conduit with carers and loved ones and that Hospitals endeavoured to take the necessary steps to ensure it was a positive relationship.  It was recognised that there could be issues around communication and not being able to access patients. 

Ambulance/Handover Waiting Times – Concerns were raised about the length of time people were left waiting for an ambulance and of the handover period (upon arrival at hospital) which was seen to be increasing.  It was noted that there was the potential to be more efficient if the Departments were more co-located.  It was explained that the challenge was that the Department was originally designed for 200 patients a day, however, on a busy day this now reached over 400. The Panel heard how building work had been undertaken to make the system more efficient and improve the flow but that they continued to be challenged on busier days. 

It was explained that the problem was around bed bases and having to sustain flow when ambulance peaked at certain times of the day.  Members heard how there tended to be certain patterns during the day when an ambulance was called for, then on arrival at the hospital it would takes around 2 hours to process a patient.  Members were informed that the problem was how there were no immediate beds, and therefore patients would have to wait somewhere.  It was noted that there was a need to balance where it was the safest and sometimes that this was with the ambulance crew or in the hospital.  It was explained that the hospitals would try to avoid ‘corridor care’ because it had risk for the patient and that discharges were being pushed, for example, discharges in the morning allowed for better patient flow. It was commented that co-location was not an option at present, so it was about creating more capacity to generate empty bed spaces and to use those spaces to create better patient flow out of Emergency Department and therefore performance could be better. 

It was explained that on occasion, Doncaster and Bassetlaw Hospitals and South Yorkshire Hospitals supported one another in order to help manage risk, treating patients as quickly as possible and keeping wait times down.

It was reported that across South Yorkshire (during the last period, since October onwards), the number of times that Trusts had declared Opal Level 4 (alert indicating that Trusts were at capacity) had increased significantly, as they had all been dealing with increased Covid and influenza numbers.  Reference was made to pressures being experienced in the remainder of the system.  It was commented that patients, who had not attended healthcare over the last few years, had developed more complex health and care needs as well as demand increasing and the system had not expanded to cope.

It was noted that when everyone was trying to recruit at the same time then there was competition for staff and also staff taking up different posts with higher salaries.  It was commented that the Integrated Care Strategy played an important part in helping everyone to work together as a health community, thinking about Doncaster as a place, what it could achieve and how everyone could become more effective and efficient.

Further information was requested on ambulance waiting times data for Category 1, 2 and 3.  Members were informed that this was reported on a monthly basis in the public board session, which should be available to them.

DNA (Did Not Attend) – Concerns were raised that DNAs were resulting in costs to time and money as well as causing delays to treatment.  

Members were told that before the pandemic, the hospitals were undertaking a major programme of work to reduce DNA risks (which at that time was over 10%).  It was explained that there was a small degree of overbooking clinics to reduce the lost slots from DNAs, which was not efficient.  It was commented that during the pandemic, appointments were even more complex as they were not being undertaken face-to-face.  Members were informed that in some instances text reminders were sent where the hospital was in possession of the relevant details to do so.  It was recognised that technology played a vital part but there was a need to return back to good housekeeping measures. 

It was recognised that the last few years had changed the way hospitals had interacted with patients.  Future steps would include patient initiated appointments, alternatives to face-to-face appointments, for example, virtual or by telephone, further use of technology, Electronic Patient Record (EPR) project and virtual wards, all which should help demand and decrease DNAs in order to return to pre- pandemic numbers. It was felt that the EPR project was important in driving efficiencies.

The Chair commented that from her own experience, it was not always clear what type of appointment was taking place. It was acknowledged that communication did need to be improved with patients and recognised that the future was about technology, ease of access and using artificial intelligence.  It was noted that the most expensive area was the hospital and there was a need to work together to minimise the costs of the most expensive areas that patients need to access. 

Recruitment and Staffing – Reference was made to the overspend on temporary staffing, which had been impacted by the pandemic as well as other factors. Reference was made to the early 1970s when there were predictions around the falling numbers of nurses and particularly those retiring from 2000 onwards.  

It was seen during the pandemic, that there had been an imbalance which had become worse, and that the number of staff retiring but not returning had increased alongside a higher demand for health services and longer length of stays.  Members were advised about steps taken involving national level planning, developing a long term workforce plan and by communicating what a great place the NHS was to work.  It was recognised that staff tended to live where they worked, moving to a place for a university then establishing themselves in their place of work and having in place appropriate terms and conditions.

It was noted that the opportunity of a new build and facilities in Doncaster was exciting.  Members were informed that a case had been developed for a university hospital and new build hospital.  It was explained that it would help attract investment for research and other benefits through the levelling up fund and will provide decades of benefits.

Concerns were raised about the problems surrounding the logistical issues of discharge and it was questioned whether hospitality facilities had been considered for supporting patients prior to being released.  Members were informed that this had been considered but would not be feasible as those types of venues were no longer empty (as they were during the pandemic) and were not reflective of the care provided within a hospital.  It was explained how the focus on how we can keep people in their normal care environment.

Virtual Wards –It was explained that a virtual ward was about a group of people with something in common such as certain conditions, for example, respiratory problems.  It was outlined that it was an approach with people in the community supported by a range of clinicians, that monitoring was undertaken through hubs and there were links with the acute hospital if required in order to provide that specialist oversight.

RESOLVED that the Panel note the information provided.