The Committee will received an update on Urgent and Emergency Care from Sarah Webster, Executive Director for Berkshire West Place, ICB.

Sarah Webster, Executive Director for Berkshire West Place, BOB ICB, gave a presentation and update on local NHS urgent and emergency care pathways over the winter period. It was noted that it had been widely reported in the national press and media that the NHS had experienced its busiest winter on record and it was acknowledge that these pressures had also been felt locally. The presentation covered the following urgent and emergency care pathways:

Primary Care

In relation to primary care, it was noted that activity had remained at similar levels to the previous year up until November 2022. However, During December and early January, demand for appointments had increased, in particular for children due to the concerns around Strep A. There had also been an increase in appointments due to high levels of respiratory illnesses after the Christmas period.  The ICB had been able to provide additional funding, through until the end of February, for primary care practices to increase workforce capacity, provide additional appointments and commission clinics to focus on respiratory illness. Work had also been continuing to improve access to primary care by upgrading telephony systems, improving digital accessibility and literacy, communication around the appropriate use of services and increasing referrals to community pharmacies for minor illness. It was further noted that NHS 111 had seen a significant increase in the volume of phone calls. This had resulted in more patients being transferred into primary care which contributed towards increased activity. Work had been taking place to implement an enhanced Clinical Assessment Service which was due to go-live to help manage demand on general practice.

Urgent Care Centre

The presentation provided an update on the Urgent Care Centre which had opened on 5 December 2022. The centre, based at the Broad Street Mall, was open 8am until 8pm, 7 days a week. The service provided was GP-led but staffed by a multi-disciplinary health team. The service aimed to reduce Emergency Department (ED) attendances and provide overflow capacity for primary care. The centre had capacity to see up to 100 patients per day, including 50 patients referred by either the ED the at the Royal Berkshire Hospital (RBH) or by GP practices experiencing high on-the-day demand and a further 50 self-presenting walk-in patients. The service was running well but had not yet reached full capacity, this was partially due to the timings of appointments and due to the fact that the new service was still bedding in. Underutilisation of capacity was being closely monitored and work was taking place to ensure that capacity was fully utilised.

Ambulance Response and Conveyance

The presentation noted that there had been a lot of pressure and publicity nationally on ambulance availability and response times. Locally, over the Christmas period, ambulances had experienced increases in the number of handover delays whereby ambulances had needed to wait for periods of over 30 minutes or 60 minutes. The delays were due to capacity within the RBH ED and also reduced in-hospital flow. The delays had held up emergency pathways and meant that ambulances were unable to be released to attend other calls. To reduce handover delays, the RBH had created a flexible off-loading bay to minimise the amount of time ambulances were required to wait within the ED. Implementation had proved effective and, as of this week, handover delays had been reduced significantly. Work was continuing to maintain this reduction. 

Emergency Department Attendances

Attendances at the Emergency Department at the RBH had increased over the winter when compared to the previous few winters. However, the percentage of patients then admitted to hospital had reduced.  This was partially due to an increase in the number of patients presenting with minor illness and injuries but was also due to the introduction of new pathways that had been implemented across Berkshire West to improve same-day emergency care which allowed patients to be treated rapidly, on the same day, without the need for them to be admitted into hospital. Work was continuing with key partners to implement more services designed to reduce the number of hospital admissions.

Discharge and onward care

There had been an increase in the length of time that patients needed to wait in hospital to be discharged once they were ready to leave. This was due to the increased complexity of patient care needs and the availability of appropriate care packages within the community. There had been a significant focus on improving the pathways out of hospital to speed-up discharges, including many good examples of partnership working with adult social care. Additional funding of around £1.3 million had also been secured from a national fund of £500 million for the Reading Better Care Fund to invest in services to help patients leave hospital as quickly as possible. Such services included providing care in residents’ own homes, step down care in care homes, and provision of complex care packages for those with very high care needs.

At the meeting it was noted that forward planning had started for the winter of 2023/24 and that an update on preparations, produced jointly by the BOB ICB and RBC Adult Services, could be provided at a future meeting of the Committee

Resolved –   

(1)          That the presentation be noted;

(2)          That a copy of the presentation slides be published with the Minutes;

(3)          That an update, be brought to a future meeting of the Committee outlining the plans for the 2023/24 winter period.