Agenda item

Conor Burke, Accountable Officer, Barking and Dagenham, Havering and Redbridge Clinical Commissioning Groups, presented the report and explained that Emergency Care and achieving the 95% four hour waiting target consistently was still a challenge.  System leaders had also recently met to look at what else could be done in the short and medium-term to reduce demand at Accident and Emergency (A&E)

The Chair advised that a question had been raised at the Council’s 13 July Assembly on the trial at Queen’s Hospital that had seen patients assessed at the door and those that required non-emergency were referred to their GP or pharmacist. The Chair said that the Council had worked hard to build a relationship with local health care providers and was concerned that nobody had thought about consulting with the Council before putting the pilot into testing and extending that for a further two weeks.  Given the scale of the Council’s ambition to transform local health and social care services the pilot at A&E would not fix the problems around medical advice or treatment when GP’s were already under enormous pressure.  The Chair made the point that to stop people turning up at A&E more effective local provision, including accessible GPs and out-of-hours services, were needed.

Conor advised that the initially the method had originated as a tool to deal with demand during the Junior Doctors Strike and the pilot had been agreed at the SRG, at which Council officers were present.  The SRG had subsequently agreed at its July meeting to keep the pilot going in order to collect more representative data and to enable tracking of those referred elsewhere.  Conor stressed that the initial data suggested that up to 60% of people that attended A&Es do not need treatment of any sort.

Dr Moghal explained that there had been a huge surge in demand at A&E departments, both locally and nationally, by those not needing urgent care and this had caused resource challenges in dealing with the critically ill.  During the pilot 50 to 60 patients per day were triaged by a consultant and / or a GP.  The parents of some 21% of children that had attended were assured that they could wait for a non urgent GP appointment.  The priority had to be those that were critically ill, and that was best served by ensuring resources were not deflected to non urgent attendees.

The Chair said that she did not disagree with the need to target resources to the critically ill, however, before others were turned away there needed to be somewhere consistent, open and available for non urgent patients to go to.  In addition, advice from 111 also needed to be significantly better.

Cllr Oluwole asked if the approach had been piloted elsewhere or only at BHRUT and if there had been any follow up to find out what had happened to those sent elsewhere.  For example, had the re-entered the system later in a more acute condition or not sought any medical advice or treatment.  Cllr Oluwole also wished to know if the pilot was being extended to paediatric A&E.

Dr Moghal advised that the model was being tried elsewhere.  There had been a significant drop in A&E attendance during the Junior Doctor strike, which clearly indicated that there was a lot of personal choice about why people attend A&E, rather than a real clinical need.  Dr Moghal advised that many of paediatric cases could be dealt with by self-care or at primary care and did not need A&E advice or treatment.  In addition, audits were undertaken to find out why people attended A&E and during the pilot tracking and the patient experience would be part of the considerations of the outcome of the pilot. 

Cllr Turner asked for clarification on the 25% of people who had been attended A&E at least once before in the past year.  Mr Moghal advised that in the majority of cases these were elderly readmissions.

The Board:

(i)  The Board received and noted the report on the work of the System Resilience Group (SRG), which included the issues discussed at the SRG meeting held on 23 May 2016;

(ii)  Requested further details and data on the pilot scheme at Queens A&E, where people were being assessed by a Consultant / GP as to whether they require emergency or urgent care and directed to the appropriate setting.  The Board also reminded those present of the need to improve service provision within Primary Care, which in turn would reduce the demand from residents feeling they needed to attend A&E. 

(iii)  Noted that this issue would be considered at the next Board development session.