The Chief Participation and Place Officer (CPPO), NHS NEL, presented a report on the development of several improvement programmes aimed at resolving some of the significant pressures being felt across Barking and Dagenham, Havering and Redbridge in the Urgent and Emergency Care (UEC) service.
The CPPO referred to the unprecedented demand arising from the current high temperatures, which were causing air pollution and created a ‘pollen bomb’ which was adding to the pressures within UEC.
The Barking, Havering and Redbridge University Hospitals NHS Trust (BHRUT) had been placed under the Single Oversight Framework level 4 (SOF4) as the result of a combination of non-elective performance challenges and financial sustainability issues. A Care Quality Commission (CQC) inspection took place in November 2022 at BHRUT, focused on urgent and emergency services. This was a follow-up to a visit in November 2021 where issues were identified within the UEC pathway. At the same time, all four urgent treatment centres provided by the Partnership of East London Cooperatives (PELC) were inspected along with both emergency departments and medical care provided by BHRUT.
The CQC was critical of BHRUT over quality of care and waiting times. The CQC also found that all four Urgent Treatment Centres (UTCs) delivered by PELC were inadequate and enforcement actions were issued. Inspection findings covered areas such as access to care and treatment in a timely way, a need to improve governance and accountability, a need for clearer vision and strategy and leadership capacity and skills.
BHRUT have drawn up a plan of action to address the CQC’s concerns. PWC was commissioned to provide an external perspective on the requirements necessary to improve the resilience of the system. Their report would be brought to the Committees in Common for consideration. The CPPO emphasised that the plan would address the entire system and not just emergency care services.
NEL ICB had been designated as an ICS in Tier 1 for urgent emergency care by NHS England. The CPPO explained that this was because of NEL ICB was an outlier in terms of its performance and that the designation would result in NHS England providing additional support. Keeping residents well at home in order to minimise avoidable admissions was a priority, as was ensuring that patients were not discharged until they were well enough and a care plan had been agreed.
The Executive Director of Partnerships (EDP) at North East London Foundation Trust (NELFT) noted that when people were in crisis, they often turn up at A&E and, as part of the mental health planning process, additional beds were being prioritised. It was acknowledged, however, that this would not address systemic issues as, overall, there was still a shortage.
There was a considerable debate on the issues and the role of all stakeholders in reducing demand for UEC, and how to communicate to the local community what services were available. The Chief Operating Officer for the B&D GP Federation asked that the Federation be involved in the process due to the integral role that GPs have in urgent care provision and the similar pressures on demand that they are experiencing. The Executive Director of Partnerships, NELFT, also referred to the challenges within the mental health service and the important role that the voluntary sector could play through the provision of community-based services. The DPH, LBBD, added that the issue was not necessarily the UEC service itself, but rather what was being done to prevent admissions to hospital and diagnose disease earlier.
The Chair suggested that further discussions take place over the Summer on the preferred model of access and the most appropriate way to communicate with residents on how to access the appropriate service.
The Health and Wellbeing Board and ICB Sub-Committee noted the report and UEC Improvement Plan, as set out at Appendix 1 to the report.