The Board considered a report of the Greater East Midlands Commissioning Support Unit (GEM CSU) Performance Team and Leicestershire County Council Chief Executive which set out an overview of current performance against the Board priorities and key aspects of the national performance framework established in relation to Clinical Commissioning Groups (CCGs) and providers, along with associated commentary by exception. A copy of the report marked ‘Agenda Item 10’ is filed with these minutes.
Arising from discussion the following points were raised:-
(i) It was felt that the level of information contained in the performance report was too detailed. It was suggested that future reports should focus on key themes and highlight innovative work or concerns which could not be resolved through other means.
(ii) With regard to Delayed Transfers of Care, it was noted that some of the delays arose due to a shortfall in community care for certain types of rehabilitation. Work was underway to improve provision, which was related specifically to health rather than social care.
(iii) The CCGs were committed to reducing pressure ulcers to zero; however it was acknowledged that the trajectory for reduction was extremely challenging and would not be achieved. Although progress had been made and areas of excellence which could be used to reduce pressure ulcers in other areas identified, it was felt that avoidable pressure ulcers were unacceptable and that performance in this area would need monitoring.
(iv) It was expected that reliable data for ambulance response times in urban and rural areas would be available by the beginning of winter 2013.
(v) The Board raised serious concerns relating to Emergency Care as the current level of performance did not represent good patient care. A number of actions had been put in place to improve performance across the system. These included changing GP opening hours and arrangements for home visiting; the development of the ambulatory care pathway; the introduction of single door access to the Emergency Department; consultant triage when GPs telephoned to get patients admitted; and improved discharge arrangements. These measures had not yet resulted in a sustained improvement in performance; accordingly the Urgent Care Board would continue to manage the situation on a weekly basis.
(vi) The openness and transparency of UHL with regard to the problems with Emergency Care performance was welcomed, as was the system-wide approach to solving them. The remaining significant issues to be addressed related to the flow of patients internally through UHL. In response to this, UHL was creating a single urgent care floor. A strategic outline business case had been submitted to the Trust Development Authority. Once approved, a formal timeline would be put in place. It was expected that more details would be available later in the year.
(vii) Concern was expressed that a number of plans had been made previously to address Emergency Care performance and that they had not been successful. The Board was advised that the current plan had a number of key differences, namely:-
· The system wide approach;
· The high level co-operation of UHL with the process;
· Consultants from the Acute Medical Unit and discharge were involved as well as consultants within the Emergency Department;
· Admissions were being audited to identify whether changes in GP practice could have prevented them.
(viii) It was noted that clinical problem solving had been used to improve performance for stroke care, cancer care and ophthalmology. This involved understanding where the problems arose and considering good local examples of commissioning.
(ix) It was noted that performance for admissions to care homes for the 65+ had deteriorated. This was an important issue which would require further consideration.
(a) That the progress made to date in developing the performance framework be noted;
(b) That the performance summary and issues identified this quarter and actions planned in response to improve performance be noted;
(c) That the Director of Public Health be authorised to make amendments to the map attached as Appendix 1 to the report in conjunction with other structure changes within the performance framework.