Report of the Staffordshire and Stoke-on-Trent Integrated Care System (ICS)

The Planned Care Lead for Staffordshire and SoT ICS and Chief Operating Officer UHNM were in attendance to provide an update report in respect of Elective Recovery across the three main provider organisations that serve Staffordshire and SoT, namely  University Hospital of North Midlands (UHNM), University Hospital Derby and Burton (UHDB), and the Royal Wolverhampton Trust (RWT).

Members noted that although significantly reduced, the number of Covid patients in hospitals beds continued to put pressure on the Trusts. The report outlined actions that were planned in respect of elective recovery endeavours to reduce waiting for an elective procedure, the approach as an Integrated Care System (ICS) with regard to elective recovery and an update on Cancer Service performance for the three providers as of April 2022.

Committee noted that:

• The first milestone was to eliminate the number of patients waiting 104 weeks by the end of June 2022 and 78 week waits by March 2023. Patients were waiting for complex surgery and more specialist services. Limited workforce was a challenge, particularly theatre staff, there was more flexibility with surgical staff.
• The aim was to reduce the waiting period to 18 weeks, where it had been pre-pandemic. Members suggested that an ambition for zero waiting time would be ideal, but recognised it was unlikely. Hospital Trusts were working closely with independent sector to reduce waiting times, the NHS had always worked with the independent sector and would continue to do so.
• Backlog had built up during the first wave of Covid when apart from cancer and critical surgeries many surgeries were ceased or slowed.The challenge of treating patients who had been waiting was acknowledged, conditions had progressed. There was a growing number of urgent surgeries and a reduced number of less urgent longer waits.
• Members were assured that all theatres were currently operating at 100% and new theatres were planned.
• Progress on addressing the backlog :
  • RWT was on track, it was geographically well placed and was well supported by other Black Country NHS Trusts.
  • UHNM secured some support with bariatric patients from Worcester area. UHDB was struggling with bariatric patient treatment
  • County Hospital was trying to ensure a range of procedures at hospital day surgery in the local area,  major surgery would be dealt with elsewhere.
  • Cannock Hospital -Two further theatres were operational to focus on a broader range of procedures
  • Burton hospital had also invested in additional theatre space.
• Approach to elective recovery three areas:

1.   Demand management- alternatives to referral/ fit for surgery

2.   Existing capacity best use - NHS and independent sector

3.   New capacity at sites.

• Members noted that health inequalities had broadened over the course of the pandemic and that information to inform services was being evaluated.
• Patient choice – some patients had declined a date offered if it did not suit their own circumstance. Members were assured that those patients would not go to the ‘back of the queue’ and that patients would be managed both on urgency and time they have waited.
• Referral conversations between clinicians were increasing to ensure appointments were not made when it was not necessary, making more efficient use of clinician time and a better use of patient’s time.
• Concern was raised about GP Access: triage, form filling and digital appointments which were difficult for the older population who prefer to go to the doctor’s surgery. Assurance was given that there would be ways for all residents to access primary care. The pandemic had changed the way NHS worked, its aim was to have a more flexible model of communication, a discussion with the most appropriate consultant in the preferred way and for the patient a mix of digital, telephone and face to face consultations. ICS had launched the GP Access plan and was communicating to the public about ways to make contact and the different roles in practices.
• Equal access for minority communities in Burton and other areas, it was understood that lessons had been learned during the Covid vaccination roll out and would be used in future campaigns.
• Training and development of staff in technology to use digital or video routes as enablers to the public. Some staff already used digital solutions with patients, data on numbers could be provided.
• During the pandemic many staff had been redeployed to areas of need and roles that they were not employed to do, they were now returning back to their teams, for theatre staff this was having a positive impact.
• Members were assured that communications and support for staff under pressure remained in place, also wellbeing support. Staff were now working slightly differently, and more staff were being recruited. It was noted that mask wearing and other measures were still in place as Covid was an ongoing issue.
• Members welcomed an update on the recent critical incident (CI) called at UHNM by the NHS system. The flow through the hospital was exceptional. Members understood that this was not one thing that had changed, but that a number of actions from across the system had been built to an improved flow through the hospital. Members were assured that lessons learnt, and changes made would be followed in future critical incidents.

The Chairman thanked the Chief Operating Officer and Planned Care Lead for their contribution to the meeting. Committee was satisfied that there was a clear plan to address elective recovery and progress being made to address the 104 week backlog by June 2022 and 78 week backlog by March 2023. Committee welcomed the additional increase in hospital theatre space, the drive to pull in additional staff, and recognised the improvement made and positive communications with residents.

Resolved:

1. That the Health and Care Overview and Scrutiny Committee note the current position and actions being taken for the Staffordshire and Stoke-on-Trent ICS in respect of Elective Recovery.

2. That further information be circulated to members of the Health and Care Overview and Scrutiny Committee on the following matters:

a.   A theatre plan for University Hospital North Midlands (UHMN)

b.   The forecast for 104 week wait by specialism

c.   The extent of digital consultation data