Issue - meetings

To receive a report and presentation from John Wardell, Chief Operating Officer, Enfield Clinical Commissioning Group (CCG).

RECEIVED the report of John Wardell, Chief Operating Officer, Enfield Clinical Commissioning Group (CCG).

NOTED

As John Wardell was unwell and unable to attend the meeting, Vince McCabe (Director of Commissioning, Enfield CCG) introduced the report, highlighting the following:

?  Boxing Day onwards saw a huge surge in demand across North Central London and this was sustained in both patient numbers and acuity, leading to extreme pressure at local A&Es. There was also an increase in emergency admissions in December and January.

?  The North Middlesex Hospital University Trust (NMUH) recovery trajectory was set to reach 90% in December 2017 and 95% in March 2018.

?  Enfield was consistently overachieving against the National Delayed Transfer of Care target. He thanked the social care locally.

?  There had been an increase in the number of out-of-hours GP appointments available, and continuous communication kept up.

?  Work with care homes had increased the confidence of providers to seek advice, and to minimise A&E attendance.

?  Streaming through the Urgent Care Centre and NMUH was higher than many peers. At the peak it had been necessary to open over 60 escalation beds. A new way of managing clinical flow was being implemented to make it sustainable.

?  There had been reductions in delayed discharges, and more people were assessed at home in a safer environment. Partnership working was key.

?  Planning had already started for winter 2018/19.

?  Healthwatch Enfield had been commissioned to help understand why people went to A&E, particularly walk-in patients.

?  He would like to hear how elected members wished to continue to be involved.

IN RESPONSE comments and questions were received, including:

1.    The Chair thanked Vince McCabe for the helpful presentation, and asked about the percentage of discharges which resulted in re-admission within two weeks. In response it was advised that re-admission was monitored and taken seriously, and that NMUH was not an outlier on this.

2.    In response to Councillor Cazimoglu’s queries about cancelled operations, it was advised that planning began early on not scheduling elective surgery during December/January. These were not last minute cancellations. Elective surgery was now being phased back in. Cancer and emergency surgery continued. The hospital was now able to close escalation beds to increase the capacity available for elective surgery.

3.    In response to Councillor Cazimoglu’s question about discharge to assess, it was confirmed that assessment at home was done only if it was safe to happen, and had been very successful to date with good feedback.

4.    Maria Kane was asked for more details about the work carried out by Enfield Healthwatch. It had been noted that there was very high A&E attendance in December, but the admission rate was half the national average, which indicated a lot of people were coming to A&E who did not need to be there. Surveys were carried out by Healthwatch, using community languages, and a narrow set of questions, and 37,000 pieces of data were collected. This confirmed that many of the attendees did not  ...  view the full minutes text for item 3