Agenda item

The Chairman invited to the table:

·         Mr Neil Snee, Director of Commissioning, Barnet CCG

Mr Snee updated the Committee on the winter pressures experienced by Barnet hospitals and highlighted to the Committee that the pressures on emergency departments over the last year had been rising. He noted that Walk-In Centres were now in high demand to help ease the pressure. Mr Snee said that the Royal Free was struggling with the increases in admissions and that the CCG was currently working with social care providers and the Royal Free to manage this. Mr Snee said the weekly volume of delayed transfer of care, and the impact this has on emergency departments, was being closely monitored.

Mr Snee explained that 30% of the delay in transfer of patients was a result of family choice as families are not always happy with the home that has been allocated to the patient. He said it was a balancing act as patients in acute care need to be moved through the hospital quickly, although it must always be recognised that people still need to be treated with dignity and respect.

Mr Snee said the CCG had invested an additional £1 million into the discharge assessment module, with 30 beds having been made available with a turnaround of 28 days as a pathway measurement.  He said that 90% of patients moved through beds by 18.5 days and 100% by the 28 day target. He said this improvement of flow through the hospital had been achieved by working as a whole system.

Mr Snee told the Committee that the system was facing real pressure due to the increase in demand and was adapting as quickly as possible. He said negotiations were being held around establishing a properly structured workforce with 200 additional evening and Saturday appointments available. Mr Snee explained the pressures faced were not exclusive to Barnet but are evident in all urban environments.

Mr Snee said there were problems surrounding ambulances from East Anglia being diverted to Barnet hospitals. He said that due to significant pressure within Hertfordshire trusts, ambulances were being sent to the next nearest emergency department which is in Barnet. He commented that there was a problem with the lack of a dual-system to manage this issue. Mr Snee said conversations with East Anglia had been initiated and there was now a 33% drop in the number of ambulances from these regions being sent to Barnet hospitals.  He told the Committee that it was a complex and difficult system but everyone had been very responsive to representations.

Councillor Cohen enquired about the Forest Care Village model. Mr Snee said that this model was being tested to see how well it works before moving to a more appropriate local site. Councillor Cohen asked whether there was a shortage of community places for patients to be discharged to and was this part of the problem. Mr Snee said that the situation is complex and there is a need for a different type of system to improve the flow of patients through hospitals. He also said there was a demand for beds that needs to be addressed and that he would be working with CLCH to monitor the data.

Councillor Old asked whether care homes were sending clients to A&E less frequently. Mr Snee said there was currently not enough data to confirm whether this was a trend. However, anecdotally, he believed that training packages were helping and having a real impact.

Councillor Stock asked whether it was correct that there are significant problems in regard to recruitment within A&E departments. Mr Snee confirmed there was a shortage of doctors in emergency departments and that it is becoming increasingly more difficult to recruit. Mr Snee said that the ‘Safer, Faster, Better’ programme at the Royal Free was looking into how to improve training for colleagues and how the better allocation of tasks could free up doctor time.

RESOLVED – The Committee noted the report.