Agenda item

To receive a presentation from Birju Bartoli, Northumbria Healthcare NHS Foundation Trust, and David Lea, Northumberland CCG.

Members received presentations from David Lea, Northumberland CCG and Birju Bartoli, Northumbria Healthcare NHS Foundation Trust.     

Points raised by David Lea included:-

·            Urgent Care – Accident and Emergency

·            Northumbria Healthcare figures compared with Newcastle Hospitals and England and showed a consistently strong local performance.

·            Recovery performance improving despite increases in patient volume.

·            Acuity of Accident and Emergency Patients

·            The continued increase in the level of Type 1 patients (with life threatening conditions) month on month was concerning.

·            Planned Care – Referral to Treatment Waiting Lists

·            Patients should be seen within 18 weeks of referral but COVID had impacted waiting times due to social distancing and PPE requirements. 

·            Some planned routine procedures were suspended following a national directive with some specialties being impacted more.  Other services had improved due to different pathways being used.

·            Waiting List Profile

·            Recovery of performance against waiting time threshold was now being seen although there had been a rise in the volume of patients on the waiting lists.

·            Again, Northumberland patients, on average, waited less time than the overall England position.

·            Maximum waiting time peaked in May 2020 but were now reducing.

·            Figures shown for diagnostic tests with a peak in May 2020 followed by recovery.  99% of patients should be referred within six weeks.

·            Mental Health Overview – Children and Young People’s Service (CYPS)

·            Northumberland had a consistently strong performance with a slight deterioration from January 2021.  Breaches were due to children not being available for appointment and a significant increase in the volume of the referrals.

·            Most children waited no longer than 10 weeks and none longer than 14 weeks.

·            Improving Access to Psychological Therapies

·            A strong recovery rate was shown for those receiving treatment.  There was a much lower volume of referrals being received into the service.

Points raised by Biriju Bartoli included:-

·            Emergency Department

·            Patients were expected to be seen, treated and admitted/discharged within four hours and this target had been consistently achieved other than in January 2021.

·            Attendances decreased significantly between March-June 2020 but had steadily risen in the first quarter of 2021.  Attendances were now back to pre-COVID levels.

·            Referral to Treatment (RTT)

·            92% of referrals should be seen, treated or discharged within 18 weeks.  Elective services resumed in August 2021 and it was aimed to meet the 92% standard by October 2021.

·            Waiting list and health inequalities and clinical prioritisation lens to ensure no-one is waiting detriment to those measures.

·            RTT – 52+ Week Waiters

·            It was practice to ensure that patients were seen in chronological order where possible but clinical priorities had to take precedence. 

·            Cancer – 62 Day Standard

·            Cancer performance had been maintained throughout COVID.  It had been difficult to maintain that standard during June and July 2021 due to an increase in some types of referral, possibly due to people not presenting due to the COVID situation.

·            Some referrals came from outside the normal catchment area, possibly because the Trust was meeting the standards.

·            Diagnostics

·            The standard was for 99% of patients referred for a diagnostic test to be seen within six weeks.  In July 2021, the Trust had struggled to meet this standard but plans were in place to meet the standard.

·            Summary

·            The Trust along with others was struggling to meet standards in July due to the increase in COVID numbers but also because of staff being ‘pinged’ and household contacts testing positive. 

·            Balance to be found between waiting lists and track and trace requirements and increasing capacity in system whilst allowing staff to have some down time.

·            The Trust had a strong history of delivering performance targets and had a recovery programme across all disciplines.  Improvements were already being seen.

The following comments were made in response to queries and comments from Members:-

·            Anyone with a suspicion of cancer was referred by GP on a two week wait basis and most were seen within seven days.  If there was concern following this referral, then the patient would join the cancer pathway and would be prioritised and seen more quickly within the standard 62 day period.

·            Whilst statistics were important, information was also gathered by other methods such as patient experience surveys during and post treatment, national surveys, serious incidents etc.

·            Patient waits of over 52 weeks were reported to the Safety and Quality Committee.  For cancer, patients waiting over 104 days were reported to understand why and whether any harm had been caused.

·            Mental health services relied on self referrals.  There had been a reluctance for people to seek help during the pandemic.  Also during the school holidays people had less access to privacy in their homes and were less likely to go forward with the service.  In Emergency Departments there were more mental health, alcohol and drug cases in generally younger people.  Some people were attending Emergency Departments rather than going to their GP as they knew that they would be seen that day.  Activity did change throughout the pandemic in line with peoples’ expectations.

·            There had been a change in Emergency Department attendance during the height of the pandemic but it was uncertain whether this was due to people not going out to socialise or if they were too frightened to.  It was most likely that they were too afraid to go to hospital in case they became infected. This fear had now disappeared.

·            The 62 day cancer target was a good one and meaningful to clinicians.  Other targets were also appropriate, and it had been shown that they could be met.  Confirmation of the new Emergency Department standard was awaited.  The current four hour standard allowed management of crowding to prevent the Department from becoming unsafe.

·            The figures provided in the presentation referred to all activity relating to Northumberland patients irrespective of whether they attended a Newcastle hospital.

·            There were a number of mental health pathways in Northumberland for children and young people starting with the Early Health offer in schools.

·            Cancer treatment was usually chemotherapy, hormone treatment or surgery and this treatment was prioritised.  Colorectal treatment was done at Northumbria as the critical care unit was there.  Additional surgical lists were being created and would have priority over other surgery lists.

·            Spinal work/surgery was a particular problem area for the Trust.  One of the presentation slides showed a breakdown of waiting list by speciality.  The longest waits were for the Ophthalmology Service, however, there were assurances that these patients’ case notes were reviewed on a regular basis and they were lower risk patients.  The volume of those waiting was reducing month on month.

The Chair thanked David Lea and Birju Bartoli for their presentation and attendance at the meeting.

RESOLVED that the presentation be noted.