To consider the temporary winter closures of the Ross-on-Wye and Leominster minor injury units (MIUs), in the context of urgent and emergency care, and to determine any recommendations the committee wishes to make to a responsible NHS body and / or to the executive.

The chairperson invited Jade Brooks, acting director of operations of NHS Herefordshire Clinical Commissioning Group (CCG), and Jane Ives, managing director of Wye Valley NHS Trust (WVT), to introduce the item.

The key points included:

i.           The paper (agenda pages 25-51) detailed the current position on urgent and emergency care in the county and provided information on the temporary closures of the minor injury units (MIUs).

ii.         The arrangements adhered to national guidance on urgent and emergency care, with an accident and emergency (A&E) delivery board in place to oversee developments and a programme of transformation, and to ensure that system partners came together to provide a good standard of care for the population.

iii.        The NHS planned for surges in demand during the winter period and patient safety was paramount.

iv.        This was the third year where a decision had been taken to close the Leominster and Ross-on-Wye MIUs temporarily during the winter period in order to maintain patient safety across Herefordshire and mid-Powys.  The first year was described as an ‘ad hoc’ arrangement, with people uncertain about the opening times.  For the second and third year, proactive and earlier decisions had been taken.

v.         The winter pressures were due to the increase in demand and the acuteness of illnesses, particularly in terms of respiratory and cardiovascular diseases, which resulted in longer lengths of stay.  This limited the availability of beds and resulted in congestion in the hospital.

vi.        It was reported that, over the last two years, adult emergency demand had increased by 70 admissions per week.  To manage the additional demand, WVT had opened 24 more beds and had improved ways of working but there were still significant pressures during the winter period.

vii.       There was a workforce of emergency nurse practitioners, who largely worked autonomously, and could see three to four patients per hour.  It was reported that the demand at the Leominster and Ross-on-Wye MIUs was around one patient per hour and it was not considered that the emergency nurse practitioners were working at full capacity in the MIU settings.  In addition, there was a shortage of nurses generally and emergency nurse practitioners in particular.

viii.      A range of measures over the last two years had improved triage times, maintained ambulance turnaround times, and reduced mortality rates.

The chairperson welcomed the reduced mortality rates and made the following observations:

i.           Illustration A (A&E attendances at Wye Valley NHS Trust April 2017 to November 2019, agenda page 25) showed attendances declining during the winter period.

Ms Ives said that there was a difference between attendances and admissions.  Attendances were higher in the summer months, due to minor injuries, but adult admissions were higher in the winter months, as demonstrated by Illustration B (ambulance conveyances to Wye Valley NHS Trust April 2017 to November 2019).

ii.         The framing of the attendances in Table 2 (Total attendances at MIUs September 2017 – August 2018, agenda page 30) which incorporated the winter closure period in the calculations  ...  view the full minutes text for item 35