To receive an update from the Trust on various issues.

The Committee received an update from the Primary Care Trust on various issues.

A report from the PCT was circulated at the meeting.  This covered the following issues:  the delivery of the target of treating 90% of patients within 18 weeks of referral to the Hospitals Trust; the Reforming Unscheduled Care Project designed to improve the way urgent and emergency (unscheduled) care was planned, delivered and used looking at reducing or avoiding attendance at A&E, reducing emergency admissions and reducing emergency length of stay; the membership of the Professional Advisory Commissioning Executive and the development of the Local Area Agreement and the Local Delivery Plan.

Mr Paul Edwards, Director of Commissioning and Strategy, presented the report.

The summary of progress on delivery of the 18 week target was that there was one major risk (orthopaedics) to the delivery of the admitted patient target but it was still expected that the target would be achieved by the end of December 2007.  The target for non-admitted patients was also expected to be achieved.  It was noted that issues around the transfer of records to the new computer system installed by the Hospitals Trust were being resolved and data should be available to demonstrate achievement of the targets.

Performance monitoring of indicators relevant to the Reforming Unscheduled Care Project showed that there had been some reduction in emergency occupied bed days, length of stay and admissions.  However, there was scope to deliver further change particularly around the avoidance of A&E and the development of alternative pathways.

The Local Delivery Plan for 2008/09 had to be submitted by the end of March 2008 and a report could be made to the Committee then if required.

In the course of discussion the following principal points were made:

·         In response to questions about the 18 week target Mr Edwards reported that about 1,300 patients were involved and 800 had been treated to date within the target.  Asked about the cost of meeting the target he said that whilst difficult to quantify precisely it was about £2.7 million.  It was a Department of Health target.

One of the key actions listed in the report to meet the target was to facilitate early discharges including the use of community hospital beds.  It was asked how this would be implemented when community hospital beds were themselves full.  Mr Edwards said that work was being carried out to look at the patient care system as a whole in order to move patients through the system.  More transfers were being achieved year on year. Two extra social workers had been appointed.

·         Asked about the rate of readmissions to hospital Mr Edwards said that this was regularly monitored and that it was not a problem. Readmissions were not in the hospital’s interest.  He was confident the data was accurate.

·         It was asked what communication arrangements were in place to direct patients to the correct source of care.  Mr Edwards said that anyone attending A&E inappropriately was given a leaflet, which was widely available, explaining the range of services available.  GPs with patients who frequently attended inappropriately were expected to look into the reasons. 

·         In response to a further question he said that the majority of inappropriate admissions to A&E were not at evenings and weekends but during daytime on weekdays.  Maintaining access to primary care was a challenge. The PCT monitored the ability of people to make appointments within 24-48 hours.  The scope for practice based commissioning was also kept under consideration.

·         Access to pharmacies was also raised, noting that people who found their pharmacist closed might well go to A&E.  Mr Edwards said that the issue was in part one of educating people that they could not expect their local pharmacist to be open all the time.  The role of Minor Injury Units and pharmacies in supermarkets was part of the picture.

·         On behalf of the PCT Public and Patient Involvement Forum it was reported that they were shortly to report to the PCT on the operation of the out of hours service.  The conclusion was the service did work although it was not flawless.

·         In response to a question Mr Edwards explained the operation of the out of hours service reporting that performance was meeting the national standards. 

RESOLVED:  That a report on the Local Delivery Plan 2008/09 be added to the Committee’s Work Programme.