Agenda item

Urgent and Emergency Care - 7 Day Services - Update

[Dr Jonathan Odum, Medical Director, Royal Wolverhampton Health Trust to present report]


Dr Jonathan Odum, Medical Director – The Royal Wolverhampton Trust, presented a report on the Urgent and Emergency Care Seven Day Services.  The seven day service delivery had been an aspiration of Government for some time.  It had been a challenge across the country to implement the Government’s aspirations.  It was important to be clear that it was not about delivering elective, non-emergency care.  There were four priorities out of the ten that had been set out by NHS Services.  Those being: -


a)    All patients admitted as an emergency to be reviewed by an appropriate consultant within 14 hours of admission.


b)    All patients to be reviewed daily via a consultant delivered ward round.


c)     Seven day access to consultant directed and reported diagnostics.


d)    Twenty-four hour access to consultant directed interventions e.g. endoscopy and emergency surgery.


The Medical Director stated the monitoring of the seven day service was done centrally through a tool kit. The results of the monitoring for the last three years were listed in the report. The first standard, the assessment by an appropriate consultant within 14 hours of admission, the Trust had consistently achieved the pass standard over the last two years.  The daily consultant review standard for last year was at 95%.  The Trust was slightly below this figure for 2018, this was down in part to the selection of the case records and some outstanding consultant appointments in the care for the elderly. 


The Medical Director stated that in relation to accessibility to diagnostics and early interventions, the Trust had always been fortunate to have seven days a week full access and thus achieved a consistent pass rate.  The area which the Trust was making inroads was in relation to the patient daily review.  Nationally there was a shortage for care of the elderly consultants, but he was pleased to report that the Trust had recently appointed two more consultants in this specialism.  The other area where there had not been a full complement of consultants was in neurological services, this was however to be re-established in the near future. 


The Medical Director stated that the reporting mechanism was due to change.  Reporting mechanisms would in future be via Trust Boards and the CCG Improvement and Assessment Framework.  The data which the Trust had gathered showed the changes to service delivery had positively benefited the care of patients attending for emergency care at RWT.  The feedback from patients and their relatives had been positive about the opportunity for consultants to see them at weekends.  The availability of consultants at the weekend had led to timely interventions in patient care, which in the past would have waited until the following Monday.  There were ongoing developments about a move to 7 day services in primary care. 


The Medical Director highlighted that the Trust faced some challenges with the transfer of mental health patients to community sites at weekends.  Overall the Trust was in a good position. 


The Chair of the Healthwatch Advisory Board commented that Healthwatch had been receiving feedback on the matter of aftercare advice and support following discharge and transfer into community care.  She was of the opinion that sometimes patients were rushed out of hospital without their being the appropriate support in place.  There were sometimes occasions where there was no care or nursing homes available or they had not been offered as an option.  The Director of Adult Services responded that a huge amount of work had taken place to improve discharges within the City.  There were about 90 vacancies across all the care homes in Wolverhampton at anyone time throughout the year.  The challenge was with care homes accepting people in, without a senior of member staff going to visit the individual beforehand and approving them.  Through the Better Care Fund and the additional money received last spring, the Council had been trialling some different models including the block purchasing of some beds and agreeing quicker protocols around the moving of people into them.  In addition the Council had their own internal provider services.  The Council had more control over who used those beds over the weekend. 


The Director of Adults Services stated that one of the Council’s priorities was to get people back into their own homes and help them to recover.  When people did need a residential environment, they had some reablement flats at Showell Court.  They had also purchased some beds in public residential care homes for use by people who could not go directly home and were not well enough for a reablement flat.  


The Chief Executive of the Royal Wolverhampton Health Trust commented that he was not concerned about 7 day urgent care service from a local perspective but was on a national scale.  The financial and staffing resources were not available to be rolled out effectively on a national scale. 



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