Agenda item

CCG Accountable Officer to report

The Committee received a report of the Accountable Officer for NHS Oldham Clinical Commissioning Group which assessed access to urgent and emergency care facilities in Oldham and the impact of Covid-19 on the provision of those services.

The Committee was advised that historically Oldham has three pathways into urgent and emergency care: Firstly, Primary Care GP’s providing same day urgent care where capacity permitted, with access out of hours through NHS11; secondly via the Oldham Walk-in-Centre (WiC), providing urgent primary care without an appointment 8am-8pm; and thirdly Accident and Emergency at the Royal Oldham Hospital.

When patients accessed urgent and emergency care through these points there were limited pathways to direct patients quickly and efficiently to the care they needed, and many were directed to A&E.Following lengthy consultation in 2017 it was agreed to redesign the WiC and develop a system offering bookable appointments for urgent primary care that met the ‘least acute, most appropriate, closer to home’ national ambition.  However, at the onset of the pandemic in 2020, this discission was still to be implemented as development work was still ongoing and a review was underway.

The onset of the Covid-19 pandemic, from March 2020, brought new urgent challenges which needed addressing. These included: the immediate development of a Covid Assessment Centre; the closure of all walk-in services; maximising acute capacity; implementing digital and virtual care; supporting Care Homes and the vulnerable. In response to Covid-19 the WiC was redesigned to provide the Covid Assessment Service and this led to the implementation of a digital urgent care offer to support the system and the Urgent Care Hub (UCH) was created.The WiC budget was utilised to fund the development of the UCH & Covid Assessment Service.  It has also funded the Covid Oximetry @ Home service, a nationally required service for patients who are covid positive but remain at home while being monitored.

The GM Clinical Assessment Service (CAS) launched on 9^th November 2020, offering clinical ‘Hear & Treat’ from NHS111 on a GM footprint with the aim of reducing the number of A&E attendances. On 1^st December 2020, the national ‘111 First’ initiative was launched, which was part of the national UEC By Appointment programme, requiring localities to offer direct bookable appointments for urgent care, including in A&E departments, Urgent Treatment Centres and other Primary Care services.

The Committee was informed that a North West Ambulance Service (NWAS) and A&E Ambulance Handover Process has been implemented in A&E to improve ambulance handover times, If a patient meets the appropriate criteria, a handover checklist can be completed, and patient can be left with the A&E team to await further assessment. This will allow crews to handover patients quicker and be available to respond to other calls sooner.

The Committee was informed that the UCH (Urgent Care Hub) takes on average per month:1,575 referrals from NHS111 and Greater Manchester CAS 353 referrals from Health and Social Care professionals, including care homes, paramedics, GP’s; 424 referrals from Pre-Emergency Department. In addition, the UCH will respond to: NWAS crews within 20 minutes of their call; Health and Social Care professionals within 30 minutes; NHS111 and Greater Manchester CAS within 1 – 12 hours dependent on the clinical need of the patient. Patients referred from Pre-ED to the UCH will receive a clinical assessment from the hub within 30 mins to 4 hours dependent on their clinical need.

Ongoing developments included preparatory work for the winter period. Currently there is being built a System Winter Plan which included implementing additional capacity schemes to meet the anticipated demands. There was a Falls Service that is being reviewed and mapping work on the current level of service is being undertaken to identify any areas for improvement and looking to support care homes when falls occur. Another key area was Care Home A&E attendance audit: staff are currently doing an audit of residents from care homes who have attended A&E to better understand the necessary response to urgent needs that may arise in care homes and to identify any area where we can improve our support. This was a large project where care homes records, GP records and A&E records will all be scrutinised in order to draft an improvement plan.

Resolved:

That the report be noted.