Agenda item

To note the Intergrated Performance Report.

Jude Adams presented the item, noting that the NHS is entering its most challenging quarter, particularly around delivery and performance during the winter months.

It was noted that there had been positives within the report, highlighting that sickness absence was down and that there had been a focus on welcome back conversations. Consultations were ongoing around some posts, and the financial implications that these would have. Success around managing stress was noted, and it was highlighted that cancer metrics were on track and in a good position. It was noted that NCA provides the bulk of dermatology work in GM and that the usual dip that is seen in the summer was maintained this year. Planned care performance was static, despite the fact that demand was up, and that work was ongoing to bring down the back log.

Community diagnostics were noted, highlighting that this was part of demand work. Work was also being done on productivity, and it was noted that this was not about working harder but redesigning services. It was highlighted that some metrics shifted when there were focuses into them. It was also noted that extra capacity gets harder through the financial year, which emphasises the need to redesign.

Urgent care metrics were improving, and it was noted that they were 5% better than this time last year. It was also highlighted that the gap to target was much narrower than in previous years.

It was noted that there were several focuses taking place, particularly around vaccines, paediatrics and the rise of respiratory ill health, and the need to do better during the winter months was highlighted. It was noted that the vaccine prevention factor was crucial, particularly as indications suggested that flu season would be worse this year, and that additional resource would be allocated for vaccinators. On paediatrics, it was noted that there would likely be an increase in viruses due to children being back in school. On the rise of respiratory ill health, work was being done on managing these at home, to help avoid hospital cross contamination.

It was also noted that the winter months would lead to other issues, such as the post-Christmas surge in fractures due to falls and slips in icy conditions, and the adverse effect of dark nights on mental health. It was highlighted that it was key to ensure that gains that had been made in all areas were not lost amidst surges in demand. Quality metrics were being watched to ensure this and staff were being urged to go back to basics on infection control, i.e. hand washing.

Members noted the recent political climate around vaccines, and were advised that resourcing would be needed to ensure improvement of around 18% was achieved due to initial lower rates. It was highlighted that a clear comms plan was in place to demonstrate the need for vaccines, including community role models. Messaging was noted as another key theme, including finding out why people who don’t get vaccinated choose not to do so.

Members noted that on a recent visit to a hospital, pumps and handwashes were not always stocked. It was noted that this was an estates and facilities responsibility, but that a message around challenging staff on hygiene was key, as were checks on top ups and PPE by senior staff.

Overpayment of staff was also noted by members, and it was noted that these monies are chased up and reported on too.

Members noted that performance metrics were improving but still not reaching targets, and that savings were being looked for at the same time. It was noted that there had been some additional funding, but that this was not the funding required to close the gap, and that metrics were more of a challenge across GM than nationally. It was highlighted that money alone would not close the gap, and that productivity improvements were key as well. It was noted that Outpatients needed to be rethought out structurally as the model of care was not sustainable. It was noted that Jude was happy to bring an item on Outpatients to a future meeting of the Committee.

It was noted that every year that the NHS was behind on improvement plans made future years even more difficult.

Members queried what steps were being taken to stop stress and avoid absences. It was noted that the SCARF Programme provided resources and signposting, and that training to recognise the signs of stress was taking place. It was noted that once staff were off with stress, it was harder to get them back to work. It was noted that welcome back conversations were key, particularly in highlighting what the NHS could do as an organisation. It was also important that staff felt valued and recognised for their contributions.

Members queried whether there were any particular areas for stress to be noted, and it was highlighted that nurses and healthcare support workers were having targeted work carried out. Admin staff were noted as having spikes in work loads, but that vacancies were being filled to try and alleviate this problem. Emergency departments were noted as a particular problem, specifically around violence, overcrowding and aggression incidents. It was highlighted that mental health liaison officers were working to resolve some of these issues in Emergency Departments, but that there was a greater presence of security at weekends due to the business of departments.

Members queried what short term actions would help with bed capacity. It was noted that the question was essentially how to avoid admissions and that this would come down to directing people to other services. It was noted that the bed shortfall was driven by deprivation and that there needed to be a focus on living well activities, as well as being better at lengths of stay and collaborative working was being done around this matter.

Members queried why some of the data was in figures, whilst others were percentages, noting that the data on its own is limited in context, and that percentages would be appreciated. It was agreed that a written explanation would be provided and circulated to members.