Agenda item

To receive an update from Croydon Health Service NHS Trust.

The Sub-Committee considered a report set out on pages 27 to 38 of the agenda which an update from Croydon Health Service NHS Trust on Urgent and Emergency Care Pressures. The Chief Executive of Croydon Health Service NHS Trust and Place Based Lead for Health introduced the item and summarised the key points of the report.

The Chair asked commented on Urgent and Emergency Care Pressures being a year round issue that was more acute at winter, and asked about any imminent short term risks. Members heard that the combination of Flu, COVID and other respiratory issues had added challenge and it was not yet known if this had reached its peak or whether the challenge would further increase. The impact on staff in Urgent and Emergency care was substantial, and cumulative whilst the pressures were high. Members heard that current industrial action was affecting Croydon through the London Ambulance Service strikes, but this was being managed well; a ballot for a Junior Doctors strike was ongoing and could lead to industrial action in March 2023.

The Sub-Committee asked about patient pathways and anecdotal evidence of patients presenting at A&E instead of GPs, due to long waiting times, and pressures caused by part-time GP working. Members asked what was being done to address this, manage demand and drive residents to enrol at GPs. Members heard that capacity in hospitals, community services and primary care was greater than ever before, and that there were now double the number of GPs at the front of A&E to divert appropriate cases. The Chief Executive of Croydon Health Service NHS Trust explained that as quickly as capacity was being created, this capacity was being used due to increased demand and the slowing down of the flow of patients through services. Members heard that it was crucial to look at expanding capacity and how this capacity was used at the same time to ensure services were efficient. This was being done in conjunction with colleagues in Health and Social Care and a national pilot to integrate services was due to start in Croydon called the Frontrunner programme.

Members asked about bed blocking and were informed that there was a system in place to check the status of patients in the hospital on a daily basis to identify expected discharge dates. These dates could be extended for a variety of reasons, and these factors all contributed to the figures of those who did not require medical care, but were still in hospital. The Sub-Committee heard that because this was multifaceted, the issue was complex to solve, but work streams were looking at all factors in collaboration with Health and Social Care. Members discussed anecdotal cases of patients who had been in hospital for a significant length of time due to mental health factors, and suggested that additional psychological help for these patients could increase rates of discharge. The Chief Executive of Croydon Health Service NHS Trust agreed that this was an important issue that need to be tackled as it affected all areas of the hospital. The Corporate Director for Adult Social Care and Health explained that there were different pathways for acute care and mental health cases and that both could be complex. Members heard that winter pressure was being monitored regularly to ensure the flow of discharges remained stable and that capacity was maintained; work on ‘Pathway Zero’ to support those with less complex needs to be discharged was ongoing by providing help with grocery shopping, making sure heating was available at home, etc. The Sub-Committee heard that ensuring discharges happened was important, but it was vital that support services were available in the community to enable this to happen. The Frontrunner Programme was looking at what was needed in Croydon to reduce the pressures of high demand on the hospital by growing reablement and joint care capacity. The Corporate Director for Adult Social Care and Health explained that they were working with partners across London in their capacity as the Director of Adult Social Services to ensure that patients who were residents could take beds in Croydon where possible, but that ultimately the goal was for patients to return to their homes.

The Chair commented on mental health as a topic on the work programme, and the prevalence of long-term hospital stays on mental health grounds. The Corporate Director for Adult Social Care and Health explained that there was work happening with the South London and Maudsley NHS Foundation Trust and the Bethlem Royal Hospital to support hospital discharge and that it was vital that support services and placements were available in the community for these patients.

Members asked whether Croydon was taking on patients who should be served by hospitals in other boroughs as a result of reduced capacity in other areas because of industrial action and other factors. The Chief Executive of Croydon Health Service NHS Trust responded that they had not seen a huge change in the numbers of patients from other boroughs during industrial action, but agreed with the Corporate Director for Adult Social Care and Health that these patients were often more difficult to discharge due to the need for two authorities to liaise on follow up support arrangements.

In response to questions on follow up community support and reduced funding for these services, the Corporate Director for Adult Social Care and Health explained that the authority had encouraged local partners to bid for the Innovation Fund to deliver ‘Pathway Zero’; this had been successful for the bids submitted by Age UK, the Red Cross and Croydon Neighbourhood Care Association. This was short-term funding until the end of March 2023, which would be monitored to see how this effected the flow of patients through the hospital, and whether ‘Patient Zero’ would be funded long-term. The Chief Executive of Croydon Health Service NHS Trust added that the Social Care Discharge Fund would be replicated next year.

The Sub-Committee asked how well new initiatives were being communicated to the public to empower them to make different choices around services. The Chief Executive of Croydon Health Service NHS Trust responded that partners had been engaged as new services were developed, and as they were offered to patients; it was acknowledged that this was not ideal, but the importance of communicating with individual families, communities and patients was noted, and it was explained that time was not always on the side of delivering comprehensive communications at the same time as delivering new initiatives.

The Chair welcomed the government’s increase in short-term funding and the signs of good partnership working in Croydon. The Sub-Committee acknowledged that certainty and long term funding would be significant challenges that were largely not in the hands of the partners and needed to be addressed by central government. The Sub-Committee were of the view that certainty and proper funding were essential in making services work properly. The Corporate Director for Adult Social Care and Health added that the money from the Better Care Fund had arrived quickly, but that monitoring and reporting on the funding was extremely regular, and that criteria for spending was stringent and could not be used for preventative measures. The Chair thanked the Corporate Director for Adult Social Care and Health for their comments and raised concerns about the level of bureaucracy required to receive short term funding, and the lack of funding available for preventative measures.