Agenda item

The Health & Social Care Sub-Committee is presented with an update on the management of waiting lists for elective care at Croydon University Hospital. The Sub-Committee is asked to:

1.    Note the update provided on the management of waiting lists at Croydon University Hospital.

2.    Consider whether its conclusions on the information provided and whether there are any areas in need of further scrutiny.

The Sub-Committee considered a report set out on pages 19 to 26 of the agenda which provided a follow-up from the Sub-Committee’s visit to the Elective Centre at Croydon University Hospital in regard of managing its waiting lists for elective care. The report was introduced by Mathew Kershaw, Chief Executive at Croydon Health Services and Place-based Leader of Health.

-          Councillor Yvette Hopley – Cabinet Member for Health and Adult Social Care

-          Councillor Margaret Bird – Deputy Cabinet Member for Health and Adult Social Care

-          Matthew Kershaw – Chief Executive at Croydon Health Services and Place-based Leader of Health

-          Rachel Flowers – Director of Public Health

-          Annette McPartland – Corporate Director of Adult Social Care & Health

The first question asked by the Sub-Committee asked how the reduction in waiting times for patients waiting for more than 65 and 78 weeks had been achieved and what strategies were being implemented to maintain the process. It was advised that the hospital had created a facility that allowed services to be planned more efficiently, and as a result utilise existing resources more effectively. It was explained that the hospital had created an area for elective care only, which helped to reduce the risk of postponing the surgery due to emergency needs. It was further explained that CHS had also improved the efficiency and expanded capacity of their operating theatres. However, it was stressed that it continued to be an ongoing journey, and they had not yet achieved the desired results.

The next question from the Sub-Committee asked about the analysis conducted on the waiting list data, and whether it had indicated that any groups were being more affected by prolonged waiting times than the others.  It was explained that the most effective way to reduce the disparities was to decrease overall waiting times. It was added that together with Public Health, CHS had been working on population health management and health inequalities to identify any potential themes. Assurance was offered that if any inequalities were identified, there would be appropriate changes implemented. It was also highlighted that waiting times in Croydon were lower than the rest of the South-West London and most of London.

The Sub-Committee questioned whether residents requiring more complex surgery tended to have a longer wait than other patients. It was explained that surgery was scheduled based on the urgency. Therefore, if a more complex surgery was relatively urgent, then the waiting time would be appropriately shorter. It was further explained that if the clinical urgency was equal to many other procedures, then the waiting time would depend on the demand for that particular service and availability of the consultants. It was assured that for areas with historically higher waiting times, for instance hip surgeries, CHS were constantly trying to improve the efficiency and availability of slots.

The Sub-Committee asked a supplementary question about whether a patient’s condition was monitored while they were waiting for their elective surgery. Assurance was given that an appropriate mechanism was in place to monitor patient’s conditions. If it was identified that the level of urgency had increased, the waiting time would be amended accordingly. It was also highlighted that a patient was able to request reassessment if they felt that the condition was worsening.

Then, the Sub-Committee asked about the main reason for the long wait times for the elective surgeries. It was explained that currently almost all Croydon patients were treated in the Borough, which in past had not always been the case as they had been able to rely on availability in the neighbouring boroughs. It was explained that staffing numbers was having a clear impact on waiting times, and recruitment to fill up the vacancies was challenging. However, it was assured that a lot of work had been done to reduce vacancies, which included the use temporary staff where needed. Another significant factor was the available capacity within the system, which in the last 12 months had been particularly affected by industrial action, which had an impact on maintaining elective services on a consistent basis. However, it was assured that CHS had mechanism in place to minimise the negative impact on the elective care.

The next question from the Sub-Committee asked how much capacity was lost due to patients not attending their scheduled surgeries, what was being done to address this, and how much capacity was lost due to patients not wanting surgery at certain times of the year, for instance Christmas. It was explained that the NHS monitored the number of patients not attending surgeries (DNA – did not attend). It was explained that in the last 11 months there were approximately 1,200 DNA cases for inpatients and day cases, which was equal to 4%. It was explained that DNA were caused by a variety of reasons, including some caused by the hospital – for instance, the operation date was communicated too late. It was assured that CHS had been constantly working to decrease the number of DNAs, through action such as improving communication with patients, including explaining the risk and loss of resources as a result of missed appointments. It was also explained that there were slots that were not taken up, however, it was normally easy to predict these, allowing work to be planned around it to ensure that as little resource was lost as possible.

The next question asked how communication between the patients awaiting elective care and the hospital was maintained. It was explained that there was a dedicated team within the hospital that managed this type of communication, and they constantly monitored the situation with the clinical team. It was explained that in general this team was performing well, however, they managed a considerable number of patients, which could result in delays or mistakes. In follow-up, further information was requested about how CHS communicated with DNA patients and the impact of DNA on the system. It was advised that in many cases CHS tried to communicate the impact of missed operations. However, this needed to be managed carefully as in some cases it was not patient’s fault.

The Sub-Committee moved on to questions about sexual health provision in the borough. The first question asked about complex sexually transmitted infections (STIs) in the Borough and what was being done about it.  The Director of Public Health explained that the Council emphasis focused upon preventative work and informing residents about sexual health. This included teaching people how to negotiate sex safety. As part of this work, the Council tried to target groups that were particularly vulnerable. It was emphasised that an important piece of work was to destigmatise sexual health and STIs. The Chief Executive of Croydon Health Service added that one of the most important factors was the changing nature of the population, for example HIV infections and the significant change in the life expectancy. There was added complexity related to the increase in life expectancy and the treatments available as previously many HIV patients would not get many other infections in their lifetime. It was highlighted that there had been a lot of work on the prevention and early detection of HIV, including every blood sample in Croydon being tested for HIV, unless a patient opted out. It was also highlighted that Public Health worked directly with residents to develop communication around HIV and other STIs.

The next question asked by the Sub-Committee related to the access to sexual health clinics and testing. The Sub-Committee Member pointed out that currently the Council’s website was signposting to the wrong website. The Director of Public Health assured the Sub-Committee that the information available on the website would be improved.

The next question asked what were the most common STIs in Croydon, and whether there was any STI that was harder to detect. The Chief Executive of Croydon Health Service explained that the NHS monitored this kind of data, and more precise information could be provided to the Sub-Committee. The Director of Public Health added that they could also share information with the Members in regard to the numbers and symptoms.

Subsequently, the Sub-Committee asked a question about feedback from service users and whether this had led to any risks or issues being identified. The Chief Executive of Croydon Health Service advised that they listened to patient feedback and had amended the operation of the clinic accordingly. It was also added that the postal service was very good and allowed residents to access tests more discretely.  It was highlighted that CHS had a dedicated part of the service that focus on education.

The final question from the Sub-Committee asked how people were recruited to be part of the coproduction, how the localised message was spread, and whether there was a focus on any particular groups. The Chief Executive of Croydon Health Service explained that CHS used a bus, which allowed them to reach many local groups directly. It was also added that they worked together with existing community groups, and tried to spread the national campaigns. The Director of Public Health also provided assurance that they tried to target the most vulnerable audience to decrease the risk of spreading STIs. Then, the Sub-Committee asked a supplementary question concerning the influence of the Sexual Health strategy on their services. It was explained that the STI part of the strategy was a standard piece of communicable disease control, and it was part of health protection.

Actions:

Following its discussion of this item, the Sub-Committee agreed the following actions for follow-up after the meeting.

1.     It was requested that the section regarding sexual health on the Council’s website was reviewed and updated.

Conclusions:

From its discussions of the Croydon University Hospital – Elective Care Waiting Lists, the Sub-Committee reached the following conclusions:

1.     The Sub-Committee recognised and commended the hard work of the Croydon Elective Centre for receiving the ‘Get it Right the First Time’ accreditation from the NHS England.

2.     The Sub-Committee acknowledged and commended progress made in reducing elective care waiting times.

3.     The Sub-Committee recognised the hard work of staff in reducing waiting times and providing sexual health services.