Agenda item

Helen Medlock (Associate Director of Urgent Care and Trauma, NHS Kent and Medway), Helen Buckingham (Deputy Chief Executive and Director of Whole Systems Commissioning, NHS Kent and Medway), Ian Ayres (Accountable Officer, NHS West Kent CCG), Emma Burns (Head of Media and Communications, NHS Kent and Medway) were in attendance for this item.

(a)       Members had before them a copy of the HOSC review report into level of attendance at A&E departments, Not the Default Option, along with responses from the local NHS. In introducing the ongoing work, NHS representatives commented on the quality of the report and how the challenges it posed were useful locally in taking the work forward. Clinical Commissioning Groups (CCGs) were taking the recommendations into account as part of their urgent care review. Following one of the recommendations, media and communications were being coordinated across all Trusts in Kent on this issue. Working across sectors was showing dividends in winter planning.

(b)       Communication of what services were available where along with clarity over what people could expect from walk-in centres compared to minor injuries units and other services was a major theme in Members comments and questions. Publicity material was being circulated through the Your Health magazine, GP practices, GP patient reference groups, acute and community hospitals, to parents through parents’ mail, and other methods. Members drew attention to a couple of examples of incomplete or inconsistent information and NHS representatives undertook to note and check on these and ensure they were correct.

(c)        Picking up on one of the points raised by Members, NHS representatives confirmed that the issue of nomenclature was being looked at to see if having a number of different terms for different services, walk-in centres and minor injuries units and so on, was helpful or confusing. NHS surveys also suggested people often had misconceptions about what A&E could provide, such as the belief it was a source of free prescriptions. Minor injuries units were being reviewed in East Kent at the moment and this review was looking at the issue of standardised opening hours, which had been an idea put forward by Committee Members. The location of these centres and units was also raised as an issue, with the response from the NHS being that it was not possible to have a minor injuries unit in every town. The financial and clinical arguments dovetailed; while it would be expensive to do this, it would also be unsafe as it would not be possible to have the right staff skill mix at every site. Responding to a specific question, NHS representatives undertook to check the figures for levels of attendance at the Folkestone minor injuries unit as those quoted in the report seemed too low.

(d)       Responding to the issue of whether the real or perceived lack of access to GP services was a reason for people attending A&E, it was pointed out that parents of young children have good access to GP services yet often go straight to A&E with their children because of the increased worry. The Committee was also reminded that all GP practices were part of CCGs, with West Kent CCG having 62 member practices. These did not provide services but did allow peer to peer support in order to improve. The CCG representative present encouraged the use of Patient Advice and Liaison Services (PALS) and similar as patient feedback was very useful for commissioners and providers. Related to this topic, GPs in West Kent were working with Maidstone and Tunbridge Wells NHS Trust on a way to relieve pressure on A&E by instituting a ward where GPs could directly refer patients for tests. 

(e)       Mental health was another area of concern given the high proportion of people attending A&E with mental health problems. It was reported that improvements had been made to access to Crisis Resolution Home Treatment Teams, working with Kent and Medway NHS and Social Care Partnership Trust, allowing fast tracking back to the service where necessary. Work was also being undertaken with SECAmb to ensure mental health emergencies received the appropriate response. Members were also updated with the information that the Liaison Psychiatry Service had now been rolled out to all Acute Trusts in Kent. The point was also made that A&E would still often be the most appropriate place for patients with mental health needs as they would still often have physical health needs.

(f)         The new 111 service being introduced into Kent and Medway in 2013 was seen as a way to bridge the gap between the fact that for the individual patient, any health need could be seen as serious, and the need for them to access the most appropriate care. Calling this number would, when the service is launched, connect the caller to someone able to access a database of what services were available at that time. It was believed this would divert a lot of patients from A&E. The NHS undertook to report back on the performance of the 111 service once it had been operational for 6-9 months. In response to a specific question, Members were informed that the 111 service had a call answering target of 60 seconds, compared to the 5 seconds of the 999 ambulance service.

(g)       NHS representatives presented the idea that the individual patient was never in the wrong place and often made the most rational decision for them. The challenge was to build a good service around where they were. The importance of accessing services physically and electronically was discussed. A smartphone app was in development and the work of the Kent and Medway Transport Working Group was continuing. The role of pharmacies was also highlighted and it was confirmed pharmacies would be on the 111 database. Robin Kenworthy was invited to speak and he explained he was the sole patient representative of the Health Living Pharmacy project which has worked with the Department of Health and others on 100 pharmacy pilots over the last 18 months looking at the role of the pharmacy. Members were requested to forward any feedback on pharmacy service to him.

(h)        The Chairman thanked the guests for attending.

(i)         AGREED that the Committee note the report.