Report of NHS Devon, attached
(Councillor J McInnes attended in accordance with Standing Order 25 and spoke to this item with the consent of the Committee and referred to health and social care workforce recruitment and retention and parity of esteem for social care, professional development and career progression; and pharmacy services).
The Committee considered the Report of NHS Devon on System Development and Improvement and working together in Devon through
Devon’s Integrated Care System, which was known as One Devon, established on 1 July 2022. The Report highlighted the significant challenges faced by health and social care partners and how new ways of working could make a difference to patients and join up the entire urgent and emergency care pathway.
A set of overarching goals for urgent and emergency care had been developed to set expectations for the health and social care system, and to enable delivery of an improvement programme. Delivery of the goals would be achieved through whole system collaboration involving NHS Devon (the Integrated Care Board), the One Devon Partnership, social care partners,
Local Care Partnerships (LCP); and Provider Collaboratives, including partners across public services and the third sector.
System priorities for urgent and emergency care were:
1. Effective navigation
2. Same Day Emergency Care
3. Ambulance Handover Improvement
4. Improving flow through Emergency Departments
5. Community Urgent Care
6. Access to Primary Care
7. Access to Mental Health Services
Devon’s system remained under sustained pressure due to a range of complex and multi-faceted issues – including the pandemic, increased demand, staff shortages, and vacancy rates in health and adult social care providers.
In regard to winter planning, NHS England had written to all systems to set out the next steps in increasing capacity and operational resilience in urgent and emergency care ahead of the forthcoming Winter. Six specific metrics would be used to monitor performance in each system, which were key to the provision of safe and effective urgent and emergency care:
• 111 call abandonment
• 999 call answering times
• Category 2 ambulance response times
• Average hours lost to ambulance handover delays per day.
• Adult general and acute type 1 bed occupancy
• Percentage of beds occupied by patients who are medically ready to go home or to other care settings, such as social care placements
Members’ observations, comments and discussion points with the Deputy Chief Executive NHS Devon/ICS included:
· the change of the 111 Service from Devon Doctors to a new provider which was due to become operational shortly;
· the increase in the vacancy rate since last year (from 8% to 12.5% (4,561 vacancies)) across health and social care;
· the challenging budget for 2022/23 and required savings and efficiencies of £142.2m to be delivered across the Devon NHS system (on which more information was available via the Integrated Care Board) and the progress to date in planning to achieve the required saving;
· the successes highlighted in the Report;
· the target of having no more than 5% of general and acute hospital beds occupied by patients who no longer needed specialist hospital care; and the capacity and workforce issues and the resulting degree of variance from this target as detailed in the Report across the acute hospital settings in Devon (including Torbay and Plymouth);
· measures which could be developed to help retention and recruitment and the impact of the ‘Proud to Care’ and the national ‘Love Care’ campaigns (on which a Briefing Note would be prepared for Members) and the need for more information relating to why people were leaving health and care careers;
· the lack of information in the Report relating to the ‘patient experience’;
· confirmation that the Devon Stakeholder event had taken place on 13 September 2022 on which more information would be provided to Members;
· the valuable work of the Community and Multi-Disciplinary Teams to support short-term rehab placement resulting in significant reduction in occupancy of acute beds and development of this initiative working with care homes to support hospital discharge;
· reasons for the increased mental health needs on which more information was requested by Members; and
· the need to review pharmacy services across the County, their value in reducing pressures across the health and social care and the role of the Health and Wellbeing Board and NHS England as the commissioner; and issues faced by local members in helping ensure proper provision with new and expanding residential growth points in the County (notably SW Exeter/Teignbridge, Cranbrook, Sherford and North Devon).
It was MOVED by Councillor J Bailey, and SECONDED by Councillor S Randall Johnson and
(a) that a report be made to the Committee for its next meeting on 22 November 2022 on the budget position and progress in addressing the target saving/efficiency savings of £142m across the Devon NHS system for the current financial year;
(b) that an update report on System Development and Improvement: Winter Evaluation be presented to the March 2023 to include:
(i) progress on the six specific metrics (referred to above) for the provision of safe and effective Urgent and Emergency Care used to monitor performance in each system;
(ii) the impact of local and national workforce recruitment and retention initiatives (to include work force exit information);
(c) that a Review of Community Pharmacy be added to the Work Programme (Spotlight or Task Group review).