Scottish Government Health and Social Care Directorate

EMERGENCY ACCESS DELIVERY TEAM

Minute of meeting held on 6 February 2012, St Andrews House, Edinburgh

Present:Mr Tim Davison (Chair)

Mrs Kathleen Bessos

Mr Frank Strang

Ms Jackie Britton

Mr Martin Hopkins

Dr William Morrison

Mr Duncan Miller

Dr Anne Hendry

Dr Dan Beckett

Dr Stephen Potts

Dr Robert Williams

Dr Catriona Hayes

Ms Claire Gordon

Mrs Fiona Mackenzie

Dr Sian Tucker

Mr Graeme Aitken

Mrs Anne Azak

1.Welcome and Apologies

Tim Davison welcomed everyone to the meeting including Ms Sian Tucker from

NHS Lothian.

Apologies were received from Prof. Derek Bell,Dr Marion Storrie,

Ms Susan Bishop, Ms Heather Kenny, Dr Graeme Walker and Ms Gill Stillie.

2.Note of previous meeting

The note from the previous meeting of 12 December 2011 wasapproved.

TD welcomed FS back to the EADT and explained that as from 1 April 2012 he would be taking over from KB and the work of the EADT would be moving to Primary Care Division within SG.

3.HEAT T10 Reducing Attendances

(i) Reducing Attendances - update on current position

FMack gave a brief update on the current position stating that the figures for December were slightly higher than November and at the same time last year.

She clarified that those patients that have been redirected from A&E are included in the baseline A&E activity and this information had been cascaded to Health Boards.

TD asked if D Bell’s issue raised at the last EADT meeting around recording attendances differently in Glasgow around Stobhill and the Victoria and it was confirmed that this had been resolved.Also the suggestion that the reports are annotated with commentary on the changes. Was this all to put in here?

It was highlighted that because of different service models and changes across the country it is difficult to compare one year against another and therefore caution should be used when analysing the data.

(ii) Patient Flows

CH distributed papers and updated the meeting on the work done so far around patient flows.

CG stated that caution should be used when looking at the overall Scotland figures as Glasgow requires more work on analysis.

The charts issued were for NHS Lothian for 2008/09, 2009/10 and 2010/11 and for NHS D&GApril to September 2010 vs October 2010 to March 2011 with also for Lothian’s figures broken down for the period October 2010 to March 2011 for age groups 0-15, 16-24, 25-34, 35-64, 65-74 and 75+.

In Lothian there is not much change in A&E activity over time but most apparent in the monthly trends in NHS24.

In D&G activity was greater April-September 2010 than in October 2010-March 2011.

There then followed a discussion, a summary of which:

AH asked that information be cascaded both to Boards and also at a local level? RW confirmed that this varies across the country depending on the Board.

DBkt asked that there should be a shared file set up giving Boards access to allow everyone across the country each others information and share it also including

GP practices and they should be more involved engaged in this.

WM acknowledged this large collection of data and KB stated that the information was being used in local partnerships and EDs

SP asked if the group was confident that the information was being sent to the correct people and WM confirmed that they were.

AH asked that there should be a data link between Patient Flows and Milestones to make it more meaningful.

TD summarised that if this work continues over time the results will become more worthwhile and asked that JB and CH meet to think about ways to publicise and cascade this information.

Action: JB and CH to meet regarding how to publicised cascade information.

(iii) Milestones 2012/13

JB gave an update and asked for any comments concerning the updated draft Milestones for 2012/13 which were circulated.

SP welcomed that mental health and addition services has been amalgamated together.

AH asked that Boards and partnership measure outcomes be more detailed in the final version.

Action: Any comments to be sent to JB and draft Milestones to be updated before issue.

(iv) Messages to Patients – proposal

KB stated that there had taken place meetings between clinicians, access services and social marketing colleagues and there had been conversations concerning key points and highlighted that there is a possible disconnect between clinicians and patients.

It had been decided that they would look at three areas redirection, triage and redirection pathways.

The draft of those discussions was not ready for issue but when it is this would be issued to the EADT, after this certain members of the EADT would be asked to attend a meeting with Derek Feeley (DF).

TD asked that the draft summary would be made available before the meeting with DF.

WM agreed and stated that redirection was only part of the issue and there had to be clear messages to the public to make the process clear.

TD stated that members of the public are also making an informed choice to go to A&E rather than OOS or minor injuries and this needs to be addressed.

DBkt asked if there is information on GP Access Surveys but it was acknowledged that this was not available at the moment.

WM stated that the public do not want to used NHS24 because of a range of reasons and these issued need to be teased out and looked at in detail.

FS stated that from 1 April there would be good data available.

AH stated that there was a need to look at Anticipatory Care Planning led by the QAF.

SP highlighted the need to engage general practice in this process.

(v) Clinical Indicators – HIS

JB stated that she was in the process of arranging a meeting with Frances Elliot of HIS who was keen to have a meeting a.s.a.p. and this would link in with OOS, older peoples services and A&E.

SP asked why we are looking at more clinical indicators when data shows that we are not achieving the targets with the ones at the moment?

TD asked that SG and HIS look at all the indicators closely.

SP asked that there is an ED indicator for each speciality.

(vi) Mental Health Services

SP gave a brief update stating that there were 68 breaches of the 4 hour standard caused by waiting for a mental health expert which equates to 1% of the total.

There should be more of a push to highlight this to medical managers once the Milestones are developed and finalised.

JB highlighted that in Glasgow there was data linkage allowing both mental health and A&E access to records, where this had been done both parties have been delighted with the data linkage which is working well.

4. 4 Hour Wait

MH gave a brief update to the meeting with regards to the standard highlighting Primary Care linkage and T10, clinicians and managers will be looking at perceptions and problems with ImperialCollege, London in the near future. They will look at how to manage, understand and generate capacity and also to make decisions at the right time.

5. Winter PlanningUpdate

RW updated the meeting stating that so far during the winter of 2011/12 both Norovirus and flu have been at low levels and there is no big dip in performance during the first week of January as in previous years.

12 hour breaches are still a concern in some areas and work is ongoing with Boards to address this but other performance is good.

RW said that he would circulate after the meeting a management report on winter planning and asked for views and comments by the end of February. The intension is to compile another report (if the EADT think this would be the best course of action) and publish in June 2012 for use next winter.

RW asked for comments regarding the proposal to change the Winter Planning National event, the suggestion was that it would be much smaller with a Winter Planning Lead from each Board attending so that discussions would be more tailored to each geographical Board. The pros and cons regarding this suggestion would be circulated and asked for comments to be returned to himself.

AH agreed with the proposal for a National event and asked that perhaps three smaller Regional events would be an idea to consider to allow everyone from all areas to attend.

TD agreed with smaller more focused National meetings and 3 Regional events. He asked that RW would contact Boards to find out their views on the National and Regional events and then prepare paper and feedback to the EADT.

Action: RW to circulate Winter Planning Management Report and suggestion paper for the Winter Planning National event asking for comments to be returned to himself.

To contact Boards regarding the new proposal to change the National and Regional events then prepare a paper and feedback to the EADT for the next meeting.

6. LTC Task and Finish Group – draft report

AH updated the meeting regarding the group and LTC pathways (anything more to go in here?)

Rapid response and Intermediate Care services met 5 times in 2011 and its report was issued to the EADT and comments sought including the 10 recommendations.

It was noted that sick older adults and falls were the most recorded by SAS.

KB asked that in the report there would be locally built in information and AH agreed.

Action: Comments on the draft report to be sent directly to AH and to report back at the next EADT meeting.

7. Future Focus of EADT

KB updated the meeting with the focus of the EADT after 1 April which will move to Primary Care under FS.

The 3 issues to concentrate on would be

  • 4 Hour wait Standard.
  • Reducing A&E using pathways and facilities.
  • Unscheduled Care Advisory Group whose role is a policy issue and is envisaged would meet 2-3 times a year.

Primary Care would also have responsibility for SAS, GPs and GP OOS and there would be realignment within SG internally to move this forward.

DBkt asked that there be more engagement with OOS and the issue of public holidays.

WM agreed and stated that redirection was only part of the issue.

TD asked that we need to be clear especially around redirection and what we aim to achieve from the target and then give advice to DF.

KB said that the aim was that approximately 6 people to meet with DF in March which would include GPs and clinicians and feedback from this meeting would be sent to the EADT.

8. Date for next EADT

The date of the next EADT will be Monday 16 April 2012 at 10am in Conference Room D, St Andrews Housefollowed by Monday 11 June.

1

.