To consider:

·         an update report on services commissioned at the Emergency Department by the South Devon and Torbay Clinical Commissioning Group;

·         a briefing note of the pressures faced in the Emergency Department prepared by South Devon Healthcare NHS Foundation Trust; and

·         the current position in relation to ambulance handover times at Torbay Hospital prepared by South Western Ambulance Service NHS Foundation Trust.

Representatives from South Devon and Torbay Clinical Commissioning Group (CCG), South Devon Healthcare NHS Foundation Trust (the Acute Trust) and South Western Ambulance Service NHS Foundation Trust (the Ambulance Trust) attended the meeting to discuss services at the Emergency Department at Torbay Hospital.  Representatives from Healthwatch Torbay also attended the meeting to share their views.

The CCG presented its report which detailed a change to the internal configuration of staffing within the Emergency Department at Torbay Hospital so that five additional specialist nurses were funded rather than a GP and/or general nurse.  Whilst the satisfaction level and experience of those patients that were seen and treated was good, there were concerns about the cost-effectiveness of the previous GP service given the low levels of activity.

The additional specialist nurses which were recruited included two with specialist paediatric skills which reflected the fact that children under 5 were among the most common attendees of the previous service.

The CCG and Acute Trust then went on to explain the increased pressures which were currently being felt within the Emergency Department with the four-hour waiting target in Accident and Emergency (A&E) being missed over the past seven weeks.  The target was seen as an indicator of other pressures within the health and social care system (including community care and social care).  It was reported that there had been a significant increase in the number of patients with complex and acute needs with an 8% increase in ambulance activity.  The Intensive Care Unit had frequently been full.

The Acute Trust highlighted that its review of every “four hour A&E breach” patient had shown that availability of beds was the primary cause for patients experiencing unacceptable delays.  However, through good partnership working, there were very few delays in securing community or intermediate care beds.  Beds within the rest of the Hospital were not being freed up as quickly as normally due to the high acuity of patients requiring longer stays and the consequent low level of discharges.

The very good relationship between the Acute Trust and the Ambulance Trust meant that handover delays were being kept to a minimum.  The representative of the Ambulance Trust gave details of how its “Hear and Treat” and “See and Treat” initiatives were helping to reduce the numbers of patients being taken to the Emergency Department.

One of the issues highlighted during the debate was that patients are not necessarily choosing the appropriate healthcare setting for their needs.  For example, attending the Emergency Department if they are unable to book a GP appointment for a time that is suitable to them or if they are not able to readily access the Out of Hours GP service (through, possibly, not knowing which telephone number to dial).  It was felt that the “Choose Well” message needed reinforcing especially in relation to the availability of services through pharmacies.

Healthwatch Torbay suggested that it could provide the patient view on satisfaction with the Emergency Department.

Resolved:  (i)  that Healthwatch Torbay be requested to provide the patient view on the Emergency Department including the reasons why patients choose to use the Department over other alternatives; and

(ii)        that Healthwatch Torbay are also invited to highlight other issues that could be the subject of future review by the Health Scrutiny Board.