Report to follow.

The Board gave consideration to a report of David Allison, CEO and Janelle Holmes, Chief Operating Officer, WUTH that provided members with an update on the formation of the Wirral Health Economy A&E Delivery Board. The report confirmed the Terms of Reference including Health Economy Partners roles in sustained delivery of A&E performance and contained recommendations for both reporting and ongoing visibility across the Health economy for services which impacted on emergency patient flows. It further provided an update on the health economy assessment of its state of readiness to deliver the national service improvements outlined in the A&E Rapid Implementation guidance.

It was reported that earlier in the year following continued poor performance nationally against the 4 hour standard of 95% of patients to be seen, treated and either admitted or discharged from A&E a directive had been issued by NHS England supported by NHS Improvement to establish both local (Wirral) and system wide (Wirral & West Cheshire) A&E delivery boards. These were to replace the previous CCG led System Resilience Groups (SRG) and be chaired by the provider organisation focused specifically on improving performance against the 4 hour standard. The expectation was that the members of the group were at executive / senior management level with the authority to make decisions on behalf of their organisation at the Board.

It was reported that whilst accountability for the delivery of the 4 hour standard sat within A&E and therefore the acute provider it was recognized that reliability of delivery was based on whole health economy patient flow and as such needed to be owned by all health and social care commissioners and providers. This was because any changes to capacity or demand across the health & social care economy had a direct impact on patient flow into ED, through the hospital and back home. Because of this accepted interdependency it was critical that there was a clear line of sight & transparency of all services which supported urgent care and patient flow across the whole system.

On the 29th September 2016 the inaugural meeting of the Board had been held. At the meeting the Terms of Reference attached to the report as (Appendix1) had been agreed by all health & social care partners.

The Board were informed that as part of the refresh two pieces of work were expected from each health economy and reported nationally these were:

·  To undertake a baseline assessment of current service provision across all points of delivery against nationally agreed best practice outlined in the ‘A&E Rapid Implementation Guidance’ (Appendix 2)

·  To align health economy escalation plans and expected response using the nationally agreed OPEL system (Appendix3)

The self-assessment for the Wirral Health Economy had been undertaken in partnership with all health economy providers including the North West Ambulance Service (NWAS). The results were detailed in (Appendix 4) of the report.

It was noted that as a health economy Wirral already had an overarching action plan to improve patient flow & ED performance developed & monitored by the Urgent Care Recovery Group.

The key service improvement actions required as a result of the assessment were therefore included in the health economy plan.

It was also reported that health economy partners were in the process of reviewing & aligning the new OPEL system to the existing system so that at any given time the health economy had a OPEL score (1 -4 ) but more importantly that the expected actions to support de-escalation were undertaken by each partner. It was noteworthy to recognise that some of these expected actions might/would have a resource implication for partner’s e.g. opening additional capacity.

With regard to the next steps it was noted that in recognising the agency interdependencies it was equally important that the A&E delivery board had a full overview of the systems in place across Wirral which supported patient flow. This needed to include:

·  What services had been commissioned and their current capacity to include Primary, community, secondary & adult social care. The agreed contracts & provision including the services commissioned within the ‘Better Care Fund’.

·  Performance against agreed KPI’s or improvement KPI’s for the commissioned services.

·  Where new services had been commissioned to support patient flow through the ‘better care fund’ that there was defined tracking of expected outcomes to monitor return on investment.

·  Any proposed changes to capacity (decommissioning of services)

·  Any unplanned changes to capacity (loss of a care provision)

This would enable the system to understand the impact on performance of any changes to current capacity and demand and support the decision making process for any future investments in services

Janelle Holmes, Chief Operating Officer noted that the Wirral A&E Delivery Board reported directly through to the Wirral & West Cheshire A&E Delivery Board. However, each provider would need to agree how the reporting from the Board was fed into their existing governance arrangements.

It was recommended that the outputs from the Wirral A&E Delivery Board were reported to the Wirral Health & Wellbeing Board going forward so that there was clear line of sight at Health Economy level.

Val McGee commented that a lot of work had been undertaken in preparation around rapid community service, signposting, triage and a single point of contact outside of hospital.

Dr Sue Wells commented that everyone must work together as it was in everyone’s interests as long term hospital stays could result in patients becoming reconditioned and there were a number of clinical reasons demonstrating that care in the community or in the patient’s own home was a better option so it was important to get this right.

Councillor Chris Jones questioned how this would work if patients were not able to get an appointment at their GP practice. Janelle Holmes explained that there would be urgent access back to GP practices and alternative ways of dealing with this.

Resolved - That;

1. the progress to date on the establishment of the Wirral A&E Delivery Board be noted.

2. the Board provide any feedback on the Terms of Reference.

3. the interdependencies of all health economy partners to the reliable delivery of the 4 Hour standard be recognised.

4. that the new national escalation system (OPEL) actions may result

in a resource implication for providers be understood.

5. the Wirral ED Delivery Board update as a standing item on the Health & Wellbeing Board.