Agenda item - Ambulance to Hospital handover update

Report of the Head of Law, including an update from SECAmb on recent handover performance (copy attached).

9.1       This item was introduced by Geraint Davies, Terry Parkin, Tim Fellows and Ben Banfield of SECAmb. Dr Magnus Nelson, XXXXX, represented Brighton & Sussex University Hospitals Trust (BSUH).

9.2       Mr Davies told the committee that handover represented an area of very high clinical risk for the trust. This risk is increasing, as handover times continue to lengthen – for example handover delays at the Royal Sussex County Hospital (RSCH) are up 35% on this time last year.

9.3       Mr Fellows told members that SECAmb does all that it can to manage RSCH delays. This includes holding a daily conference call with colleagues from BSUH, being in regular contact with social care, and regularly diverting patients to other hospitals. Although relations between SECAmb and BSUH staff are inevitably strained at times, the two organisations are working really hard together to provide the best service possible in the circumstances.

9.4       Mr Parkin added that SECAmb was currently undertaking around 3.5 ambulance calls (rather than the target 5-6) in a 12 hour shift because of excessive handover delays. Patients waiting in ambulances are safe, but ambulance crews cannot respond to additional calls whilst queueing at A&E, and this means that call targets cannot be met. This situation must be swiftly resolved, with handover waits of 30 minutes at most.

9.5       Dr Nelson told the committee that there was a very strong working relationship between BSUH and SECAmb, but that the system was experiencing extreme pressures for which there was no ready solution. The core problem is the increasing acuity and complexity of patients presenting for treatment, which has not been properly recognised in resourcing terms. This is a system-wide problem, but A&E is an obvious pinch-point.

9.6       Mr Davies told members that there needed to be a system-wide conversation about how to better manage handover. This needs to include HOSCs. HOSCs have no reason to feel confident that the system is managing handover effectively, and ought urgently to seek assurance on this issue. Agreement needs to be reached with NHS commissioners as to how to move swiftly to achieving a maximum 30 minute ‘turnaround’ time from arrival at hospital to being clear to respond to new incidents. Mr Parkin added that SECAmb could not continue managing this level of risk alone, particularly as this is a system-wide problem. The trust has internally debated this issue for a number of months and the Board has decided that there is no option other than to speak publicly and candidly with stakeholders.

9.7       Mr Davies noted that there are local examples of good practice with regard to handovers. Very poor handover times at Medway Hospital Trust have been addressed by the use of dedicated handover nurses.

9.8       In response to a question from Cllr Marsh on the potential to divert patients from A&E, Mr Fellows told members that SECAmb does all that it can in this respect, with more than 50% of ambulance attendances not resulting in conveyance to A&E. Brighton & Hove currently has no Acute Medical Assessment Unit to offer an alternative to A&E, and the development of such a unit might help ease pressures.

9.9       In response to a question from Cllr Peltzer-Dunn on the trend of performance, Mr Davies told the committee that things were getting worse rather than better. For this reason it is important that the HOSC holds the local System Resilience Group (SRG) to account for handover performance.

9.10    In answer to a query from Cllr Taylor on when delays peak, Mr Banfield explained that peaks tended to be out of primary care hours and on Mondays (when services are put under increased pressure by numbers of people who have become ill over the weekend but have waited to present for treatment).

9.11    Mr Parkin told the committee that the four hour A&E target is a problem, distorting attempts to triage patients. However Dr Nelson disagreed, arguing that the target had driven improvements in A&E performance. There was agreement that different agencies will inevitably prioritise the targets that mean most to them, and as these targets are not always compatible, that the SRG has a key role in ensuring that agencies work smoothly together.

9.12    In response to a statement from Colin Vincent, suggesting that delayed transfers of care are at the core of hospital flow problems, Mr Davies agreed that discharge is an important factor and again urged the HOSC to take to the SRG about this as this is another matter that the SRG is responsible for co-ordinating.

9.13    RESOLVED – that the information provided be noted and that this issue be revisited at the July 2016 HOSC meeting, with the Brighton & Hove System Resilience Group asked to attend and contribute.