North by North West: Escaping the A&E chopping block

Pulling back from the brink

Two months have passed since two chief executives were sacked over their trust’s accident and emergency performance, in a move intended to ram home the importance of meeting the four hour target.

The message will have been heard loud and clear at some North West providers, which may well have been mentioned, but ultimately spared, in some of those P45 discussions.

The statistics looked particularly troubling for Aintree University Hospital Foundation Trust and Wirral Teaching Hospitals FT, which were reporting performance of 82 and 81 per cent respectively for the first six months of 2017-18.

Since then, both trusts have pulled back from the brink.

Wirral reported a dramatic improvement in September and October, reporting 87 and 88 per cent, while Aintree reported 84 per cent with signs of further improvement in November.

Both trusts have been taking advice from consultancy firm EY, which seems to have made an early impact. Hopefully, it pays off with sustained improvement over winter.

Care home closures

East Lancashire Hospitals Trust has moved up the A&E risk register due to two imminent care home closures in Pendle. Both homes were criticised in recent Care Quality Commission reports.

Besides reducing beds in the system, the closures will require a huge amount of social care time and capacity to relocate the residents, which means less time and attention on tackling delayed discharges.

There has been lots of effort to support the care home sector in Pendle through commissioners’ work with the Airedale vanguard, so the closures will be a major concern.

Headcount reductions

There may have been some extra revenue funding in the Budget, but it’s all been earmarked to shorten waiting times and comes with a clear expectation of increased productivity.

The government has so far been vague on what it means by productivity, but an area where we’re likely to see further tightening is the running cost budgets of clinical commissioning groups.

In some areas this will run alongside, or even follow, the transition to accountable care systems (with commissioning teams either centralised or merged into council structures) but in others it will provide the final push.

As my colleague Dave West noted last week, lots of areas remain relatively untouched by CCG consolidation or leadership sharing.

Lancashire has the second most CCG accountable officers per head of population, Cheshire and Merseyside the fifth most, and Greater Manchester the eleventh most (out of 44 Sustainability and Transformation Partnerships).

The starting gun for CCG consolidation has already been fired in Greater Manchester and there will be increasing pressure on the other STPs in the North West to follow suit.

STP finally gets going

The cumbersome Cheshire and Merseyside STP was always going to be tricky to get a grip of. There had been little to no history of joint working across the footprint, and initial efforts focused on integration between the NHS organisations in three geographies.

But the geographies made little sense, local authorities felt excluded and there wasn’t much evidence of progress.

In the summer, a full time chair was appointed plus a new leader, and a different approach is apparently being taken with the STP split into nine boroughs and focusing on health and social care integration (ie: talking to the councils).

Meanwhile, the KPMG has been commissioned to work with the NHS Transformation Unit, which led the Healthier Together programme in Greater Manchester, to work on plans for acute reconfiguration across the patch.

According to one senior figure in the region, it feels like things are finally getting going.

New management

Stockport’s plan for an “accountable care trust” may have stalled, but the partners are doing what they can to integrate services on the ground.

There is now a single line of management for the integration work, badged as Stockport Neighbourhood Care, which reports into the “alliance board” which has been formed between the NHS trusts, council, and GP federation.

This week it was announced that SNC will be headed by Caroline Drysdale, who has been running the Bury locality for Pennine Care FT.

Keeping tabs

Under a Lord Carter aligned pilot project, the Countess of Chester Hospital FT has this year been using tracking technology to help manage its beds, patient flows, staff and equipment.

More than 4,000 infrared sensors have been installed above beds and doorways, which are triggered by tracking devices in patient wristbands, staff security cards and tags on equipment.

The idea is that real time and more accurate information will help identify areas of inefficiency, while freeing up staff whose job it was to monitor this stuff.

It’s early days of course, but leaders at the trust are excited enough to have invited stakeholders in the next month to show it off.

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