Kat Davidson, Chief Operating Officer, Royal London & Mile End Hospitals and Tom Cornwell, Divisional Director of Operations, Emergency Care & Trauma Division (RL & ME Hospitals), gave an overview of the Urgent and Emergency Care service for the sub-committee. This included the changing demands of the service, A&E department and Urgent Treatment Centres (UTC) performance summaries, system wide challenges, the referral to treatment process and cancer and diagnostics KPI’s.

Healthwatch Tower Hamlets also submitted a report on patient feedback for waiting times for elective surgery and accident and emergency procedures.

Mr. Cornwell explained that the four hour performance level  for A&E in April 2019 was around a 75% which has dropped to about 58% since August 2023.This equates to around 1000 per month. The UTC are managed by the GP Care Group,  this departments four hour performance level was around 98% in April 2019. This dropped to 76.9% for August 2023. Overall attendance has risen by around 80% at around 3 to 4000 per month.

There are numerous reasons, such as the decline of the pandemic, the increase in transport links with the Elizabeth line opening, enabling access to neighbouring borough UTC's and system wide changes to Primary Care. Discussions are taking place with Primary Care around access and supporting colleagues with the high turnover in patients.

Sub-committee members were informed of NHS challenges regarding the number of mental health referrals and the lack of beds for patients, as waiting times in the department have risen from 6 hrs to 12  since July 19 at an 11% increase. The levels of patients from outside the borough are causing considerable pressure on staff and patients and there can be delays in discharging patients from other areas who are medically fit but require care packages and community assistance to remain at home.

Kat Davison noted that waiting times for elective surgeries were also impacted by the pandemic, although steady progress to reduce this has been made. High Volume Low Complexity (HVLC) recovery of elective care services at Whipps Cross and Newham hospitals has enabled Royal London and Mile End Hospitals to focus on more complex procedures. The 78 week wait has decreased significantly and progress towards a 65 week clearance is underway.

A major challenge is addressing the inequalities data and access to elective and dermatology services, which paused in the borough and contributed to significant waiting times. Discussions are ongoing to develop a recovery plan now the service has been reactivated. Ms Davison then explained that achievements in cancer diagnostics recovery plan.

Further to  questions from the sub-committee, Tom Cornwell and Kat Davison;

·       Explained that details of mental health referrals requiring ongoing assistance noted in the presentation relate to adults. Figures for children are lower, as East London Foundation Trust (ELF) would usually provide assistance to children and adolescents and hold data. Ongoing work with ‘Care Navigators’ takes place to offer community assistance.

·       Noted that around 65 to 75 patients who are classed as medical fit, require a community bed, nursing home or their own home with a package of care prior to discharge. The levels of patients from outside the borough has increased the pressure on services and equipment, as has the rise in homeless residents. Current work with partners is ongoing to support patients within the borough and address those challenges.

·       Conceded that the industrial action has impacted services and waiting times. Derogation with regard to staff will be put in place, in the event of further action and plans for winter health concerns will be made in collaboration with NHS North East London. Priority will always be given to emergency services in these cases and discussions with unions are ongoing

·       Confirmed that UTC accounts for around 50%-55% overall performance and the good relationship between A&E and UTC means joint meetings to support performance and effective commissioning to ensure a sustainable workforce are in place. All patients are assessed in terms of severity to safeguard urgent treatment.

·       Clarified that the  76% target equates to an approximate 4hr waiting time, and with around 600 to 700 patients a day, this is challenging especially at weekends. The transformation plan for unplanned care will classify those requiring urgent care to those less urgent and assist in reaching the target. Other solutions include managing patients' expectations at the front door, scheduling appointments for patients with less critical needs to reduce the numbers. 100% of our Paediatrics patients were seen within target last week.

·       Observed that ongoing discussions are taking place with neighbouring hospitals to redirect patients to access hubs closer to home, rather than the Royal London or Mile End Hospitals to reduce the new demand.

·       Explained that trails on iPads for patients whose first language is not English to assist in translation have been promising and there are plans to offer this in other departments. A&E attendance waiting times and UTC are monitored separately, although performance figures presented still contribute to the overall target of 76%. Additional work is required to ensure new staff members are more understanding to patients during busy and demanding times.

·       Clarified that a Theatre Improvement Programme has been created to reduce waiting times for Children. Ongoing work with local hospitals is taking place to address this, particularly in  audiology and audiology departments due to a national shortage of staff in that speciality.

RESOLVED that:

1.    The presentation be noted.