NHS North West

NHS North West has commissioned a review of emergency care services across the North West region, which will encompass the ability to deliver operational standards, changes in demand for emergency care services, key constraints in capacity and escalation procedures, and performance management arrangements around the targets, both within health economies and at SHA-level.

This is because although in 2008/09, the 98% four-hour performance target for Accident and Emergency Departments was achieved across England, three SHA regions, NHS London, NHS West Midlands and NHS North West, did not deliver the required standard of performance, achieving 97.9%, 97.7% and 97.7% respectively.

In the North West, seven Trusts were categorised as “underachieving” and four as “failing”. Particular problems with performance were evident during the winter period, with A&E performance falling to levels not experienced since pre-2007. In addition, the range in weekly performance was significant for several Trusts, with performance ranging routinely by 10% and in some cases significantly more.

Similarly, the North West Ambulance Service experienced difficulties in achieving the Category A and Category B performance targets, delivering 74.0% and 87.3% respectively for 2008/09. A significant drop in performance against the Cat A8 Call to Connect target was observed during the winter 2008/09 period, coupled with a significant increase in the number of calls received.

Terms of Reference

To review the response of the North West region to the delivery of operational standards and targets, the planning of winter pressures and the ability of Trusts, Primary Care Trusts (PCTs) and NHS North West to cope with, and manage, increased pressures including a rising tide of flu, Norovirus and unseasonably cold weather. This will include the response of

• The Strategic Health Authority as a whole and specifically the performance team;
• Primary Care Trusts;
• Provider organisations including Acute, Mental Health and Foundation Trusts;
• North West Ambulance Service (NWAS);
• Monitor.

To review the performance management arrangements within organisations in regards to emergency care targets including the 98% A&E operational standard and the Cat A8 Call to Connect ambulance target.

To undertake a review of capacity and demand and understand the rise in emergency admissions in the North West over winter 2008/09 compared to previous years, the capacity of the NHS in the North West to cope with the increase, and the impact on performance against the 98% A&E operational standard and ambulance targets.

• To understand any key constraints that have contributed to some acute provider organisations being unable to deliver the 98% A&E operational standard.
• To investigate, drawing on work already undertaken by commissioners, the large increase in Cat A 999 calls.
• To review the role of primary care in managing demand on acute hospital services.
• To learn from best practice both regionally and nationally and understand why some health communities have been able to cope with the winter pressures.
• To review the way NWAS, PCTs, Mental Health and Acute providers have adopted best practice clinical and managerial models that are in place elsewhere.
• To make a series of recommendations with a timeline for implementation that will enable the NHS in the North West to resolve the issues identified and ensure ongoing and systematic, sustainable delivery of the emergency care operational standards and targets whilst providing high quality care.

Core Team for the Review

Aidan Kehoe, Acting Chief Executive of Blackpool, Fylde and Wyre Hospitals NHS Foundation Trust (BFWH NHS FT) is chairing the review. The project manager for the review is Victoria Ellarby, Assistant Director of Business Development, also at the Blackpool Acute Trust.

The core team comprises:

Aidan Kehoe Project Chair aidan.kehoe@bfwhospitals.nhs.uk
Victoria Ellarby Project Manager victoria.ellarby@bfwhospitals.nhs.uk
Karen Campion karen.campion@northwest.nhs.uk
Dr Simon Walford simon.walford@btinternet.uk
Jeremy Pease jeremy.pease@btinternet.com
Karen Young Project Administrator karen.young@bfwhospitals.nhs.uk

Sharing event May 2009

An all-day feedback event was held on Wednesday 20th May to provide feedback on the interim findings, as well as acting as a forum to share good practice and gather ideas for future improvements.

The programme included presentations of the interim findings from the core project team, as well as short case-study presentations from several health economies, which highlighted initiatives that have been successful, as well as allowing Trusts to share schemes that have been trialled but have perhaps not worked as well as intended.

To view presentations from the event, please see below

Introduction
Methodology
Findings
4 Hours and All That
Liverpool Health Economy
Knowsley
Stockport
Winter Review – Ambulance Perspective
Salford
Central Manchester
Pennine Acute Hospitals - Part 1
Pennine Acute Hospitals - Part 2
Pennine Acute Hospitals - Part 3
Pennine Acute Hospitals - Oldham
Closing Remarks