From Board to Ward – February 2024
It’s been a busy start to 2024 and here we bring you some highlights including what we’re doing about waits for patients needing emergency care.
Every month our Board leaders meet in public to assess how we’re doing for the patients and communities we serve, how we’re doing for our staff, our achievements, our challenges with a big focus on what we’re doing to address them and what our plans are for the future. Who are our Board? https://www.plymouthhospitals.nhs.uk/trust-board
Here we share three key highlights from each Board meeting in a bid to shine a light on key progress, decisions and share in an open and transparent way some key developments. Highlights from February Board:
Improving services for patients needing Urgent and Emergency Care
Our Chief Operating Officer Jo Beer explained at our Board meeting that we know waits for patients needing Urgent and Emergency Care are too long – we have significant ambulance handover delays which, in turn, impacts on ambulance community response times. This is driven by a number of factors including an increase in the number of people attending, the acuity of patients (how sick they are), occupancy levels and the number of patients with no criteria to reside (these are patients who are medically fit to leave). Jo also talked about how hard we’re working to reduce these waits by creating a special Surgical Same Day Emergency Care (SDEC) area to treat patients needing urgent surgical care, opening another medical ward with 23 patient beds later in the spring and we’re also starting work on our plans to build an Urgent Treatment Centre next to Derriford Hospital which should open in the autumn.
Natasha Keeler was the third patient to be admitted to SSDEC. She said: “I came in at 9:20 this morning fully expecting to be here for the next 12 hours. Instead, I’ve been given a bed in a quiet space and should be going home by 2pm.”
What’s going well …
- No Criteria to Reside - For the third consecutive month we reported a reduction in the no. of patients with ‘no criteria to reside’, i.e. those who are medically fit to leave hospital (in Sept 2023 this was 14.6%, in December 2023, it had fallen to 10.4%)
- Emergency Dept: GP Streaming – We have increased the number of emergency patients being streamed to the GP service in December 2023 this was 473, up from 239 in November.
- Length of Stay: Our length of stay for emergency patients in December 2023 was 7.5 days, this was 0.9 days lower than the same month last year (December 2022, 8.4 days) and an improvement of 0.6 days on November 23. Getting people home sooner when they are well means we have beds free to admit new patients into.
What remains a challenge
- Ambulance Handover Delays: Hours lost >15mins – we continue to report significant volumes of ambulance handover lost hours.
- Emergency Department : % Waits >4hrs – waiting times in our Emergency Department remain consistently poor and above the target of four hours.
Working with GPs and our colleagues in primary care
We often get out and about with staff from our acute hospitals visiting GP surgeries (primary care) across Plymouth, east Cornwall and south west Devon. By working together we can deliver joined-up and better care for patients. Our Director of Integrated Care, Partnerships and Strategy Rachel OConnor told today’s Board meeting that we’re stepping up this approach. We’re running a pilot project with Launceston and Tamar Valley Primary Care Network.
The pilot focus is on exploring care closer to home, embedding population health, equity of access and outcomes for that particular catchment population. This is an exciting pilot as this Launceston and Tamar Valley Primary Care Network had secured some funding for a small local health hub, which gave us a model to consider how we could really support this facility, including direct linkage to the VCSE sector. The pilot has resulted in a series of outputs that will focus our priorities as a result of this partnership working. We are now planning to progress and expand this roadshow approach with eight other Primary Care Networks over the next few months. Our clinically led team will be going out to meet each network, reflecting on an insight framework for these meetings, aligned to referrals, urgent and emergency care, planned care and waiting lists. Each Primary Care Network does have a distinct catchment population so there are key considerations that may be more aligned to a geographical area. However, overall, we know we have deep areas of deprivation, embedded health challenges to respond to, and a growing, aging population. This project provides a partnered working approach to explore how we can provide the very best service delivery model for our patients now and for the future. Rachel thanked the Primary Care Networks for their enthusiastic response.
Teledermatology – good progress for patients with suspected skin cancer
Do you know someone who has been affected by skin cancer or has been worried about having a skin cancer diagnosis?
Our dermatology team saw a huge rise in referrals for suspected skin cancer last year and were worried that they couldn't keep up. Consultant and Service Line Director for Dermatology and Plastics Jolita Zakaraite talked to our Board leaders about what happened as part of the staff story heard today. The skin cancer team used to be able to see about 15/20 patients in every four-hour clinic but this wasn't enough to keep up with demand. "We knew we had to do something completely different," she said.
So Jolita and her team met with colleagues and explained that in order to see patients with suspected skin cancer quickly, they had to change the diagnosis pathway. They trained three Healthcare Assistants (HCAs) to use special magnifying cameras to take images of suspect skin conditions and designed a patient pro-forma to capture the required information for each patient. The photos would then separately reviewed by a consultant, who can also ask a colleague for a second opinion if required, and a diagnosis and treatment plan drawn up.
The new service was launched in August 2023. Patients were written to and invited to the clinic to have their pictures taken and the new diagnostic process was explained. In the first four months, nearly 3,000 patients were seen this way.
The evidence shows that teledermoscopy is clinically as good as seeing a patient face to face. Only by doing it this way instead of 15/20 patients being seen every four hours, 40 patients' skin conditions can be reviewed and diagnosed in the same period. By adopting this new diagnosis pathway, the team are now well on top of their performance for seeing patients with suspected skin cancer within two weeks.
Jolita explained: "Everyone is loving it. We explained the 'why' we needed to change to everyone in the team, that we were doing this to see patients quickly and people saw the benefit of that and understood their role in the patients' journey. Teamwork, feedback and understanding the why have all been key to this."
Well done to everyone involved.
Do you want to get involved?
- Would you like to join our Board as a Non-Executive Director? We’re looking to strengthen the breadth and diversity of our Board and we’re looking for new non-executive directors https://www.plymouthhospitals.nhs.uk/latest-news/would-you-like-to-join-our-board-7031
- Did you want to ask the Board a general question? If you do, please let us know by emailing communications.phnt@nhs.net and we will put it to them and get an answer at the next Board meeting on xx March 2024.
- Would you like to attend and watch the Board meeting? Dates, venue details and papers all here: https://www.plymouthhospitals.nhs.uk/trust-board-meetings-and-papers
