Minutes:
County Councillor Sue Whittam, Lead Member for Health, Paul Lee, Director of Adult Care and Provider Services, Sue Lott, Head of Service, Urgent Care, Acute and Prisons, Dr Tony Naughton, Place Based Clinical and Care Professional Lead and Heather Woodhouse, Integrated Place Leader – North Lancashire, Lancashire Place Based Partnership attended the meeting to provide information and partake in a discussion on NHS Urgent and Emergency Care Admission Avoidance.
The report circulated in the agenda pack provided an update on urgent and emergency care (UEC) delivery across Lancashire.
The Chair invited questions from committee members and a summary is outlined below:
· Regarding virtual wards, the committee queried their progression and further queried their effectiveness in winter from periods of high sickness. The committee were informed that there were 373 virtual ward beds within Lancashire and South Cumbria Trusts, this was in line with the national average in relation to population. It was further explained that work had been ongoing with Trusts and clinicians to maximise their effectiveness. The occupancy for virtual wards was currently operating at approximately 70-75%, with the national target being 80% however it was highlighted that 17,000 patients a year were supported through virtual wards. Further to this, the committee were informed that it had been set out in the Integrated Care Board's (ICB) commissioning intentions to transition to a more generalist model in comparison to current condition specific virtual wards.
· Members heard that there were three phases to management which included pre-arrival to hospital, the experience in hospital and moving people out of hospital. It was further highlighted that there were several strategies in place to prevent people from attending A&E and sharing risk between primary and secondary care settings. Members were informed that the individuals most likely to attend A&E were from the most deprived areas in the community. It was explained to the committee that local culture and behaviour was challenging to change and took place over an extended period of time however it was highlighted that a number of community projects were ongoing across Lancashire, including Healthy Fleetwood.
· It was further queried by the committee if all deprived areas of Lancashire were receiving support to access healthcare. Members were informed that there was a Population Health Lead for every Health and Wellbeing Partnership, and that the work being undertaken by these partnerships was informed by local data and feedback from the community to address area specific issues. Regarding the New Hospitals Programme, the committee were informed that there was a focus on community infrastructure with potential health hubs in each area set up prior to the opening of the 2 new hospitals, to ensure grass roots community care.
· Regarding admission avoidance, members queried if Artificial Intelligence was being utilised to inform which areas had the highest level of health poverty, as well as which areas had the lowest uptake in vaccinations. Members were informed that predicting admissions was not a challenge, the current prediction model had been in place for several years. It was also explained that an Urgent and Emergency Care dashboard was utilised and provided real time information on deprivation, proximity to an A&E, wait times etc to inform service provision. Further to this, it was explained that a number of successful national pilots took place in the North West to predict people's likelihood of admission which then informed the creation of other services such as advanced primary care however these were not commissioned nationally. Regarding vaccinations, the committee were informed that there had been a large uptake in vaccinations in pharmacies however social media had fuelled the spread of misinformation and therefore the overall vaccination uptake had decreased.
· Regarding health inequalities in deprived communities, the committee raised concern over healthcare provision available to children and the effects on their education and social capability. It was highlighted to the committee that there were multiple factors affecting health inequalities such as food poverty, access to transport and access to paid work for parents however it was explained that there were health consequences to these factors such as poor literacy skills in children.
· Members queried the main challenges in regard to discharging from hospital care. The committee were informed that staffing remained the main challenge within Adult Social Care, along with recruitment and retention. It was further explained that strikes had also impacted the service, but work was ongoing to mitigate those factors.
· It was highlighted to the committee that primary care hubs were part of the Integrated Urgent Care Commissioning Programme and separate to the New Hospitals Programme. It was further confirmed that the timescale for their implementation was April 2026.
· The committee queried how success was measured. Members were informed that in regard to urgent and emergency care, nationally the two key areas that were monitored was the 4 hour performance in A&E wait times and the other was category 2 ambulance response times with a target of 30 minutes.
Resolved: That the report be noted.