Medical Director blog: December 2022 – Dr Frankie Swords

13th December 2022

Where has this year gone? As I am writing this, I can’t believe 2022 is nearly over.

But one thing that we can all agree on, is how busy, challenging and demanding 2022 has been. It’s felt like winter for the health and care system all year, but it’s time to take stock and reflect on the significant progress we’ve made across a number of areas – despite all of this pressure – some of which I will cover in detail below.

Urgent and emergency care

We’re still in Critical Incident but we have made significant, and now sustained progress after an extraordinary amount of work across our whole system. Before we step down, we need to know that we have addressed the four key clinical risks to our patients as summarised below.

  • Our highest risk is that to patients waiting longer than they should do for an ambulance response times has reduced:
    • To step down from critical incident, we agreed that our most urgent Category 1 ambulance mean response time should be below 14 minutes. We have now achieved this, it varies but at the time of writing this was 10minutes 6 seconds
    • The next Category, C2 mean Performance Target needs to be under 60 minutes. This has also now improved and we are currently an average of 38 minutes, 66 seconds.
  • The next risk relates to patients delayed in ambulances awaiting hand over at acute hospitals. We agreed that we needed to have no ambulances waiting for more than two hours, sustained for 48 hours before we could step down. We are very close to this, with no delays over 2 hours for the last 24 hours, but this isn’t quite sustained yet.
  • The next risk is to patients being cared for in non-standard settings (for example extra beds in emergency departments, wards, community, mental health and multiple other sectors). This is largely due to poor flow and high occupancy, and so our target here is for bed occupancy to be less than 98% so that we have somewhere for emergency patients to flow into. So, delivering this indicator is really all about discharge. At its peak, the number of people in our hospitals that did not have a criteria to reside but who were still in hospital was over 600. Since the end of September we have opened more than 250 additional beds or bed equivalents and we now have a discharge board specifically overseeing this but it is still a massive challenge.
  • Finally, we were worried about how our system could respond to any concurrent EPRR incidents, and so again, we are pleased that at the time of writing this blog, we have no provider organisation declaring a critical or business continuity incident.

So, we’ve made massive progress and I hope will be able to step down the critical incident shortly, and in time for Christmas!

Primary Care

The latest data available for activity across primary care shows once again, an incredible month for primary care across Norfolk and Waveney.

  • A staggering 689,573 appointments, as well as 80,422 COVID-19 vaccinations led by primary care were delivered last month.
  • 76% of appointments were face to face, compared with a national average of 71%
  • 17% of appointments were by telephone, compared with a national average of 24%)
  • And a whopping 268,094 appointments took place either the same day or next day making primary care by far our largest provider of urgent and emergency care.

Unfortunately, we are still seeing about 1 in 20 patients failing to attend their primary care appointments though which is incredibly frustrating and a real waste. Our communications and engagement team are helping to push this message of support to primary care as well as to our public, with our winter campaign in full swing, advice on choosing wisely, and to remind people to attend or cancel their booked appointment.

Two very positive articles went out in the Eastern Daily Press last week – if you haven’t seen these, please give them a read. It was heartening to see their health editor summarise our performance figures, with a very reassuring message that our general practice staff are indeed seeing hundreds of thousands of people every week. Whilst we still have almost 20% of appointments taking place via telephone, more than three quarters of appointments were face to face, well above the national average as well as a reminder about all those appointments that were booked but did not attend.

Offering patients access to new health information

The access to future care records was delayed for various reasons last month, but nationally GP IT systems are being reconfigured in a phased rollout to allow new health record entries, including appointment details, test results and clinical letters, which will be made visible to patients automatically. You can read the latest update on the NHS Digital website.

This programme aims to support the legal rights of patients to be able to access their health record and, as the NHS Constitution pledges that all clinical correspondence should be shared with the patient, these will be visible by default for most patients from now on and no longer require the patient to be specifically “copied in”.

The measures will apply prospectively, so previous correspondence will not automatically be made accessible – but it is important to remember that patients will continue to have the right to make a Subject Access Request for historic information about themselves and their care.

Medical examiner roll out

The roll out of the Medical Examiner (ME) system to scrutinise all community deaths will become a statutory requirement from April 2023. The hospital based ME teams have expanded to be able to offer this service to interested practises or care homes now, so please do get involved by contacting your local ME office if you would like to help pilot this locally. The more planning we do together in advance, the easier the system will be for all of us from April.

Group A Strep

You will all have seen media coverage about Group A streptococcus (GAS) and Scarlet fever in recent days.

The group A streptococcal infection and scarlet fever season has started earlier than usual, and tragically, 11 children have died across the UK, compared to just four deaths in the whole of the 2017-18 season, the last high season for the infection.

NHS England have issued interim clinical guidance in response to an increase in infections, which can be found here.

Additional clinical guidance can be found from UKSA at Group A streptococcal infections: guidance and data, and the NICE guidelines for management of Scarlet Fever.

We are sharing this UKHSA advice on social media, along with a dedicated page on the Norfolk and Waveney ICS website and a lot of advice and information on the CYP website for parents who may be worried.

We have also been working with Norfolk County Council to communicate with schools and with our community pharmacies to ensure stocks of antibiotics are safeguarded. Please follow the detailed clinical advice above, and please reserve liquids for those that truly can’t take tablets or capsules.

Our children and young people’s services are very busy at the moment, with children presenting with a range of conditions, including flu. For general health advice for pregnancy, babies, children and young people, Just One Norfolk can be accessed online or by calling 0300 300 0123 or texting 07520 631590.

Industrial action

The Royal College of Nursing (RCN) ballot outcome did indeed recommend industrial action, but no trusts in Norfolk are directly affected. Similarly, our Ambulance Trust, EEAST did not vote to strike.

Clinical and Care Professional Leadership Programme

Finally, I would like to thank everyone who took part in our local CCPL survey last month. This was the first CCP survey of a planned series that we aim to run every six months or so, giving the people who make up our workforce regular opportunities to share their views and experiences.

A total of 144 people took part, which might not sound like a lot, but compared with other systems where only around 45 people shared their views, we have heard from a greater number and wider variety of people across our workforce.

Most of the people who took part were doctors and nurses, but we were also delighted to see representatives from other professional backgrounds such as AHPs,  Community Pharmacy, Dentistry and Optometry.

Highlights included that responders felt that our CCPs are largely reflective of the community we serve, although existing CCP leaders may perhaps less diverse than our general workforce. There were some excellent suggestions for improvement – more protected time for leadership development and roles, and active encouragement for younger, female and BAME CCPs to be brought into leadership roles as well as some frustrations voiced, reflecting current systems pressures. The full report as well as lots of other key information about our CCP framework is accessible on our the Norfolk and Waveney Clinical and Care Staff Leadership Programme landing page – please do have a look and feed back if there’s anything else you would find useful for us to add here.

The new CCP Assembly will review all the ideas and suggestions that come out of our smart surveys when it launches in January. This will take over from the CCTG which concluded this month, and has a much more diverse membership to reflect all of the different CCPs working across our system.

And finally…

I would like to take this opportunity to thank you all once again for the fantastic work you are all doing across Norfolk and Waveney. Whatever your role, wherever you work, we all continue to make a difference to the lives of our local people and communities. It’s vital we continue to work together to help people lead longer, healthier and happier, lives.

I’m sure most of us will be working for at least some of the festive season, but I do hope that we all manage to get some time to relax and recharge with family and friends. And have a happy new year all!

With best wishes,