Agenda item

To consider a report from the Head of Democratic Services introducing a Leeds Teaching Hospitals NHS Trust report on access to services, particularly related to dermatology and spinal surgery services; alongside the latest Integrated Quality and Performance Report (January 2020) and an overview of the West Yorkshire Association of Acute Trusts (WYATT). 

The report of the Head of Democratic Services introduced a Leeds Teaching Hospitals NHS Trust report on access to services, particularly related to dermatology and spinal surgery services alongside the latest Integrated Quality and Performance Report (January 2020) and an overview of the West Yorkshire Association of Acute Trusts (WYATT).

The following were appended to the report:

-  Leeds Teaching Hospital Trust’s Integrated Quality and Performance Report

-  West Yorkshire Association of Acute Trusts Annual Report 2018/19.

The following were in attendance for this item:

·  Julian Hartley, Chief Executive (Leeds Teaching Hospitals NHS Trust)

·  Clare Smith, Director of Operations (Leeds Teaching Hospitals NHS Trust)

·  Matt Graham, WYAAT Programme Director.(Leeds Teaching Hospitals NHS Trust)

·  Helen Lewis, Interim Director of Commissioning, Acute, Mental Health and Learning Disability Services (NHS Leeds Clinical Commissioning Group)

An overview was given of access to Dermatology Services.  The following was highlighted:

·  Services were based at Chapel Allerton hospital.  81% of patients were commissioned by Leeds CCG with 11% coming from Calderdale.

·  There had been an increase in waiting times over the past 18 to 24 months with increased referrals from Calderdale putting pressure on the delivery of the service.  There had been a response with the provision of additional clinics and work was ongoing with Calderdale to address this.

·  Patients were taken on a clinical needs order and then chronological order.

·  Waiting times were currently around 11 weeks.

In response to questions, the following was discussed:

·  There was no problem with recruitment and there had been innovative practices including the use of tele-dermatology.

·  It was a challenge at a West Yorkshire level to meet capacity and demand and a network was being developed across West Yorkshire.

·  WYAAT held a monthly meeting to discuss key pressure areas.  There had been difficulties in Calderdale as they had been unable to recruit consultant dermatologists.

·  Concern that Leeds were having to take more patients from other areas and this affected treatment for Leeds residents.  It was reported that there were challenges across West Yorkshire and nationally.  Consideration was being given to demand and workforce issues and how these could be managed.

An overview was given of access to Spinal Surgery Services.  The following was highlighted:

·  Spinal services in Leeds were tertiary and covered West Yorkshire and Harrogate.

·  Most of the work was based at LGI with some out-clinics at Wharfedale.

·  There had been 52 patients waiting for spinal surgery across West Yorkshire over the 52 week waiting list target; 15 of these patients coming from Leeds.  This had reduced over the past two years with considerable improvement over the past year.

·  Reference was made to the ‘Getting it Right First Time Program’ which enabled efficiencies in the service.

In response to questions from the Board, the following was discussed:

·  Patients who had been waiting for longer periods had less clinically urgent cases than others.

·  Challenges facing the service – allocation of resources; complexity of cases often with other health issues and the impact of this on the wider service.

·  There had been a growth in spinal surgery and a larger number of complex cases.

·  58% of patients were seen within the 18 week referral to treatment timescale which was above average nationally.

·  The longest waiting time for a patient had been 72 weeks.

An overview was given of the Performance Report.  The following was highlighted:

·  The report drew together all the different strands of quality and performance across Leeds Teaching Hospitals.

·  There were a number of quality markers to comment on which included environment, staff and experience.

·  The report focussed on issues including quality of care, efficiency and patient experience.

In response to questions from the Board, the following as discussed:

·  Operations cancelled on the day – there were various reasons but main reasons included unavailability of beds or not enough theatre time left available.  There was also intense pressure in the winter months particularly on urgent care and admissions.  There had been an improvement in the last year.

·  Cancer referrals – Leeds Teaching Hospital Trust was the specialist referral service for the region and relied upon timely referrals from others to meet the 62 day standard.  Work was ongoing with WYAAT to improve the patient pathway.

·  Referral to Treatment – there were big issues with backlogs for spinal surgery and other specialty areas.

·  Readmission to hospital – Leeds compared favourably nationally and was considerably below peer trusts.

·  An issue was reported regarding a recent case of admission to A&E which was not resolved satisfactorily due to waiting times and concerns that the service appeared to be understaffed.  It was reported that there had been a focus on recruitment and retention and although the service was under pressure, the length of time in this case was not within target. 

·  Funding – The Trust had met their control total and had been eligible for further monies which had been spent on capital equipment.

·  The waste reduction programme was tied to quality goals and there had been work with clinical teams to identify waste reduction and improvements.  The trust had been rated as outstanding by the CQCfor use of resources.

·  Rise in the number of super stranded patients – there was a variety of reasons for this including varying clinical reasons and those waiting for transfer of care.  Figures tended to rise over the winter period.

·  Challenges highlighted included reducing times for spinal operations, reducing length of stay in hospital and reducing pressures on A&E.  The main challenge was how to do the very best for patients in Leeds.

The Chair thanked those in attendance for this item.

RESOLVED – That the report and accompanying information be noted.