From Board to Ward – April 2024

We’re on a mission – to improve the service we offer to people needing urgent and emergency care and this was one of the items discussed repeatedly in this month’s Board meeting in public. We want and need to do better for patients.

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, and our challenges with a big focus on what we’re doing to address them and what our plans are for the future.

Here we share three key highlights from each Board meeting to shine a light on key progress, decisions and share in an open and transparent way some key developments.

Highlights from April Board: ??

End of Year Review

Our staff have made a difference to the lives of many thousands of patients over the last year and our leaders looked back at some of the achievements and continuing challenges, In 2023/24:

• 156,316?patients attended our Urgent and Emergency Care units
• We cared for 21,609?Same Day Emergency Care patients
• We carried out 68,348 planned operations
• 653,686 outpatient appointments have been attended
• 59,569 patients have been cared for on our wards

Improving Urgent and Emergency Care for patients

• We have invested in our clinical teams in our assessment areas meaning patients can be seen more quickly?
• We have improved our Same Day Emergency Care offer so more people who attend as emergency cases can now be treated on the same day and return home, without being admitted and we have treated 14.6% more patients this year
• We have funded End of Life care for patients to ensure they receive the right?care, expertise and support in the right place -?and through this we have reduced the number?of patients being admitted to the hospital?
• We have opened additional beds in Derriford and our Mount Gould wards including 23 beds on Carey (spring 2024), 12 extra beds on the Discharge Assessment Unit at Mount Gould and 50 Virtual Ward beds for patients
• We have reduced the time patients spend in hospital by just over one day
• We have moved our?'Acute Frailty Unit' into a dedicated space and invested in the frailty?service
• We are working in collaboration on the new Care Coordination Model?to improve and streamline capacity and processes to provide care closer to home, and in the community where possible

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Caring for patients at the end of life

“We only get one chance to get end of life care right,” – Ali Griffiths, Advanced EOL/Palliative care practitioner.? With a new scheme, we hope we are getting it right. We have a new End of Life Nurse role which has been funded initially by Macmillan to identify patients being brought to or arriving at the Emergency Department in their last days or hours of life. Ali, who is an Advanced Care Practitioner Nurse, supports patients to die with dignity and privacy and wherever possible, in the place of their choosing. We hear from one relative about the positive impact this has had on her family. We are now expanding this scheme.

Improving planned care for patients, we have:

• Significantly improved care for patients with cancer – we continue to exceed the target of 75% of patients falling under the 28 Day Faster Diagnosis pathway
• Almost eliminated waits of 104 weeks for patients and reduced 78 week waits.?We continue our work now on?reducing 65 week waits
• Created a new purpose built three floor REI?(Royal Eye Infirmary) which delivers enhanced ophthalmic care, bringing together outpatient and surgical eye treatments as well as an expanded service for children, has moved away from the Derriford Hospital site, relieving additional space and bed capacity on the main site
• Built the new Chestnut Urology Investigation Unit – an expanded dedicated unit which sees 500 patients each week, offering an improved experience
• Engaged in the Get It Right First Time (GIRFT) Further Faster programme
• We opened our new Orthopaedic elective ward and have three new additional theatres due to open at the end of May 2024
• Expansion of robotic surgery has commenced in?hepato-biliary

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Thank you to our staff and partners for enabling us to care for all these patients and families. We’ve also been busy developing more space to care for the future as can be seen below.

Our Urgent and Emergency Care Performance

Improved performance

No Criteria to Reside - UHP reported a year-end position of 9.9% of patients with ‘no criteria to reside’ i.e. those who are medically fit to leave hospital which is a significant improvement on a position which had exceeded 14% at times during the year

Length of Stay: Our length of stay for emergency patients in March 2024 was 7.8 days, this was 1.1 days lower than the same month last year (March 2023, 8.9 days). Getting people home sooner when they are well means we have beds free to admit new patients into

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Remaining a concern

Ambulance Handover Delays: Hours lost >15mins – we continue to report significant volumes of ambulance handover lost hours and benchmark poorly with 9,326 hrs lost in March 2024

Emergency Dept: % Waits >4hrs – waiting times in our Emergency Department remain consistently poor with performance at 54.1% (March 2024) against the four hour waiting time target, tracking below plan (64.8%) and national ambition (76%)

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We are the worst hospital in the country for ambulance handover delays and our Interim Chief Executive, Mark Hackett, told the Board: “We need to aspire to high quality urgent and emergency care for patients and we are working on a single improvement plan which we will improve the quality of care, patient experience and outcomes, as well as the experience of our staff.” Mark described that the Single Improvement Plan, which will be ready in early May, is built around three pillars:

1.?????? Reducing the number of patients attending and being admitted from the Emergency Department, by looking for more appropriate settings for their care, for example people with issues in early pregnancy going straight through to our Early Pregnancy Service

2.?????? Dynamic Flow – making sure patients get to the right place for their care without long delays.

3.?????? Getting patients home to their right place of residence as soon as they are medically ready

The Board heard about some of the actions we are already taking to reduce the waits for emergency patients. This includes extending Same Day Emergency Care services so more patients can be seen and treated as same day emergency cases; right sizing the Medical Assessment Unit to 73 beds as it is currently too small; opening an additional medical ward this month with 23 beds which will reduce the number of patients who are medical outliers away from their specialist ward and planning in autumn 2024 to open a new on-site Urgent Treatment Centre.

Targeted Lung Health Checks

Do you smoke or have you previously smoked? Are you aged between 55-74? If so, you could be invited for a free lung health check. People aged 55-74 years old who smoke or have previously are being risk-assessed a free lung health check in a bid to diagnose lung cancer earlier.

Dr Cyrus Daneshvar, Consultant in Respiratory Medicine, presented information about the Targeted Lung Health Check Programme to our Board meeting. He explained that lung cancer accounts for 1 in 4 cancer deaths. Of all the lung cancers detected historically, around 30% are curable.

In August 2022, Plymouth joined the national lung screening programme which uses GP records to identify eligible patients who are invited by letter and telephone and then assessed face-to-face. If they are assessed to have a >1.5% risk, they are given a low-dose CT scan. If that shows a possible lung cancer, the patient is referred onto the suspected cancer pathway. Since August 2022, 13,622 patients have had CT scans and 153 lung cancers have been diagnosed. This means that of all the patients screened, 1% have cancer.

Dr Daneshvar explained that earlier diagnosis of lung cancer saves lives and 80% of the patients who have a cancer detected through this screening programme have curative disease, compared to 30% of patients who come through a standard healthcare pathway. This shift to earlier diagnosis of cancer is both helping survival rates and address health inequities.

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