>>Malcolm Grant: So may I move us now please on to item 8 on the agenda, which is the
corporate and performance report. Matthew, can i ask you to kick off please.
>>Matthew Swindells: Let me first follow Simon's words by just paying tribute to the NHS emergency
services staff who responded with their usual professionalism last Wednesday, and particularly
to the ambulance and paramedic staff, the staff from St Thomas' who came onto the bridge
to care for injured people, and to those at St Thomas', King's, Chelsea and Westminster,
St Mary's and the Royal London who took patients from the incident. I think it was another
example of the NHS at its best.
Looking at the performance for January, A&E attendances in the last three months have
fallen to a growth rate of 1.7%; so over the year, they are up by 3.3%, but over the last
three months, that rate has been 1.7%. They are actually 1% lower than they were in January
2016, so that is the first time since April 2016 that we have had a month-on-month fall.
Emergency admissions were up by 1.5% in January 2016, up 3.3% over the past 12 months. I think
there is some good news in there, that we are seeing demand growth moderate as the urgent
and emergency care strategy starts to have an effect, as primary and community services
are going the extra mile, and as the public are working with us to access the best services
for their needs. Overall, A&E performance against the four-hour wait standard fell to
85.1% of people being discharged and treated within four hours, which is not an acceptable
position. Of the third of those people who attended a minor injuries unit, a walk-in
centre or an urgent treatment centre, 99.4% were treated within four hours, so it shows
that it is both to the benefit of patients and the NHS as a whole for people to use the
right facilities and use urgent treatment centres when they can, which is why in the
Urgent and Emergency Care Plan for next year we will be enhancing 111, we will be developing
urgent treatment centres, and we will be introducing streaming within A&E departments to ensure
that people get to the right care.
In terms of delayed transfers of care, there was a small increase in the bed days lost
to delayed transfers of care in January to 197,000 bed days. That is the equivalent of
an average of 6,356 beds lost each day from appropriate NHS use; that is up 23% on the
previous 12 months, so this is a significant issue. We have seen a 191,000-bed-day increase
in the NHS delays - that is a 17.5% increase - and a 209,000 increase in the bed days lost
to social care delays; that is a 39% increase. In the coming year, there is going to be a
very significant focus on the NHS improving its discharge management and reducing its
delayed transfers of care, and it is really crucial that the additional funding from the
Budget that has gone into social care is used, in part, to ensure that patients who are stuck
in hospital due to an absence of home care or care home places get access to those services.
Because we know it is important in a whole host of areas: it is important for patients
themselves; these are usually elderly people who are having their liberty constrained,
and spending too long in hospital rather than being in the most appropriate place for them
to enjoy their older years. It is important for patients who are in A&E, because one of
the major reasons why people are not getting through A&E and admitted to the bed that need
in hospital is because that bed is filled by somebody who should be being cared for
somewhere else. It is important for people who are waiting for surgery, because we are
cancelling operations because there is not a bed to put that person into. It is important
for the finances of the NHS, because trying to run a hospital at 95% bed occupancy or
higher is not an efficient way of running the services, so on all counts this is a really
high priority for us next year.
111 answered 1.27 million calls in January: that is 45,000 more than January 2016, and
over 88% of those were answered within 60 seconds, which is better than December, the
month before, and better than January the year before.
As we go forward, we are trying to put in place the set of actions around urgent and
emergency care which will turn the corner on performance and see that going back up
to the standards that we expect, and it will be a big focus for next year. Clearly, freeing
up bed capacity, both social care discharges and NHS discharges, to try and get the 2,000
to 3,000 beds back into use that currently have social care patients in them; managing
demand, so standardising urgent treatment centres so that they are uniformly consistent
in the high-quality care that they can offer and services they have; supporting care homes
to manage patients better, so we get fewer patients admitted to hospital from care homes;
increasing the clinical support within 111, so that when you ring there, your chance of
getting to speak to an appropriate clinician and therefore avoiding having to go to a GP
or avoiding having to go to A&E, will go up; and the front-door streaming that I talked
about, will all be targeted at recovering our A&E performance.
In other areas, we have seen the referral to treatment has been at about 90% for the
past month, of people seen and treated within 18 weeks. That is a small improvement on December.
We have seen cancer hitting four out of five of the cancer standards, so the focus in the
coming year will be on getting the 62-day standard back on track to where it needs to
be. We have seen all three standards for access to psychological therapies continue being
hit. I think there is some really strong performance in there, but we really need to get our focus
on the emergency care, the right people in hospitals, and getting flow-back into the
system so that people get the right care in the right place.
>>Malcolm Grant: Thank you, Matthew. I think it is conceivable that the Delivery Plan tomorrow
may have some things to say on those critical areas.
>>Michelle Mitchell: Thank you, Matthew. Local authorities have been experiencing quite significant
financial pressures. How do you plan to work with local authorities to ensure that the
funding on social care really benefits citizens, as you say, who are inappropriately delayed
in hospitals?
>>Matthew Swindells: There is no question that local authorities generally, and social
care specifically, have come under huge financial pressure over the past few years, which is
why we have made the argument consistently over the past year for additional investment
in social care, above and beyond additional investment in the NHS, so we are delighted
to see the announcement in the Budget. The caveat that the Chancellor put around that
in his speech was that councils need to take immediate action to fund care packages for
more people, support social care providers and relieve pressure on the NHS locally, and
I think that plays well into the partnership work that has been going on through STPs over
the past year, where increasingly, health and social care are working very closely together
to address these issues, and it is important now that that goodwill and that close working
now turns into real action for patients.
>>Joanne Shaw: Matthew, I was concerned by the number of 111 calls that resulted in an
ambulance being dispatched, the 13%, and that did seem to me to be exceptionally high; the
idea that one person in six who rings 111 is going to end up in an ambulance, with obvious
knock-on effects for other patients who need ambulances, and for the congestion that we
are seeing in A&E departments. I wondered if you might tell us a bit more about what
you are doing to support 111, both in terms of increasing the clinical expertise in 111
but also, I think at least as importantly, to refine the algorithms using that experience
base of 1.3 million calls per month?
>>Matthew Swindells: It is a very good question, and I think over the next few years, 111 will
become an increasingly crucial part of our urgent care offering. At the moment, around
80% of the people who call in to 111 speak to a call handler who is using digital technology
to advise them through a pathway and recommend what they should do next. That means about
20% of them get to speak to a GP or a nursing clinician for advice. We have committed to
increasing that proportion to 30%, and then I expect it to rise to 40%, 50%, and to much
higher numbers, because the evidence shows that once you have used the technology to
stream patients through a call handler, a significant proportion then, if you actually
get to speak to a doctor, they are better at judging risk and better at interpreting
the person who they are talking to than the IT is.
We have to do two things simultaneously: one is to get the technology enhanced so that,
as we deal with more patients, we learn from it, we build the algorithms and we guide patients
to the right place as quickly as possible. We are moving to make those algorithms available
online directly to patients, so that they can answer the questions online and get advice,
and do not have to ring and speak to someone. During next year, we will be enhancing those
algorithms with special protocols for children and for people with mental health problems,
and for the frail elderly, to make them more specific. We also know that we should be diverting
more people to a telephone conversation with a clinician, rather than telling them to go
to their GP or go to the A&E department, and that when we do that, more patients can have
their problems solved over the telephone. We will also be investing in the technology
over the coming year to make it that, for patients who grant permission, the doctor
they are speaking to on the phone can see their records, and increasingly, would be
able to write them a prescription if that were appropriate, and so on, so it becomes
a more holistic service.
>>Joanne Shaw: That is really good to hear. Just to perhaps conclude that, do you have
a date when you expect online self-assessment to be, if you like, reinstated from the NHS
Direct service that was decommissioned with the demise of NHS Direct?
>>Matthew Swindells: There will be some data published in the Delivery Plan, and I would
hate to spoil the excitement.
>>Joanne Shaw: Thank you; we look forward to that.
>>Malcolm Grant: The answers will all be provided tomorrow, as is always the way.
>>Karen Wheeler: This really follows on from what Matthew has said, because both the operational
performance in the NHS and everything that we are going to be publishing in the Delivery
Plan tomorrow is underpinned, of course, by the work that has been going on in our national
priority programmes. They have continued to make good progress across many areas, which
will be talked about in the Plan, but a lot more work that clearly needs to be done, and
that is laid out in some granular detail in the Delivery Plan. I will not go into detail
on those, but I did just want to say, as a result of that thinking around the Delivery
Plan, we have taken the opportunity to think how those programmes need to be supported
going forward so that they are more connected to the local delivery in the STPs, through
the regions, and the programmes are being realigned to that model more clearly and explicitly,
in many cases. Really, that is all I wanted to say at this stage, unless there are any
particular questions on either the programme status report or the corporate risks.