Health chiefs respond to consumer champion report

Earlier this week we revealed the extent to which some of those who keep the county's NHS running felt there was a 'constant battle' to keep services afloat.Today, health organisations were keen to emphasise the work they were doing to move forward.

A statement from all five of the county's clinical commissioning groups said: 'The Healthwatch Report recognises the immense complexity and scale of the NHS and all partners in the 'system' work closely and corroboratively to ensure patients receive the appropriate care at the right time and in the right place.

'All NHS services - from GP practices to our hospitals - are very busy and we do not expect this to change, which is why we have formed the Norfolk and Waveney Sustainability and Transformation Partnership (STP).'

The CCGs said around 90pc of the NHS workload is dealt with in primary care (GPs, dentists, pharmacies etc) and that patients will only be referred to secondary care if it is necessary.'

Rosin Fallon-Williams, chief executive at Norfolk Community Health and Care NHS Trust (NCHC), said: 'We welcome the findings of the Healthwatch Report as it recognises the national and regional pressures that we all face in finding better ways of caring for patients within the resources we have. In Norwich locality, patient, family and carers expectations of our community nursing service rightly remains high – we balance this with the national and local recognition that our Trust cannot meet the population's community health needs alone and so we have developed strong partnerships with all providers in the Norwich area.

'Our trust is at the forefront of shaping new models of care with our partners in Norwich and already our staff, patients and GPs are telling us this is improving their experiences of working in or receiving our services. We know our staff go above and beyond to meet the healthcare needs of our patients and often will work additional hours and be flexible in meeting patient needs to achieve this. There's a national shortage of qualified nursing staff so our Trust's Workforce Strategy is developing the competency of our workforce and 'growing our own' staff through apprenticeships and other means.

Mental health

At the region's mental health trust, Norfolk and Suffolk NHS Foundation Trust (NSFT), some staff quoted in the Healthwatch report felt a large number of referrals made by GPs were 'inappropriate'.

NSFT medical director Dr Bohdan Solomka recognised communication between the trust and GPs needed to be better.

Dr Solomka said: 'At NSFT we fully recognise the importance of working hand in hand with our hardworking GP colleagues to ensure we offer easy access into mental health services and to best support people living with mental health conditions in their local communities.

'We all work for the NHS, we are all under pressure, but we are all here to serve the need of our patients and that has to remain our central focus. How we best do that is by raising issues that will always be found in a high-pressured system, by addressing them and by working with each other to solve them. I believe [the Healthwatch report] is going to help us do just that.

'The vast majority of people who present with a possible mental health condition are treated by their GP and never touch our services; as a mental health trust we are therefore in a prime position to further support and advise our GP colleagues in helping to keep people out of hospital wherever we can.

'To help with this, in central Norfolk, we have begun to establish named mental health workers within groups of GP practices and we will be monitoring the effectiveness of this to consider rolling it out across all of Norfolk and Waveney. Of course, our Wellbeing services provide support and sessions in many GP surgeries across the county. But there is always more we can do.

'Our trust has put closer working with GPs at the top of agenda for this year and we have a strategic objective focused on improving physical healthcare for mental health service users too by joint working with GPs.

'In the autumn we are launching the joint learning with GPs project as one of the ways to address any disconnect or lack of understanding between our two vital parts of the local NHS system. Again, all of this is about improving things for our patients.'

Accident and emergency

Another issued raised in the report was the pressure put on A&E departments, which were seen as a catch-all solution.

A spokesman for Norfolk and Norwich University Hospital (NNUH) said: 'Approximately 75pc of patients attending the A&E either by ambulance or self-presenting do not require admission to hospital. We are confident that, with good partnership working between ourselves and others, we help to ensure that patients access the appropriate care for their needs.'

'We work closely with our local GPs and social care providers to ensure patients are discharged in a timely manner. In March 2016 the Trust appointed a senior Matron to manage the integrated discharge team and in the last 18 months we have appointed a team of Discharge Co-ordinators to support safe and timely discharges throughout the organisation.

'In May 2017 we created a co-located Discharge Hub at the NNUH, housing staff working for the acute Trust, the Community Trust and Social Care. This Hub acts as a central point of contact for all NNUH wards and staff to access support with discharge planning, and helps to ensure an efficient integrated service for patients. In April 2017 the NNUH launched a new service to support patients and families who require a nursing home placement or domiciliary care on discharge. The service is provided in partnership with Care Homes Selections Limited and provides a dedicated care co-ordinator for patients and their families to support them in making this transition in a more timely manner, thus reducing the time the patient waits in hospital for an appropriate placement or package of care.

'Over the past 12 months a great deal of work has also been focused on reducing the number of 'stranded' patients who have been in hospital for more than 14 days, in order to support faster recovery at home. In April 2016, stranded patient numbers were on average 350 patients each day. The number of stranded patients now stands at between 140 – 150 each day. This is a significant achievement and supports improved patient flow through the hospital with fewer medically fit patients waiting for discharge in an acute hospital bed.'

At James Paget University Hospital (JPUH) chief operating officer Graham Wilde said: 'In common with other hospitals, we often have patients attending A&E who do not need urgent care, which can create additional pressure at times of peak demand.

'To help reduce this pressure while ensuring our patients receive the right level of care, we have introduced GP-led streaming. This currently operates on weekends and bank holidays but, using £1m of capital funding from the Department of Health, and working with our partners in the local healthcare system, will become a seven day service in the autumn.'

IT systems

Out-of-date communication methods such as fax and IT systems which did not communicate with each other were another cause for concern for staff.

At JPUH, director of governance Anna Hills, said: 'We are constantly looking at ways of streamlining our service, for the benefit of our patients. Last year, we implemented an e-communication system to help with the prompt and efficient transfer of patient discharge documents to GPs. The system means that more than 25,000 documents are now sent each month electronically, rather than on paper, improving efficiency, and saving both time and money.'

And the CCGs added: '85pc of GP Practices use the same IT system, called SystmOne. In Norwich the new alliance of GP Practices, OneNorwich, has worked with the Norfolk and Norwich University Hospital to enable more doctors to access SystmOne. This could significantly assist clinicians and mean swifter more joined-up care for patients.

'Patients can help too, by giving permission for their GP records to be looked at by hospital clinicians when needed. Your 'Enhanced Summary Care Record' is a short but detailed summary of your medical record that gives clinicians caring for you invaluable information, when you need health care away from your usual doctor's surgery. If you want a hospital doctor to be able to see your Summary Care Record if there is an emergency please ask at your GP reception.'

'Ahead of the recommendations in the Healthwatch Report, we've been pioneering work co-ordinating NHS IT systems in Norfolk; in partnership with CCG colleagues and with One Norwich, we are working on a prototype county-wide integrated digital care record that will improve patient and GP access to information.

Ms Fallon-Willaims, from NCHC, said: 'Joined-up digital pathways are already improving care for our patients. There are just over 734,000 patients registered with our SystmOne GP practices in our area, and 69,300 patients in NCHC receiving active care registered on SystmOne. Care information is already being shared – many of our patients also use Social Care services, so health and care staff are now able to view each others' records.

'Through the STP and the upcoming Lord Carter review (we are one of 23 Community/Mental Health Trusts leading national work on efficiency and effectiveness ) opportunities are being explored for collaborative procurements in IT and systems that will go on to benefit the NHS on a national scale.'