To consider a report by North Cumbria University Hospitals NHS Trust (copy to follow).
The Committee received a presentation from North Cumbria Integrated Care NHS Foundation Trust regarding cancelled operations in North Cumbria. Members were informed there were six purpose?built theatres at the West Cumberland Hospital (WCH) and a further ten theatres at the Cumberland Infirmary, Carlisle (CIC) with all of them used for both planned and urgent operations.
The Committee was informed that overall cancelled operations were showing a slightly increasing trend since April 2019. It was noted that hospital initiated non clinical and clinical cancellations were showing a slightly increasing trend since April 2019 with patient initiated cancellations remaining constant over the same period.
A discussion took place regarding patient initiated cancellations and officers felt there was a need to improve joint decision?making with patients to ensure they were aware of the outcome and benefits of the surgery and hopefully avoid cancellations.
Members were informed that the 28 day breach performance had deteriorated compared with the same period the previous year, although the position in August was similar year on year. It was noted that the number of non?clinical cancellation on the day was similar year on year, however, there had been more 28 day breaches in 2019/20.
It was explained to members that for quarter 1 in 2019/20 the Trust compared favourably with the national average number of non-clinical cancellations, but had more than double the national average breaches.
A detailed discussion took place regarding the information presented and members were informed of the trend towards a growth in cancellations for a number of reasons. It was explained to members that although every effort was made not to cancel operations on the day this did happen.
The Committee raised their concerns regarding the lack of communication with patients regarding cancelled operations. Members felt that pro?active work was needed to ensure patients were informed of cancellations. The Trust acknowledged the communication problems and informed members that work was being undertake to improve this. During the course of discussion the Committee drew attention to possible technological solutions and it was confirmed this was being investigated.
It was agreed that data regarding operations cancelled two or three days in advance of the planned date would be provided to the Lead Health Scrutiny members.
During the course of discussion members asked whether account was taken of pre?existing conditions of patients, particularly with regards to cancellations. It was agreed that further information would be provided to the Committee.
The Chair of the North Cumbria Integrated Care NHS Foundation Trust highlighted that the Trust’s Board was concerned with the situation; and taking into account the onset of winter, had agreed to make extra beds available in the system to try and alleviate the problems, particularly at the CIC.
During the course of discussion concerns were raised regarding the disproportion between the north and south of the county with better performance in the south. Officers explained that the number of operations required were significantly more than available resources could deliver, acknowledging that north Cumbria had a fundamental mismatch in their ability to deliver care. It was acknowledged that an improvement in efficiency was required, highlighting the problems incurred due to lack of theatre nursing staff, less efficient theatres, issues regarding booking, planning and ring?fenced beds with a need to understand how to get a better insight into demand.
Whilst members appreciated operations were being scheduled with finite resources a question was raised as to whether the Trust had the ability to minimise the breach of the 52 weeks target. The Committee welcomed the extra beds and questioned whether the ring?fence arrangements were effective.
Members were informed that the CIC bed issues had been mainly due to practical estate issues in the Hospital. It was explained they were due to fire safety in the building which had meant a ‘de camp’ ward had been created to allow patients to be relocated whilst works were being undertaken.
A discussion took place on the Action Plan and it was confirmed that progress on this to address cancellations and work to reduce waiting times would be reported regularly at the Lead Health Member meetings. It was agreed that a further report would be made to the Cumbria Health Scrutiny Committee if no improvement was evident.
(1) the presentation be noted;
(2) data regarding operations cancelled two or three days in advance of the planned date be provided to the Lead Health Scrutiny members;
(3) progress on the Action Plan to address cancellations and work to reduce waiting times be reported regularly at the Lead Health Member meetings with a further report to the Cumbria Health Scrutiny Committee if there was no evident improvement;
(4) further information be made available to the Committee on how pre-existing conditions are taken into consideration particularly for patient cancellations