Agenda item

          The Board received a report from the Halton Place Director, which provided an update on the Urgent Care Improvement Programme and its current performance against national standards, which resulted in the continued focus of resources and efforts to drive forward improvements.

          Over the past year, both Warrington and Halton Hospitals NHS Foundation Trust and Mersey and West Lancashire Teaching Hospitals NHS Trust, had faced challenges on their emergency care performance, which had led to their classification as Tier 1 status.  To address these issues, both Trusts had received additional support from the National Emergency Care Improvement Support Team (ECIST) alongside assistance from other external agencies.

Key sentinel metrics, supplemented by a wide range of indicators, were used to monitor performance and reported daily. Although standards had been achieved, results remained inconsistent. As a result, the improvement programmes were important to improve performance and deliver positive benefits for patient outcomes. 

It was noted that the current Accident and Emergency (A&E) 4-hour performance, remained below the national standard, which indicated a continued pressure on emergency departments.  In response, Mersey and West Lancashire Teaching Hospitals NHS Trust was progressing several key actions to improve patient flow and overall performance within A&E and these were outlined in section 3.5 of the report.  Warrington and Halton Hospitals NHS Foundation Trust operated a smaller bed base, and many of its challenges resulted from consistently high bed occupancy levels, which averaged 101% on most days. In response, Warrington had implemented a substantial improvement programme within A&E, with full details provided in section 3.7 of the report.

The report explained that the wider system work programme was taking  forward actions to help hospital trusts. These focussed on reducing unnecessary A&E visits and making sure patients could leave hospital promptly once they were medically ready.

Following discussions and questions raised by Members of the Board, some additional information was noted:

·       Some Board Members shared personal encounters of A&E and suggested that the statistics provided in the report did not truly reflect lived experiences.  They also suggested that clearer communication was needed to help prevent unnecessary attendances at A&E and encourage use of alternative services such as Urgent Treatment Centres (UTC);

·       Board Members were reassured that, through Healthwatch, hospitals were actively seeking patient feedback across a range of services. They were also assured that Halton had performed well in reducing unnecessary hospital attendances and supporting people to remain well in the community, whilst recognising that further progress was still required to meet national standards.  It was further noted that, with Healthwatch’s support, Warrington Hospital had introduced live A&E waiting times on its website, along with waiting times for the UTC in Runcorn. This enabled patients to make informed choices about the most appropriate service to access. However, similar information was not yet available for Whiston Hospital;

·       The “Blackburn Come Back Model” was introduced in October 2025, which aimed to reduce the number of patients waiting all night in A&E by offering them a timed appointment in the morning.  The Board requested a future update on the progress of this model in due course, as well as patients who had remained on wards for more than 21 days;

·       Healthwatch raised concerns about the standardisation of UTC’s across Cheshire and Merseyside, saying that they did not want to see this as a cost cutting exercise or see standards being lowered across the Board, but rather that they would like to see the consistent services and opening hours at all UTC’s.  The Board was advised that whilst financial constraints needed to be considered, the development programme was intended to analyse and compare variations, before reviewing services to ensure maximum impact;

·       Questions were raised about whether Halton had a similar provision to the “Hospital at Home” scheme in Cheshire West, which had proven highly effective in supporting elderly patients by avoiding A&E attendances and hospital admissions;  Members were advised that a range of options were being explored;

·       Ambulance handover times were also discussed. A site visit last year observed 32 ambulances waiting outside Whiston Hospital. Whilst handover times remained behind target, it was noted that improvements had been made and A&E triage was moving in the right direction, despite performance still being rated in the red; and

·       Finally, the Board asked about the impact of the Integrated Care Boards staff reduction programme on the hospitals and it was explained that although staff reductions were expected in the future, emphasis would be given to protect critical areas whilst working with partners to manage any impacts.

          RESOLVED:  That the Board:

1)    supports the ongoing Urgent Care Improvement Programmes that aim to reduce pressures in the acute hospital setting and improve overall patient care and experience for local people; and

2)    continues to have oversight on the key improvement metrics to ensure progress towards the standards and seek assurance that Halton residents are being treated within an efficient and effective health system.