Agenda item


Jo Yeaman, Director of Marketing, Communications, and Patient & Public Involvement, will give a presentation update on the Next Stage Review.


A copy of the report is attached at appendix B for Members only.  Copies of the report can be viewed at or from the Customer Service Centre, King Street.


Councillor Allen, with the support of the Committee, opened up the debate by allowing questions to be put to Officers on a number of issues in relation to the Next Stage Review Update – Excellence for All.


Councillor Allen questioned Officers in relation to the ‘Cross Cutting’ issues as detailed in the research evaluation paper provided, and in particular raised concerns about IT Support Systems and the need for better Communication and Information.


Malcolm Lowe-Lauri, Chief Executive Officer, University Hospitals of Leicester (UHL) NHS Trust acknowledged this by stating that there was a need for the better integration of Information Systems, that work was being undertaken with patients to develop clearer expectations about conditions and treatment, and that the UHL Trust was undertaking targeted work to raise the levels of communication with patients.


Jo Yeaman, Director lead for Consultation and Engagement expanded on Planned Care, stating that there was an emphasis in the proposals of the Next Stage Review on:


  • Reducing waiting times
  • Offering more specialist services in a single place
  • Developing a shared electronic patient record
  • More local community clinics to avoid unnecessary hospital visits
  • Introducing more convenient telephone appointments
  • Using day surgery where evidence suggests it be the better choice
  • Early access to key services such as physiotherapy
  • Shorter hospital stays and a reduced number of visits/stays
  • Clear information and proper support provided to patients
  • Immediate identification and provision of equipment 


Jo explained further that the proposals had received very strong support, particularly in relation to better follow up care and more information for patients and families.  


Malcolm added that too many people were attending the Leicester Royal Infirmary, Glenfield Hospital and the General Hospital for assessment, diagnosis and treatment. The UHL Local concept was being developed in partnership to address the greater provision of assessment, diagnosis and treatment on a more local basis.


A Member of the Committee queried what systems had been put in place, or were proposed, to address the issue of long waiting times and appointment lists. Further, concerns were also raised about the failings of the Choose and Book telephone appointments booking system.


A Member of the Committee queried whether, in relation to over the phone health assessments, patients would still be able to visit a health professional if they wished. Further, the total number of missed appointments was also requested, as was information about the timescales for achieving the single patient electronic record. 


Jo explained the context of the research evaluation document (Appendix B) and the resulting feedback was to be used to develop a vision to be achieved. The second piece of work was to address the matters raised by the engagement programme.


Malcolm explained that the organisation of outpatient management and the matter of cancellations could be organised better. With the exception of Accident and Emergency and Orthopaedics the median waiting times were 8 weeks. Patients had also been sent to the Nuffield Hospital in an attempt to improve waiting times. On telephone appointments, patients were still able to choose to see a healthcare professional and improvements were being made to the Choose and Book telephone booking system. On missed appointments, approximately 8% of patients did not attend appointments. in comparison to the London average of 15%, this was a low figure. Finally, on the single electronic patient record, the key challenge would be the development of the interface between the different IT systems and that it was not possible to specify a time for when this would be in operation.


A Member of the Committee queried whether it was possible to improve the appointments booking system, and specifically whether multiple or block bookings could be avoided, with more specific appointment times provided. Malcolm agreed to provide a written response on the matter. 


The Chair questioned whether any services were required to be provided externally in order to take service delivery further. Malcolm responded by indicating that capacity was purchased from other healthcare organisations, at the same time as working on initiatives to drive up performance in internal teams. Malcolm also explained that, in terms of financial management, the organisation would have been better placed for any economic downturn if the fixed cost base was not grown significantly.


A Member of the Committee queried whether we had enough Healthcare practitioners. Malcolm commented that recruitment in Leicester was generally not a problem and Leicester hospitals were regarded as an attractive opportunity.


Jo explained to the meeting the matters around End of Life Care. The following points were explained further:


  • Discussions on the preferred care package and location for patients nearing end of life
  • Setting up community support teams concerned with looking after people who wanted to die at home, in care or in a hospice instead of a hospital
  • The coordination of all aspects of end of life care, including supporting families and providing bereavement services
  • Providing out of hours support for people at the end of life
  • Developing end of life care based on patient needs, carers and providing real choices about care provided


Jo stated that the proposals received overwhelming support, particularly in relation to supporting greater choice, and the need for more information and support for patients and families of patients nearing end of life.


A Member of the Committee raised concerns in relation to access to services and the matter of transport. Jo responded by explaining that more information on the access and transport challenges throughout Leicester and Leicestershire was required. In the meantime, the Choose Well campaign was being launched to inform patients about accessing services.


Rachel Cox, Community Hospital Review Programme Manager, explained that results of public consultation had indicated transport and access to hospitals as a problem. From this, the Leicestershire Access and Transport Board, as part of a six-month pilot scheme, had been asked to look at the significant concerns generated by the possible relocation of services. These concerns would be used to inform a wider transport plan for Community Hospital service provision. No reconfiguration of services would occur until a full review of access and transport had been undertaken.


Tim Rideout, Chief Executive Officer, NHS Leicester City explained that, in relation to service delivery, extended GP opening hours had been implemented and that GPs had also been contractually incentivised to deliver an extended service with a greater choice of services available.


Members of the Committee raised concerns about the overuse of the Accident and Emergency facility and questioned whether any information was available about the cultural or demographic overuse of facilities.


Tim responded by indicating that confusion existed amongst service users about the best course of action for achieving healthcare, and that more improved information was needed to enable choice. On capacity, in the City there was an undersupply of Community Primary Care Services, whilst services available in the County were not made best use of. Finally, on the cultural or demographic aspect of overuse, there was a perception amongst some groups that the hospitals were the first place to visit when in need of healthcare, and that work with the different groups was required to design and communicate better services. 


The Chair concluded by thanking the Officers for their work and input on the Next Stage Review.



                        that the verbal report and presentation be noted.