To consider a briefing paper that outlines the methodology behind the University Hospitals of Leicester (UHL) NHS Trust’s bed model and how this compares to expected demand in 2019 / 20.
Mark Wightman, Director of Strategy and Communications, University Hospitals Leicester (UHL) and Samantha Leak, Director of Operational Improvement, UHL presented a briefing paper that outlined the methodology behind the UHL NHS Trust’s bed model and how it compared to expected demand in 2019/20.
Members considered the report and during the ensuing discussion, the comments made and their responses included the following:
· The complexities around bed modelling were noted. A Member questioned how flexible the UHL could be as even if additional wards were opened, appropriate staff would also be needed. Mr Wightman explained that if there was a spike in admissions for example, the easiest option to create extra capacity was to cancel elective surgery as the UHL had been directed to do the previous year. It was noted that an extra ward in the Glenfield Hospital and two extra wards in the LRI had opened last year because of the very high demand. Mr Wightman added that staffing was an issue as the UHL were understaffed.
· It was noted that some treatments could be carried out elsewhere such as in GP practices and Urgent Care Centres which would ease the pressure on hospitals. A Member commented that if the work around the discharge process and the flow of patients could be improved, bed capacity would no longer be a problem.
· A Member welcomed the report and that there were plans to increase the number of beds and that the decision had been made following the careful analysis of data. It was noted that a review of bed capacity planning was taking place at least monthly and this was also welcomed.
· A Member welcomed the efforts that were being made to prevent people from needing to be admitted to hospital and also the work being carried out to prevent them staying longer than necessary. However, robust community services were needed to care for those people outside of the hospital environment. The Member was not convinced that the community health services were robust enough to cope and one of the reasons for her concerns were the staff shortages. The Member added that she was not convinced that there was a change taking place in the culture in health services to attract and retain staff.
Mr Wightman referred to the situation in primary care and the shortages of GPs. Efforts were being made to recruit and retain GPs, but he added that it was not easy being a GP. There were many demands on her / his services and time and patients did not always want to be seen by a practice nurse. However, a five year programme was just starting which would address some of those culture issues.
· Dr Underwood, HealthWatch Rutland referred to the bed occupancy rates. The meeting had heard that occupancy rates were at approximately 93%, but Dr Underwood had looked at the NHS statistics which quoted occupancy rates to be at 85 – 90%. Dr Underwood expressed concerns that according to NICE guidelines, patient safety could be compromised where occupancy exceeded 85%. She asked whether, with a growing and ageing population with increasing health and care needs and with new housing developments, the UHL would be able to safely match capacity with demand.
Ms Leake responded that occupancy rates changed every day and were different in every speciality; the safety issues were not so much about safety in the wards but about the flow and getting patients into beds. However, the efficiencies that were being put into place would lower the occupancy rate.
Mr Wightman said that their degree of confidence in safely matching capacity with demand over the next 5 years was good and their bed modelling had been signed off by Public Health in the city and county. It was their job however to be agile and flexible enough to plan for all eventualities. In relation to the NICE guidelines regarding a bed occupancy rate of 85%; if this was adhered to at the LRI, there would be 300 beds unoccupied which was the equivalent of 10 wards. However as regards safety, the relevant indicators were going well and for example the Standard Hospital Mortality Indicator was going down and less people were dying in Leicester hospitals than before and less than in the average Trust in the UK.
Dr Underwood referred to the NICE guidelines and expressed concerns that where bed occupancy rates rose above 85% there were increased risks to the patient, including risk of infections and risks of being nursed in the wrong ward. Dr Underwood said that those risks should be acknowledged.
The Chair commented that it was important to know the NICE guidelines but also to understand the complexities around this issue and that for example a small change in delayed transfers of care could have a large impact on bed occupancy.
The Chair commented that the report was encouraging as a few years ago there was talk about losing 400 beds and she welcomed the fact that the numbers had been recalculated. The Chair questioned the main drive behind planning bed capacity and Mr Wightman responded that they wanted to do what was in the best interest for the patient. It was now recognised that a hospital was not always the best place for a patient and a study had shown that people who remained in hospital longer than was necessary became de-conditioned.
The Chair drew the discussion to a close and said that they would be watching with keen interest the outcome of the Community Services Review. Mr Wightman had previously referred to the UHL being ‘just big enough’ and she recognised that it wasn’t feasible to have a lot of un-used extra beds on standby. However, Mr Wightman had also referred to the need for the UHL to be agile and flexible and the Committee would like future assurances that this was the case. The Chair added that she looked forward to seeing the re-calculations and reconfigurations when the UHL received the anticipated additional capital funding.
that the report and comments of the Members be noted