Due to your hard work, passion and commitment, services in Leeds have been able to continue over the winter months, despite almost overwhelming pressures. We would like to thank you for your efforts and compassion during this challenging period, and for the work you do every day in different settings across the city to support people who use heath and care services.
We know, too, that a lot of work is already underway to join up services, reduce delays and ensure patients get the right care in the right place at the right time. This is certainly starting to have a positive impact. But, as a city, we need to do more.
A&E is rarely the best place for people to be, unless they have a life-threatening illness or injury. Attendances at A&E in Leeds were very high in November and December. While overall figures have now dropped after a national and local media campaign, the number of older people attending A&E continues to rise.
How can we ensure that more people are safely supported in the community instead of coming to A&E?
Please always consider the alternatives.
Does your patient need to come into hospital or could they be supported in the community? If they only have social care needs then hospital is not the best place for them. We would like to thank GPs and practice staff who are already using the SPUR number as an alternative to hospital admission, when appropriate. 111 should also be publicised wherever possible.
Think about what else might be going on in someone’s life. It’s not always enough to treat a single illness or injury, especially if someone has multiple health problems. To avoid people repeatedly ending up in A&E we must help them stay physically, mentally and emotionally well. By working with colleagues in the relevant support services we can address issues like loneliness and depression, drug or alcohol use across organisational boundaries.
Admission rates for older people are rising. We know from evidence that, generally speaking, the shorter the time that someone spends in hospital the better their health outcomes will be. How can we make sure that patients who are admitted to hospital get the treatment and support they need as soon as possible and can leave without delay?
We must ensure patients admitted to hospital can be seen by a consultant earlier. Even an overnight delay can have an impact on a patient’s health outcome and lead to them spending more time in hospital, especially if they are older or frail.
Give people an expected date of discharge as soon as they’re admitted. This helps everyone – patients, family members and staff – to start to plan for discharge in advance.
Have productive conversations with patients about their care options. It’s important that patients and their family members understand that there is a date by which they will need to leave hospital if they’re medically fit to do so – and that support can be provided during and after discharge. There is a letter from the hospital’s Chief Executive which can be used to support these conversations.
Arrange appropriate tests and investigations as quickly as possible. We should arrange only what the patient really needs and consider what could be done in a community setting after they have left hospital.
Arrange assessments and follow-on support more quickly. Delays are rising for health-led assessments, home care, residential and nursing care placements. If you’re responsible for planning or carrying out assessments, ask yourself first if the patient really needs the assessment you are considering and what benefits it’s likely to have. If they do need the assessment it should be arranged and undertaken as soon as possible.
Liaise closely with colleagues in the community to ensure a smooth transition for
the patient. This includes making sure community services are clear about the person’s ongoing support needs, and that the patient has all the necessary medication and care advice before they go home. Where possible try to discharge same-day referrals in the morning.
Carry out assessments after discharge. This is a new approach that we will soon be piloting with a specific cohort of patients. Where this has been tried elsewhere in the country it has helped patients leave hospital earlier and ensure that ongoing support can be arranged more quickly.
Work more closely with local charities and community/voluntary groups. There are many services that can help people get settled back at home and provide ongoing support if needed. One example is the ‘Hospital to Home’ service currently being piloted by Age UK Leeds and the Red Cross.
If we can do these things, and do them well, it will help to ensure that health and care services in Leeds are sustainable for the future, and that people’s experience of services continues to improve.
Please join us in working together to make Leeds the Best City for Health and Wellbeing.
Chief Executive, Leeds City Council
Chief Executive, Leeds and York Partnership NHS Foundation Trust
Chief Executive, Leeds Teaching Hospitals NHS Trust
Chief Executive, Leeds Community Healthcare NHS Trust
Dr Andy Harris
Clinical Chief Officer,
NHS Leeds South and East Clinical Commissioning Group
NHS Leeds North Clinical Commissioning Group
NHS Leeds West Clinical Commissioning Group