System solutions needed to ambulance and hospital delays

A new systemwide approach is needed by the NHS, councils and care providers if Shropshire is to begin to tackle the issues of delays affecting many parts of the health service.

This covers delays in ambulance services, access to hospital A&E departments, and primary care services.

Another pressure on the system can be delays to patients leaving hospital, typically because the support in the community they need is not ready from them to leave hospital.

This follows a review by a group of councillors scrutinising the situation and the causes of delays in the system, particularly around ambulance services, after a motion passed by Shropshire Council earlier this year to investigate the issues in the health system in the county.

A report to the Health and Adult Social Care Overview and Scrutiny Committee, who meet on Monday 12 December 2022, says that there are many factors that contribute to the delays in the health care system.

These include the difficulty some people have in accessing primary care appointments, and Shropshire’s sparse rural nature and ageing population that is likely need more urgent care.

Difficulties in attracting staffing into caring roles, particularly given the rising cost of living, is also having an effect on care providers’ capacity; despite the council now working with hospitals to discharge almost twice as many people from hospital into social care without delay than it did before the pandemic.

The group is also waiting on confirmation from the NHS on the number of hospital beds that are available to people who use Shropshire’s hospitals, now and in the future, which could impact on its ability to cope with higher demand. Initial information points to this potentially being lower than other comparable areas in the UK.

The report says that the key to this will be improving early prevention to reduce those needing to go to hospital in the first place.

Claire Wild, who leads the councillors Task and Finish Group that produced the report, said:-

“There is no one part of the system responsible for the delays we are seeing, but we have lots of different factors coming together to create a perfect storm for Shropshire people.

“Ambulances are delayed because beds aren’t available; people struggle to get GP appointments or primary care isn’t open long enough; social care is struggling with recruitment which means that people can be delayed leaving hospital.

“We have people who are clinically fit to be discharged but, for a variety of reasons, can’t be: this could be treatments not being ready, a lack of transport, or care providers having the beds available but not the staff.

“The public’s frustration is understandable when they experience a system that is not coping. Shropshire’s nature too plays a part: whether due to the distances involved, an above average and increasingly older population, a health infrastructure that appears to be a poor relation when compared with other areas, and a difficulty attracting and retaining staff.

“There is no one silver bullet that can solve this, but it needs sorting out because our residents are getting an inferior service.

“We need to work together to find solutions and not try and pass the buck onto one part of the system.”

The report calls for improved sharing of information across the ICS (Integrated Care System), and asks for the Joint Health Overview and Scrutiny Committee (which also covers Telford and Wrekin), as well as the council’s Health and Adult Social Care Overview and Scrutiny Committee, to regularly question the ICS about what it is doing to address and improve the situation.

The report will be considered by the council’s Health and Adult Social Care Overview and Scrutiny Committee when it meets on Monday 12 December 2022 at 1.30pm.