The Health Overview and Scrutiny Committee is scheduled to meet on Wednesday 17 June 2026 to discuss urgent and emergency care and patient flow, and to review the committee's work programme.

Urgent and Emergency Care (UEC) and Patient Flow

The committee is set to receive an update on the work being undertaken across the health and care system concerning Urgent and Emergency Care (UEC) and Patient Flow. This update will cover the Winter 2025/26 period, from October 2025 to March 2026. Representatives from NHS Herefordshire and Worcestershire Integrated Care Board (HWICB), Worcestershire Acute Hospitals NHS Trust (WAHT), Herefordshire and Worcestershire Health and Care NHS Trust (HWHCT), West Midlands Ambulance Service University NHS Foundation Trust (WMAS), and Worcestershire County Council have been invited to attend.

The report pack indicates that the Winter 2025/26 period presented significant operational challenges, including high bed occupancy levels and the use of Temporary Escalation Spaces (TES) at Worcestershire Royal Hospital. Industrial action by resident doctors also added strain to the system. Despite these challenges, key UEC performance measures are reported to be improving and becoming more sustainable.

A detailed Winter Plan was agreed by health and social care partners across Worcestershire in October 2025. This plan focused on several key priorities, including reducing ambulance handover delays, improving Emergency Department (ED) waiting times and the Emergency Access Standard (EAS) performance, and reducing instances of corridor care. It also aimed to improve the system's response to frail and end-of-life patients and optimise acute and community bed capacity, embedding approaches like discharge to assess and Home First .

Specific partner actions to support these priorities included further development of Worcestershire's Single Point of Access (SPoA) to avoid unnecessary admissions, reconfiguration of hospital assessment areas, increasing Same Day Emergency Care (SDEC) capacity, and expanding virtual ward capacity. The plan also involved establishing a trauma pathway, strengthening operational and clinical oversight, investing in additional primary care appointments, and maintaining vaccination campaigns.

The report notes that the HWICB hosted system partners and regional colleagues on 2 September 2025 for winter assurance and readiness. Feedback from this visit highlighted stronger governance, visible leadership, and a more coordinated system-wide approach. Regional colleagues positively noted progress in areas such as ambulance handover performance, with an ambition to achieve 90% of handovers within 45 minutes. Vaccination planning was also described as being in a stronger position than the previous year. The Assurance Team concluded that considerable progress had been made across the Herefordshire & Worcestershire Integrated Care System (ICS) since the previous winter, with stronger leadership, cultural maturity, and system-wide collaboration providing a solid foundation.

Regarding activity and the Emergency Department, the report indicates a 5% increase in overall ED demand during winter 2025/26 compared to the previous year, with January 2026 being particularly challenging. Ambulance activity also increased by 5%, largely due to the cessation of intelligent conveyancing, which kept patients within their respective counties. The system experienced sustained levels of seasonal flu and an increase in paediatric respiratory presentations, placing additional pressure on services.

To mitigate demand, the Worcestershire System invested in the Single Point of Access (SPoA), which is reported to be redirecting over 250 patients each month to primary care with same-day appointments, thereby avoiding ED attendance. There was also a 5% increase in patients utilising the SDEC pathway, which provides specialised care and helps prevent unnecessary admissions. Nationally, there was an ambition to improve Emergency Access Standard (EAS) performance to 78% by March 2026. The report states that EAS performance is currently at its highest levels for over four years and has moved from being the most challenged within the Midlands region to the fourth best.

Significant focus has been placed on reducing ambulance handover delays, with schemes such as SPoA, Pit Stop, and Urgent Community Response being implemented. The aim is to ensure ambulances are directed to the most appropriate location and that alternatives are sourced when an ambulance is not required. Over the winter period, there was a 20% reduction in paramedic lost hours, a 12% reduction in ambulance handover delays, and a 5-minute improvement in mean response time to Category 2 ambulance calls.

Work to improve hospital flow is ongoing through an urgent and emergency care reset programme, with various workstreams focused on attendance/admission prevention, reducing length of stay, and early discharge. These include initiatives for the Frailty Front Door, Acute Care standards, Front Door transformation, Effective Site Management, and Effective Discharge. Schemes contributing to improved processes include the development of Acute Medical Assessment units, a pilot of Acute Surgical Assessment areas, and an increase in Hospital at Home capacity.

Community health services, provided by Herefordshire and Worcestershire Health and Care NHS Trust (HWHCT), have played a central role in supporting patients at home. An improvement plan across Community Hospitals resulted in a reduction in average length of stay from 29 days in September 2025 to 24 days by March 2026. Targeted winter schemes, including a £120,000 investment in Pathway 1 services, significantly reduced waits for double-handed care. The Hospital at Home service expanded its capacity, supporting around 80 people each month. The Community SPoA continued to receive over 1,000 referrals per month, and the Urgent Community Response (UCR) service achieved a 90% two-hour response rate against a 70% target.

The report also touches upon the government's Neighbourhood Health Framework, published in February 2026, which aims to reorganise local services around the individual. The framework's objectives include improving health outcomes, reducing health inequalities, and supporting people to stay well at home through prevention, strengthened primary and community services, and better collaboration with specialists and local authorities. Work has commenced in Worcestershire through a local Neighbourhood Health Delivery Framework, supported by various providers, which is beginning to show progress in reducing avoidable hospital attendances.

In summary, the report indicates that performance across key UEC metrics has improved and been sustained for a longer period than in the last four years. Improvements are also noted in operational resilience and reduced delays across the UEC pathway. The Worcestershire system acknowledges that further improvements are required and continues to work collectively to enhance performance and patient experience. Progress has also been made in improving efficiencies related to hospital flow between HWHCT and WAHT.

The committee is asked to consider and comment on this update and determine if any further information or scrutiny is required.

Work Programme

The committee is scheduled to review its work programme for 2026. This programme is part of the Council's rolling Annual Scrutiny Work Programme, which was discussed by the Overview and Scrutiny Performance Board (OSPB) on 16 October 2025 and agreed by Council on 6 November 2025. The committee will consider the existing programme and decide whether any amendments are necessary, while retaining the flexibility to address urgent issues that may arise.

Future meetings are scheduled for 21 July, 3 September, 12 October, and 11 November 2026. The report pack outlines potential future items for scrutiny, including End of Life Care, Frailty and the implementation of the New Strategy, updates on Adult Mental Health Rehabilitation Redesign and Acute Inpatient Improvement, Planning for Winter, and an Integrated Care Board Update. Other possible future items include Neighbourhood Health and its impact on Long Term Conditions, Routine Immunisation, the Robotic Strategy, Leukemia and lymphoma rates in Worcestershire, post-elective surgery morbidity and mortality, updates on services to support stopping smoking, patient signposting, waiting times for diagnostics and elective surgery, patient representation, effective patient communication, Healthwatch, employment protection from abuse and attacks, NHS IT Systems, the Worcester City Inpatient Unit, Community Paediatric Services, Stroke Services, Eye Services, and Acute Dermatology Services. Standing items include substantial NHS service changes requiring consultation, updates on improving patient flow, annual overviews from West Midlands Ambulance Service and Public Health, and annual reviews of NHS Quality Accounts.