The Joint Health Overview & Scrutiny Committee met to discuss urgent and emergency care, rural proofing in health and social care, and a request for more detailed reporting of performance data. The committee decided to start using the Rural Proofing for Health Toolkit to assess new policies, and to further investigate recruitment and retention issues in the local health system.

Urgent & Emergency Care

The committee received a verbal report on urgent and emergency care.

The committee heard that while ambulance handover times had improved since November 2023, they were still below the national average. Additionally, while there has been a reduction in patients waiting to be discharged, a relatively high number of patients were still experiencing so-called 'no criteria to reside' (NCTR) delays. An NCTR delay occurs when a patient is deemed medically fit to be discharged but remains in hospital.

Councillor Halliday asked whether the 27 patient reduction in NCTR delays following the addition of 62 new beds at Royal Shrewsbury Hospital in December 2023 was in line with expectations, and how this compared with other hospitals.

Since the 62 beds have become available at the end of December 2023 there has been a reduction of 27 NCTR patients. Was this expected and if so, does this data reflect good or bad performance?

The Director of Delivery and Transformation for the Shropshire, Telford & Wrekin Integrated Care System (ICS) responded that there was no national dataset on NCTR delays, and that there was a clear correlation between patients waiting to be discharged and bed capacity .¹ The Director also argued that while the new beds at Royal Shrewsbury Hospital had reduced delays, it was important to avoid having to use 'escalation capacity' - that is, beds in inappropriate wards - to accommodate patients.

The committee also discussed the performance of the Shropshire, Telford and Wrekin Virtual Wards service. The Virtual Wards service launched in August 2022 and allows patients to receive care at home rather than in hospital. The service has supported over 3,000 people in the 18 months since it launched.

Councillor Dugmore asked why the service was running at 75% capacity when there was a backlog of patients waiting to be discharged from hospital.

Hospitals and GP are stretched financially and some patients cannot be discharged into their own home if they are not confirmed as medically fit. Only 75% of beds are being used, why was the service not at full occupancy and what happens to patients who cannot be discharged home but do not require social care?

The Divisional Manager Urgent Care for Shropshire Community Health NHS Trust responded that they were open to taking on patients if capacity is available .

Rural Proofing in Health and Care

The committee received a report from the Shropshire Health and Overview Scrutiny Committee on the topic of 'rural proofing'.

Rural proofing is a process that seeks to understand and mitigate the particular challenges of delivering services in rural areas. The report was informed by the work of a Task and Finish group, which had been set up to examine how the council could better consider the needs of people living in rural areas.

The committee voted to adopt the Rural Proofing for Health Toolkit² and to begin using it to assess new policies and strategies.

The committee also voted to undertake a 'deep dive' into recruitment and retention of staff within the Shropshire, Telford & Wrekin Integrated Care System.

Co-Chair's Update

The Co-Chair updated the committee on a request from a member of the public for a report detailing the performance of the Shropshire Acute Hospitals NHS Trust (SaTH) and the Shropshire, Telford & Wrekin Integrated Care System. The committee agreed to consider this request in more detail at a future meeting.