North by North West: Help needed from the North East

New depths

Emergency services in Lancashire have never had things easy, but their performance against some of the key waiting time targets have plumbed new depths in 2018.

The most alarming figures have been the number of patients breaching the 12 hour standard for admission to a ward.

In the latest quarterly figures, for the three months to September, Lancashire reported 233 breaches of the 12 hour target, which was more than half of all breaches in England. Something has gone particularly wrong in East Lancashire and Blackpool, which between them accounted for 177 of those cases.

What the high level stats won’t tell you is most of the breaches were mental health patients needing crisis support, as opposed to primarily physical health needs.

Blame game

This will not be a straightforward problem to solve, partly because there are multiple organisations involved and a high risk of fingers being pointed.

From an acute perspective, there is temptation to blame the liaison psychiatry service, provided by Lancashire Care Foundation Trust, which is very thinly spread across emergency departments, especially overnight. Immediate delays arise when these staff are not on hand.

There is also a back door problem, as Lancashire Care has long struggled to provide adequate inpatient capacity (out of area placements have been a problem for years).

Earlier in the year it received £4.6m from commissioners to buy additional private sector capacity (and other provision), but this hasn’t had any significant impact so far.

The struggles are partly explained by a spike in Section 136 cases – in which police officers take mental health patients to ED as a place of safety.

But any blame directed at the police will be met with a strong response from Lancashire Constabulary. A few weeks ago, chief constable Andy Rhodes took the unusual step of publicly criticising the county’s mental health provision, saying his officers are having to pick up the pieces of a system in crisis.

He says more investment is needed in crisis teams, inpatient beds and community support, and there are other parts of the country which seem to be getting it right.

One of those places is in the north east, and Northumberland, Tyne and Wear FT has been commissioned to come and do a full review of the Lancashire system.

This will hopefully provide a solid template on which Lancashire Care’s incoming chief executive can build.

Lagging

Lancashire’s performance against the main four hour target has also been dire, lagging well behind the national average.

The type 1 figures (which exclude walk-in centres) are particularly troubling for Blackpool Teaching Hospitals FT, where in 2018 almost half of patients have waited longer than four hours for treatment, admission or discharge.

Missing the 95 per cent target by a few percentage points is widely excused these days. But when the target is being missed by this margin, there are serious concerns that quality of care is suffering.

Earlier this year BTHFT received a generally encouraging inspection report from the Care Quality Commission, with improvements made in two of the five domains. But beneath this, Blackpool Victoria Hospital received poor ratings for its urgent and emergency services, including an “inadequate” rating for safety. It doesn’t look like things are getting any better.

There will be multiple factors making life difficult for Blackpool – not least the mental health pressures – but it’s also worth noting that some others have managed to turn around performance by tackling internal problems.