South Tyneside Urgent and Emergency Care Equity Audit

1. South Tyneside Urgent and Emergency Care Equity Audit Jack Lewis, Senior Public Health Intelligence Analyst Amanda Healy, Director of Public Health

2. Purpose of Audit • Follows the response to the relocation of the Jarrow Walk in Centre services to an integrated GP/urgent care hub based at the Emergency Department at South Tyneside Hospital. • The Health and Wellbeing Board endorsed a recommendation in June 2015 that a full equity audit of access to the new Urgent Care Hub be conducted by Healthwatch South Tyneside.

3. Authors • Members of original Assurance Group, including Healthwatch • Additional members from • North East Commissioning Support • South Tyneside CCG • South Tyneside Council Public Health

4. Question • “After the relocation of the Jarrow Walk-in Centre to the new Urgent Care Centre, can the South Tyneside population equitably access urgent and emergency care services now in place?” • Unable to look at any one service in isolation. • Unable to distinguish between urgent and emergency care demand. • Limited data showing system after the relocation – focused on access to the system as a whole over 14/15-15/16.

5. Summary • On the whole, and using information available, there appears to be equity of access to urgent and emergency care services for the residents of South Tyneside. • Provision is comprehensive, accessible and timely for the varying needs apparent across the borough. • Given South Tyneside’s geographical position in the region, there is comprehensive access to services provided in neighboring boroughs and cities, as well as services provided locally in communities, centres of expertise, and people’s homes. These are available both in and out of hours and they are provided relative to need and urgency.

6. Definitions • Urgent needs: illnesses that are not life threatening and injuries that are not serious. • Emergency needs: that require “time-critical” care i.e. care that if not provided within a specified timeframe could lead to a loss of life or a permanent disability.

7. Equity • Need is balanced with supply across all population groups • Age, gender, deprivation, ethnicity, geography

8. Need and Access • True need is difficult to measure • Requires a proxy: demand (expressed need) • Access: receiving care according to some standard for timeliness • 60 second answer time for 111 • 8 minute wait for ambulance • 4-hour standard for A&E • GP patient survey responses

9. The Urgent and Emergency Care System • NHS 999 • NHS 111 • Ambulance • Urgent Care Hub & A&E • GP OOH, GP In-Hours • Dental OOH, Dental In-Hours • Pharmacies/Think Pharmacy First • Mental Health Initial Response Service • Self Care and A Better U Equity Analysis Patient feedback Activity Data

10. NHS 999/111 • 93% UK adults own a mobile phone • 66,000 contacts a year • 60 second response time standard for 111 • NEAS achieves 95.1% • Different way of measuring locally that shows some variation • Calls not prioritised within service • Requires further investigation

11. Variation in South Tyneside: 111

12. Variation in South Tyneside: 111

13. Ambulance Calls • Significant national variation

14. Good response times locally • 8 minute response for Red1 Calls • Slowest postcode: SR6, median 6 minutes 2 seconds • Whitburn and Marsden • Cleadon and East Boldon • 79% of calls <8 minutes • Quickest postcode: NE32, median 4 minutes 45 seconds • Jarrow • Fellgate • 97% if calls <8 minutes

15. Some variation for Red, none for Green or Urgent • No association with deprivation • Geographical variation for Red1 and Red2 calls • Distance from hospital largest factor • Slower responses around borders of the borough. • Average response in all wards less than 8 minutes

16. A&E • We’ve already established system equity of access through phone support and ambulance response. • 79,000 attendances 2015/16 • 80% to STFT • Sunderland, Gateshead and Newcastle other 20% • 4th highest rate in NE • 4-hour standard • Equity across deprivation, gender, ethnicity, home address • Variation observed across age groups

17. Age and the 4-hour standard • 99.5% 0-4 year olds meet target vs. • 83% of 85+ year olds • Likely a combination of factors, but deservers further review: • Higher admission rates 85+ • Complexity of care • Delayed transfers of care • Paediatric department at STFT

19. GP in hours and Out of Hours • No individual level data • More satisfied locally than nationally • No correlation between practice survey scores and practice deprivation level • Scores are decreasing locally as they are nationally • More likely than the average patient in England to be very or fairly satisfied with: • the contact they have with their GP surgery by telephone • how much the GP involves them in decisions about their care • the opening hours of their GP surgery • their GP surgery overall.

20. Able to get an appointment

21. Out of Hours

22. Additional Services • Dental Urgent Care • Good access. No link to deprivation. Females and young adults access more than males and older adults • Pharmacies and Think Pharmacy First (TPF) • PNA tells us there is adequate access • TPF showing good activity that is on the rise • Mental Health Initial Response • Single point of access that operates 24/7 • Self Care • NHS Choices receives 2 million visits daily • Several specific programmes targeting self-care, including A Better U

23. Conclusions • 111 and 999 call services that are available to anyone who can access a telephone, • An ambulance service that responds (particularly quickly in South Tyneside) according to need and will convey people to and from care settings, and • Good primary care coverage and accessibility, particularly for GPs and Pharmacy,

24. Conclusions Continued • Emergency and Urgent Care services available in South Tyneside, Gateshead, Sunderland and Newcastle, • An underlying health and care system that supports urgent needs through: • promoting self-care, • pharmacy services, • health and social care integration to support people in their own homes, • urgent dental services, and • a mental health initial response service.

25. Further Analysis Required • Ambulance Red response times at the coastal wards of South Tyneside and in Hebburn North, • The age inequality in the 4 hour wait standard for Accident and Emergency, and • The variation in 60 second responses to NHS 111 across groups of people within South Tyneside.