Meeting documents

The Committee is looking at systems resilience, with a particular focus on winter pressures and the challenges faced by patients and health and social care services in Buckinghamshire. Early advanced planning across whole systems is an essential component in identifying concerns and overcoming potential difficulties.

The Committee will receive:

·         An outline of the multi-agency Systems Resilience Group (SRG) in Buckinghamshire, its role, structure and current projects under review for easing pressures on acute services during winter 2016.

·         A presentation of the current challenges faced by following an imaginary patient through from GP, Ambulance, A & E and in-patient services to the discharge team and home

Attached is the annual report of the South Central Ambulance Service for Buckinghamshire

A briefing paper covering the work of the SRG to follow

Contributors:

Neil Dardis, Chief Executive, Buckinghamshire Healthcare Trust

Lou Patten, Chief Executive, Aylesbury Vale CCG

Annet Gamell, Chief Executive, Chiltern CCG

Mark Begley, Area Manager - Milton Keynes & Aylesbury Vale, South Central Ambulance Service NHS Foundation Trust

The Chairman welcomed: Mrs Lou Patten, Chief Officer, Aylesbury Vale CCG, Dr Annet Gamell, Chief Executive, Chiltern CCG, Mr Mark Begley, Area Manager - Milton Keynes &Aylesbury Vale, South Central Ambulance Service NHSFoundation Trust, Mr A Battye, Area Manager Chiltern, SCAS, Mr Neil  MacDonald, Chief Operating Officer, Buckinghamshire Healthcare Trust, Mr Lee Fermandel, Service Manager, Safeguarding, CHASC and Ms Ai Bulman, Service Director, CHASC

During presentations the following points were covered:

Systems Resilience Overview

·           An overview of the governance and assurance arrangements of Buckinghamshire Systems Resilience Group. (SRG)

·         The SRG oversaw the systems performance, delivery of the NHS Constitution Standards and ensured shared learning. It was overseen by the emergency and urgent care networks.

·         Systems resilience was essentially concerned with the flexibility of services to meet extremes of variation and day to day variation.

·         Last year was the first year Systems Resilience (SR) funds went into CCG baseline budgets. CCG’s were trying to develop the use of funds as a long standing response to SR.

·         Focused funding had been given to reducing admissions and enabling discharge.

The Ambulance Service

·         A member with a life threatening illness would get an emergency ambulance service.

·         Any person who did not have a life threatening illness would be assessed and triaged. The call could be referred to 111, a clinical support desk, an alternative care pathway or a 999 resource.

·         There was a multi-disciplinary assessment service funded by the SRG for frail and elderly people which prevented automatic admission to hospital. In addition there was a fall support service.

·         A large proportion of direct referrals were made to GP services.

·         SCAS also had a dedicated mental health practitioner to which referrals could be made.

·         Latest statistics showed that for all 999 calls received by SCAS only 46% were sent to hospital.

Bucks Healthcare Trust

·         The rapid response assessment team was a team of physiotherapists, occupational therapists, social workers and dieticians based in the A & E department and acute assessment unit for 12 hours a day. They were funded from the SRG budget.  The team were there to conduct rapid assessments as soon as the patient arrived. The Team had been successful in enabling community links, putting in short term support either through health or social care. This helped to either avoid admission or reduce length of stay.

·         The SRG had also funded Bucks HCT to deliver rehabilitative packages of care in the home setting whilst longer term care packages were being assessed and agreed.

Adult Social Care

·         The discharge pathway from hospital was now covered in the Care Act 2014.

·         Options available to support timely discharge were; reablement, which supports and promotes independence;  live-in support and assessment process for up to 14 days; and retaining care packages for up to 10 whilst someone was in hospital. Long term residential or nursing home care was seen as a last resort.

·         The Care and repair scheme was highlighted which looked at care and the timely supply of equipment in the home.

·         To help the system and assessment process as a whole, adult social services had increased social work staff in the hospital and added social work assistants.

·         The use of step up and step down beds in hospital settings avoided the use of acute services if not necessary prior to discharge home.

·         There was a project currently looking at optimal use of domiciliary care, which considered alternative mechanisms such assistive technology.

In response to questions from Members the following areas were highlighted:

·         How Wexham Park fitted in with the Bucks SRG

·         Rises of respiratory illnesses were linked to surges in the system.

·         Social Care related discharges – Bucks was performing well and was second in its comparator group.

·         Re-admissions to acute services was estimated at around 8%.

ACTIONS:

·         Adult Social Care to provide the current figures for delayed discharges.

·         Buckinghamshire Healthcare Trust to provide HASC with re-admission figures