Meeting documents

Purpose:

For the Committee to hear about the health and social care winter plans and to seek reassurance that lessons from previous years have helped shape and inform the plans for this year.

Attendees:

Karen Jackson, Director of Operations, Bucks County Council

Natalie Fox, Chief Operating Officer, Bucks Healthcare Trust

Debbie Richards, Director of Commissioning and Delivery, Clinical Commissioning Group

Papers:

Presentation attached

Intended outcome:

For Members to be reassured that the system has prepared as much as possible for winter and the pressures it brings.

The Chairman welcomed Ms N Fox, Chief Operating Officer, Bucks Healthcare NHS Trust and Ms K Jackson, Service Director of ASC Operations.

The presenters referred to the presentation which was included in the agenda pack and the following main points were made during the discussion.

·         All systems across the country, including Buckinghamshire were preparing for a challenging winter and had been working hard to prepare for the increased pressure on services.

·         A number of schemes across the system had been set-up to reduce unnecessary admittance to A&E which included use of GP services, community hubs, prevention measures, improving communications with the public and working with care homes to help reduce Hospital admissions.

·         Work was underway to improve Hospital discharges and a robust plan had been developed across the system to reduce length of stay.  A discharge to assess model had been developed which reinforces the "Home First" philosophy across the system.  Closer working with the voluntary sector, particularly the Red Cross who would be providing an enhanced care service to help stabilise people in their own home.

·         A winter Director had been appointed and would be starting on 10^th December.

·         A regular winter Director telephone call took place across the system where issues were discussed, in particular looking at how the system could work differently to alleviate pressure and what else would be needed to manage demand. 

·         Lessons had been learnt about pressure on staff so more focus had been placed on how best to support staff during the winter months.

·         In response to a question about the lack of detail around pharmacy services in the plan, Ms Jackson explained that it was a system plan and she agreed to discuss the key public messages around pharmacists at the next A&E Board, particularly opening times of local pharmacies over the festive period.  The key role that pharmacists play in providing services to take the pressure off GPs was acknowledged.

·         The additional hours provided by GPs to help improve access to appointments had recently been launched and so far, the service had not been fully utilised to date and had only been up and running for the last 6 weeks.  It was acknowledged that more publicity was needed to support this.

·         The skill mix of the workforce had been reviewed.  Paramedics had been brought into A&E, for example.  The Trust had also looked at how unregistered staff could cover certain tasks to release registered staff to carry out other clinical tasks.  There was still a high vacancy rate and the Trust was continuing to work on recruitment and skill mix across the organisation and the system.

·         In response to a question about the flexibility around the GP streaming service in the Hospital setting, Ms Fox explained that this was a robust system but she agreed to look into whether more could be done to increase GP provision across the system, particularly where the additional GP hours were not being utilised by specific surgeries.

·         It was agreed that Ms Fox would provide the Committee with further details on the referral routes of people using the GP streaming service in the Hospital.

ACTION: Ms Fox

·         The plan stated that support for self-funders would be improved.  Ms Jackson explained that self-funders were entitled to an adult social care assessment under the Care Act and this needed to be promoted so that people received the right signposting and right service.  Ms Jackson commented that it could be difficult for self-funders to navigate the care system and the Bucks Brokerage Service was available to help.

·         The system was moving to an integrated discharge team with a joint manager.

·         Following a question regarding the planned timing for the name change of the MIIU to an Urgent Treatment Centre, Ms Fox agreed to come back with the details of the launch.

ACTION: Ms Fox

·         There was a national drive towards Urgent Treatment Centres (UTC) and a Member commented that there needs to be very clear communication around what services would be available at an UTC.

·         The introduction of the Airedale project across more than 30 care homes was well received but Members asked for further details around the outcomes of the project and asked to see the evaluation of the project before it was rolled out further.  The model would allow for timely intervention and reduce stress for the individual.

ACTION: Ms Fox

·         The Psychiatric in Reach Liaison Service (PIRLS) was commissioned by the Clinical Commissioning Group.  Occasionally patients had to be placed out of county but when this happened, the patient would be transferred back to the Whiteleaf Centre as soon as possible.  The A&E Delivery Board would track the waiting times for people requiring a bed.  All key Directors had robust discussions on a weekly basis.

·         A Member asked where the three Improved Access Hubs were located (mentioned on the "Avoidable Attendances to A&E" slide).  Ms Fox agreed to come back with the details.

ACTION: Ms Fox

The Chairman thanked the presenters for attending.