Meeting documents

·         Briefing on whole system winter planning – to be presented by Ms D Richards, Director, Commissioning and Delivery.

·         Update on cancer alliance work – to be presented by Ms J Ricketts, Divisional Director, Division of Surgery and Critical Care.

·         Update on the Better Care Fund – to be presented by Ms J Bowie, Service Director, Integrated Commissioning and Ms D Richards, Director, Commissioning and Delivery.

Whole System Winter Planning Briefing

Ms D Richards, Director of Commissioning and Delivery (CCGs)provided a presentation on system winter planning and highlighted the following points:

• The winter plan was a comprehensive, detailed and robust plan
• The plan had been developed by system partners and contained links to the national and local "must dos" and was based on lessons learned locally at Sustainability Transformation Plan (STP) level and Thames Valley Partners.
• There was now a Winter Operations Look Forward (WOLF) weekly meeting with NHS England and NHS Improvement colleagues.
• The Integrated Care System (ICS) had appointed Ms Frances Woodruff as the Winter Director.
• There were weekly director calls with the CCG, Adult Social Care, Mental Health and primary care colleagues to look at the week ahead and how to best support providers.
• The Accident and Emergency (A&E) Department was not achieving the 95% 4 hour standard but compared to colleagues Buckinghamshire was doing well.
• NHS Improvement had provided support, advice and analysis and the ICS had taken action on the relevant areas.
• Bed capacity modelling had been undertaken.
• A large amount of work had been undertaken on non-elective demand and there was now a comprehensive programme in place focussed on avoidable attendance to A&E, avoidable non-elective admissions and supportive discharge.
• There had been an increase in attendance to A&E and an overall increase in non-elective admissions.
• Use of the NHS 111 telephone line was increasing; there was now a Directory of Services (DOS), which was regularly refreshed for use by the telephone operators.
• Direct bookings to the Urgent Treatment Centre (UTC) in High Wycombe could now be made.
• The NHS 111 online service had been rolled out this year.
• There was increased access to the GP service with an additional 270 hours per week available in Buckinghamshire; this was currently running at 70% utilisation.
• The UTC in High Wycombe had seen an activity increase of 6.3 %; achieving 95% wait times for adults and children.
• Psychiatric liaison support was available at Stoke Mandeville A&E Department.
• A lot of work had been undertaken to improve the discharge process.
• An increase in children and young people pressure had been noted, particularly for respiratory conditions; a clinically led, multi-agency programme was in place.
• Prevention was a key focus – a joint communications plan had been put in place.
• Flu – the school vaccination programme had been extended and increased uptake at schools.  Over 80% of the CCG staff, more than 50% of BHT staff, and 40% of Oxford Health staff had received the vaccination.  Over 80% of the Hertfordshire Partnership Trust staff working in Buckinghamshire with learning disability clients had received the vaccination.
• At the end of October/early November 2018 the norovirus caused the plan to be tested and services were well maintained.

The following key points were raised by members of the Board:

• In response to a question on how this plan was different to previous years, Ms Richards stated that more focussed planning than ever before had been carried out but acknowledged the system would be challenged.  There were robust plans for working together but there would always be spikes and pressures.  The number of people attending services this winter had been greater than before; the peaks had not been foreseen but it was clear that the service had responded well to times of pressure. There was now a national focus on performance and also quality; the hospital had been working with partners and had not triggered any of the quality flags; quality had been maintained.
• Mr D Williams, Director of Strategy and Business Development, stressed that it was their responsibility to keep patients safe and to put procedures in place to minimise routine work and ensure patients received the care required.  The discharge to assess programme would help to get patients home.  Mr Williams emphasised the importance of the public messages and encouraged neighbours and families to check people were warm, hydrated and that the medicine cabinet was stocked.
• It was confirmed that there was an adequate supply of the flu vaccination.  The over 65 year olds would receive a different vaccine which had been manufactured to provide more immunity for the different strains. 
• The Chairman commented on the low take up of the vaccination by NHS staff and asked for the reason.  Mr Williams explained that the staff were encouraged to have the vaccination but it was not mandatory.
• Ms Jervis from Healthwatch Bucks advised that feedback received on the letter sent to parents regarding the flu vaccination had a low level of readability/understanding and stressed the importance of communications being readable for the broader population.
• Dr Sutton advised that primary care were already feeling the winter pressures.
• Mr Whyte asked how the NHS 111 service would prevent people from Buckingham visiting A&E in Milton Keynes or Stoke Mandeville because they did not want to travel to High Wycombe.  Ms Richards agreed to check where the directory of services (DOS) was directing patients from Buckingham to and feedback to Mr Whyte.

ACTION:  Ms Richards

Update on the Cancer Alliance Work

Ms J Ricketts, Divisional Director, Division of Surgery and Critical Care provided a presentation, contained in the agenda pack, and highlighted the following points:

• In the Thames Valley there were 2.3 million people covered by three Sustainability Transformation Plans (STPs), four Clinical Commissioning Groups (CCGs), five provider trusts and one tertiary provider.
• The Thames Valley Cancer Alliance (TVCA) spanned primary, secondary and tertiary care and was funded by NHS England.
• Ambitious ambitions – by 2020, 57% of patients with cancer would survive10 years.
• The Buckinghamshire ICS and the TVCA were focussed on five key areas and were making significant progress.
• The TVCA programme of work would continue over the next 2-3 years to achieve sustained improvement in access, care and quality.

The Chairman stressed the importance of the TVCA.  Mr Williams stated that the NHS ten year plan, due before Christmas, was likely to have a heavy focus on screening and cancer pathways. 

The following key points were raised by members of the Board.

• In response to whether the TVCA included Macmillan and the hospice movement; Ms Ricketts agreed to find out if they were part of the Alliance.  Mr Williams added that the hospices were linked in closely to the work carried out locally. 
• A Board member asked whether there were any differences between children and adult cancer pathways. The Chairman asked for a short report for the next Health and Wellbeing Board meeting.

ACTION:  Ms Ricketts

• In response to a question on how smoking target reductions could be achieved, Ms Rickets said it was a changing culture and that there was a drive to make smoking unacceptable.  Many people had moved onto vaping and Dr O’Grady stated that Public Health had seen that smoking rates were coming down but one in four hospital beds was occupied by a smoker. 

Update on the Better Care Fund (BCF)

Ms D Richards, Director of Commissioning and Delivery

provided the following update:

• The refreshed BCF Plan was submitted to the BCF national team in line with requirements and no changes were needed. 
• The Integrated Commissioning Executive Team (ICET) continued to meet and provided monthly oversight of the performance measures of the BCF.
• The Delayed Transfers of Care (DTOC) performance continued to be challenged as it was not achieving the national trajectory and there had been an increase during September 2018.
• The High Impact Change actions were detailed in the report and were now monitored nationally by the system through the A&E Delivery Board (A&EDB).
• Improvements had been seen in the last six weeks. 
• There was a daily 9:00 am medically fit call with partners to discuss all patients on the medically fit list.
• Wexham Park Hospital (WPH) continued to be an outlier and the winter plan should help with supporting patients home from WPH. 
• Other elements monitored were non-elective admissions which had increased but the proportion of people admitted for less than 24 hours was much greater than the overall number of admissions meaning that the number of people in hospital for longer than 24hours had come down.

The following key points were raised by members of the Board.

• The Chairman commented on the large increase in DTOC in September 2018 and asked what the current estimate was for November 2018.  Ms Richards was unable to provide a figure but reassured the Board that she received a daily report.  Buckinghamshire Healthcare Trust (BHT) had held a "fabulous fortnight" and the number of actual DTOCs had been lower than the preceding weeks.  It was agreed that the Board required more up to date figures and acknowledged the ability to get patients home was one of the biggest challenges due to its complexity. 

ACTION:  Ms Richards

• A member of the Board asked whether social care delays were attributable to the community hospital projects and the ambiguity over the beds at Buckingham Community Hospital.  Mr Williams stated that there were a lot of patients who could go home if a package of care was ready.   Ideally patients should go home rather than to the community hospital.  The Discharge to Assess programme would help to get patients home.  Concern was raised over whether the figure was correct.  It was agreed that the Board had a statutory responsibility to monitor the data and needed accurate information and a new set of indicators to draw the right conclusions. 
• ACTION:  Ms Richards 
• Ms Quinton reassured the Board that the Discharge to Assess programme would help as ASC had commissioned a number of beds in the community in order to discharge people more quickly.  Work was also taking place to implement a joined up technology system.  One of the reasons there was a shortage of domiciliary care packages was because it was difficult to predict when a patient would be ready for discharge and the technology solution would help with the planning.

The Chairman summarised that the Board required improved commentary and suggested a different style of paper be prepared for the next meeting.

RESOLVED:  The Board NOTED the report.