Agenda item

This item provides Committee Members with an opportunity to review the Winter Plan for the health and social care system.  Representatives from across the system will present the Plan and Committee Members will have an opportunity to ask questions.

Attendees:

Ms Caroline Capell, Director of Urgent and Emergency Care, Buckinghamshire Healthcare NHS Trust

Cllr Zahir Mohammed, Deputy Cabinet Member for Public Health

Ms Jenny McAteer, Director of Quality, Performance and Standards, Adult Social Care

Mr Raghuv Bhasin, Chief Operating Officer, Buckinghamshire Healthcare NHS Trust

Dr Rebecca Mallard-Smith, Medical Director – Berkshire, Buckinghamshire and Oxfordshire LMCs

Mr Gary Elton, Buckinghamshire Local Pharmaceutical Committee

Papers:

Cover report

Winter Plan

The Chairman welcomed the following presenters to the meeting Dr George Gavriel, Chair of Buckinghamshire General Practice Leadership Group for the ICS, Caroline Capell, Director of Urgent & Emergency Care, Buckinghamshire Healthcare NHS Trust (BHT); Raghuv Bhasin, Chief Operating Officer, BHT; Jenny McAteer, Director of Quality, Performance and Standards, Adult Social Care; Dr Richard Wood, CEO, Berkshire West, Buckinghamshire and Oxfordshire LMC; Debbie Wiggins, Buckinghamshire Local Pharmaceutical Committee and Cllr Zahir Mohammed, Deputy Cabinet Member for Public Health. 

Philippa Baker, newly appointed Place Director for Buckinghamshire, attended the meeting as an observer as she has not yet started in her role.

During their presentation, the following key points were made:

·       The System Winter plan covered early stages of planning through to implementation. The focus laid around providing resilience for social care, effective discharge practices, outbreak management and vaccination provision.

·       Buckinghamshire Healthcare NHS Trust (BHT) had taken a similar approach to winter planning as last year, with each of their providers contributing to delivering and supporting winter pressures.

·       The pressures on mental health services had been increasing, particularly in light of the COVID pandemic. A number of patients had been in hospital due to poor mental health, and the teams were working closely with Oxford Health to get them into more appropriate settings.

·       Pressures on primary care resulted in increased pressures on hospitals. BHT had been working with SCAS to direct patients through the 111 service. A central clinical assessment service was also in development. Furthermore, work had been undertaken with local pharmacies to strengthen support, particularly around infection control.  Dr Wood and Dr Gavriel pointed out that those representing General Practice care providers had not yet been involved in winter resilience planning in General Practice.

During the discussion, Members raised the following questions:

·        In response to a Member question, it was noted that NHS England had made an assurance framework for all local ICBs, which contained actions around key focus areas. The System Winter plan had been subjected to a peer review by Surrey Heartlands. It was agreed to circulate the peer review report to Members.

Action: Caroline Capell

·        Actions outlined in the plan were tracked by the Buckinghamshire Urgent Emergency Care Board to ensure delivery.

·        Regular and ongoing communication with all key partners and service providers was key to successful delivery.

·        In response to a Member question, Caroline Capell reassured the Committee that work streams across all providers had intensive project plans dealing with each of the actions outlined in the plan. Fortnightly meetings were held with BHT’s improvement board looking at hospital actions and weekly meetings were held with the ICB.

·        As with previous years, there was a lot of uncertainty around winter planning, however, partners were ensuring that resources were in place to meet the additional demands, particularly in terms of staffing. A fundamental focus also laid in mitigating ambulance handover delays to ensure individuals requiring rapid care were treated promptly. It was agreed that more detailed information acquired in the upcoming meetings would be shared with the Committee before the next Select Committee meeting in November.

·        A Member asked how the pressures on bed capacity in hospitals would be tackled over the winter. It was noted that an additional facility in Olympic Lodge at Stoke Mandeville had been independently evaluated as providing good outcomes for residents. This would be reopened on 3^rd October with an additional 30 beds being provided by mid-November. Additional community beds within the main community wards in Amersham and Buckingham were also available.

·        In December, the new paediatric Emergency Department building at Stoke Mandeville Hospital would be opened, providing 14 new bed spaces for young people and providing emergency care.  The vacated space would provide additional overflow and assessment capacity.

·        In addition to the increased number of beds, a Member asked how the additional staff required to manage this increased capacity would be managed. It was advised that some of the staff previously working at Olympic Lodge had been retained, but additional staff had also been recruited through agencies (one vacancy remained out of the 14 required).  The Chief Nurse, was also working with senior nurses to examine how to best manage staff over the coming period. There was also a focus on international recruitment, particularly for maternity and midwifery. In the past 18 months, a programme delivering over 200 staff had also been successful. An additional £3.3 million of funding was provided to fund the increase in capacity. Although there was a 10 % vacancy rate, the team were continuously recruiting new staff, particularly nurses and healthcare assistants.

·        A Member was interested in the development of virtual wards. Raghuv Bhasin explained that the roll-out of this project had gone well.  Virtual wards allow healthcare professionals to monitor patients in their own homes through technology, with checks from nursing teams and oversight from clinicians. There were plans to expand this service to frail patients and potentially patients with diabetes.

·        A Member raised concerns around the viability of virtual wards for patients who were less confident with digital technology. It was explained that the project initially started with small numbers. The Committee was reassured that treatment through virtual wards needed to work for both patients and the organisation. Patients would be provided with the equipment and technical competence would be checked throughout the process, so that any challenges were identified and support provided. Both the equipment and the support were fully funded. It was agreed to supply further information around patient satisfaction of the virtual ward programme to the Committee.

Action: Raghuv Bhasin

·        In response to a Member question, Dr Gavriel explained that the Additional Roles Reimbursement Scheme (ARRS), in relation to Primary Care Networks, could deliver virtual wards, but the guidelines relating to the additional roles had to adhere to strict national guidelines. Dr Wood pointed out that the additional roles were originally conceived to support the sustainability and activity of General Practice.  The Chairman reflected on the lack of flexibility around ARRS roles. She welcomed the approach to digital monitoring, though emphasised the importance of maintaining face-to-face care for some patients.

·        A Member asked about same-day emergency pathways as a way to reducing the demand on the ambulance service. It was noted that these services were treating patients who did not require a Hospital admission, with a maximum treatment time of up to 23 hours, which adheres to the national guidelines.

·        The 111 service was delivered by South Central Ambulance Service. Work was being undertaken with SCAS and other urgent care providers to increase the workforce and use existing resources more effectively. Recruitment support for paramedics was also sought through different tiers, such as emergency care practitioners and increased support at the call handler stage.

·        The well-being and resilience of staff was a priority across the whole health and social care system. There had been an increase in psychological and well-being support, more spaces for rest areas and flexible working support as a result of the cost-of-living crisis.

·        Members raised concerns regarding the increased pressures on pharmacists due to the pandemic, particularly from residents who may be digitally excluded. The Chairman also asked what preparations for increased pressures would be put in place for pharmacists during the winter months. Caroline Capell acknowledged these pressures and went on to say that she was particularly concerned about remuneration remaining stagnant despite increased workloads. The Committee agreed that the increased use of pharmacies needed to be encouraged and highlighted the continued delivery of the vaccination programme by pharmacists alongside GPs.

·        In response to a question about the integrated covid and flu vaccination programme, Caroline Capell explained that this directive comes from NHS England and the responsibility sits with the ICS with GP practices and partners responsible for delivering it. There can be supply issues due to the different ways the medications needed to be stored which can lead to problems with being able to administer both vaccines at the same time. Dr Gavriel added that communication between local providers was important in ensuring that the service was effective. Standalone vaccination centres were run by either local GP practices, pharmacies, or through a combination of independent providers. The Chairman agreed to contact the ICB’s lead on the vaccination programme to ask for more information on this.

Action: Chairman

·        A Member asked about the additional capacity to support children’s mental health. Caroline Capell explained that Oxford Health had put a number of programmes in place to increase their workforce. Clinical support had been increased over the past 12-18 months. However, the provision of in-patient mental health facilities was a national problem. The teams were working towards early interventions through 111 and ambulance call centres.

·       The market capacity around health and social was challenging nationally, but efforts were being made with an integrated approach with partners to generate additional capacity. The importance of communication between partners to ensure the best possible outcomes for residents was highlighted. A Member also emphasised the need for transparency around plans for discharging patients from hospital.

·       Members raised concerns around support for carers. Jenny McAteer explained that adult social care had a transformation work programme working on this issue and she agreed to share the detailed plan with the Committee.

Action: Jenny McAteer

·       A Member questioned what support would be provided to support vulnerable and older adults. A programme around admission avoidance, Immedicare, had been in place to directly support all care homes. The team had issued communications around this to promote the service. Public communications would also be distributed, as would information about support available from the Council and the voluntary sector.

·       A Member asked whether plans were in place to provide cover for staff absences.  Ms McAteer explained that although maintaining staffing levels remained a challenge, both locally and nationally, ways to mitigate the pressures on staff had been implemented.  This was mainly through work with the voluntary and social care sector to ensure that adequate care as in place for people who were discharged from Hospital.   She agreed to provide more details around these plans with the Members.

Action: Jenny McAteer

The Chairman thanked all the presenters for their attendance and participation.