Agenda item

Caroline Capell, Director of Urgent and Emergency Care, Buckinghamshire, Oxfordshire and Berkshire West Integrated Care Board.

The Chairman read out the question from Mike Etkind and the summary response.

Question - Will there be any co-production involved in developing the comprehensive public engagement plan referenced in the executive summary of the winter plan? 

Summary Response - There will be two plans across the Winter period, The BOB ICB Winter Communications Plan, and the local Buckinghamshire System Plan. Both will be co-produced with partners and key stakeholders across the Buckinghamshire System.

Caroline Capell, Director of Urgent and Emergency Care, Buckinghamshire, Oxfordshire and Berkshire West Integrated Care Board (BOB ICB), reported that the Buckinghamshire Health and Care System winter plan focussed on managing the anticipated challenges across our emergency and urgent care footprint across Buckinghamshire.  It was recognised that there would be five key challenges:

·   An increase in access to same day care

·   Reducing admission levels

·   Increasing capacity across the whole system

·   Reducing delays to discharge

·   The overall management of surge

The plan had been developed from lessons learned from last winter.  The system now had access to a forecast tool which used historic data in order to anticipate peaks in demand; an ED peak was expected at the end of October.  The team would also be looking at comparing performance in order to manage improvement throughout the winter by focussing on specific actions.  All patients self-presenting at Stoke Mandeville Hospital (SMH) would now follow an urgent treatment care pathway, which would operate 24/7 to ensure the right patients were sent to either urgent care or emergency care. The forecast model also anticipated a spike in ambulance activity in January and initiatives would be focussed where demands were anticipated.  The data would be refreshed to identify potential new peaks and national performance and demand would also be monitored.  The team had been working closely with mental health colleagues and the 111 service would be going live with a direct link for mental health patients.  There was also a psychiatric liaison support available at the front of SMH Emergency Dept and this would remain throughout the winter.  Escalation reports are provided daily to NHS England for assurance.  The team was working closely with Adult Health services to help facilitate discharge and admission avoidance work.  Escalations would be managed through an OPEL Framework which would change as pressures increased/ decreased.   The escalation processes included a structure including gold, silver and bronze teams to continue as normal to manage periods of surge across the whole Bucks system.

The Chaiman thanked Caroline for her summary and mentioned that the Buckinghamshire winter plan supported the Frimley winter plan but did it support the Milton Keynes winter plan?  Caroline confirmed that this was an omission, the team worked with colleagues from Bedfordshire, Luton and Milton Keynes colleagues and the plan would be updated.

Action:  Caroline Capell

The following key points were raised in discussion:

·   Katie Higginson had received feedback from two local charities, AGE UK Bucks and Carers Bucks who were affected by winter.  Both organisations would welcome engagement to create the winter plan in future.  Carers Bucks noted there was no mention of the key role of unpaid carers in engaging family in admission or discharge conversations. There was also no mention of unpaid carers in the Healthier Happier Lives Strategy or in the BEP report; Katie stressed that the health impact on unpaid carers cut across so many pathways.  Carers Bucks had also asked that their ‘UK 2022 State of Caring’ report be shared with the HWB.

Action:  Rebecca Carley

Caroline recognised it was an omission and would make contact as an action. 

Action:  Caroline Capell

Craig McArdle confirmed he would ensure that Age UK and Carers Bucks would be involved in the Adult Social Care winter plan.

Action:  Craig McArdle

·   Dr Sian Roberts highlighted that 25% of patients over 65 years old would have dementia. and asked how that was being addressed.  Caroline stated that it was challenging on how to manage dementia; there were interventions and they were enhancing the frailty line and had a single point of contact for care homes.  Work was happening but it was a challenge on how to take forward.

·   The chairman asked if people knew what ‘virtual wards’ were?  Caroline advised that the scheme was being developed at the moment, particularly for respiratory issues in winter, and it would be promoted towards the end of the year. Virtual wards were where patients were referred into a pathway, and informed that they were being managed by the acute trust, but in their own home.

·   Dr Jane O’Grady stated she was in interested in the predictions based on previous years and noted that there was a predicted peak in emergency department access across all areas in October.  Dr O’Grady queried what was behind the peaks and what could be done to prevent it and stated it would be interesting to see if predictions had come true after the winter.  Caroline explained that it was a national tool and they were governed by what was taken from the data.  It would be monitored to see if predictions came true.  It could be based on the weather; there were two communications plans; an ICP and a targeted Buckinghamshire plan.  When a respiratory surge was anticipated they would look at providing targeted clinics; respiratory clinicians would focus on where required.  The data changed each month and would be monitored to see if the prediction was accurate.

·   Neil Macdonald advised that the winter plan had been a long piece of work and stressed the importance of moving the Urgent Treatment Centre (UTC) to a 24/7 model.  However, services were going out to open market tender and some colleagues at SMH were unsettled and Neil asked for assurance on how the process would be managed.  Caroline advised that the development of the Buckinghamshire UTC had been in development for 18 months.  It had been taken through the governance structure which required it to be taken to the open market.  It would take all 111 dispositions for primary care, GP primary care, (not dentistry and pharmacy, and opticians) into a clinical assessment service 24/7 where patients would be clinically triaged and sent to the most appropriate place. A lot of work had been carried out with community pharmacies on strengthening those pathways via the clinical assessment service. They would, then incorporate the out-of-hours and home visiting, so it would become a single service which would be more effective and efficient.  Existing providers and been informed and TUPE rules would apply for procurement.  Caroline acknowledged it was a turbulent time for those concerned. 

·   Zoe asked what a Buckinghamshire resident with an urgent health problem should do?  Caroline advised that the person should contact 111.  Zoe responded saying that, last year, due to capacity issue of 111, people went straight to SMH A&E and thought that the communications around UTC were confusing.   Caroline explained that if a patient arrived at an emergency department they would be assessed more quickly and provided the best pathway.   The Chairman added that improved communications were needed. 

·   Dr Sian Roberts said that the other point of contact was GPs, who experienced similar surges.  Was there anything in the winter plan to support GPs?  Caroline explained that they were seeing that 60% of demand at the UTC would have gone to GP practices but would now be dealt with that service so reducing demand on GP practices.

·   John Meech noted that patient flow and bed occupancy was at more than 90% occupancy and asked what the impact of high occupancy was on patients.  Would virtual wards help reduce high levels of occupancy?  Neil advised that the virtual ward was a new model and had not been evaluated yet.  The ideal occupancy was 85% and 75% in critical care.

·   The Chairman asked Caroline to circulate information on the Mental Health Safe Haven Scheme.

Action:  Caroline Capell

It was agreed that the HWB would re-visit the winter plan in six months’ time.

Action:  Rebecca Carley to add item to the forward plan

The Chairman thanked Caroline for attending the meeting and the HWB noted the winter plan.