Agenda item

The Committee will hear from key health and social care colleagues about this years’ system winter plan.

Presenters:

Caroline Capell, Director of Urgent and Emergency Care

Angela Macpherson, Cabinet Member, Health & Wellbeing

Craig McArdle, Corporate Director, Adults and Health

Tiffany Adonis-French, Service Director, ASC Operations

Tracey Ironmonger, Service Director, Commissioning

Raghuv Bhasin, Chief Operating Officer, Buckinghamshire Healthcare NHS Trust

Martin Thornton, Interim Deputy Director for Bucks GPPA and FedBucks Director

Daryl Lutchmaya, Chief Governance Officer, South Central Ambulance Service (SCAS)

Paul Stevens, Assistant Director Commercial Services, SCAS

Emma Crozier, PTS Area Manager, SCAS

Mark Begley, Head of Operations, SCAS

Papers:

System Winter Plan

The Chairman welcomed the following presenters to the meeting:

Caroline Capell, Director of Urgent and Emergency Care

Angela Macpherson, Cabinet Member, Health & Wellbeing

Tiffany Adonis-French, Service Director, ASC Operations

Tracey Ironmonger, Service Director, Integrated Commissioning

Raghuv Bhasin, Chief Operating Officer, Buckinghamshire Healthcare NHS Trust (BHT)

Martin Thornton, Interim Deputy Director for Bucks GPPA and FedBucks Director

Mark Begley, Head of Operations, South Central Ambulance Service (SCAS)

Daryl Lutchmaya, Chief Governance Officer (SCAS)

Paul Stevens, Assistant Director, Commercial Services (SCAS)

Emma Crozier, Patient Transport Service Area Manager (SCAS)            

During the discussion, the following key points were made and Members asked the following questions:

·       The planning for winter 2024 to 2025 would start in February and would focus on same day care, increasing capacity, reducing discharge delays and demand caused by surges such as the increase in streptococcal A infections.

·       Healthcare provision had improved since last winter and should be the first year “back to normal” after the Covid pandemic.

·       In response to a question about improved dementia care, the Chief Operating Officer for BHT outlined two improvements. The first Admiral nurse had been recruited and it was hoped that another nurse would be recruited soon.  There was also a better relationship with a small number of care homes who had formed a hub to provide dementia support. This had resulted in patients staying in care for shorter periods of time whilst their care packages were established (reduced from an average of 85 to 35 days).

·       The Chairman asked for more information on the effectiveness of these care hubs.  The Service Director for Integrated Commissioning explained that, over the last year, joint working with care providers had been effective.  There were five hubs providing 26 beds as well as 22 beds in the Olympic Lodge facility at Stoke Mandeville.   The Service Director for ASC Operations said that the working model had been tested before the winter challenges started and that the multi-disciplinary approach was producing better outcomes for patients.

·       A Member raised concerns about Buckinghamshire residents who were discharged from neighbouring hospitals, such as Milton Keynes and Wexham Park Hospitals, particularly when there were social care needs.  The Service Director for ASC Operations explained that there was a dedicated team who were handling out of county hospital discharges.

·       The Head of Operations highlighted that the South Central Ambulance Service (SCAS) had a number of pathways available to them to ensure patients were treated at the right place and ambulance crews would do their best not to take patients to hospital. He went on to say that 50% of patients who called 999 did not go to hospital.

·       A Member asked how Olympic Lodge would be staffed and the impact future industrial action would have on being able to staff this facility over the winter.  The Chief Operating Officer advised that there would be a dedicated team of nursing staff and that the ward was nurse and therapy led and would not be adversely affected by any industrial action.

·       In response to a Member question about the risks associated with covid variants leading to more hospital admissions, the Chief Operating Officer explained that there was additional capacity to help manage such an event although Covid outbreaks created additional pressure on space as the patient needed to be isolated.

·       The Chairman asked if there was a mechanism to collect patient and carer feedback on the Care Home Hub.  The Chief Operating Officer said that there had been a full evaluation of the Olympic Lodge facility from last time.  The Chief Executive of Heathwatch Bucks added that there was a plan to review the patient and carer journey.

·       In response to a Member question about the availability of covid booster and flu vaccinations, the interim Deputy Director of GPPA explained that capacity and financing were variable. In some places, patients could get both jabs. Home visits for housebound patients were available but provision was patchy as these are time-consuming. There was a 26.4% vaccine take-up in the BOB area as at 7^th October 2023. 

·       In response to a question about sufficient capacity in the adult social care system, the Service Director for Integrated Commissioning explained that capacity was generally good but there were some areas where there were challenges.  

·       In response to Member questions about the winter vaccination programme, the interim Deputy Director for GPPA explained that vaccinations were being carried out in surgeries rather than large vaccination centres as there were no social distancing requirements now.

·       A Member asked whether additional capacity had been put in place to deal with a spike in respiratory diseases over the winter, the Chief Operating Officer said that clinicians had good data to help manage demand over the winter months.

·       In response to a question, on the challenges in primary care, the interim Deputy Director said that the Clinical Assessment Service (CAS) had been providing additional support, in terms of triaging patients which helped GP surgeries manage their increased demand.

·       The Chairman asked about increased pressure on the 111 service.  It was agreed by health partners that the performance of the service had improved.

·       In response to a question from a Member on surge planning in emergency care, the Director of Urgent and Emergency Care explained that the Operational Pressures and Escalation Levels (OPEL) framework operates across the whole country, sharing useful data. The Chief Operating Officer added that the data allowed clinicians to plan for a surge in demand and to predict peak demand.

·       A Member spoke from personal experience about care and support for people with dementia and their carers when an emergency occurs.  The Chief Operating Officer outlined the services available through the hub, which was based at Stoke Mandeville Hospital.  The Member felt that the information about the services provided at the hub should be made available to Members and promoted more widely to the public.

Action: Raghuv Bhasin

·       In response to a question about handover delays in hospital, the Head of Operations at SCAS said that paramedics had a number of pathways available to them and not all patients were taken to the Emergency Department. The Chief Operating Officer went on to say that there were now twelve A and E consultants compared to six last year.

·       In response to a query on delayed patient discharge, the Service Director for ASC Operations explained that a new Transfer of Care Hub would be opening on 16^th October 2023 offering a range of options for patients which would assist in the discharge process.

·       A Member asked for clarification about the performance tables on page 14 of the agenda pack and queried whether there were a lot of people returning to the safe haven scheme.  The figures cover Stoke Mandeville Hospital and the Urgent Treatment Centre, where a combined number of 500 patients were seen each day. The Director of Urgent and Emergency Care explained that many of the repeat attendees to the safe haven scheme were planned. 

·       The Chairman asked that the winter figures should be reviewed as part of the evaluation of the winter plan item which would come to the Committee later next year.

·       In response to a Member question about ensuring a rapid response to mental health issues, the Director of Urgent and Emergency Care said that there was a pathway for patients to contact Oxford Health.  Oxford Health staff were also working in the 111/999 call centres.

·       A Member asked how the Virtual Ward Bed scheme was working and if staffing levels were sufficient.  The Chief Operating Officer said that there were currently 90 virtual ward beds and the aim was to provide virtual ward care to 160 patients. The two largest groups of patients being looked after were those with frailty or respiratory needs.

·       In response to a Member question about staff wellbeing, the Chief Operating Officer explained that emotional and physical wellbeing support was provided to all staff. 

The Chairman thanked all the contributors for their time and said that she looked forward to hearing how the plans for this winter hold up against the pressures over the coming months.