To be presented by Caroline Cappell, ?Director of Urgent and Emergency Care -?Buckinghamshire Healthcare NHS Trust.
The Winter Plan is part of an annual planning process in collaboration with Buckinghamshire Integrated Care Partnership led by the Urgent Care Board.
The Health and Wellbeing Board is invited to receive and note the updates and presentation at the meeting and consider its role in supporting identified areas and recommendations included in the report, including a commitment to:
• Ensuring the safety of patients during the Winter Period and during the Covid Pandemic:
• Supporting staff
• Working together as a Buckinghamshire System to provide the best care in the right setting for our population
• Engaging and communicating with our population and key stakeholders in a timely, supportive and safe way
The Chairman read out the following questions which had been submitted by the Health & Adult Social Care Select Committee and advised that written responses would be provided and appended to the minutes:
The report identifies the numbers of patients in each cohort for flu vaccines this year (with the additional age group of 50-64 year olds). Can you confirm how many flu vaccines are available across the Buckinghamshire system to meet the target of 75% in each cohort and how confident are you that you can meet this target?
How well prepared are the Care Homes in Buckinghamshire, in terms of staffing levels, access to PPE and access to flu vaccines for staff and patients?
In the event of another surge in hospital Covid cases, what lessons have been learnt around the hospital discharge process (i.e. patients being discharged to care homes) and what improvements have been put in place over the next few months to ensure safe discharges from the hospital setting?
Dan Gibbs, Chief Operating Officer, BHT, introduced Caroline Cappell, Director of Emergency Care for BHT, who advised that she would address the questions during the presentation. C Cappell referred to slides 26-42 of the presentation appended to the minutes and highlighted that there had been a different approach to winter planning this year as the winter plan had been developed alongside the Covid Second Surge Plan and the Buckinghamshire Flu Plan. The Covid Recovery Programme had provided an opportunity to undertake a wider Transformation Programme for all Urgent and Emergency Care Services and the winter and flu plans had been developed within the context of the wider plan. Urgent emergency care had not stopped during the pandemic; the same triage system would continue.
The plan consisted of six key work streams:
- Pre-hospital (999, 111, pathways)
- Front door of acute trust (reconfiguration of urgent and emergency care access to ensure the patient saw the right clinician at the right time)
- Ambulation and acute (how to provide same day emergency care within 24 hours, not admitting to hospital ward)
- Post-acute (internal process of patient flow to optimise health delivered within BHT)
- Get me home (ensuring patients were safely discharged home).
- Anticipate, not react (a move to anticipating and preparing for demand).
The Buckinghamshire system’s winter approach plan would be governed by five principles; patient outcomes, prevention, avoiding attendances, avoiding admissions and rapid discharge.
Response to question three - Care homes would be kept safe with a Care Home Support Package to provide direct support to care homes. All care home patients admitted to hospital would be tested for Covid-19 48 hours prior to discharge. Tracey Ironmonger, Interim Service Director, Integrated Commissioning, added that progress had been made; workshops had been held on what had gone well and what could be improved on from when a patient was admitted until the patient was discharged to their place of care. There was now a single discharge assessment amended to reflect a patient’s needs on discharge.
The Winter Plan contained a number of key actions for partners to deliver:
Think 111 First - a national initiative, going live in Buckinghamshire on 12 October 2020 to ensure patients dialled 111 before presenting.
Discharge Guidance - a Home First model was being developed where a multi-disciplinary team would manage the transfer of the patient from the hospital to their own environment.
Paediatric Pathways - work was being carried out with acute, primary and social care colleagues on developing pathways to safely manage children in an acute setting.
Increase uptake of Flu vaccinations and the response to question one - it was essential people were immunised, particularly this year. In January/February each year the Services which delivered flu vaccinations submitted their requirements to the national team. This year, those numbers were less than what was needed now that the cohort had been extended to include the over 50’s. C Cappell confirmed that enough vaccine had been received in the initial cohort and the practices and community pharmacists were well underway with vaccinating the population, frontline health and social care workers. The national team would deliver the remainder of the vaccines for the additional cohorts and the potential additional capacity that would be required. There was a system wide vaccination flu group and BHT was also part of the Buckinghamshire, Oxfordshire and Berkshire (BOB) group so were able to support each other across the wider system. Work had been undertaken with partners to ensure that safe practice was in place to deliver the vaccination programme and C Cappell stated she had been assured that there would be adequate supplies.
Covid Second Surge Plan
Lessons had been learned from the first surge and governance was in place for a second pandemic situation. During the recent pandemic, Fed Bucks provided safe hubs to assess patients and this was still in place. There had also been a Covid clinical assessment service operated by 111; this was a national service and was likely to be re-implemented in the coming weeks. Work was being undertaken with Buckinghamshire Council (BC) colleagues to develop the Winter Communications Plan and would align with the national 111 Think First winter campaign. The importance of partnership working over the coming months was emphasised.
Response to question two - T Ironmonger advised that the Government had introduced a new scheme for social care providers to access free Personal Protective Equipment (PPE) which would run until March 2021. The Service was working with providers to ensure they were all signed up to the scheme. Staffing support was in a much better position with a provider cell in BC in constant contact with social care providers to offer support and monitor the national capacity tracker and provide early warning of issues in the care system. Staffing was relatively stable and infection control training had been provided to a number of providers.
Jane MacBean raised an additional question in the chat bar, as she was having a technical sound issue.
Question - One member had highlighted that care homes were waiting up to nine days for the result of a Covid test making keeping residents and staff safe very difficult. Was this issue being addressed?
Response - this was related to the national testing programme and the service was engaging with care homes to identify where there were delays and feeding back to the national programme through various routes. There had been an improvement in timescales for results more recently. Results were monitored daily and no onward transmission, where staff had been identified as Covid positive in care homes, had been identified.
Written responses to J MacBean’s other questions raised in the chat bar were appended to the minutes.
The Chairman thanked everyone for their contributions.
RESOLVED: The Health and Wellbeing Board RECEIVED and NOTED the updates and presentation at the meeting and CONSIDERED its role in supporting identified areas and recommendations included in the report, including a commitment to:
· Ensuring the safety of patients during the Winter Period and during the Covid Pandemic
· Supporting staff
· Working together as a Buckinghamshire System to provide the best care in the right setting for our population
Engaging and communicating with our population and key stakeholders in a timely, supportive and safe way.
- Winter Plan_front sheet_Oct20_final, item 9. PDF 642 KB
- Buckinghamshire Health Wellbeing Board_Winter Planning_6_10_2020-final, item 9. PDF 286 KB
- HASC questions at HWB_written response and additional chat bar questions.._, item 9. PDF 646 KB