Agenda item

The Committee will hear from representatives from across the health and social care system in relation to the Winter Plan.

Presenters:

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

Cllr Carl Jackson, Deputy Cabinet Member for Public Health (standing in for Cllr Angela Macpherson, Cabinet Member for Health & Wellbeing)

Ms Gill Quinton, Corporate Director, Adults and Health

Ms Tracey Ironmonger, Service Director, Adult Social Care

Papers:

·       System Winter and Surge Plan.

The Chairman welcomed Ms C Capell, Director of Urgent and Emergency Care, Buckinghamshire Healthcare NHS Trust, Cllr C Jackson, Deputy Cabinet Member for Public Health and Ms T Ironmonger, Service Director, Adult Social Care.

During the presentation and subsequent discussion, the following main points were made and questions asked by the Committee.

·       The Winter Plan had been developed by all system partners and it feeds into the wider Buckinghamshire, Oxfordshire and Berkshire West Integrated Care System Plan.

·       The Plan adopts an action focussed approach and there was a weekly system meeting to monitor the actions.

·       The Surge Plan focussed on reporting the system plan regionally, paediatrics and Hospital discharge.

·       A Member asked for clarification around who was part of the tactical cell. Ms Capell explained that each provider across the Buckinghamshire Integrated Care Partnership was represented, including primary care, ambulance service, adult social care, public health and mental health.  She went on to explain that the system cell was set-up at the start of the Covid pandemic and met every day – it now meets weekly and would continue to do so throughout the Winter.  There was a separate escalation cell across the system.

·       In response to a question about what was meant by “stranded patients”, Ms Capell explained that these were patients who were medically fit to be discharged but were not in the right medical place.

·       A Member asked whether the Trust were experiencing any hospital supply issues as reported in the national media.  Ms Capell explained that, in terms of the issues with fuel, this was being monitored across the system on a daily basis which included the ambulance service and the patient transport service.  During Covid, the Mutual Aid process had strengthened and if the fuel crisis continued, then mutual aid would be considered.  Blood tubes for testing had been another area of reported shortage but Ms Capell said that the Trust had not run out and if necessary, areas would be prioritised if stocks were limited.

·       A Member expressed surprise that the Winter Plan did not include more information on Covid vaccinations, particularly the roll-out of the booster programme.  Ms Capell explained that the deadline for submitting reports to the Committee meant that the details around the booster programme had not be finalised but she updated the Committee to say that the programme had started three days ago and she confirmed that the Trust staff were receiving their booster vaccinations.

·       In response to questions around access to GPs, Ms Capell explained that the national average for face-to-face GP appointments was 57% and Buckinghamshire was currently operating at 50%.  The Trust was working with primary care but it remained a challenge.  It was acknowledged that the 111 service was an integral part of ensuring people were seen by the most appropriate health service.

·       A respiratory “hot hub” had been set-up for children and there were plans to employ more GPs within the Hospital Trust so that more children could be seen at the front door.

·       A Member asked whether there was a separate communications plan to support the key public messages which were contained within the Winter Plan.  Ms Capell confirmed that the Trust were working with Buckinghamshire Council’s communications team with a specific campaign around the 111 service – direct bookings could be made from 111 to GPs.

·       There was Government funding to support more communications around the ambulance service.

·       Ms Capell confirmed that the Trust works closely with the voluntary and community sector.  Ms Ironmonger added that this sector was part of the Council’s Adult Social Care Plan which she agreed to share with the Committee.

Action: Ms Ironmonger

·       A Member asked about the handover time of ambulances as it was recently reported that Scotland were experiencing 9 hour handover waiting times.  Ms Capell explained that some days were better than others and the Trust was working hard with the ambulance service to reduce the delays, which were currently between 6-7 hours.  She went on to say that around 70 ambulances arrived at Stoke Mandeville every day with around 4-5 queuing at any one time but the Trust was working hard to improve this.

·       In response to a question about whether Hospital staff were affected by the high level of people being “pinged” by the track and trace Covid App, Ms Capell explained that the app was turned off in the Hospital and each ward/area was risk assessed on a case by case basis and relevant measures put in place if required.  Staff had regular lateral flow tests.

·       A Member thanked Ms Capell for her reassurances around “stranded patients” but went on to ask who was responsible for mental health patients who were placed in out of county facilities.  Ms Capell confirmed that if they were residents of Buckinghamshire, then they would be the responsibility of the Buckinghamshire system.

·       A Member asked how Buckinghamshire was performing in terms of the consultant connect pathways and the agile platforms to aid PCN referrals, which were subject to national benchmarking.  Ms Capell explained that there was scope to develop the connections further, for example, the dermatology service.  The frailty connection was working well between primary care and hospital consultants and had moved to a 24/7 service about 6 months ago.

·       Ms Capell confirmed that the integrated discharge team worked seven days a week and the whole system worked together to find the right placements for their patients.

·       Members expressed concern around GP access and whilst acknowledging this was primary care, Ms Capell agreed to take these concerns back to the Clinical Commissioning Group for a response.

Action: Ms Capell

·       A Member asked for some examples of the better ways of working which were referred to in the presentation.  Ms Capell explained that a number of pathways had been strengthened, including mental health services and colleagues were now working alongside the 111 service, 24/7.  Ms Ironmonger added that the support to care providers had also been strengthened, including more pro-active communications between social care and care providers.

·       A Member asked for reassurance in terms of oversight of all the actions across the system and the measures in place to ensure delivery of the actions, particularly in relation to the IAPT service and the provision of urgent psychological assessments.  Ms Capell confirmed that the actions were reported and managed through the weekly tactical cell meetings.  There was an urgent risk register where all the actions had been mapped by providers.

·       A Member expressed concern about maternity services and mothers being sent to the wrong location by the 111 service.  Ms Capell explained that the 111 service operators use a local directory of services which was the responsibility of the local providers.  The Trust acknowledged that the directory needed to be updated and work had started on this a few weeks ago.  Ms Capell agreed to update the Committee once completed (expected by the end of October).

Action: Ms Capell

·       A Member referred to the statement in the presentation about the Buckinghamshire system not being mature enough to enable cross organisational working and asked for further details.  Ms Capell explained that the Trust was part of the Urgent Care Programme.

·       In response to a question about the involvement of local pharmacists in developing the Winter plan, following a request by the HASC Select Committee to the Health & Wellbeing Board, the Deputy Cabinet Member said that he would check this and confirm their involvement.

Action: Cllr Carl Jackson

·       Ms Capell confirmed that the 111 service was booking directly into local pharmacy services and that the Trust was working closely with the Local Pharmaceutical Company to help strengthen the pathways.

The Chairman thanked the presenters for attending the meeting.