Agenda item

 

To receive an annual update in respect of the Rotherham Place Winter Plan.

 

 

The Chair welcomed Steph Watt, Health and Care Portfolio Lead, SY ICB to the meeting.

 

They provided an overview regarding what had worked well last year and what was being implemented under the 2024/25 winter plan.  The Health and Care Portfolio Lead explained that there was a whole system approach which involved health, social care and the voluntary and community sector, adding that they had rolled forward what had worked well from last year and added additional work streams.

 

Against the context of an aging population in Rotherham, and an otherwise challenging demographic, demand had increased, particularly around acute care and complexity which mirrored the national picture.

 

Last year, industrial action exerted additional pressure on the healthcare system along with the impact of the cost-of-living crisis.  For 2024/25 money from the BCF (Better Care Fund), which was a joint health and social care fund, was targeted to seasonal pressures spread across partners including the Acute Respiratory Hub which, in partnership with GPs, diverted pressure aware from urgent and emergency care. There was also additional investment in enablement services and social workers to support people at home which data reflected better outcomes were achieved. This also supported better flow, and was supplemented by additional community beds for non-acute care where return home was not feasible. The hours of the community ready lounge had been extended, to efficiently process discharge and mitigate unnecessary bed blocking.  More evening and weekend transport was also running to facilitate even flow and Age UK were operating a bursary scheme which supported discharge.

 

The virtual ward, which went live in 2022, had been particularly successful, with 3611 admissions since 2022.  In quarter two, this avoided 442 admissions.  They described the routes into the virtual ward and how this maximised care at home. There was a frailty pathway, a respiratory pathway and a heart failure pathway had just been launched.

 

The Health and Care Portfolio Lead described work that was being done with YAS (Yorkshire Ambulance Service) to reduce avoidable conveyances to hospital, through utilising community teams and services to deliver care.  This was a new pilot for this winter.  A new falls pathway for care homes was also being piloted, to offer wrap around care in care homes and avoid unnecessary attendance and waits at hospital which research showed did not improve outcomes.

 

They were also looking at patient flow through acute care, with increased medical and nursing staff leaving far fewer gaps in the workforce. Discharge was another focus of system flow, with the development of the transfer of care hub with multiple agencies providing wrap around care at home.  This was extended to consider how this could incorporate YAS. Co-location with YAS to a view to impactful cross-fertilisation of conversation was anticipated.

 

A discharge to assess model was being implemented, to improve the real-world assessment of need to reduce overprescribing, whilst maintaining patient safety and welfare.  It was acknowledged that this was complex and required effective collaborative working across agencies.

 

Trusted assessor roles had been recruited to advocate for care homes, supporting with conducting assessments, facilitating communication and building relationships, good understanding of need and minimising delays.  Feedback to date had been positive and would be fully evaluated following the pilot, but early indications were that this was improving assessments, decision making and reablement.

 

They explained that a lot of work was ongoing with CYPS (Children’s and Young People’s Services) particularly in schools, targeting vulnerable families and addressing system flow in mental health involving housing officers, the funding of crisis beds and the extension of safe spaces.  The Health and Care Portfolio Lead outline that there was also a really strong online support offer through Rotherhive which they urged members to review.

 

With regards to the vaccination programme, the position remained that prevention was better than cure, and as such there was a strong offer for Rotherham. Primary care and PCN’s were signed up to Covid and Flu vaccines for eligible patients, alongside vaccinations for whooping cough and RSV (respiratory syncytial virus). The Trust were vaccinating their own staff, but were also being proactive in the community and working hard to drive up vaccination rates.

 

Support for cost of living remained an issue and work was ongoing to offer support in the community and signposting information had been included in the slide pack as a reference point for members.

 

The Chair thanked Steph Watt, Health and Care Portfolio Lead for the dynamic and informative presentation.

 

Councillor Baker-Rogers commented that they felt innovation being shown in approaching health issues would place Rotherham in good stead over the coming years.

 

The Chair invited question or comments on the presentation.

 

Councillor Clarke outlined a personal journey connected to wrap around care and patient flow, identifying issues with capacity and technological integration across Trusts and the adverse impact on patients where such issues occurred. They welcomed the reassurances that had been offered through the presentation regarding wrap around care and patient flow and how that might prevent patient distress.

 

The Health and Care Portfolio Lead outlined the additional focus on end-of-life care and the transfer of care hub and how that may have positively impacted in the circumstances described by Councillor Clarke, whilst acknowledging this was dependent upon having the right capacity at the right time.

 

Councillor Duncan was interested to know what the current vaccination uptake levels were, what final projections were, the expected impact of current and projected rates of vaccination on service delivery and system stresses, and what steps were being taken to mitigate anticipated challenges and adverse impact.

 

The Director of Public Health advised that there was a huge amount of work going on around vaccine uptake and concerned with the promotion of vaccination programmes for Flu, Covid, RSV for the first time and pneumococcal.

 

As RSV and pneumococcal were one off vaccinations, with RSV implemented for the first occasion this year, no data was yet available. They were not in possession of up-to-date flu vaccination data, but reported that feedback from GP services was that there was good take up.  83% of care homes in Rotherham had been visited for Covid vaccines, with the expectation of 100% by the end of the month. Across Rotherham as a whole 42000 patients of 102000 (41%) eligible have received the Covid vaccine, have been vaccinated.  There was the desire to increase this. Covid numbers were declining rapidly and achieving the lowest levels of the year, so this was not expected to peak at the same time as flu, during the winter which was positive news for system pressure and did appear to be aligned with the vaccination programme’s implementation. Flu was at fairly low levels but had begun to rise amongst younger age groups as was the expected trajectory.  The peak was expected beyond the Christmas bank holiday period.

 

Councillor Havard noted the lack of reference to social prescribing which had featured in last year’s winter plan, setting out the intention extend scope of service outside of primary care.  They queried whether this had been taken forward and what the impact had been if so.

 

Claire Smith, Director of Partnerships/Deputy Place Director (Rotherham Place), South Yorkshire ICB (Integrated Care Board) advised that in addition to social prescribing for long term physical conditions which was the main element of social prescribing offered a pilot for SMI (Serious Mental Illness) had been implemented using ‘community connectors’ and had encouraged those affected to undertake annual health checks and supported them to access additional voluntary sector and community based assistance.

 

Councillor Havard queried whether the initiatives that had been identified as having worked well last year were being implemented again, and whilst acknowledging expansion of social prescribing to assist those with mental ill health was welcomed, asked what was being done to support the elderly and vulnerable with respect to social prescribing.

 

The Health and Care Portfolio Lead confirmed that specific interventions had been put in place in previous years.  Last year, Age UK had extended working hours and weekend working but this was not particularly effective so they have reverted to the core offer, looking at what was in the Age UK contract.  That has been changed to include more non-personal care, providing support up to 30 days after discharge and extended to prescribing and delivering low level equipment. 

 

They explained that a previous pilot had implemented a social prescriber to support system flow. This had worked really well, was now embedded and has become a permanent post as part of the social prescribing contract.  Another pilot addressed delays due to barriers to discharge.  An example was cited in which medications had to be kept at low temperatures, but the patient had no fridge at home and grants could be given to allow purchases to be made to facilitate timely discharge in those circumstances.  Grant funding had been topped up to support this over the winter.  Age UK were now accessing and administering that grant funding.

 

Councillor Bennett-Sylvester advocated the role of ‘open arms’ in accessing cost of living support, acknowledging that whilst numbers weren’t where they would want them to be, significant benefits had been realised in terms of accessing benefits and other means of support. They had also had a positive personal experience of the virtual ward.

 

Feedback on the virtual ward was welcomed and would be passed on.

 

Councillor Bennett-Sylvester queried whether there was an inherent risk aversion in online assessment systems contributing to increased demands on urgent and emergency care. 

 

The Health and Care Portfolio Lead advised that GPs had noticed an upturn in the number of patients in the 20-40 age range presenting repeatedly and that similar trends had been observed in emergency care.  Work was being done to understand the reasons for this trend, so it was accepted that Councillor Bennett-Sylvester’s suggestion may be worth further consideration.

 

Councillor Bennett-Sylvester also queried what was being done to ensure that hard to reach communities were being targeted to increase vaccination take up.

 

The Director of Public Health advised that meetings took place monthly at Rotherham and South Yorkshire level regarding vaccination take up. This year, there had been a move away from the targeted delivery that had become familiar during Covid, with a return to GP led and national booking service access to vaccinations. They advised that local GPs were therefore pivotal to uptake in their communities.  Additional work had been undertaken to ensure that communications were appropriately positioned to encourage vaccination uptake, particularly to those communities that were traditionally hard to reach.

 

Councillor Bennett-Sylvester sought reassurances as to the flexibilities that were built into the system to respond to the pressures of winter, particularly given the loss of winter fuel allowance for some and the unknown health implications that may bring.

 

The Health and Care Portfolio Lead advised that a new role was being implemented in January focussing on system flow, forecasting and trend analysis to allow the system to become more responsive. An escalation framework specific to Rotherham was in place, where senior managers met three times per week.  This also tied into resilience across the whole of South Yorkshire through the system command centre.

 

Councillor Yasseen queried whether this year’s winter plan was ready for the adjustment of returning to the four-hour emergency care standard.

 

The Director of Partnerships/Deputy Place Director (Rotherham Place), South Yorkshire ICB advised that Michael Wright, Managing Director, TRFT who was unable to attend the meeting would be best placed to respond to that question, however, the ICB had received assurances that additional staff to support urgent and emergency care, but accepted there was still some risk in the system in terms of achieving the 78% target.  Rotherham had made significant improvements and were in line with South Yorkshire partners, despite having previously been a pilot site.  The ICB was confident that there was a system in place, with rigorous processes in the Trust, but acknowledged that this was a challenge.

 

Councillor Yasseen expressed the view that front facing services often had the biggest impact in terms of providing support, and queried how much of the BCF funding was used to resources services in that category as opposed to high level management or administrative functions.

 

The Health and Care Portfolio Lead explained that the administration of the BCF was overseen by the Health and Wellbeing Board, through Councillor Baker-Rogers with strict governance processes. They explained that through partnership work and a whole system approach, they had considered where the BCF could be utilised to support innovative work and the delivery of strategies such as in home, intermediate and reablement support. Funds had been used to maximise the Rotherham pound across a diverse range of services.

 

Councillor Yasseen expressed concerns around groups not accessing funds that could represent meaningful preventative work outside the medical sphere, and the potential to better deploy funds like the BCF to invest in those services.

 

Councillor Clarke supported Councillor Bennett-Sylvester’s advocacy of open arms, and added that in their ward demand exceeded supply, with regular queuing observed which caused concern for the elderly and frail.  They queried whether footfall data was collected borough wide, and whether this was used to inform service planning and delivery. They sought reassurance that services understood where the demands were, and asked if any data collected could be shared with Councillors.

 

The Director of Public Health advised that their team was not directly involved in the commissioning of open arms, but would feed back in relation to footfall and pinch points with a view to enabling capacity to meet the needs of residents.

 

Councillor Havard raised concerns regarding discussion around the withdrawal of funding for admiral nurses and sought reassurance in respect of how that gap would be filled.

 

The Director of Partnerships/Deputy Place Director (Rotherham Place), South Yorkshire ICB advised that they were aware of concerns and as a result were conducting a review of dementia services over the coming weeks and months to assist in understanding the implications. The hope was that this would provide a developed understanding of commissioned dementia services, allowing accurate identification of service gaps and how best to work collaboratively to bridge them.

 

Councillor Havard advised that there were many examples of the elderly looking after the elderly and they were worried about the support that may be available to them and the implications for at home care of loved ones.

 

Resolved:-

 

That the Health Select Commission:

 

1.    Noted the Place Partners Winter Planning Annual Update.

2.    Requested that the Council and relevant delivery partners consider the mechanisms for gathering data on footfall at open arms sessions to inform planning and service, and how that data could be shared with Councillors.