Agenda item

 

Steph Watt, Portfolio Lead – Urgent and Community Care, ICB, to present the 2025/26 Winter Plan.

 

 

Steph Watt, Portfolio Lead Urgent and Community Care, presented a report on the 2025/26 Rotherham Winter Plan together with the following powerpoint:-

 

Winter 2024/25

-        Urgent and Emergency Care Programme focussed on increasing out of hospital pathways as alternatives to avoidable conveyances and admissions and reducing discharge delays

-        Additional monies were invested across Place to support system flow over winter utilising Section 75 Better Care monies and the national Discharge Fund together with organisational investment by The Rotherham Foundation Trust (TRFT) and Council

 

Winter Schedules 2024/25

-        Comprehensive vaccination programme co-ordinated across Primary Care, TRFT and the Council supporting vulnerable citizens, care homes and health and care staff

-        Increased GP appointments including acute respiratory hub

-        ‘PUSH’ Community Health and Social Care Teams responding to non-critical 999 calls to reduce ambulance conveyances, including new respiratory and mental health pathways

-        Increased capacity on the virtual ward

-        Additional staffing resource including Consultant and resident doctor medical cover, therapy, Social Worker, enablement and portering resource

-        Extended opening hours for Community Ready Unit with support to ensure timely medicines

-        Extension of patient transport

-        Home from Hospital Pathway to reduce waiting times

-        Priority services identified for children with plans for temporary reductions elsewhere to support peak pressures

-        Reduce in out of area mental health placement

-        Robust mental health digital offer

-        Rotherham safe space provided additional out-of-hours support for individuals in crisis

-        Voluntary sector support through Age UK Hospital Aftercare Service, Urgent and Emergency Social Prescribers and NHS Responders providing post-discharge medicine delivery service

 

Going into Winter 2025/26

Post Winter/Summer Period

-        Successful winter schemes embedded into business as usual

-        £7M investment in new medical SDEC and ways of working

-        Transfer of Care Hub co-located in the community setting

-        High impact work/pro-active care

-        Increased capacity virtual ward including remote tech

-        Enablement waiting lists reduced from high of 66 to record low of 9 as of 13^th August 2025

-        Impact of system flow roles

-        4 hour performance improving – 70%+

-        NCTR metric improved, metrics for 7, 14 and 21 day delays and discharges pre-5.00 p.m. all compared favourably with the region and those with lower NCTR

-        Understanding ED demand work to target and promote alternative pathways

Challenges

-        Demand still high in community and ED

-        High levels of acuity and complexity reflecting Rotherham’s ageing population and demographic

-        New ED attendance normal 300+ compared to c270s previously

-        Playing out through system flow and pressure on discharge care co-ordination and community pathways

-        Record high of 391 attendances as at 20^th October 2025

-        Escalation beds remained open over the summer

-        30 surge beds open in October

-        High levels of scrutiny

 

National Performance Metrics 2025/26

-        Reduce ambulance wait times for Cat 2 (stroke, heart attacks, sepsis and major trauma) from 35 minutes to 30

-        Eradicate ambulance handover delays – maximum 45 minutes

-        Ensure 78% of people who attend ED were admitted, transferred or discharged within 4 hours

-        Reduce number of patients waiting over 12 hours for admission or discharge

-        Reduce the number of people waiting over 24 hours in ED for mental health care

-        Tackle discharge delays initially focussing on those over 21 days (14 and 7 days).  Aim for complex discharge within 48 hours

-        Increase the number of children seen within 4 hours

 

National Learning re Vaccinations 2024/25

-        Importance of vaccination uptake to reduce attendances/staff sickness

-        Plan for peaks based on southern hemisphere and monitor actual impact with flexibility to adapt plans

-        Need to build annual leave/staff sickness into plans

-        Review IPC what has and has not worked and how connects with overarching plan

-        Consider how staff vaccination programme can be incentivised

 

National Priorities for 2025/26/Rotherham Plans

-        Improve vaccination uptake and reduce sickness

Targeted plans to increase citizen/staff vaccination rates in Primary Care, Public Health and TRFT.  TRFT aiming for 5% increase

Joint working to target areas of high foot fall for over 75s/immunosuppressed

Staffing/resources based on southern hemisphere – peak from New Year/February and national data

Staff wellbeing support and targeted rotas to cover annual leave/sickness

-        Improve access to Primary Care

High impact respiratory, diabetes and proactive care pathways including highly complex frail patients

Community-based multi-disciplinary co-located Transfer of Care Hub to reduce avoidable conveyances, admissions and discharge delays through referral, triage and allocation to community pathways

Investment in enablement to embed D2A pathway and release capacity for UCR and virtual ward

Expansion of the virtual ward including remote tech to support ‘amber’ acuity including SDEC hypertension

Community X-ray pilot for care homes

Enhanced mental health offer – safe space, crisis support, on-line/text support

-        Increase the number of people receiving urgent care in Primary, Community and Mental Health settings including UCR and virtual ward

-        Meet the 45 minute ambulance handover standard - W45 live from September

-        Improve flow through hospitals including meeting 4 hour performance and ambulance standards, reduce 12 hour and discharge waits

ACT/RMBC service re-design service improvements – releasing capacity

Additional medical, clinical staff and porters to support periods of high demand

Increased capacity for care co-ordination/timely decision making via TOCH

New single referral form to streamline processes and reduce delays

Improved process for out-of-area discharges

Extended transport hours

Reduced TTOs and Age UK TTO delivery service

-        Set local target to improve discharge times

Discharge trajectory across pathways.  Review of system flow in community bed base.  New dashboard and system escalation process

-        Reduce lengths of stay for those requiring overnight emergency admissions

Understanding demand in ED targeted action plan

Medical SDEC opened July 2025 reducing need for overnight admission, new paperless processing

Extended/consistent SDEC opening

 

Organisation Development, Communications and Engagement

-        Whole system working together to support right care, time, place and reduce pressure on individuals/teams

-        Targeted organisational development work

-        Champion roles

-        Communications and engagement plan with national, SY ICB and local plans aligned

-        Local communications informed by understanding ED demand analysis

 

Discussion ensued with the following issues raised/clarified:-

 

·        The virtual ward was currently focussed on those patients with hypertension and allowed them to be monitored at home and not brought into hospital for monitoring

·        Section 25 monies had been used to “grow” enablement

·        Ongoing high demand seen particularly as move into the winter with a lot of poorly patients in hospital. Delayed discharges were checked on a daily basis. The Out of Hospital Pathways were working but these were people who needed to be in hospital

·        There were additional appointments in practices and also through the Respiratory Infection Hub

·        The Yorkshire Ambulance Service had worked hard with the Trust to introduce a new pathway around mobile x-rays which was being piloted in care homes.  Good feedback was being received from the homes

·        W45 was a national initiative where if an ambulance had been waiting for more than 45 minutes the crew handed over the patient regardless of what the position was in ED.  A whole new process had been put in place in the acute hospital to manage that situation and had been used as a national exemplar

·        A number of schemes were in place to support the health and wellbeing of staff together with organisational development support and training around the changes being implemented

·        The Emergency Department Care Hub provided an alternative to ED.  Some patients were directed straight there from Primary Care

·        A key part of the Winter Plan was the communication plan.  Members of the public complained that they could not get an appointment; they could but may not be at the time and place they wanted.  Work was being undertaken around understanding ED demand and why people attended when they did

 

Resolved:-  That the information provided be noted.