Agenda item

 

To receive a presentation setting out the Rotherham Place Partners Winter Plan for 2025-26.

 

 

The Chair welcomed Steph Watt, Portfolio Lead for Transformation and Delivery in Urgent and Community Care, SYICB, Jodie Roberts, Director of Operations and Bob Kirton, Managing Director, TRFT and Scott Matthewman, deputising for Emily Parry-Harries, Director of Public Health, RMBC to the meeting and invited Steph Watt to introduce the Place Partners Winter Plan presentation.

 

The Portfolio Lead for Transformation and Delivery began by emphasising that the Winter Plan was not only a national requirement but also a priority locally, reflecting Rotherham’s long-standing commitment to robust winter planning. They explained that the plan had been developed collaboratively with all place partners including the Council, Primary Care Networks, The Rotherham NHS Foundation Trust (TRFT), Rotherham, Doncaster and South Humber NHS Trust (RDaSH), and Voluntary Action Rotherham.

 

The plan had undergone rigorous assurance processes and was formally signed off by the TRFT Board, the Place Board, and the South Yorkshire Integrated Care Board (SYICB). The plan had also been stress-tested through scenario planning at both regional and local levels and aligned with national urgent and emergency care standards, particularly the four-hour emergency department target, ambulance response times, and discharge delays.

 

The Portfolio Lead for Transformation and Delivery reflected on last year’s approach, which had focused on expanding out-of-hospital pathways. Additional funding from the Better Care Fund and Section 75 agreements, alongside organisational investment, had supported several schemes. Learning from these initiatives had informed this year’s plan, recognising that post-COVID demand remained consistently high throughout the year, with winter pressures exacerbated by flu and other infectious diseases.

 

They outlined significant developments over the past year, including the creation of a new medical Same Day Emergency Care (SDEC) unit, which had utilised £7 million national funding, and the establishment of a Transfer of Care Hub (ToCH). This hub brought together a multi-disciplinary team comprising Yorkshire Ambulance Service, health professionals, social care staff, and voluntary sector representatives. Its purpose was to co-locate specialists to manage referrals from both acute hospital and community settings, enabling real time decision making to avoid unnecessary admissions and ensure only those requiring hospital care were conveyed. They highlighted the benefits of co-location, which allowed immediate professional consultation and faster resolution of complex cases, particularly as patient acuity and complexity continued to rise.

 

Members heard that high impact activities had targeted frequent attenders with respiratory conditions, diabetes, and frailty. Capacity on the Virtual Ward had been increased to support admission avoidance and discharge for high-acuity patients who would otherwise require hospital care. Led by nurse consultants and urgent care specialists, the Virtual Ward now included new pathways for heart failure, alongside existing frailty and respiratory pathways. Remote monitoring technology had also been introduced, enabling clinicians to observe patients at home using wearable devices, a development being tested with potential for future expansion.

 

The Portfolio Lead for Transformation and Delivery reported that service redesign within social care, particularly in enablement services, had significantly reduced waiting lists from a peak of 66 last winter to just nine in August, creating additional capacity. New targeted roles had been introduced, including a matron in the acute setting and a system flow coordinator to manage complex discharges. These changes had contributed to improved four-hour emergency department performance, which had risen steadily to over 70% since the end of last winter. Discharge metrics, including timely discharges and reductions in long-stay patients, compared favourably with regional benchmarks.

 

They described ongoing work to understand emergency department demand, supported by Healthwatch, which had conducted interviews during peak periods. Deep-dive data analysis was underway, with an action plan in development to address overrepresented and underrepresented groups.

 

They acknowledged persistent challenges, including sustained high demand, changing population expectations, and increased emergency department attendances which were regularly exceeding 300 compared to the previous modelled figure of 270. These pressures were impacting system flow and discharge pathways, with escalation beds remaining open year-round and 30 surge beds were activated in October. She confirmed that governance processes were in place to monitor and assure performance, reporting through regional and national structures.

 

In response to early and severe flu prevalence, planned activities had been accelerated. The Acute Respiratory Infection (ARI) Hub, providing additional primary care appointments, had opened early, and all Trust schemes were operational from the start of November. National priorities included improving vaccination uptake and reducing workforce sickness. The Portfolio Lead for Transformation and Delivery described coordinated efforts led by Public Health, primary care, the Trust, and the Council, including innovative approaches such as ward-based staff vaccinations, weekend clinics, and targeted outreach for vulnerable groups.

 

Other initiatives included:

 

·       Enhanced primary care access through additional GP appointments and the respiratory hub.

·       Proactive care pathways led by Primary Care Networks (PCNs), using risk stratification and multi-disciplinary reviews for those most at risk of admission.

·       A community geriatrician-led complex care pathway, combining clinical review with person-centred planning and medication checks.

·       Collaboration with Yorkshire Ambulance Service to reduce avoidable conveyances, including a care home pathway and the community X-raypilot, which enabled on-site imaging in care homes to prevent unnecessary hospital transfers.

 

They highlighted improvements in hospital flow through multi-agency events such as ‘Every Minute Matters’, which identified and addressed discharge delays. Community flow was also under review, with targeted actions based on delay metrics. Assurance processes included thrice-daily Trust discharge meetings and thrice-weekly place escalation meetings, which escalated to daily during peak pressures and involved executive-level representation.

 

Examples of new roles were shared, including Flow Capacity Managers coordinating complex cases across agencies and Care Home Trusted Assessors, who facilitated safe and timely discharges by liaising directly with care homes and families. Organisational development work supported these changes, with champion roles promoting new ways of working.

 

A comprehensive communications and engagement strategy underpinned the plan, aligned with national, regional, and local messaging.  The Portfolio Lead for Transformation and Delivery concluded by outlining governance arrangements, winter resilience testing, and key risks, which included sustained demand, staff wellbeing, sickness absence, and industrial action. They reassured the Commission that robust, tested contingency plans were in place and continuously reviewed.

 

The Chair thanked the Portfolio Lead for Transformation and Delivery for the comprehensive presentation and invited questions and comments from Members.

 

Councillor Brent highlighted the complexity of the report and the heavy use of abbreviations and acronyms. They explained that as a lay person their understanding had been limited by unfamiliar terminology used. They suggested that future reports should either include a glossary or define acronyms at first use.

 

Officers acknowledged this concern and agreed to provide that explanatory detail in future reports and presentations. The Chair also advised that a Health Select Commission glossary had been produced previously and would be re-circulated to all members.

 

Councillor Tarmey asked how recent changes to the GP contract might affect emergency department demand during winter, questioning whether it would improve, remain static, or increase pressures.

 

The Deputy Director of Place for Rotherham, SYICB, Claire Smith responded that while national challenges existed, Rotherham GPs were highly engaged with health and ICB colleagues. They noted that all practices remained open until 6:30 pm and that online access was being monitored. Overall, minimal impact was anticipated. The Managing Director, TRFT reinforced this point, citing strong local relationships and described that GP clinical directors had visited the Urgent and Emergency Care Centre (UECC) and the new Same Day Emergency Care Centre (SDEC) to understand how they could work together to improve patient care. They explained that these visits had included discussions about out-of-hours care and integration with urgent pathways.

 

Councillor Tarmey queried whether recent rounds of industrial action had had a significant impact locally. The Managing Director, TRFT confirmed that Rotherham had experienced similar patterns to the national picture, with approximately 50% of resident doctors participating in strikes.  This was lower than previous periods. The Portfolio Lead for Transformation and Delivery explained that senior doctors largely continued working, which allowed the Trust to maintain most elective activity and deliver 90% of planned procedures. However, they stressed that this did not diminish the level of planning and disruption required to maintain safe care.

 

Councillor Harper raised concerns about ambulance wait times and handover delays, referencing national targets of 30 minutes for Category 2 response and 45 minutes for handovers. They asked whether these targets were realistic and how they interacted, noting that delays in handover could prevent ambulances from responding to urgent calls.

 

The Managing Director, TRFT explained that the 30-minute target for Category 2 calls was a national standard, whilst the 15-minute handover target had long been unachievable nationally. The new 45-minute threshold aimed to drive improvement.  They described that Rotherham had excelled, achieving an average handover time of 14 minutes, better than the national ask of 15 minutes and ranking as the best performer in Yorkshire and Humber. They attributed this success to a whole hospital approach and system wide co-ordination, noting that only six ambulances had breached the 45-minute threshold so far in 2025, compared to much higher figures elsewhere.

 

Councillor Harper asked whether the impact of early flu peaks would affect performance in that area.

 

The Portfolio Lead for Transformation and Delivery acknowledged that performance might deteriorate slightly during peak periods due to infection control constraints but noted that early preparation and robust measures were in place. They added that the expected flu peak in mid-December, rather than post-Christmas, might actually be beneficial for planning.

 

Councillor Harper also queried the reference to “Southern Hemisphere” in planning assumptions.

 

The Portfolio Lead for Transformation and Delivery explained that flu predictions and vaccine development were based on patterns observed in countries such as Australia and New Zealand, which had experienced a severe season. They confirmed that early indications suggested the current vaccine strain was well-matched, which should mitigate severity.

 

Councillor Harrison asked how scenario testing and escalation processes would be monitored during winter.

 

The Managing Director, TRFT described regular scenario exercises within the Trust and across the wider place, supported by dynamic bed management and robust governance through the Urgent and Emergency Care Delivery Group. They emphasised the importance of cultural alignment and multi-agency collaboration during high-pressure periods. They also noted that cyber security risks were now a major concern, perhaps more so than traditional winter pressures.

 

Councillor Harrison wanted to understand which risks were rated highest and what mitigations were in place.

 

The Portfolio Lead for Transformation and Delivery and the Operations Director, TRFT identified demand, staffing, and industrial action as the key risks, with scenario plans covering illness, holiday periods, and vaccination uptake. Admission avoidance pathways had been embedded ahead of winter to minimise disruption, and staffing plans accounted for seasonal leave and sickness.

 

Councillor Clarke sought assurance on capacity within community pathways and enablement services to prevent discharge delays, and asked how the Transfer of Care Hub would improve flow.

 

The Portfolio Lead for Transformation and Delivery explained that the hub provided real time co-ordination across services, prioritising home based care where safe and appropriate, supported by a tiered approach from voluntary sector ‘settling in’ services to high-acuity virtual wards. They gave an example of Age UK’s hospital aftercare service, which could bridge short term gaps by supporting patients between discharge and the start of formal care packages. Where home pathways lacked capacity, commissioned beds were used as alternatives. The hub ensured accountability for individual cases and facilitated rapid escalation to the correct pathway.

 

Councillor Clarke asked about delays caused by hospital dispensing, which they noted they had raised previously with the Trust via the Health Select Commission.

 

The Managing Director TRFT acknowledged past challenges but reported improvements, including a pharmacist embedded in the discharge lounge, extended weekend hours, and Age UK support for medication delivery to patient homes following discharge. They added that electronic referral systems had also been streamlined to replace multiple forms with a single, dynamic form covering all pathways, reducing duplication and improving information quality.

 

Councillor Harper asked a question concerning staff vaccinations, noting changes to COVID eligibility.

 

The Managing Director, TRFT confirmed that COVID vaccinations were no longer provided by the Trust and were now accessed via GPs for those who qualified, but flu vaccination uptake among staff had reached a record 56%, supported by ward-based delivery and outreach to ambulance and GP federation staff. They emphasised that flu posed a greater risk than COVID in terms of hospitalisation, with current COVID-related admissions averaging one patient per week compared to much higher flu-related admissions.

 

Councillor Harper queried the rationale for moving to a single referral form and the impact that this had realised.

 

The Portfolio Lead for Transformation and Delivery explained that while a single form had existed for acute discharges, it had been redesigned as an electronic system with conditional drop-down menus, simplifying completion and improving data quality. This change reduced duplication and ensured individuals only needed to share their information once, improving continuity across organisational boundaries.

 

Councillor Clarke posed a broader public health question, citing research from a national care home chain showing that changing meal timings had significantly reduced slips and trips. They asked whether similar principles could inform community nutrition initiatives, such as reintroducing Meals on Wheels.

 

The Assistant Director of Strategic Commissioning acknowledged the importance of person-centred planning and close collaboration with independent providers.  The Portfolio Lead for Transformation and Delivery  expressed interest in reviewing the evidence and sharing best practice regarding the findings Councillor Clarke had referred to through care home and home care forums.

 

Resolved:-

 

That the Health Select Commission:

 

1.    Noted the contents of the Rotherham Place Partner’s Winter Plan 2025-26.

 

2.    Requested that when presenting the 2026-27 Winter Plan, elements of success from previous years, or elements implemented and deemed unsuccessful from 2025/26 or otherwise not replicated be highlighted and information provided regarding the rationale for those decisions.

 

3.    Requested that where risks were presented in the context of the Winter Plan, the associated grading was detailed to clearly illustrate the greatest areas of concern to Health Select Commission members.

 

4.    Requested that when referring to acronyms or abbreviations connected with technical health issues, report authors include the full term on first use or provide a glossary to aid members’ understanding.

 

5.    Requested that Councillor Clarke liaise with the Portfolio Lead for Transformation and Delivery at the ICB to support the sharing of best practise in relation to the impact or mealtime variation on trips and falls.