Presentation by Claire Smith, Integrated Care Board
Minutes:
Consideration was given to a powerpoint presentation in respect of the Winter Plan, presented by the Deputy Place Director, Claire Smith. The presentation identified the plans of Place Partners to meet challenges in the system, moving into the winter. The approach involved co-ordinating response and included workshops around thinking differently to capture learning from previous years. The Plan was developed in collaboration with all Place Partners and had been agreed through the Urgent Emergency Care Board.
The presentation highlighted the following points in implementation of the Plan that will be different this year, in terms of Acute Care provision, Community Services, Primary Care, Children and Young People, Mental Health, and the wider system:
Acute
• Admission avoidance in UECC extending social work function and expanding to include Voluntary Sector
• Transport provision to be extended based on capacity/demand planning by 31st October 2022.
• Continued increased utilisation of Same Day Emergency Care (SDEC) facilities with extended opening hours and additional consultant resource through winter by 31st October 2022.
• Increased opening hours of discharge lounge. Additional capacity/orthopaedic footprint will allow continuation of electives when under operational pressure by 30th November 2022.
Community
• Implementation of Discharge to Assess (D2A) at home pathway including additional resource (nursing/therapy) and a shift of resource from Acute to Community by 30th November 2022
• Home care capacity - increase Bridging service to support D2A pathway by 30th November 2022
• Additional community short stay beds in care homes will support effective flow by 31st October 2022
Primary Care
• Primary care will run at full core capacity, with Enhanced Access and same day care provided by PCNs from 1st October 2022
• PCN offer of Enhanced Access delivery - additional clinical backfill to enable longer appointment times and discharge from hospital reviews
• Flu and Covid Vaccinations for patients delivered as a system using PCN/place footprint for delivery
Children and Young People
• Self-help support and wider public health information will be promoted
• CYPs Crisis & Intensive Community Support Team will engage to provide risk assessment/care/treatment to avoid re-presentation at UECC
• The Me in Mind Teams will work intensely with schools to support resilience and provide early intervention where children and young people are showing the early sign of emotional distress.
Mental Health
· Delivery of mental Health communications plan
· Development of safe space crisis drop in as an alternative to crisis team providing emotional and practical support to people in need.
· RDASH patient flow team expanded to ensure effective flow through system and reduce risk of OOA placements
· Crisis accommodation commissioned until March 2023
System
• Agreed approach to Winter and System Exceptionality meetings re Covid Outbreaks in Care Homes in place.
• Communications plan across Place including refresh of ‘Home First’ principles.
The presentation noted several areas that were working well:
• Place winter plan developed in collaboration with all partners, aligned to UEC priorities
• Strong relationships with agreed escalation to executive level for assurance
• Elements of plan already delivered across Place – Ibcf c.£500K identified to support discharge and flow;
• Additional transport 1xcrew daily
• Extension of social work into UECC
• Additional community beds (including covid if needed)
• Discharge to Assess pathway – resource into nursing and therapy
• Additional home care bridging service
• Virtual wards – pathways agreed and recruitment underway
• Urgent Response 2hr implemented - 9 clinical conditions met, meeting 70% national threshold with growing trajectory
The presentation also identified the key challenges associated with delivery of the Winter Plan:
• System challenges – leads to fire fighting not transformation
• Demand, complexity of patients and delayed discharges impacting on performance at times of pressure
• Maintaining an elective programme
• Risk of further bed reductions in acute - Due to cohorting flu and covid19
• Pressures on social care provision – home care market
• Workforce challenges :– Sickness, morale, and mental health. Risk of recruiting to winter resource
In the ensuing discussion, the following points were raised/clarified:
- It was felt that plans were as good as they can be for dealing with what was to come.
- All partners recognised that this was expected to be an extremely challenging winter. Plans had therefore been stress teste to the maximum degree.
- The approach across Place Partners would be characterised by close contact and flexibility, and by check and challenge on a weekly basis going into the new year.
- In support of the Winter Plan, the Trust (TRFT) was undertaking meetings three times each week to discuss discharge, assess and improve flow within the Trust.
- The continued need for prevention efforts to reduce acuity of sickness and help reduce the length of admissions.
Resolved:- That the Winter Plan be noted.