Agenda item

Claire Smith to present

Steph Watt, Deputy Place Director for Rotherham Integrated Care Board (ICB), presented an update on the Rotherham Place Winter Plan with the aid of the following PowerPoint presentation:

 

Introduction-

•         The plan was developed in collaboration with all Place partners and built on learning from previous years.

•         Approval and assurance through the Urgent Emergency Care (UEC) Board was completed in September and it was taken through the UEC Alliance, Place Leadership Board and to Health and Wellbeing Board.

•         Additional resources were prioritised, allocated and assured through the Better Care Fund which supported integrated working across health and social care.

 

Summary of Key Learning-

•         Key Themes:

?    Key pressure points were Primary Care, Urgent and Emergency Care Centre (UECC) and Discharge, including access to community services impacting on system flow.

?    Winter came early, pre-Christmas 2022, including acute respiratory infections and/or Covid.

?    The impact of industrial action and cost of living would continue to be a factor.

•         What worked well:

?    A whole system approach.

?    Strong partnership working.

?    Targeted schemes.

?    Additional senior management support at key pressure points.

?    Acute escalation framework and a command centre.

•         Challenges:

?    Short term funding schemes and/or recruitment challenges.

?    Unprecedented pressures were seen in November and December 2022, this included paediatric acute respiratory.

?    Pressure on general and acute beds.

?    Barriers to timely discharge and decision making.

?    Communication challenges in a fast-changing context.

•         Strategy:

?    National funding was for the period of 2023-2025, this enabled longer term planning.

?    Winter schemes would start before Christmas this year.

?    Target key themes would include:

-         Access to primary care.

-         Alternative pathways to UECC.

-         New ways of working and/or investment in the community.

-         Right size of general and acute bed base.

-         A review escalation framework and access to information which would provide a whole system overview.

 

 

 

The year in Primary Care-

•         The Primary Care Hub would be delivered by the GP Federation between the period of December to February, this would support acute respiratory infections and seasonal variations (national forecasts suggested a flu peak between January and February 2024).

•         Additional clinical capacity.

•         Additional reception capacity and hosted (cloud) telephony would be in place in all practices, with a call back functionality which would ensure callers would not loose their place in the queue.

•         Community teams linked to all practices.

•         All CQC registered care homes had an aligned GP practice, with specific responsibilities to provide continuity of care and avoid admission to hospital.

•         Flu and Covid Vaccinations would be delivered as a system using practice footprint, this would include residents and staff in care homes.

 

This year, alternative pathways to the Emergency Department-

•         Virtual Ward (hospital at home):

?    This would be for people who would otherwise be in an acute bed.

?    Frailty and acute respiratory pathways.

?    Utilising remote technology where appropriate to identify changes in condition.

?    Avoiding unnecessary admissions and facilitating early discharge.

•         Urgent community response (UCR):

?    A two-hour response standard, 70% of the time.

?    Nine clinical conditions.

•         Yorkshire Ambulance Service (YAS) PUSH Model:

?    Where 999 was called but did not require an emergency response.

?    Calls ‘pushed’ to Rothercare for falls with no injury and UCR for minor injuries and illnesses.

•         Same Day Emergency Care:

?    Medicine, surgery and gynae.

?    Direct access for YAS, avoiding UECC and/or admission.

 

This year, in the acute hospital-

•         Urgent and Emergency Care Centre:

?    Appointment of seven new consultants in the last year.

?    Improved nursing position.

?    Expanded dedicated social worker resource to support avoidance of unnecessary admissions.

?    Twilight shift for porters.

?    Improvement programme with YAS.

•         Increase general and acute beds:

?    Twenty-four additional beds and fifteen surge.

?    Surge plans for paediatrics, including beds and staffing.

?    Plans to protect electives and orthopaedics from bedding and/or outliers.

 

•         Cancer:

?    New senior role to oversee cancer and elective care.

?    Additional MRI scanner that had improved MRI waiting times.

?    Breast pain pathway to filter non two- week wait, patients to the right clinic and improved capacity.

 

This year, discharge-

•         Medical and pharmacy resource in ‘community ready’ (discharge) lounge.

•         Additional patient transport shifts.

•         Additional nursing, therapy, reablement and social worker resource to support discharge/patients at home.

•         Home from hospital home care service commissioned to provide additional hours.

•         Fund to support additional community beds, focussing on complexity.

•         fifteen residential surge beds at Lord Hardy Court.

•         Out of area trusted assessment pilot.

•         Care home trusted assessment pilot.

•         Integrated working with the voluntary and community sector.

?    Re-prioritisation of the Age UK hospital after care service.

?    Urgent and emergency social prescribing pilot.

?    Personal health budget pilot with the You Asked We Responded Community Group.

 

This year, in Mental Health-

•         There had been an increase in the mental health workforce within Primary Care with the introduction of the Mental Health Additional Roles Re-imbursement Scheme (ARRS), psychology post and community connectors.

•         Joint working between Well@work and Rotherhive, to support employers and employees.

•         The rollout of more mental health awareness training.

•         The expansion of the Rotherham Safe Space, to four nights a week.

•         The launch of a new service to support people who had attempted suicide.

•         Support would be available from the following:

?    RDaSH /Samaritan Wellbeing Check Pathway.

?    Peer support groups, such as Andy’s Man Club, S62, Parent Carers Forum, Survivors of Bereavement by Suicide, Women Acceptance, Support, Kindness mental health support group (ASK).

?    A range of community mental health initiatives funded by the Black Asian Minority Ethnic (BAME) Crisis and mental health grant schemes.

•         Mental health digital resources including Rotherhive and Kooth and Qwell.

 

This year, for children and young people-

•         Self-help support and wider public health information would be promoted.

•         CYPS Crisis and Intensive Community Support Team would engage to provide risk assessment, care and/or treatment to avoid re-presentation at UECC.

•         The Me in Mind Teams would work intensely with schools to support resilience and provide early intervention where children and young people are showing the early sign of emotional distress.

 

This year, for improved cross system communication and decision making-

•         Community transfer of the care hub:

?    Multi-disciplinary team for referral, triage and assessment of step up and step-down patients.

?    For admission avoidance and discharge, the service would ensure the right level of care according to need.

?    24-hour response service and/or core offer, seven days a week.

?    This would include nursing, therapy, social workers, reablement co-ordinators, wellbeing and call handlers, pharmacy technician and the voluntary and community sector.

•         New escalation framework:

?    New Place escalation wheel that would provide a holistic view of the whole system flow for the first time.

?    Aligned to national operational pressures escalation levels (OPEL), action cards for each level.

?    This would feed into team, organisation, Place, South Yorkshire, regional and national framework.

?    South Yorkshire ICB and Place communications plan.

?    New operational and performance reports.

•         South Yorkshire ICB and Place winter communication campaign.

•         Support with the Cost of Living, with promotion of support schemes.

 

Next steps-

•         Place workshop to scenario test plans.

•         Would continue to plan for industrial action.

•         Would complete outstanding recruitment.

•         Would launch schemes.

 

Discussion ensued on the presentation with the following issues raised/clarified:

 

•       It was noted that last year Covid levels were exceptional; this year Rotherham was in a better position to cope with potential surges, this was due to increasing resources and working in different ways. The NHS in Rotherham was part of a wider South Yorkshire system, therefore, wider assurance was required that other areas of the NHS in South Yorkshire were in a good position.

•       NHS partners in Rotherham had fifty additional doctors compared to levels in 2019.

•       The NHS hospital site in Doncaster required a re-build.

•       There were new guidelines in place relating to emergency treatment for young people, an example was provided that the trust had worked to ensure that all children with significant health concerns could access the hospital. Assurance was provided that the relevant guidelines were in place and would be published and circulated in due course.

 

Resolved:- That the Health and Wellbeing Board:

1)    Noted the update on the Winter Plan.