Agenda item

Chris Edwards, Executive Place Director, NHS SYICB, to present

Chris Edwards, Executive Place Director NHS SYICB, introduced the 2024-25 Winter Plan in the absence of Claire Smith.  Fran Costello, Emergency Care Programmer, presented the following powerpoint presentation:-

 

What worked well last winter

-        Better Care Fund discharged monies including £500k investment schemes plus organisational investments

-        2,407 additional appointments in Primary Care including ARI hub.  1,856 attendees/77%

-        Positive working with Yorkshire Ambulance Service including community in-reach and 3 PUSH pathways and on scene referral to the Community Respiratory Exacerbation Service

-        Acute front door, extended SDEC hours, flexible shifts to support cover, overnight portering

-        B5 converted to nurse-led discharge ward

-        Community read unit with dedicated support for TTOs

-        Introduction of Therapy Discharge to Assess model with 403 patients supported October-April

-        Closer working between IDT and community teams through the Transfer of Care Hub for admission avoidance and discharge

-        Virtual ward frailty/respiratory step up and step down pathways for those who would otherwise be in an acute bed.  Aligned with urgent community response for greater flexibility of resource

-        Additional community resource Home from Hospital 20 hours per day 7 a.m.-11 p.m. 7 days a week November-March.  259 shifts/1,810 hours enablement resource released through service improvement.  Additional therapy locum/community nurse resource

-        Cohorted community beds onspot purchase basis with improved bed management

-        3 voluntary community sector pathways with 88% and 72% patient wellbeing ratings for social prescribing and personal health budgets respectively

-        Reduced mental health out of area placement (0 at start of the year)

 

Challenges

-        High incidences of acute respiratory infections/flu peaked in January, alongside diarrhoea and vomiting (impacting on acute beds and care home closures).  Covid not a significant factor last year (end of testing)

-        Increased demand for Primary Care appointments

-        Unprecedented growth in attendances at UECC (reflecting national trend)

-        Additional escalation beds opened resulted in SDEC/B5 being bedded creating pressure on ED plus increased demand on discharge team and community discharge pathways

-        Increased complexity, acuity, end of life and out of area placements

-        Workforce challenges across health, social care and independent providers

-        Impact of workforce/cost of living pressures in care homes, reducing the options for managing surge

-        Placement of mental health patients out of area

 

External Challenges

-        Industrial action impacting on planning time/staffing and recovery lag with over 20 incidences in 2023-24

-        Potential impact of GP collective action 2024-25

-        Re-introduction of 4 hour standard – significant change to working practice

-        Increased admissions to Rotherham hospital from out of area residents

 

Summary of Key Plans 2024-25

Area	Impact
Investment Better Care Fund to support Acute Respiratory Infection hub for more Primary Care appointments, additional support to care for people at home, additional winter beds with therapy support, social care resource to support discharge and extended hours for discharge transport and community ready lounge plus an increase in voluntary service bursaries to support discharge	Targeted additional support to known system pressure points to reduce discharge delays and improve flow through the system
Primary Care Enhanced access to Primary Care Vaccination Programme	Improve access to treatment, support for vulnerable patients, reduce avoidable attendances at ED
Alternative Pathways to Ed Introduce heart failure virtual ward pathway and remote tech     Support for care homes through re-launch of falls and deterioration pathway, pilot smart lights for falls detection and trusted assessor roles	Supporting more people at home to reduce admissions promote early discharge   Reduced avoidable conveyances, less risk to residents, reduced demand
Acute Care Six transformation workstreams including working with Yorkshire Ambulance Service to reduce avoidable conveyances/access to SDEC; ambulatory care, internal pathways; patient flow; workforce and digital Increased medical cover in ED and use of SDECs Additional escalation beds.  Increased portering at peak times	Improve patient experience and patient flow enabling those requiring acute care to be seen in a timely way
Discharge Develop and embed Transfer of Care Hub/Discharge to Assess Model.  Increase enablement capacity Spot purchase additional community winter bed capacity according to demand Increase patient transport	More accurate assessment of need as people are assessed in own home, reduced risk to patient through more timely discharge Increase resource in discharge pathways to manage peaks in demand
Children’s Services Vulnerable children and family oversight and assurance including fortnightly place meetings.  Transformation and business continuity plans for all portfolios.  Identified resource to be re-allocated to manage peaks	Improve support for individuals and families.  Re-allocation of resource to manage peaks
Mental Health Additional roles to support high intensity needs and housing officer, short stay crisis beds and on-line support for advice and information Relaunch of safe space	Improve in-patient experience and patient flow.  Improved patient experience and reduced length of stay.  Support for most vulnerable

 

Winter Vaccinations

-        Why is it important to vaccinate

·        During winter high number of patients attend ED and Primary Care for general coughs and colds and vulnerable groups are at high risk of admission for flu/Covid placing additional pressure on the system

·        It is essential that we provide the opportunity for patients to be vaccinated to ensure patients are protected and prevent avoidable hospital admissions and additional demands on the system

·        In addition, front line health and social care staff are at risk of catching flu and Covid with the risk of staff shortages due to high sickness rates and the impact on service provision

·        The ICB has responsibility for overseeing the vaccination programme and at a Place level need to be assured that provider organisations had plans in place to deliver flu and Covid vaccine programmes for eligible patients and staff

-        What is the Rotherham Plan

·        All PCNs and Practices signed up to the Covid and Flu Programme

·        Working closely with ICB Communications Team to promote vaccinations

·        Proposed pop-ups at Breathing Space to increase respiratory patient uptake and Riverside House for RMBC front line health and care staff

·        Discussions taking place across the Rotherham system to address other at risk groups

-        Risks

·        Last year there was a reduction in patient uptake nationally

·        Work to do to raise the importance of vaccinations across all cohorts with particular emphasis on respiratory patents, MI, Immunosuppressed and LD and eligible staff across health and care

 

Winter Vaccination Programme

-        Covid/Flu (annual vaccine)

·        You can get both the NHS flu and Covid-19 vaccines if you are aged 65 or over (including those who will be 65 by 31^st March 2025)

Have certain health conditions

Are pregnant

Live in a care home for older adult

-        Flu only (annual vaccine)

·        Children aged 2 or 3 years

·        School-aged children (Reception to Year 11)

·        Children aged 6 months to 17 years with certain long-term health conditions

-        Pneumococcal (one-off vaccine not administered annually)

·        If you are aged 65 or over

·        Babies at 12 weeks and a booster at 1 year

-        RSV (currently a one-off vaccine not administered annually but this was being reviewed)

·          If you are pregnant or aged 75-79.  If you turned 80 on or after 1^st September 2024 you were also eligible for the vaccine until 31^st August 2025

-        Pertussis (one-off vaccine not administered annually)

·          Administered all year round but GPs have been asked to invite all pregnant women who have not had a vaccine due to recent outbreaks and decline in uptake nationally

 

Cost of Living Support

-        Warm Welcome Campaign

·        RMBC works together with partner organisations across Rotherham to ensure a Warm Welcome for residents across a range of spaces across the Borough.  Warm Welcome spaces provide an opportunity for people to come together, share and use resources, with many spaces, such as the libraries, putting on additional activity sessions through the winter.  A list of warm spaces was available at Warm Welcome Campaign

-        Money Matters

·          There was a range of local help and national support available which was accessible by the RMBC website Money matters-Rotherham Metropolitan Borough Council

-        Open Arms – Community Support Hubs

·          In February 2023 the delivery of a new community-based support project – Open Arms – began

·          RotherFed, Citizens Advice, Laser Credit Union and Voluntary Action Rotherham have partnered to develop and deliver a co-ordinated response to support communities most affected by the cost of living crisis

·          This project would deploy the Community Engagement Team and advisers to deliver information, advice and guidance ‘one stop shops’ across 10 areas

·          The support delivered would have a strong focus on financial and social inclusion, empower communities with a foundation of support and make better use of community assets

·          Each hub has a drop-in session in each location throughout the day every fortnight and would be there for local people when they needed it.  Open Arms – Community Support Hubs – Rotherham Federation

 

Discussion ensued with the following issues raised/clarified:-

 

-        There was a massive amount of work behind the Winter Plan which should not be underestimated

 

-        Things would happen every year that were not in the Plan but the escalation process across organisations had been tightened up

 

-        Even if the Plan was working smoothly, if there were issues in Barnsley, Doncaster or Sheffield, Rotherham would have to offer mutual aide  where appropriate which could then result in knock-on effects

 

-        Learning from previous Plans had resulted in work on the transfer from hospital into the community, targeted work with care homes and  offering specific support/different options to minimise the impact on the person and wraparound services

 

Chris was thanked for his presentation.

 

Resolved:-  That the presentation be noted.