Agenda item

Please be advised that this agenda item only includes selected appendices from the Winter Plan. 

The Winter Plan with all appendices can be viewed in the agenda for Health and Wellbeing Board on 27^th September 2018 accessible via this link:

https://cds.bromley.gov.uk/ieListDocuments.aspx?CId=617&MId=6344&Ver=4

The Sub-Committee considered a report providing an update on the development of a Bromley System Winter Plan from Mark Cheung, Programme Director: Integrated Care Services and Clive Moss, Urgent Care Lead, Bromley Clinical Commissioning Group, and Mark Davison, Interim Head of Programme Design (ECHS).

The Bromley System Winter Plan had been developed to provide a framework for health and social care partners within the Bromley system to manage surge and capacity issues at both technical and strategic levels within the local health and social care system during Winter 2018.  A number of objectives had been identified within the Plan which comprised establishing a shared understanding of surge and escalation criteria used across health and social care services, defining a flexible framework for response and defining procedures and processes about escalation in the event of an actual or potential surge and capacity issues.  During surge and escalation issues, the Plan also specified frameworks for informing, coordinating and supporting the health and social care services response to incidents and to actively engage with the public, as well as to provide a mechanism by which issues for joint resolution by partners could be escalated at both a tactical and strategic level.  Winter Resilience Schemes focused on three joint strategic themes which comprised increasing capacity in the work force as well as in service provision, and the integration of services to prevent the need for hospital-based care and streamline discharge processes.  Further Winter System planning had taken place across a wide range of areas including infection control, processes for hospital repatriations, improving ambulance handover workstreams, minor breach reduction work planning and out-of-hospital Borough-based service mapping.  The Bromley System Winter Plan 2018/19 had been considered at the meeting of Health and Wellbeing Board on 27^th September 2018, at which Board Members had resolved to agree the Plan.

In considering the report, the Chairman was pleased to see the move towards increased collaborative working by health and social care partners and underlined the importance of highlighting the contribution of pharmacies to winter planning and service delivery, such as through the flu vaccination service.  Another Member emphasised that the role of domiciliary care provision within winter planning should be realistic in terms of what could be delivered, and the Interim Head of Programme Design (ECHS) outlined work currently underway with providers, key partners and service users to co-design a new model of domiciliary care provision in Bromley that was able to meet the changing needs of service users and be more responsive to service pressures including increased seasonal demand.  A Member queried how performance during Winter 2017/18 had not met national standards, and the Urgent Care Lead explained that this measure related to the operational standard of 95% of patients attending Emergency Departments being seen within four hours and that a number of additional measures had been introduced for Winter 2018/19 to improve performance in this area.  Another Member noted the increasing demand for General Practitioner home visits during winter and suggested the potential for a similar scheme making use of highly qualified Nurse Practitioners.

Members generally discussed the additional pressures on the health and social care system from older and frail people during the winter months, and the Urgent Care Lead advised that falls and viral infections such as flu were more prevalent in winter and were likely to exacerbate existing conditions affecting older and frail people.  A short information briefing outlining key health messages for Bromley residents would be provided to Members following the meeting.  In response to a question from a Member, the Urgent Care Lead confirmed that the use of escalation stages was helpful in identifying the seriousness of system pressures and that further information on escalation in system pressures during Winter 2017/18 would be provided to Members following the meeting.  The Chairman noted that the Health Scrutiny Sub-Committee had responsibility for scrutinising the provision of health services in Bromley, and requested that Members be made aware of any situations being managed through the Bromley System Winter Plan that were identified as being exceptional.  The Chairman also suggested that consideration be given to inviting the Portfolio Holder of Adult Care and Health Services to join Bromley A&E Delivery Board.

The Chairman led Members in thanking Mark Cheung, Clive Moss and Mark Davison for the excellent Bromley System Winter Plan which provided a comprehensive framework for managing winter pressures.

RESOLVED that the update be noted.