Agenda item

Report CSD19175

The Board considered a report providing an overview on the development of the Bromley System Winter Plan 2019/20, which was presented as part of the local scrutiny and assurance process. The Winter Plan built on the ongoing One Bromley Urgent and Emergency Care programme, which was designed to deliver the One Bromley vision of developing an integrated urgent and emergency care system.

Over previous winters, the London Borough of Bromley (LBB), NHS Bromley Clinical Commissioning Group (Bromley CCG) and King’s College Hospital – Princess Royal University Hospital (KCH PRUH) had made financial investment to provide additional capacity to the system during winter months, to ensure patients are seen in the appropriate care setting. This included schemes to support patients, clients and healthcare professionals in secondary, community and primary health and social care.

The plan was developed through the Bromley A&E Delivery Board, which delivered a whole systems approach to planning, improved performance and the development of a coherent local service framework for urgent and emergency care.

For the first time, Bromley’s voluntary sector had been asked to contribute to the Winter Plan, including their hospital aftercare and community services. The Bromley CCG and LBB were currently engaged with trialling a project looking to provide healthcare services to Bromley’s Homeless Shelter over the winter period.

The Bromley CCG and LBB would be providing flu vaccinations to their frontline staff, and Bromley Well staff that had contact with clients. Targeted leaflets would be delivered to 100,000 homes this year, providing details on the flu vaccination programme and GP hubs. It was noted that additional slots for the flu vaccinations had been allocated for Fire Brigade and Police officers.

The Winter Plan was a sizeable document which contained system escalation protocols for managing surges; winter scheme spend; and further winter planning including infection control / flu plans, minor breach reduction plans, improving ambulance handover plans, borough-based and South East London contact lists and provider assurances of managing demand and capacity.

The winter schemes spend had been based on learning from the previous year, and stakeholders had agreed that increasing capacity in existing services, whilst strengthening the community reactive / urgent response offer would be an effective use of resources for this winter. The Managing Director – Bromley CCG advised the Board that a strategic approach had been taken, with all schemes fitting into three themes:

-  Avoiding unnecessary hospital attendances

-  Maintaining hospital flow

-  Reduction in delayed discharges through integrated working.

Examples of schemes included a clinical triage system within the Bromley Healthcare Care Coordination Centre and additional GP hub appointments. A new hub was also planned in, or near to, the PRUH and additional Healthcare Assistant capacity to maintain patient flow. In response to a question, the Urgent Care Lead said that during previous winters, once a patient had presented themselves at the Urgent Care Centre (UCC), they were reluctant to be redirected to the GP hubs. To address this, the new hub would be moved closer to the UCC, and would have weekday evening and weekend appointments. Consideration would be given as how this would be best communicated. It was planned for leaflets and cards providing information on the hubs to be made available at the UCC reception, and patients would be redirected by its staff. The Managing Director – Bromley CCG advised the Board that patients could also use the NHS 111 system as a single point of access to be booked into the GP hubs, out of hours service or UCC, based on the information given. Details of the service would be included on the website and in leaflets, which would be distributed from the following week. It was agreed that the Urgent Care Lead would provide a copy of the patient leaflet to the Healthwatch Bromley representative and the LBB Head of Service for Early Intervention and Family Support, for them to communicate the details to their service users via various platforms.

In relation to the availability of GP appointments, the Managing Director – Bromley CCG informed the Board that those patients using the triage system had found it easier to get an appointment. The issue was the need to increase capacity. The GP hubs would allow appointment hours to be extended into evenings and weekends, and the disproportionate number of patients being seen by a GP could be reduced by utilising other healthcare professionals. In response to a question, the Managing Director – Bromley CCG advised that figures relating to the number of GP vacancies in the borough could be provided to Board Members following the meeting. A Member noted that the inability to get appointments was often impacted by patients wanting to see a named GP, which often meant there was a longer waiting time due to split shifts and part time working. It was felt that work was required to educated patients on the various ways that healthcare could be accessed. This was echoed by the Healthwatch Bromley representative who said that they found people were not aware of the hubs, and GP’s were not signposting their patients to them. For patients to be empowered, they needed to be better informed.

A Member suggested that an additional column be added to the appendix tables in the report, to state if each scheme was fully staffed or highlight any staffing difficulties. In response to a question, the Urgent Care Lead advised the Board that he was not aware of any schemes being delayed due to staffing issues, but he would check and confirm this following the meeting.

In respect of Telehealth monitoring, the Urgent Care Lead informed the Board that this was to be a very small scale pilot over a period of six to twelve months. It would involve a wearable armband being used to monitor patients’ vital signs, producing a live feed with alerts if a follow up call or visit was required by the Rapid Response team. The Chairman invited the Urgent Care Lead to present an update report on the pilot to the spring meeting of the Health and Wellbeing Board.

RESOLVED that the update be noted.