To follow

The Sub-Committee considered a report providing an update on the development of the 2019/20 Bromley System Winter Plan from Clive Moss, Urgent Care Lead, Bromley Clinical Commissioning Group (“Urgent Care Lead”).

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 the past few winters, the local health and social care system had felt increased pressure during the winter months, with most services seeing a surge of activity and demand, with a more complex range of patient needs. Additional challenges had included seasonal presentations of influenza and norovirus. These additional pressures on the health and social care system affected all age groups, but were primarily from older and frail people. Bromley health and social care system leaders had developed a plan to manage safely and effectively the additional pressures during this period.

The plan was developed through the Bromley A&E Delivery Board, which delivered a whole system approach to planning, improved performance and the development of a coherent local service framework for urgent and emergency care. The plan contained within it 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 list and provider assurances of managing demand and capacity). The A&E Delivery Board was responsible for the oversight and management of the plan, which would be a live document throughout winter to ensure that all information was kept as up to date as possible.

The focus for this year was to provide schemes that built on the lessons learned from previous year, and there were three joint strategic themes: avoiding unnecessary hospital attendances; maintaining hospital flow; and a reduction in the delayed discharges through integrated working.

A Member noted that the handyman service was a fantastic year-round offer, and asked for more information on the twelve dedicated Extra Care Housing Assessment Flats. The Urgent Care Lead said that these flats were located in different warden based housing units across the borough. Three of these flats were dedicated to Discharge to Assess (D2A) step down beds. The Managing Director, Bromley Clinical Commissioning Group advised that these step down beds were available within twenty four hours to those needing extra rehabilitation. Occupants would live in the flats on their own, but may have packages of help which came in, and took place in a controlled environment.

A Member highlighted that there was a need to maintain patient flow at the hospital at all times. The Urgent Care Lead said that a new pilot had been trialled at another UCC over the winter, with a floor co-ordinator role being implemented. This role covered the evenings and weekends when there was not a service manager scheduled to work, and supported patient flow. The aim was for it to have a positive impact on waiting time management by ensuring that patients were seen in a timely manner. So far, this had only taken place at the Queen Elizabeth Hospital, Woolwich, but it would be rolled out at the PRUH.

In response to a question, the Urgent Care Lead said that the total budget for the CCG winter schemes was £646k. The estimated cost of the proposed schemes was now up to just over £600k, but costs could still increase further. It was noted that the CCG and LBB winter resilience funding was part of the agreed Bromley Better Care Fund, and King’s winter resilience funding was part of their contracted baseline.

A Member asked for an update in relation to the flu immunisation campaign. The Urgent Care Lead said that the public campaign was on track, and the same patient advertisements and displays would be used as in previous years. There would be an increased push for staff to take up the offer of a flu jab, and for the first time they would be offered to Local Authority staff. Take up of the immunisation would be monitored through the data received.

A Member noted that some of the Key Performance Indicators (KPI) provided in the appendices to the report were blank, and enquired if quantitative information would be put against the schemes. The Urgent Care Lead said that for some schemes, data was not available, however KPI’s for similar services that were evaluated last year could be provided to the clerk and circulated to Members following the meeting.

In response to a question from the Chairman, the Urgent Care Lead said that severe weather protocols were incorporated in the system plan, and that there was shared oversight with the Delivery Board.

The Chairman welcomed Christopher Evans, the newly appointed Chief Executive of Community Links Bromley to the meeting.

Mr Evans noted that the plan was developed through the Bromley A&E Delivery Board, which worked in partnership with a range of providers including the Bromley Third Sector Enterprise. The commitment to increasing capacity in existing services, especially at a time of difficult financial constraints, and the strengthening of the community reactive urgent response offer were welcomed.

However, the report was silent on the important and potentially developing role that the wider voluntary and community sector (VCS) could play in addressing some of the issues that they were seeking to address. Many of the current VCS services in Bromley were already in the front line of the preventative work to address winter pressures. The Night Shelter support to rough sleepers and the homeless in Bromley was illustrative of this. Other initiatives had included a Citizens Advice provision of free information and advice to ease financial worries and minimise fuel poverty enabling people to feel warm and well. The volunteer Snow Friends were another example of where the mobilisation of the community could play an important role. Small groups such as Careplus, as well as Faith based organisations, also had a role to play here. In previous years, volunteer Health Champions had been recruited and trained to deliver winter health messages to groups of older, vulnerable residents.

In recognition of the key role that the sector was able to play, many parts of the country had developed voluntary sector grants programmes to enable engagement with providers to develop innovative preventive interventions. Whilst there was an appreciation that budget provision had been made for the forthcoming winter, it was suggested that this approach was further explored. Grants could be used to reduce social isolation amongst vulnerable older people, and link people into services and grow awareness of the support available. Whilst these grant programmes were frequently modest, the reach could be extensive. Further consideration could be given to the use of the Innovation Fund as part of this offer, and thought could be given to using any underspend to help fund these initiatives going forward.

RESOLVED that the update be noted.

Following this item, Councillor Christine Harris and Councillor Judi Ellis left the meeting.