Agenda item

Clive Moss, Senior Commissioning Manager (Urgent and Emergency Care) – SEL CCG, and Jodie Adkin, Associate Director – Discharge Commissioning, Urgent Care and Transfer of Care Bureau, provided an update on the Bromley Winter Assurance Plan 2020/21.

The Senior Commissioning Manager advised Members that last year, the Bromley System Winter Plan had brought together a single view of how the local health and social care system would proactively manage additional demands felt throughout winter. This year, in addition to winter, the Plan also provided a response to the COVID-19 second wave as set out in the NHS England / Improvement, third phase NHS response letter on 31^st July 2020. The Plan, and associated activity, had never been so important as the country entered, what was likely to be, the most challenging time for the health and social care economy on record.

Alongside the Plan, which highlighted arrangements, risks, mitigations and governance, was the agreed additional funded activity through the CCG, Local Authority (LA) and King’s. Furthermore, the Department of Health and Social Care (DHSC) had requested confirmation by the 31^st October 2020 of a LA Winter Plan, which was being finalised locally building on the elements highlighted within the ONE Bromley System Winter Plan.

The Plan had been considered and reviewed at the Bromley A&E Delivery Board and would be submitted to the SEL Urgent and Emergency Care Board for review. This approach included coordinated planning for, and management of, winter pressures and other periods of enhanced demand on the health and care system. The Board was facilitated by NHS SEL CCG (Bromley), working in partnership with King’s College Hospital, the London Borough of Bromley, Greenbrook Healthcare, Oxleas NHS Foundation Trust, Bromley Healthcare, Bromley GP Alliance, St Christopher’s, the London Ambulance Service and Bromley Third Sector Enterprise. The Plan was aligned with the One Bromley Recovery Plan which had been approved by the One Bromley Executive. The plans had been considered and commented on at the Bromley Health and Wellbeing Board and would receive final sign-off following challenge from the Health Scrutiny Sub-Committee. It was noted that the Plan was a “live” document and would be amended as necessary by the health and social care system, with operational oversight from the Bromley A&E Delivery Board.

A Member noted that the Bromley System Winter Plan 2020/21 was a large document and suggested that an index might make it easier to read, particularly on electronic devices. The Associate Director – Discharge Commissioning, Urgent Care and Transfer of Care Bureau agreed that a contents page and Executive Summary should be added to the document.

The Committee were requested to review the ONE Bromley System Winter Plan 2020/21 and associated activity, providing scrutiny to the proposal, risks and mitigations. The Chairman highlighted that the report requested the Health Scrutiny Sub-Committee to ‘support and challenge the local system to ensure the elements included in the Plan are delivered and the local system works together to respond to the challenging seasonal demand’. As the next meeting of the Sub-Committee was scheduled for January 2021, consideration would need to be given as to how this requirement would be fulfilled.

Members had been provided with the full draft plan, the funded Winter Resilience Schemes, and the Staying Well This Winter 2020/21 draft patient leaflet. The approach taken in the Plan highlighted the coordinated planning and management of winter pressures and other periods of enhanced demand on the system. Activity and performance analysis from previous winters and the COVID-19 pandemic had been considered to inform recommendations, which were noted in the Plan. A summary of the provider and systems robust governance arrangements and Winter Risk Register had been included, along with details of the additional CCG and LA funded schemes. Plans outlining the flu vaccination programme had also been included, and it was noted that winter communications would be key this year. Details had been provided of how national campaigns would be aligned with local communications to patients, GP practices, pharmacies and community services. It was noted that the Staying Well This Winter leaflet would be targeted at residents living in areas that historically had a low take up of the flu vaccination. In response to a question from a Co-opted Member, the Senior Commissioning Manager advised that Public Health England had produced an ‘easy read’ version of the winter campaign communications, which could be circulated following the meeting.

The Chairman said that several of her constituents had indicated that they had been unable to access flu vaccinations at their GP practices, and were advised to contact their local pharmacy. The Chairman raised concerns over the availability of flu vaccinations. The Senior Commissioning Manager noted that the stock of vaccinations needed to be managed carefully as the national immunisation programme had been extended to include the 50-64 year old cohort. The vaccinations were therefore being staggered, providing them to the over 65’s and vulnerable patients first, and then the 50-64 year old age group. These concerns were shared, and had been fed back to the national stock – they were in constant contact through the primary care team and flu immunisation group to ensure that local pharmacies and GP practices had as much stock available as possible.

A Co-opted Member highlighted the recommendations made for 2020/21, to ‘consider an admission avoidance approach for frail and elderly patients and those with respiratory conditions to reduce pressure on hospital based care throughout winter’, and asked for assurances that patients would be adequately supported with welfare calls. The Associate Director – Discharge Commissioning, Urgent Care and Transfer of Care Bureau advised that admissions avoidance was part of the community respiratory pathway. This was being developed with clinicians from the CCG, Bromley Healthcare and King’s College Hospital NHS Foundation Trust to avoid extremely vulnerable patients being admitted to hospital, wherever possible – ensuring these patients were clinically safe, and that all care provided in the home environment was sufficient and appropriate. If a patient did require hospital care, this would be actioned in way that did not put them at increased risk. It was noted that the clinical oversight and care was very robust and was the key driver in the development of the care pathway. In response to a further question from the Co-opted Member, the Senior Commissioning Manager advised that digital exclusion had been considered with regards to the respiratory pathway. Referrals were most likely to come from a patients GP, or a hospital, and the patient would be able to indicate their preferred method of contact, including via telephone or a face to face visit at their home.

In response to a question, the Senior Commissioning Manager said he believed there was online access to the 111 Direct service, and following the meeting he would confirm what 111 provision was available to patients who were deaf. It was highlighted that the 111 direct booking pilot was not to stop walk-in attendances, but to help the Emergency Department to manage their flow of patients. This would stop them being “overloaded” and allow social distancing guidelines to be adhered to in the waiting rooms.

The Co-opted Member representing Experts by Experience (X by X) said they had been notified earlier in the year that some direct payment users had encountered difficulties in accessing PPE, particularly for their PA’s, and asked if it would now be more readily available. The Associate Director – Discharge Commissioning, Urgent Care and Transfer of Care Bureau acknowledged that this had been an issue at the time, however national guidance had now been updated making it clear that the LA was equally responsible for those people they directly funded, as well as self-funders and those receiving direct payments. Work was underway across the LA to consider how best to proactively engage with a much wider cohort, to ensure they had sufficient and robust access to PPE. It was noted the LA’s PPE hub had been run very successfully and had delivered items to a variety of people and local care providers. Several CQC registered providers now accessed PPE through the national portal, which would allow the local hub to focus on the groups mentioned.

In response to a question relating to the summary of organisations assurance plans, the Senior Commissioning Manager advised that there was a South East London A&E Delivery Board, under which sat the Bromley A&E Delivery Board. The Bromley A&E Delivery Board focussed on day to day operational issues and relationships with local provider leaders, as well as providing a forum for discussions around how each plan fitted and aligned with each of the others. An example of this was providing health and care at home – each provider or organisation would look internally at what they could do, and then put forward suggestions. The Bromley A&E Delivery Board would then take the proposals to the system, allowing for comments as to how this would fit into the current services provided and check for any duplication. The Associate Director – Discharge Commissioning, Urgent Care and Transfer of Care Bureau noted that the rationale behind having a single system plan was to look at themes and issues, rather than each individual organisation. The A&E Delivery Board then created multi-agency sub-groups to hold providers to account.

The Co-opted Member representing Experts by Experience (X by X) noted the reference made to a ‘focus on supporting vulnerable groups to prevent the need for hospital based care’, and said that the organisation would like to contribute to the strategic scheme, supporting local disabled people to ensure support was delivered in an empowering and accessible way. The Senior Commissioning Manager agreed that this could be discussed in further detail outside of the meeting.

The Chairman thanked the Senior Commissioning Manager and the Associate Director – Discharge Commissioning, Urgent Care and Transfer of Care Bureau for their update on the Bromley Winter Assurance Plan 2020/21.