Agenda item

To follow

Report ACH20-081

 

The Board considered a report providing an overview and update on the overarching One Bromley Winter Plan and the delivery of the NHS SEL CCG (Bromley), London Borough of Bromley Winter Schemes 2020/21 (funded from the Better Care Fund (BCF)). All schemes / funding lines would be evaluated at the end of the period and reported as part of the Winter Evaluation.

 

The plan had been considered and reviewed at the Bromley A&E Delivery Board. 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. It had also been discussed and inputted into previously by the Bromley Health and Wellbeing Board, Bromley Health Scrutiny Sub Committee, Bromley Borough Based Board and had formed part of the assurance on Winter Plans to NHS England / Improvement.

 

The Plan update report was presented to the Health and Wellbeing Board as part of the local assurance scrutiny and assurance process. The report provided an update on mobilisation of the CCG and Local Authority’s 2020/21 winter schemes which the Board were asked to note and comment on. The Plan included reference to the Bromley Adult Social Services Winter Plan (the Local Authority template sent out for completion by the Department of Health and Social Care) that set out the approach to be taken around care and support sufficiency and quality of care services for residents supported in the community.

 

The overall aim of the plan was to provide an overview of how the Bromley system would respond to seasonal demand and a potential second wave of COVID-19 at both a tactical and strategic level. Furthermore, the plan would support the local health and social care system to effectively manage winter pressures, for example with hospital discharge pressures or supporting patients in the community through robust care and support offers to help them remain independent in their own home.

 

The Senior Commissioning Manager advised that the funding for CCG and LBB winter schemes is budgeted from the Better Care Fund, whilst King’s schemes were funded internally via their core contract. NHS SEL CCG (Bromley), London Borough of Bromley (LBB) and King’s College Hospital (PRUH site) had proposed winter resilience schemes that supported delivery of the strategic priorities of the winter plan. Those strategic priorities were as follows:

·  Meet additional winter demands on front line services with a focus on supporting and preventing acute pressure;

·  Focus on supporting vulnerable groups to prevent the need for hospital-based care;

·  Ensuring sufficient resource to manage a potential COVID-19 wave 2, learning from wave 1;

·  Flu vaccinations for staff at provider organisations (including Local Authority and Bromley Third Sector Enterprise staff) and patients via primary care, community and pharmacies; and

·  Alignment of winter communications with SEL CCG and robust patient engagement in planning winter services.

 

The Senior Commissioning Manager noted that in line with these strategic priorities, the following schemes had been agreed:

 

1.  Meet additional winter demands on front line services with a focus on supporting and preventing acute pressure:

 

A)  Additional capacity to support Bromley SPA

The SPA for Hospital Discharge was formed in March 2020 as part of a mandated response to the COVID-19 Pandemic to support appropriate and effective hospital discharges. Faced with potential additional demand, the CCG had ensured the SPA had additional therapy and nursing staff in place over winter to triage the patients and support safe and timely hospital discharge.

 

B)  Additional capacity to support the Urgent Treatment Centre

Additional staffing had been put in place to support evening and weekend attendance surges. A Floor Coordinator had been put in place on the PRUH site, who supported clinical shift leads in the busy periods and helped manage the flow and siting of patients. This was especially important due to the social distancing requirements. The role also played a valuable one in patient liaison, and dealing with simple patient concerns and being a good information flow to patients. The role would also support the shift lead in being a conduit between the service, ED and patients, and could carry out admin tasks, freeing up shift leads for more clinical oversight.

 

The funding agreed would also extend the shift time of the Health Care Assistants (HCAs) to finish at midnight rather than 9pm during winter, 7 days a week. The HCA role was an excellent support role to clinical teams and reduced pressures on the shift lead and streaming function. It would also support the fact that capacity within all departments remained an ongoing risk over winter with current COVID-19 levels, HCAs could step in to complete some tasks normally completed by trained staff.

 

C)  Additional capacity to support rota fill over Christmas and New Year

Additional capacity would be put in place for GP Out of Hours and GPs within the Urgent Treatment Centre services over the Christmas and New Year period, where previous years there had been a surge in demand.

 

D)  Additional capacity into Primary Care Access Hubs

Additional consultation appointment slots would be made available for patients on days of the week that were currently seeing high demand. Additional slots would run from early December 2020 to the end of March 2021.

 

E)  Additional Adult Social Care Capacity

Increased Care Management capacity across the Hospital Discharge and Adult Early Intervention Team (AEIT) due to the increased demand for Care Act assessments and support throughout the winter period. There would also be additional Moving and Handling Risk assessors to respond to the increase in clients requiring double handed care, and support to ensure promotion of independence through timely intervention and review.

 

2.  Focus on supporting vulnerable groups to prevent the need for hospital-based care:

 

A)  Community Respiratory Management Service (Pilot)

COPD and respiratory presentations were the highest reason for attendance during winter months, whilst also being particularly vulnerable to COVID-19. The objective of this scheme would be to reduce emergency admissions in the hospital with management of patients in the community.

 

  The scheme was an extension of the existing Bromley Healthcare Community Respiratory Service, which would provide additional capacity to provide an extended hours provision to manage acute exacerbation of chronic respiratory conditions. The service would include consultant oversight from the PRUH. Once accepted by the service, the respiratory team would triage and visit patients at home as required. In addition to this, telehealth would be used to provide some ongoing monitoring. If the patient was triaged as being able to and was mobile, the patient may be booked into appointments at the GP Access Respiratory Hub.

 

B)  GP Access Respiratory Hub

The Bromley GP Alliance had opened a new GP Access Respiratory Hub in the Beckenham Clinic. The hub would be open daily and available for same day booking of registered patients who had a previously diagnosed respiratory condition, and, after a clinical assessment, were assessed as having an acute exacerbation of the condition or a new respiratory illness requiring urgent attention. This included respiratory patients with a confirmed or suspected COVID-19 diagnosis.

 

C)  Urgent response support in community therapy and rapid response teams for patients in crisis

Additional capacity had been put into the Rapid Access Therapy and Rapid Response Teams, to treat patients who required a two-hour and same day responses in their own homes. The services mainly supported primary care in the community to avoid admissions, but could also support patients who had attended ED but could avoid being admitted with rapid access to therapy in their own home. Bromley Healthcare were deploying additional staff in their Rapid Response Team to bolster this urgent home visit service by over 30%. It was expected that additional capacity would be in place from 7^th December 2020, for 12 weeks, and would end on the 1^st March 2021.

 

D)  Frailty Care Navigators

Care navigation support for frail patients to ensure that the were supported through the health and social care system. This would involve expanding capacity in Bromley Well services that supported social care e.g. frailty navigator, handy man, care navigators and emergency shopping.

 

E)  Rapid access: Assisted technology, home repairs, deep cleans and declutters

Vulnerable patients may need support post discharge to return home. This may be due to frailty / fall risks and would benefit from pendant alarms or sensors so LBB would commission an external agency to provide urgent hardwiring in a timely manner. LBB would also commission significant repairs and deep cleans to allow clients to receive care in their own home preventing admission or supporting hospital discharge.

 

3.  Ensuring sufficient resource to manage a potential COVID-19 wave 2, learning from wave 1:

 

A)  Nursing and Residential Home Isolation Unit for COVID-19 patients post discharge

In line with national legislation, these units were used predominately for COVID-19 patients to complete their isolation period required following an acute admission. However, there was an option for the capacity to also be used as interim assessment beds should the demand for COVID-19 beds decrease. The plan was for most patients to return to their existing placement at the end of their isolation period, however for new patients requiring a change of setting or a review of their existing levels of support, an assessment of their long-term care and support needs (Care Act Assessment) would take place whilst the client was in the units so they were discharged to their long-term care setting i.e. home, Extra Care Housing or long term placement. The Residential Isolation Unit had opened at Burrows House, and the Nursing Unit was being jointly commissioned with Lewisham.

 

B)  Jointly commissioned discharge support including care home capacity and domiciliary care

This included delivering sufficient resources to enable timely hospital discharge and prevent admission as per national guidance, and as per the successful approach adopted during wave 1. Dedicated D2A domiciliary care resources were in place, alongside a joint contract for making care home placements under COVID-19 funding.

 

4.  Flu vaccinations for staff at provider organisations (organisations (including Local Authority and Bromley Third Sector Enterprise staff)) and patients via primary care and pharmacies:

 

A)  Flu Vaccinations for Staff

Each provider organisation member of the Bromley A&E Delivery Board had submitted their staff flu vaccination plans and were monitoring uptake. Staff at the London Borough of Bromley and NHS SEL CCG were being asked to get their flu vaccinations via their local pharmacy which could then be expensed. The CCG was also providing funding so that Bromley Third Sector Enterprise staff could similarly get free flu vaccinations as these were staff who would not ordinarily qualify for a flu vaccination via thenational flu immunisation programme 2020/21. 

 

B)  Flu Vaccinations for Patients (including additional cohort of 50-64 year olds)

Bromley GP Alliance were providing flu vaccinations for all care home staff and residents. Bromley Healthcare had been delivering flu vaccinations for all housebound patients.

 

5.  Alignment of winter communications with SEL CCG and robust patient engagement in planning winter services:

 

With their stakeholders, the CCG had co-designed a ‘Staying Well This Winter’ leaflet for residents, informing them how to seek advice via 111; how to access GP services during the evenings and weekends; where to access voluntary sector services support; and where to get the flu vaccination and other immunisations. This would be targeted at areas where there was low flu vaccination take up last year, to ensure the most vulnerable were protected.

 

The Senior Commissioning Manager advised Board Members that in relation to mental health support, work was also being undertaken at a South East London level, looking at crisis homes as an alternative for those patients presenting at the ED but not requiring admission.

 

The Chairman noted that a very comprehensive report had been provided, and noted that it was encouraging that a number of the items previously discussed at meetings of the Health and Wellbeing Board had now been put in place.

 

The Borough Based Director – SEL CCG (“Borough Based Director”) highlighted that in addition to the winter schemes being implemented, a huge amount of other “business as usual” work had been taking place. It was highlighted that this had included working in partnership with the Local Authority to provide support to care homes, and the data for August, September and October 2020 showed there had been a 40-50% reduction in the number of residents visiting and being admitted to A&E, compared to the previous year. This was due to a several factors, including the pandemic; the training and support provided to care homes; and the GP practice for care homes.

 

In response to a question regarding social isolation and loneliness, the Portfolio Holder for Adult Care and Health noted that a considerable amount of funding had been secured through the Direct Line Group to support to some service providers in the voluntary sector, agreed via Community Links Bromley, over the last six months. The volunteering programme would also be continuing – a number of volunteers had remained in contact with residents that they supported through the first wave of the pandemic, and would continue to do so going forward, which would help to reduce the effects of social isolation and loneliness. The Director of Adult Social Care highlighted that the voluntary sector had provided some brilliant support, as had a number of the contracted providers, and they would continue to build these relationships. The Chairman noted that messaging on loneliness was also being shared with communities via faith groups, friend groups and resident’s associations. The LBB Communications Executive advised Board Members that the assistance line also offered a befriending service, and suggested that this could be publicised in the lead up to Christmas.

 

In response to a question, the Borough Based Director said that staff recruitment had been a challenge again this year, although they had tried to recruit staff earlier. They were looking to use primary care staff in a different way, as several practices were managing patient appointments digitally. However, some pressures remained in the hospitals, such as providing nurses for extra beds. The Senior Commissioning Manager said that community health care was fully staffed, but there were issues around acute care which was reflected nationally.

 

The Borough Based Director informed Board Members that the Senior Commissioning Manager would shortly be moving to a secondment role at the SEL CCG, and thanked him for all the work he had undertaken, particularly in relation to the Winter Plans produced in recent years. On behalf of the Board, the Chairman thanked the Senior Commissioning Manager for his presentation and wished him all the best in his new role.

 

RESOLVED that the update on the Winter Schemes 2020-21 be noted.