Agenda item

Report ACH21-055

The Board considered a report providing an update on the planning and actions being taken by the ONE Bromley partnership to respond to winter demands.

The Associate Director – Urgent Care Hospital Discharge and Transfer of Care Bureau (“Associate Director”) informed Board Members that the ONE Bromley Winter plan brought together all actions being taken by ONE Bromley organisations in order to respond to additional pressures on the health and care system during winter. The plan was based around 5 pillars:

1. Increasing System Capacity

2. Data Sharing and Escalation

3. Single Point of Access and Discharge Arrangements

4. Admissions Avoidance

5. Communication and Engagement

Increasing system capacity would involve additional workforce to respond to the demand on services. This included Rapid Response Advance Nurse Practitioners (ANPs), Rapid Access to Therapy therapists, Care Managers (adult social care), brokerage and Moving and Handling Risk Assessors. There would also be additional service capacity, with over 500 extra Primary Care Access Hub appointments over the Christmas and New Year period to compensate for the opening hours of other services. Assistive Technology (AT) was also being used in creative ways across the borough to allow residents to remain at home whilst they received care.

With regards to pillar 2, data sharing and escalation, the Associate Director advised that a data dashboard would be mobilised to identify pressure on the system in terms of workforce challenges and extra demand. A Clinical and Professional Advisory Group had already been launched to break down operational and organisational boundaries and ensure that consistent messages were being heard by residents and patients. A Clinical Monitoring meeting was used to share current clinical pressures and information that would help the system to be responsive.

The Bromley Single Point of Access (SPA) and Discharge Partnership were now fully established. Capacity had been further increased by providing access to Bromley Rapid Access to Therapies (RATT); Hospital@Home for children and young people; and the Bromley Community Covid Management Service and Long Covid clinics. The Assistant Director for Integrated Commissioning chaired a Demand and Capacity meeting, which would continue to maintain system oversight of pathways and capacity, ensuring sufficient access to resources throughout the winter period. This year, in addition, a community in-reach offer would be delivered to reduce inpatients length of stay in hospital and an Enhanced Community IV/AB short course would be offered to enable early supported discharge and admission avoidance. Integrated models of care would be used in relation to admissions avoidance, including the Community Respiratory Pathway, and the provision of dedicated St Christopher’s Capacity into care homes (in line with the successful model delivered during the COVID-19 pandemic) to support rapidly deteriorating patients post discharge.

The Associate Director highlighted that communication and engagement would be undertaken to ensure that the same messages were being relayed to both the health care workforce and general public. The winter PR campaign ‘Together Through Winter’ had been launched and would support a system-wide communication and engagement plan, maintaining and providing 2-way communication on winter pressures, updates on winter schemes and capacity, and supporting the workforce. A leaflet had been distributed to households, providing information on what services could be accessed, and when, enabling residents to choose which service was right for them. In response to a question, the Director of Adult Social Care said that colleagues in Finance were putting plans in place, including signposting for residents, and would distribute the Housing Support Grant as required.

Jonathan Lofthouse, Site Chief Executive – PRUH and South Sites, King’s College Hospital NHS Foundation Trust (“Site Chief Executive”) informed Members that he had recently taken over the role of chair of the ONE Bromley Executive Board. There had already been a large swathe of winter monies into the SPA, and last week a further £2.5m of winter funding had been secured and would be brought into the system. It was considered that the system response was as well placed as it had ever been, going into what would be a difficult and challenging winter period.

In response to a question, the Site Chief Executive advised that across London the system was seeing pressures escalating. The PRUH had already used, and would continue to use, escalation processes to galvanise extra levels of response – this meant that they were asking more and more from health and social care workers. The Site Chief Executive informed Members that the London Region had recently refined guidance relating to ambulances presenting at A+E departments and the offloading of patients. It was noted that this was a challenge at the PRUH and South Sites due to the physical design of both the site and the A+E department. Three weeks ago, a pilot had been initiated to redirect the postcode boundaries for ambulances. The London Ambulance Service (LAS) had acknowledged that as the PRUH was in outer London there was nowhere else for ambulances to go and had therefore altered the postcode definition for the five hospitals on the most extreme curtilage. It was highlighted that there was a defined LAS protocol, and patients aged over 65, children, and those already known to the hospital would still be directed to the PRUH.

In response to a question, the Site Chief Executive said the previous day, performance of the National Four Hour Standard stood at 77% for the PRUH – this was below the required 95%, but within the tolerance level. It was noted that the performance for our Type 3 patients, seen and treated within the Urgent Treatment Care (UTC), was significantly higher, at above 90%. There were three markers in terms of ambulance handover and drop-off – handover in 15 minutes, 30 minutes and 1 hour. Within the last 24 hours, there had been less than 10 handovers in the last two categories and the hospital was averaging 82 ambulance handovers per day. The Site Chief Executive said he would be happy to provide further statistics relating to this following the meeting.

A Member enquired if the LAS communicated with hospitals with regard to waiting times. The Site Chief Executive said that the LAS used an ‘intelligent conveyance’ level of technology, which allowed vehicles in the fleet to assess algorithms across London. However, it was highlighted that if one hospital was busy, it was extremely likely that its neighbouring hospitals would be in a similar position. Another Member enquired if the tracking of ambulances could be provided to the general public, allowing them to see where queues were building up. The Site Chief Executive said that he was not aware of any service that offered that level of information. It was emphasised that when there were ambulance handover delays, patients were kept in the vehicles and received clinical assessments and care from nurses and/or doctors – each patient was triaged and received pain medication if required. The Site Chief Executive confirmed that any patients waiting in ambulances were provided with the appropriate welfare, nutrition and hydration, depending on their circumstances. In an escalating situation, all patients would continue to be treated with dignity and respect. The Chairman considered that the Health Scrutiny Sub-Committee could request an update from the LAS at a future meeting.

In response to a question, the Site Chief Executive informed Members that COVID-19 was currently having less of an impact on the PRUH, as it became an endemic situation, which was lived with in society. At this time last year, there had been more than 300 positive cases of COVID-19 – however in comparison, as of that morning, there were 23 patients across the PRUH and South Sites with a confirmed inpatient diagnosis of COVID-19, and these numbers were not causing operational distress.

In response to a question from the Chairman, the Director of Public Health advised that the number of cases of flu was currently low, both in Bromley and nationally – however it was noted that the flu season had not yet fully started. A Member noted that countries, such as Austria, had made COVID-19 vaccinations compulsory and enquired if this may be implemented in the UK. The Director of Public Health said there was a requirement for social care staff to be double vaccinated, and this would soon be extended to medical and clinical staff – however she was not aware that this requirement would be introduced for the general public.

The Chairman thanked the Associate Director for her excellent presentation to the Board and enquired if there was anything further that Members could do to support the system. The Associate Director said it would be useful for everyone to be giving the same message in terms of keeping well and getting vaccinated. It was agreed that a copy of the ‘Together Through Winter’ leaflet could be circulated to Board Members for onward dissemination.

RESOLVED that report be noted.