Agenda item



Report ACH22-012


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 Bromley Borough Director advised Members that the system had worked well – a difference this year had been the degree of partnership working which would see them well placed for next year. A workshop would be held to look at what could be done better, and data would be analysed to ensure the system was in the best position possible to deal with future pressures.


The Associate Director – Urgent Care Hospital Discharge and Transfer of Care

Bureau (“Associate Director”) informed Board Members that the update highlighted all actions taken / being taken by One Bromley organisations in order to respond to the additional pressures felt on the health and care system during winter. The report was based around 5 pillars which were:


1.  Increasing system capacity

2.  Data sharing and escalation

3.  Single Point of Access and discharge arrangements

4.  Admissions avoidance

5.  Communication and engagement


Information had also been provided in relation to vaccinations, outbreak management, recommendations and next steps.


Data regarding increasing system capacity, up until February 2022, demonstrated the additionality that had been incorporated, including:

-  More than 19,000 primary care appointments had been provided, with standard and additional appointments offered through the extended hours GP access hubs;

-  Over 43,000 patients were treated at Urgent Treatment Centres (UTC), which was a significant number;

-  3,324 patients were visited by the community Rapid Response team;

-  2,688 visits had been made by the urgent therapy team to support admissions avoidance and facilitate early supported discharge; and,

-  5 additional organisations had been added to the framework of domiciliary care providers.


The Associate Director advised that month on month, utilisation rates for GP hub appointments had remained above 93% and had increased throughout the winter period. It was noted that staffing hub appointments became a challenge, and due to work pressures, some moved to virtual appointments. There had also been a request from NHS England for the mobilisation of a local Clinical Assessment Service (CAS) which had responsibility for Bromley patients who phoned 111 with primary care dispositions. Initial findings indicated that the service had a positive impact on patient access, and reduced pressure on UTCs with a 10% reduction on the number of patients being booked in. Throughout the period, the system had been intelligence-led – demand and capacity dashboards had demonstrated the need for escalation. These had been presented at regular Winter Demand and Capacity meetings to quantify demand on local services and respective teams and highlight any potential surges in activity across pathways to allow for forward planning.


A Member congratulated the Associate Director and Bromley Borough Director on the format and content of the report provided. It was highlighted that it was good to see better access to GP appointments being provided, and it was hoped that this would continue to be seen going forward. The Bromley Borough Director noted that complaints were still received in relation to access to GPs. This would be part of the embedding process, not just in relation to capacity, and they were looking to improve other parts of the service, such as telephony systems.


Board Members were informed that the Bromley Single Point of Access (SPA) had won a national award for the work undertaken. Throughout the 2021/22 winter period there had been a total of 5,824 discharges from the Princess Royal University hospital and 2,373 supported discharges were also facilitated for Bromley residents – 80% of discharges had taken place within 24 hours of a patient being declared medically fit for discharge. Professionals had worked together, and it was noted that, despite its older population, Bromley continued to perform in line with the national and London average percentage of patients discharged to their usual place of residence.


The Vice-Chairman asked for clarification regarding the statement that ‘community in-reach to the PRUH as part of the Stranded Reviews to ‘pull’ patients supporting the Trust when under significant bed pressures’. The Associate Director advised that this brought together clinicians to look at how patients, who were medically fit, could best be supported. The Bromley Borough Director emphasised that those who were not medically fit would not be moved and noted that this was being seen much less since the introduction of the SPA. If patients remained in hospital when they were deemed to be medically fit for discharge there was an increased risk of them becoming unwell again, as they were more prone to developing chest infections, and this aimed to break the cycle. This was something that they were embedding as normal practice rather than as an emergency intervention.


In relation to pillar 4, a pilot service had been introduced which currently focussed on admission avoidance and early supported discharge from the PRUH allowing patients to receive intravenous antibiotics for simple infections at home rather than in hospital. The pathway had seen growth in utilisation and had conducted over 347 home visits – feedback had been very positive and had laid the foundations to develop an offer for expanding support to nursing homes and end of life care services. Enhanced end of life support had also been added into the system, the St Christopher's Winter Support Team working in partnership with Bromleag Care Practice, to provide palliative care to patients, and Advance Care Plans had been undertaken for care home residents post discharge to establish clear escalations of care.


The Associate Director advised that a comprehensive One Bromley winter plan had been developed to deliver national, regional, south-east London wide and borough specific information regarding flu, COVID-19 and winter health. A One Bromley staff event had been held to launch the winter campaign and encourage working together and referrals to different parts of the system to help with winter pressures. This had been attended virtually by 200 people and may more had viewed videos produced of main winter schemes to help promote availability and how to refer across the local system. A new monthly ‘Together Through Winter’ e-bulletin had been created to give information about resilience schemes,  winter challenges, pressures and share key information with the workforce – before Christmas, a winter health leaflet had also been delivered to every household in Bromley which provided information on vaccinations, using the right service, children’s health and self-care. In response to a question, the Associate Director said that communication would be an area of focus as they were aware that this was something which could be improved. They were keen to have regular user involvement to provide insight on hospital discharge.


The Bromley Borough Director highlighted that the success of partnership working had been reflected in the achievements of the borough’s COVID-19 vaccination programme – Members and partners had assisted in encouraging one of the best uptake rates in London. Since December 2020, over 500,000 vaccinations had been delivered across borough and the One Bromley collaboration had been central to achieving excellent uptake. It was noted that uptake from the younger age groups was not as good as they would like, but was higher than many other boroughs, and the following day they would begin delivering vaccinations for at risk 5–11-year-olds. Residents were still coming forward for first doses and variations in uptake were continually being monitored. This included, for example, uptake from pregnant women – Bromley had the best uptake rate across south east London, but this was still only 70%. Work was also continuing to manage outbreaks of COVID-19 in care homes. In response to a question, the Bromley Borough Director advised that some specific pop-up COVID-19 vaccination hubs had been held in Penge, but uptake could sometimes be slow. The data on vaccination uptake by ethnicity was monitored by ward on a monthly basis and could be provided to Board Members.


The Bromley Borough Director advised that next steps would include a tapering of additional winter capacity to revert back to ‘business as usual’ levels. A winter reflection workshop would be held on 12th April 2022 to identify what had gone well; analyse unpredicted issues that emerged, their impact, how they were addressed and could feed into relevant organisation’s business continuity plans; and identify recommendations for next winter. All approaches would be celebrated at the upcoming One Bromley Awards which would recognise the work undertaken by staff, particularly throughout the winter period.


The GP Clinical Lead – SEL CCG said it was important to note that a number of the interventions implemented to address winter pressures would be embedded, which they would look to improve and extend going forward. This was in addition to other work related to long-term conditions – work would continue across the system as a whole to ensure the right escalation plans were in place and residents were able to get the advice and help they required quickly. It was hoped that the winter reflection workshop would allow new initiatives to be taken forward as lots of the work had manifested from the collaboration of clinical professionals.


The Chairman thanked the Associate Director and Bromley Borough Director for their update to the Board. It was stated that this had been a fantastic effort and the slides should be publicised more widely. The Portfolio Holder for Adult Care and Health said that a phenomenal piece of work had been undertaken and staff had remained resilient throughout unprecedented times.


RESOLVED that the report be noted.

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