Agenda item

The Assistant Director – Urgent Care, Hospital Discharge and Transfers of Care (“Assistant Director”) provided an update on the proposed One Bromley Winter Plan 2022-23.

Members had been provided with a copy of the One Bromley Winter Plan for 2022/23 which described how the system would respond to seasonal pressures, as well as how individual organisations were preparing for winter.  The plan also outlined the financial investment being made from non-recurrent winter monies to support the increase in capacity across the system. Following a request from Members, it was agreed that a glossary of terms would be provided, and is attached at Appendix A.

The Bromley Executive Lead – South East London Integrated Care Board (SEL ICB) (“Bromley Executive Lead”) advised that a strong partnership approached had been developed across Bromley in relation to the management of winter pressures. This year they would build on lessons learnt from the COVID-19 pandemic. The Assistant Director highlighted that the 2022/23 winter plan was rigorous and comprehensive, and aimed to deliver on the successful elements of the previous year’s Plan, as well as responding to new emerging needs and system changes. The Plan focused on providing additional capacity to the system at points of expected surges on existing services. The plan was being built on three key pillars:

1. Increasing system capacity

- Primary Care

- Admission Avoidance

- Discharge

2. Meeting Seasonal Demands

- Respiratory pathways – Adults and Children and Young People

- Christmas and New Year additional capacity

- COVID-19 and Flu vaccination planning

3. Information Sharing and escalation

- Winter Intelligence Hub

- System Escalations

- Winter Communications and Engagement

In response to questions, the Associate Director said that staffing issues were the biggest risk, however as a One Bromley system a huge amount of work had been undertaken in relation to recruiting and retaining staff. A range of training and qualification opportunities were available, and this offer was continually being increased. It was emphasised that this risk was being closely monitored, and everything possible was being done across the organisations.

With regards to a potential nurses’ strike, the Bromley Executive Lead said that nurses were a key part of the community response, but noted that they were not the only professionals working in this area – patients were supported by a range of staff when they left hospital, such as Health Care Assistants (HCAs) and therapists. If there were additional pressures on the workforce, consideration would need to be given as to how people could be better supported in their own homes. A benefit of the Winter Intelligence Hub was that these issues could be discussed when they were happening, and consideration given as to the alternative ways in which other staff could be used. The Site Chief Executive said that the Royal College of Nursing had balloted its members for consideration of strike action – the ballot opened on 6^th October and would run until 2^nd November. It was noted that the British Medical Association (BMA) junior doctors committee had now also balloted its members. The outcome of both consultations would not be known for some time, but it was highlighted that in the UK there were certain actions that could be carried out – for example individuals and representative bodies could refuse to work overtime, rather than downing tools and walking out. During the last junior doctors strike, acute services and primary care practices had continued to be provided and, although availability was reduced, it was at a tolerable standard. With the knowledge they currently had at a senior level, a variation to the service would be made to allow them to continue to provide life or limb critical response.

In relation to COVID-19 vaccinations, a Member noted concerns that there now seemed to be some apathy toward this, and questioned if there may be a lower take up. The Bromley Executive Lead said that, traditionally, Bromley had been a keen borough in terms of taking up both flu and COVID-19 vaccinations. As of last week, more than 50% of residents in the over 75 cohort had received a further COVID-19 vaccination. There was a programme of visits to care homes by the Bromleag Care Practice to deliver COVID-19 vaccinations, the first round of which would be completed by 23^rd October 2022. Uptake from residents was usually good, and they would also look to vaccinate staff members at the care homes too. It was noted that last year, vaccination uptake from care home staff had been good as at the time it was believed that this would be a condition of their employment, however this had not been the case. The uptake of flu vaccinations was going well – however it was anticipated that an awareness campaign for both flu and COVID-19 would be needed later in the year to further increase uptake. It was noted that around 15% of these vaccinations were given at the same time, but they hoped this would increase as they went through the winter period. The Director of Public Health agreed that there appeared to be some reluctance from people to get further COVID-19 vaccinations, as people felt that COVID-19 was no longer such a big issue – to address this, campaigns were continuing, and information was available on the website.

In response a to question from another Member, the Bromley Executive Lead said that the programme for the workforce to get a further COVID-19 vaccination had got off to a slow start – it was expected that most staff would receive both the COVID-19 vaccination and flu jab together, and they had been waiting for the supply of flu vaccinations to arrive. The flu programme had started from the 1^st October. At the beginning of last week, around 10% of staff across SEL hospitals and mental health units had received their vaccinations. It was still very early in the programme, and therefore not possible to yet draw any conclusions on uptake, but it was anticipated that a big uplift would be seen by the end of the month. The Director of Public Health informed Members that, in addition to frontline staff being offered a flu vaccination, the Local Authority had agreed to reimburse all staff if they purchased a vaccination privately. This was due to the level of concerns around a potential flu outbreak, and would increase the number of staff vaccinated. The Chairman reminded Members that the SEL vaccinations update session for Councillors would be held on 3^rd November 2022.

In response to a further question, the Bromley Executive Lead confirmed that vaccinations administered by pharmacies should be registered in order for it appeared on a patient’s GP records. Another Member enquired if the One Bromley Partnership worked with pharmacies to encourage uptake of the vaccinations, and asked if there was a point in time where it was considered to be too late to get vaccinated. The Bromley Executive Lead said that the One Bromley Partnership worked closely with pharmacy colleagues – around 8 or 9 pharmacies across Bromley were delivering COVID-19 vaccinations, and even more were delivering flu vaccinations. It was emphasised that it was worth getting both vaccines as the peak for this winter had not yet been reached, and outbreaks of flu could still be seen into next year.

With regards to the second pillar, a Member asked what things were considered as part of the seasonal demands in adult social care. The Assistant Director said that in Bromley, the demands often related to the older adult population, and things such as slips and falls were monitored closely. Activities included ensuring that they were providing timely access to care and support; support for carers; and sufficient workforce to deliver the statutory duties of the Care Act.

A Member asked for further information on the One Bromley @Home service virtual bed offer. The Assistant Director advised that this was a national initiative – in Bromley a mixed model was offered, with direct specialist input from acute consultants. For those patients who were acutely unwell, but safe and confident in managing their own condition, virtual monitoring could be offered through Assistive Technology (AT). For those unable to use the virtual monitoring system, the workforce would be used to carry out interventions, allowing the patient to be treated in their own home. The national data suggested that there had been significant reduction in the number of people for which health care needed to be provided and an improved recovery rate.

The Chairman thanked the Assistant Director and Bromley Executive Lead for their update, and noted that Bromley was in a strong position. The Portfolio Holder said that a resilient plan had been produced and thanks were extended to everyone one involved. The Director of Adult Social Care highlighted that it demonstrated the collaborative system approach to winter, and was a plan that she was very happy to support.

RESOLVED that:

i.)  the activity and schemes taking place to mitigate against seasonal increases in demand and pressure be noted; and,

ii.)  the ONE Bromley 2022/23 Winter Plan be endorsed.