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 ONE Bromley Winter plan brought together all actions being taken by ONE Bromley organisations to respond with additional pressures felt on the health and care system during winter. The report was based around the following pillars:
1. Increasing system capacity;
2. Meeting seasonal demand; and,
3. Information sharing and escalation.
In addition, the Winter Plan also outlined key actions and risks for each individual organisation.
The Associate Director – Urgent Care Hospital Discharge and Transfer of Care Bureau (“Associate Director”) noted that Strep A was currently receiving a significant amount of media attention. In response to this, primary care, acute colleagues and specialist paediatric medicine had been brought together in Bromley. Additional specialist GP Hubs had been provided in the community, specialist paediatric capacity had been added in the non-urgent treatment centres, and three extra paediatric beds had been put into the acute sector. A webinar would be held the following day for primary care colleagues regarding diagnosing, responding to Strep A and prescribing, and access to the Consultant Connect system was also being increased in response to demand.
In relation to attendance and admission avoidance, the Associate Director highlighted the One Bromley @Home service – this provided a virtual bed offer to support acutely unwell respiratory, frailty, Intravenous Antibiotics (IVABs) and palliative care patients to receive care in their own home. The patients remained under the care of a consultant, and their supporting team, who provided treatment and interventions to prevent hospital admission. There was a huge amount of evidence in relation to this model and the progress made in Bromley had been very impressive.
Effective winter communication and engagement was another area of focus which aimed to support the general public to understand how best to access services. The ‘Winter Services Directory’ had been delivered to all households in Bromley and described the services that were available to support patients. There were QR codes included which could be scanned to take the reader to the relevant section of the NHS website. The One Bromley ‘Making a Difference Together’ bulletin would be utilised to support a system wide communication and engagement plan – maintaining and providing two-way communication on winter pressures, updates on winter schemes and capacity, and supporting the workforce. There was also a significant piece of work being undertaken in relation to staff wellbeing and ensuring that they remained healthy and well.
Debbie Hutchinson, Site Director of Nursing – PRUH and South Sites (“Site Director of Nursing”) highlighted that lots of work was being carried out across partner organisations. In the acute sector they were looking at the various pathways within the hospital, with specific work taking place in relation to the same day emergency care pathway. There were ambulatory-type areas which patients could be referred to, from the ED or community, to receive care in a timely manner. There was also an acute frailty assessment unit which allowed staff to respond quickly to the needs of this group of patients, and get them to the right place to receive the care required. A number of ward moves had taken place in recent weeks – this had been done in order to reorganise environments and make pathways easier to manage. As expected, a significant amount of work was taking place in the ED to maintain safety and in relation to ambulance handovers. In terms of staff health and wellbeing, they were aware that the next few months would be difficult, and a number of things were being put in place to help support staff.
The Portfolio Holder for Adult Care and Health congratulated the teams on an excellent example of partnership working. The Assistant Director for Integrated Commissioning said that the whole system was prepared, and once people were discharged from hospital support would be provided accordingly.
A Board Member noted the contribution made by the community and voluntary sector, who had also been involved in distributing the winter communications booklet. The cost-of-living pages developed by Bromley Well and Community Links Bromley were acknowledged, and it was highlighted that around 43 ‘Warm Hubs’ were being established across the borough. Board Members were encouraged to share the resources available. The Director of Adult Social Care extended her thanks to the community and voluntary sector. The work undertaken by care provision staff was also acknowledged, particularly over the last couple of year which had been extremely difficult. It was intended that a local celebration would be held for providers and staff in the new financial year to recognise their work.
In response to questions, the Associate Director advised that there was a national drive around the range of professionals that could support patients at a primary care level, and using the workforce as best they could. In terms of the net increase of GP appointments, additional clinics were held at the PRUH on a Saturday, Sunday and Monday, with 60 extra virtual and face to face appointments available on each day, and extended access hubs were also running. A Board Member noted that primary care was much broader than just GPs and practice nurses – to put this into perspective, it was noted that there were not enough rooms at his surgery for all the staff working as the workforce had been greatly increased. The vast majority of GPs just did face to face appointments, but there were also staff members who were undertaking visits through Bromley Healthcare’s Rapid Response Team. Additional roles were continually recruited through Primary Care Networks (PCNs), such as paramedics, physiotherapist, pharmacists and dieticians, as the aspects of the work presented were vast. In the last week there had been a huge increase in demand due to concerns regarding Strep A – practices were trying to be as flexible as possible, and triage systems had been implemented to absorb these contacts each day. Working together, across Bromley, was vital. Beyond general practice, pharmacies were extremely busy and, in addition to providing advice, were delivering COVID-19 and flu vaccinations. There was also direct self-referral access to mental health, physiotherapy and enhanced eye care services.
With regards to the threat of industrial action, the Associate Director noted that King’s College Hospital NHS Trust was not listed as one that would be striking, however as part of the South East London system they were planning to do as much work as they could to support the whole system during that period. A huge amount of learning had been taken from the COVID-19 pandemic, with staff deployed across the system to manage risk. Social care colleagues were involved in discussions relating to this to ensure that staff were in the right place to manage the required needs.
Jacqui Scott, Chief Executive Officer – Bromley Healthcare informed Board Members that, in terms of community services, a focus of their work was on keeping residents out of hospital. Bromley Healthcare had been one of the national accelerators for the Urgent Community Response, which had now been rolled out across the country. This ensured that there was resilience within the service and provided a response to prevent unnecessary admissions into hospital. Capacity had also been increased in the home rehabilitation service and the district nurses completed around 600 visits per day to look after people in their own homes. At Bromley Healthcare there had also been a focus on staff health and wellbeing and an awards ceremony had recently been held to thank the teams and acknowledge their achievements.
A Board Member noted that, following discussions with residents, it was felt that the ‘Winter Services Directory’ was having a calming effect – it was not driving people to use services, it was having the opposite effect, and gave confidence in terms of how to access services when they were required. In response to a question from the Chairman, the Associate Director said there was still a huge amount of work to do around public responsibility as it was not uncommon for there to be numerous contacts across the system, but it was positive to hear the effect the directory was having. The Site Director of Nursing said that, in terms of communication with the local population, it was great that there were a number of initiatives taking place. In the acute sector it was noted that the degree of frailty and dependency was ever increasing within patients – it was likely that families who cared for the elderly would need to be reassured, particularly over the Christmas and bank holiday periods, and provided with this key information. The Associate Director said that this could be taken forward with the communication and engagement leads, with links circulated to networks before Christmas.
The Chairman thanked the Associate Director for her presentation to the Board. Thanks were also extended to all the staff across the One Bromley system for the work undertaken.
RESOLVED that the update on the Bromley Winter Plan 2022/23 be noted.