Agenda item

To follow

Report ACH23-007

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.

In relation to how the system had faired over the Christmas and New Year period, 23^rd December 2022–4^th January 2023, there had been 591 more attendances at the PRUH ED, compared to the same period last year, totalling 4,497. However there had been 173 fewer LAS ambulance arrivals (totalling 697), with two peaks occurring on Christmas Eve and the 4^th January 2023, which was not in line with previous years. This was believed to have been impacted by Strep A and a number of viruses circulating, causing the run up to Christmas to be incredibly busy. The Assistant Director noted that the numbers attending, and the acuity of patients, had remained consistent – even though patients were not necessarily travelling to hospital by ambulance, those who were very sick were getting to the hospital to receive the care they needed. There had been sustained pressure over the two-week period however, following the national press coverage prior to the last bank holiday (2^nd, 3^rd and 4^th January 2023), there had been a dip in the number of attendances at the UCC.

The Bromley@Home Service, which supported patients at home and in the community, had mobilised before Christmas – it had experienced high activity and was continuing to grow. There had been 31 more ward admissions at the PRUH, and 24 fewer discharges, compared to previous years – this pattern of high admissions versus low discharges had continued over the whole period. The Assistant Director advised that staffing had been one of the main challenges reported over the Christmas period – this had been due to COVID-19 and viral infections circulating. There had been some issues related to the overspill following industrial action, and staffing within the acute setting had been particularly difficult on some of the strike days.

The Assistant Director considered that the work put into planning for the Christmas and New Year period had been extremely beneficial. There had been an additional 754 GP appointments provided over this period; Bromley Healthcare’s GP out-of-hours service had provided a significant amount of support to the 111 service; Bromley Healthcare’s community response services had made visits to patients, allowing them to stay at home; and the Adult Social Care provision had arranged for guaranteed domiciliary care capacity. The voluntary sector had seen a significant amount of patients over this period, particularly in response to the cost-of-living crisis and ensuring they returned to safe homes. There was enough capacity throughout the discharge services, but the challenge had been to get patients fit and ready to be discharged.

The Chief Executive Officer – Bromley Healthcare said that another key service related to admissions avoidance had been Urgent Community Response – they had a target to see 70% of patients within two hours, in order to keep them out of hospital. This had worked very well, and capacity had been increased within this service – and current overall performance was at 92-95%. With regards to the GP out-of-hours service, it was noted that this had again worked well, and was something that they would be keen to continue. The Hospital@Home service had also provided support to the PRUH to ensure that children returned home in a safe way, and as soon as possible.

In response to a question, the Bromley Executive Lead said that higher levels of flu had been expected this year, however high levels of respiratory syncytial virus (RSV) had also been experienced. What had not been expected was Strep A and scarlet fever being highly prevalent at this time of year, and cases had been much more severe. This had created a huge demand for children to be seen by healthcare professionals, on top of the winter pressures. Some of the infections and illnesses seen this year had been more virulent than usual, which may be as a result of reduced circulation during lockdown. It was noted that over the last few days the numbers of people attending the PRUH ED and UCC had been returning to more normal levels, however this may change as children returning to school could have an impact on viruses spreading.

Another Member noted the comments made regarding the prevalence of Strep A being unexpected and enquired what could be learnt from this. The Bromley Executive Lead said this was something that was difficult to plan around – what they must do was stay alert to further outbreaks, with children returning to school and the usual increase of cases occurring in the spring. There had been a shortage of liquid antibiotics due to huge demand and the UK Health Security Agency had asked for there to be a low threshold for prescribing them during this period. Other ways of managing this issue had been considered as well as how quickly supplies could be received. They had quickly set up some specialist paediatric care hubs to see children which helped to absorb a lot of the workload. Paediatric registrars had also been used at the treatment centres to increase capacity and expertise. The Assistant Director highlighted that the Bromley system was nimble and had structures in place to set things up quickly if required.

In response to a question regarding the number of care home beds, the Assistant Director for Integrated Commissioning said that they wanted people to be cared for at home wherever possible – this could be increased by the use of assistive technology and wrap around care, and further capacity would be brought forward this year. There were also Extra Care Housing schemes, and they would look to put further step-down schemes in place to provide support in the community. In terms of procuring beds, it was noted that there were sufficient beds available, but the issue was affordability. Two admission avoidance beds had been contracted in a care home for a short stay before patients returned home, and step-down beds had been commissioned on a similar basis. Over the next couple of days they also hoped to secure 16 beds which would be available until March. Work had been undertaken on a market sustainability plan for the coming year, with additional government funds used to support the market.

With regards to the Additional Hospital Discharge Fund, the Assistant Director advised that £2.314m had been received from NHS England (ICB - £1.322m and LBB - £992k). The funding was ringfenced to fund activity associated with hospital discharge only and was required to be spent on actual activity between 19^th December 2022 and 31^st March 2023. It was noted that commentary had been provided regarding the strategic challenges in the system and how the money had been allocated. The Assistant Director advised that this funding was non-recurrent. They did not want to inject money into the system and destabilise the future market, and put more pressure on the system – however they were getting as much value out of the funding as possible.

In terms of governance, the national announcement had been made in September, but details were not received until early December – there was then a two-week turnaround to draft a submission and present it to the Health and Wellbeing Board. The comments received from the Chairman’s sign-off had been provided in the report, and the plan had been submitted to NHS England on 19^th December 2022. It was noted that updates on the spend would be reported to the Health and Wellbeing Board as part of the Better Care Fund arrangements.

In response to questions, the Director of Adult Social Care advised that feedback had been provided via the Local Authority and Association of Directors of Adult Social Services (ADASS) stating that it was unhelpful to receive short-term money, at very short notice, as these were longer term issues. It had also been flagged that the funding related to hospital discharge but as a system they wanted to undertake work to prevent hospital admissions. It was noted that work relating to a permanent housing shelter in the borough could  be picked up with colleagues in the Housing Directorate.

The Chairman highlighted that a huge amount of planning that had been undertaken and noted that the system had stood up well despite the challenges faced. On behalf of the Sub-Committee, thanks were extended to officers and partners for the work undertaken and the update provided.

RESOLVED that:

i.)  the verbal feedback provided on the systems response to Christmas and New Year winter pressures be noted; and,

ii.)  the Hospital Discharge Monies submission to NHSE, as agreed by the Health and Wellbeing Board, be noted.