Agenda item

Report ACH23-041

The Board consider a report outlining the ONE Bromley Winter Plan 2023-24.

The ONE Bromley system developed a Winter Plan each year which described how seasonal pressures would be mitigated and managed locally. The Winter Plan built on learning from previous years, and responded to any new national policy change and local system changes since the previous plan. The co-ordination and delivery of a joint Winter Plan placed Bromley in a strong position to respond effectively to the changeable position through winter. The joint plan set out how local services would be arranged, expanded, flexed and work together to meet the pressures experienced throughout the period and manage risk as a system. Through this residents would be supported to make the most cost-effective and sustainable use of joint resources, while enabling better outcomes and ensuring they were able to provide services for the most vulnerable.

The Associate Director – Urgent Care, Hospital Discharge and Transfer of Care Bureau, SEL ICB (“Associate Director”) advised that the 2023-24 Joint Winter Plan described how health and care services across Bromley would organise themselves and work together to ensure local residents were able to access the services they needed and stay well throughout winter. The Plan was set out in two sections:

Section 1 – described the work that would take place before winter to reduce risk to vulnerable residents; and,

Section 2 – described, under the 3 pillars of winter planning, the activity that would take place during winter to increase capacity across key health and care services, manage the impact of seasonal pressures and viruses and maintain oversight to manage the system throughout.

Engagement with a wide range of stakeholders had taken place to inform the Plan with specific, special interest working groups set up around key themes to develop the plans in these areas. Workforce engagement had also taken place throughout the development of the Plan including engagement of primary care, community health providers, social care workforce and providers and the voluntary sector.

The Bromley Place Executive Lead highlighted that this was a partnership piece of work to manage winter and some schemes would be expanded to ensure that residents and patients had a good flow through the urgent care pathways. Board Members were advised that, in terms of discharge arrangement, Bromley was performing the best in London. Over the last few months there had been a significant reduction in ambulance delays at the PRUH, which reduced waits for patients, and it was hoped that this would be maintained throughout autumn and winter.

The Associate Director noted some of the key additionality for this winter:

-  bigger net increase in primary care and GP appointments;

-  increased availability of all hospital discharge services and improving their connectivity;

-  increased focus on respiratory conditions (a more robust pathway from diagnostics, proactive management and responsive support);

-  paediatrics – additional GP capacity (particular focus on proactive communications, building the confidence of parents to manage children’s illness over the winter);

-  children’s Hospital@Home Service to also accept referrals from GPs; and,

-  a more proactive approach to information sharing, communication and engagement, targeting particular groups of individuals/communities.

A Member highlighted that as patients were being discharged from hospital quicker, with more complex needs, this had an impact particularly on social care workers and domiciliary care provision. The Associate Director said that the successful performance around hospital discharge was underpinned by the robust local domiciliary care market, which was incredibly responsive. The Bromley Place Executive Lead advised that although they were not seeing huge increases in discharges those patients’ leaving hospital had more complex issues. They often had longer stays in hospital and needed more interventions after they left. It was noted that the virtual wards in the community were working well. These patients were still very vulnerable having been through the virtual ward system and they were looking to ensure they had an extra layer of support after they received interventions at home, as they were at a greater risk of being readmitted to hospital.

A Board Member suggested that the ‘catch it, bin it’ campaign posters could be displayed on buses again as part of communications element. It was also noted that the report stated there was no impact on the local economy, however if the winter plan was successful it was considered that it would have a huge impact on the local economy. Another Member agreed, and suggested that working days not being to sickness could be a measure.

Councillor Colin Smith left the meeting at 2.00pm.

In response to a question regarding additional same day GP appointments being scalable and responsive to seasonal demand, the Associate Director advised that the strong GP Alliance ran the additionality. It was noted that these appointments were held at times when practices were not traditionally open and therefore the existing workforce provided the additionality – GPs could cover locum shifts at the four hubs across the borough. It was agreed that figures on the increase in GP appointment capacity could be circulated following the meeting. In response to a question from the Chairman, the Bromley Place Executive Lead advised that GPs were taking a more proactive approach to patients with chronic diseases – ensuring that these patients were as good as they could be prior to the start of winter. There were clear escalation points and putting time into these patients early would save on additional appointments later on. It was noted that a large proportion of the primary care workforce did not work full time and there was the capacity to expand their clinical sessions.

A Member enquired what support was in place for GPs who stepped up to cover additional appointments. The Bromley Place Executive Lead said that there were a number of initiatives where staff could get help and support if they were feeling stressed, both at a SEL level and nationally. It was noted that the ICB supported practices, rather than individuals – the winter period had a strain on all health professionals, not just GPs. Staff were asked to be sensible, and it was a duty of GPs to ensure they took care of their own health. The Bromley Place Executive Lead said she would enquire if the primary care team could provide any further information on the support available.

The Chairman enquired as to when the additional 16 beds at the PRUH would be instated. The Interim Site Chief Executive advised that this was likely to be in January 2024. It was highlighted that the work undertaken in relation to the winter plan was a fantastic joint partnership effort. It would likely be a challenging winter with the usual issues plus the extended industrial action. Anything that could be done to support the flow through the hospital and in the community was very welcomed.

The Chairman asked for an update in relation to the vaccination programmes. The Bromley Place Executive Lead advised that the vaccination programme had been brought forward, starting last week. There were 23 pharmacies across the borough delivering flu and COVID-19 jabs, and the Health Hub in The Glades had been reopened. GPs were delivering vaccinations to their housebound patients and the care homes programme had also commenced the previous week. Work would also be undertaken to look at inequalities and pop-up vaccination clinics would be held in different locations. It was noted that GP practices had also started their flu campaigns. In response to a question from a Board Member, the Bromley Place Executive Lead said that a pop-up vaccination clinic had previously been held in Mottingham and there would be the ability to do so again.

In response to a question from the Chairman regarding COVID-19 rates, the Director of Public Health said these had gone up both nationally and locally – they did not have accurate data as there was no longer a requirement to test for COVID-19, but hospital data and admissions indicated an increase. Board Members were advised that there was a new variant, but only a small number of cases had been identified in the UK. This variant had lots of mutations, and was a different strain – it was too early to say if it would be a more severe disease and therefore vaccination was important.

The Chairman thanked the Associate Director and Bromley Place Executive Lead for their update to the Board.

RESOLVED that the ONE Bromley Winter Plan 2023-24 be endorsed.