Agenda item

To receive an update on the approach being taken by all statutory agencies across the Hampshire and Isle of Wight geography to prepare for winter 2019/20.

Representatives from the three acute systems presented a report on winter planning in Hampshire and the Isle of Wight.  Members heard:

Work has been undertaken all year for health and social care systems due to an increase in pressures in both attendances and complexity on an annual basis.  Implementing sustainable changes and not staying passive or static by looking and learning lessons from painful experiences is critical to collaboration and success.     

The Sustainability and Transformation Partnership challenge lies in becoming co-supportive in terms of fundamental aspects, capacity issues, and adequate resources.  The goal is to stop people from deconditioning and deteriorating prior to acute crisis, as bringing vulnerable elderly people to hospitals is more detrimental.  Prevention or short visits are the priority.  Additional resources must be used to change the balance of how challenges are addressed.  

In the health economy, the emergency department serves as a barometer for the hospital and lack of primary care, pharmacy advice, etc. all contribute to attendance.  Hospital flow is a necessity for safety and requires a multi-factorial approach and obsessive drive affecting the length of stay, timeliness of advice and discharge.  For the frail vulnerable elderly, long stays are harmful - keeping everyone safer in their own residences continues to be the goal.   

Acute mental health issues have continued to grow for acute systems and require further and continued focus and investment.  Evaluating and addressing key risks through collaboration, such as potential issues with work force resilience, flu impact projections, escalation issues, policy and protocols, plans, etc. for a coordinated approach to address ambulance handover delays and severe weather functionality.

Understanding that access is a huge public expectation and ten-fold in primary care for same day appointments but unfortunately, resilience isn’t as good as it has been.  The “Choose Well” campaign and signposting to lower denominations of care is vital to balancing the public’s expectations versus needs as is working across boundaries.  The issues often start out in primary care and then are felt in acute hospitals.  

All local systems have plans in place but need to be realistic in managing the high-risk workforce by addressing vacancies in critical roles, additional staff on call, increasing the uptake of flu immunizations, etc.  While often constrained by national workforce challenges in recruitment, recent efforts to fill positions and being creative and flexible have been successful though specific skill sets remain hard to find, fill, and retain. 

Flow through hospitals and social care capacity are issues, alongside the issue of patients medically fit for discharge, but delays can occur due to a combination of factors – transportation, prescriptions, step-down care, etc.  Proactive attention, focus, and actions are being taken on to reduce this as the pressures are now felt all year round with the additional impact of severe weather and flu.  

Plans are in place currently, but the concern is not Christmas and New Year social care provision, but the wave of demand from mid-January and the capacity to support people out.  Performance-wise this was the major issue last year and even flow is manageable, but a surge is a huge challenge.  Planning better and collective investment in getting people back into independent living is the ideal outcome.  

Communication has been coordinated across HIOW including a vast array of poster campaigns, local media, social media, radio, etc. to keep in touch and get the message out.  New technologies such as MiDoS helps professionals to help identify the most appropriate service and further development is being made to have more access at their fingertips which will be coming online and January 2020.  Public access could also be helpful and 111 is already available to everyone.

Efficiencies in the local resilience system (LRS) can be achieved through collaborating with the Hampshire Fire and Rescue Service (HFRS) to address weather challenges and ambulance delays.  Awareness of the downstream effort and community safety officers can help with capacity flow out of hospitals addressing risk being created elsewhere in the wider system.  Resources are available and it is best for colleagues to follow established protocols for ease of coordination for systematic access.

Queen Alexandra Hospital in Portsmouth have had significant issues with ambulance delays in the past, but over recent months have made immense improvements.  The risk does not lie in the acute systems alone but must be managed elsewhere in the wider system.  

Patricia Hughes left at this time.

Increasing capacity in primary and non-acute care with pooled resources and additional monies will create further capacity for support to deliver better results.  The majority of funding is not for acute systems.  Funding must address also the severe mental health crisis and defining the PCP to Acute pathway. 

Investment in primary care does not distract from multidisciplinary staff and assessments as there are a finite number of GPs and primary care staff.  To address pressures, the critical period must accommodate additional appointments.  It can be complicated and difficult for patients to know how to access the right service for their needs.

Collaboration between Primary Care Networks (PCNs) and acute colleagues across the divide would allow for better working.  Communication with public will help direct them appropriately and not just to the front door of the hospital.  The bigger picture for urgent and/or emergency care is a race to get everything in place, but the yearlong strategy is key.  

RESOLVED: 

That the Health and Wellbeing Board:

·         Noted the overview of the urgent and emergency care programme for Winter 2019/20 and the summary of each Integrated Care Partnership plan, which sets out key initiatives to manage increase demand over the Winter period

Meeting closed at 12:41pm.