Agenda item

10:45

The Winter Plan 2017/18 was presented to this Committee in November 2017 and an evaluation considered by this Committee at the last meeting in June 2018.

This report (JHO7), prepared by the Systemwide Winter Planning Group and approved by the Integrated System Delivery Board, follows up on the evaluation regarding the subsequent effectiveness of the Plan, as requested by Committee at its June 2018 meeting.

This item will also outline the Winter Plan for 2018/19 which will include learning from the previous year(s).

The Committee welcomed the following representatives to the meeting:

-       Louise Patten and Diane Hedges, Chief Executive and Chief Operating Officer, Oxfordshire Clinical Commissioning Group (CCG)

-       Tehmeena Ajmal, Winter Director for Oxfordshire, (joint appointment for Oxfordshire health and social care system)

-       Pete McGrane – Acting Clinical Director, Operations Services, Oxford Health NHS Foundation Trust (OH)

-       Ross Comett – Head of Operations, South Central Ambulance Service (SCAS)

-       Kate Terroni, Director for Adult Social Services, Oxfordshire County Council (OCC)

-       Rachel Piri, Lead for Older People Commissioning Mkts, OCC

Diane Hedges gave a presentation on the 2018-19 Oxfordshire System Winter Plan, together with a summary on what worked and what didn’t work in relation to last year’s Plan. She took the opportunity to introduce the newly appointed Urgent Care Director, Tehmeena Ajmal, who worked to the Chief Executives of OUH, OH, OCCG, SCAS, GP Federation and the Director of Adult Services, OCC, co-ordinator of a Team from all these organisations on a demand/capacity dashboard. This would hold information updated on a day to day basis and sometimes on an hour to hour basis, looking at, for example, how many people were waiting to be admitted, or how many were waiting for an ambulance, so that actions could be taken quickly and patients were supported appropriately through the Winter period, enabling them to recover quickly. Following a review of last year’s Plan it had been found that:

·         too much time had been spent on the delayed transfers of care and insufficient attention given to caring for people in their own home;

·         emergency care and Out of Hours did not necessarily co-ordinate or plan ahead on what may be needed on a day to day basis;

·          there was duplication in some areas where three teams were working together – more time with people was required rather than excessive geographical travel.

Tehmeena Ajmal had discussed with Healthwatch Oxfordshire and provider and third sector organisations on how to keep people safe and well and how to work together to ensure there were plans in place for people to receive help when needed, for example for volunteers to go to the shop for the basics, such as milk and bread.

In relation to risks, she added that it was important to ensure that influenza inoculations for front line staff were begun earlier. Also, during inclement weather it was important that each organisation had an instant plan which would ensure that they had sufficient capacity to look after people in their own homes. She was also looking to ensure that nursing staff and therapists could respond quickly when they were needed and with no gaps, by creating overall system plans. There was also a series of projects to best help people to stay at home. Each organisation was asked to identify what could be done with the funding in order to respond to the Winter Plan. This confident style approach enabled the Team to use resources most effectively. She emphasised that hospital beds were available when required.

Diane Hedges informed the Committee that £700k had been set aside by the Better Care Fund Joint Management Group for winter pressures, funded by OCC and the OCCG. There was also an additional level of improved capacity, for example, the preparatory work which was being undertaken with pharmacists and the Out of Hours service prior to the onset of winter.

Kate Terroni was asked to explain further how this new system would work, given the DTOC statistics and despite the excess demand for beds which had been forecasted. She explained that there would no longer be a monthly update, there would be a weekly email summary of exactly what the position was alongside weekly capacity demand. It would in future be a collective decision made by all the Chief Executives to ensure delivery. Sara Randall added that this new process gave a good sense of the current position and what was required for the following week.

A member asked if there was sufficient capacity for those people in domiciliary care who were not on the Health pathway, but who required a bed. Kate Terroni responded that early on in the process she had sat down with the providers and looked at what the allocations looked like at local level and if there was additional capacity to help specifically with winter pressures. She added that she had also been working with providers on a wider basis and had confidence with the joint planning which was taking place. She was also working with third party providers. In addition, a review of short stay beds had taken place to help avoid admission to hospital and looking at the range of options available to people.

A member made a plea for a clearer and easier to understand explanation of the additional projects and how they tied up with the whole.

When asked if there were sufficient staff/ambulances strategically placed throughout Oxfordshire to cater also for people living in the rural areas, Ross Comett responded that they were strategically placed in Adderbury, Kidlington, Oxford and Didcot. They were also placed at standby points and at the main hubs across the county in Wallingford, Abingdon and Bicester. They were controlled centrally in Bicester and were able to be despatched at a constant flow. There would be an array of back fill for any gaps in provision in the form of first responders, with defibrillators, and with the Fire Service. Moreover, there were sufficient ambulances and crews and the service was forecasting for additional staff and reviewing rostas in anticipation of the growing demand. Pete McGrane added that part of the learning process had been that the systems that did well were those that were actively working with the 111 service so as to deploy ambulances in places where they were really required. If this was to be put in place and it could be assured that sufficient ambulances were able to attend, this would not then place undue stress on the service.

A member asked if the ambulances would be suitably equipped to manoeuvre around the narrow roads in the rural countryside, particularly in winter weather conditions. Ross Comett responded that the normal ambulances were very heavy which gave better traction on the roads. There was also a fleet of four by four vans manned by officers who were clinically trained. In times of heavy snowfall or heavy rain where roads were no passable, Fire Service responders, mountain rescue services and air ambulance were also deployed to get help to people.

A member asked how would the necessary supply chain work for patients being cared for at home during adverse weather. Tehmeena Ajmad responded that her team was working with the hospital on the use of nurse practitioners who would bring the appropriate equipment out to the home environment. In addition, Oxford Health was giving a lot of thought to ensuring a quick response. Sara Randall also explained that the Trust had worked with NHS England after 5.3% of bed occupants had been victims of the flu virus last year (which was more than the average of 4.1%). To this end the Trust was ensuring wide advertisement of flu vaccines for patients and staff to cover the winter pressure period.

Tehmeena Ajmad was asked if she had a ‘Plan B’ if the gap should widen in relation to the sufficiency of beds in January. She explained that the Team had been working through various scenarios to ensure a speedy response in the provision of additional capacity where required; and one of the things she was focusing on was how to create more capacity for patients to go home as soon as possible. This was in the form of additional nurses and therapists, as a patient’s health decreased if they remained in bed for too long. She was also looking at creating capacity for more beds, if required, during the winter pressure period.

Pete McGrane was asked if it would be more beneficial if a patient, who was unable to be treated at home, was moved from an acute bed to a community hospital, rather than staying in the system. He responded that in the past this was deemed the best solution, however, it prolonged hospitalisation which was detrimental to patient outcomes. This was the clinical experience every day, particularly for a frail patient, with complex health problems. Furthermore, the process of disruption could also prolong their stay in hospital with one week in bed equating to 10 years loss of muscle function. It could also affect people socially. Thus, from a clinical point of view it was important not to take patients into a community hospital setting, but to put them into the right place.

In response to some Committee members remaining unconvinced of the reasoning behind the assurances given that increased demand for services could be managed effectively, Pete McGrane stated that it was important for the Team to understand which parts the Committee was unhappy with. To this end he offered to return to a future meeting to talk through what could be put in place in relation to Plans C and D.

In response to a question about what facilities were available for older people to obtain their flu jab, Diane Hedges stated that the take-up had been good last year, but this was still deemed not sufficient as more were claiming the jab this year. The OCCG was looking very proactively with the NHS at some possible options, one of which was for pharmacists to undertake the injections and another for eligible patients to receive a text message where possible. She added that the OCCG was also monitoring those GP practices who did not perform as well last year to ensure all patients received their jabs. She explained that there were also issues with supplies of vaccines not getting to some practices.

With regard to a question about whether there was sufficient GP availability across the practices, Diane Hedges responded that the OCCG was still working on directly slotting in GP hubs into the 111 service, and also on enhancing the availability for GP appointments. At the same time the OCCG was also working on resourcing more primary care so as not to de-nude the in-house scheme.

Diane Hedges confirmed that there would be a larger number of community hospital beds available on a short-term basis in recognition of the fact that during the period of winter pressures they would be needed. She explained that the OCCG did not contract on beds, but on the number of episodes. In past years a whole range of beds had been available, some of which lay empty. There was a need for greater and better usage of beds available, therefore greater bed capacity.

In response to a further question about whether the OCCG/Trusts were looking at community beds on a county, not local capacity, Sara Randall explained that each morning there would be a meeting which would take place to decide where was the best place for each person to go. This would be led by OUH, OH and Social Care based on the needs of the patient and the needs of the whole family.

The representatives were thanked for the report and for their attendance.