Agenda item

Dan Leveson (BOB ICB – Place Director, Oxfordshire), Lily O’ Connor (BOB ICB Programme Director Urgent and Emergency Care for Oxfordshire), Dr Ben Riley (Executive Managing Director- Primary, Community and Dental Care at OH), Lisa Glynn (Director of Clinical Services OUHFT), and Victoria Baran (Deputy Director of Adult Social Care), have been invited to present a report on Winter Preparedness.

The Chair welcomed the following invitees; Dan Leveson (BOB ICB – Place Director, Oxfordshire), Lily O’ Connor (BOB ICB Programme Director Urgent and Emergency Care for Oxfordshire), Dr Ben Riley (Executive Managing Director- Primary, Community and Dental Care at OH), Lisa Glynn (Director of Clinical Services OUHFT), and Victoria Baran (Deputy Director of Adult Social Care) to present a report and answer questions on readiness to respond to the increased demands on the health and social care systems over the winter period. .

The ICB Programme Director for Urgent and Emergency Care (Lily O’ Connor) summarised the following points to the committee:

1.    There had been immense work with all Primary Care partners to develop a more integrated approach with additional resources added to help them manage frail or complex individuals in their own homes.

2.    There was an OPEL (Operational Pressures Escalation Levels) framework and process that is utilised to assess whether existing demand is being met, with scorings from 1 to 4. The ICB was working with SCAS, Oxford Health, Oxford University Hospitals and the local patient transport service as part of this OPEL framework process.

The following points were also provided by the Executive Managing Director- Primary, Community and Dental Care at Oxford Health (Ben Reily):

1.    There was a need to simplify the complexity for people to understand the services available to them.

2.    Prevention was a key principle, to preclude surges of demand, both within the winter as well as in other seasonal periods.

3.    Community services were being pulled together to ensure that there was one single team to call when patients require help, who could then arrange the appropriate response and prevent patients being passed around; this work was a key element of the projects around the single point of access.

4.    There needed to be clarity regarding the right place to go when needing to be seen by a professional. People were finding it difficult to access care, walking into different services such as a minor injuries unit or Accident and Emergency, only to be informed that they have to go elsewhere for help after having waiting for several hours.

5.    It was important that there were staffing resilience measures, and it might be necessary to think about how to pool and organise staffing on a wider scale to avoid abrupt closures of services caused by staff absences. 

In referring to the development of a support structure to integrate local community services, the shape and nature of the resultant services was queried, particularly how they would operate at a community level.

The point was made that it was important for transparency that HOSC and the public knew which areas tended to be rated OPEL 3 or 4 and were thus under greatest pressure. More information on where the greatest risks lay within the system was requested.

The ICB Programme Director for Urgent and Emergency Care explained that SCAS were declaring OPEL 4, and could declare this during the evenings and during the night hours; this required good communication with the acute services (John Radcliff and Horton Hospitals) to help ensure timely ambulance handovers. Considerations would also be made as to whether any other additional resources were required by Emergency Departments to free up ambulance crews and reduce ambulance OPEL levels. Within community services, district nursing was under continuous pressure, and in some areas of district nursing there were some vacancies arising on a daily basis. Even in some areas that are fully staffed, there existed the possibility that demand could outstrip capacity owing to the needs of local populations.

The ICB Programme Director for Urgent and Emergency Care also specified that in relation to the acutes, an OPEL could mean any of the following:

1.    The number of people in an emergency department waiting to be seen.

2.    The number of intensive care beds available.

Consequently, risks across the system varied, but SCAS did consistently tend, to experience risks that escalate in the evening and night hours. Work was underway to determine how people who could be treated at home might receive care at home without having to be admitted into hospital.

If any provider within the system were to fall under the category of OPEL 4, there would be regular meetings at frequent intervals of approximately every two hours in an attempt to identify what the causes of the OPEL 4 were, and to devise and implement mitigations across the entire system to bring any relevant provider down from OPEL 4 as swiftly as possible.

Every effort was made to ensure that the system did not wait until demand rose, but took measures as far in advance as possible whenever it was anticipated that demand would increase. This logic would also apply to junior doctor strikes.

It was asked how urgent treatment centres could be optimised so as to cope with a potential increase in demand. It was explained to the Committee that there is an Urgent Centre on the Horton site, which worked very well with the out-of-hours service from Oxford Health. Another Centre located on the John Radcliff site is run by Oxford City Primary Care. When respiratory issues or Strep A incidences occurred, these Urgent Centres supported Primary Care; they had seen children, adults, and all-age patients when Primary Care struggled to meet the demand. Had these patients not been seen by Urgent Centres, they would more than likely had ended up attending Emergency Departments. Hence, such Centres could flex very rapidly and bring in extra resource (including additional locum GPs) to address increased demand. Out of hours services tended to experience increased demand related to respiratory illnesses, particularly in the winter months. Reference was also being made to the cyber attack which led to an IT outage for a significant period of time, including to the Electronic Patient Record System; one of the benefits was that there was an opportunity to redesign data systems in a manner that allowed data to be used to proactively predict what staffing levels were required to match demand. The ambulance service also made use of this form of data prediction. Immense work was taking place with the Community Information Network, and that there are also fantastic winter communications being made; including the use of ‘buddy systems’ for moments where a resident may feel particularly unwell.

A further query concerned whether there was sufficient resource for mass Flu and Covid vaccination campaigns. It was explained that there is an increased confidence in how the vaccines could be delivered effectively, and that this was becoming business as usual. The structures were in place, and the system was responding to calls for vaccination campaigns. However, in counterbalance, it was also noted that there remains the tendency for ‘vaccine fatigue’. In spite of this, it was highlighted that despite variations in the uptake of vaccines, there was still positive progress that was being made, particularly around engagement with the public over vaccines.

In respect to vaccines, Healthwatch had received some phone calls regarding residents over 80 not being able to receive Covid vaccines, or not being able to travel to where they were being informed to go to.

It was queried as to how the system would be reaching out to BAME communities, and the purposes that this outreach will be utilised for. It was explained to the Committee that this was a comms programme, where a lot of work had been undertaken with different communities and religious groups regarding how to access healthcare services. There were also other projects looking at deprived areas in Oxfordshire, thinking about how to get messages to them, but also how to have medical assessments organised for hard-to-reach groups. Considerations as to what could be done to increase and improve communication with hard-to-reach groups about service availabilities as well as how to live healthy lifestyles were also being looked at.

The Committee emphasised the importance of communications campaigns to convince certain population groups and communities about the safety as well as the significance of taking vaccines, including for Covid-19.

The Committee then explored that given that emergency departments may not be the most ideal destination/location for those suffering a mental health crisis, what alternative options would be provided for such patients. The Committee also enquired as to how the potential existence of safe havens would be communicated to patients or ambulance staff. It was responded to the Committee that there is immense confidence in the NHS 111 and 999 service for mental health, and that there was a well-integrated service for mental health. Although it is not always safe havens that are the appropriate solution for mental health crises. The most important aspect was having a good crisis-response across Oxfordshire so as not to have exclusive reliance on safe havens, as it might be more appropriate to support patients experiencing a crisis in their own home. Furthermore, mobile units were also being explored for mental health patients, so that people could be seen at home without having to resort to attending Emergency Departments.

Further questions were raised over how the mental health of staff would be supported throughout the ensuing winter months, particularly given that pressures and demand often increase during such periods. The Committee was advised that measures were being put in place so as to support the wellbeing of staff, and that Oxford University Hospitals, have a ‘People Plan’, which is a plan to support staff overall. There were also wellbeing leads, as well as psychological-support services being offered to staff. Cameras were also being utilised to prevent or monitor abuse towards staff.

It was queried how the system would balance the need for efficient and swift discharging on the one hand, with adequate care and support for patients on the other. The Chair also asked how it would be ensured that there is a consistency in the criteria utilised for assessing when and how patients should be discharged. It was explained that the process over discharge was often multi-disciplinary, and that patients actually tended to want to be discharged as swiftly as possible. Therefore, the discharge to assess process ensured that once patients were medically optimised in a manner that would enable them to return home, the transfer of care hub would look at all relevant information to ensure that being at home would be the most appropriate measure to take. Reablement support was also being maximised to allow people to receive support at home. Patients should not be held unnecessarily in hospital beds, as this is not conducive to patient recovery or to the mental spirit and wellbeing of patients who do not have to remain stuck in hospital settings. However, when patients are clearly not ready to be sent home due to not being medically optimised, then every effort would be made so as not to hasten their discharge. Step Down beds could also be used where relevant in Care Homes.

Finally, it was queried whether there were any ensuing plans to close any additional community hospital beds in other areas around the County, and the Committee asked to be kept updated of this if there were any such plans, now or in the future. The Committee was assured that no such plans existed at present.

The Chair concluded the item and thanked the invitees for their attendance and overall contribution to this item on Winter Planning.

The Committee AGREED to finalise a list of recommendations outside the meeting, and to subsequently submit these.

It was also AGREED that should pressures increase on the system significantly during the ensuing Winter months, that HOSC would receive an informal briefing on this; particularly if pressures were to increase beyond what was expected by the system.