Agenda item

Matthew Drinkwater (Head of Emergency Preparedness Resilience and Response, NHS England – South (South East)), Mark Atkinson (Head of Urgent Care, NHS West Kent CCG), Bill Millar (Chief Operating Officer, NHS Ashford CCG and NHS Canterbury & Coastal CCG) and Julie Hunt (Director for Performance Delivery, NHS Dartford, Gravesham & Swanley CCG and Clinical Programme Lead for Community Services, NHS Dartford, Gravesham & Swanley CCG and NHS Swale CCG) were in attendance for this item.

(1)       The Chairman welcomed the guests to the Committee. Mr Drinkwater outlined the actions that were being taken across the health and social care system in Kent to prepare for winter. He stated that there were four Systems Resilience Groups in Kent & Medway: East, North, West and Medway & Swale. Kent County Council was a core member of each of these groups. NHS England had developed a South Surge Management Framework to ensure a consistent standard of plans; NHS England required all Systems Resilience Groups to prepare Surge Management Plans that were aligned to the Framework. NHS England had conducted a table top exercise with each Systems Resilience Group and presented them with feedback to ensure that lessons identified were learned ahead of winter. There was a national ‘Stay Well This Winter’ campaign  to ask the public to protect themselves as the cold weather sets in, by staying warm, stocking up on prescription medicines or checking in on friends and neighbours and taking up the offer of a seasonal flu vaccination,  which was  supported by Kent County Council. He noted that there were high rates of Delayed Transfers of Care at some NHS hospital sites in Kent and further work was required.

(2)       Members of the Committee then proceeded to ask a series of questions and make a number of comments.  Members enquired about Delayed Transfers of Care. Mr Drinkwater explained that Delayed Transfers of Care were a particular challenge at Maidstone and Tunbridge Wells NHS Trust where 7% of patients who were medically fit for discharge were still occupying an acute bed; in comparison to 3 – 4% in other areas. Mr Atkinson stated that the main reason for delay was patient choice with family members coordinating and finding a suitable place for their relatives. Discharges at the Trust had improved with the introduction of an Integrated Discharge Team which included KCC Social Workers to assist with transfers and the purchase of commercial beds. The Trust was also working with Age UK who provided a Home and Settle service to prevent readmission which had been commissioned using winter resilience money. He noted a further area for promoting the efficiency of discharge and throughput through the hospital was a reduction in the length of stay. He highlighted that the difficult winter period was to come and that as social care started to reduce, services would need to be realigned to promote discharge.

(3)       In response to a question about pandemic flu, Mr Drinkwater explained that NHS England had carried out a deep dive review of pandemic flu plans which had been tested by a table top exercise. NHS England was participating in a national pandemic exercise in February 2016. He noted that a pandemic was a ‘rising tide’ event such as swine flu and there would be several weeks’ notice before its arrival to the UK. He reported that the flu vaccine had been expanded to children via a nasal spray; he explained that children were the main transmitter of flu to the elderly.  Mr Scott-Clark added that the vaccine was the best way to prevent flu and reduce pressure on the NHS. He stated that community pharmacists were offering the vaccine for free to those who met the NHS criteria.

(4)       Members enquired about winter staffing and ward closures. Ms Hunt reported that no wards would be shut over Christmas at Darent Valley Hospital; the Trust had already opened 40 escalation beds to increase capacity. She reported that elective surgery would continue as normal except over the Bank Holidays and no leave could be taken over and above entitlement. She highlighted that the most dangerous period was after Christmas and New Year, additional resources and step-up plans were in place for 2 January onwards. She stated that there was good medical cover with doctors in A&E but there were shortages of nurses in community hospitals; Kent Community NHS Foundation Trust had appointed nurses from Spain who were trained to a higher acuity than UK nurses and moved onto new organisations quickly. She also reported staffing shortages in domiciliary care; staff recruited on 0 hours contracts were under no obligation to work over Christmas and the New Year.

(5)       The Chairman invited Mr Inett to speak. Mr Inett stated that Healthwatch Kent had reviewed each Trust’s winter care plans and would be carrying out Enter & View visits to A&E departments in the New Year. Mr Inett enquired about assessment of elderly patients. Mr Millar reported that CCGs in East Kent had been working with GPs and community groups, using winter monies, to identify patients aged over 75, who were at risk at being admitted, to keep them at home or if admitted get them home quickly with additional support due to the improved outcomes at home. Schemes using winter monies included an Integrated Discharge Team and incentives for GPs who monitored at risk patients more closely.

(6)       There were a number of questions about winter monies and the planned junior doctors’ strike. Mr Drinkwater confirmed that operational resilience funding had been shared with CCGs as part of their baseline allocations. Mr Drinkwater stated that there were national and local plans in place to cover the three days of planned strikes. He reported that a full review would be carried out after the first day of strikes to prepare for the second and third strikes.

(7)       RESOLVED that the report be noted and NHS England be requested to provide an update about the performance of the winter plans to the Committee at its April meeting.