Agenda item

To receive a briefing that describes the actions taken by the Health and Social Care system to prepare for and respond to winter

(1)       Ms Ford introduced the report which described the actions taken by the health and social care system to prepare for and respond to winter.  Ms Ford said that over Christmas and New Year in 2014/15 there had been severe pressure on the health and social care system; the key vehicles for winter preparedness and response were the systems resilience groups established in 2014; and the report provided a summary of the high level assurance that was now in place.

(2)       Ms Ford drew particular attention to: the System Resilience Group Assurance ahead of winter; surge management plans and exercises; the winter communication plan to reduce pressure on frontline services; and the winter resilience room that had been in operation between 17 December 2015 and 29 January 2016.

(3)       Ms Ford also said that the industrial action by junior doctors planned for January had been postponed and might take place in February. 

(4)       Each of the CCGs provided an update on the experience over Christmas and New Year 2015/16. 

North Kent

(5)       In north Kent, as predicted, there was increased pressure, particularly on acute services, over the Christmas period.  The Darent Valley Hospital held up last year.  This had continued in many respects this year, however, there had been deterioration in the Accident & Emergency position despite a reduction in activity levels.  SECamb had seen an increase of 9% in the total number of calls received and the emphasis on “see and treat” and “hear and treat” had contributed to a 1% reduction in conveyance rates to the Darent Valley Hospital. The number of ambulance conveyances had reduced from an average of 450 per week for the first 2.5 weeks of January 2015 to an average of 400 for the same period in 2016.

(6)       It was considered that problems were likely to be the result of intra-hospital pressures and work was underway to understand the reasons. Efforts were also being made to understand the reasons for the increase in Delayed Transfers of Care from 1.7% in November/December 2015 to 2.74% in January 2016.

(7)       Primary care and ambulance services had coped well across DGS and Swale with providers of the out of hours service being able to fill all shifts; the 111 service had also coped well particularly as 50% of calls from Yorkshire and the north of England had been re-directed to the south as part of business resilience plans in response to flooding.

(8)       Ms Davies also said it was worth noting that the A&E Department at the Medway Hospital had remained “green” in the two weeks to Christmas and was one of the last hospitals nationally to declare “black” on 5 or 6 January 2016.

(9)       Overall, primary care, community services and the out of hours service were robust and had performed well, while there were lessons to be learned in relation to acute services.

West Kent

(10)     Admissions to hospitals in Maidstone and Tunbridge Wells had remained level with a normal seasonal increase in the number of long stay patients which put more pressure on beds.  The emphasis in the A&E Departments was to find beds quickly for those who needed to be admitted.   In addition to some delayed transfers of care to social services, there were issues relating to nursing and care home capacity in West Kent and the potential need for accommodation with doctor oversight particularly for those who required rehabilitation and re-ablement services but not the full services of an acute hospital.

East Kent

(11)     Ms Carpenter said that East Kent’s performance had to be considered in the context of on-going activity including “discharge to assess programmes” that had been in place since October 2015; the A&E recovery plan; and work continuing in primary care to reduce hospital admissions, particularly, among the over 75’s.  East Kent Hospitals University Foundation Trust had an 82% bed occupancy rate on Christmas Eve but the position deteriorated from New Year’s Eve onwards especially at the Queen Elizabeth, Queen Mother Hospital as a result of significant staff sickness and the lack of agency staff on shifts. 

(12)     Footfall in primary care had been lower than predicted between Christmas and New Year but had been higher in A&E.  Work was underway to understand why this was the case and to ensure people were sign posted to the correct service or capacity was provided where it was required.

(13)     The System Resilience Group in East Kent was now well placed to take forward the A&E Recovery Plan and there was now a clear focus on being prepared for the half-term holiday in February. 

(14)     Dr Jones drew attention to work that was being done collectively to: avoid unnecessary admissions to hospital; manage the flow of patients through the hospitals; and avoid delayed transfers of care.  The capacity of primary care during the day was satisfactory but there was a need to recognise capacity issues arising from seven-day working.

(15)     Mr Ireland said that there was a greater collective focus on sustainable ways of supporting patients to be in their own homes, however, there were acute pressures on workforce supply in the social care market as a whole and particularly on homecare.  Integrated care responses would continue to be developed.

(16)     Mr Scott-Clark said that the flu rate, monitored by Public Health England was half the rate at the end of week 2 compared with the same period in 2015.  However the prescribing guidance on anti-virals had been instituted in the last three weeks and this was triggered when flu rates were higher nationally.  He also said that outbreaks of flu were being reported in primary schools but this could be due to increased vigilance.

(17)     In response to questions, Ms Ford said that the industrial action taken by junior doctors had excluded urgent and emergency care and had affected elective activity.  Trusts were now seeking to recover from this.   The impact on services would be much greater if there was a full walk out and plans were being made to keep emergency care pathways open.

(18)     Resolved that the report and updates be noted