Agenda item

Matthew Drinkwater (Head of Emergency Preparedness Resilience and  Response, NHS England - South (South East)), Pennie Ford (Director of Assurance & Delivery, NHS England – South (South East)), David Robinson (Lead Commissioning Manager - Urgent Care, NHS West Kent CCG) and Corrine Stewart (Assistant Director of Commissioning, NHS Dartford, Gravesham and Swanley CCG) were in attendance for this item.

(1)       The Chairman welcomed the guests to the Committee. Ms Ford began by providing an overview of the two papers. She explained that preparations for winter in Kent had worked well; although the health and social care system was challenged, none of the systems moved into whole system Black escalation. She noted that the systems worked well together and were able escalate and manage pressures locally which reflected the hard work undertaken behind the scenes. She reported that all systems including social care did escalation exercises in advance of winter to test their plans and further exercises were planned for the summer and autumn in preparation for next winter. She stated that NHS England had run Winter Resilience Rooms to monitor and support systems and manage data reporting. She noted that the spike in winter pressures was in February and March which was later than the spike before Christmas during the previous winter; work was being undertaken to prepare for next year’s spike. She explained that she was very grateful to all Trusts’ for their effective emergency planning and response during the periods of industrial action; the system had worked well. She noted that NHS England was waiting on the outcome of the BMA national ballot on the new agreement for the Junior Doctor contract.

(2)       Mr Drinkwater explained that there had been a national Winter Resilience Room in London, a regional Winter Resilience Room in Reading and a local Winter Resilience Room in Tonbridge. He explained that the local Winter Resilience Room in Tonbridge monitored pressure being experienced across the South East and allowed NHS England to support systems as required particularly in Surrey and Sussex during spikes. Mr Robinson reported that NHS West Kent CCG no longer planned just for winter; they were constantly reviewing services with partners. The CCG and providers had come together to reflect on the previous year and completed exercise scenarios. The CCG had also updated surge plans, membership and risk register of the local Systems Resilience Group. Daily conference calls with providers had taken place and designated leads were assigned which had improved relationships and communication. Ms Stewart explained that in North Kent workshops had been carried out with all providers to ensure the necessary escalation plans were in place prior to winter. Daily telephone calls with providers took place during the winter to enable the CCGs to understand and deal with local pressures. Workshops to refine the plan for the upcoming winter were planned. She noted that there were significant challenges throughout the year and the system was continually under pressure.

(3)       Members of the Committee then proceeded to ask a series of questions and make a number of comments. A Member enquired about the SAFER bundle. Mr Drinkwater explained that it was an evidence based system to improve patient flow which included senior clinical review. He noted that during the industrial action patient flow was more efficient as consultants were able to use their clinical judgement to discharge admit or patients.  Mr Robinson stated that SAFER stood for:

Senior Review

All patients would have an Expected Discharge Date

Flow of patients would commence at the earliest opportunity from assessment units to inpatient wards.

Early discharge

Review of patients with extended lengths of stay (over 14 days)

(4)       A Member asked about the impact of the mild winter on NHS services. Mr Scott-Clark explained that the previous winter was the worst in 10 years and excess deaths were caused by the circulating flu virus and not the weather. He stated that the flu virus in 2014/15 particularly affected the elderly and was not covered by that year’s flu vaccine. He reported that in 2015/16, the weather was warm until after the Christmas period and the circulating flu virus was H1N1 – Swine Flu which was more prevalent in younger people and did not cause them serious illness. Mr Drinkwater explained that a bad winter was defined by a number of factors including seasonal influenza and respiratory illness, cold weather and snow. He stated that, in the event of bad weather, he had high levels of confidence in the NHS emergency planning and support from organisations in the Winter Resilience Forum such as the Police, Fire Service and Environment in responding to the situation.

(5)       In response to a specific question about funding for winter pressures and the industrial action, Mr Drinkwater explained that year round surge money was included in CCG baseline budgets. Ms Stewart noted that in North Kent, the CCGs had invested in an integrated discharge team which was a multi-provider team based at Darent Valley Hospital including KCC care managers, community services and end of life specialists from the Ellenor hospices. She reported that the North Kent CCGs had also implemented an integrated primary care team to provide responsive out of hospital care. The team included colleagues from KCC, mental health and community services reviewed the top 2% of patients at risk of being admitted to hospital or who had comorbidities and put a care plan in place to support them. She highlighted that the North Kent CCGs had also rolled out the Single Health Resilience Early Warning Database (SHREWD) which enabled providers to upload performance data; this provided the CCGs with advanced notice of escalation and enabled them to plan and respond to it. Ms Stewart highlighted that the cost of the industrial action had been absorbed by the providers.  Mr Robinson stated that in West Kent CCG four additional GP appointments per GP practice had been made available which had cost £6000.

(6)       A Member enquired about the sustainability of domiciliary care. Ms Ford explained that domiciliary care was challenged and  needed to be included as part of short and long term planning across the health and social care system. She noted that early discharge was part of the SAFER bundle and it was important for frail and elderly patients to be discharged back home quickly as it reduced the amount of domiciliary care required. She stated that the career path for domiciliary carers into other roles such as Health Care Assistants and nursing was difficult. Mr Drinkwater reported that the availability of domiciliary care was an issue across the South East and innovative thinking was required to make it an attractive care path. He noted home care and integration would be part of the current sustainability and transformation plans to deliver the Five Year Forward View. Mr Robinson noted that West Kent CCG had a discharge to assess model to enable a timely discharge to home or a community setting for patients. Ms Stewart reported that in North Kent elderly and frail patients were assessed, using the primary care screening tool, at the earliest opportunity. The North Kent CCGs were working with voluntary organisations particularly Age UK to support elderly and frail patients to return to their homes.

(7)       A number of questions were asked about the dates for the winter resilience room, the review of communication plans, the impact of the industrial action on primary care and areas of improvement for next winter. Mr Drinkwater explained that the dates for the winter resilience room were set nationally; the winter resilience room was extended virtually until May due to pressures in Surrey and Sussex. He reported that there had been a series of reviews of the communication plans. He stated that as part of the post-winter debrief with the System Resilience Groups, A&E clinicians reported a positive impact of the media campaigns. He highlighted a quantitative review by the Department of Health which found that national media campaigns targeted at the over 65s had the greatest impact on over 75s. He noted that there had been a decline in A&E attendance during the industrial action which was attributed to media campaigns. He explained that there was a minimal impact on primary care as junior doctors were not able to work independently; they are shadowed by existing GPs. He highlighted that the unions were balloting ambulance staff for industrial action.  He reported an area for improvement for next winter would be the implementation of criteria for escalation using common language; this winter in Surrey and Sussex, there were occasions where hospitals with the same issues would move to different levels of escalation. He noted that the emergency planning process with cyclical and was constantly being reviewed and improved.

(8)       RESOLVED that the report be noted and NHS England be requested to:

(a)       provide an overview of the 2016/17 winter plans to the Committee at its October meeting;

(b)       provide a written briefing on the SAFER bundle to the Committee.