Agenda item

To receive an update on the system’s preparations for winter pressures and lessons learnt.

The Board received a presentation in relation to the winter plan and the system approach to how work would be undertaken during the demands of the winter season.    Engagement had taken place with partners to bring together a robust plan using different sources of intelligence.  This would focus on demand and capacity modelling and information held across the social care partnership in order to be in the best position.  It was proposed this would be an annual cycle/process which would be implemented from October with implementation being undertaken between now and March.  Evidence would be gathered and liaison with partners in April/May 2023 and then in June 2023 the plan would be reassessed.   The Plan had been approved by the CEOs of the Integrated Care Board (ICB) at a meeting held on 28 September 2022.  Tracking and monitoring of the plan would take place and mitigation measures/adjustments made where necessary.

Key elements of the plan were historic trends, flu and covid demands, length of stay in beds and the impact of bed usage, MMFD and the discharge at the point of medical intervention, elective demand and interplay between urgent and planned care and the impact of demand during winter.  A reconfiguration of part of the hospital had allowed for extra bed capacity and there was a special entrance for ambulance patients.

A conservative position of 50% in relation to the usage of virtual beds had been used and it needed to be considered what the ratio of the virtual beds meant in actual bed terms.

In relation to flu, covid and infectious diseases, this was a constantly moving picture and would be re-visited as intelligence became available.  There was no national modelling in relation to this and work was being undertaken with public health colleagues in order to look at disease outbreaks and their impact.

The next steps would be to undertake additional work on the surge plan and what could be done in order to address a shortage of beds and the most likely scenarios.  Some difficult decisions and robust conversations would take place with partners in order to re-direct or gain capacity and this would be finalised by mid- October.

Looking at primary care, it was hoped to bring online some extended access to appointments within primary care during the winter months and expanding the rapid response service to two hours in relation to emergency care.  Enhanced therapy support would be offered outside the setting of the acute trust.

Six additional spaces had been within the hospital setting had been created in order to bring people off ambulances before being headed over to acute care in order to get ambulances back out into the community. 

In relation to acute and reablement beds, an enhanced community capacity be provided to allow patient flow out of hospitals and into a more appropriate setting.

During the debate some members of the Board raised concerns regarding recruitment of staff and what action had been taken to mitigate against this, how the virtual beds would be monitored and any progress to date, the progress on staffing levels and their training in relation to virtual beds. 

It was confirmed that workforce issues were a concern across all partners locally and a wider piece of work was being undertaken beyond the winter plan.  The work factored in absence and sickness rates and annual leave and would be revisited in respect of flu and infectious diseases.   It was also part of the work of the urgent care delivery board and would be monitored and mitigation actions taken where necessary.  The cost of living crisis would also be part of the discussions.  In relation to virtual beds, advice from experts and consultants had been sought and the current model would be implemented for the winter and would be closely managed by the community trust and included staff levels and the skill set.

Due to the increasing demand across every service and a surge response being a big issue it was suggested that the issue of virtual beds be discussed at the next meeting of the Board. 

A campaign in relation to getting a vaccination would be publicised.