Agenda item

SURREY HEARTLANDS WINTER PREPAREDNESS REPORT

This report is to inform the committee of the impact of winter 2018/19 on the Surrey Heartlands system, including reference to previous winter pressures; and to describe the whole system measures being put in place to promote resilience throughout the upcoming winter period.

FRIMLEY HEALTH AND CARE PREPARATIONS FOR WINTER PRESSURES REPORT

To outline the impact and risks associated with winter pressures and the measures put in place by the whole System for mitigation and promotes resilience throughout the winter season.  

To assure the Select Committee that appropriate measures are in place in preparation for seasonal winter pressures, ensuring that local people receive services at the right time in the right place and have the best possible outcomes.

1. Surrey Heartlands Winter Preparedness

Witnesses:

Dr Claire Fuller, Senior Responsible Officer for Surrey Heartlands

Karen Thorburn, Director of Performance, Surrey Heartlands Integrated Care System

Giles Mahoney, Integrated Care Partnership Director - Guildford and Waverley

James Thomas, Chief Operating Officer, Ashford and St Peters NHS Foundation Trust

Jackie Raven, Associate Director for Urgent and Integrated Care, Surrey Heartlands

Liz Uliasz, Deputy Director, Adult Social Care

Key points raised during the discussion:

1. The Chairman introduced the item and highlighted that an addendum to the report was published in a supplementary agenda on 8 October 2019. The Director of Performance, Surrey Heartlands provided Members with a presentations which has been included in these minutes as Annex 1.
2. Members raised concern with the figures in the report related to flu vaccination for NHS staff which stated that the percentage of staff from the Surrey and Boarders Partnership (SABP) which received vaccinations had lowered from 54% to 47%. It was also highlight that the percentage of NHS staff in the Royal Surrey Hospital receiving a flu vaccination had reduced from 71% to 55.8%.  The Senior Responsible Officer stressed that this was a wider problem as there was an emergency situation in Surrey due to the lack of people receiving vaccinations. In regards to SABP and Royal Surrey Hospital, the Senior Responsible Officer informed Members that there were ongoing campaigns to work to increase the number of vaccinations in these organisations. Members further asked if staff were asked the reason why they were choosing not to receive a flu vaccination. The Chief Operating Officer, Ashford and St Peters NHS Foundation Trust, explained that there were a number of factors which led to people not receiving vaccinations which included lack of communication, lack of access and simply not wanting to be injected. Following on from this, Members noted officers comments which highlighted that more could be done to maximise the joint working with Local Authorities and Councillors to improve communications around the subject.
3. Members highlighted that there was a lack of knowledge in local communities that flu vaccinations could be received in pharmacies. The Director for Performance informed Members that pharmacies were commissioned by NHS England to provide flu vaccinations and that there was a communication plan in place to outline that flu vaccinations could be received in community pharmacies. The communication programmes were in the processes of being delivered and includes the use of social media. 
4. In regards to GP Access, Members requested further information on the number of people who failed to obtain and appointment on the same day as requested. The Director of Performance stated that additional GP appointments were being well used and that there were a number of programmes in place to increase the number of hours GPs were available. Members noted that data was not recorded on the number of people not able to access a GP on the same day as requested.
5. Officers confirmed that extended access to primary care was now standard in Surrey Heartlands and that there would be GP access on Christmas and Boxing Day in some areas. The timing for extended access was confirmed to be 8am to 8pm.
6. The Select Committee noted that attendances to A&E were rising and asked what more could be done manage visits. Officers explained that there was ongoing work to look into the reconfiguration of urgent care in Surrey Heartlands called the Big Picture Programme in North West Surrey and the Better Care Together programme in Guildford and Waverley. These programmes promoted a different view of urgent care and looked into alternatives. It was noted that an update on these programmes would be considered at a future Select Committee meeting.
7. Members highlighted that mental health problems increased in the winter months and asked officers how confident they were that they were resilience to this additional pressure. Officers stated that the NHS did face challenges with resilience in this area. To face challenges, It was noted that the service would continue to undertake work to support mental health in the community and that there was an ongoing pilot of work on Primary Care Networks. This was focused on how the provision of the right services for each patient could be improved.
8. The Select Committee asked how Surrey Heartlands were working to support rough sleepers throughout the winter period. The Director of Performance highlighted that Surrey Heartlands was working closely within their integrated care partnerships to organise the right approach as well as beginning conversations with food banks to understand what could be done collectively.
9. The Select Committee asked how prepared the service was in the event of a high pressured flu virus session and if there was a possibility of being overwhelmed. Officers explained that they were confident the plans and processes in place were practical and robust enough to manage a surge of the flu virus as it incorporated flexibility. It was further stated that in the event of sustained surge then services would be challenged but the best plans were in place to mitigate this.

Recommendations:

1. The Select Committee requests that a further report be circulated in spring 2020 which outlines performance against the key themes outlined in the report.

2. Select Committee requests a further report which provides a detailed overview of the ongoing work to improve the take up of appropriate vaccinations in Surrey for residents, NHS staff, partners and those who interact with the system. For specific reference to be made to:

a.     Performance data which includes data on the reasons why someone would refuse a vaccination / not come forward

b.     Communications

c.      Partnership work to raise awareness and how local authorities can feed into the communication and promotion of vaccinations

3. Notes that due consideration is needed to recognise the need for provision of appropriate mental health support for those in need using system.

4.  Recognises the planning in place to prepare for additional pressures during the winter period

b.     Frimley Health and Care Preparations for Winter Pressures

Witnesses:

Shelley Head, Area Director - North West Surrey and  Surrey Heath, Adult Social Care

Nicola Airey,  Director - Planning and Performance, Surrey Heath CCG

Jonathan Sly, Associate Director of Integrated Care

Kate Scribbins, Healthwatch Surrey

Key points raised during the discussion:

1.     The Director - Planning and Performance introduced the item and provided Members with an overview of the report. It was highlighted that Frimley Health and Care were preparing for increased pressures over the winter period and reassured Members that they had historically had strong performance as a system. The reason for good results was said to be due to shared ownership through the system to ensure all areas were focused on improving the experience and outcomes for service users. Members noted that a focus for the system in the coming year was to ensure people were leaving hospital at the correct time.  Due to the reduced number of admissions and flat A&E attendances, there was an increase in more complex patients admitted therefore more needed to be done to communicate and prepare them for leaving hospital. Members went on to receive an introductory presentation which is attached to these minutes as annex 2. In regards to flu preparedness, it was noted that additional funding had been allocated to housebound patients who would be seen by community teams to receive vaccinations. In regards to Mental Health, The Director - Planning and Performance explained that some people experience Seasonal Affective Disorder during the winter months and that it was part of the system’s communications plan to provide information and support on how to help manage symptoms. This disorder affected a variety of people and not just those already with severe mental health needs. Members also noted that the breakdown of carer support could lead to people having to visit hospital more therefore there was also support available for carers during the winter months.

2.     The Select Committee asked whether the system was sufficiently staffed to meet additional pressures during the winter season. Officers explained that the system did not have high levels of vacancies across its providers due to the good reputation and benefits of the integrated care teams which provided support to all staff. It was noted that the Surrey and Boarders Partnership had also recently conducted various workshops focused on staff wellbeing and resilience.

3.     The Select Committee noted the system’s good performance and asked whether good practice was shared with other systems. Officers confirmed that they had taken many opportunities to share good practice with other systems nationally to help improve outcomes. Members noted that some national policy was shaped around the Frimley Health and Care system.

4.     The Chief Executive from Healthwatch Surrey noted the ongoing positive work to prepare patients for discharge from hospital and requested more information on the early conversations taking place. The Associate Director of Integrated Care explained that there was frailty work taking place which focused on having conversations in the community before patients visit hospital to ensure they were prepared in the event of being discharged. It was also highlighted that, historically, it was the hospital’s responsibility to have conversations with patients about discharge but the new processes of sharing responsibility with the community was having very positive outcomes.

5.     The Select Committee asked if there were issues related to patients with dementia deteriorating after entering hospital and how this was being dealt with. The Associate Director of Integrated Care stated that this may be an issue called Delirium and that there were situations where a patient’s mental health deteriorates with no confirmation whether it was a short or long term issue. Members noted that a pathway to support this had been development in partnership with the acute provider.

Recommendations:

The Select Committee:

1.     notes that the Frimley Health and Care System had contained the growth of Accident & Emergency attendances and reinforces the importance of sharing good practice nationally on areas of good performance.

2.     requests that the Frimley Health and Care system feed into the vaccination report outlined in recommendation 2 of item 7a of the current meeting.

3.     notes the plans put in place by the System Partners for 19/20 Winter Plan together with the risks associated with winter pressures and the mitigating actions.

4.     is assured of the measures put in place by the whole System for mitigation which promoted resilience throughout the winter season.

5.     notes that due consideration is needed to recognise the need for provision of appropriate mental health support for those in need using system.