Agenda item

Purpose of the reports:

For the Select Committee to receive reports on the measures put in place across the health system to mitigate against pressures during the 2022-23 winter period.

Witnesses:

Liz Bruce – Joint Executive Director for Adult Social Care and Integrated Commissioning (Surrey County Council and Surrey Heartlands ICS)

Ben Hill – Director of Urgent Care (Surrey Heartlands ICS)

Dr Charlotte Canniff – Joint Chief Medical Officer (Surrey Heartlands ICS)

Jo Hunter – Deputy Director of Recovery (Surrey Heartlands ICS)

Nikki Mallinder – Director of Primary Care (Surrey Heartlands ICS)

Dr Pramit Patel – Primary Care Network Leader (Surrey Heartlands ICS)

Dr Helen Rostill – Deputy Chief Executive and Director of Therapies (Surrey and Borders Partnership)

Daryl Gasson – Executive Place Managing Director (NHS Frimley)

Stephen Dunn – Director of System Delivery and Place (NHS Frimley)

Mark Eley – Deputy Director of Operations (South East Coast Ambulance Service NHS Foundation Trust)              

Helen Wilshaw-Roberts – Strategic Partnerships Manager (South East Coast Ambulance Service NHS Foundation Trust)

Maria Millwood – Non-Executive Director (Healthwatch Surrey)

Key points raised during the discussion:

1. Witnesses from Surrey Heartlands and the South East Coast Ambulance Service (SECAmb) presented slides (Annex 1). Witnesses from NHS Frimley also presented slides (Annex 2).

2. A Member asked about the implications of the ICS restructuring on preparations for winter this year (2022). The Joint Chief Medical Officer (Heartlands) explained that there should be limited implications if all partners worked together to create the capacity required. The Director of System Delivery and Place (Frimley) added that NHS Frimley were developing a five-year strategy which involved significant stakeholder engagement during the summer regarding working together on collective priorities.

3. A Member queried the measures in place to support the mental health of staff during a period of increased pressure on the system. The Deputy Chief Executive of Surrey and Borders Partnership (SABP) explained that the system approach in place was the wellbeing hub which all staff could access. Individual organisations were now considering the cost-of-living crisis and how to support staff through that. SABP had also been linking in with other organisations to support their employee assistance schemes.

4. In response to a question on the fragility of the workforce, the Deputy Director of Operations (SECAmb) explained that they were aiming to reach 2,555 frontline staff by March 2023. SECAmb currently had approximately 2,150 frontline staff, with 150 in training. There had been a small reduction in overtime and the Deputy Director explained that it was about being able to achieve balance and not exhausting staff, whilst still offering the opportunity to earn extra money. Thus, the overtime hours made available were reviewed weekly. New avenues for recruitment had been developed and there had been international recruitment events targeting trained staff.

5. A Member queried whether the countries SECAmb were recruiting trained staff from were also short of staff. The Deputy Director of Operations (SECAmb) explained that they were recruiting from countries where they trained more staff than they were able to recruit. The Member asked at what stage SECAmb would be fully staffed. The Deputy Director responded by this time next year (October 2023), the resources were planned to reach the target number of frontline staff. One challenge was that there was a shortage of paramedics graduating from university nationally and they were competing against other ambulance services, therefore, SECAmb were exploring how to make themselves a more attractive employer. The Member also asked whether there were enough ambulances to cope with demand. The Deputy Director explained that SECAmb ran 140% of the number of ambulances required and he was comfortable that number could be met. There were weekly planning meetings to balance the staff required across SECAmb in the local areas. There was also the ability to flex private ambulances to meet the requirements.

6. A Member questioned the early prevention measures in place to support the mental health of residents. The Deputy Chief Executive (SABP) explained that the voluntary and community sector offered services such as, group events, direct counselling and broader mental health support and residents were able to self-refer for those services. There were also a range of resources on the Healthy Surrey website. Schools received a named mental health practitioner per cluster and there was young person’s safe haven based in Guildford.

7. The Chairman asked about the new electronic patient record system and whether it would work with the other systems in place. The Joint Chief Medical Officer (Heartlands) explained that the ambition was for it to work with the rest of the systems and it was a national digital model. The Chairman asked whether the system would assist in data capture of outcomes. The Joint Chief Medical Officer explained that acute hospital trusts produced good data already, but it would improve that data. The Director of Urgent Care (Heartlands) explained that they had taken time to embed the system and understand its benefits. 

Cllr Angela Goodwin joined the meeting at 11:20am.

8. The Chairman queried how mutual aid worked if everyone within the system was at capacity. The Director of Urgent Care (Heartlands) shared that Surrey did not meet the number of extensive care places per population and explained that they were working closely with NHS England (NHSE) to achieve this. Mutual aid was set up during the pandemic, they hoped to continue this. This winter there was not acute illness due to covid, but the system was reliant on the vaccination programme to protect the population and there was work with regional colleagues to address any peaks.

9. The Non-Executive Director of Healthwatch Surrey asked about the reasons behind the termination of the LIVI contract and about how a consistent approach for appointments would be ensured. The Director of Primary Care (Heartlands) explained that LIVI was commissioned by a different provider. Once Surrey Heartlands were alerted of the termination, they worked with the provider to gain a safer exit plan. LIVI was reinstated for a period of time to allow exit plans and communication plans to be formally worked through and evaluated. The reason LIVI was terminated was because their pricing model doubled in the last six months and other local solutions were being deployed.

10. The Chairman raised the issue of waiting multiple days for a reply from a general practice. The Director of Primary Care (Heartlands) explained that due to the acceleration of online service during the pandemic, there was inconsistency in terms of the online services offered by different practices. The Primary Care Network Leader added that it was essential to manage user’s expectations.

11. A Member questioned whether the government announced funding of £500 million for discharge to assess was enough. The Joint Executive Director (Heartlands and SCC) explained that this was nationally announced funding and therefore, would be split throughout the country. During the pandemic £491 million funding was announced, of which Surrey received £10 million. The discharge to assess programme would cost approximately £12 to £15 million per year. It was also unknown who the funding would be allocated to. There were some patients waiting to be discharged from Surrey hospitals who were West Sussex patients. Therefore, partners were trying to work collaboratively to solve such issues.

12. In response to a question on the rollout out of the GP integrated mental health service (GPimhs) programme, the Deputy Chief Executive (SABP) explained that there were eight remaining to rollout. SABP had an effective relationship with primary care and were using existing forums to work with GPs. So far there was data to suggest that the wait time for psychological therapists had reduced, there was a 26% reduction in referrals through the mental health single point of access and increasing awareness of social care issues. The Primary Care Network Leader (Heartlands) added that the programme was co-designed with GPs. There was a one-to-two-year independent evaluation underway, with the first report due in December 2022.

13. A Member asked about the expected use of agency staff during the winter period. The Primary Care Network Leader (Heartlands) informed Members that they had been engaging with Lantum agency and had recruited 55 GPs and other healthcare professionals through that bank. This created 15 additional sessions a week per practice which equalled around 240 appointments. There were plans to free up capacity by using community pharmacists. The Member also asked about access to in person appointments for those who required them. The Joint Executive Director explained that they would look into incorporating appointment preferences for those with mental health issues or autism into the Surrey Care Record. The Director of System Delivery and Place (Frimley) added that they had experienced a 13% increase in in person appointments and 56% of appointments were now in person.

Cllr Rebecca Jennings-Evans left the meeting at 11:56am.

14. Responding to a question on ensuring that primary care helped to relieve the pressure on A&E, the Joint Chief Medical Officer (Heartlands) explained that it was about making it less complicated for residents so that they understood what services to access in certain circumstances. The communications team were doing a targeted piece of work on this and SECAmb had developed a directory of services which highlighted alternative options to A&E. The Deputy Chief Executive (SABP) added that safe havens were a useful alternative to A&E for those with mental health issues. The Primary Care Network Leader (Heartlands) added that there were about 624 ‘very high health users’ in east Surrey and in a 12-month period those patients accessed A&E departments 1,900 times. This was a system issue, and it was crucial to support each other.

15. A Member enquired as to whether there were sufficient vaccines for both influenza and covid. The Non-Executive Director of Healthwatch Surrey also raised issues regarding dosette boxes, opening hours, and picking up prescriptions. The Joint Chief Medical Officer (Heartlands) clarified that there would be enough vaccines available and the communications and order of vaccinations were set nationally. The Chairman asked for data on the staff uptake of the influenza vaccine and the Joint Chief Medical Officer explained that all NHS staff were encouraged to take the influenza vaccine, but they had a choice. Data could be shared on the uptake. The Director of Primary Care (Heartlands) added that Surrey Heartlands had taken on responsibility for pharmacy, podiatry, and dentistry. It had been noted since taking these on that there had been more unplanned closures within community pharmacy than in previous years. Therefore, there was work to bring together the whole workforce to prevent that from happening in future.

Action/request for further information:

1. The Joint Chief Medical Officer to share data on the uptake of the influenza vaccine across NHS staff.

Recommendations:

1. For Surrey Heartlands ICS & Frimley ICSto work towards a swift rolling out of comprehensive Cloud Based Telephony Systems across GP Surgeries throughout Surrey, and to provide a future update in a formal Adults and Health Select Committee meeting on progress toward this.
2. For Surrey Heartlands ICS, Frimley ICS, & SECAmb, to implement and ensure there are support initiatives in place for the mental health of staff members, and to provide a future written update with qualitative and quantitative data to the Adults and Health Select Committee on progress toward this.
3. For the Joint Executive Director Adult Social Care & Integrated Commissioning, Surrey Heartlands ICS, and Frimley ICS to work on improving Discharge-to-Assess processes and to address the funding issues therewithin; and to provide a more detailed update to the Adults and Health Select Committee in an informal meeting, on the details of Discharge-to-Assess processes & funding issues, and whether improvements have been achieved.
4. For Surrey Heartlands ICS & SECAmb, to ensure that staff utilising PaCCS and 111 services, are sufficiently trained to correctly assess patients and appropriately determine ensuing pathways; and to provide a written update to the Adults and Health Select Committee on this.
5. For SECAmb to address the concerns raised by the most recent CQC report, and to provide an update in an informal meeting to the Adults and Health Select Committee on the extent to which SECAmb is addressing these concerns.