Agenda item

To receive a report on the Haringey Winter System Resilience.

Ms Rachel Lissauer and Ms Sara Sutton introduced the item.

The Board heard that:

·      It was still early into the winter and the cold seasonal period had only just begun.

·      There were likely to be many issues about residents not being able to top up their meters as debt repayments were so high.

·      There was concern about adult social care users not being able to get access to warm spaces. Consideration needed to be given to the effect on the workforce and the need to be flexible and to adapt to emerging needs.

·      There needed to be a considerable amount of engagement to get to wider partnership groups from a broad range of partners and organisations.

·      Each individual organisation and frontline workforce were likely to feel the most impacted and some of the elements of the warm welcome campaign including the pay it forward idea would need to become an increasing area of focus.

·      Hospital trusts were looking to have foodbank provision within their spaces.

·      The pre-payment meters had been discussed. Energy companies were changing tariffs for people and work was being done with energy providers about what this would look like for residents with pre-payment meters, but this had not yet been outlined.

·      There were mechanisms for residents to come forward when energy costs needed to be paid. 

·      There were people who could not afford bus fare for hospital appointments. 

·      Public messaging for dealing with the winter months would be useful.

·      Household support fund would continue to be funded for another year.

·      Consideration needed to be given on how the disabled (including children and young people) could be supported such as provision of equipment.

·      Some residents in the NHS Gloucestershire area would have their energy bills paid for through the Warm Home Prescription scheme. Some consideration needed to be given to see what would be possible for Haringey residents.  

·      In relation to potential blackouts, it was important to ensure that medical equipment was up-to-date.

·      Some London boroughs were also investing in residents being given assistance to purchase healthy food.

·      If parents were cutting back on heat, then children were likely to suffer and this may increase the need of for use of the health services.

·      Household support fund also supported care leavers and would need to continue to be supported.

·      More households which were not able to heat or have proper ventilation would need to be raised with Cabinet due to the cost of living.

·      The Children and Young People Scrutiny Committee would be asked to add housing, mould and damp to the agenda.

·      The attention of central government needed to be raised regarding issues of damp and mould. It was an issue that existed both in private rented accommodation and housing associations. There were also issues with overcrowding. 

·      It was not clear if charities or trusts such as Wood Green Urban District were being contacted enough or offering enough support. Any relevant websites needed to be adequately updated.

·      The meeting noted that care leavers were included in the housing support payments.

·      There were more warm centres and spaces but there were also informal spaces. Residents were making use of warm spaces where possible such as the Chestnuts Community Centre.

·      In relation to Winter Access Programmes, North Middlesex Hospital was already running. The goal was to get them running by December 2022. Administrative recruitment would take time, but child clinics and nurses’ appointments could start immediately.  Pro-active care could start quite quickly.

·      The GP Assistant role would involve managing documents and following specific protocol. They may also take a blood or undertake basic health checks. There was competency framework they had to follow and they would be reimbursed through the additional roles scheme. There was a particular focus on Rapid Response and virtual wards. These were services Whittington Health had been running for almost a decade. Last winter, there had been a request to support virtual wards for North Middlesex Hospital. Enfield Community Services and Whittington Health had assisted in developing the virtual wards further. Virtual wards were useful for assisting patients before they entered hospital and bringing patients home early from hospitals. Patients would remain under the oversight of a hospital consultant so that they would get expert clinical oversight.

·      The Rapid Response service was where patients were seen at their home before going into hospital. There was an attempt to ensure that patients calling out an ambulance who did not need to be transferred to a hospital could be referred into Rapid Response or virtual ward service. Paramedics would be asked to shadow the services so that they could learn about them. Carers would also be asked to make referrals.

·      Remote monitoring would be offered to patients to allow their blood pressure and other vital statistics to be monitored. 

·      Work was underway to for therapy sessions to be extended in to the weekends. 

·      Virtual wards did have carers but Haringey Reablement Service also provided carer facilities for those who had used virtual wards or Rapid Response.

·      Whittington had a hospital at home service for the paediatric section. A virtual ward was also being funded for children’s services. The service would be made available at North Middlesex Hospital (NMH).

·      Discharge planning for those who did not need support when they went home came through the integrated discharge team would have a social worker present. When talking to patients and their relatives about their discharge home, their home environment would also be discussed.

·      Individuals that come into the hospital via an ambulance would be given information on the patient and when they go and pick up patients, they have iPads to take pictures (with consent) of people's environments. This would be brought into hospital so that information would be present for discharge planning.

·      More people wished to go home than be admitted anywhere else, but it was important for patients to be safe.

·      Some individuals had been put off important procedures due to a housing issues. 

·      There was an increase of 256 referrals per month into reablement services. It was not just the cost of that care that was important but also the recovery opportunities.  Where people were not reconditioned appropriately, quality of life deteriorated. It was important to highlight wholescale look at how to interpret recovery in light of the significant challenges of volume and for the workforce to be able to respond to create better outcomes. This was particularly true for the social care area where people were not re-conditioned and needed more care at a higher cost and we are not even in the winter.

·      There was a mental health crisis number, but the service was not well known and mental health trusts needed to be consulted in a more wider and public manner.

·      The new NHS West Green surgery needed more attention.

·      There were various reasons why people visited A&E instead of going to their GP and this needed to be examined more closely. 

RESOLVED:

That the contents of the briefing be noted.