Agenda item

To provide an overview of the approach to winter resilience in NCL for 2022/23 including the High Impact Winter Action Plan and additional funding for winter demand/capacity and discharge.

Alex Smith, Director of Transformation at the NCL ICB, introduced the winter resilience update noting the following key points:

• The winter had been a particularly challenging period with a high level of flu and respiratory illnesses as well as industrial actions.
• Partners across the health and care system had been working closely together to manage safety and to support each other during a period of increased pressure. This included a focus on hospital handover times and discharge delays as these could sometimes be caused by something elsewhere in the system not working.
• Additional funding had been allocated from NHS England for additional capacity and from the Department for Health & Social Care to support hospital discharge and this had helped to get people home quicker when they were ready to do so.
• There had been collaboration with the London Ambulance Service (LAS) to improve the handover of patients. During the period of industrial action there had been the involvement of GPs and senior clinicians to provide the right advice over the phone which meant that, in some cases, it was not necessary to send an ambulance. There were challenges in doing this in the longer-term due to the demands on the workforce. There had also been collaboration between the LAS and the Urgent Community Response services to reduce the need for hospital admissions.
• There would be an evaluation process over the summer to provide learning over what had worked well and not so well in time for next winter.

Alex Smith then responded to questions from the Committee:

• Cllr Dey raised the difficulty of obtaining GP appointments which increased the demand on A&E departments. Alex Smith said that there were a myriad of reasons for this and, while sometimes this may be due to patients not being able to obtain a primary care appointment, it could also be about what patients knew about primary care and how they preferred to access the system. Extended access GP services was a part of tackling this but, in the longer term, a review of primary care services would be commencing soon to look at workforce challenges, how well the full range of primary care services were working and the information available to patients about accessing primary care services.
• Cllr Cohen requested further details about the follow-up reablement care that was provided following discharge and the impact of the additional funding. Alex Smith explained that they worked closely with the five NCL local authorities that provided these services and all had felt that they could meet the financial demands over the winter. While the funding and workforce issues in this area were well known, additional capacity was added so far as was possible with the additional funding over the winter period. However, there were some areas that needed improvement and some further guidance on hospital discharge was expected soon.
• Asked by Cllr Anolue about the lack of resources for personal care in the home, Alex Smith said that this question would need to be directed to local authority colleagues but that the NHS worked closely with them on discharge issues including on putting together the right care team to support people in the reablement process.
• Cllr Connor observed that some patients who had just been discharged from hospital would not necessarily know who to raise issues and complaints with and asked what oversight NHS colleagues had over this. Alex Smith said that a written response would be necessary on this. (ACTION)
• Cllr Connor asked about the special NHS funding provided for short periods following hospital discharge and the impact on patients after this ended. Alex Smith explained that, until March 2022, there had been national arrangements in place which provided hospital discharge funding for the first 4 weeks of care. That funding had now stopped and so there were discussions with local authority partners about improving the provision of reablement costs at the point of discharge, though current arrangements varied by Borough. Cllr Connor requested further details on the financial circumstances for this, including self-funding arrangements and the circumstances in each Borough. (ACTION)
• Asked by Cllr Clarke and Cllr Dey about the impact of the industrial action, Alex Smith said that the main focus had been on safety issues but acknowledged that the action had been costly and had a significant impact on staff.
• Cllr Revah observed that patients were often provided with equipment to support them when discharged from hospital but that these were often not returned which seemed to be a waste of resources. Alex Smith said that around 60% of equipment was collected in some areas but agreed that it was necessary to do better and said that there was work ongoing with Borough Partnerships on how these arrangements could be made more effective.
• Cllr Revah asked how many people were sent to care homes if prolonged care was needed and requested a breakdown to be provided on this by borough. Alex Smith said that there were Better Care Fund (BCF) metrics available on this in terms of reducing the number of people going into long-term care which could be provided to the Committee. (ACTION)
• Cllr Revah raised concerns about palliative care and said that there were no set times about visits for medication, injections and other treatments which was confusing for patients. Alex Smith said that he would take this feedback to the End-of-Life commissioner (ACTION) but noted that there was now a single point of access to palliative care with a 24-hour phone line. Cllr Connor added that it could be very difficult for people to access palliative care staff at weekends and that the public often did not realise how much work in this area was done by the charity sector.
• Cllr Revah reported that some elderly people could not get transport until late at night when being discharged from hospital. Alex Smith agreed that this should not be happening and said that there was some work being done on discharge during the day which was also important because it would make more of the capacity in the community. He noted that NCL had some of the better rates on this in London but that there was more that could be done.
• Cllr Revah suggested that ‘geriatric wards’ was inappropriate wording and that they should be renamed to something friendlier. Alex Smith agreed with this point.
• Cllr Connor raised the missed opportunity clinical audit undertaken at North Middlesex University Hospital with the aim of identifying patients who were not on the correct pathway following their attendance at the Emergency Department, noting that the outcome report was expected to have been completed by Feb 2023. Alex Smith agreed to provide further details to Committee on this report. (ACTION)
• Asked by Cllr Connor about the appropriate time the Committee to examine the winter resilience arrangements for next year, Alex Smith suggested November or December 2023 (ACTION).
• Cllr Clarke suggested that cutting down on agency staff would help to reduce costs. Alex Smith acknowledged the concern but noted that some colleagues worked on an agency basis to be able to afford to live in certain areas of London. He added that there had been a London-wide cap on agency rates and that recruitment could be improved by planning further ahead in partnership with local authorities.