Agenda item

To provide an overview of the planning for winter resilience in NCL for 2023/24 and on actions to improve ambulance response and handover times.  

Elizabeth Ogunoye, Director of System Flow & Resilience, introduced the report on this item noting that it provided an overview of the experience of Winter 2022/23, with challenges including flu/respiratory illness and industrial action. The learning from this review process would contribute towards the winter planning process for 2023/24 which involved a joined-up approach, reflecting work in all areas of health and social care, overseen by a Strategic Board and supported by a partnership all-systems group called the NHS Flow Operations Group.

Elizabeth Ogunoye highlighted the timescales for the Winter 2023/24 planning process set out on page 93 of the agenda pack, the end result of which would be a draft plan produced later in September. She added that the population health strategy in NCL would continue alongside this work with workstreams focused on higher risk groups for ill-health, there would also be proactive management of high-risk patients with long-term conditions and work to increase the vaccination take-up rate.

In terms of ambulance handover times, Elizabeth Ogunoye highlighted the pilot for new handover protocols set out on page 95 of the agenda pack which would be evaluated in readiness for Winter 2023/24.

Elizabeth Ogunoye concluded by setting out the next steps which would include working with local authority partners to plan for capacity and demand, including with a refreshed Better Care Fund (BCF) planning process by October. There was also a joint programme on the sustainability of discharge services across NCL.

Elizabeth Ogunoye then responded to questions from the Committee:

• Cllr Connor asked for further details about the learning from Winter 2022/23, particularly in terms of bed capacity and workforce. Elizabeth Ogunoye said that key learning was around joint working with health and social care on bed capacity and maximising flow, hospital discharge and care packages. Another part was on same day emergency care to avoid overnight stays where possible and maximise bed capacity. Avoiding infection was also a key piece of work including increasing the uptake of vaccination. Improvements in the proactive case management of people with long-term conditions was also part of the planning process. She added that the planning process had included modelling of various scenarios (including covid scenarios) and they were confident that sufficient bed and workforce capacity would be in place to respond.
• Asked by Cllr Atolagbe about the physical space for beds, Elizabeth Ogunoye acknowledged that physical space was always a challenge but that this had been taken into account in the long-term estates planning.
• Cllr Revah raised the issue of discharge from hospital and commented that information about the specific arrangements for discharge was not always shared well with the families which could make the post-discharge period more difficult. Elizabeth Ogunoye responded that the joint piece of work on sustainable discharge aimed to address what could be done better including communication, the flow of information and ensuring that patients were well supported at home. Elizabeth Ogunoye agreed to take these comments back for further consideration. (ACTION)
• Cllr Revah added that she was particularly concerned that the next of kin for patients with dementia were not always consulted about the patient’s needs and suggested that this needed to be addressed. (ACTION)
• Asked by Cllr Cohen how well the system was prepared for a future pandemic, Elizabeth Ogunoye said that scenario planning had included the worst case of flu and covid together and found that, if there was no community bed or virtual ward capacity, an additional 23-25 beds would be needed. However, the virtual ward and community bed capacity mitigated against this. A scenario worse than what had been modelled would create a challenging situation which would likely need to be discussed at London or national level. Cllr Chakraborty suggested that there could be an overreliance on virtual wards as these only helped to determine whether patients needed hospital treatment and that therefore the worst case scenario would be if a large number of patients actually did need hospital treatment. Elizabeth Ogunoye said that the reliance was not just on virtual ward capacity as there was also a focus on other prevention measures that had previously been mentioned such as proactive case management and vaccination as well as the measures to free up acute beds. Cllr Connor noted that community beds would not be useful in a pandemic scenario as they were often in the same place as other residents.
• Cllr Cohen queried why a pilot was required to improve ambulance handover times. Elizabeth Ogunoye explained that this was a pan-London pilot that had resulted from recent learning and the need to reduce handover delays. Cllr Clarke suggested that the JHOSC could speak to the London Ambulance Service directly to understand the impact of the pilot on their service. It was agreed that this would be added to the Committee’s work programme. (ACTION) The Committee also requested that the evaluation be provided when it was available. (ACTION)
• Cllr Connor sought clarification that the strategic board included local authority and GP representation and Elizabeth Ogunoye confirmed that this was the case.
• Cllr Connor referred to the single point of access intervention set out on page 94 of the agenda pack and proposed that further details on how this would work in practice could be included in the next report on winter planning. (ACTION)
• Cllr Chakraborty suggested that, after Winter 2023/24, it would be useful to understand whether the modelling had been accurate in reflecting what had actually happened. It was proposed that this information be provided in the next report on winter planning. (ACTION)

RESOLVED – That the evaluation on the ambulance handover pilot be circulated to the Committee when it has been completed.

RESOLVED – That details be provided to the Committee on the information shared with families during the hospital discharge process.