Agenda item

To provide an overview of 2024/25 winter planning in North Central London.

Details also included about the Your Local Health Team campaign.  

The Director of Finance for Strategic Commissioning introduced the report.

-       This report was part of the annual emergency services planning. Emergency activity was up and there had been an improvement in performance averaging 76%.

-       There had been consistent challenges when it came to ambulance hand over delays. However, performance again had improved with now over 89% of ambulance hand overs being done within 45 minutes. However, he emphasised that category two hand overs were still quite problematic and needed to be worked on.

-       Hospital occupancy was still high at 98% - this, he explained, created issues.

-       The report was dynamic and contained proactive actions to help manage the influx of patients.

-       Southern hemisphere COVID and Flu population modelling had informed the assumptions.

-       The Head of Operation and Assurance added that the plan built on last year’s achievements -  and also reflected the NHS England Recovery Plan.

-       Work included:

o    Better communication across departments, so that all understood interdependencies where needed.

o   An intervention approach to promote a reduction in demand on hospitals. This would ensure that the most vulnerable patients were supported.

o   Extra capacity was also engaged  especially in children and young people’s services.

o   Flu and COVID vaccination programmes were also rolled out and extra engagement activities were being used to encourage take up of vaccinations.

o   Pharmacy First had been maximised to reduce reliance on primary care.

o   Work had been carried out with care homes to ensure that patients only attended hospital if absolutely necessary.

o   111 increased its capacity and has piloted an AI triage.

o   Targeted appointments have led to a 6% improvement.

o   Infection control policy was very robust.

o   This year has seen a robust comms plan to support this work.

The floor was open to questions.

Discussion turned to vaccinations and methods to engage all groups to encourage take up of vaccines. The Executive Director for Performance stated that issues were complex. Working with the Public Health Directors in each borough was vital for the team to understand the different needs and concerns of communities – and also where they could build stronger relationships of trust. Targeted work was being carried out to reach communities who were distrustful of vaccines. He stated that this approach had seen an increased uptake. The Executive Director for Performance pointed out that in London the  NCL had closed the gap of uptake vaccines in many communities.  He then suggested that information be circulated to the Committee about the nature of the NHS targeted work with communities, vaccine uptakes and the details of why there had been resistance from different communities. ACTION. The Chair suggested that work through nursery staff and family hubs had seen good results. The Executive Director of Performance and Transformation agreed that the ‘family effect’ had seen good results. Although there was national guidance on this targeted work – nursery staff had not been included but this was something that the trusts were discussing further.

Discussion turned to the nature of the issues with vaccine uptakes. A question was raised as to whether the issues were about availability or about distrust. The Executive Director of Performance responded that it depended on different communities. There had been instances were when the availability of vaccines had increased – and an uptake in vaccines had also occurred. However, there were also issues with communities receiving news from disreputable sources – and this was where targeted work and building relationships was key. He emphasised that increasing opportunities to have positive conversations around vaccines would help people make the right choices.

The Chair then asked about the nature of ‘Care Transfer Hubs’ . The Head of Operations explained that these were a virtual interdisciplinary group of partners and professionals who integrate care for patients from acute, community and less acute settings. She emphasised that these hubs exist in all boroughs but with different iterations. These hubs ensure that duplication of assessments from different agencies would not occur and that delays could be identified early, and the whole process ran smoothly and efficiently.  The Chair then asked whether funding was attached to these hubs so if a delay in discharge was identified the matter could be dealt with there and then. The The Executive Director for Performance stated that in these circumstances the Personal Health Budgets would be used.

A question was asked then about the nature of ‘High Impact Interventions’ . The Head of Operations responded that one of these interventions were the use of Urgent Response Cars. The cars would ensure that patients would see a GP/ medical professional within two hours and reduce the need for an ambulance. The Executive Director for Performance stated that the biggest impact on hospital numbers was seen in Islington when the Urgent Response Car and Virtual Ward was used together to monitor and treat patients instead of taking to A&E.   It was then stated that the model would be looked at as part of a review to see if it could be rolled out to other areas. Another intervention was the Silver Triage Model which was able to triage and possibly assess patients in care homes – to ensure that they did not have to go through to hospital if it was not necessary.

In response to his opinion on the biggest concerns for Winter Planning, the Executive Director for Performance responded that the biggest area of growth and concern was around getting the right support for older people over 65. He emphasised that the Winter Plan did address this with robust processes however this section of the population was the most vulnerable. Outreach was to be conducted to all frail over 75s through the GPs and Community Services – to provide information on Community responses and a clinical check in. 

A question was then asked about the nature of the Local Healthcare Team National Campaign. The Head of Communications and Engagement explained that this was a long-term campaign was around raising public awareness about the different types of medical care professionals that help patients stay well in the winter. It was an integrated campaign that had been rolled out to stakeholders and the public to advertise the different roles (other than GPs) who can help patients. The Campaign has been evaluated in a number of ways including Community Outreach, work with partners and a Community Voices Panel (which included thousands of local residents). The Head of Communications stated that her team would keep evaluating the absorption of messages. A question was raised as to whether this had its own funding stream. She stated that funding had been allocated from the Winter Planning Fund and Primary Care Fund.

Discussion then turned to GP’s receptionist training and whether this had a discernible impact on waiting times and had been absorbed by patients. The Head of Communications stated that the Local Healthcare Team Campaign included resources for GP Receptionists and Practice Managers which would support Receptionists to help patients. The Head of Communications offered to return to the Committee with more information on this.  ACTION

Discussion then turned to waiting times for patients in ambulances to be discharged into A&E. The Executive Director for Performance admitted that in the past this had been a major issue in the Winter months, however across London all hospitals had signed up to a policy of a waiting time of no more than 45 minutes with anything longer than a two hour wait as a breach of this policy – this was to keep the most ambulances on the road. The aim was to get the waiting time for discharge into A&E down to a 30-minute wait.

The Chair then mentioned that although ambulances were being freed up, patients still faced a long wait often in a corridor – she asked about the pressures this put on Emergency Department staff. The Executive Director for Performance stated that this did put extra pressure on staff however this was now being managed. Chief Medical Officers and Nurses were being asked to map out processes for situations such as this – and managers were informed, and patients monitored and recorded. 

The Chair requested:

• In future reports, more detail be added to the Summary of High Impact Interventions. ACTION
• She also requested further information on vaccinations and what the trusts were doing to address issues of misinformation and mistrust in communities.  She requested more information specifically on how nurseries/family hubs and schools were doing to address this mistrust on a local level. ACTION
• More information was requested on the Community Voices Panel. ACTION 
• An update was also requested on the aim by the Trusts to bring down the waiting time for patient discharges to A&E from ambulances. ACTION