Agenda item

Report of the Integrated Care Board

The Chief Executive ICB, introduced the report and provided context on the current pressures nationally and in Staffordshire. The impact of the Covid pandemic had brought about unprecedented levels of ill health, which increased demand and pressures on urgent and emergency care UEC, ambulance services, discharge and domiciliary care across the Country. Discussions relating to funding support systems locally and nationally were ongoing, including £500 million for social care support, the funding would be available but the difficulty across the system would be appointing staff and this was of significant concernmoving into the winter pressures.

The Chief Delivery Officer, ICB, outlined the report and slides highlighting the current pressures and indicated that workforce, demand, and acuity of patients compared to pre-covid were the prevalent issues. Staffing capacity and flow had been impacted by Covid spikes and Covid levels were rising again. Handover delays at hospitals had been stressed as the issue causing public concernand Royal Stoke was receiving support relating to handover delays, but it was explained that all partners have a role to play in system flow and the report detailed the operational response for interventions being taken at each point of the pathway:

Interventions were grouped in areas:

• Pre-hospital
• In-hospital
• Discharge
• Learnings
• Winter Planning
  
  

The presentation did not detail the preventative work that was also taking place to look at long term sustainable solutions for the emergency care system.

Committee noted main messages from the presentation:

·       There were significant pressures on domiciliary and care home provision and a discharge review was due to commence.

·       System colleagues from Health and Care had built learning into forward plans and were working together, meeting daily to discuss escalations and agree tactical actions.

·       Capacity plans were prepared to address additional winter pressures, including flu and covid, capacity plans work alongside existing plans for elective and cancer services.

·       Additional capacity, workforce would be a challenge moving into winter.

·       Flu and Covid boosters were rolling out, Committee supported the importance of individuals receiving both vaccinations.

·       The relationship with Staffordshire and Stoke on Trent local authorities was good, there was an opportunity to consider what worked and what could be improved in the discharge review, and put in place quick wins and actions coming from the review, if possible, but not at risk of destabilising the winter plans.

The following comments and responses to questions were noted:

·        A concern was raised about people queueing outside in poor weather for vaccines at the Fire Station in Leek. An apology was given to those people affected and a written response would be provided to Councillor Charlotte Atkins.

·        Workforce numbers and initiatives to grow the workforce. It was understood that additional staff would be required, recruitment and retention of staff was a big issue and solutions were in place to address workforce issues, these included new roles, the public sector reserve model to support in case of escalations and training new to care people to create a new workforce. In addition to help work life balance ICB had employed three retention co-ordinators to support managers to look at ways to retain staff through rota management, flexibility etc. and the drive to recruit innovative and international staff was ongoing.

·        The work life balance solution would be essential to retain and recruit staff. Finding the right balance between work from home and additional hours and the right flexibility.

·        £5.7m capacity scheme funding and other funding had been invested in winter and transformative schemes. Funding was considered sufficient, but workforce was an issue.

·        ICB Clinical and Professional Lead would oversee the system review on discharge. It was confirmed that Partner feedback had been received and the draft plan would be considered in the next few weeks. An update would be presented to committee in November 2022.

·        It was considered important to have flexibility to deploy staff where needed. ICB had been very impressed with UHNM ability to deal with the elective backlog, for 78-week waits and managing expectations for 104 week waits. Members understood that it was essential to ringfence the dedicated support but noted it would be harder through winter pressures to mitigate risk across the system.

·        Communication strategy. Issues relating to backlogs and waiting times had been communicated, members questioned how an individual would know their waiting time to receive treatment or diagnosis.

o   ICB Communications team advised that campaigns were underway to provide a range of information and publications about the winter vaccines and where to get support.

o   UHNM had carried out a validation exercise on contact details and had purchased a texting service to try to give people an estimated time on the waiting list. Members were advised that long waits had significantly reduced and would be down to single figures by November. They acknowledged that people had a choice to delay appointments where necessary due to life events.

o   MPFT Community Services had also carried out a validation exercise, to check contact details, there were no people waiting over 52 weeks.

·       Delayed diagnosis position. Some specialist areas had workforce issues but generally there has been improvement in waiting times. Additional CT Scanning was in place on two sites and there was a plan to recover the 6 weeks position for cancer scans, but there was still a challenge with ultrasound scans. Staff training and other measures had resulted in a much improved position.

·       In relation to the hidden backlog of people coming forward to GP practices post pandemic, this was difficult to manage, there may be hidden pockets of demand, but the individuals need to come forward. The number of GP appointments were back to pre-pandemic levels. There was still sustained pressure on GP services, the complexity and acuity of conditions presenting were generally higher than normal levels pre-pandemic. The ICB Communication team were running campaigns to encourage people who were concerned about health issues to come forward and get help.

·       In relation to flow rates through the system and pinch points, the CE ICB advised that discharge process goes through several steps in the pathway and if it started to block at any stage the entire system stalls and there was a struggle to move people through the system. Urgent and emergency care (UEC)was thought of as a ‘wicked problem,’ the best way to simplify the problem was to look at small changes in the process, all elements were relevant, flow within each organisation is important as well as interfaces between organisations.

·       Flow improvement initiative ‘North Bristol’ Pull model rather than a push model. Push model gives an impetus of flow asking organisations to proactively prepare for patients along the pathway. Consultants were looking at the flows and pathway in the system. This work was critical to improvement, pulling together a number of strands which were data based and making changes to move through the pathway.

·       The initiatives in the report align to Winter Plan and would be implemented prior to Winter 2022. The impact of the initiatives would be circulated to committee in briefing notes.

·       Call abandonment referred to 111 calls, but some people do call 999. The 111 call abandonment was low in Staffordshire and should be congratulated.

·       Repeat admissions, discharge in a timely and safe manner. It was a fine clinical balance of when to discharge patients. Many were frail and elderly, they were not kept in hospital longer than necessary.

·       In relation to winter demand and activity planning, figures were based on 2019 -20 activity plus flu and Covid numbers, current challenges relating to acuity levels were planned in. Assurance was given that winter demand was looked at and reviewed in light of current challenges.

·       The Chairman highlighted that there may be opportunities to bring other partners into the system to help services at end-of-life pathway and to visit frail and elderly people to help prevent hospital re-admissions.

The Chairman thanked guests for their contribution to the meeting and for the work being done to mitigate and respond to pressures in the system.

Resolved:

That the Health and Care Overview and Scrutiny Committee note the progress report.