Agenda item

22.1     The Committee considered a report on the NHS Sussex Winter Plan. The Winter Plan sets out how the local health and social care system plans to effectively manage the capacity and demand pressures anticipated during the Winter period. The Winter Plan is a whole system health and social care plan, recognising the interdependencies of the system to meet the needs of the local population and runs from October 2022 to April 2023.

22.2     The Committee welcomed the degree of collaboration and focus on admission avoidance in the Winter Plan and asked if there were any particular areas or specialities where there were concerns.

22.3     Adam Doyle, Chief Executive Officer NHS Sussex, outlined there were four main areas which the system is working on areas of risk. These are:

• The numbers of people having a response to an ambulance call out. Work started two months ago to reduce 60 minute handover delays to ensure patients are seen quickly and free ambulances to respond to other calls and also as part of the rapid improvement programmes looking at patients who could be seen by a different service (e.g. community nursing teams) rather than waiting for an ambulance.
• Work to monitor and reduce the number of people in Emergency Department (EDs) waiting over 12 hours for a bed. Performance against this measure is quite good in East Sussex.
• Working with the Sussex Partnership Foundation Trust (SPFT) on mental health presentations in emergency (ED) and urgent care pathways to make sure people are seen quickly.
• The risk to the workforce from staff shortages across the system and the affect on staff morale. There is a weekly leadership meeting which looks at staffing issues. This is also being addressed in longer term through the 10 year workforce plan.

22.4     The Committee asked what the position was for upper gastrointestinal (GI) surgery at the Royal Sussex Hospital after the suspension of some non-urgent surgery following the Care Quality Commission (CQC) inspection and the subsequent press release.

22.5     Adam Doyle outlined that NHS Sussex works very closely with the CQC and was aware of the inspection and suspension of some surgery. All patients who have been affected by this have been contacted to let them know what their care pathway will be. Communications were sent out by the University Hospitals Sussex Trust (UHSx) and NHS Sussex will review how communications are handled should a similar situation occur in future. Adam Doyle offered to speak to Cllr Osborne outside the meeting concerning the communications with GP practices in her area.

22.6     The Committee asked what the impact had been on bed occupancy and making sure patients are seen, as the Winter Plan had been operating since October.

22.7     Adam Doyle responded by providing an overview of the position. From October to the end of November all measures were tracking in the right direction in terms of the numbers of people waiting over 12 hours for a bed and over 60 minutes for a handover from an ambulance. All five rapid improvement programmes were starting to have a positive effect. Then over the last two weeks across the NHS and locally there was a significant increase in demand due to paediatric presentations for Strep A infections. As a response to this new issue a number of respiratory hubs will be set up in the community for children and adults. The number of presentations for respiratory issues should reduce over the next two weeks, and then the system will need to respond to the forthcoming industrial action.

22.8     Joe Chadwick-Bell, Chief Executive of ESHT gave an update on bed occupancy. Schemes to take action on discharges are taking place over the next two weeks, after which time there is expected to be a reduction in bed occupancy. This is to mitigate an existing gap to ensure there are sufficient beds over the winter period. So, it is likely that there will not be an overall reduction in bed occupancy, but the discharge schemes will better manage the risk. The effect of the discharge schemes on bed occupancy will be measured but as of today bed occupancy is around 98% or 99%. An update can be provided at the next HOSC meeting.

22.9     The Committee asked how NHS Sussex is working with the voluntary sector on discharges and what the capacity is of the Red Cross to provide services across all areas of East Sussex.

22.10   Jessica Britton, Executive Managing Director, NHS Sussex responded that they are working with a range of voluntary partners including the Red Cross. NHS Sussex is reasonably confident there will be sufficient capacity in the voluntary sector to provide the take home and settle support across the County but acknowledged the level of volunteers is not the same in all areas. Whilst the coverage may not be the same in all areas, there is a service in place across the whole of East Sussex.

22.11   The Committee asked if it would be possible to receive the Winter Plan earlier in the year and what parts of the Plan are working well at present and what areas may need to be looked at again.

22.12   Claudia Griffith, Chief Delivery Officer NHS Sussex responded the elements of the Plan that are working well are the out of hospital urgent care and work to better co-ordinate the services to support the ambulance service. This is to ensure the ambulance service can respond to those people with the most serious conditions. This means making informed decisions when an ambulance needs to be dispatched and when another service could step in thereby releasing ambulances by utilising other services. Ambulance crews also have a dedicated number they can use to access other services so they can be released from scene.

22.13 The Committee noted that Emergency Departments are very busy and asked what impact this was having on ambulance responses times.

22.14   Joe Chadwick-Bell outlined that additional staff resources have been provided via senior clinicians, nurses, and colleagues from social care so that people can been seen quicker and admitted quicker to reduce the numbers in Emergency Departments. Some people have been moved to same day urgent care services. Work has also been taking place on discharges to reduce the length of stay and bed occupancy, thereby improving the flow of patients through the hospital. Emergency Departments have been very busy especially over the last two weeks and a lot of work has been undertaken to support ambulance handovers, thereby releasing ambulances to go to the next call.

22.15   The Committee commented that admission avoidance is very important and asked what interventions are in place for those people at risk of admission.

22.16   Mike Jennings, Interim Chief Executive SCFT outlined that there are new urgent care teams working on this who aim to respond withing two hours. The teams are staffed by experienced nurses, occupational therapists and physiotherapists who carry out assessments and can call on GPs and other resources to provide care packages for those people at risk of admission. Community nursing teams are working with GPs and Primary care Networks (PCNs) on patients with known conditions. They carry out pro-active visits, provide advice on manging conditions and can provide links to other services. It was clarified that care packages are part of short term care services for between one to ten days, which are comprised of personal assistants, occupational therapists and physiotherapists. After that time, care packages will depend on need and health and social care provision. It was acknowledged that there are some capacity issues in health and social care, but patients will not be dropped.

22.17   Mark Stainton, Director of Adult Social Care and Health added that needs will be assessed on a patient by patient basis and it was a balancing act between allocating resources to enable patients to be discharged from hospital and admission avoidance.

22.18   The Committee commented that the health and care sector depends on having fully supported staff and there are some concerns about how we value staff and recruit and retain staff. The Committee asked how we send out the message that we support staff and want to make the service sustainable.

22.19   Adam Doyle acknowledged the importance of this point and that it is important to lead with positive intent with staff and how we work together on issues. There may be more that can be done locally to get people into the health and care workforce, and maximising retention is very important. Lobbying for a long-term funding plan for the sector is also of vital importance.

22.20   Joe Chadwick-Bell commented that some staff are becoming tired and exhausted and there are pockets of low morale. Work is taking place on the recognition of staff and the provision of wellbeing and mental health support. Recruitment and retention is a key point to explore to promote careers in health and care in East Sussex. Recently the Trust held two recruitments workshops at two sites which attracted around one hundred people at each to talk about roles in the NHS. Attendees were able to have interviews on the spot for vacant roles and could be offered jobs. This demonstrates that there are people willing to work in the NHS, but a different approach to recruitment may need to be taken. There has also been a successful overseas nurses recruitment scheme. There is a recognition that if we can reduce bed occupancy this will have the most impact on the pressure the system faces. The Trust has also moved staff into new wards and has opened one hundred more beds to improve capacity.

22.21   Mike Jennings commented that this year feels more difficult that previous years, but for different reasons. There is an acknowledgement that the workforce is the system’s biggest asset and there are staff who are still positive and enthusiastic about their roles. As well as international recruitment there has been a focus on local recruitment events as most staff live locally. There has also been work on how people can be supported to have careers within the system and have different roles rather than leaving the health and care system altogether. Wellbeing is also really important as well as providing space and time for staff to take a break. There is also support for staff to speak up if they have concerns.

22.22   The Committee asked if the re-instatement of the nursing bursary had affected recruitment.

22.23   Joe Chadwick-Bell confirmed that it had a positive effect on nurse recruitment.

22.24   The Committee asked how the rates of Covid and seasonal flu, as well as the uptake of vaccinations, had affected the demand for services and staffing.

22.25   Claudia Griffith outlined that modelling work for the rates seasonal flu and Covid infections had taken place over the summer with colleagues in Public Health. These were then included in the demand model in the Winter Plan together with interventions to mitigate any gaps in services. The rates of infections are being monitored and additional inventions will be taken if rates are different from those included in the plan. At present infection rates are running at levels just below what was expected, but the system is ready to take additional measures if this changes.

22.26   The Committee asked if the use of Livi had been discontinued.

22.27   Joe Chadwick-Bell outlined that access to GPs via virtual consultations is being provided in some Urgent Treatment Centres (UTCs) in order to provide more primary care access in the UTCs.

22.28   The Committee asked what measures are in place to deal with strike action over the winter period.

22.29   Adam Doyle outlined that the health system is looking at multiple waves of industrial action involving ambulance staff from South East Coast Ambulance Trust (SECAmb), nursing staff who are members of the Royal College of Nursing (RCN) and members of the Chartered Institute of Physiotherapists. For the impending industrial action by ambulance staff derogations will be negotiated with the unions to ensure essential services are still provided. NHS Sussex has worked across all elements of the service and will publish a plan to mitigate the risks.

22.30   The Committee commented that with all the communications and media coverage about the crisis in the NHS some people may be avoiding presenting for treatment. The Committee asked if NHS Sussex will be taking this into account after the winter period.

22.31   Adam Doyle responded that the learning from the pandemic showed that it can take a long time to recover if you cancel services such as routine operations. So NHS Sussex is still trying to provide all services both emergency and routine. The impact of each decision that is made over the winter period is looked at carefully to see how quickly the system can recover services and provide them normally.

22.32   Claudia Griffith added that a core part of the winter plan is the communications message that the health service is still available to everyone and direct people to the most appropriate service. The clear message is that people should still come forward for treatment. In parallel to this the data on referrals is being tracked (e.g. cancer referrals are at 140% of pre-pandemic levels and cancer treatments are at 120% of pre-pandemic levels) to see if more needs to be done to address any issues.

22.33   The Committee asked if the number of intermediate care beds in community hospitals had been expanded to provide additional capacity to support the service over the winter period.

22.34   Mike Jennings responded that work had been undertaken to expand the number of community beds across the whole of Sussex. Across Lewes, Uckfield and Crowborough hospitals there has been an increase of around six to eight beds due to the space constraints and the need to provide all the facilities and hygiene control. These units have also contributed to additional capacity by looking a patient flow with partners to ensure people move through these units as quickly as possible.

22.35   The Committee asked about the availability of consultants out of normal operating hours (Monday – Friday) and the impact of private work on access to consultants.

22.36   Joe Chadwick-Bell outlined that consultants work equally hard but acknowledged that there may be a tendency to work a five-day working week as this is what they are contracted to do. However, there are consultants on-site at weekends and they are available through the on-call system. Changing five-day working week contracts is a longer-term issue and would have resource implications. If there are any issues with junior doctors accessing consultants out of hours this will be addressed individually. In terms of private consultant activity carried out at the unit at the Conquest Hospital within the Trust, this has benefits for training, recruitment and retention of consultants and is done within their own time. If patients seek private treatment and are referred back into the NHS (e.g. for diagnostic tests), they will come in at that part of the patient pathway and will wait the same amount of time as NHS patients and NHS patients will not disadvantaged.

22.37   The Chair thanked everyone for attending the meeting for this item.

22.38   The Committee RESOLVED to:

1) Note the report; and

2) Request a further update on the progress of the Winter Plan at the Committee meeting to be held on 2 March 2023.