Agenda item

32.1     The Committee considered an update 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 and runs from October 2022 to April 2023.

32.2     The Committee asked how the virtual wards were staffed and where the patients were located.

32.3     Claudia Griffith, Chief Delivery Officer NHS Sussex responded that the virtual wards were a national model which is being piloted across Sussex. They are not located in any particular area and are supported by existing staff in community health services and by hospital clinicians. The concept is to try and keep people at home and wrap services around them for clinical conditions that can be safely managed at home.

32.4     The Committee asked if the virtual wards model was expensive and whether it could be expanded.

32.5     Claudia Griffith outlined that the model was more efficient but there is an issue with being able to increase the workforce in order to be able to expand the pilot. There are National Plan targets to increase capacity and there is a focus on how virtual wards could be used for patients with respiratory conditions and frailty patients who are at risk of admission.

32.6     The Committee noted that ambulance handover times had improved and asked how long patients were having to wait for an ambulance.

32.7     Claudia Griffith explained that the are a number of factors involved in ambulance response times for category 1, category 2, category 3 and category 4 calls. It is not just handover delays that affect response times and there have been a number of capacity issues for the South East Coast Ambulance Foundation Trust (SECAmb) which have affected response times. NHS Sussex has worked with SECAmb to support them and has used other Trusts such as the South Central Ambulance Service NHS Foundation Trust to provide additional capacity. Claudia Griffith agreed to circulate some information on ambulance response times for category 1, 2, 3 and 4 calls.

32.8     Claudia Griffith added that handover delays were very low at the current time and are in single figures for delays over one hour. Charlotte O’Brien, Director of Transformation and Improvement at ESHT commented that there had been only one handover delay over one hour this week at East Sussex Healthcare Trust (ESHT) hospitals.

32.9     The Committee observed that this winter period and particularly the time around Christmas and New Year had been challenging. It asked what the impact had been on staff and for an update on staffing issues.

32.10   Claudia Griffith acknowledged that it had been a really challenging situation and the health system does have a very tired workforce. There has been a lot of effort to support staff, but the situation remains very pressured taking into account the industrial action as well as winter pressures. There has been a significant focus on recruitment and retention and there is a workforce programme in place across Sussex. There are a number of things being done to support staff including financial assistance with cost of living pressures. Charlotte O’Brien added that the last few years had been very challenging for the workforce, and we are now seeing industrial action as a result. ESHT is committed to supporting its workforce. Claudia Griffith commented that Providers are being supported through the period of industrial action to maintain services and to allow staff to take strike action.

32.11   The Committee asked what percentage of staff were on long term sick leave.

32.12   Claudia Griffith outlined that there had been an increase in staff on long term sick leave due to stress and anxiety but would have to come back to the Committee with precise figures. Work is being undertaken to increase the mental health and emotional wellbeing support for staff and there is also the existing Staff in Mind service. Feedback on these support services is being looked at in order to further improve support for staff.

32.13   The Committee asked about the waiting times in Emergency Departments and reports that some patients have been waiting in corridors.

32.14   Claudia Griffith responded that Emergency Departments remain very pressured coupled with the need to handover patients from ambulances into Emergency Departments. Work programmes are in place to manage the flow of patients through hospitals and discharge those who are medically fit to free up beds for admissions. Re-admission rates are also being monitored to ensure patients are not being discharged too early. Congestion in Emergency Departments is being addressed through the national Emergency Care Recovery Plan, which aims to increase the number of beds and ambulances, improve patient flows, and same day emergency care services. This will focus on areas to work on in the next twelve months.

32.15   For people with complex respiratory problems, the Committee asked if there is a better way of managing their condition e.g. with a bespoke health plan and access to antibiotics.

32.16   Claudia Griffith responded that the Virtual Wards programme aims to target patients with complex respiratory conditions to provide them with support and early intervention in the community to keep them well in their home.

32.17   The Committee asked for details of where in East Sussex the additional 39,000 GP appointments had been provided and how many people were waiting over 52 weeks for elective care treatment.

32.18   Claudia Griffith outlined that the industrial action will have an impact on waiting times and the national target will be amended to 65 weeks at the end of next year. A breakdown of those waiting over 52 weeks can be provided, but generally ESHT’s performance is good. The position is more challenging at University Hospitals Sussex (UHSx) and they are working with Queen Victoria Hospital (QVH) to provide additional capacity to reduce waiting lists. A breakdown of where the additional GP appointments have been provided can be provided after the meeting.

32.19 The Committee asked about the call abandonment rate for the 111 Service, the use of VOCARE, and the level of vacancies in the call centre.

32.20   Claudia Griffith outlined that the 111 Service faces a challenge in terms of recruitment and retention of staff. This is a demanding and stressful role and NHS Sussex is working with SECAmb on recruitment and retention and is trying to make the roles more attractive. VOCARE were brought in to provide more capacity and support in response to the 50% call abandonment rate.

32.21   The Committee asked if future reports could also provide information on the UHSx and Maidstone and Tunbridge Wells NHS Trust (MTW) hospital performance that East Sussex residents use (e.g. Royal Sussex Hospital and Pembury Hospital) in addition to ESHT hospitals.

32.22   Claudia Griffith outlined that NHS Sussex can provide equivalent figures for Pembury Hospital operated by MTW and the Royal Sussex. Performance at Pembury is good, but the Royal Sussex is one of the most challenged sites. Work has been carried out to improve hospital handovers at the Royal Sussex, but people are waiting for long periods in the Emergency Department (ED) and in corridors. There are plans to enlarge the ED at the Royal Sussex now that the new building is complete which should address some of the Estates constraints faced by the current ED.

32.23   The Committee asked how many more ambulances would be provided from the Government funding for the national Emergency Care Recovery Plan and what the Havens mental health provision involved.

32.24   Claudia Griffith outlined that 800 more ambulances would be provided under the Emergency Care Recovery Plan which would be split across the eleven Ambulance Trusts. Further information on how many have been allocated to SECAmb can be provided once this is known. Charlotte O’Brien explained that the Havens are provided in each of the locations that SPFT provide inpatient facilities and the service provides dedicated mental health crisis assessment facilities where people with mental health issues can be seen and assessed, avoiding the need for them to present to an Emergency Department.

32.25   The Committee thanked NHS Sussex for the Covid vaccination programme update and asked if the uptake figures were as high as had been expected.

32.26   Claudia Griffith responded that NHS Sussex had hoped for higher uptake figures. The uptake in the older age group cohorts has been good, but the uptake of vaccinations in the younger age groups has been lower. This may be due to a level of normalising of Covid infections and that the risks are perceived as being lower for younger age groups, which is having an impact on public behaviour.

32.27   The Committee asked the Director of Adult Social Care and Health if he had any comments on the report.

32.28   Mark Stainton, Director of Adult Social Care and Health observed that it had been one of the most challenging winter periods that the system had experienced. There had been good partnership working and planning to deal with the challenges faced during the winter period. Although the Adult Social Care delayed discharged funding had been received relatively late, it has been used to reduce discharge delays and the length of time before discharge.

32.29   The Committee asked if the hospital handover data for SECAmb could be broken down by hospital for future reports.

32.30   The Chair suggested that the updates requested on the figures contained in the report, including information on MTW and UHSx hospitals could be provided in an update report at the June HOSC meeting. SECAmb are also presenting a report at the June meeting and could be asked to provide updated information on 111 performance and 999 response times for all call categories and a breakdown of hospital handover data by hospital.

32.31   The Committee RESOLVED to:

1) Note the report; and

2) Request further update report on the Winter Plan at the June HOSC meeting.