Agenda item

23.1     The Committee considered a report on the NHS Sussex Winter Plan 2024/25. 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 reflects on lessons learnt from previous winters and other system pressures.

23.2     The Committee asked what level of vaccine uptake was being aimed for over the winter and how vaccination take up compared with previous years’ levels.

23.3     Dr James Ramsay, NHS Sussex Chief Medical Officer, explained that vaccine uptake was monitored against national levels, and that NHS Sussex was in line with national averages despite a slow initial uptake. There was reduced uptake this year than in recent previous years, due to vaccine hesitancy and fatigue in both the general population and the workforce. NHS Sussex was working with providers to increase uptake within staff groups.

23.4     The Committee noted that the Joint Committee on Vaccination and Immunisation (JCVI) had announced that it was planning to tighten eligibility for vaccinations in 2025 and that this would need to be considered as part of on next year’s Winter Plan.

23.5     The Committee asked what was being done to improve vaccine take up with vulnerable groups.

23.6     Dr Ramsay confirmed that work was ongoing to increase vaccine uptake in vulnerable groups. People who were more likely to require acute services and healthcare over the winter, such as those with learning disabilities or frailty were being identified at a primary care level and support was being put in place to increase vaccine uptake in these people. In line with the general population there had been reduced uptake in these groups than in previous years, but that NHS Sussex continued to try and increase uptake.

23.7     The Committee asked for more information on temporary staffing levels that would be required over the winter period.

23.8     Richard Milner, ESHT Chief of Staff, noted that temporary staffing would not be coordinated system-wide but by individual provider trusts. ESHT sought to minimise its use of temporary staff and so had enhanced processes for booking staff rotas and managing staff leave over the period to have these set 6-8 weeks in advance. ESHT had a ‘bank’ system for permanent staff that wished to do additional hours which didn’t have the same associated cost as using temporary staff. Planning for staff levels began in August to ensure temporary staff were not required over the winter period. John Child, SPFT Chief Operating Officer, noted that the processes for SPFT were similar to ESHT to have staffing levels and rosters planned well in advance of winter. SPFT had ‘safer staffing numbers’ which mandated minimum staff levels for safety and quality of care, and processes in place to bring in temporary staff to meet patient need and acuity.

23.9     The Committee asked what the uptake of the flu vaccination was among staff.

23.10   Richard Milner responded that while he did not have figures to hand, there was a level of vaccine fatigue within some clinical staff. ESHT had communicated the importance of staff being vaccinated for not only their own safety but for their colleagues and patients also. To complement staff communications ESHT also sought to maximise the availability of vaccines to make it as easy as possible for staff to receive the vaccine without disrupting their work, such as with roving vaccination teams.

23.11   The Board noted the challenges people had with accessing GP appointments and the importance of primary care appointments in preventing people needing to access more acute services and asked how this was being improved.

23.12   Dr Ramsay accepted that access to primary care could be challenging at times and availability of appointments was monitored and compared to other Integrated Care Boards (ICBs). NHS Sussex ranked 15^th of the 42 ICBs in relation to the number of GP appointments available, and East Sussex was in line with that Sussex-wide level. Work was ongoing to improve access and build capability such as through multi-professional teams made up of GPs and other healthcare professionals who were able to provide appropriate support for patients. Unscheduled care hubs with multi-professional care teams had been established to triage patients to the most appropriate care setting to try and mitigate against patients who, having failed to access primary care presented to the Emergency Department (ED) instead. These had only just been set up, but initial indications were showing that these teams were effective in ensuring people got to the right place for their clinical needs.

23.13   Ashley Scarff, Director of Joint Commissioning and Integrated Care Team Development (East Sussex) noted that there had been an update report on access to primary care at the previous HOSC meeting and there would be another update at the next HOSC meeting as well.

23.14   The Committee asked where the unscheduled care hubs were based.

23.15   Paul Fisher, SECAmb Operating Unit Manager, explained that hubs had been established in the Make Ready Centres at Falmer and Polegate. Patients did not attend the hub but rather it was where a multi-disciplinary team was set up which would then triage patients to the most appropriate care setting based on the emergency response information. When a 999 call was received that triggered a potential ambulance response, the multi-disciplinary team would review the call and determine whether an ambulance response was necessary and where the patient should be directed instead. Ambulance crews were also able to contact the hub to discuss a patient and determine whether somewhere other than ED was the most appropriate place for them to be taken. The hubs had been in place for about 3 weeks, and each had resulted in roughly 10 people a day being streamed away from ED. Richard Milner added that there was an ESHT consultant involved in the screening of the emergency calls that were received and that since the hubs had been set up ESHT had already seen a decrease in the number of ED conveyances.

23.16   The Board noted that the importance of continuity of care and asked how providers fulfilled the workload of staff who left.

23.17   Richard Milner noted that when staff left replacements would be recruited, noting that recruitment continued to be a challenge. ESHT worked hard to make itself an organisation that people wanted to work for so that when clinical staff were being recruited there was a high quality of candidates that applied for the roles. Dr Matthew Clark, explained that most consultants would slowly wind down their hours, meaning that there would be a gradual handover of work and responsibilities, and there were always plans in place for when people left and joined the organisation.

23.18   The Committee asked what was being done to encourage neurodiverse individuals to be vaccinated included through special sessions that were more comfortable for them.

23.19   Dr Ramsay responded that he was unsure whether there were sessions more accommodating and that he would provide an answer outside of the meeting.

23.20   The Committee asked whether the Winter Plan was robust enough should there be a spike in virus infections due to the lower uptake of vaccines this year.

23.21   Dr Ramsay noted that due to the rise in cases of Covid-19, winter flu, RSV and norovirus, there had already been increasing system-wide pressures and there were significant concerns nationally regarding these. The Winter Plan had been designed to help alleviate the operational pressures that these viruses created. NHS Sussex continued to encourage the uptake of vaccines.

23.22   The Committee asked if there were similar triage processes in place for 111 calls and walk-in ED presentations to ensure people were being treated in the right place to meet their clinical need.

23.23   Dr Ramsay explained that walk-ins to ED would be streamed to the environment that best met their clinical needs. If a patient could be treated at an Urgent Treatment Centre or a Minor Injury Unit then they would be streamed to those more appropriate areas on-site.

23.24   The Committee asked what monitoring of the success of Pharmacy First had there been and if the programme had resulted in people being diverted away from hospital.

23.25   Dr Ramsay said that he was not aware of what monitoring was done of Pharmacy First but agreed to explore that issue further and provide a response outside the meeting.

23.26   The Committee asked how NHS Sussex worked with neighbouring ICBs to ensure that patients near the boundaries of the county were appropriately supported.

23.27   Ashley Scarff explained that NHS Sussex engaged directly with all healthcare providers that delivered services to East Sussex residents, including the University Hospitals Sussex and Maidstone and Tunbridge Wells NHS Trusts. All Integrated Care Systems had integrated system winter plans and the Sussex system worked with them on a daily basis to manage operational pressures and patient pathways and flow.

23.28   The Committee asked where individual provider winter plans could be accessed.

23.29   Nicki Smith said that they would be public documents and that individual provider trusts would be able to share those documents.

23.30   The Committee asked for further detail on SAFER patient flow bundles.

23.31   Dr James Ramsay explained that SAFER was one of four key elements of improving hospital discharge, to ensure patients had access to senior decision maker support to advise on treatment and discharge planning earlier and seek to discharge patients earlier in the day. A review of the six acute hospitals across Sussex had been undertaken to assess compliance with the SAFER bundle, and recommendations to improve discharge would be made to acute providers following this. Further elements to improve discharge included keeping patients active while they were still in hospital, optimising the Transfer of Care Hubs to reduce discharge delays, and ensuring care capacity matched demand.

23.32   The Committee asked for further detail on improvements to community care capacity that were being made to hasten patient discharge from hospital.

23.33   Leigh Prudente, ESCC Assistant Director Operations, explained that Adult Social Care worked with the independent care market to ensure they have capacity in the community to support people once they leave hospital. There was also preventative work so that once people moved into community care there was support in place that would hopefully prevent them needing to return to hospital. One way this was done was through the Joint Community Rehabilitation (JCR) teams that worked in hospitals and in the Transfer of Care Hub, and 77% of referrals that went through JCR resulted in no ongoing care support.

23.34   John Child explained that SPFT also had discharge issues and that it, working with NHS Sussex and the social care authorities in Sussex received funding from the national Better Carer Programme to work with IMPOWER to identify targeted areas to improve discharge. For East Sussex there was a recommendation to develop an East Sussex mental health discharge hub, to work with stakeholders to improve discharge. SPFT also worked closely with adult social care and district and borough councils to identify care placements for those with the acute needs.

23.35   The Committee noted the comparatively low uptake of vaccines and asked what factors were preventing a more effective roll-out.

23.36   Dr James Ramsay explained that NHS Sussex was working with its communications team to make sure the importance of vaccination reached all communities, particularly the most vulnerable.

23.37   The Committee asked what specific measures had been put in place to support staff morale through the winter period, and asked how morale levels compared with the previous year.

23.38   Richard Milner explained that there was a broad range of occupational health support available to staff, including around mental health. Over the Christmas period there was work done on the softer side of support, such as senior management working on wards, chocolates put out for teams, and wards were encouraged to decorate. Staff morale at ESHT was generally quite good based on staff surveys, but the significant operational pressures were recognised.

23.39   The Committee RESOLVED to:

1) note the report; and

2) receive an update in June 2025