Agenda item

22.1     The Committee considered a report on the NHS Sussex Winter Plan 2025/26. The Winter Plan sets out how the local health and social care system planned to effectively manage the capacity and demand pressures anticipated during the Winter period. The Winter Plan is both a Sussex-wide plan and a whole-system health and social care plan, recognising the needs of the local population. The Winter Plan 2025-26 reflected on lessons learned from winter 2024-25 and other system pressures. The plan included: progress to date; key risks impacting services provision; preparation and performance of elective and non-elective services; a staff wellbeing focus; continued focus on discharge and admission avoidance; plans for seasonal illness including infection control and vaccination plans; and key system performance measures and monitoring. Identified from learning in winter 2024-25, the system would continue to focus on patient discharge, flow, vaccination and supporting the workforce.

22.2     The Committee asked what the current status of flu cases was in East Sussex.

22.3     Richard Milner, Chief of Staff, East Sussex Healthcare NHS Trust (ESHT), responded that although ESHT sites had observed a spike in the rate of flu and Respiratory Syncytial Virus (RSV) cases recently, this was not uncommon and not unplanned for. Communications were being deployed to encourage staff and patients to wear face masks in high volume areas and minimise face-to-face meetings, to promote a safer environment and manage the spread. The flu was not causing concern from an operational management perspective, but ESHT were investing in planning and prevention, to keep staff and patients safe over the winter period.

22.4     The Committee asked what the system was doing to promote vaccination, including in the workforce, schools and the wider population.

22.5     Rachael Kramer, Deputy Director of Emergency Preparedness, Resilience and Response, NHS Sussex, responded that the flu vaccination uptake in East Sussex was at 57% of the target population (those that are eligible for vaccination). The ICB was doing a range of communication work in the lead up to Christmas to promote vaccinations, including advertorials in Sussex World, weekly newsletters online, messaging from the Chief Nurse advocating vaccination, advertisements on bus stops (particularly those in Hastings), and a social media Q&A with Lewes District Council leaders. The ICB aimed to increase staff flu vaccination uptake by a minimum 5% across all NHS Trusts in East Sussex, which was being addressed by offering staff bookable clinics, delivering vaccinations on wards directly to staff via roving vaccinators. An informal community of practice was developed with the support of the ICB to support staff to get vaccinated and address challenges, such as with the booking system, sharing best practice and mutual support to improve vaccination rates.

22.6     The Committee noted that the plan highlights the need for timely discharge to improve patient flow in hospitals, and asked what capacity Adult Social Care (ASC) has to support timely discharge.

22.7     Mark Stainton, Director of Adult Social Care, East Sussex County Council (ESCC), responded that patients are often discharged to the independent sector market, which provides both home care and bedded care. There was a block contract in place and good market supply in the home care market to ensure timely discharge, but while market supply for bedded care was good, it could be difficult to source for patients with complex needs or in specific areas. In these circumstances, the Discharge to Assess process would be used. ESCC employ 70 ASC staff in hospitals and around hospital discharge, so are well-resourced to support this. However, staff find that patients with higher and more complex needs, like cognitive impairments and mental capacity issues, would have a longer discharge process, due to needing to undertake capacity assessments and best interest decisions. ESCC were working with ESHT to reduce the number of assessments needed in hospital by introducing a Trusted Assessor Approach, whereby long-term assessments would be conducted in individual’s homes, or in a Discharge to Assess bed.

22.8     The Committee asked why there are fewer touchpoint calls between ESHT and ESCC compared with West Sussex County Council and Brighton and Hove City Council.

22.9     Mark Stainton clarified that quick touchpoint calls were conducted on Mondays, Wednesdays and Fridays but were only one point of contact across the system. ESCC were in daily contact with ESHT at a senior level throughout the winter period and had made a local decision that Tuesday and Thursday calls were unnecessary due to their existing close working relationship. However, this was constantly being assessed and if officers decided that more contact was needed, the calls could be increased as appropriate.

22.10   The Committee requested vaccination figures for Royal Sussex County Hospital and Princess Royal Hospital, for residents for whom these hospitals are closest.

22.11   Rachael Kramer answered that the current rate of flu vaccination uptake in Brighton and Hove was 49%.

22.12   The Committee asked what work was being undertaken to increase virtual ward (VW) capacity, and what work was being undertaken to improve information sharing in relation to patients with complex needs.

22.13   Richard Milner responded that increasing VW capacity was important to increasing capacity by reducing length of stay and improving patient flow, as maximising community and VW bed space can be used to support discharge from hospital. System planning and hospital planning for winter 2025-26 were focussed on mapping capacity and the proportion of it in acute sites, and how to maximise community space and virtual wards.  He confirmed that the Trust were also working with the voluntary sector and looking to utilise Joint Community Rehabilitation (JCR) and Urgent Community Response (UCR) to increase community bed base.

22.14   Simon Dowse, Director of Transformation, Strategy and Improvement ESHT, added that the Trust employ several methods to increase VW capacity. This included increasing resources to the Home First team (a UCR team providing discharge care) temporarily over the winter period to give a large block of capability to discharge patients into supported care. He clarified the difference between Home First and VWs was that people ill by definition were admitted to a virtual ward, but that patients discharged into Home First were people who may not qualify for a social care package but might need additional support for a short period of time. The Trust were working with Primary Care through the neighbourhood health programme to identify and support people with a high risk of being admission to hospital to stay at home, which would increase hospital capacity further.

22.15   Ashley Scarff, Director of Joint Commissioning and Integrated Care Team Development NHS Sussex,added that South East Coast Ambulance (SECAmb) were integral to the development of the Winter Plan 2025-26. SECAmb were ensuring that they had adequate staff in place will help the system to manage spikes in demand by building capacity and ensuring that ambulances are released to respond as soon as possible to emergencies.

22.16   The Committee asked what system is in place to support residents with complex needs that live alone and may have difficulties communicating their medical needs.

22.17   Dr Stephen Pike, Deputy Medical Director, NHS Sussex, responded that NHS Sussex had launched a proactive care scheme, to be focussed on complex and frail patients, and risk stratify them, ensuring that emergency services had access to a summary of patient’s care records.

22.18   John Child, Chief Operating Officer Sussex Partnership Foundation Trust (SPFT) added that SECAmb had access to a ‘Blue Light Line’ service, for SPFT patients with complex cognitive needs such as dementia. This enabled them to contact SPFT to seek medical advice for patients if needed. SPFT were piloting a VW service for patients with acute dementia needs that would be otherwise admitted to inpatient services, to support them to remain at home.

22.19   The Committee asked what the criteria for flu and COVID vaccinations was for Winter 2025-26, and whether this applies to residents with mental health needs.

22.20   Dr Stephen Pike responded that at risk groups are identified based on national criteria set by the Joint Committee on Vaccination and Immunisation (JCVI). Residents aged over 65 are eligible for flu vaccinations, and residents over 75 are eligible for the COVID vaccination, and other criteria include residents with compromised immunity. This wouldn’t apply to residents with mental health needs, unless they have separate complex needs, but residents can receive their vaccination privately if they do not meet NHS eligibility criteria, for a small charge. He noted that due to the new flu variant, many East Sussex residents were receiving private immunisations from the community pharmacy.

22.21   The Committee asked how many residents aged under 65 are admitted to hospital due to serious flu, noting that it would be beneficial to vaccinate everyone.

22.22   Dr Stephen Pike responded that the current strain of flu was one that hadn’t arisen for a while, which meant that herd immunity to the strain was low. The criteria for vaccination is determined nationally with consideration to cost effectiveness, so although offering the vaccination to younger people would greatly improve herd immunity and reduce the community carrier rate, this was not possible under the current framework. There was also an issue of stock availability: NHS Sussex ensured they had sufficient stock for all those eligible in the health system, but there have been shortages for those outside of the eligibility criteria trying to access private immunisations.

22.23   The Committee asked how many No Criteria to Reside (NCTR) patients were currently in East Sussex hospitals, and what was being done to manage their routes out of hospital and reduce NCTR numbers.

22.24   Ashley Scarff responded that discharge is a key part of system flow. Work took place daily across the system to identify challenges in discharging individuals and to remove barriers to get patients discharged as soon as it is safe and appropriate to do so, but the health and social care system faced significant challenges, so the ICB was working to maximise resources.

22.25   Rachael Kramer responded that the number of NCTR patients changes daily, but the latest figures showed 148 NCTR patients in ESHT hospitals. The system had just conducted a Multi-Agency Discharge (MADE) event for community services, which involved examining patients in community care, whether their care was appropriate, and whether they could be moved to care elsewhere in the system. She reported that they had already seen the number of NCTR patients reduce due to this, and the aim of the event was to reduce the worst of the system pressures before the peak of the winter period.

22.26   Mark Stainton added that Transfer of Care Hubs, which are multi-agency hubs located in the hospital, were in operation for Winter 2025-26, and staff on these hubs worked on a patient-by-patient basis to manage patients’ discharge. There was a well-established process for managing discharges and factors that might delay discharge included housing or family concerns, safeguarding concerns, and concerns about mental capacity. Staff would focus on patients with longer Length of Stay or Delayed Discharge as part of their processes, but a core challenge for ASC remained the high proportion of older people in the county, presenting a challenge of many patients with very complex needs. ASC conducted preventative work to support people from being admitted to hospital, as well as a wider drive to encourage healthy lifestyle in the long term, so that people live healthy lives for as long as possible.

22.27   Richard Milner reassured the committee that NCTR patients were discussed daily amongst staff to find routes out of hospital. Staff employ models such as moving patients out of acute hospital settings and into more appropriate community care; MADE events, for example, help encourage patient flow and ensure that care is appropriate. This was in conjunction with patient safety events for staff, to ensure that if patients should remain in hospital, that their care is clinically appropriate to their needs and safe.

22.28   John Child confirmed that resource capacity within mental health services impacted the ability of trusts to ensure patient flow, especially where patients have complex needs. Demand and capacity issues are also experienced by mental health services, so working with clinicians was important to the Trust to make the best use of available resources. He added that often the language of productivity wasn’t appropriate for clinicians, language around patient safety and patient outcomes often works better to engage them to deliver outcomes.

22.29   The Committee RESOLVED to:

1)    note the report; and

2)    receive a feedback report in June 2026.