Brighton & Hove County Council Health Overview and Scrutiny Committee (HOSC)
Sussex System Winter Plan 2024/25
November 2024
1.1 This report provides a summary of the approach to the Sussex System Winter Plan that spans the period from November 2024 to March 2025. The report highlights the Sussex wide and Brighton and Hove specific approaches and aims to provide information to the Brighton & Hove City Council HOSC that the health and social care needs of the local population will be met over the winter period. The final Winter Plan will be considered by the NHS Sussex Integrated Care Board on 27 November 2024 and once agreed, further detail can be provided to the HOSC.
1.2 The Sussex System 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. It is an annual national planning requirement and provides assurance that the system and partners have the necessary measures in place to deliver health and care for the local population.
1.3 We know there has been continued increased demand across primary, secondary, community and mental health services. Over the winter months this can become increasingly challenging as there are seasonally driven increases in illness such as acute respiratory illness, flu, Covid, and norovirus, together with the impact of cold weather and the ongoing impact from the cost-of-living crisis which constrains the ability of the most vulnerable in our population to keep themselves well.
1.4 The key focus of the plan
is action to support people to stay well and to maintain patient
safety and experience. We will focus on five key areas as part of
this:
1. Prevention and case finding to support people to stay well and to target additional support to our most vulnerable populations to prevent hospital admission where possible
2. Same day urgent care to help maximise access to urgent help for local people, reducing the need for people to attend Emergency Departments
3. Improvements in discharge to support patient flow to help people to get home from hospital in a timely way and to ensure good access to inpatient beds when people need them
4. Sound operational management to ensure we have robust mechanisms in place with clear coordination across the system and rapid routes for escalation where required
5. Oversight, governance and escalation to ensure we have the right oversight in place.
1.5 Our plans are underpinned by a
series of principles designed to ensure that a focus on quality and
safety in maintained. These are:
· Maintaining the quality and safety of services is the primary objective of all system partners
· System partners will work together to ensure timely access to services for the entire population, supported by a clinical risk-based focus at times of surge in demand
· We will prioritise the most vulnerable and at risk
· System resources will be targeted in the areas where we will get greatest impact or in the areas of greatest need
· We will protect the wellbeing of our workforce
· System partners will work together to balance clinical risk
· Our clinical leaders will be at the heart of decision making throughout the winter period.
2.1 The Sussex system approach to developing our Winter Plan was driven by two key influences.
2.2 Every year NHS England
issue guidance to local systems setting out key priorities.
This includes a planning and financial framework and focuses
on:
· Providing safe care over winter, including a focus on access to urgent and emergency care with the further development of same day emergency care; the development of access hubs, and the further development of virtual wards.
· Supporting people to stay well, including the national flu immunisation programme; the COVID-19 autumn/winter vaccination programme for eligible groups; and the Respiratory Syncytial Virus (RSV) Vaccine
· Maintaining patient safety and experience.
2.3 In addition to this, NHS
England has indicated specific requirements for all trusts and
provider organisations. These relate to:
· reviewing general and acute core and escalation bed capacity plans
· reviewing and testing full capacity plans.
· ensuring the fundamental standards of care are in place in all settings at all times:
· ensuring appropriate senior clinical decision-makers are able to make decisions in live time to manage flow.
· ensuring plans are in place to maximise patient flow throughout the hospital, 7 days per week.
Sussex requirements
2.4 In addition to the national requirements, the Sussex system considers what specific priorities or areas of focus are required to best meet the needs of the local population, based on locally observed demand and capacity, and the governance arrangements required to ensure all parts of the system work together to best mitigate the risks for the entire population.
2.5 We bring together actions and intelligence at neighbourhood, place and system level, and prioritise the areas of focus so we can respond effectively together. We also undertake a learning exercise after winter every year to ensure that the system follows a cycle of continuous improvement. We therefore build on learning from previous years to improve our framework for system oversight with a focus on the key actions all system partners are taking to deliver continued access to safe services.
2.6 Together with our key priority areas of focus, we have the following four areas of work that underpin these:
· Demand and Capacity modelling
· Principles designed to ensure that we maintain a focus on quality and safety
· Clinical risk monitoring and escalation processes
· Clinical Leadership.
Prevention and Case finding
3.1 The key aim is to support our population to stay well and ensure we have proactive care in place for those most at risk.
3.2 Our vaccination programme is central to this in protecting the Sussex population and we are working with partners to optimise the take up of this within eligible populations.
3.3 For the Covid vaccination we are working with across Sussex with network of providers which include 24 local Primary Care Networks (PCN), 107 Community Pharmacies and 3 General Practice Federations to develop and deliver our programme. In Sussex there are 609,706 people eligible for the Covid Booster, as of 7th November 2024, 279,340 doses have been administered. In Brighton and Hove 78,752 people are eligible for a Covid Booster, as of 7 November 2024, 31,127 doses have been administered.
3.4 As with previous campaigns we will be working alongside our local public health colleagues, engagement teams and local providers to deliver our targeted access and inequalities programme.
3.4 Flu Vaccination: Sussex has a total eligible cohort of 1,009,239 people. Between 1 September 2024 and 7 November 2024, 457,049 vaccinations have been administered. In Brighton and Hove there are 144,836 eligible people and as of 7 November 2024, 37,102 vaccines have been administered. Flu vaccinations are delivered across a range of providers organisations and settings, including general practice.
3.6 Respiratory Syncytial Virus (RSV) Vaccinations: In August it was announced that the NHS would be rolling out a new vaccination for RSV for all adults turning 75 after 1st September 2024, women who are 28 weeks pregnant or more, and a catch-up programme for adults between 75-79 years. Sussex has a total eligible population of 75-79 years old of 93,612 and in Brighton and Hove the eligible population is 9,498. To date, 27.4% of older adults (25,615 have been vaccinated) in Sussex, including 2,573 in Brighton and Hove. Communication promotions are underway, with news stories being shared, films with clinicians, targeted social media and work through community and voluntary groups to share the message.
3.7 Case finding is the Sussex system proactive approach to identifying those patients most at risk of needing non-elective care or urgent and emergency care over the winter months. We want to better support these people and will focus on:
· Identifying at risk individuals and ensuring a proactive care approach is taken to minimise the risk of a deterioration in their health
· Optimising VCSE support, and reprofiling existing resource to focus on at risk patients
· Ensuring that there are clear alternatives to acute admission and should their health deteriorate.
· Ensuring that we have a clear 7-day support offer for care home in order to reduce the risk of admission for vulnerable residents.
3.7 This is supported by General Practice who are best placed to identify those in most need who can be supported by a multi-disciplinary teams’ approach linked to wider voluntary and community sector support offers.
3.8 In Brighton and Hove there are services designed to support this proactive approach including a multi-disciplinary team frail elderly pilot in the West and East Health Hub that covers the East and Central parts of the city.
3.9 The approach to improving same day urgent care for the winter period focuses on four key areas to: improving access to same day non-urgent care services; improve flow in the Emergency Departments; improve access to community physical and mental health services; and ensure people are supported by our services out of hospital where possible and appropriate.
3.10 To respond to this we are focusing
on:
· Optimising our existing services such as Urgent Treatment Centres to make sure people are seen in a timely way that responds to need
· Increasing capacity in the system by increasing how we use virtual wards to support people and increasing the use of pharmacy services
· Navigating people to the right service and implementing our unscheduled care hubs which will support the utilisation of alternatives to hospital and reduce conveyances to hospital by the ambulance service.
Improving discharge from hospital
3.12 The four workstreams that will support this
are:
· Implementation of the SAFER patient flow bundle
· Support to patients to stay active whilst in hospital to minimise any deterioration in their health and well-being
· Optimisation of the Transfer of Care Hubs which are multi-disciplinary hubs focused on getting the right support in place to enable timely discharge
· Development of a needs-based demand and capacity model to help us get the right type of support in place to respond to people’s needs.
3.13 In Brighton and Hove specific work includes an increase in bariatric short-term reablement beds; and increase in workforce capacity for the same day discharge team; increased pathway 2 beds to support people in community settings; increased Homecare packages of care hours; increased Social Worker capacity; and increased discharge workforce at University Hospitals Sussex NHS Foundation Trust and Sussex Community Foundation NHS Trust.
4.1 As in previous years, maintaining the capacity and resilience of our workforce will be key to the delivery of safe and high-quality services and is an important part of our plan.
4.2 A range of targeted action is in place to help us: manage our temporary workforce; improve our staff wellbeing; increase uptake of vaccinations amongst staff; manage our staff absences; maximise opportunities to share staff; work with our voluntary and community sector; and minimise the risk of the cost of living on staff. This will be regularly monitored throughout the period.
5.1 We will ensure effective clinical leadership throughout winter, and we will focus on key metrics that help us understand how the system is performing and any action we may need to take to continue to ensure safe and effective access to care.
6.1 A coordinated system wide communications and engagement plan has been developed with system partners to ensure clear communications are in place to support operational delivery over the winter period. This includes global approaches to key messages for the public, partners, and staff, as well as targeted and focused approaches based on data and insight.
6.2 The plan will bring together activity over the Winter period, covering Flu and Covid19 vaccinations, preventative advice and support to key audience groups such as respiratory advice for children and young people and urgent and emergency care pathway information.
6.3 Our communications plans will focus on addressing health inequalities, and insight will shape communications activity and ensure that work considers the whole population.
7. Sound Operational Management and Governance and Oversight
7.1 Our objective is to ensure that the Sussex system has robust operational management in place with clear coordination across the system and rapid routes for escalation where required.
7.2 The following systems and processes are in place to support this objective:
System Co-ordination Centre (SCC)
a dedicated operational team who provides support interventions across the ICS on key systemic issues that influence patient flow.
Winter Standard Operating Model
seven days a week capability to monitor and respond to operational pressures in the system.
ICB Rapid improvement approach
a multi-disciplinary team that can respond in an agile way to emerging pressures.
Protect the delivery of elective care, cancer and diagnostic services
system capacity will be prioritised for the effective operational management of elective care throughout winter.
7.3 We have clear governance for overseeing delivery of the winter plan, with clear routes to escalation where needed. This includes clear roles and responsibilities; clear reporting; implementation of national escalation frameworks; and clear underpinning policies in place.
8. Individual organisational plans
8.1 Underpinning the overarching Sussex system winter plan, each of our provider Trusts have developed their own winter plans and have contributed to the system wide demand and capacity modelling.
8.2 These ensure a specific focus on ensuring the right capacity is in place, the right processes are in place to support timey care and good patient flow, the use of all extra capacity and schemes in place are maximised and robust infection prevention and control measures are maintained.
8.3 Local authorities play a role in many of the initiatives that are developed to support winter and as in previous years, our approach to planning has been in collaboration across all organisations Sussex wide, and with a focus on each place, including Brighton and Hove. In addition to work focusing directly on supporting the plan, work is underway to consider any further action that could be taken to support people living in or at risk of deprivation.
9.1 The approach to the Winter Plan will enable us to focus on the action we need to take to maximise support for people this winter focusing on particular initiatives that will help keep people well; avoid unnecessary hospital admission; and ensure access to safe services for local people. The plan will be submitted to the NHS Sussex Integrated Care Board on 27 November 2024 and will be closely monitored over the winter as part of a whole system approach.