Brighton and Hove City Council Health Overview and Scrutiny Committee (HOSC)
Winter Plan Review and Evaluation Report – June 2025
Introduction
1. The Sussex ICS Winter Plan 2024/25 focused on supporting the population to stay well while maintaining patient safety and experience. The plan was structured around five key pillars, which are explained in more detail in Section 2 of this report:
· Prevention and case finding
· Same day urgent care
· Improvements in discharge to support patient flow
· Sound operational management
· Oversight, governance and escalation
2. The approach to the development of the plan built on lessons learned from previous years. It outlined the key actions to be taken by NHS Sussex and system partners across the ICS to maintain access to safe services during the winter period.
3. The plan drew on a core set of actions developed over the previous year, informed by data analysis and supported by a clearly defined system oversight model based on clinical risk.
4.
The Urgent and Emergency Care (UEC) Improvement Plan and Discharge
Plans, which formed the foundation of the Winter Plan, were
developed collaboratively with partners and providers across the
system. The final Winter Plan was approved by the NHS Sussex ICB in
November 2024.
5. Update reports on progress against the plan were provided to WSCC Health and Adult Social Care Scrutiny Committee (HASC), Brighton Health Overview and Scrutiny Committee (HOSC) and the East Sussex Health Overview and Scrutiny Committee (HOSC) in November 2024.
6. Demand and capacity modelling was carried out by the NHS Sussex Business Intelligence Team, informed by data analysis from previous years’ winter performance. The modelling reviewed bed occupancy using a series of demand assumptions and predicted likely gaps between capacity and demand. The impact of planned mitigations outlined in the plan was also modelled to ensure those gaps identified could be mitigated by the planned actions being undertaken within the workstreams supporting the five pillars.
7. As a result of the modelling, several schemes were identified as having an expected impact on performance over the winter period, such as A&E four-hour performance, patients waiting over 12 hours in A&E, the average length of stay and the number of patients with a ‘no criteria to reside’ (NCTR) status. These were monitored throughout the winter period by the ICB Resilience and Strategic Intelligence teams using SHREWD data platform and national data streams.
8. The Winter Plan included an outline of the Winter Operating Model for system oversight via the System Co-ordination Centre (SCC), and governance and escalation routes.
9. Each provider outlined their high-level actions, which were underpinned by their organisational plans, within the overarching Winter Plan. Providers will complete internal reviews of their action plans.
10. In addition to the Winter Plan, a Reset Event was scheduled for the two weeks leading up to, and two weeks post, the Christmas and New Year bank holidays. This did not form part of the initial plan but was requested by the System Oversight Board following receipt of the plan. This was also evaluated as part of the review of the Winter Plan and details are included in the report below.
11. Each of the five Pillars were reviewed by workstream leads to determine whether they were effective in maintaining performance, patient safety and experience. The demand and capacity modelling has been reviewed against actual performance to determine accuracy. A system debrief session was held on 30th April 2025 to gain insight into what went well, what did not go so well, and what could be fed into future planning. A provider survey was conducted, alongside a patient discharge experience survey, to give further insight into the success of the Winter Plan.
12. This report outlines the results of the review and evaluation of the plan which took place the end of March 2025, which immediately followed the cessation of the period covered by the Winter Plan.
1 Winter plan review outcomes
13. The following sections of the report contain the detailed outcomes of the Winter Plan review set out in the key areas summarised above, describing each of the key measures and pillars, what worked well and areas for improvement.
2.1 Demand and Capacity Modelling
14. Demand and capacity modelling was carried out the by NHS Sussex Strategic Intelligence team in conjunction with provider plans, using a series of assumptions based on previous years increased activity due to known winter pressures on the bed capacity and therefore the predicted gap in demand. The identified gap was modelled against the winter schemes, and interventions to test whether they would mitigate the bed gap and what impact they might have on system performance. To support decision making a small number of metrics were identified to act as a proxy for clinical risk and these were added to a separate Single Health Resilience Early Warning Database (SHREWD) dial so that they could easily be monitored.
15. The demand and capacity modelling indicated a starting gap of 164 beds at the peak demand in the first week of January 2025 and that the actions described in the Winter Plan would close the gap to 6 beds (figure 1). Until the end of December the bed occupancy broadly followed the modelled average. In January and February 2025, the occupancy rose significantly to an average of 85 beds above the modelled capacity requirement, due to higher number of beds occupied by patients with flu. Additional recorded capacity classified as “general and acute (G&A) beds opened” was not accounted for in the original model and therefore not included in the analysis. This should be addressed in future models. Further planning will be undertaken with Public Health teams to improve infection forecasting in relation to the bed modelling.
Figure 1: Predicted Bed Gap Following Modelling 2024/25
For Brighton and Hove, the winter bed plan modelling indicated that based on bed occupancy and a series of demand assumptions, a reasonable scenario would result in a starting gap of 16 beds at Princess Royal Hospital (PRH) in the second week of March (winter peak) and a zero bed gap at the Royal Sussex County Hospital (RSCH). The modelling indicated that the starting bed gap at PRH would be reduce to two beds at PRH by the mitigating actions.
Throughout the winter period at both hospitals, the number of beds occupied fluctuated close to the modelled average beds occupied. In both PRH and RSCH bed occupancy dropped during the Christmas and New Year period.
In early January 2025 the system saw a spike in influenza (flu) admissions which increased pressure on beds. PRH flu admissions peaked at 25 in February but recovered by the end of February. However the number of admissions at RSCH fluctuated significantly over the winter and averaged at 25 which a peak of 76 in the first week of January 2025. Flu could have been an underlying cause of the slight increase in January 2025, but it was not the cause of the ongoing pressures.
16. A small number of metrics were agreed as proxy measures of the system resilience. These were monitored throughout the winter period. A summary of the performance from each one is given below:
2.1.1 Four-hour A&E performance target
17. Four-hour A&E performance target remained close to season trends, with performance at 69.5% in the last week of March 2025 and an overall monthly performance of 73.8%, against the 78% target (please see table 1 below). This benchmarked as upper quartile performance nationally.
Table 1 - 4 Hr performance in A&E
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It was projected that the completion of the actions in the Winter Plan would result in increased levels of performance at both RSCH and PRH, however the target performance of 78% was not reached. At year end, performance was 73.4% at RSCH and 69.8% at PRH.
2.1.2 12 Hour stay in A&E
18. The 2024/25 actual performance for the 12 Hour Stay in A&E metric was broadly unchanged over winter and has held at around 7-9% over the past 12 months. This is up from around 4-6% in 2023/24. There was a spike to around 12% during December and January. (At the time writing this report national data was unavailable).
In Brighton and Hove the number of patients waiting in A&E for over twelve hours remained broadly unchanged compared to 23/24, implying that the improvements planned have not materialised. However, an improvement was seen at RSCH in March 2025 with them ending the winter period only slightly above their mitigated target of 10.1% at 10.7%. PRH performance remained unchanged over Winter with a peak in mid-January of 14%. Performance has since decreased, ending the year at 9/7% against it’s mitigated target of 9.7%
2.1.3 Average length of stay (LoS)
19. The average length of stay (LoS) increased in December and began to decrease from January, and did not meet the reduction target (8.7 days) by the end of the winter period. The Sussex length of stay in the last week of March was 9.8 days.
Average Length of Stay at RSCH was lower than last year over winter and well below the mitigated target of 12.5 days. It was slightly above the 10% winter reduction target of 10.7 days at 11.2 days.
Average length of stay at PRH however, increased over winter, peaking in January 2025 at 11 days. Which is higher than in 23/24 position and well above the mitigated projection of 8.2 days, ending the year at 9.5 days in March 2025, implying that the mitigation actions did not have an impact.
2.1.4 Ambulance response times (Category 2 incidents)
20. Data shows that the South East Coast Ambulance Service (SECAmb) improved their performance position from 5th of 11 Ambulance Trusts to 2nd of 11 Ambulance trusts, for Category 2 performance, during the period October 2024 – March 2025 (please see table 2 below). SECAmb response times within Sussex ICS, for five out of the six winter months, were faster than the national average. The national target was for category 2 calls to be responded to within 30 minutes. SECAMB achieved this in 3 out of 6 months over the winter period and responded to category 2 calls between 12 and 15 minutes faster than the national average over the final quarter of the year.
Table 2: Ambulance Response Times (Cat 2)
2.1.5 No Criteria to Reside (NCTR)
21. Across Sussex we continue to see a high number of patients remaining in inpatient beds despite being defined as either Not Meeting Criteria to Reside (NCTR) or are Clinically Ready for Discharge (CRFD).
22. There are a range of reasons for why discharge is delayed for these patients. Examples include waiting for NHS community care, waiting for social care, waiting for residential care, and waiting for non-clinical processes to be completed, such as prescription medications being prescribed.
23. Pillar 2 of the Winter Plan focused on improving discharge to support patient flow and aimed to reduce the number of patients residing in acute, community and mental health beds.
24. The local ambition to reduce NCTR numbers by 33% by the end of March 2025 was not achieved. However, there was an improvement compared to the ‘Do-Nothing’ position. Sussex NCTR position (acute, community and mental health) was 847 in the last week of the March 20224/25 compared to the ‘Do-Nothing position of 983, an improvement of 14%. However, this was significantly higher (193) than the ambition set out in the winter plan, indicating the actions set out in the winter plan did not have the desired impact. There was an improvement in the week before Christmas which coincided with the RESET event, however the numbers increased again from January.
The local position in Brighton and Hove mirrored that of Sussex with both trusts not achieving their ambition.
Nationally University Hospitals Sussex (UHsx) is one of the Trust’s with the highest percentage of beds occupied by NCTR patients.
25. In Sussex the percentage of beds occupied by NCtR patients was 20.7% for March 2025, which was considerably higher than the national average of 13.1% with the Sussex ICB performing between 40th to 42nd out of 42 ICBs (see table 3 below).
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· Despite significant efforts over the past year to decrease the number of patients occupying beds or services that no longer have any criteria to reside (NCTR), Sussex remains the most pressured system in the country for 14+ NCTR bed occupancy across acute sites and remains at 42 against national benchmarking.
· Long term sustained action continues to be focussed on reducing both the number of discharge-ready patients and their length of stay, both pre and post discharge ready).
· Providers and Local Authorities across Sussex have recently developed a set of place based site level discharge improvement plans, with a view to reducing the number of NCTRs across each acute, community and mental health settings to a Sussex baseline position of 14.3% by March 26.
· Provider stakeholders from across health and social care have set out a series of key actions they will collectively undertake during 25/26 to support the reduction in NCTRs.
· Plans and actions are nuanced across place sites, reflecting the diversity of Sussex but range from:-
· Recruiting additional Social Worker, therapies and HomeFirst Staff
· Implementing SAFER across all acute wards/divisions
· Criteria Led Discharge – Increasing Pathway 0/1s over 7-day model.
· Increased capacity within Community Reablement Services
· Implementation of Choice Policy pan Sussex
· The plans were formally signed off at the Discharge Oversight Board on Friday 13 June, but recognised that the plans were fluid and would need to be reviewed by place-based Boards monthly and flexed/amendment regularly to meet changing needs of targets and overall areas of improvement.
2.2 Workstream Pillars: Pillar 1 – Prevention and Case Finding
26. The objective of the Prevention and Case Finding pillar was to support our population, including NHS staff, to stay well and ensure the system had proactive care in place for those most at risk.
2.2.1 Workforce and Wellbeing
27. The Chief People Officer (CPO) group oversaw the aims of this workstreams.
Notable achievements:
· Staff networks were developed to create and promote a culture of wellbeing, dignity, respect and inclusion for all.
· Over 18,500 healthcare workers self-declared as having received either a Covid and/or flu vaccination, reducing staff sickness absence over the winter period.
· Staff absences over winter decreased slightly from 5.7% in 2023/24 to 5.6% in 2024/25, improving workforce resilience over the winter period.
2.2.2 Vaccination Programme
Access & Inequalities (A&I) Programme Autumn / Winter 2024 – 25 (AW24-25)
·
The core aim of the Covid-19 Vaccination Access and Inequalities
(A&I) Programme was to reduce
the gap in vaccination uptake by eligible individuals and cohorts
within population groups who experience health inequalities, and
link population groups and areas of need to preventative healthcare
and support. The objective was to:
- remove barriers and increase access to vaccinations for those populations who could not or struggled to access core services.
-
build confidence in vaccinations and wider health services among
individuals and groups who may not typically have taken up
vaccinations or engage with health services through standard
approaches.
· In Sussex, the AW24-25 Covid-19 A&I programme targeted areas of deprivation and low uptake and our rural populations with outreach services. In planning the programme of clinics and communications and engagement work we reviewed areas of lower covid-19 vaccination uptake in Autumn/ Winter 23, against other agreed measures including Core 20 Index of Multiple Deprivation (IMD), ethnicity, health deprivation, disability and percentage of people aged 65 and over. Broadly these areas overlaid – there is a clear corelation between areas of lower uptake and those facing inequalities/disadvantages of different kinds.
• Based on this analysis our A&I programme focused on the following geographic areas:
- West Sussex – in and around coastal areas in Bognor, Littlehampton, Worthing, Lancing, and areas in Crawley;
- East Sussex – in and around coastal areas of Eastbourne, Hailsham, Polegate, Bexhill and Hastings;
- Brighton & Hove – the city, with some additional focus on the east.
Within these areas there were differences in the local population (for example, specific vulnerable groups such as Gypsy, Roma and Traveller communities (GRT), homeless, asylum seekers; different levels of deprivation and different health inequalities, etc) that required a tailored local approach.
·
There is currently a competitive procurement process for outreach
services in Autumn/Winter 2025-2026 (AW25-26) East Sussex, West
Sussex and Brighton & Hove.
· These services will deliver Covid vaccinations and clinics which could be temporary offsite clinics (formerly known as pop ups) or using roving vehicles. Scope of delivery will depend on specific local population needs and which other providers are delivering locally (such as PCNs or community pharmacies) and will build on any learning from previous outreach programmes.
Brighton & Hove
Brighton & Hove GP Federation
• This was the first time Brighton & Hove GP Federation had delivered A&I clinics. The Fed used its extensive experience and knowledge of population needs in B&H to develop an effective programme to address health and vaccine inequalities in the city. They utilised existing strong links with community partners and VCSEs, GP practices and the local authority.
• Using a roving vehicle they delivered vaccines to homeless people, working closely with Arch Healthcare. They also ran enhanced roving service clinics focused on key communities which included LGBTQ+, GRT, those living in deprived areas, specific in the east of Brighton and ran quiet sessions. This included offering MECC activity.
• Throughout planning and delivery the Fed worked in close partnership with the local authority and VCSEs the Hangleton and Knoll Project, the Trust for Developing Communities (who jointly ran a comms and engagement project – see below).
• A total of 41 clinics were run, delivering 2,161 vaccinations.
• MECC activity included blood pressure checks, atrial fibrillation check, pulse, wellbeing advice
• It was important to work flexibly, adapting the projects to deliver more enhanced roving clinics when it was clear there was less need for the number of clinics for homeless people.
• Useful learning for the future included – LGBTQ+ sessions were highly valued reaching people who would otherwise not have been vaccinated (very safe space), clinics at Asda Marina and Whitehawk were very successful; other less successful clinic venues will be reviewed for future programmes.
Trust for Developing Communities/Hangleton & Knoll Project
• TDC and HKP worked in close collaboration with B&H Federation and local authority public health to facilitate and promote vaccination clinics, vaccine benefits and answer vaccine hesitancy questions. Key targets were Core20 neighbourhoods and underrepresented groups. Activities included events, online comms, face to face conversations, newsletter, poster, flyer and leaflet distribution.
• Their previous comms and engagement experience was used effectively to plan and deliver the project. Building on trusted relationships was key to reaching those who are less engaged. Collaborative working was essential, as was ongoing communication between key stakeholders.
• We also invested in several targeted pre-Spring communication and engagement projects in Brighton and Hove run by TDC & HKP, Impact Initiatives and Together Co.
28. The vaccination programme was a key element in protecting our population. The programme focused on three areas and aimed to maximise the uptake of COVID, Flu and RSV Vaccinations. The eligible cohorts for each vaccine were identified by the Joint Committee of Vaccinations and Immunisation (JCVI).
29. The campaign ran from October 2024 to March 2025 (this is a rolling programme and 2024/25 was the first year for this vaccination campaign), the results of which are laid
out in figures 2 and 3 below:
Figure 2: Sussex total for each vaccination campaign
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Figure 3: Vaccination results by area
Notable achievements:
· Uptake across all three vaccinations (Covid, Flu, and RSV) was above the national average for both COVID and Flu as outlined below:
· COVID - Sussex 53.6% vs National 44.5%
· o Flu – Sussex achieved above the national averages for each of the cohorts eligible for a flu vaccination
· RSV – Sussex 66.4% vs National 63.7% (as of 12 June 25)
· There were 526 eligible older adult care homes with residents eligible for a COVID vaccination - 100% of which were offered a covid vaccination
· An internal MDT weekly meeting was established to provide leadership and oversight of performance and planning over the Winter Vaccination Campaign.
Areas for improvement:
· Uptake for both flu and covid vaccinations across health and social care staff was lower than in previous years; with a few acute trusts not offering on-site staff vaccination which may have impacted on uptake. At the end of the 24/25 Autum/Winter Campaign this was represented in Sussex Staff vaccinations being ranked nationally as 15th out of 42 ICBs for Covid and 19th out of 42 ICBs for Flu.
· Healthcare Support Workers (HCSW) were not included in the Joint committee on Vaccination and Immunisation (JCVI) eligible cohort which caused some mixed messaging about the eligibility of vaccinations for Winter 24/25. It is uncertain if HCSW staff will be included in the JVCI cohort for this Winter, but earlier work with Trust CPOs to ensure that plans are in place to offer vaccinations to the HCSW will be carried out, including workshops planned in Summer to prepare for Autumn and Winter covid and flu vaccination campaigns.
· Early and active engagement with key stakeholders will be crucial to the success of the Vaccination Campaigns
2.2.3 Prevention and Case Finding
30. The Cohort Identification and Multi-disciplinary Teams (MDT) programme was introduced to support winter preparedness and to build links between GP practices and community teams in the management of patients at higher risk of admission to hospital and increased GP appointments.
31. The approach was to identify the cohort of patients at primary care level and optimise their care by referring them to a proactive MDT and link them the wider service provisions such as virtual wards or voluntary sector services. The programme was well received and there is an appetite to continue and enhance it further.
Notable Achievements:
· 138 out of 156 practices across Sussex signed up to the programme
· Practices with existing community team relationships implemented new processes smoothly
· Workshops were delivered to support frontline staff
· GP practices reported that the MDTs alleviated pressure on their services.
Areas for improvement:
· A small number of practices did not sign up to the programme
· Consider sign up on a Primary Care Network (PCN) basis to reduce pressure on community teams.
· Improve the consistency of services in each MDT
· Improve access to prescribers in community teams
· Quantifying the impact of the programme has not been possible, but work is underway with our business intelligence team to ascertain if there is any noticeable impact between the practices that participated and those that did not.
Of the 138 / 156 practices who signed up to the programme across Sussex 119 submitted returns for all three months of the programme. Therefore, the dataset is still provisional.
2.2.4 Place Based Integrated Community Teams plans
32. The Integrated Community Teams (ICT) included a wide range of stakeholders across the Sussex system including providers, local authorities, public health and Voluntary, Community and Social Enterprise (VCSE) services. Over winter the ICTs in each Place, tested a range of initiatives described as ICT Neighbourhood Level Tests of Change. The key focus was on prevention, admission avoidance, and testing new ways of working.
Brighton and Hove Tests of Change
Notable Achievements:
· Integrated working on preventative and proactive care for a targeted cohort provided greater assurance on delivery
· Targeted communications improved engagement
· Volunteer expertise is effective to providing relevant support and advice
· Adopting learning from previous years enabled the VCSE network to grow a wider membership
· The Proactive Care Huddle reduced avoidable hospital admissions, enabling healthcare professionals to strengthen existing pathways.
Areas for Improvement:
· The need to move from siloed pilots with small cohorts of complex patients, with time-limited action to support individuals and communities, at scale and embedding this business-as-usual system change resulting in improved outcomes and experience for the local population.
· Ensuring awareness of the non-NHS range of provision by service providers
· Optimising preventive – community asset which is valued by the population
· Optimising the offer of volunteer support across the system.
Brighton and Hove ICT
Winter 2024-2025 test of change schemes provided an opportunity for key partners to come together in a multi-disciplinary approach, across organisations to focus on an identified cohort that are most likely at risk of health deterioration over winter. Community events and webinars took place to create awareness of available local service provision, following the events and the feedback received from attendees and those involved in the events, recommendations were made on how to improve targeted comms and engagement. A directory of services across health and social care was circulated widely to all stakeholders to support awareness and referral processes to a suite of local services ‘supporting people through winter and beyond’.
East ICT Partnership Group established a health hub in Robert Lodge within one of our Core20 areas of the city. The hub model responded directly to local health data and community feedback delivering a range of health and wider determinants activities.
West Hove ICT frailty pilot focused on a local target priority cohort testing a proactive, multiagency interventions to better support complex health needs in the community and reduce risk of the need for urgent care services. Each person received a total 360 assess, MDT working and links to VCSE and ASC services.
2.2.5 Communications and Engagement
33. It is recognised that clear communications and engagement can have a positive impact on prevention and how people access help and care over the winter period. A coordinated communication approach was developed across the system focused on two key areas:
· ‘Helping you this Winter’ – shared assurance that partners were working together to ensure plans, services and systems were in place so that patients would get the care they needed.
· ‘Help us to help you’ – targeted campaigns promoting key information, advice and public health messaging.
Notable achievements:
· Clearly branded (recognisable) system-relevant campaign for ‘Let’s Get You Home’, with positive and impactful team collaboration and creativity to assure members of the public that plans were in place and partners were working together to ensure they get could get the care they needed over the winter period. A combination of national and locally created assets were shared to promote key health information and advice.
· Using real people to tell the story worked well.
· Strong media relationships as well as Sussex Partnership Community NHS Trust communications team relationships and coordination.
· Intelligent linking of local activity to national/regional communications as well as the system mental health campaign, focussing on discharge.
·
Consistent media coverage, partner communications, granular
operational communications combined with national marketing worked
well.
Areas for Improvement:
· More proactive targeting of specific audiences and geographies could be done using social listening, insights and service data to enable communication via their preferred method, such as Instagram or WhatsApp.
· More could be done to make the messaging more diverse to reach people in their first / preferred language, which may not be English.
· Targeting working aged adults around getting repeat prescriptions in time for bank holidays, or when an A&E is busy and highlighting alternative services.
2.3 Workstream Pillars: Pillar 2 - Same Day Urgent Care
The objective of the Same Day Urgent Care programme was to ensure patients received rapid access to the service which best met their needs. The approach focused on 4 key areas:
· Improving access to same day non urgent services
· Improving ED flow
· Improving access to community physical and mental health services
· Increasing redirection across Urgent and Emergency Care (UEC)/Out of Hospital (OOH) pathways
Notable achievements:
Unscheduled Care Navigation Hubs (UCNHs)
· Two UCNH pilots were developed at pace between July and December 2024 – with support from SECAmb, UHSx, SCFT and ESHT – in Brighton & Hove and East Sussex. The hubs are located at SECAmb’s Brighton and Polegate Make Ready Centres, respectively.
· The aim of the UCNHs are to reduce ambulance callouts and conveyances to our local EDs by reviewing patients awaiting a category 3 or 4 ambulance response both pre and post-dispatch; and referring them to alternative acute, community, primary, mental health and voluntary-based admission avoidance services.
· The Sussex UCNHs are staffed by a multidisciplinary team (MDT) of senior clinicians from acute, ambulance and community NHS Trusts operating together either virtually, or in the same room. The knowledge and trusted assessor status each clinician has of their own services and pathways enables the UCNH to access alternative services far more effectively and efficiently than paramedic crews have traditionally been able to do themselves.
· In the case of the Brighton Hub, this includes either an ED or Frailty Consultant from UHSx and a virtual link into a GP located in SCFT’s OneCall. SCFT also provides periodic on-site support via a Urgent Community Response (UCR) Advanced Care Practitioner (ACP).
·
· Between 4th December 2024 and 30th April 2025, The Brighton Hub had 1,100 discussions with patients resulting in 824 patients who would have been conveyed to ED receiving another outcome. These outcomes included a See and Treat from the crews on scene (using the hub’s additional clinical knowledge); a referral to UCR or Virtual Ward; a conveyance to a non-ED service like SDEC; a GP referral; or, for mental health patients, a referral to the Blue Light Line. The majority of the other patients were conveyed to ED, due to their high acuity, but the hub was able to contact ED ahead of time to ensure they were medically expected, speeding up their journey through ED.
· Analysis of the Brighton Hub suggests that of these 824 patients, 38%, or 313, would have been admitted for an average of 9.3 days, increasing their risk of decompensation, costing UHSx 2,911 additional bed days, and increasing the need for Pathway 1 discharge support from UCR.
· The Brighton hub has therefore helped reduced conveyances to ED, improved patient flow, improved patient experience and outcomes, and improved SECAmb’s category 1 and 2 response times by freeing up their crews to attend additional patients. It is also estimated that the hub has saved the system more than £560k over 5 months.
· This has helped to improve flow and increase redirection of patients across Urgent and Emergency Care (UEC) / Out of Hospital (OOH) pathways.
· Strengthened links between Urgent Treatment Centres (UTCs) and Primary Care
· Increased awareness and use of Same Day Emergency Care (SDEC) as an alternative to admission
· NHS111 patient satisfaction improved during winter, which correlated to response times improving.
· Virtual Ward (VW) capacity increased to over the 250-bed target
· 300 additional referrals from primary care into VW, with 80% of VW beds utilised, which avoided patient admission to hospital.
Areas for improvement:
· Variation in UTC models across sites led to inconsistencies in patient experience
· Workforce challenges affected GP availability at some UTC sites
· Clearer governance structures needed to ensure SDEC spaces are used as intended
· Agree clinical pathways for palliative care in VWs
· Improve Acute hospital referrals to VWs
· Expansion of Unscheduled Care Hub into West Sussex and weekend operation.
2.4 Workstream Pillars: Pillar 3 – Improvement in discharge to support patient flow
34. The objective of Pillar 3 was to reduce the number of patients who reside in acute, community and mental health beds to improve patient experience, outcomes and system flow.
Notable achievements:
· A reduction from 22.3% to 20.7% in the number of NCTR and Clinically Ready for Discharge (CRD) patients in the Sussex system during the pre-Christmas and New year period.
· System coalesced around an agreed plan
· Sustained reduction through to the end of Q4 in relation to mental health CRD patient numbers
· SAFER bundle implemented. SAFER is a tool used to reduce delays for patients in adult inpatient wards (excluding maternity). The SAFER bundle blends five elements of best practice: Senior Review of All patients, Flow, Early Discharge and Review. When followed consistently, the length of stay reduces, and patient flow and safety improve.
· Therapy model supporting optimising mobilisation and independence in acute hospitals commenced.
Areas for improvement:
· Transfer of Care Hubs (TOCHs), which coordinate the discharge of patients waiting to leave hospital and who require post discharge support, were not fully optimised during the winter period as they were relatively early in their maturity.
· Some identified investment to improve capacity over winter was not fully utilised in a timely manner.
· Surge planning and discharge optimisation should be a rolling programme rather than only facilitated over winter.
· Embed surge planning into overall site improvement planning and system improvement plans
· Ensure site focussed improvement planning is at the heart of delivery
· Build on impact reviews of historical investment
· Ensure there is capacity flexibility across the system to be immediately responsive.
2.5 Workstream Pillars: Pillar 4 – Sound Operational Management
35. The objective of Pillar 4 was to ensure that we had robust operational management in place with clear coordination across the system and routes for escalation where required.
Notable achievements:
· The System Coordination Centre (SCC) function to improve patient care was achieved in line with the SCC Operational Specification and acted as the single point of access with NHS England – South East region enabling timely cascades of information both into and out of the system.
· The Winter Operating Model was effective in ensuring that system partners came together regularly to discuss emerging issues and escalate where necessary.
· Daily Situational Reports to NHS Sussex Chiefs enabled top level oversight throughout the winter and rapid intervention where necessary.
Areas for improvement:
· The Systemwide Business Continuity Incident (BCI) Process in relation to system pressures was tested during the peak of system demand in January and several key lessons were identified. This document has now been updated to include recommendations agreed at the subsequent debrief and incorporate the new OPEL framework triggers.
· Implementation of a debriefing process to be used following OPEL 4 declarations.
2.6 Workstream Pillars: Pillar 5 – Governance, Oversight and Escalation
36. The objective for Pillar 5 was to ensure that we had a robust approach to cover delivery of the winter plan, with clear routes for escalation where issues are encountered.
Notable Achievements:
· The ICS was the first in the country to implement and roll out the new OPEL 24/26 framework.
· Winter Plan progress updates were provided to relevant governance forums throughout the winter period.
Areas for Improvement:
· Look at the frequency of and approval routes for reporting to the ICB governance groups to provide assurance, to improve efficiency and effectiveness of reporting.
· Review the plan with the SCC stakeholders more frequently throughout the course of the Winter Plan period.
2.7 The Reset Event
37. The Reset Event ran for four weeks from 19th December 2024 to 15th January 2025 (with a break for the Christmas week). The purpose of the event was to bring together providers of Health and Care to agree and undertake rapid improvement actions to support patient flow during this period of peak pressures.
38. The event concentrated on the efforts to prepare and recover from operational pressures which typically arise over the Christmas period. Eight interventions were grouped into five workstreams with an objective to reduce the bed occupancy to 93% by 24th December and then to reset the occupancy position in the beginning of January 2025. The objective was to maintain patient flow during this period so that those individuals requiring rapid access to emergency care and in particular, and emergency admission, could receive care and treatment in a timely manner.
39. Each workstream had dedicated leadership from the ICB with an executive Senior Responsible Officer (SRO) and MDT from the system to drive the operational and clinical expectations. Each provider nominated leads to drive the interventions within their own organisations.
Notable Achievements:
· Good engagement at an executive level via twice weekly panels, which supported focussed working on key issues
· Choice Policy agenda promoted to ensure early discharge planning and that patients were aware of their planned onward journey in a timely fashion
· Positive coordination from communications teams
· Clinically led focus on specific areas in acute settings
· Increased flexibility in criteria (SCFT/SPFT)
· Delivery of sub 92% bed occupancy on 26th of December which created sufficient capacity to manage patient flow over the Christmas and new year period, avoiding the system needing to declare a major incident, which was observed in a number of other parts of the country.
Areas for improvement:
· Early engagement with stakeholders to agree and formalise the process in advance of initiation of reset event.
2.8 Winter Plan Survey
40. The Winter Plan survey was conducted between 8th and 23rd April 2025. This went out to all system partners as a precursor to the Winter Plan debrief session in order to give people the opportunity to feedback their observations of the effectiveness of the plan. 21 responses were received from across our system partners, which is an increase on previous years.
Notable findings:
· The average score for the effectiveness of the plan was 6.26 out of a possible 10.
· The key areas of focus or pillars where respondents observed the greatest impact were ‘communications and engagement’ and ‘improvement to discharge and flow’.
· The key areas of focus or pillars where respondents observed the least impact were ‘the vaccination programme’ and ‘governance and oversight’.
· The average score for implementing the Winter Plan within their team / services was 6.70 out of 10.
· The greatest barriers to implementation of the plan were identified as ‘operational pressures’ and ‘workforce challenges’
Improvement Suggestions:
· More involvement from digital colleagues.
· Review the meeting cadence or consider move to one daily touchpoint meeting to reduce the burden on colleagues across the system.
· Stand up a Winter Plan Forum attended by all system partners to start the planning process earlier in the year
· Greater cooperation between providers
· Include more about Neighbourhood Care.
2.10 Winter Plan Debrief
41. The Winter Plan Review and Evaluation Debrief was held on 30th April 2025 with representation from system partners and ICB workstream leads.
42. Representatives agreed that the plan had identified the main risks to the system during the winter and anticipated activity was as expected in the most part. One exception was that of an increased demand for acute and community beds caused by Flu and respiratory diseases which were higher than anticipated in January and February of 2025.
What went well
· The winter operating model was effective in bringing together system partners in times of pressure and felt responsive and supportive. Implementation of the new OPEL framework and use of the SHREWD data platform enabled ‘live’ system situational awareness for all partners.
· The roll out of the Unscheduled Care Hubs and the increase in virtual ward capacity were notable achievements.
Areas for Improvement:
· The cohort for patients eligible for vaccinations was changed with late notice
· Increase the uptake of vaccination amongst healthcare workers.
· The quality of care provided to patients who were cared for in temporary escalation spaces should be reviewed.
· There was little improvement in the ability of the system to discharge patients who no longer needed to be in hospital (NCTRs).
Recommendations for Improvement:
· Create a common set of triggers for escalation based on the new OPEL framework.
· Improve NCTR numbers.
· Work to eradicate patients being cared for in temporary escalation spaces.
· Improve awareness of respiratory diseases and expected impact for modelling.
· Move to an annual or continual surge plan based on agreed triggers.
· Review the winter operating model meeting cadence to avoid duplication.
3 Conclusion
43. Although the Sussex health and social care system faced a challenging winter, it performed strongly against national benchmarks, particularly in relation to the four-hour A&E targets and Ambulance Cat 2 response times (see tables in Section 2). However, the mitigations put in place to, discharge patients who no longer met the criteria to reside, reduce average lengths of stay, and 12 hour waits in A&E, did not have the level of anticipated impact.
44. In line with previous winters, some patients were cared for in temporary escalation spaces and waited too long in our emergency departments for admission and this will be a critical area of focus for our Winter Plan in 2025/26.
The surge in demand due to flu and Covid in the weeks following Christmas and the New Year created further operational pressures. Improving vaccination rates will be another critical area of focus for our Winter plan in 2025/26.
45. A full and comprehensive review of the Winter Plan has been carried out, and key lessons have been identified. These will be used to inform future planning.
46. Planning for Winter 2025/26 will commence in June 2025.