Agenda item - Sussex-Wide Winter Plan 2021/22

Report of the Executive Lead, Strategy, Governance and Law (copy attached)

14.1    This item was introduced by Rob Persey, BHCC Executive Director, Health & Social Care; Lola Banjoko, Executive Managing Director, Brighton & Hove CCG; Dr Sarah Richards, CCG Medical Director; Becky Woodiwiss, Public Health Principal; and Ben Stevens, University Hospitals Sussex East (UHSxE) Chief Operating Officer.

14.2    Lola Banjoko explained that winter planning is an annual process as there is a consistent surge in health and care demand in the winter months. The biggest risk this winter is likely to be capacity in the local care market, particularly in terms of the interrelations between the care market and hospital admission avoidance and timely discharge. There are also significant challenges across the health and care workforce, particularly as staff have been working ceaselessly on the pandemic and then on service recovery. The system has been working hard to provide enhanced nursing support to care homes; on public messaging (working closely with Healthwatch Brighton & Hove); and on enhanced primary care services, with a particular focus on identifying and supporting vulnerable people in the community.

14.3    Ben Stevens added that the main challenges for UHSxE are around workforce and demand. There is a particular focus on managing hospital bed capacity, especially in terms of the timely discharge of patients who are Medically Fit for Discharge. The Trust is trying to recruit more medical and clinical staff, but is also investing in community services such as admission avoidance. UHSxE is also working to enhance critical care capacity and general bed capacity, but workforce is a factor here.

14.4    Becky Woodiwiss told the committee that having an annual Cold Weather Plan (CWP) is a statutory requirement. Cold weather typically impacts on people with respiratory conditions, and particularly on those who struggle to afford to heat their homes. This impact can be felt even when the weather is not especially cold: e.g. where temperatures are below 8 degrees outdoors/18 degrees indoors. Really severe weather can create additional problems: e.g. snow and ice can impede people’s access to services. This year there will be additional risks and pressures from Covid and it is vital that as many people as possible get vaccines and booster jabs. The CWP is a relatively high-level plan, with detailed service plans sitting beneath it.

14.5    Cllr West asked a question about staff getting to work in harsh weather. Mr Stevens responded by noting that UHSxE, and other providers, have business continuity  severe weather plans, which include the use of volunteer 4x4 drivers.

14.6    Cllr West asked whether there is capacity within severe weather plans to deal with prolonged extreme weather. Mr Persey replied that there is capacity for severe weather within the plans, but there will inevitably be challenges in a really harsh winter.

14.7    Cllr John asked whether both a system winter plan and a local CWP are really required. Ms Woodiwiss responded that the plans do have different focuses, with the CWP looking at broader determinants of health and the winter plan at services. However, both are national requirements, so the local system is obliged to plan in this way.

14.8    In response to a question from Cllr John about fuel poverty in the context of rising energy prices, Ms Woodiwiss told members that fuel poverty is challenging to measure, and that there is an unavoidable lag in data reporting. However, an Excess Death Working Group does meet regularly to evaluate the latest data, so the system is as up to date as it can be.

14.9    In answer to a question from Cllr John on support for homeless people, Dr Richards told the committee that locally homeless people have been classified as clinically extremely vulnerable and have been prioritised for vaccination and boosters. Services have worked closely with Arch Healthcare to provide outreach to homeless people and to other vulnerable communities.

14.10  Cllr Grimshaw noted that the funding for fuel poverty work seems limited, and that advice on managing heating costs may not be relevant to everyone at risk, particularly for people who have pre-pay meters. Ms Woodiwiss agreed that fuel poverty is a big worry this winter. The council is working closely with the Local Energy Advice Partnership to ensure that good advice is communicated as widely as possible.

14.11  Cllr Brennan noted that advice to keep warm (e.g. by leaving heating on overnight) was of limited use to people who simply can’t afford to keep their heating on for long periods. Could the council look at other measures, such as loaning out small electric heaters? Cllr Brennan also noted that the Severe Weather Emergency Protocol (SWEP), designed to offer beds to rough sleepers in cold weather, will only accept people after a key worker assessment. However, some people feel unable to take part in assessments. What can be done for these people, and how many SWEP beds will be available this winter? Ms Woodiwiss agreed to provide a written response to these questions and also to pass on member comments about pre-pay meters and an electric heater scheme to the  Fuel Poverty and Affordable Warmth Steering Group

14.12  Cllr McNair asked a question about the availability of face-to-face GP appointments. Dr Richards responded that GP services have been open throughout the pandemic and that GPs have been meeting patients face-to-face when clinically indicated. However, demand is very high, and GPs are also leading on the Covid vaccination programme. In addition, with rates of Covid remaining high, there is a clinical risk for patients in attending GP surgeries. For these reasons it is not possible to give a percentage target for face-to-face appointments.

14.13  RESOLVED – that the report be noted.