Agenda item

To receive an update regarding winter pressures on the health and care system, as well as the system response.

Phil Porter (Strategic Director Community Wellbeing, Brent Council) introduced the report, which provided information on the system response during winter and winter pressures. He advised that the system was fortunate in Brent that there were very good working relationships and a strong commitment to support the residents of Brent to stay out of hospital and get the appropriate care at the right time, working with the acute trust. Phil Porter and Robyn Doran (Chief Operating Officer, CNWL / Brent ICP Director), as co-chairs of the Integrated Care Partnership (ICP), had focused on winter planning for the past 3 ICP Exec meetings and would continue to throughout winter to ensure the system was working. He reassured the Board there were daily calls with the hospital to discuss discharge as needed, as well as daily calls at a NWL level for Directors of Adult Social Care (DAS) and ICP directors. He advised that the report set out the support Adult Social Care had put in place to help with the discharge process, with a lot of work put in to support residential and nursing homes and supported living and extra care, particularly with the closure of 9 nursing homes in Brent. A range of services in social care had been maintained through the hard work of all in the department as well as those in care homes and home care providers, and Phil Porter extended a special thanks to all those individuals.

Robyn Doran agreed that they were very conscious of the need for all agencies to work together at a local level, as well as feed in to the system as a whole. Daily calls with DAS and ICP directors allowed the NWL system to pick up issues across the patch. For example, many care homes were closed, including in Brent and particularly in Ealing, with both boroughs used by London North West University Healthcare NHS Trust (LNWUHT) to move patients down. The arrangements allowed for the system to use other capacity, such as community rehabilitation beds, to plug those gaps and move patients.

James Walters (Chief Operating Officer, LNWUHT) agreed that he had felt the partnership over the holiday period, where it would have been challenging for the hospital had it not had the support of the ICP through the winter schemes delivered locally. The hospital had been ensuring a business as usual approach, including accident and emergency for those attending with urgent care needs not limited to Covid-19, and maintaining a focus on elective services. The hospital was moving towards achieving the levels of activity it had seen prior to Covid-19. Throughout the period the hospital had focused on keeping patients and staff safe through ensuring good infection control and prevention measures across all wards and supported staff with equipment, vaccination and PPE.

In relation to care homes, Basu Lamichhane (Chair of Brent Care Home Forum) advised that care homes had support from the local authority, CCG and a good network that helped each other. For example, one care home had ran out of PCR testing kits the previous week and 2 care homes who had extra stock had been able to share theirs. The mandatory vaccination for care home staff came into place on 11 November, and while there were a few issues with staffing it was not as severe as was predicted. Through support care homes had been able to recruit and fill those vacancies. NHS had now also mandated vaccinations for staff. There was a Covid-19 safe pathway for admittance of any new residents in care homes, where they were first assessed for Covid-19 through a risk assessment and only admitted if safe. There had been several outbreaks in care homes, including staff sicknesses which had been difficult during the previous week with the delay experienced with PCR results being returned. Visitors were still allowed to visit on an individual basis.

The Chair thanked health colleagues for their introductions and invited comments and questions from those present, with the following issues raised:

·         In relation to the report, Phil Porter agreed to provide further details to the Board on whether all posts listed in section 3.2.3 (E. F and G) were in place.

·         The Positive Behavioural Support Pilot Service was for those patients being discharged into care homes who often found it unsettling to suddenly be placed in a new environment where some care homes did not have the specialist knowledge or expertise to work with them during the settling in period. The pilot put in place a small team of experts from Central and North West London NHS Foundation Trust (CNWL)
 to support care home staff with putting in place routines and appropriate support to help someone settle in to a place that was suitable and sustainable long term. The Board were pleased with the long term strategy and were keen for pilots like this to develop. Communications would be sent to GPs looking after care homes to make them aware of this new support scheme.

·         Due to several care homes in Brent being closed, alternatives had been looked into, working with the community provider to support people to go home more. Between 6-7 people had been supported to go home with a 24 hour package of care for a fixed period, in an environment they knew and were comfortable in. The service would look to see if this was possible on an ongoing basis. The Board heard that the ‘needs must’ approach to finding alternatives had provided this positive outcome.

·         An innovative pilot had been conducted with Harrow which acted as a Front Door for the Urgent Treatment Centre (UTC). Brent had employed a GP and Harrow had supplied a Specialist Nurse, and working with the Acute Trust they had looked at patients coming in to the Urgent Treatment Centre and had been able to review over 790 patients within a month from December. Patients were either able to see a GP, a nurse was able to provide advice, or the patient had been able to book a face to face appointment in an access hub or GP surgery. This had supported the Acute Trust Provider with the number of people that attend the UTC and the pressures they would normally experience during the winter period.

·         GP surgeries had been focusing on Covid-19 vaccination as well as monitoring those patients who became positive through their own surgeries or referrals to the Harrow Hub Home Oxygen Monitoring Service. Those referrals had increased and there was now a taxi available to deliver oxygen saturation metres to patient homes. Over the next few weeks, GPs would be focused on elective recovery and getting primary care back to a level of normality. There was pressure on primary care but a clear message that services should be looking after long term conditions, particularly as recent evidence showed that patients with hypertension not adequately controlled had a risk of hospitalisation from Covid-19. A spirometry hub was being set up in Brent and due to start in February 2022. PCNs had been encouraged to recruit to the additional roles scheme, including additional roles for mental health. There was a focus on conducting health checks for those with Learning Disability and Serious Mental Illness and that was reiterated on every occasion, with a letter from NHSE received confirming their position on that.

·         A meeting was held the morning of the Health and Wellbeing Board with Central London Community NHS Healthcare Trust (CLCH) colleagues and Primary care, in relation to cardiology services in the community. In addition, CLCH, alongside partners, had focused on reduced attendance to accident and emergency, preventing hospital admissions and hospital discharge pathways. In response to the need for discharge, the Robertson Centre had been reopened that week with a full complement of patients. There were pressures in the system with around 6% of staff off sick at any one point throughout the last few weeks and CLCH had been required to implement business continuity plans. Daily calls were conducted at trust level, divisional level and carrying out the actions of NWL Gold Command.

·         Inpatient services for mental health at CNWL had been challenging due to the wave of Omicron, with 12 wards closed across the Trust at its worst. 5 of the 5 wards in Brent had been closed at one point but they were all now reopened. The challenges had impacted the Acute Hospital so beds from the private sector had been commissioned. At its worst, there were around 25 people above CNWL’s normal bed numbers for Brent, with more people presenting and needing admission than ever before to inpatient services. Patients were predominantly detained under the Mental Health Act meaning they did not have a choice to be there, therefore the inpatient services were open to visitors, with mask wearing mandatory.

·         A PCR fast-track service had been started for Brent GP staff. That offer had been extended to the local authority to allow quick results for essential and key frontline staff needing results quickly. It had gone live on 24 December 2021 and would remain until 16 January 2022. Dr M C Patel advised this had proved positive as Brent GP surgeries had not had any practices shut down as a result of sickness.

·         In relation to young people and CAMHS, Robyn Doran advised that this was one of the priorities of the ICP. As co-chair of the ICP she reported directly to the Brent Children’s Trust, who had a work stream around the waiting times of CAMHS and actions to bring those down. At the most recent Children’s Trust meeting the Local Clinical Lead and Service Director from CAMHS had been invited to talk about the steps they were taking. She highlighted the importance of working with the third sector to reduce those waiting times, and agreed to share the action plans outside of the meeting with Board members. She reminded members that Councillor Ketan Sheth was hosting an event with Brent Healthwatch on 26 January about CAMHS and waiting times.

·         Board members asked how the resilience of staff was being looked after longer term. The Board were advised there was a Health and Wellbeing Hub across the whole of NWL that staff could access, and Health Education England had put in more resources for the whole sector and all partners. It was highlighted that staff wellbeing was a number one factor when on calls with NHSE. James Walters added that LNWUHT had the biggest Employee Assistance Programme they had ever had and taken the opportunity to recruit a full Health and Wellbeing Team and invested in their staff. Executives had been through the wards and made staff tea and coffee and chatted with members of staff. Early on in their winter planning, LNWUHT had recruited additional therapists and radiologists to spread the portfolio, which had helped with the recruitment ask and took a weight off across each area. Dr M C Patel highlighted that GPs were individual units and often isolated and hoped to discuss with NWL how GPs and their staff could be supported and tap in to what was happening locally.

RESOLVED: to note the information provided in the paper.