Agenda item

To update the Health and Wellbeing Board on a comprehensive winter plan with input and engagement across system partners in Brent.

Tom Shakespeare (Managing Director, Brent Integrated Care Partnership) and Antoinette Jones (Head of ICP Delivery, NHS NWL) introduced the report, which set out the winter schemes that the Integrated Care Partnership (ICP) would be implementing in Brent with all key partners. In introducing the report, the following key points were highlighted:

·         The system was now into winter and the acute system was under significant pressure. As a borough partnership, the ICP took its responsibility in supporting the system very seriously and had taken a number of actions to progress the support to the system during winter pressures, including escalation meetings and focused support around discharge.

·         The focus of winter planning was on a whole system approach, including incorporating prevention, housing, and wider social determinant interventions within the system.

·         In relation to prevention in order to keep people well in the first place, an area of focus was on covid and flu vaccinations, with a robust vaccination programme across all cohorts. There were a number of community pharmacists, local Primary Care Networks (PCNs) and Brent Civic Centre engaged in the vaccination programme. At the time of the meeting, the ICP had been notified that the majority of patients residing in care homes had been vaccinated as planned. Within the area of prevention and keeping residents well, the Brent Well and Warm Service offered advice and vital support to vulnerable residents to help keep bills down.

·         Subject to final approval, primary care would increase additional appointments in core hours, in addition to the existing enhanced appointments offered at weekends and bank holidays.

·         There was now a primary care programme supporting carers with their health and wellbeing while they cared for loved ones to help reduce hospital admissions of carers and subsequently the person they cared for.

·         Across the system, the ICP was engaging with key stakeholders and partners and there were community strategies in place to ensure residents could be navigated to the right care offer and receive the right service at the right time. Self-care messaging would begin in November 2023. In addition, the wider NWL winter communications and engagement plan would support patients and residents with information about what services they could access during winter.

·         A Children and Young People Campaign had launched in September 2023,

·         BHM were reaching out to homeless people and asylum seekers to encourage vaccinations. There was Brent wide housing need preparedness operating through a number of services, geared towards supporting those experiencing homelessness and sleeping rough, including Turning Point, Brent Outreach Link Service, and the winter shelter which would be open 7 nights a week from the coldest period in the year.

·         London North West University Healthcare NHS Trust (LNWUHT) would be opening additional beds to support the system over winter, and Central London Community Healthcare (CLCH) would support Brent through rapid response times, preventing admissions to hospitals. The ICP knew that, in 2022-23, CLCH delivered a 98% response rate and managed over 400 referrals a month, and that support was expected to continue into 2023-24.

·         CLCH had opened a ‘step-up’ pathway from rapid response into a community bedded unit, improving the utilisation of beds, reducing hospital admissions and freeing up hospital beds. This was being piloted with 1-2 beds at the time of the meeting and it was hoped that, on a longer term basis, depending on the outcome of the pilot, that could move beyond winter.

·         Central and North West London NHS Foundation Trust (CNWL) had introduced a number of high impact interventions following work undertaken at the Provider Collaborative, such as the introduction of 8 mental health crisis beds in Kingsbury, expanding the CAMHS service and crisis support as an alternative to crisis admissions.

·         In 2023-24 the system had been allocated £3.5m and, due to the number of schemes that delivered good outcomes for residents in 2022-23, the ICP had extended and strengthened 15 schemes across the system with 14 having already gone live.

The Chair then invited contributions from those present. The following issues were raised:

·         The Board felt impressed with the amount of work the Council, local health service and voluntary and community sector had done around this.

·         The Board highlighted that some might say the health service was in crisis all year round and asked what scope there might be for mainstreaming services on a whole year basis for some of those projects, rather than them coming to an end on 31 March. Tom Shakespeare highlighted that the system was limited by that non-recurrent funding every year. If that funding was recurrent, it would make it significantly easier to maintain those services across the whole year. Within Brent, if the system could evidence the impact and benefit of the schemes implemented, then the ICP would make a case to sustain those schemes, which would be consistent with the approach taken with the Better Care Fund in previous years.

·         The Board asked what common communications approach could be taken across the health and social care sector to reach residents. Tom Shakespeare highlighted communications was very important and the ICP was focused on communications support for a winter campaign for the next quarter and ensuring it was joined up. This communications plan would take into account and build on national communications and local provider communications.

·         In relation to the Well and Warm Programme, the Board highlighted that Brent Council had operated ‘Warm Hubs’ through libraries the previous year, with a small pot of funding for organisations to bid for to make their premises warmer, and was looking at doing that again this year. The Board asked for the ICP to ensure organisations that would be making a warm space were equipped with the skills to know how and when to make a referral.

·         Northwick Park Hospital had seen sustained pressure throughout the summer period through to September 2023. London Ambulance Service (LAS) conveyances were around 19% higher than the same time in 2022, which was a significant increase, and a high proportion of those were blue lights. A number of winter schemes from 2022 continued throughout the summer period which helped improve flow and offload ambulances. The Trust was well advanced in the recruitment of nurses and consultancy staff to the new 32-bedded modular ward, with approximately 60% of those vacancies filled, and they would be onboarded as soon as possible to help with winter pressure prior to those beds opening. In advance of that ward opening, Northwick Park Hospital had increased bed capacity for winter, and there were a number of other new initiatives for additional capacity such as supporting early offloading of ambulances and cohorting within the A&E department. The new ‘Reach’ model had also launched, providing dial in support to avert attendances into hospitals.

·         CLCH had advised community nurses that Warm Hubs would be opening again and to speak to patients they felt it was relevant to. Consideration was given to a written communication to give out regarding Warm Hubs.

·         The Board discussed what more could be done to increase the uptake of covid and flu vaccinations in the 65-year-old plus cohort, and dispel some of the myths that the covid vaccination could affect patients with heart problems or underlying health conditions. Dr Melanie Smith (Director of Public Health, Brent Council) felt this was an important point as, on reflection, much of the national material cascaded locally focused on younger age groups. This was because, nationally, the vaccination rate in the over 65s cohort was quite high. Brent had previous experience in targeting vaccine hesitancy so would revisit those approaches and get tailored communications out to over 65s to encourage them to get vaccinated. Dr Melanie Smith affirmed that both the covid and flu vaccination were safe and even more important for older cohorts and cohorts with underlying conditions than the general population. Dr Melanie Smith asked those who were aware of any local issues to pass them on to the Public Health Team.

·         Dr Melanie Smith confirmed that everyone within the homelessness and asylum seekers groups housed in interim accommodation sites, irrespective of whether they fell into a clinical risk group, was being encouraged and offered the flu vaccination, including staff working with those groups.

·         Simon Crawford (Deputy Chief Executive, LNWUHT) detailed the current Covid figures at Northwick Hospital, explaining that the numbers were relatively low. There had been a rise in presentations of Covid at the end of August 2023 but it had since dropped. The hospital was admitting very few patients with Covid as the main reason for admission, although Covid might be subsequently picked up as a result of other testing. Dr Melanie Smith added that there was no longer the robust local data around Covid testing that was available during the initial lockdowns, but there was relatively reliable data at a national level, which showed low levels of all seasonal viruses at the time of the meeting. This highlighted the importance of getting vaccinated as early as possible to prevent illness.

·         There were challenges with recruitment at CLCH, particularly with community nursing staff and therapies. The rapid response team was very well established and the new initiative being put in place would be cost neutral, which would ‘step up’ patients into community beds for patients who fit the criteria to avoid conveying those patients to acute care.

·         In relation to Adult Social Care, Claudia Brown (Director of Adult Social Care, Brent Council) explained that winter was starting earlier and lasting longer each year, so some of the winter pressure schemes introduced the previous year that worked particularly well had ran through summer. She highlighted the difficulty in recruiting for temporary schemes and then releasing those staff again, so there was always an attempt to keep schemes running through the winter and summer period, balanced by identifying the schemes working really well compared to those not working as well. Brent was one of the best performing services for hospitals so the schemes were doing well, but there were recruitment challenges. As a result, a paper would go to Brent General Purposes Committee asking for approval to introduce retention bonuses and golden hellos to encourage staff to join or become permanent.

·         In relation to workforce, the Board heard that LNWUHT was part of an acute collaborative with Chelsea and Westminster, Hillingdon and Imperial, who had a common workforce strategy across those organisations. There was a vested interest in trying to keep staff in NWL, and the Trust tried to recruit from outside to increase that pool. 5 new Orthopaedic posts had been recruited to in the past 4 weeks for the Elective Orthopaedic Centre. There were a number of new developments including Community Diagnostics Centres, expanding Endoscopy on the Central Middlesex site, a newly opened Breast Unit, and a newly opened Neurology Unit in Northwick Park, all of which had successfully recruited staff.

·         Workforce in Adult Social Care was a challenge across the whole of NWL. The Association of the Directors of Social Services (ADASS) had agreed agency rates for staff that local authorities should adhere to, but some boroughs were having to go outside of that to get staff in, meaning that cap in agency rates had not been as effective as anticipated. She highlighted the positive that Adult Social Care had taken on 15 apprenticeships with the aim of keeping those on once they had finished, as well as SAYEs who were newly qualified. However, it was important to also have experienced and qualified staff given the complexity of caseloads. As such, a paper would go to Brent’s General Purposes Committee asking for approval to introduce retention bonuses and golden hellos to encourage experienced staff to take up permanent roles.

·         Dr Haidar agreed that recruitment was a challenge and that the way forward was to make Brent a more attractive place to work in, particularly due to the inner and outer London weighting affecting where people looked for jobs in London. There were many initiatives in Brent trying to think outside the box. Brent had invited asylum seeker and refugee professionals to work as Health Care Assistants and Community Champions. As such, there was a powerful narrative of dedicated professionals being introduced into hospitals and being supported to establish themselves and achieve professional goals. Another challenge was around the aging population of GPs, who were nearing retirement age. It was an increasing challenge to recruit new GPs so workforce planning was focused on introducing Allied Health Professionals including Physician Associates, Clinical Pharmacists, Paramedics and Advanced Nurse Practitioners.

·         In relation to CNWL, there were recruitment and retention pressures in the CAMHS service. The ICP were working jointly with CNWL to develop a business case to recruit for CAMHS from within the voluntary sector. This was a good opportunity for both the recruitment of staff into the service and future planning to put CAMHS on sustainable footing.

·         The Chair asked for assurance around how the Board would know these initiatives were working at the next meeting. He thanked all those involved in the work, and noted the need for opportunities for a shared communications strategy between the local authority and local NHS to reach residents. There was an opportunity for the system to learn from winter planning to provide whole year service improvements and this was more likely if there was longer term funding, which should be communicated to NWL ICB, NHSE and the Department for Health and Social Care.

RESOLVED: To note the Winter Planning initiatives that have been identified as proactively looking after residents over the winter period.