Agenda item
Partner Updates on Winter Pressures
To provide an update on the challenges and responses related to winter pressures as faced by local healthcare partners.
Minutes:
The Chair opened the item by acknowledging the pressure services were under to deliver care across NWL and in Brent. He had requested a brief report from partners on how they were working in Brent to address those winter pressures, and invited Steve Vo (Assistant Director of Place – Brent Borough, NWL ICS) to introduce the report.
Steve Vo highlighted the following key points in relation to the report:
- The current challenge for the local health and social care system, adult social care, and the Brent Borough Based team was the discharge delays being faced, which had increased during the holiday period.
- Workforce challenges remained, with a lack of social workers impacting the overall discharge rates.
- Care homes were more reluctant to accept patients with complex needs which was also driving the delays in discharge.
- There were also challenges in finding temporary accommodation following discharge for patients who required it.
- Actions being taken locally to address those discharge delays
were:
- The offer of weekend coverage for non-complex discharges.
- Hospital teams having direct access to care providers to facilitate discharges over the weekend.
- Close working with CLCH to commission a provider to support patients with Stomas and feeding tubes, although further work was needed to address long term care for those patients as that pathway was only for 6 weeks.
- The team had learned form best practice in other boroughs across NWL and implemented some of that learning in Brent, particularly the model for in-reaching patients with dementia.
- To further address the challenges with discharge, the team was moving to a more preventative approach, focused on hospital admission avoidance with care homes by equipping staff with the skills and tools to manage more complex patients.
- Work was being done with CLCH’s Enhanced Care Home Team to provide training and advice to care homes, ensuring the Enhanced Care Home Team was well utilised so that patients were managed well within the home rather than being admitted to hospital.
- There were many pathways for admission and discharge in Brent, and colleagues would be reviewing those pathways over the next few weeks to ensure a cohesive approach was being taken and those pathways were right for Brent’s patients.
- A Frailty Management Service in Brent was being provided by 3 GP Federations who worked closely with CLCH to ensure that patients with a rising risk of frailty were well looked after in the community to avoid admittance to hospital.
The Chair then opened up the discussion to those present to explain what they were doing to address winter pressures in their own organisations. The following points were raised:
· Claudia Brown (Director of Adult Social Care, Brent Council) informed the Board that there was a lack of social workers currently, with specific challenges in asking social workers to work in a hospital setting. That work was seen to be fast paced and had challenges relating to professionalism and how health professionals related with social workers, so social workers did not stay in the hospital setting long and there was a rapid turnover of staff. This was impacting how fast discharges could happen. Main areas of concern were P1s and P2s and getting those people out of hospital safely. There was also a need to ensure other professionals recognised that social workers were the decision-makers in relation to a patient’s discharge care plan. Discharge care plans were not straightforward and had many complex factors causing delays, including transport for the person, relatives wanting to receive them home, or step-down bed capacity. In relation to complex C3s for dementia patients, Brent was looking to learn from the Ealing model in how they flow that person through hospital and work with the care home to receive that person back.
· Simon Crawford (Deputy CEO, LNWT) provided an update from the acute trust, highlighting that the pressure and demand had significantly increased compared to the previous year and had seen an increase in the acuity and complexity of patients. On any one day, Northwick Park received the most ambulances in London and the most blue lights. In Harrow there was similar pressure. He highlighted this was due to an increasing population, including an increase in the age profile of the general population with people living longer with comorbidities. He believed there was more that could be done in the community, with the Integrated Neighbourhood Teams having a lot of potential to make a difference to the local resident population. Some work was being undertaken in Brent and Harrow to analyse the reasons for admissions and any trends in that, looking at whether there was a high prevalence from particular care homes or specific conditions, so that support could be targeted. He added that, generally, the hospital received good support from social care and challenges and issues were worked through professionally and a good relationship maintained.
· Jackie Allain (Director of Operations, CLCH) provided an update on community services, which had been actively involved in the initiatives put in place to improve patient flow. She added that a major challenge for CLCH this year had been staff sickness as a result of flu, which had been much higher this year than previous years. In Brent, there was some vaccine hesitancy amongst staff which further impacted sickness rates.
· Rushda Butt (Primary Care Delivery Manager - Brent) provided an update for pharmacies. She advised the Board there had been a lower uptake of flu and covid vaccinations this year, alongside an increase in flu cases over the holiday period which had increased pressure in primary care, including on GP practices. Pharmacies in Brent had been supportive of the covid and flu vaccination campaigns over the winter, with 9,802 flu vaccinations administered as of 3 January 2025 and over 13,000 covid vaccinations. 26 community pharmacies were taking part in the delivery of vaccinations. The flu vaccination campaign would continue until March 2025. In relation to the MMR Community Pharmacy Pathfinder, two sites in Brent had been confirmed (Gimmack Pharmacy, Cricklewood, and Jade Pharmacy, Kinsgbury) which would come to an end in January. The roving team and Brent Health Matters were doing outreach work to spread public awareness of the vaccinations on offer in different areas of Brent. The next steps were to launch the spring campaign in April to June. She also provided an update on Pharmacy First, where a patient could now be seen at a pharmacy with a minor illness which meant they did not need to see a GP. 91% of pharmacies in Brent were participating in Pharmacy First, addressing minor illnesses and improving patient access. Pharmacies had now been told they could offer anti-viral medication to high-risk patients experiencing severe flu symptoms. She concluded her update by advising members that efforts were continuing to integrate community pharmacies and PCNs to optimise care delivery.
o In response to a query on whether the pressures in hospitals would be reduced if the eligibility criteria for vaccinations widened, Dr Melanie Smith (Director of Public Health, Brent Council) expressed that she personally did not think the pressures would be reduced. She felt that the priority should be to increase vaccination rates within high-risk groups, particularly as this had been a poor year nationally for vaccination uptake. The advice of the Joint Committee for Immunisations was largely driven by a desire to reduce pressure on the system, so the priority should be improving rates in high-risk groups as opposed to widening the net.
The Chair then invited questions and comments, with the following points raised:
- In paragraph 3.3.2 of the report, where reference was made to an increase in mental health cases leading to 72 hour breaches, the Board asked what was meant by that and how that related to winter planning. Simon Crawford explained that mental health patients were spending a lot of time in A&E as opposed to going to mental health services. They were often quite distressed when they arrived at A&E and needed individual one-to-one support and observation. Clinicians aimed to move mental health patients out of A&E departments and not admit them onto wards as they needed to either go to CNWL or CNWL needed to find alternative provision for them as the mental health provider. Northwick Park was seeing an increase in those mental health patients staying for longer in an A&E department, which was already under pressure because of winter. This exacerbated the complexity and pressures during winter. Toby Lambert added that there were actions in the NWL Joint Forward Plan to address these breaches so that mental health patients were being directed straight to mental health services and did not present to A&E in the first place. Outreach work was also happening into communities to identify people not currently known to services who may then present as another way to identify demand and divert those from emergency departments sooner. The swifter and more seamless that process was, the more capacity there was in emergency departments and the less waiting times, and this was why there was a strong focus on admission avoidance and prevention.
- Claudia Brown added that there was a shortage of mental health beds, meaning there were not enough beds to move mental health patients on quickly enough from the hospital setting. Adult Social Care was also undertaking assessments in the community, so there would be people waiting 72 hours or more both in the hospital and community setting for a mental health bed.
- Simon Crawford informed the Board that LNWT held a monthly Urgent and Emergency Care Board meeting with all relevant stakeholders as part of that. That Board annually undertook a review of winter planning and pressures in April-May to reflect on how it went, which then fed into winter planning for the following year. He offered to bring the outcome of that review to a future Board meeting. Tom Shakespeare added that a similar review of discharge funds and contributions to the Better Care Fund and their effectiveness was also done with a similar timetable that could be brought to Board, as well as a review of local plans and KPIs.
As no further issues were raised, the Chair drew the discussion to a close and asked the Board to note the update.
Supporting documents: