Agenda item

To provide an update on winter planning and community services for 2026, including admission and discharge planning and the impact of NHS reforms.

Jasvinder Perihar (Programme Manager – Intermediate Care, Brent) introduced the report which set out the comprehensive winter plan for Brent. In introducing the report, she highlighted the following key points:

• The plan presented collated information on winter initiatives from system partners across Brent so provided a comprehensive overview of winter planning.
• She highlighted that cold weather increased the potential of people becoming more ill, particularly vulnerable individuals, those with health conditions, over 65s and younger people.
• The increase in those becoming ill impacted and increased demand on health services, the workforce, the delivery of services, and areas such as housing, homelessness and social welfare issues such as cost-of-living.
• Section 1.3 of the report set out the areas covered in winter planning, including flu immunisations, vaccination programmes, winter schemes that supported admission and discharge planning, and areas ensuring continued access to services during the winter period.
• The Board was asked to note the winter initiatives and have confidence that key areas were addressed.

The Chair thanked colleagues for their introduction and invited input from those present, with the following issues raised:

• The Board asked whether partners had a sense yet of whether the pressures were better or worse compared to previous years. Simon Crawford (Deputy Chief Executive, LNWT) advised that the pressure and demand was higher this year compared to the previous year, and on one day that week Northwick Park Hospital had seen the second highest ever conveyances of ambulances, at 148 conveyances in one day. He added that there had not been an obvious summer period this year where the Trust would expect to see demand fall between May to September, and pressures had been fairly consistent throughout the year with Northwick Park routinely seeing over 100 ambulances daily.
• In relation to receiving 148 ambulances in one day, the Board asked whether there had been any audit as to how many were subsequently admitted and whether there were circumstances which could have avoided the need for an ambulance to convey. Simon Crawford confirmed that the Trust did analyse those percentages and could provide that to the Board covering the last 6 weeks. The Trust also tried to analyse the reasons for the conveyance and the condition patients were coming in, and looked at demographic data in terms of age profile, gender and ethnicity. He highlighted a challenge for the hospital in terms of ambulance conveyancing, because, in response to the increased demand the London Ambulance Service (LAS) was seeing, there had been a change in protocol enabling paramedics to leave the patient after 45 minutes, which he suggested should be reviewed to ensure paramedics continued to offer proactive care before dropping patients off.
• Noting that an area of significant pressure was arranging appropriate Adult Social Care discharge for hospital patients, the Board asked how the system was now managing that. Simon Crawford advised that the relationship with social services and discharges was positive. Through the emergency pathway, as quickly as patients were brought in and stabilised, the Hospital was then putting pressure on community services and social care to discharge those patients quickly and appropriately. The working relationship and processes for discharge had evolved over the years and were now well embedded, but he highlighted there were times where there were difficulties placing some individuals and it took longer than the Trust and ASC would like. The pressures meant that Northwick Park Hospital often had patients in A&E corridors on trolleys waiting for assessments. These patients were seen and checked by nursing staff, and additional nursing staff had been appointed to care for those patients. There were also situations where those needing admittance were waiting for a bed and relying on a discharge out of a ward before they could be admitted, a consequence of which was the implementation of temporary escalation spaces where patients were transferred from A&E to a ward on a trolley, not in a bed or bay, and were waiting for a discharge before they could access a bed. He advised this was not a great experience for patients but the reality of what the Trust has been facing given the pressure on the hospital. Despite these challenges, he advised that the length of stay was relatively good in comparison to others.
• Rachel Crossley (Corporate Director Service Reform and Strategy, Brent Council) added that, before winter had arrived this year, ASC was seeing an approximately 50% increase in needs assessments and reviews under the care act. The service had agreed to step up its hospital discharges over the weekends again this winter, but continued to struggle to retain staff in the hospital discharge team due to the different type of work this involved which was very quick and fast paced. ASC was also seeing an increase in short-term placements, where someone leaving the hospital was not ready to go home and had an interim residential placement, and those were lasting for longer than the 8 weeks ASC would expect them to be. In response, there was a focus on being clear in the service not to use those placements inappropriately and to move someone to a long-term placement if that was needed or encouraging a package of care to be agreed so the patient could return home. This was a blocker because there were not many step-down beds, so residential nursing placements were being used instead which were more expensive short-term. More resource had been put into the community discharge team to ensure reviews were being done and people were moving in the right direction long term and not back into hospital.
• Tom Shakespeare (Managing Director, Brent ICP) highlighted that there had been agreement to continue the investment around the children’s hospital discharge service which would support managing flow.
• Ruth du Plessis advised that data showed the flu was circulating earlier than usual, creating additional pressure on hospitals, and highlighted the importance of vaccination, particularly in vulnerable groups, and the need to practice good hygiene. Each year there were in excess winter deaths particularly in groups with dementia, over 85s, and people with heart conditions.
• The Board asked about the flu vaccination take up in Brent and what could be done to support increasing that. Ruth du Plessis (Director of Public Health, Brent Council) responded that Brent historically had a lower uptake for flu vaccination. Uptake was not as good as public health would want in nursery and school aged children or younger vulnerable groups. She emphasised that flu could affect anyone if they had vulnerabilities and those in their 40s and 50s with long term conditions were less likely to come forward for vaccination. She felt there was further work for public health to do in reminding people of the importance of vaccination, and extra sessions of the vaccine bus were being held to reach more communities.
• In terms of the low flu vaccination take-up, the Board asked whether this was because people were not aware they were eligible or because they actively did not want to be vaccinated. Ruth du Plessis acknowledged that there was a lot of vaccine scepticism amongst the community, particularly post-pandemic and the way the covid vaccination had been mandated which had created some resistance, and there was also misinformation circulating about the impact of vaccinations. Dr Rammya Mathew added that vaccine hesitancy was particularly prevalent in younger cohorts, and it was often an active decision not to take up the offer. She felt there was a lot of work to do in that area, such as through myth busting, and this was a continued area of focus for primary care.
• The Board asked whether Northwick Park Hospital checked the vaccination status of those attending A&E, which Simon Crawford confirmed did not happen. That information would be available in patient’s medical records, so LNWT could do a bespoke piece of work looking at the percentages of vaccinated patients admitted on a particular day.
• Jackie Allain (Director of Operations, CLCH) informed the Board that CLCH would be receiving some investment to develop virtual wards in communities, using the UCL rapid response services to support people to stay at home rather than having an ambulance conveyance to hospital. She would know over the next few weeks how much that investment would be and what CLCH could develop as a service. The investment formed part of the ICBs approach to move money out of acute and into community services.
• Acknowledging that there was a crisis in mental health provision for young people and the announcement that there were 250,000 young people nationally waiting to access CAMHS, the Board advised that a side effect of that was seeing more young people presenting at A&E in mental distress or as a danger to themselves and others. They asked what preparation had been put in place to deal with that demand. Tom Shakespeare recognised the significant pressure in the system caused by mental health crises from both adults and children. From a positive perspective, he highlighted good work in the NW2 and NW10 area for young Black men appearing in crisis in acute settings who were previously unknown to services. On the children’s side, he agreed there was a significant increase in pressures around CAMHS, so the system was looking at investment in early intervention, with non-recurrent additional resources secured to help with pressures on the waiting list and backlog. Investment in early intervention would help to manage pressures, and the ICP was focused on shifting the approach to prevention. A business case around the CAMHS backlog was also expected to go through the ICB. The Board was reassured that the system had identified that people felt there was nowhere to go on an acute basis for mental health support and support was being put in place to address that.
• Highlighting section 3.2.3 of the report, which detailed high demand for Adult Social Care’s Urgent Response Service, the Board asked what was causing the bottleneck and what was being done to address the issue. Jasvinder Perihar advised that the Urgent Response Service was a floating support service that went into people’s homes to deliver support overnight and reduced the need for care home placements. In response to the increased demand for that service, the number of cars going out at night had been increased. A deep dive into the patients currently receiving that service was also underway as many had been receiving the service for over the time limit, with clear operating procedures being developed from that.
• The Chair highlighted that the Council website could be used as a central point to direct residents to NHS information, particularly around vaccinations, and that the Brent magazine would include further information about winter planning.

As no further issues were raised, the Chair drew the discussion to a close and asked members to note the report. He thanked officers for presenting and showing the partnership work being undertaken to minimise the need for people to attend hospital. The Board acknowledged the close collaboration between the local authority and NHS on this work with good quality information sharing and good work to identify new sources of funding.