Agenda item

To consider the annual winter planning update from representatives of the North East and North Cumbria Integrated Care Board (NENC ICB).

The Committee received its annual winter planning update. Provided by the North East and North Cumbria Integrated Care Board (NENC ICB) Director of Place Based Delivery, key aspects included:

Ø  Context

Ø  National Guidance

Ø  2023-2024 Winter Planning

o   Local Accident & Emergency Delivery Board (LADB)

o   System Control Centre (SCC)

o   Tees Valley Incident Command Coordination Centre (ICCC)

o   Urgent and Emergency Care Highlight Report

o   Winter Plans and Business Cases

Ø  Risks and Challenges

Like all services up and down the country, the Tees Valley health system remained under significant and sustained pressure – this was impacting upon performance, particularly on flow through hospitals. Influencing factors included staffing issues across all partners, pathway and estate limitations at some sites, increased demand (linked to the elective backlog), higher acuity of patients (resulting in longer stays in hospital), and discharge delays (due to NHS Trust issues and social care / home care staffing pressures). This demonstrated a complex system-wide problem which required a system-wide response.

National guidance to address these widespread challenges was outlined, including delivery plans for recovering urgent and emergency care (January 2023), and recovering access to primary care (May 2023). Regarding the former, focus on five key areas was highlighted: increasing capacity, increasing workforce size / flexibility, improving discharge, expanding care outside hospital, and making it easier to access the right care. In addition, 10 high-impact interventions had been worked through and implemented in some form – this included reducing variation in same day emergency care (SDEC), acute frailty service provision, and in-patient care / length of stay, as well as virtual wards, single point of access, and acute respiratory infection (ARI) hubs.

From a sub-regional perspective, several entities were in place to respond to the additional challenges brought on by the winter season. The Tees Valley Local Accident & Emergency Delivery Board (LADB), System Control Centres (SCC), and the Incident Command Co-ordination Centre (ICCC) – Tees Valley (established as a result of COVID-19 and maintained to ensure connectivity between partners) were all highlighted. Specific attention was drawn to the LADB which was supported in monitoring key performance metrics via the development of an urgent and emergency care (UEC) highlight report – this pulled data from each partner along with supplementary narrative to determine key risks for discussion within the meeting. Robust data helped make good, informed decisions, and the LADB had access to real-time information.

Further detail on the process behind planning for the winter period was relayed, a key element of which was the development of a system resilience template (building in Key Lines of Enquiries (KLOEs)) to identify risks. A red / amber / green (RAG) rating was then given based on perceived risk, with the amber elements (in plans, but risks associated with delivery) highlighted in greater depth (note: there were no KLOEs marked red (no evidence of existing implementation or in system plans)). For each priority area listed, a clear Action Plan lay behind it and the overarching risk register was routinely monitored.

A prioritised list of agreed schemes / developments following the submission of proposed business cases by partners that would have a measurable impact on the health and care system over the winter was provided. Longer-term proposals involving the commissioning of a standardised Integrated Urgent Care (IUC) model across North and South Tees from the start of April 2024 was also noted.

Finally, risks and challenges associated with service delivery and performance were highlighted, with ambulance handover delays at South Tees Hospitals NHS Foundation Trust (STHFT) and category 2 ambulance response times specifically emphasised. Other issues included staffing / workforce limitations for all system partners, competing priorities (e.g. elective versus urgent / emergency care), and service demand pressures across both health (primary and secondary care) and social care. Further waves of COVID and / or industrial action also threatened the ability to meet the needs of the Tees Valley population (e.g. planned treatment may be delayed).

Discussions began with Members requesting clarity over the Tees Valley LADB. It was explained that this was a system group that met routinely, and that any single partner could request specific agenda items for discussion at any meeting.  The Board enabled the identification of critical actions which relevant partners were then responsible for acting upon. On a daily basis, partners are able to initiate Incident Command and Coordination Calls should pressures experienced warrant a system response.

The Committee asked if there was an issue across Tees Valley with patients having to wait a long time on trolleys before being seen by an appropriate health professional. Officers stated that there had been some cases of this occurring (though not to the extent as was being experienced in other areas of the country), and that such events were treated as incidents.

Continuing the theme of ambulance handovers, Members queried if mechanisms were in place to evaluate measures to make this a more efficient process. Assurance was given that real-time information was available to assess performance, and that a formal period of evaluation would take place in the new year in order to formulate plans for future arrangements.

NHS 111 staffing capacity was probed by the Committee, with officers confirming that resources had indeed been strengthened. The importance of clinical hub staff supporting call-handlers was stressed, as was the need for any additional investment to have a positive impact on the wider system.

Questioning concluded with Members asking about the impact of COVID and flu during the current season. The Committee was informed of a significant wave of acute respiratory cases across the region (with plans subsequently put in place to mitigate this), with norovirus also present on some hospital wards (with some needing to be temporarily closed to visitors and, on occasion, admissions). The importance of public communications was emphasised in order to promote the right messages to keep people safe and well, as well as reflect the pressures on the system. Ultimately, COVID was not as visible in the news nowadays and was therefore less likely to be in the public psyche.

AGREED that the Tees Valley winter planning update be noted.