Agenda item

NHS Gloucestershire Winter Sustainability Plan 2023-24

To consider proposals set out in the NHS Gloucestershire Winter Sustainability Plan 2023/24.


Included in the presentation will be an update on the work of Newton Europe, as commissioned by NHS Gloucestershire and Gloucestershire County Council.


The committee received an overview of the priorities and plans set out for the delivery of Urgent and Emergency Care in Gloucestershire across the Winter months of 2023 and early Spring 2024.


The committee was asked to consider: -


a)    The NHS Gloucestershire Winter Sustainability Plan 2023/24.

b)    A briefing paper on the ‘Working as One’ programme, including an update on current progress in delivering transformation in Urgent and Emergency Care services across the One Gloucestershire Health and Care System.


The committee will be asked to review and evaluate the performance of the Winter Assurance Plan at the committee meeting in March 2024.


To view the presentation pack published with the agenda for the meeting, please refer to the link here


Members were informed that the NHS Gloucestershire Winter Assurance Plan for 2023/24 had been developed in response to the ‘usual’ anticipated winter challenges, as well as planning for seasonal flu, the ongoing impact of Covid 19 and continuing industrial action and workforce challenges experienced across the Gloucestershire Health and Social Care Network.


The plan was produced in collaboration with system partners, including Adult Social Care, Gloucestershire Hospitals NHS Foundation Trust, Primary Care, Voluntary Care Sector providers, Gloucestershire Health and Care NHS Foundation Trust, (community physical and mental health), the South West Ambulance Service NHS Foundation Trust and Private Sector Providers.


Asked to identify key changes from previous years, the committee was advised of the key challenges, (high-impact interventions), anticipated to impact on the health and care system, and the actions being proposed to address the challenges.


Proposed interventions included: -


a)    Same Day Emergency Care: proposals included reducing variations in Same Day Emergency Care provision and providing guidance on operating a variety of services for at least 12 hours per day, 7 days per week.

b)    Frailty: proposals included include reducing variations in acute frailty service provision and improving recognition of cases that might benefit from specific frailty services.

c)    Inpatient flow and length of stay: proposals included include reducing variations in inpatient care, (including mental health), and length of stay for key Urgent and Emergency Care pathways, conditions and cohorts by implementing in-hospital efficiencies and bringing forward discharge processes.

d)    Community bed productivity and flow: proposals included includereducing variations in inpatient care and length of stay, including mental health, by implementing in-hospital efficiencies and bringing forward discharge processes.

e)    Care transfer hubs: proposals included include implementing a standard operating procedure and minimum standards for care transfer hubs to reduce variation and maximise access to community rehabilitation and prevent re admission to a hospital bed.

f)     Intermediate care demand and capacity: proposed actions include supporting the operationalisation of ongoing demand and capacity planning, including improved use of data to improve access to and quality of intermediate care, including community rehabilitation services.

g)    Virtual wards: proposed actions includestandardising and improving care across all virtual ward services to improve the level of care to prevent admission to hospital and help with discharge.

h)    Urgent Community Response: proposed actions include increasing volume and consistency of referrals to improve patient care and ease pressure on ambulance services and avoid admission.

i)     Single point of access: proposed actions include standardisation of urgent integrated care co-ordination to facilitate whole system management of patients into the right care setting, with the right clinician or team, at the right time. This to include mental health crisis pathways and alternatives to admission, e.g. home treatment

j)     Acute Respiratory Infection Hubs: proposed actions include support to consistent roll out of services, prioritising acute respiratory infection, to provide same day urgent assessment with the benefit of releasing capacity in ED and general practice to support system pressures.


Key messages highlighted during the discussion included the intention to avoid un-necessary admissions into hospitals and the focus on urgent emergency response performance. It was noted that Gloucestershire currently held the highest performance position in the South-West region for urgent emergency response.


Following NHSE guidance issued in August 2023, the Winter 2022 System Control Centres would now be identified as System Co-ordination Centres (SCCs) in recognition of their core function within the Integrated Care System and in support of local authorities, primary care, and voluntary, community and social enterprise partners. Operating Monday to Sunday from 08.00 to 18.00 the centres will provide a central coordination service to the providers of care within the ICS with the aim of supporting patient access to ensuring the safest and best quality care.


The Gloucestershire ‘Click or Call First Campaign’ operating in 2022 had been developed in consultation with Healthwatch Gloucestershire, Inclusion Gloucestershire and GP Practice Patient Participation Groups. Commended by NHS England for its uncomplicated approach, the campaign to be enhanced in 2023 by the ‘Stay Well This Winter Campaign’, covering key topics such as eating well, staying active, mental health and getting vaccinated.


New developments in 2023 included work with Age UK and the Out of Hospital Team to support hospital discharges and prevent unnecessary readmissions and the High Intensity User Project involving social prescribers and the Gloucestershire Community Wellbeing Service to provide more support to people in need of help to access local groups and activities.


Members were informed that, as in previous years, operational and clinical leads from across the system would reflect on heightened periods of pressure by coming together to provide candid and constructive feedback from their own experiences and from asking what more could be done to improve the quality of patients experience.


Stuart Appleby from Newton Europe was invited to the meeting to give an update on the progress of the Urgent and Emergency Care Transformation Work commissioned by Gloucestershire County Council on behalf of the NHS Gloucestershire Integrated Health and Care System (ICS).


The transformation programme is known as the ‘Working as One’ Programme to create cross organisational identity and to recognise the input from system partners to improve urgent and emergency care for the people of Gloucestershire.


System partners include; Gloucestershire County Council, Gloucestershire Hospitals NHS Foundation Trust, Gloucestershire Health and Care NHS Foundation Trust, South West Ambulance Service NHS Foundation Trust and NHS Gloucestershire Integrated Care Board. Joint senior responsible officers (SROs) for the programme include: Professor Sarah Scott, (Executive Director of Adult Social Care, Wellbeing and Communities at Gloucestershire County Council); Ellen Rule, (Director of Strategy, Transformation and Deputy CEO, NHS Gloucestershire Integrated Care Board), and Dr Andrew Seymour, (Chief Medical Officer, NHS Gloucestershire Integrated Care Board).


The programme is led and governed by Gloucestershire personnel, with Newton Europe commissioned as the transformation partner to bring capacity and skills to support skilled clinicians and operational staff in delivering the programme. The commissioning of Newton Europe was approved at a County Council Cabinet meeting in March 2023, with mobilisation of the programme commencing in July 2023. The programme will run for approximately 18 months to ensure recommended changes and improvements are embedded into operational activities and desired ambitions and benefits can be sustained.


Members were informed that significant progress was being made and that the programme was on track against proposed timelines and objectives. 


Key headlines included: -


  1. Programme governance had been established and was operating effectively.


  1. System programme roles had been recruited with the majority now in post.


  1. All workstreams had been established and operational, (with Executive Sponsors, Workstream Senior Officers, Workstream Leads and Design Groups established).


  1. The Newton Europe team was fully mobilised and assigned to workstreams to support delivery.


  1. Revalidation of opportunities identified during the diagnostic phase of work had been revalidated and baselines established for the measurement of benefits.


  1. The ‘Working as One’ programme name and visual identity had been approved by the Programme Executive Board


  1. A Programme Steering Group had been established to oversee and manage the day-to day delivery of the programme. 


  1. A Programme Benefits Oversight and Assurance Group would represent a critical part of the governance structure to oversee the impact of the programme on the outcomes for residents and the financial implications for both system and partner organisations.


  1. The established Urgent and Emergency Clinical Programme Group will provide expert input to the programme, including input from the Communities and Patient Reference Group, to ensure that the life experiences of people are considered throughout the delivery of the programme.


To view the briefing note published with the agenda presentation pack for the meeting, please refer to the link here


It was agreed regular updates, including key metrics and data, would form part of the NHS ICB update report to the committee. 


Other comments and questions asked at the meeting included: -


      i.        Newton Europe to analyse how NHS Gloucestershire supports people requiring specialist care and at looking at ways of reducing pressures on the urgent and emergency care system;

    ii.        Whilst Newton Europe provide useful support to the programme, it does not offer clinical expertise;

   iii.        Consideration of the need for ‘care beyond hospital care’ is an important factor;

   iv.        The views of the People and Communities Reference Group to form part of the work;

    v.        Following on from the previous year, Newton Europe to continue to measure key factors impacting on people, staff and colleagues;

   vi.        Strong governance has been put in place to ensure the ‘working as one programme’ has appropriate oversight in maintaining the delivery of objectives and benefits;

  vii.        The ‘Working as One Programme Transformation Programme Board’ will report to the ICB Strategic Executive. The ICB to receive regular updates, as and when appropriate;

 viii.        In spite of an anticipated increase in the number of scheduled meetings, the meetings will be structured to include working group discussions. Senior staff will not be required to attend all meetings;

   ix.        Meetings will become more focussed, aimed at seeking solutions in order to create a smarter way of delivering services and in making improvements for the people of Gloucestershire;

x.         The Gloucestershire Health Overview and Scrutiny Committee will   continue to be involved and updated to receive updates on the work      programme.


A member enquired about the public messaging intentions in relation to Covid-19. Expressing the difficulty in predicting to what extent the virus might impact on the health and care system, the Director of Public Health advised that, whilst the current wave of the virus was relatively small, this could change. With this in mind, the use of early warning indicators would assist with decision-making on any precautionary measures that might be necessary.


Responding to questions on Covid-19 testing arrangements, members were advised that current national guidance, although somewhat controversial, was not to test but to take other precautionary and responsive measures. These included; vaccination, rigorous hand-washing, and the wearing of masks when suffering from Covid or Flu like symptoms if it was absolutely necessary to visit public spaces.


Where possible, symptom carriers to avoid mixing with other people. It was explained that the rationale for ‘not testing’ was to avoid prioritising the Covid virus over other viruses, including flu viruses. A briefing note on current guidance/advice to be shared with the committee after the meeting. Action: Director of Public Health


Cllr Alan Preest thanked NHS Officers for the information he had received on the comprehensive Winter Vaccination Campaign in the Forest of Dean and was pleased with the update.


In noting the Winter Plan proposals and the progress in delivering the transformation programme for urgent and emergency care across the Gloucestershire Health and Care System, members commended the work and said that they were reassured by the positive progress being made.


A review of the performance of the Winter Accountability Plan will be made at the committee meeting in March 2024.

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