Michael Whitcombe (Deputy Chief Operating Officer, University Hospitals Plymouth), Louise Ford (Head of Commissioning), Chris Morley (Plymouth Locality Director, NHS Devon) and Ed Garvey (Head of Locality Commissioning, NHS Devon) presented the Winter Planning update and discussed:

a)     Winter planning was an annual process undertaken collectively across University Hospitals Plymouth (UHP), Livewell Southwest, Plymouth City Council, and wider system partners, guided by national expectations and NHS England returns;

b)    The approach was informed by predictive modelling based on previous winter demand and analysis of flu season trends in the southern hemisphere, particularly Australia, to anticipate pressures such as respiratory illness surges, high bed occupancy, long emergency department waits, and ambulance handover delays;

c)     The hospital’s operational picture indicated that without mitigations, there would be a gap of 70–90 beds against demand. Strategic actions had reduced this gap to approximately 33–40 beds, supported by seven key workstreams focusing on infection prevention and control, surge response, timely discharge, workforce resilience, and community services;

d)    Ambulance handover performance had deteriorated in October but improved significantly, with less than 1,000 hours lost and an average handover time of 16 minutes, against a mandatory target of 45 minutes and an aspiration of 30 minutes. The national standard remained 15 minutes;

e)     Key assumptions included a 1.5% increase in non-elective demand and peak flu and COVID pressures occurring in the second week after Christmas. The hospital aimed to maintain elective services and utilise virtual wards and community support to ensure timely discharge;

f)      Vaccination uptake was critical to reducing bed occupancy pressures. UHP had achieved approximately 38% staff uptake for flu vaccination, with targeted campaigns and outreach to hard-to-reach areas. Vaccinations had improved uptake compared to previous years;

g)     The hospital lost around 120 beds last winter due to flu, COVID, and norovirus, with approximately 10% of these occupied by care home residents. Actions were being taken to provide care within residential settings to avoid hospital admissions and associated risks;

h)    Virtual ward capacity included 75 acute beds (respiratory and cardiology) and 68 frailty beds, with plans to increase to 95 beds before winter. Occupancy had dropped but improvement work was underway to raise awareness and streamline onboarding processes;

i)      Additional pathway one capacity had been commissioned to support home-based care and prevent destabilisation of the local workforce, including agency support for PCC’s Independence at Home service;

j)      Brokerage processes were being strengthened to ensure timely access to domiciliary care for hospital discharge and community step-up support, alongside measures to prevent hospital admissions through wraparound services;

k)     Workshops with domiciliary care providers had secured commitments to increase workforce capacity before Christmas, supporting the system’s “Home First” approach. Approximately 66% of complex discharges now resulted in home-based care, compared to 24–25% two years ago;

l)      For pathway two (bedded care), work was ongoing with PCC to ensure capacity and reablement support, including projects to utilise additional pathway one capacity for individuals leaving bedded settings;

m)   Integrated working was supported through daily system escalation calls, weekly commissioning oversight meetings, and governance processes to monitor pressures and take rapid action where necessary;

n)    Measures to maintain market resilience included promoting vaccinations and infection prevention across care settings, monitoring demand and capacity for bedded and domiciliary care, supporting access to household support funding, and addressing staff training needs for timely discharge planning;

o)    The autumn/winter campaign was underway, targeting eligible cohorts through GP practices, pharmacies, schools, hospitals, and outreach clinics for housebound individuals and underserved communities. Uptake for flu vaccination across Devon was higher than last year, with targeted actions for areas of lower uptake;

p)    Communications focused on encouraging early protection, with messages such as “Don’t give the gift of flu for Christmas.” Booking options included the NHS website and 119 telephone service.

In response to questions, the Panel discussed:

q)    Assurance that vulnerable groups, including those in drug and alcohol rehabilitation and homeless services, were being offered vaccinations, with officers confirming eligibility and targeted outreach;

r)     Clarification on whether additional winter capacity involved new staff or existing personnel taking on extra tasks. Officers confirmed that additional care capacity was sourced externally to avoid destabilising the local workforce, while integrated working across health, social care, and providers was key to resilience;

s)     The importance of flow through capacity as well as increasing numbers, with officers highlighting daily escalation calls and governance processes to manage discharge and commissioning decisions;

t)     Uptake of vaccinations among hospital staff, which had improved compared to previous years but remained below desired levels;

u)    Emergency preparedness for future pandemics, with officers confirming that disaster plans, national escalation frameworks, and scenario modelling were in place, supported by a Devon-wide command centre;

v)     Ambulance handover times, with officers confirming an average of 16 minutes currently, significant improvement from previous delays, and assurance that patients received continuous care during any waiting period;

w)   Virtual ward capacity and challenges, noting reduced occupancy and recruitment delays but plans to increase frailty beds and improve onboarding processes;

x)    Concerns about temporary escalation spaces and corridor care, with officers confirming that the Trust did not tolerate corridor care and had measures to prevent its use except in extreme circumstances, with rapid de-escalation when required;

y)     Uptake of vaccinations in care homes, with officers confirming improved rates this year;

z)     Cultural and personal barriers to vaccination uptake, with officers noting ongoing monitoring and targeted education to address resistance.

The Panel agreed:

1. To note the Winter Planning update and the actions being taken across health and social care to manage seasonal pressures;

2. To receive data on vaccination uptake in care homes and across staff groups at a future meeting.