Winter Plan to include Adult Social Care, Urgent and Emergency Care and Planned and Elective Care
- Meeting of Health and Adult Social Care Overview and Scrutiny Committee, Wednesday 24 November 2021 10.00 am (Item 30.)
Councillor Nicholson (Cabinet Member for Heath and Adult Social Care), Craig McArdle (Strategic Director for People), Anna Coles (Locality Director), Gary Walbridge (Head of Adult Social Care and Retained Functions), Jo Beer (University Hospitals Plymouth NHS Trust) and Mandy Seymour (Livewell SW) were present for this item. The committee first heard about the challenges in adult social care. It was highlighted that:
· There were continued challenges around the workforce in particular recruitment and retention of that workforce. Also is was a really tired, exhausted workforce working through the pandemic since March 2020;
· Vaccination of care home staff and how many people have left this area of work because they were not vaccinated would have an impact on recruitment and retention;
· They were seeing an increase in referrals and services for safeguarding;
· The reform of adult social care and funding reforms that would be significant. Work for the local authorities to undertake but there would be wider reforms which would mean that adult social care would be subject to a greater assurance process from the Care Quality Commission;
· Also there were changes to legislation around liberty protection safeguards and the Mental Health Act;
· Continued to work with colleagues at Livewell SW and University Hospitals Plymouth and have recruited additional staff to assist with home care and reablement care as well as working hard on commissioning alternative bedded capacity including the Care Hotel;
· There were a number of care hotels in the city and during the pandemic were useful capacity to support urgent and emergency care flow from the acute hospital;
· They were working to identify areas to increase dementia care home capacity including supporting homes that weren’t currently registered;
· Working closely with providers across the city to identify where there may be additional capacity subject to workforce that can be opened to support the winter response.
Questions from Members related to:
· The Care Hotel and how this was managed, staffed and the number of beds available;
· What type of patients were transferred to the Care Hotel and how to ensure covid safety for staff and patients;
· Whether there was a backlog with safeguarding referrals and carer assessments?
· Whether they were successful in attracting new recruits following the big advertising campaign;
· The delays in transfers in care;
· How to make working in care a more attractive offer;
· How to support vaccine hesitant care workers and to provide them with the information and support they need to be able to feel comfortable accessing the vaccine;
· Visitors in care home and covid safety;
· Food within the care home setting and ensuring that they were nutritionally balanced;
· The complaints procedure within a care home setting and inspection of care homes by the CQC’
· Longer term service developments for care and Colwill Lodge and the Vines.
The Committee were then provided with an update on the Winter Plan, Urgent and Emergency Care and Planned and Elective Recovery. It was highlighted that:
· The western locality winter plan brings together a range of initiatives that would endeavour to support the health and care system through what would be a particularly challenging winter;
· In terms of COVID prevalence, there was an increase in demand across the system with a workforce that was exhausted after 18 month’s worth of covid response;
· There were also some significant challenges in terms of workforce and recruitment and the winter plan aims to provide an oversight around the demands they were facing;
· The plans have to be dynamic to changes that they were not necessarily expecting;
· They were expecting the peak to be around about the 12 or 14 December and likely to be in the region of around 80 patients requiring hospitalisation. With the increase in patients constitutes a reduction in critical care capacity for a major trauma centre status but also for some tertiary and specialist surgeries;
· The winter the plan also tries to take into account how to recover the elective capacity. Currently have 52 beds taken up to covid. This related to two wards that would have been used for either emergency or elective surgery;
· The emergency demand pushes out the elective capacity and then that has an impact on the ability to recover some of the waiting lists and long waiting patients. They were undertaking a huge piece of weekly work around prioritising patients according to their clinical status and prioritise theatre lists every three months;
· The workforce challenges were significant and relate to all services;
· They were looking at how to get optimum flow across the patient pathways for patients that required services;
· They had been challenged in terms of ambulance handovers for some time and were one of the worst performing trusts in the region on a regular basis and were having three weekly meetings with the regional team;
· They were aware of the need for a bigger emergency department (ED) and build on the new emergency department commences next year with an aim of being delivered by 2024;
· They were however seeing an increase in the people arriving at ED on foot and seeing a real variation of why people were presenting such as some were really unwell while others didn't need to come at all. They were working through the options to support people in accessing the best services;
· They were really keen to ensure that ED was only used for emergencies and that was not the case at the moment and were working with ED, 111, Livewell SW and Plymouth City Council on the alternatives to admission;
· They were undertaking improvement work to ensure they were being as efficient as they possibly could be and to ensure that patients flow through the pathways as efficiently as possible and includes making the right decisions around peoples complexity of need;
· The teams were working with the hospital at the front door on how they can support older and frailer patients to be turned around and to go home;
· Significant amount of work around mental health, provision and support for patients with mental health needs;
· Livewell SW were doing a huge amount of work so support Plymouth City Council with recruitment with the care pathways relating to patients requiring intermediate care and long term care and support for patients in care homes;
Questions from Members related to:
· Where there any specific protocols or routing to ensure that people were not in close proximity with a covid patient and moved as quickly as possible into a well ventilated properly protected COVID ward?
· Primary care and whether practices had opened their front doors so that patients can talk to a receptionist;
· The closure of Estover Surgery;
· Ed Healthwatch Report and when available?
· Explanation of OPAL Escalation level 4;
· Public perception of access to health services;
· What was the average length of wait time within ED;
· Whether there were pressures in in certain wards;
· Long covid and how this would be managed;
· People suffering with the mental health issues and what support was provided.
The Committee thanked officers and noted the update on the Winter Plan, Adult Social Care, Urgent and Emergency Care and Planned and Elective Care.