Agenda item

Item 5a – Barnsley UEC Strategic Winter Plan 2021/22 Cover Report

Item 5b – Barnsley UEC Delivery Board Strategic Winter Plan 2021/22

Item 5c – Barnsley Integrated Care Partnership Health & Care Summary Plan 2021/22

The following witnesses were welcomed to the meeting, some of whom attended and contributed virtually:

Wendy Lowder, Executive Director Adult & Communities, BMBC

Julie Chapman, Service Director Adult Social Care & Health, Adults & Communities, BMBC

Andrew Osborn, Interim Service Director Commissioning & Integration, Adults & Communities, BMBC

Carrie Abbott, Service Director Public Health & Regulation, BMBC

James Barker, Chief Executive Officer, Barnsley Healthcare Federation

Bob Kirton, Chief of Delivery and Deputy CEO, Barnsley Hospital NHS Foundation Trust

Gill Stansfield, Deputy District Director and Clinical Transformation Lead, Barnsley General Community, South West Yorkshire Partnership Foundation Trust

Jamie Wike, Chief Operating Officer, Barnsley Clinical Commissioning Group

Councillor Jenny Platts, Cabinet Spokesperson Adult & Communities, BMBC

Harry Truelove, Yorkshire Ambulance Service.

Councillor Jenny Platts introduced this item, highlighting that winter itself is not an emergency but part of essential future planning, with local plans providing resilience to enable us to manage pressures.  The Winter Plan for 2021/22 has had input from all health and care partners in Barnsley, with lessons learned from 2020/21. 

Jamie Wike reiterated that the purpose of the winter plan is not to duplicate or replace any of the existing plans, but a plan to manage the additional pressures of winter.  There are 4 key pressure points, linked to the pandemic, which have placed additional pressure on an already stretched health and care system:

1.            Covid pressures remain very high

2.            Non-covid health problems are move severe

3.            The workforce is depleted by sickness and recruitment challenges, and

4.            This pressure is across the whole of the health and care sector.

In the ensuing discussion, and in response to detailed questioning and challenge the following matters were highlighted:

There has been a reduction in covid case rates but these remain high.  Hospitalisations are lower than the peak but are still very high.  Death rates are 32 times greater in unvaccinated people.  High vaccination rates equate to low infection rates and this will be crucial as we move through the winter plan.  Non covid-related mental and physical health levels are close to pre pandemic levels.  Workforce pressures (staff absences, recruitment etc) are severe across every part of the health and care sector.  All of winter will be complicated and pressurised, but lessons have been learned and risks and challenges identified.  4 areas - preventing/minimising urgent care demand, access to urgent/same day care and treatment, treatment (in-patient care) and flow, discharge and out of hospital support.

The Winter Plan is monitored and assessed daily through health and care partner SitRep phone calls to consider presenting challenges, with a senior level system wide call several times a week.  The Urgent and Emergency Care Board and Integrated Care Partnership are also involved in monitoring the plan.  The flexibility and agility of services to respond is more challenging as the pace of response is often based on service capacity, staffing levels etc.  Conversation take place every week and this has been successfully managed over the last few winters.  The focus is on patient safety and escalation frameworks are in place, with trigger points across each organisation.  The plan is followed every day, 7 days a week.  Organisations across the whole sector work well together, flexing and adapting to peaks and troughs and other pressures.

Members felt that often people attend the Accident and Emergency Department when this is not necessary and that this should be discouraged.  Strong navigation at the 'front door' and clear communication messages are in place but unfortunately some will choose to attend A&E rather than another setting, particularly if they have experienced difficulties accessing GP services.  Many patients are frustrated  at not being able to access services and the messages about waiting times, the importance of uptake of vaccination and the need for people to be sensible and do the right thing should be strengthened.

Yorkshire Ambulance Services (YAS) are experiencing unprecedented demand on Emergency Category 1 and 2 calls, but a reduction in Category 4, which seems to indicate that people are ringing the services they need.  Response times are below optimum levels, which is due to demand and prioritising Category 1 and 2 cases.   People are encouraged to call 101, which was created to reduce pressure on the 999 system. Recruitment of paramedics is challenging and more are needed.  Pathways and career progression is being explored to address this, alongside creative ways of working around triage. Ambulance services in Barnsley are under more pressure than South Yorkshire neighbours but are nonetheless performing well.  More information around performance will be provided.   

GP services have been experiencing many pressures and challenges and work is underway to improve GP telephone systems but this will take some time and still requires staffing.  It has helped that Barnsley now has just one Primary Care network, enabling GPs to work closely together.  One improvement during the pandemic has been the aligning of Physiotherapists to individual GP practices. 

Very few people experience delayed discharge from hospital due to strong discharge processes.  However, the nature of the care market in Barnsley needs to change, working to 'home first' principles with good quality home based care. There is a gap in the market for residential care provision for those with dementia and mental health needs, which is being explored and developed.  The Overview and Scrutiny Committee task and finish group are looking into early diagnosis of dementia alongside a network of organisations.  Review findings will be reported back through Scrutiny.  The Third Sector Dementia Alliance will also be holding a Member briefing on dementia.

 Members were reassured that although some hospital departments - such as oral surgery - have experienced difficulties, patients are risk assessed and get the care they need.  Elective care beds are protected throughout the winter to help with sustained recovery.  The 2-week Cancer target is being achieved, although there is some pressure on the 62 day target.  There is no evidence to suggest that people are deterred from seeking treatment and communication messages are clear that if people need to use services they should come forward. 

Workforce issues are a universal challenge across the whole health and care community, with  some organisations more affected than others.  Recruitment to care is very difficult and it is impossible to recruit to some posts.  The sector needs to work together to raise the profile of some posts/careers and also to address issues such as the implementation of the Living Wage and the development of a Health and Care Academy.  Receiving the Pride of Barnsley award, the Covid-19 memorial and the Freedom of the Borough award go a long way to helping to recognise the valuable work done across the health and care sector, which is much appreciated.  We have to all work together and look after each other.    

RESOLVED that

(i)            Witnesses be thanked for their attendance and contribution;

(ii)          Thanks be expressed to all health and social care workers for their hard work and commitment to Barnsley,

(iii)         Town centre provision to support individuals under the influence of excess alcohol be explored in order to reduce demands on A & E;

(iv)         A more rigorous approach be explored around communicating information relating to primary care options, e.g. Pharmacy First, NHS111 and iHeart to reduce unnecessary demand on A & E; and

(v)          Yorkshire Ambulance Service to provide the Committee with performance data in relation to response times.