Item 17 - Winter Plan
North Lanarkshire Council · 30 November 2022
Back to Health and Social Care Integration Joint Board — 30 November 2022 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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1 REPORT Item No: 17 SUBJECT: Winter Plan TO: Integration Joint Board Lead Officer for Report: Morag Dendy, Head of Planning, Performance & Quality Assurance Author(s) of Report Graeme Cowan, Senior Manager, Strategy & Performance DATE: 30th November 2022 1. PURPOSE OF REPORT This paper is coming to the IJB for: For approval For endorsement To note 2. ROUTE TO THE BOARD Prepared Reviewed Endorsed This paper has been: prepared by the Planning and Performance Team and endorsed by senior management. 3. RECOMMENDATIONS 3.1 The IJB is asked to agree the contents of the Climate Change report prior to its submission. 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 Background 5.1.1 Annual ‘whole system’ planning is undertaken in preparing Health and Social Care Services in such a way as to mitigate the risks normally associated with winter. The Lanarkshire Health and Social Care system – in common with that across Scotland - continues to face significant challenges. Last winter, health and social care services and staff had to contend with extreme pressures, many of which continue to be issues for the system. 5.1.2 Planning for Winter 2022/23 commenced in July 2022 and, as in previous years, is undertaken in accordance with national guidance. The Lanarkshire approach to winter planning is a multi-agency approach across NHS Lanarkshire, North and South Yes No N/A
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2 Lanarkshire Integration Joint Boards (IJBs) and both Councils together with the respective supports (for example, the Scottish Ambulance Service and NHS 24). 5.1.3 Give the level of unpredictability in the Health and Social Care sectors as well as in the wider public system, this year’s Winter Plan has been developed as – and should be understood to be - a dynamic plan and one that is highly likely to be subject to change over the coming months. This has also been recognised from a Local Resilience Planning (LRP) perspective and a specific piece of work is being undertaken by NHS Lanarkshire, to take account of the increasingly likely eventuality of a number of concurrent risks which may well align to create increased system pressure. These risks include, inter alia, further waves of Covid 19; increased prevalence of flu and other respiratory infections - both in relation to infectivity and impact; uptake and efficacy of vaccination programmes; workforce shortages in all sectors and grades across the Health and Social Care sector; potential industrial action; public health impact of cost of living crisis/fuel costs and subsequent demand on health and care services; increasing numbers of displaced Ukrainians/Asylum Seekers; inclement weather; and available finances. 5.2 National Guidance / Scottish Government Correspondence 5.2.1 On 04 October 2022, Scottish Government published a Winter Resilience Overview 2022-23 which set out the actions they are taking in an effort to support the sector over the winter period. 5.2.2 That guidance set out the national expectations for those areas that local winter plans would be expected to address. As will be clear from the body of this report most of the areas identified already feature as part of the Lanarkshire winter planning process; are being reviewed/refined to ensure that they are as up to date as can be and resourced appropriately given available capacity. The guidance was further reinforced by subsequent correspondence to Chief Executives and Chief Officers on 12 October 2022 and 17 October 2022, the latter including a checklist for completion. Following a national event on 19 October 2022, further guidance was issued and an associated operational self-assessment on winter preparedness was issued. The submission made by the 7 November 2022 deadline reflected the content of this report. 5.2.3 Discussion is still ongoing at national and local level on available funding to manage the impact of Covid 19 and ongoing pressures associated with both unscheduled and planned care. Work is ongoing between the NHS Lanarkshire Director of Finance, the two Chief Financial Officers of the IJBs and Council Finance Directors to be clear of those monies which have already been committed to meet ongoing service pressures/respond to previous Government policy; and that which may be available to support any new proposals. 5.3 Ongoing Urgent and Unscheduled Care Planning 5.3.1 The national Redesign of Urgent Care programme looks to build on these opportunities to support the public to access the right care in the right place at the right time. As part of the ongoing NHS Lanarkshire Urgent and Unscheduled Care
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3 development programme work has been undertaken to identify those areas where there may be scope to introduce early change such that there can be a beneficial impact on whole system capacity. 5.3.2 As well as a refocus on the Six Essential Actions (nationally developed with the Academy of Royal Colleges) there are a further six main areas where active consideration is now being given to opportunities to support increase “flow” through the system. It should be noted that these areas are all consistent with the Scottish Government guidance from October 2022 referred to above: Hospital at Home - review of the current model and consideration of opportunities for expansion of service. Frailty – pathway development to support admission avoidance and early discharge. Development of a community-based Urgent Care Service. Development of Minors Service Hub. Expansion of the scope of the Flow Navigation Centre (FNC – see below). Development of Discharge Ward Model / Commissioned Beds. 5.3.3 Both Chief Officers of the North and South Lanarkshire IJBs are also closely involved in the Urgent and Unscheduled Care work stream. This is in recognition of the fact that currently almost 95% of patients are discharged from hospital without delay; and, accordingly, it is very important to whole system “flow” that acute services are delivered as efficiently as possible alongside expanding the capacity of and transforming the delivery of more services in the community. 5.4 Discharge Without Delay 5.4.1 A national Unscheduled Care Planning for Winter event was held on 19 October 2022 at which it was reinforced that the delivery of discharge planning by acute hospital staff was vital as part of the Discharge Without Delay programme with its emphasis on Planned Date of Discharge. 5.4.2 NHS Lanarkshire is a pathfinder site for the national Discharge Without Delay programme, which is hosted within the South Lanarkshire HSCP. Considerable work is ongoing to promote and systematise Planned Date of Discharges across all hospital sites; and work is ongoing to embed the necessary steps to improve “flow” (for example, increase pre-noon discharges) across all hospital settings. 5.4.3 Both HSCPs have Home Assessment/Home First Teams which although in their infancy are already making significant improvements in the number of people able to be supported out of hospital with no/little delay. 5.4.4 There are a range of other initiatives that are being implemented to provide better outcomes for patients and service users which also contribute to the better use of available services and reduce pressures on health and social care services. The development of third sector support for hospital discharge includes volunteer recruitment; induction and training; and process and system development to ensure
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4 volunteers and ward staff are clear on what can be done and that patients are supported to feel safe in the knowledge that the volunteers involved are an integral part of the discharge process where applicable. 5.5 Maximisation of Flow Navigation Centre (FNC) 5.5.1 The FNC offers rapid access to a senior clinical decision maker within the multidisciplinary team, optimising digital health through a telephone or video consultation where possible, and minimising the need to attend an Emergency Department. This includes the use of ‘Consultant Connect’ for rapid professional to professional clinical decisions to support clinical decision making, reduce unnecessary attendances, and to navigate patients to the most appropriate place, first time. Both of these services allow GPs to have the opportunity to discuss cases with an appropriate secondary care clinician with a view to ensuring as many patients as possible are managed in a ‘planned’ way. 5.5.2 Accordingly, as part of the planning for winter, work is being undertaken to enhance the FNC to maximise the number of people who can be diverted from Emergency Departments and managed in a different way. 5.6 Surge/Bed Capacity 5.6.1 Acute hospitals that are working close to or at full capacity are a strong indicator of a system that is under significant pressure. Surge capacity generally refers to the ability to maintain a sudden and unexpected increase in patients. 5.6.2 Unlike in previous years and in common with the position across Scotland, the scope for additional surge capacity in NHS Lanarkshire is limited. This is both in terms of workforce and accommodation, recognising other capital works ongoing on the University Hospital Monklands site means that the ward traditionally used to manage “surge” is not currently available. The latter position will be kept under constant review such that if sufficient staffing does become available, then the respective acute beds can be mobilised and introduced to support overall hospital capacity. 5.6.3 Both South and North Lanarkshire HSCPs will also utilise intermediate care beds and interim beds within care homes such that additional flow can be created in the absence of immediately available care at home or a care home of choice. 5.7 Social Care Provider Sustainability 5.7.1 Independent providers of social care in Scotland – notably care homes and care at home providers – have highlighted the extremely difficult operating environment. Coupled to the cost-of-living-crisis and the impact of the pandemic, vacancy pressures are a significant concern for many providers in terms of service viability. 5.7.2 Both HSCPs and their respective Councils have taken steps to augment their scanning of the care home provider context and provide additional support proportionate to the demands on in-house provision, available resources (noting the social care workforce challenges) and statutory/legal parameters. Within North Lanarkshire,
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5 ongoing actions include the HSCP convening the providers’ forums, and regular meetings with Scottish Care. On a Lanarkshire-wide basis, support and quality assurance for Care Homes continues on a whole system basis to be overseen by the pan-Lanarkshire Care Home Assurance Tactical (CHAT) Group; and for Care at Home Services through the equivalent Care at Home Oversight Group. The Care Inspectorate participates in both of these meetings. 5.8 General Practice and pharmacy opening 5.8.1 As in previous years, a local enhanced service to support general practices opening on the fourth day of the weekend/public holidays – that is, on 27 December and 3 January as well as the Saturdays through January 2023 - will be offered. There will also be an extended public holiday pharmacy service available to ensure that people can both access prescriptions as well as being available for re-direction from NHS24, the Primary Care Out of Hours (PCOOH) Service, Emergency Departments and the FNC where possible. 5.9 General Practice sustainability 5.9.1 As is recognised as the situation across Scotland, general practices across Lanarkshire are experiencing more pressure than at any point in their history. The Scottish Parliament’s Health, Social Care and Sport Committee has highlighted that the rise in complexity of patient needs has led to a substantial increase in the primary care workload in Scotland; and that the problems in maintaining and developing the general practice workforce also exacerbate the overall system challenges. 5.9.2 This was the subject of an extensive presentation at the September 2022 meeting of the South Lanarkshire IJB, which included describing the work ongoing to address capacity and demand – most notably, through the Primary Care Improvement Plan (PCIP) that is reported through to the IJB and NHS Lanarkshire Board as per the expectations within the General Medical Services (GMS) Contract. 5.10 Primary Care Out of Hours 5.10.1 For a considerable period, and similar to most Scottish out of hours services, the NHS Lanarkshire PCOOH Service has had to manage workforce availability challenges (notably in relation to GPs); and has regularly had to contend with escalating levels of demand. There are already approvals in place for a new clinical model and supporting project which will move the PCOOH Service to a more multi-disciplinary workforce and competency-based model of care, alongside a wider review of urgent care arrangements (as has been reported to and approved by both IJBs and the Health Board). In the meantime, work continues to stabilise the service, with contingency and escalation frameworks in place, and as previously reported to the IJB. 5.11 Planned Care 5.11.1 Work is ongoing in estimating the extent of planned care that may require to be stood down during the peak winter period, all the while seeking to minimise this such that the pace of recovery in meeting revised NHS Treatment Time Guarantee
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6 targets can be maintained. In extremis, there may be a requirement to revisit attainment of the targets depending on the impact of winter on overall system flow. 5.12 Contingency Arrangements for Additional Deaths 5.12.1 As set out within national guidance and is the case every year, work is underway – including with local undertakers - to ensure that there is sufficient ‘pace’ of funeral services (both burials and cremations) to support the eventuality of a significant excess of deaths over the winter period. Additional mortuary capacity identified for Covid 19 is still in place and will continue to be available over this winter period. 5.13 Covid 19 and Flu Vaccine Programme 5.13.1 Following final advice on the winter Covid 19 booster programme from the Joint Committee on Vaccination and Immunisation (JCVI), the following groups are being offered an additional Covid 19 booster: Residents in a care home for older adults and staff working in care homes for older adults. Frontline Health and Social Care workers. All adults aged 50 years and over. Those aged 5 to 49 years in a clinical risk group, including those who are pregnant. Those aged 5 to 49 years who are household contacts of people with immunosuppression. Carers aged 16-49 years. 5.13.2 It has been estimated that approximately 300,000 people will be eligible for a Covid 19 vaccine and 380,000 for a flu vaccine as part of the Autumn/Winter Vaccination Programme for 2022. 5.13.3 Work is well underway in pursuit of achieving an 80% uptake by December 2022 - thereby maximising protection to the community and, in turn, to Health and Social Care Services by reducing the risk of increased Covid 19 and flu related hospital admissions or other deteriorations in health such that additional support is required. Significant progress has already been made in relation to residents within the older people’s care home sector; and work is advancing in respect of the cohorts linked with those with illnesses that results in immuno-suppression. 5.13.4 Despite considerable efforts to promote the programme, uptake thus far by NHS- employed staff and social care staff from both Council and independent and voluntary sectors in Lanarkshire has been lower than predicted. This is consistent with the pattern being seen across the rest of the country. Action is being taken to try and increase uptake accordingly. 5.14 Carers Support 5.14.1 An update paper is on the agenda around Carers Support and the use of the Carers (Scotland) Act 2016 funding to enhance operational services and supports for carers in North Lanarkshire.
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7 5.15 Staff Wellbeing 5.15.1 NHS Lanarkshire’s Health and Wellbeing Strategy was launched during its Staff Health and Wellbeing week (31 October to 4 November 2022). Key messages from the Strategy form an integral part of the system wide winter plan, with the emphasis on providing a working environment in all areas across Health and Social Care where staff are able to enhance and maintain their personal and professional wellbeing and to reach their full potential in a culture that’s provides space, time and support for self-care. 5.15.2 The Strategy supports the shared vision of ensuring that staff health and wellbeing is embedded in everything we do and championed at all levels across the respective organisations. To increase visibility and awareness of staff health and wellbeing platforms, Staff Health and Wellbeing week was designed to showcase the support, resources, initiatives and opportunities currently provided to help support staff to manage their health and wellbeing. Again, like the wider approach to winter planning, this recognises pressures which are system-wide; and a shared approach to dynamic between the imperative to maintain staff health and well-being alongside the significant demand being placed on health and social care services. 5.16 Adverse Weather 5.16.1 Adverse Weather events are defined by reference to the Met Office Weather Warning system. NHS Lanarkshire and both South and North Lanarkshire Councils have policies in relation to adverse weather that applies wherever severe weather may obstruct staff from being able to attend work, and/or where severe weather poses a significant risk to the health, safety and wellbeing of staff. 5.16.2 A series of actions is open to the organisations – individually and in collaboration - in managing adverse weather and these have been refined over many years of winter planning. These include working with and through the Local Resilience Partnership (LRP) and with pre-identified voluntary organisations. 5.17 Concurrent Resilience Planning and Risks 5.17.1 As highlighted above, there is a likelihood of concurrent risks aligning to have a significant impact on the wider health and social care services. 5.17.2 Perhaps key amongst these is the threat of industrial action and the impact both directly and indirectly. As well as potential industrial action by NHS and local government staff, so too there is the indirect impact of industrial action in other sectors, for example, Education and Royal Mail. 5.17.3 Resilience Planners from across the NHS and local government have been collaborating on scoping the range and extent of the mitigating factors introduced to reduce the impact of winter on the overall system. Two ‘Winter Breach’ events have been held this year, a regional event on 26 October 2022 and a Lanarkshire LRP event on 27 October 2022. Learning from both of these events have been taken into account in reviewing the robustness of the planning to date.
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8 5.17.4 Importantly, there are well-developed escalation processes and prioritisation frameworks in place supported by ‘Strategic Command’ structures that can be introduced when required. These arrangements provide appropriate and necessary governance for services to be stood down in a planned way in extremis, and thereby ensure a focus on the delivery of essential/core functions and the provision of care for the most vulnerable. 5.18 Communications 5.18.1 Work is underway at both local and national levels on the public message in relation to the different pathways/routes into health care services the public are being asked to follow during the winter months. As will be appreciated from the foregoing range of initiatives, there are many areas where the public will be asked to assist in managing the impact of winter this year. South and North Lanarkshire HSCPs, both Councils and NHS Lanarkshire are actively involved in seeking to ensure the messages are appropriate, shared widely and understood. 5.18.2 The key message themes are to ask people to plan ahead; know the different options that are available to them to access urgent care; and to encourage as many people as possible to access the service which is closest to them and least reliant on hospitals and general practices. Communication staff from both Councils are also actively engaged in the advertising campaigns to maximise care staffing recruitment 6. CONCLUSIONS 6.1 Significant whole system planning has been undertaken in preparation for what is widely expected to be one of the most challenging winters for health and social care services on record. 6.2 The IJB will be kept abreast of developments throughout the winter period. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES 7.1 The winter planning process impacts on all nine national outcomes. 7.2 ASSOCIATED MEASURE(S) 7.2.1 The IJB and NHS Board will be measured against a number of performance metrics including the 4hr ED target and Delayed Discharges. 7.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 7.4 RISK ASSESSMENT/RISK MANAGEMENT 7.4.1 It is recommended that winter planning is added to the IJB risk register due to its potential impact on a wide range of service areas and ability to implement strategic plans.
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9 7.5 PEOPLE 7.5.1 Our winter preparation will have a significant impact on all North Lanarkshire staff and residents as outlined above. 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY 7.6.1 This report does not introduce a new policy, function or strategy or recommend a change to an existing policy, function or strategy and therefore no impact assessment is required. EQIA Completed & Fairer Scotland Impact Assessment Form Completed: Yes No N/A 8. BACKGROUND PAPERS 9. APPENDICES CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following: Morag Dendy, Head of Planning, Performance and Quality Assurance