Agenda item

The Director for Public Health and the Strategic Director for Social Care and Education along with partners from the Health Sector submit a report to the Joint Public Health and Health Integration and the Adult Social Care Scrutiny Commissions to summarise health and care system planning to manage winter pressures across Leicester Leicestershire and Rutland (LLR) in 2023/2024.

The report comprises of:

1.    A Vaccination and immunisation update.

2.    A summary of the Urgent and Emergency Care (UEC) position in LLR. 

3.    The full LLR UEC recovery and delivery plan, finalised on 31^st July 2023.

4.    A summary of Adult Social Care Winter Plan

5.    Beyond the lockdowns: Lessons learned from Leicester's COVID story (Beyond the lockdowns: Lessons learned from Leicester's COVID story)

6.    Fuel Poverty and Health Programme.

Members of the Commission are requested to note the report presented for scrutiny and assurance and pass any comments or queries to relevant City Council Directors and Health Sector partners.

The Chair of the Commission invited Health Partners and Officers to introduce the item and addressed how the items included will be taken.

The Chief Operating Officer introduced the report and provided an overview. As part of the report the improvements on the ambulance service handover times which had a 90% reduction in the waiting times, the improved capacity and the improvements to the tiering system were highlighted. It was suggested that the service was objectively in a better place and partnerships were working well and areas of improvements were being addressed.

As part of the discussions, members of the commission queried the Flu vaccinations alongside the Covid vaccination programme. It was noted that this would be addressed further in the presentations and any comments that were raised would be fed back to the ICB who were delivering the programme.

Members further queried the workforce retention and what impacts the industrial actions were having on the workforce. The Chief Operating Officer took the opportunity to note that the UHL were confident with plans put in place going forward and that and that the NHS Staff Surveys provided actions to support staff retention for all staff and helped recognise the changing UHL which included the cultural changes. More information was requested on the recruitment and retention of NHS Staff which was a national problem and it was suggested that the Health Partners were happy to provide this information at a future meeting but would reassure members that the UHL had become a more flexible employer with more permanently employed colleagues on the ward which had seen better improved care for patients.

The Director for Adult Social Care and Safeguarding delivered a presentation providing the Joint Commission with an overview of the Leicester City Council Adult Social Care Contribution to Winter Planning which identified key parts of Winter Planning to deliver effectively.

As part of the discussions, it was noted that:

·         Issues with national communication campaigns could be identified through previous experiences and considerations of improved local communications would be addressed.

·         A committee of experts decide on the cohorts of people to be vaccinated which followed a specific criteria and was not a political decision.

·         The significant pathway redesign (recovery, reablement and rehabilitation) supported all appropriate discharges home and reduced the use of commissioned care at the point of discharge. 

The Director for Adult Social Care and Commissioning took the opportunity to note that the discharge fund supported those who needed to draw on social care when leaving hospital and supported boosting workforce capacity. It was also noted that the Market Sustainability and Improvement Fund helped support the increased fee rates to social care providers and helped support increasing the workforce and retention of staff.

In further discussions, members of the commission queried how the delayed discharge looked across the city. The Director for Social Care and Safeguarding noted that this fluctuated daily and that few people with complex needs usually have a longer discharge wait.  The early discharge planning in place supported discharge without statutory discharge requirements and the Integrated Discharge Hub coordinates the oversight which was planned through multi-disciplinary meetings and was currently being piloted. It was also noted that the UHL had the lowest number of people waiting for social care and that the current partnership was strong and working on best practice with aims to make further progress.

Members of the commission continued the discussions around the ambulance waiting times and gave examples of personal experiences which suggested that there were concerns that the extensive ambulance waiting times continued. In response to these, it was noted that all calls were triaged, and ambulances were despatched dependent on clinical needs. Members were further reassured that the waiting times had improved and these were compliant with the target times highlighted.

Members of the Commission were impressed with the efforts put into diversifying the workforce across the service and queried how the disproportionate deaths of those from ethnic minorities were being addressed. It was noted that although Leicester had relatively few deaths amongst staff the Chief Operating Officer was confident that the UHL could provide a safe working environment for all staff. It was requested that the commission take the opportunity to consider carrying out further work in the disproportionate deaths of staff in the NHS.

In further discussions around vaccinations, it was suggested that there was an increased risk in multi-generational homes for contracting and spreading viruses, it was suggested that this was a key reason behind the introduction of flu vaccinations in schools. The key messaging the local authority uses still had influence on delivering an effective vaccination programme in the city amidst the distrust. There was continued frustration around how vaccinations were processed and how programmes were delivered nationally including the eligibility criteria.

The Vice-Chair of the commission raised concerns around planned care and cancer care which was still categorised as Tier1. The Members of the commission were reassured that the service were working hard to continue making changes to improve this and were hopeful that this tiering would be improved in the near future. It was suggested that a further request to update members on the areas that were working well and areas that could be improved would be an effective way to measure.

It was also suggested that the possibility of having 111 service staffed by clinicians would be a step in the right direction and a response on the status of this would be provided to members of the commission.

The Winter Plan addressed how the partnerships were working to avoid emergency care attendance at the LRI and that an offer for viable locations to receive emergency care provisions in the city was also an alternative consideration. There were risk factors in all industries including the NHS but the Chief Operating Officer of the UHL was confident that the UHL was a safer place to receive healthcare than it was 12 months ago.

In response to the Vice-Chair’s request for information on how bariatric patients were manged with care and dignity and the stress on carers in virtual wards, the Chief Operating Officer suggested that although this information was not available at the meeting, it would be provided to the Vice Chair.

Members of the commission continued to discuss the fall in calls to the ambulance service. It was noted that the figures had returned to pre-covid numbers and members were reassured that all calls were triaged and people who needed an ambulance received an ambulance.

The Director for Public Health delivered a presentation on the lessons learnt from the ‘Leicester City Covid Story’ which was available on the Council’s website written by Professor Ivan Browne.

Members took the opportunity to address issues that had caused a loss of trust in city residents and suggested that it was important to connect with communities and young people to deliver the message further. Community champions had been used during the pandemic which had been an effective means of spreading the messages within hard-to-reach communities and innovative approaches should be considered.

The Director for Public Health further delivered a presentation on Fuel Poverty and highlighted the work carried out by the Energy Advice Service which had been set up locally.

Members of the commission requested that information be circulated to them so that the Energy Advice Service could be forwarded on to their contacts for additional referrals. It was noted that this service was being expanded gradually and an officer from the team would circulate the link to members. Additionally, the Director for Public Health requested members to participate in the training on fuel poverty and suggested this would be a great beneficial starting point.

AGREED:

1.    That the Chief Operating Officer for the UHL be requested to provide information on the measures taken to support bariatric patients

2.    That the Chief Operating Officer for the UHL be requested to clarify whether clinicians and other professionals (including those who are recently retired) will be supporting the 111 service

3.    That The Chief Operating Officer for the UHL be requested to provide further details on virtual wards

4.    That the Chief Operating Officer for the UHL be requested to provide further detail in respect of UHL recruitment and retention figures

5.    That the Director of Public Health be requested to provide details of flu vaccination figures for 2022

6.    That officers be requested to circulate the web-link to direct members to relevant online sources regarding fuel poverty support

7.    The Director of Public Health invited all Members of the Joint Commission to participate in the training provided on supporting those experiencing cost-of-living/fuel poverty difficulties; and

8.    The Director of Public Health be requested to further report on the health impacts of the cost-of-living crisis and a report be brought to a future Public Health and Health Integration Scrutiny Commission meeting.