Agenda item

Rachna Vyas (Chief Operating Officer, NHS Leicester, Leicestershire and Rutland) and colleagues will give a presentation on some of the key initiatives which have been developed and delivered during the winter months to manage the increasing pressure on services.

Rachna Vyas (Chief Operating Officer, NHS Leicester, Leicestershire and Rutland) and colleagues gave a presentation on some of the key initiatives which have been developed and delivered during the winter months to manage the increasing pressure on services.

The LLR health and care community has been working in partnership to plan for and deliver services through a difficult period of seasonal pressures and at a time of unprecedented industrial action across the public sector.

Whilst demand had stabilised through the start of Q4 23/24, all parts of the system remained busy in terms of both acuity and demand. This trend spanned primary care, NHS111, Clinical Navigation Hub, home visiting, urgent care services, acute services and social care services.  Despite pressures, the LLR system has continued to deliver innovative services, grounded in true partnership; the presentation highlighted some of the key services delivered over the winter period. Colleagues from across health and care service, represented on the LLR Winter Board, would present these highlights, along with plans for further developments in 2023/2024.

During the presentation it was noted that:-

·         The Winter Plan focused on 20 key activities which were outline in the presentation.

·         The Urgent Care Response was the only system in the country that looked at falls, made sure that people hade food at home, why falls occurred and what services patients could link into.  It was an holistic approach and a person centre approach.  It was intended to grow and develop it this year and embed it within the system.

·         The Urgent community response service for Leicester City had a 100% response rate within 2 hours, with the vast majority of people kept safely in their place of residence, using a holistic checklist of care. 

·         Patients could access these services through any health and care professional.

·         This model had been used to develop the UCR model for LLR and formed the basis of the national specification.

·         About 100 patients per week being supported in their place of residence through a ‘virtual ward’.  There was very positive patient feedback, with pathways live for cardiac and respiratory illness.  There was further development of pathways to support frailty and intermediate care and an opportunity to work with LA monitoring services such as pendant alarm services etc.

·         The LLR unscheduled care hub was a team represented by all services including social care, ambulance, UHL and LPT.  It took 30-40 patients off ambulance lists every day as it assessed and supported patients in their own place of residence.  It was being rolled out across the country because of its success.  Nobody was denied a service, if they didn’t want this service they would be admitted to hospital. 10 of the patients were mental health.  There was also the nurse and paramedic in triage car available to use.

·         Initiatives in place to support discharges from UHL included a partnership approach between the Council and health to assess how best to get patients the right care at the right time, based on local insights and knowledge.  Sometimes reasons for delayed discharges could be the patient did not have a fridge, heating or food etc and whilst this was not a health responsibility it affected the patient’s discharge if it was felt their home environment was an unsafe environment, especially where the patient was elderly.  Staff worked on these issues to address them and minimise delays in discharges.

·         There had been the launch of ‘Inspire to care’ programme across the City, with a focus on recruiting new staff into care careers, retaining current staff and ensuring that new colleagues have a known career pathway across health and care.

·         The was recent evidence that hoarding and other housing related factors were impacting on ability to discharge patients from mental health wards in LPT.

·         There was an opportunity to expand the Housing Enablement Team (HET) to cover MH Services Older People inpatients wards.

·         Up to 25 patients were supported with early discharge - housing cases could have complex circumstances and resulted in long delays in discharges, impacting further on physical and mental health.

·         It was acknowledged that it was extraordinarily difficult in every area of health and care at the moment with a mix of demand, COVID/Flu, staff absence, capacity plus impact of industrial action.

·         The system had managed the ambulance service industrial action with a critical incident called at Leicester Hospitals as a partnership but it recognised that the surges in activity were causing a poorer patient experience across the pathway, with long waits across the pathway. Staff were also under increasing pressure.

·         Staff were continually strengthening the winter plan and would apply learning from what we know had worked through difficult periods throughout the year.

·         It was clear that the partnerships across health and care had held firm and these case studies demonstrated the art of the possible when services continually worked together.

The Chair thanked officers for the presentation and asked board members to take away the messages and reflect upon them.  Partnership working had been undertaken for some years and it had grown, developed and strengthened. – It had been increased during covid and some people though it had been done because it was expedient to do it and had not recognised that it was already in place.  It was important that all partners reflected upon change management messaging to reflect these partnerships had been in place for some time and  were continually being developed as they were being driven by the need to be clinical safe and in partnership with individual residents.  All partners needed to issue their own messaging on how change was being managed but not in a way that minimised issues but focused on improvements being achieved so that people understood how the changes gave better services.

RESOLVED:-    Officers were thanked for the presentation and Board members were asked to consider the comments made by the Chair above.