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 summarise health and care system planning to manage winter pressures across Leicester Leicestershire and Rutland (LLR) in 2025/2025.

The report comprises of:

1. Urgent & Emergency Care Plans

2. Immunisation Programme Campaign Update

3. Adult Social Care Winter Plan Update

4. Fuel Poverty and Health Programme

Members 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 asked members that the various reports all be presented, and that comments and questions be taken at the end in which members agreed.

The LLR Director of Emergency and Urgent Care presented the LLR winter planning update. It was noted that:

·       Vaccination programmes are important to ensuring citizens and staff are safe during the winter and communication campaigns encourage take up to help ensure immunisation coverage. There has been a slower take up of coronavirus vaccines amongst health workers, but communication is ongoing to promote safety to staff, families and patients when vaccinated. 

·       The RSV vaccination programme commenced nationally in September and paediatric consultants are confident of a positive impact on children. The programme is aimed at under 2’s, pregnant women, and those over 75.

·       Seasonal planning is crucial and partners across health and care work collaboratively to develop and refresh plans. They have also been reviewed by clinical and operational leaders to ensure the right areas are being focussed on.

·       Staff wellbeing and support has been identified to ensure resilience and that services are equipped to serve patients.

·       Communication leads have been working on joint campaigns for citizens and staff to ensure clearer messaging on the right pathways and access to services.

·       There is a focus to increase capacity for urgent treatment and joining up the frailty offer. There are good services across adult social care and acute community services but are not always interlinked in the best way so will be a focus.

·       There is confidence in discharging patients requiring social care in the city.

·       Data indicates a clear increase in demand and activity of zero length of stay and same day access, including use of virtual wards. A focus will therefore be to ensure there is awareness of alternative services for ambulances and primary care to access for patients to be treated sooner.

·       There has been an increase in investment in the voluntary and community sector for supporting individuals with mental health, learning disability or autism and evidence from last year highlights support helped alleviate individuals attending the emergency department.

The Strategic Director for Education and Social Care presented the adult social care winter plan update in which it was noted that:

·       Adult Social Care services are considered to experience consistent pressures year-round and escalation plans are therefore developed and monitored throughout the year by analysing data. The service looks across the system to ensure there is a balance of care providers across care homes, domiciliary care and exit planning for all pathways at any given time.

·       Hospital discharges and supported for patients who require social care support. There has been investment through the discharge grant which has allowed the reablement offer and timely discharge of patients seven days a week. A domiciliary care contract is in place and provision can be accommodated for discharged later in the day to receive required support during the evening when returning home.

·       There tends to be low numbers of patients waiting for social care to be discharged at any given time - across 1,800 beds, there are usually less than 30 patients waiting for discharge.

·       Leicester has an elderly population and more chance of hospital admission; therefore, there is a focus on reducing admissions.

The Heads of Service for Independent Living and Health Transfers reiterated the strengths of the discharge offer, and it was noted that double handed care has now been addressed to ensure an equitable offer for reablement. The latest data illustrated 92% patients requiring social care support were able to return home in August as opposed to a care home. Admissions avoidance was also highlighted as an area of focus with responding to falls and supporting residents to prevent calls to the East Midlands Ambulance Service.  The positive work on virtual wards had also contributed to avoiding residents being admitted to hospital as well as returning home sooner and there had been an increase in flow for the reablement offer and there was confidence in the joined-up approach across health and social care.

The Director of Public Health presented the fuel poverty and health programme, and it was noted that:

·       Fuel poverty has different definitions, with England considering income and the energy performance of a property whereas Scotland and Wales identify fuel poverty is a household have to pay more that 10% of their income to keep warm. The English definition is being reviewed as it is not clear, but millions are estimated to be in fuel poverty.

·       The two-year programme has been funded by the ICB and delivered in partnership by National Energy Action (NEA) and public health which is due to end this year. NEA have secured additional funding through the gas distribution network and agreed to continue with elements of the programme in Leicester next year.

·       The programme was established in recognition of the cost-of-living crisis and whilst fuel prices have reduced, they remain higher than before and are expected to increase again in October. The crisis therefore remains real with thousands of city residents unable to keep warm which can have a detrimental on physical and mental health, increase frailty and risk of falls and colder homes can be associated with damp and mould which also have health risks.

·       The NHS look at health inequities through the CORE20PLUS5 model. Four of the five conditions for the biggest differences in health inequality can be associated to fuel poverty and emphasises the importance of the programme to tackle inequalities in the city as Leicester generally has low income and poorer energy housing standards and high excess winter deaths.

·       The programme has been based on NICE guidelines for training and issuing energy advice as well as identifying people at risk. The team consists of 5 NEA energy advisors and trainers and 2 public health officers. The programme includes providing advice for energy and maximising income as well as outreach and engagement. Education programmes are also provided in schools to inform children of the importance of health and climate change.

·       Referrals were initially being made mostly in the west of the city where there are higher social housing tenants, but the programme has had a good spread of referrals across the city through council services, health partners and the voluntary and community sector. Residents supported through the programme often have ill health and therefore benefit from help and signposting to other appropriate service. Around £181k direct extra income has been generated for residents supported through the programme.

·       Qualified energy advisors are undertaking outreach in communities and training other individuals to promote energy awareness and ensure the programme and impact is sustained.

The Chair invited the youth representative to make comments and it was noted that respiratory services for children in community hubs as opposed to attendance at the emergency department received positive feedback, but families highlighted, they were unaware of the offer. A proactive approach is being undertaken this year to share information within school and neighbourhood settings.

The Commission commended the positive working relationships across health and social care to support residents, particularly the timely discharge of patients and reablement service. Members raised concerns about the impact of the withdrawal of the winter fuel payment to elderly residents’ health and pressures on the health service.

In response to Members comments and questions in was noted that:

·       The eBed system enables monitoring across the system of where people are for their pathway to being treated.

·       Paediatric virtual wards have been designed by clinical leads to identify cases that may benefit from a virtual ward. Patients will be assessed and only those deemed low risk and safe to use a virtual ward will be provided the option to return home. A 24hour telephone line will provide support if required.

·       The vaccination programme and engagement for vaccines will continue as in previous year but learning has been identified to improve the offer. For example, the roving unit has been popular in communities, but feedback of appropriate locations and times has been accounted for to have the most impact.

·       It is recognised that high levels of standing charges can attribute to fuel poverty and debt even where residents have not used energy. NEA are campaigning nationally for fairer solutions as it is a concern.

·       Energy advisors work to maximise income and proactive work has been underway to identify individuals who may be eligible to support to apply for pension credit as it is recognised to be underclaimed and can open access to other benefits. If cases are complicated, they may be referred on to other organisations such as citizens advice. Health also complete a checklist when discharging patients to identify patients who may be in fuel poverty and work is underway to improve advice and signposting for health contacts across the system.

·       NEA have secured funding from gas networks to replicate the fuel poverty and health programme in other cities, but assurances have been provided that it will continue in Leicester to offer sustainability, although it may not include the education programme.

·       The roving mobile unit can be accessed for vaccinations as an alternative to attending GP practices to provide flexibility for residents. 

·       Pharmacy and transport can delay discharge; a new transport provider has been commissioned and working to increase capacity over the coming weeks. Take home medication is reliant on a doctor prescribing the medication, pharmacy processing and dispensing to the ward which is being looked at for quality improvement. Patients discharged to a care home or community bed can be relocated and medication follows.

·       New hubs at Leicester General Hospital and Hinckley will create 30k additional appointments for all types of therapy.

·       48% of referrals to the Leicester Energy Action programme are from deprived areas across St Matthews & Highfields North, New Parks & Stokeswood, Braunstone Park West, Kirby Frith and Eyres Monsell.

·       Volunteers support patients being discharged from hospital across Leicester, Leicestershire and Rutland and further details of organisations would be shared with the Commission.

·       A critical incident was declared at Leicester Hospitals throughout winter 2023-24 and unfortunately negatively impacted wait times but this did not result in the closure of the emergency department. A site visit is being arranged for members to visit the emergency department and understand the processes ahead of winter.

·       Pressures are expected for winter 2024-25 as there is increased demand with a 20% higher disease burden in the city compared to pre-pandemic which is being analysed locally. Plans are in place to alleviate the strain on services with a focus on same day emergency care to ensure patients are taken to an appropriate service as opposed to waiting in the emergency department and admission avoidance through virtual wards being promoted.

·       Same day care is where a patient is admitted to the right pathway on the same day as presenting to the emergency department. The proactive care model is a national programme for GPs to use population data to identify patients at risk of hospital admission and optimising their care through tests and suitable care and crisis plans. This model has been trialled over recent years and has positive results of patients being in control of their health. The challenge with expanding this model is around resources. Intermediate care is ensuring patients are supported by the appropriate pathway when discharged, for example into a specialised care home or reablement. A partnership approach is taken for all models of care, and they can be altered if circumstances require it.

·       Public health data and societal changes shows that alcohol dependency has reduced in the city and although some people may present at the emergency department intoxicated there are also an alcohol liaison team and mental health liaison team to support patients.

·       The health inequities hub is now in place.

·       All posts have been filled to support the Leicester Energy Action programme over the last 18months and will continue. The number of complex cases being supported have been higher, and a judgement is taken on where cases may need to be referred to a separate organisation or where they can continue to be supported by the team, but all individuals referred and requiring support will receive appropriate help.

·       A contract is in place with Derby for the local 111 service and looking to increase call handlers for winter to support residents. It was agreed that further information on call back times would be circulated to the Commission.

·       Checks are available and being encouraged when in contact with patients at GPs and pharmacies for monitoring blood pressure, pulse and cholesterol as earlier identification is better to manage. It was agreed that information would be circulated for Members to help promote services and checks. 

Members raised concerns about lack of information provided directly to councillors about services to promote to residents and the variation of information issued by health providers. It was noted that various communication methods are used to target different audience and that information requested would be collated to share with Members. It was further agreed that the process for informing all ward councillors would be reviewed for future communications and Members input for identifying information to be shared was requested.

AGREED:

·       The Commission noted the report.

·       Additional information to be circulated to Members.