Agenda item

A report outlining the key challenges faced across health and care services this Winter and the preparations being made to meet these.

The Director for Living and Aging Well gave an overview of the pressures on and risks to the delivery of health services through the Wiltshire Care Alliance. She noted that there was an urgent care improvement plan for Wiltshire, before providing further detail about specific areas of focus such as emergency departments and sourcing home care. She stated that the plan, built collaboratively by partners across the Alliance, focussed on year-round pressures and delivering services in the community. The plan contained fewer projects than in previous years to concentrate efforts where the biggest impact could be made and to provide greater clarity about their anticipated impact. She then highlighted the eight key plans identified on page seven of the agenda supplement.

The Director of Locality Commissioning at the Bath and North East Somerset, Swindon and Wiltshire (BSW) Integrated Care Board (ICB) updated the committee about key risks to the delivery of plans. She reassured the members that the ICB reviewed the risks on a weekly basis, listing a range of mitigation measures in place, such as developing a resource base to combat the increased cost of locum staff.

The Director of Locality Commissioning at BSW ICB then gave details about three winter schemes being implemented across the whole of the integrated care system. A local control room had been set up in Chippenham to coordinate information and free up ambulance capacity by reducing the number of patients being admitted to hospital, when it was not the most appropriate setting for their treatment.  She then went into further detail about areas identified by the Chief Executive of NHS England to build extra capacity, and improve resilience, through the winter, before outlining how these were being applied in Wiltshire. One example was an increased focus on falls, with greater emphasis on prevention and delivering a two-hour emergency response to these incidents.  

During the conversation the following points were made:

• Members thanked the directors for the update and welcomed the schemes being put in place over the winter. Noting that many of the schemes were non-recurrent, they sought further clarity about the level of provision that would be in place post winter and for following winters. 

• The Director for Living and Aging Well acknowledged that most schemes in the winter plan were non-recurrent but stated that options for extending the programmes would be considered if these initiates proved to be successful. She explained that there was a large degree of autonomy about how the Better Care Fund could be spent, so reassured the committee that decisions for future years could be taken at a local level. She emphasised that a large proportion of current spending was used to purchase additional care home beds, and it was hoped that other measures, such as investment in funding for different patient pathways, would reduce this proportion over time.

• It was confirmed that virtual wards were due to be rolled out in Wiltshire, following similar initiatives in Bath and North East Somerset (BaNES) and Swindon.  A virtual ward was a group of patients being treated at home but having daily conversations with multidisciplinary teams about their needs, which allowed them to be released from hospital earlier. 

• Technology enabled care, such as the monitoring of vital statistics, was also a key area of innovation. Wiltshire Council’s Transformation Programme had a specific workstream focusing on this issue and would develop a strategy in close collaboration with the ICB.  

• The Director for Living and Aging Well noted that a number of care packages were being returned by providers through the Help to Live at Home Alliance. She reassured the committee that the council worked closely with providers around recruitment issues and that an increasing proportion of resources across Wiltshire was allocated to home care.

• Referring to an update received by the committee in July, from the South West Ambulance Service NHS Foundation Trust (SWASFT), which reported that the majority of patients visited to did not need to attend an emergency department, members queried the specific measures intended to address this issue within the winter plan. In response, the Director of Locality Commissioning noted that Medvivo, the out of hours call provider, had recently started taking category three and four ambulance calls. Early evidence had suggested that they had been successful at offering services to patients which meant that it was not necessary for them to be taken to hospital.

• Members spoke about the importance of educating the public about where to go for services and highlighted that the 111 website could be very useful when there were delays on the ‘phone lines.  It was also confirmed that Medvivo handled the 111 calls within BSW.

• Consideration was being given to the type of service provision in the additional 57 winter beds purchased at South Newton Hospital, as the hospital’s current focus was on rehabilitation for adults with neurological conditions.

• The Director for Living and Aging Well was pleased to report the positive work being undertaken by the reablement service and that a single point of access for care co-ordination had been established.

Resolved

1. To note the comprehensive update from the Wiltshire Care Alliance, the significant challenges being experienced across the system in Wiltshire, and the preparations to meet the additional challenges faced this winter.

2. To add an item to the forward work programme about the work underway with Medvivo to address pressures in the ambulance service.