Agenda item

Winter Planning

(To receive a report from Ruth Cumbers, Urgent Care Programme Director, which updates the Committee on Winter Planning across the Health and Care economy in Lincolnshire)


The Chairman welcomed to the meeting Ruth Cumbers, Urgent Care Programme Director, Lincolnshire East Clinical Commissioning Group and Simon Evans, Director of Operations, United Lincolnshire Hospitals NHS Trust, which updated the Committee on Winter Planning across the Health and Care Economy in Lincolnshire. 


The Urgent Care Programme Director, Lincolnshire East Clinical Commissioning Group advised the Committee that winter planning had started even earlier this year to work out the best way of responding to winter pressures as a county. 


The Committee noted that for several years' winter pressures for the health and social care system in Lincolnshire had continued throughout the whole of the year; and that it was no longer just through the winter period.  It was highlighted that it was known that there was increased need for urgent care and emergency departments across Lincolnshire during the winter months.  To help with the pressure points, part of the solution was to encourage patients to access alternatives to emergency care where appropriate. 


The Committee was advised that in September 2018, the Urgent Care Team had launched the ASAPLincs app and website.  It was highlighted that ASAP had been designed to support individuals to make the right choice and signpost citizens to the most appropriate service for their condition.  The report highlighted that the most common referral method to ED in Lincolnshire during 2017/18 was self-referral.  It was noted that in Lincolnshire 58% of the self-referrals could have been dealt with elsewhere.  The Committee was advised that following the introduction of a similar app in Gloucestershire, 15,000 people had downloaded the app in its first year and that A & E attendances had dropped by 16,000 across two acute sites, as had GP appointments involving minor ailments.  It was highlighted that the public needed reassurance to look at other options and the ASAP was one way of helping with that reassurance.


The Committee was advised that the Winter Plan had been produced by the Urgent Care Team with contributions from partners across the health and care community.  The plan confirmed organisational resilience and business continuity mitigations.  Page 4 of the report provided the Committee with details on how the system aimed to manage pressures.  It was highlighted that to support winter planning the Delivery Board had agreed to set-up a "winter room", which would be staffed seven days per week with representatives from across the urgent care system to support day to day operational resilience to manage demand, capacity and flow.  It was highlighted further that the system had also put plans in place to improve ambulance conveyance to the acute hospital sites.  The Committee was advised that "Home First Prioritisation" would run throughout the winter period. 


It was reported that week commencing 15 October 2018, a piece of work with the East Midlands Ambulance Service had commenced to review the qualitative reasons behind conveyances.  This would help crews understand the way they worked.  The auditing of the work would focus on frail and older people (over 75).  It was noted that the emphasis was on identifying frailty and how the system worked to reduce the number of avoidable A & E attendances and admissions for frail elderly patients.  Details of the frailty work within the United Lincolnshire Hospitals NHS Trust was shown at the bottom of page 6 of the report.


The Committee was also advised that the Pilgrim Hospital site was now nearing completion if its ambitious 'Big Change' programme with the new 12-bed orthopaedic ward set to open on 1 October 2018.  It was noted that Pilgrim Hospital had undergone some major reconfiguration of its urgent, emergency and ambulatory care services.  It was noted that the entire 'Big Change' programme was to improve the patient experience and journey through the hospital, in addition to alleviating pressure on the emergency department; and ensuring patients did not experience long waits in A & E.


It was reported that the new integrated assessment unit would allow patients to be seen and assessed quicker; with all teams working together to ensure that the most appropriate treatment was delivered as soon as possible.  It was highlighted that the £1.8 million capital investment project was a major improvement for services at the Pilgrim Hospital site.


In relation to Primary Care, the Committee was advised that GPs were now offering appointments outside of core working hours, making it easier for patients to get an appointment; and that appointments were available in advance and to book on the day.


The Committee was advised that the Winter Plan would be assured by Regulators NHS England and NHS Improvement, and was due to be signed off by the Lincolnshire Urgent and Emergency Care Delivery Board by 31 October 2018.


During discussion, the Committee raised some of the following points:-


·         One member enquired as to where Louth fitted into the Winter Planning.  The Committee was advised that there were plans in place for patients at Louth.  There was some discussion on confusion caused by the A & E sign at Louth Hospital and the problems this caused relating to public perception.  The Committee was advised that there was a cost associated with the removal of the said sign, and contact details would be provided for the relevant Highways Team;

·         Launch of the ASAPLincs app.  Some members enquired as to where the launch had been publicised.  The Committee was advised that the app had been advertised through social media, on the back of buses countywide, various papers countywide; and that there had been a huge launch week commencing 5 September 2018 across Lincoln.  The next phase would involve schools, children's centres and the media up to Christmas.  Other members highlighted that every publicity route should be explored as not everyone had access to computers.  Officers took on board the comments raised and also highlighted that leaflets had been issued to all district and parish councils.  The Committee requested further information on the Communications Plan;

·         One member enquired how patients would be made aware of the changes to GP appointments and their availability.  The Committee was advised that there would be communication made available to the general public from their surgeries regarding the changes to opening times outside of core working hours;

·         Some concern was expressed that some patients were being sent for treatment in Lincoln, when the service was available at Boston.  The Committee noted that some services were centralised for example the cardiac service provision.  It was highlighted that it was not the intention to make people travel when there was no need.  It was noted that Pilgrim Hospital, Boston could be used to support Lincoln County Hospital; when demand was high.  Likewise, during the summer Lincoln County Hospital was taking patients that Boston could not accept, due to increased demand;

·         One member enquired whether the Communication Plan included how to get the message out about the new ASAPLincs app to community groups across the county.  The Committee was advised that a lot of communication had been done in the community sector for example in local gyms, coffee shops and any other meeting places.  One member highlighted that GP surgeries could be help get the message out by placing a message on their in-practice notification screens;

·         A question was asked as to when the NHS would know if they were likely to receive additional funding for the proposed winter schemes.  The Committee was advised that the system was better prepared this year.  During the summer 16 schemes had been prioritised and were already in a position for a bid to be made should funding become available;

·         One member enquired as to what the Winter Communication Plan consisted of and what platforms were intended to be used.  It was noted that similar plans were in place as they had been in the previous year to reduce routine and elective operations before Christmas; and that priority would be given to urgent cases and cancer care;

·         Concern was expressed that in the previous year there had been a reduction in the number of beds for the children's departments, so that staff could support the A & Es.  With the extreme pressures on services currently at Pilgrim Hospital, Boston, a question was asked whether it was proposed to reduce or suspend services further to deal with pressures as they arose; and if such action was to be taken when would the Committee be advised of such happenings.  The Committee was advised that to sustain services through the winter, services had to be more resilient.  Steps had been taken to make services more resilient such as streaming in A & E; steps were also being taken in Primary Care and other services, so that there were contingency plans in place for A & E.  With regard to paediatrics there were a number measures in place that the Committee was already aware of and it was not expected that these would change.  There was fragility especially with sickness and leave but locums would be used to bridge any gaps;

·         One member extended thanks personally to staff at Pilgrim Hospital, Boston for their impressive emergency service; and

·         A question was asked as to why some cardiac patients were still sent to Glenfield Hospital, when Lincoln had a superb unit.  Confirmation was given that Lincoln was an excellent centre, however, it still was unable to deal with some specialist procedures; and a minority of patients were dealt with by Glenfield Hospital.


The Chairman extended thanks on behalf of the Committee to the two representatives.




1.    That the approach to this year's winter planning be noted.


2.    That a request be made for the Committee to be kept informed of the situation over the winter period and is made aware of any fragilities as soon as possible; and a request is made for an update on the successes or failings of the plan after the winter period.

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