Agenda item

Winter Resilience

(To receive a report from the Lincolnshire East Clinical Commissioning Group, which updates the Committee on Winter Planning across the Health and Care Economy in Lincolnshire.  Ruth Cumbers, Urgent Care Programme Director, Lincolnshire Sustainability and Transformation Partnership will be in attendance for this item)


The Committee gave consideration to a report from the Lincolnshire East Clinical Commissioning Group, which provided an update on Winter Planning across the Health and Care Economy in Lincolnshire.


The Chairman welcomed to the meeting Ruth Cumbers, Urgent Care Programme Director and Simon Evans, Director of Operations, United Lincolnshire Hospitals NHS Trust.


The Committee was made aware of the background to winter pressures, the national context, and the local picture for Lincolnshire.  It was highlighted that in Lincolnshire there was continued progress to integrate services, with a number of projects being set up under the new care models programme that were starting to deliver prevention and improved care for patients closer to home.  It was highlighted further that the development of integrated urgent care services was maintaining and building on this momentum.


Details of the six areas of winter planning were shown on pages 89 and 90 of the report.  It was highlighted that despite early preparations, trusts were always concerned about winter pressures.


It was reported that for the winter of 2018/19, the demand for services had increased significantly through December, with the ambulance service having a particularly challenging time attempting to cope with the high level of demands from patients.  The Committee noted that as the national situation deteriorated regulators had sought assurance from local systems as to how they were responding.  It was reported that Lincolnshire teams were able to demonstrate that a more joined up approach by system leaders had translated into a more joined up system management and resilience.


However, despite the pressures the system had received praise from the regulators for its resilience, grip and management of issues and the ability to recover from periods of unprecedented demand.


The Committee were made aware of who was responsible for the plan; the purpose of a winter plan, how the system aimed to manage the pressures; and who implemented and monitored the winter plan. The plan for Lincolnshire was for Health and Care colleagues from across the system to continue working together with a particular focus on learning and understanding reasons at a system level of what needed to be done to reduce avoidable attendances and admissions to hospital and ambulance conveyances.


Details of the Surge and Escalation Plan, Cold Weather Plan were shown on pages 92 to 93 of the report for the Committee to consider.


Other areas referenced were the Stay Well This Winter Campaign, Flu Prevention, Maximising Capacity some reference was made to the Christmas and New Year; Planned Care Activity over the Winter, Transitional Care; Local Authority Plans; Mental Health and Acute Services.


In conclusion, the Committee was advised that the system had learnt from 2018/19 and there was belief that the winter planning for 2019/20 was robust.


During discussion, the Committee raised the following issues:-


·         The percentage of staff who had received a flu jab.  The Committee was advised that all organisations had been above target at around 72% and that ULHT had been 83%;

·         Black Alert – Clarification was given that the term 'black alert' had in effect been replaced by Operational Pressures Escalation Level 4 (OPEL 4).  Reassurance was given that no provider was allowed to go above OPEL 3 without system involvement, with procedures and monitoring in place to provide support;

·         The inappropriateness of patients with mental health issues using 111; and the availability of overnight beds for patients with mental health issues.  The Committee was advised that there were patients with mental health needs in acute beds out of County;

·         Reassurance was given that lots of work was on-going with regard to the provision of transport when patients were discharged.  Clarification was given that there were clear processes in place surrounding the discharge of patients;

·         Reference was made to GP receptionists, many of whom had received training;

·         Reduced planned activity during January and February; and how this approach related to the emerging options for trauma and orthopaedics and general surgery, which aim to reduce operations.  The Committee was advised that this year there would be better access this year, as a result of the pilot at Grantham Hospital, the system was less susceptible to the effect of winter pressures;

·         The timescale for the wholesale reconfiguration of Lincoln County Hospital for additional physical capacity; and whether funding was in place.  The Committee was advised that the reconfiguration would be completed the second week of December 2019; and that the additional capacity had been designed to use efficiencies to create more capacity, with many patients able to return home on the same day;

·         Details of the new care models programme – The Committee was advised that the new care models were part of the integration work of the STP; and that further information would be available from the Programme Director, Lincolnshire STP;

·         Pressures on A & E and how they continued to grow year on year.  A question was asked whether one way to alleviate the pressure would be to re-open Grantham A & E on a 24/7 basis as the need was clearly exhibited throughout section 1.1 of the report.  The Committee was advised that the Acute Service Review was on-going; the outcome of which was still awaited; and

·         The dedication of staff in an emergency situation.  Confirmation was given that plans were in place to accommodate staff that remained on sites to help out in emergency situations such as the 'Beast from the East in 2018'.


The Chairman extended thanks to representatives for their presentation.




1.    That the Winter Resilience Report presented be received.


2.    That an update report on Winter Resilience be received by the Committee in one year's time.

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