The
Director of Integrated Care (DIC) at North
East London Integrated Care Board (NEL ICB) presented an
update on the approach that the Integrated Care System (ICS) was
taking to managing winter pressures in 2022/23, as well as an
update on a recent
winter summit that was held by the Barking and Dagenham
Partnership, to consider actions that could be taken locally to
keep people safe and well at home.
In response to questions from
Members, the DIC stated that:
- Workforce was always a risk area;
however, the ICS had received some additional funding over winter,
which had been directed to providers such as Barking, Havering and
Redbridge University Hospitals Trust (BHRUT), North East London NHS Foundation Trust (NEFLT) and
the local authority, for these to invest in workforce capacity.
Support also needed to be streamlined: in terms of Barking and
Dagenham, funding needed to be streamlined to support social work
in A&E and to increase capacity in emergency response
services.
- Whilst the ICB did not employ
frontline staff (as these were employed by the NHS providers), it
was working to develop a Workforce Strategy so that each of the
provider organisations would have its own Workforce Development
Strategy around recruitment and retention, with some of this being
related to training and skills development. There was also a
constant review around caseloads and capacity. It was also
considering career opportunities and new models of care, such as
through looking at new roles and rotations across organisations to
encourage people to work in Barking and Dagenham.
- Work was also being undertaken
across the Partnership to consider care provider resilience and to
undertake scenario planning to best respond to any issues, such as
where care providers were no longer able to operate.
- The Barking, Havering and Redbridge (BHR) Workforce Academy was
working to understand where there were gaps in recruitment and to
provide recruitment opportunities.
- There were a
number of services in the community that focused on
proactive care; through general practice, NEL ICB had commissioned
an enhanced health care home scheme, which provided
multidisciplinary support to residents in care homes who had
complex needs. This was a collaboration between Primary Care and
community services, with links through to Rapid Response teams as
necessary.
- The Barking and Dagenham
Partnership had recently piloted a population health management
approach to keeping people well at home, which was exploring a
greater collaboration between the Health and Voluntary sectors.
This had shown that a number of factors
that impacted on health were sometimes best addressed by other
services not provided by the NHS, meaning that greater integration
between Primary Care, community care and voluntary services was
essential.
- The ICB had commissioned capacity
in community urgent care services. The Community Treatment team,
which had had significant investment over recent years supported by
system development funding, was designed to ensure that people
could receive a rapid community response if their health
deteriorated more rapidly, to avoid an ambulance trip into
hospital. Generally, these services were for people with long-term
conditions who were on the practice caseload for integrated case
management and were generally maintained, fit and well; however, at
times their health would deteriorate and
they would not be able to get access to an urgent community
service.
- Across the BHR system, the ICB
had commissioned an Integrated Discharge Hub, which was hosted by
NELFT; it also had the local authority discharge functions
integrated into the team, so that health and care were working
together to support hospital discharge. This was primarily for
people who required health or care support following discharge, to
ensure that they received an assessment when they were discharged
to their home and that they had an ongoing care package in
place.
- The system had a very good
partnership arrangement around discharge, which was very much
strengthened during the Covid-19 pandemic. There was a two-weekly
discharge working improvement group, which was chaired by the
Director of Adult Social Care at Havering Council, which brought
together all partners in BHRUT, NELFT, and Barking, Havering and Redbridge Councils, to look at pathways
around discharge and discuss opportunities for improving these. At
an operational level, there was a daily discharge call, which
involved Health and Care and looked specifically at individual
patients and which actions needed to be taken to facilitate their
discharge.
- A number
of ideas had arisen from the Winter
Summit in relation to children and young people, such as through
empowering secondary school pupils to take more control of their
health, as well as improving immunisation rates for flu, to address
respiratory viruses in the youngest cohorts.
In response to questions from
Members, the Integrated Care Director (ICD) at NELFT stated
that:
- Whilst it was a peak time for
NELFT in terms of working through bank and agency staff requests,
there was a range of different staff. Its Workforce Development
Plans were also looking at increasing workforce capacity and
developing a new workforce, such as through Clinical Associate
Psychologist (CAP) roles, to create more substantive
posts.
- In terms of staffing shortfalls,
NELFT was in a similar position as to other NHS Foundation Trusts
nationally.
The Council’s Director of
Public Health highlighted the importance of supporting both the
clinically vulnerable, and those affected by the cost-of-living
crisis through the winter, as well as the need for close
collaborative working between the NHS, the Voluntary sector and the Council through the place-based
arrangements to deliver this support. There had also been
a number of changes in general practice
and primary care in terms of supporting residents without them
needing to go to A&E. Going forward, it would be vital that
residents understood the help they could receive for conditions and
when to seek support, so that they did not need to present to
A&E.
The Council’s Acting Chief Executive and Place
Partnership Lead (ACEPPL) then presented an update on the
approach that was being taken by the Council to support residents
through the current cost-of-living crisis. This provided a summary
of key engagement with partners and residents, as well as actions
being taken to mitigate against difficulties, such as through the
establishment of the Barking and Dagenham Cost of Living Alliance
and a warm spaces network.
In response to questions from
Members, the ACEPPL stated that:
- There was lots of support that
could be accessed by the Health
workforce within the Borough.
- She would request a detailed
written response as to the Leeds Credit Union and the APR of 42.6%,
which would then be provided to the Committee.
- Residents could access additional
information as to the warm spaces network, from the Barking and
Dagenham website. The Council would also provide an update as part
of its December newsletter, which would be circulated to all
residents who had signed up to this via email.
- The Council had very successfully
taken part in the Cosy Homes Scheme, which helped eligible
residents stay warm, save energy and
lower their energy bills through subsidised energy-saving
improvements. The ACEPPL would request a more detailed written
response as to the number of homes that the Council hoped to be
able to insulate moving forward.
- Many positive comments had been
received as to the leaflets that had been circulated to residents
regarding support that they could receive around the
cost-of-living. If any resident had not received this for any
reason, they could get in contact with the Council to request a
copy.