Agenda item

The Director of Integrated Care (DIC) at the North East London Integrated Care Board (NEL ICB) presented an update on the NHS North East London Severe Weather System Response, which provided context as to:

• The main risks to the NHS and to patients during severe weather;
• NHS Emergency Preparedness, Resilience and Response (EPRR) planning;
• The NEL ICB Severe Weather Plan and multi-agency planning;
• How the NHS responded to the 2022 summer heatwave and lessons learnt from this; and
• 2023 heatwave planning.

In response to questions from Members, the DIC stated that:

• From a NEL ICB perspective, she was not aware of any issues that had been reported as a result of the Summer 2022 heatwave. The main risk that had presented had been around fire and the need for the ICB to respond to this.
• There had not been a cold weather alert this winter; however, the risks seen had largely presented around Covid-19 and infection.
• Elderly residents were a vulnerable group who were more likely to be impacted by extremes of weather than younger patients. Whilst one of the objectives of the Severe Weather Plan was to identify vulnerable groups who might require more support during extreme weather, it was not felt that this had occurred in a systematic way during the Summer 2022 heatwave and this was to be better incorporated into NEL ICB planning for the 2023 summer. NEL ICB also had the opportunity to take more of a localised approach to this through its Borough Partnership work.
• Whilst she did not have data that reflected the service impact of severe weather, it was fair to say that services had been impacted by this, such as through additional patient admissions.

The Cabinet Member (CM) for Adult Social Care and Health Integration (ASCHI) stated that there had not been enough analysis undertaken of who presented most during the severe weather periods, which she intended to look into at the Partnership Board and bring back to the Health Scrutiny Committee. Whilst data was available at a North East London level, she wanted to know what was happening at a local level. She also stated that a data sharing agreement between local partners was essential in helping to support all vulnerable patients during crises; all organisations needed to work with one definitive list, to ensure that no patient would miss out on support because they were on one organisation’s contact list, but not on another’s. A protocol needed to be developed, to ensure more effective planning.

The Integrated Care Director (ICD) at NELFT stated that it was important to define the term ‘vulnerability’ and what this meant in terms of actions that needed to be carried out. She also stated that extreme weather also led to the cancellation of clinical appointments, either because patients could not travel or the environments were too hot, for example due to the older buildings and lack of air conditioning. This would then delay patients’ treatment pathways, due to the inability to deliver the appointments and the higher ‘did not attend’ rates. The Borough Partnership would be useful to discuss potential improvement opportunities, with the Estates Group that sat under this also presenting an opportunity around how different infrastructure could be better employed to deliver services during crises.

In response to further questions from Members, the DIC stated that:

• There was still more planning to be undertaken. The document presented was the North East London Heatwave Plan, and there was an intention to use the Borough Partnership as an opportunity to gain a much better understanding of what local actions needed to be taken to mitigate some of the risks, for example in relation to vulnerable residents or through some of the estates. An executive meeting was to be had in a couple of weeks’ time, looking at feedback from the NHS Arctic Willow incident in December 2022.
• There had been some management emergency response training within NEL ICB; however, this had not yet been rolled out across the entire organisation. She would approach the NEL ICB Incident team around the plans for this and relay these to the Committee in due course.
• Most of the system response over the Winter had been coordinated through the System Operational Command Group (SOCG), which operated across Barking and Dagenham, Havering and Redbridge and included the local authorities, the hospital trusts and the Integrated Care Partnership. The SOCG discussed how the organisations could best respond and support each other through the risks that could materialise over winter.
• The DIC would relay information back to the Committee around the latest flu vaccination figures for Barking and Dagenham.
• The high cost of power and energy bills was a significant pressure for the NHS, as it was for local authorities. The NHS was currently having to absorb inflationary pressures and had not been given any additional resource to manage them. It was believed that the NHS allocation for 2023/24 would be flat cash on 2022/23, so it was unlikely that there would be additional growth to offset the impact of inflation.

The ICD at NELFT also stated that NHS organisations were included on the Government’s ‘Must Do Must Supply’ energy list and that work had been conducted to identify critical sites within the NHS property. Whilst not every GP practice or community clinic would be a priority site for energy should there be any restrictions to energy supply, Barking Community Hospital had been identified as a priority site due to its urgent treatment facility. As such, planning was being undertaken around potential energy impacts and the ability to continue to deliver critical services during crises.

The DIC at NEL ICB stated that the majority of the NHS estate in Barking and Dagenham was either privately-owned or belonged to NELFT. NEL ICB had set up a local infrastructure forum, which reported through to the Barking and Dagenham Partnership Board and looked to co-ordinate improvement actions that were required around estates, such as to consolidate or to develop sites. Through the Estates team, it would also be looking at how it could either decommission older estates, re-provide services or potentially bring in capital to improve services.

The ICD at NELFT stated that NELFT was looking at a range of options to ensure that future clinics did not need to be cancelled due to severe weather, such as through temporarily moving air conditioning units. The capital flow across Northeast London was going to be tight, meaning that specific sites and venues would need to be prioritised and that this would be a balancing act in terms of available capital for infrastructure. It was hoped that the Borough Partnership would provide opportunities to enable all to think more collectively and creatively about infrastructure challenges.

The CM for ASCHI stated that the Borough Partnership would be pivotal in effective planning, for example through ensuring that services could be delivered in another building if required. Furthermore, uptake of the flu vaccine had been very low in comparison to the uptake of the Covid-19 vaccine, despite joint communications and publicity campaigns across North East London. The Director of Public Health provided a general update around uptake, noting the challenges in different cohorts. He also stated that it was likely that the impact of flu would be seen within the next couple of weeks, with likely excess pneumonia deaths and with a significant portion of these likely to be seen in those who had not been vaccinated.