Agenda item

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.