Agenda item

The Committee received a presentation from Michael Laing, Director of Integrated Community Services, County Durham Care Partnership on winter planning and service pressures for 2022/23 (for copy of presentation see file of minutes).

Introducing the presentation, the Director of Integrated Community Services explained the presentation was an update on the health and social care response to winter pressures, since the previous presentation to the Committee in November 2022. The Committee heard that the local winter plans reflected the national plans with the key elements being surge planning and cold weather planning.  To date, due to the mild winter weather, the cold weather plan had not been activated. In terms of surge planning, daily operational meetings were being held throughout the winter, to manage pressures with a focus on national priorities which included supporting the health and wellbeing of the workforce, protecting elective surgery and embedding infection prevention principles.  There had been a period of sustained demand over the Christmas holiday period which was managed with the help of short term changes to alleviate pressure, such as increasing bed capacity and front of house staff cover. There had also been additional investment in transport and pharmacy provision to support discharges to take place on evenings and during public holidays. 

The Committee noted the introduction of an £8 million Discharge Fund for County Durham to increase capacity in post-discharge care. The County Durham Care Partnership had agreed priorities and the projects funded included care home capacity and mental health housing support. 

There had been a marked decrease in demand during the days affected by the recent industrial action and the Director of Integrated Community Services commented on the co-operation between trade union representatives and staff, during the period.  

In conclusion, the Director remarked that the winter plans were progressing well, with thanks to additional funding and the great effort made by staff and he added that patient and staff wellbeing will continue to be at the forefront of future work.   

Comments and questions were invited from the Committee.

Councillor Martin commended the work and he asked how the mild winter had contributed to the smooth running of the winter plan thus far. 

The Director of Integrated Community Services replied that the mild winter had led to fewer incidents of slips, trips and falls and minimised the impact of cases of flu and Covid-19,  however, other factors such as the impact of the cost of living crisis on mental and physical health were placing pressure on services.  Councillor Martin welcomed the Discharge Fund and, noting that the funding will be recurrent, he asked how the funding will be used in the future. The Director of Integrated Community Services replied that he expected the funding to be spent on roles within hospitals and the independent and voluntary sectors, to support safe discharge.

Replying to a question from Councillor Gunn for further information on the increase in bank rates, the Director of Integrated Community Services explained that the increase in rates had been used to encourage bank staff to fill vacant shifts in order to meet the national ratio of qualified staff to beds.  Councillor Gunn also welcomed the Discharge Fund, however, she observed that it was a small amount for the scale of the work involved.  Referring to the fall in demand during the period of industrial action, Councillor Gunn expressed her opinion that this may be a reflection of the public support for the industrial action and she expressed concern as to how a pay award would be funded. The Director of Integrated Community Services replied that it was unclear as to whether a pay award could be funded from within the existing NHS budget. He commented that there was work to be done to promote careers in social care and he referred to workforce pressures and the government’s new national workforce strategy which is expected in the summer. The Director also commented on pressures in GP practices, as a decreasing number of doctors are willing to become partners, deterred by the additional responsibilities. In response to a question from the Chair as to how he expected GP surgeries to adapt in the future, the Director of Integrated Community Services responded that he expected that an increasing number of GP practices will seek support from Trusts or form larger practices, in order to share the burden of non-medical responsibilities related to running a GP practice.

Councillor Quinn referred to the pressure in the domiciliary care sector and to the untapped potential, with an increasing number of people being encouraged to return to the workforce.  Councillor Quinn suggested that more work could be done to highlight the benefits of a career in the care profession, including the flexible working hours and job satisfaction.  Referring to supporting discharge from hospital, Councillor Quinn spoke of her concern that people are often discharged into a care setting many miles away from their home and family. The Director of Integrated Community Services acknowledged the staffing pressures in respect of domiciliary care and he agreed with Councillor Quinn’s comments on the benefits of being discharged into a provision in familiar surroundings. The Director pointed out there is a balance to be achieved as discharges must be carried out in a timely manner.  In addition, he pointed out that the rural nature of the county can lead to community hospitals taking patients from a wide region and, in some cases, the closest provision may be many miles from home. 

Councillor Hovvels enquired as to what percentage of the Discharge Fund had been invested in mental health services and what plans were being considered for future investment to improve mental health. The Director of Integrated Community Services replied that approximately £2 million had been spent on mental health housing support and he added that, as the county lacks a dedicated mental health A&E, he suggested this may be an area for future investment together with the crisis service.  Councillor Hovvels spoke anecdotally of concerns from residents regarding the impact on their mental health due to cost of living pressures and whilst she welcomed the introduction of Warm Spaces, she questioned how many vulnerable people including those with mental health problems would access the spaces.  She asked what mechanisms are in place to ensure those with mental health issues and other vulnerable groups are not neglected. The Director of Integrated Community Services informed the Committee that the winter planning group which is chaired by the Director of Public Health draws on expertise across the Council and voluntary and community partnerships such as County Durham Together, to support mental health and wellbeing.  District and Community Nurses receive training to identify vulnerabilities and, in response to rising energy costs, the service had contacted all those who were supplied with electrical medical devices at home, to offer financial assistance.

Councillor Kay asked whether admitting those suffering from a mental health crisis to a general medical bed was the most appropriate treatment for that person and whether it was the best use of a surgical bed.  Councillor Kay also asked what checks were done to ensure that when patients who had been treated for mental health issues are discharged from hospital, they are safe.  The Director replied that in many cases, those in mental health crisis, upon examination, are also found to have physical issues which require treatment.  He clarified that a multi-disciplinary team must agree the discharge and those who are homeless are provided with a package of care including supported accommodation.

In response to a question from Councillor Stubbs as to whether there had been a spike in demand for services in the days following the period of industrial action, the Director replied that information on the impact will be reported to the Health and Wellbeing Board and will also be shared at a future meeting of the Committee.

Resolved

a)    That the presentation be noted. 

b)    That winter planning be included in the Committee’s work programme for 2023/24.