Agenda item

The Committee received a presentation from Sue Jacques, Chief Executive County Durham and Darlington NHS Foundation Trust and Michael Laing, Director of Integrated Community Services, County Durham Care Partnership on winter preparedness 2023/24 (for copy of presentation see file of minutes).

The presentation provided an update from 20 November 2023; priority areas for 2023/24; funding for 2023/24; details of managing winter pressures together; plans and reflections.

Councillor Crute indicated that he was pleased to see that most of the pressures had been managed as there had been a lot of pressure on staff. Given that the priorities were set every year by Government, NHS England and ICB he asked if this information particularly on the pressures outlined in the presentation go back to these organisations as he would like to think that priorities would be set every year using the previous year’s data. He had a personal concern about Government setting those priorities as people in County Durham may have different priorities to other parts of the North East. He then referred to ambulance handovers and was aware that NEAS were looking to remove ambulance handover performance data from their quality accounts and asked if the Local Authority would still receive this information to monitor what was happening with those priorities.

The Chief Executive County Durham and Darlington NHS Foundation Trust responded that the data was shared with the organisations who set the priorities. Meetings had taken place regarding performance challenges with the ICB so they had a good understanding of the increased activity that they had seen. She stated that ambulance handovers over the Christmas period highlighted that Durham and Darlington were first and second best performing for handovers in the region. In January they dropped to close to the bottom due to the 31% increase in activity and were now third and fourth in the region and expect to improve further. Performance would continue to be monitored although it was reported that NHS planning guidance for next year was yet to be published. It was anticipated that the new guidance would confirm national priorities, but stated they were also able to set priorities at a local level and intend to do that and would bring updates to the Committee. She advised Members that they would keep ambulance data handovers locally even if they did not have to report this data.

Councillor Haney referred to no additional funding for extra beds given by the ICB. He stated that it was great that they were managing to make extra beds for Durham and had heard that five beds were in four bed bays and if the crash team were called the fifth bed was moved to the corridor. He stated that you must ask about patients’ privacy and dignity. He stated that they have a lovely facility at Shotley Bridge that could have dozens of beds installed if the Government would give the money to refurnish or build a new hospital that would be a wonderful solution.

The Chief Executive County Durham and Darlington NHS Foundation Trust responded that in terms of the additional money the ICB sought to allocate this at the beginning of the financial year. Members were advised that the ICB had not secured any extra funding for more beds but CDDFT had flexed available bed spaces across Bishop Auckland Hospital and other community hospitals within the County.

The additional ward opened at Bishop Auckland because Durham and Darlington Hospitals were at maximum capacity and the patients needed some of the additional facilities that were available at Bishop Auckland. They also expanded community beds that was part of the original planning. They had not anticipated such an increase in the amount of admitted patients and ambulance attendances that was different to what they had experienced in previous years and was unique within the region. They responded as well as they could, but those patients needed medical oversight at consultant level and often needed a multi-disciplinary approach which required treatment at the larger acute hospital sites. The full capacity protocol was a risk based methodology used by the Trust to increase the number of beds in a particular area that ensured patient safety and dignity was not compromised. In the longer term if they continued to see the increase demand for bed spaces, a plan had been submitted to the ICB that proposed an increase in beds by using some estate at the Darlington Memorial Hospital and brining forward the planned short stay surgery unit at UHND. She continued that some patients would not be suitable for a community site due to the different infrastructure in place.

Councillor Haney commented that they could be in total crisis in a few years’ time but appreciated they were doing the best with the resources available.

The Chief Executive County Durham and Darlington NHS Foundation Trust assured Councillor Haney that they were looking at the longer term and stated that every Trust in the region were using full capacity protocol this winter.

Councillor Lines referred to the climate continuing to change, and the seasons changing and asked if any work was going on in the background to identify trends about the changes in the phasing of pressures on the service and also the phasing of increased demands as these can also change due to the changes in the climate.

The Chief Executive County Durham and Darlington NHS Foundation Trust responded that they have carried out some work jointly with other local authorities and others on sustainability and one strand of that was adaptation. She continued that the strand was looking at how you adapt services to the different patterns in weather events. This had caused them to look at everything they do such as severe storms to floods and how they manage patients in that emergency situation. It was often about getting professionals out to those people who need to be seen that day who maybe in their own home and do not have any electricity. Heat and cold could also have an impact, they wanted to have as minimal carbon impact on the environment as possible and were carrying out a lot of work around this and had been successful for some grant funding for an air source heat pump. They were working with Durham University looking at different ways to reduce the carbon footprint as it does have an impact on health. The adaptation work was more on how they looked to manage the services differently over the longer term. The planning had been in place now for three years that was still at an early stage particularly around adaptation but was happy to bring a further report to the Committee on this as it progressed.

The Director of Integrated Community Services indicated that the Council had a cold weather plan in place that does not just deal with snow and frost it also deals with floods. He continued that measures were in place to deal with those events that were becoming more frequent. It was particularly relevant for staff in the Trust’s Community Services Team who were delivering care in people’s homes and the Council’s Social Care Teams, so they had factored in those features into the business continuity and recovery plans. He commented that storms were now more of a feature than snow and ice.

Councillor Earley indicated that the issue was that they do not have enough beds. He continued that this was always coming, and everyone knew it was coming but nobody did anything about it. It came to a point that this was dangerous, running a hospital on 95% would be regarded as risky but they are patching a system that was not coping. He then referred to a story he had been told regarding a patient who had to spend time in the A&E department in Durham as Sunderland Neurology Department would not accept the referral as the referral had to come from a consultant.

The Chief Executive County Durham and Darlington NHS Foundation Trust responded that she would take this issue back as they do have a neurology service provided by Sunderland with pathways and if it was not working effectively, they would need to look at. With regard to the full capacity protocol this was risk assessed and if they got into an unsafe position they would declare as a Trust a critical incident that triggers at a regional level and invokes something further. She continued that they have things that they had not had to invoke but they do exist to keep patients safe. At no point have they felt that things were unsafe on a risk-based judgment but recognised that for the patient it was not as good experience. They have submitted a plan for additional beds, they think they need them and would be happy to share this aspect of the wider part of the plans to give some reassurance next year.

Councillor Earley referred to pressures and all year spikes and stated that they know what was happening with the ageing population. All year bed increases would take pressure from everyone. He was not convinced that protocols were working.

The Chief Executive County Durham and Darlington NHS Foundation Trust responded that the number of beds had increased not decreased. She stated that they do their own modelling and build in the impact as they see it, but the ageing population was linked to the beds included in the plan. They do know Easter was always busy and a lot of presentations in the summer due to the heat. She continued that they do not just plan for the winter they plan for all year.

Councillor Savoury commented that the Trust had come under a lot of criticism in recent years with regard to the Bishop Auckland Hospital and stated that it was good to see an extra ward had been opened and utilised to relive the pressures and was sure that the public would be pleased to see a ward utilised on that hospital site.

Resolved: (i) That the contents of the presentation be noted.

(ii) That further information on the CDDFT surge planning and information on the age profile of patients being admitted into hospital be brought to a future meeting of the Committee.