Managing system pressures this winter
Health and care services continue to be under significant pressure, with challenges including timely discharge of patients impacting on patient flow within hospitals, alongside ongoing pressures in mental health services. We continue to prepare for the possibility of high prevalence of flu, based on the evidence from other countries and advice from public health experts.
In October NHS England wrote to all ICBs to set out the winter resilience plans, asking them to be prepared for things to get even tougher over the coming weeks and months. The letter set out a number of expectations to improve operational resilience, reduce pressures on services and improve bed capacity while continuing to prevent and manage infections as much as possible and deliver existing transformation programmes
We have a number of local initiatives that we are implementing to help manage the anticipated pressures on services over the upcoming months.
Residential rehabilitation centre
The Turn Furlong centre in Northampton has been repurposed to strengthen the recovery model and maximise the use of all available bed capacity delivering vital short-term care for people who are not quite ready to return home after a hospital stay and free up acute beds across county.
The unit is now being operated jointly by Northamptonshire Healthcare NHS Foundation Trust (NHFT) and West Northamptonshire Council (WNC).
The centre will work in a new integrated way with senior nurses, staff nurses, physiotherapists, occupational therapists, medical staff, and social care colleagues all working together. We are investing to be able to open more beds and enhance the levels of staffing across the unit to better support people’s recovery.
This new approach will be tested until the end of March 2023. During this period our Integrated Care Board (ICB) will assess the role short term recovery beds will play in our overall system provision longer term.
Virtual wards
Supporting people to remain in their own home when unwell (where safe to do so) or to return home to continue recovery earlier in their journey, is a key focus of all health and care systems. During the first waves of Covid evidence gathered demonstrated that using technology, supported with remote monitoring by specialist nursing and medical teams, enabled people to get home from hospital sooner with low readmission rates.
NHS England has asked systems to use this learning to increase the number of people being cared for at home rather than in a hospital bed. Where a patient is safely treated in their place of usual residence rather than a hospital bed they are classed as being in a Virtual Ward until they have recovered sufficiently to be discharged.
Funding has been given to ICBs to move to a target of 45 to 50 Virtual Ward beds per 100,000 of 16+ population. For Northamptonshire there are already around 260 people on any day being managed in this way. We are seeking to increase this to 300 by December and to 340 by the end of March 2023.
A number of presenting conditions are suitable for being managed at home and we are expanding existing Virtual Ward provision, including new Virtual Wards for cardiology and for renal patients. We are also looking at learning from other systems to identify where children and young persons could be safely managed in Virtual Wards.
Virtual Wards are part of our overall approach to blend technology and hands on care to support and monitor identified patients when they are stable enabling us to identify quickly any changes or deterioration. We have established a nurse led monitoring hub operating seven days a week, 7.30am to 11pm who work alongside the 24 hr Local Authority lifeline call handlers and response staff. We are increasing the specialist nursing capacity to ensure our most vulnerable persons at risk of unplanned escalations receive the intensive support needed.
We are working with East Midlands Ambulance Service (EMAS) and with NHS 111 so that persons who can be managed in a Virtual Ward are directed to the 2 hour Urgent Community Response Service who then link the person into the correct specialist team. Having this relationship with the EMAS desk has enabled us to respond much sooner to non-injurious falls where a long wait is likely to arise. Responding sooner reduces the time the patient spends on the ground in turn reducing pressure sore risk, dehydration and delirium occurring. The success of this approach has already avoided many conveyances/admissions to hospital and we are now expanding to include falls minor injury as the next cohort.
Frailty
Frailty Same Day Emergency Care (SDEC) units are operating at Kettering General Hospital (KGH) and Northampton General Hospital (NGH). These have been introduced to reduce frailty admissions and improve outcomes for frailty patients through a mobile and dynamic multi-disciplinary frailty team.
The frailty SDEC teams help to identify those in need of support at the earliest opportunity so that they can be cared for in an efficient and coordinated way and then discharged to their most independent setting. This part is in partnership with community-based health and social care teams.
NGH frailty SDEC is open 7 days per week having increased its opening hours since mid-October following a successful recruitment drive. KGH’s frailty team have had a strong September-November, supporting almost 100 of the most frail elderly patients in Emergency Departments (ED) each month, and helping 70% of these avoid admission.
Flu and COVID-19 vaccinations for staff
All frontline healthcare workers are being offered the COVID-19 and flu vaccines. Our system recognises the importance of the vaccines to protect staff and their patients, and we have been doing everything possible to make the vaccines as accessible as possible and encourage uptake.
System pressures campaign
We are running our system pressures campaign which aims to raise awareness across our county about steps they can take to stay well over the winter months, and how and where to access support if they need it. The campaign is data driven to understand who are the key target audiences are, and will take a multi-channel approach to ensure we reach as many of our target audience as possible.