NHS England’s winter resilient system roles and responsibilities plan has highlighted integrated care boards to maintain 24/7 oversight through a system co-ordination centre, the role for digital in supporting primary care access, and a target for virtual wards to maintain 80 percent occupancy rates over the winter period.
Following the ‘high impact interventions’ shared by NHSE last week to support systems and providers, NHSE has gone on to specify which organisations should take responsibility for which interventions, as well as noting specific actions for organisations to take with regards to winter planning.
Integrated care boards
It states integrated care boards should be accountable for the delivery of virtual ward capacity and maximising virtual ward use, with an aim to maintain 80 percent occupancy rates over the winter period.
It goes on to note that “systems should ensure appropriate step-up and down capacity is in place at scale” to support heart failure, respiratory and frailty, whilst step-up virtual wards should be accepting admission alternative referrals from a broad range of organisations such as care homes, ambulance trusts and community response teams. This aims to ensure that capacity is “tightly aligned to winter flow priorities” and to support more patients in gaining access to remote care.
For children and young people services, the plans noted that arrangements should be considered “to support scaling of age-appropriate virtual ward models”.
The plan goes on to note ICBs should take the lead on ensuring data sharing arrangements are in place “to enable rehabilitation/recovery plans to be shared by partners providing services and to streamline pathways and reduce duplication.”
Also falling under the ICB remit is the work around driving standardisation of urgent integrated care coordination, to support whole system management – placing patients into “the right care setting, with the right clinician or team, at the right time.” This will include expanding the variety of services profiled on the Directory of Services (DoS) and putting steps in place to ensure the DoS is fully utilised.
In addition, the guidance draws attention to the need to support delivery of key actions from the primary care recovery plan to support winter pressures, including supporting practices to adopt cloud-based telephony and improving online patient journeys such as on practice websites. The guidance lists aims such as enhancing online navigation and triage processes, improving accessibility, ensuring easy usability of online platforms and working to “understand and better match demands and capacity”.
Acute, specialist trusts and integrated care providers
In terms of acute and specialist NHS trusts, the focus is on bed productivity, patient flow, data and workforce. Here, it encourages the implementation of “flexible mechanisms for staff pooling and utilisation of resources across organisational boundaries”, noting that increased use of staff banks and ‘mutual aid’ arrangements can be “supplemented by digital solutions”.
In addition, the guidance touches on the need to provide “timely data where needed by care transfer hubs”, in order to support governance and clinical decision-making along with supporting care capacity and demand planning.
With regards to the responsibilities of community trusts and integrated care providers, the guidance draws focus to the importance of data sharing and submission, particularly with regards to “reducing variation in inpatient care and length of stay by implementing in-hospital efficiencies and bringing forward discharge processes.” It encourages these providers to submit data for all commissioned community beds to the Community Discharge SitRep, and to ensure that data sharing arrangements are in place to enable rehabilitation and recovery plans to be shared by partners, and to “streamline pathways and reduce duplication”.
In addition, it encourages the implementation of digital solutions to “release therapist time and increase rehab capacity,” alongside the implementation of data and operational dashboards to ensure daily oversight of capacity, demand and blocks in the pathway.
The guidance states a need to “ensure tools are in place to understand demand, activity, workforce and capacity in mental health provider pathways”, which should be shared across the system to provide a view on pressures and potential support needs.
For local authorities, it notes to improve data flows, particularly where their Better Care Fund capacity and demand plans show limited data or insights, which impacts the ability for local areas to accurately forecast demand for these services throughout the year.
In other news around tackling winter healthcare pressures, last year we looked at Scotland’s “winter resilience’ strategy, which highlighted the role of digital in a number of areas including remote monitoring and supporting mental health.