Mark Creelman (Local Executive Director) and Graham Terry (Assistant Director Adult Social Care Community and Housing) introduced the item.

Mark informed the board that each year they were given guidance around health and social care, particular on how to manage resilience throughout the winter months.

£3.26 million was allocated towards health, which was the same amount allocated the previous year. With escalated winter pressures it was important that funds were allocated as wisely as possible. Some of the initiatives in place was placing a London Ambulance Worker in the Emergency Department which allowed people to get into the emergency department quicker. Space within the emergency department was increased to allow for more people to be seen and reduce the time people had to wait in an ambulance. A Transfer Care Hub was also being developed. This was a joint development across all partners with the aim to have an integrated team to discharge patients as efficiently as possible. There was now a frailty zone within the emergency department in St Georges Hospital to ensure patients received the right care as quickly as possible. Escalation beds were also now open in St Georges Hospital. Alongside local authority partners, they looked at intermediate care to support those who were discharges but needed further support.

Primary care was presented to OSC (Overview and Scrutiny Commission) which highlighted some improvements they could make, but it was important to highlight that across the 21 practises in Merton, there were 6 PCN’s (Primary Care Networks). Primary care appointments were available 7 days per week between 8.00am – 8.00pm which included a mixture of practices, primary care networks and boroughwide enhanced GP Hubs. Over the last couple of years, they recruited 70 new staff into Merton Primary Care to enable residents to be seen by the right person, at the right time and as quickly as possible. This would also help to take some of the pressure off of GP’s.

A range of digital solutions were coming online, such as the NHS App, but they recognised that the digital approach did not suit everyone and would ensure that non digital solutions remained. Investment in a cloud base telephony service was being rolled out across all practices and would help to avoid residents from having to call at 8.00am and wait in queues to get an appointment.

Graham informed the board that a letter from the Ministry of State was received which set out the expectations of adult social care over the winter months.

Adult Social Care introduced key services such as the reablement service which, at any one time, would enable up to 50 people to be discharged safely from hospital. During winter and where possible, they would increase capacity.

The Mascot Telecare Service provided a free 4 week telecare service for those who were discharged, this was currently being rolled out within the community and they estimated that approximately 30 people per month would benefit from the service. The free 4 weeks offered was a trial period for people to experience telecare, with 6 out of 10 people retaining the service.

They continued to line up residential and domiciliary, particularly around fast response and homecare. Last year, there was a service which could respond within 2hrs and was now built into new contracts.

Some of the allocated funds were used to support voluntary organisations such as Age UK and Carers Support Merton, which allowed them to work within hospitals and promote the services they provided. Going forward, they wanted to expand this approach.

The letter from the Ministry of State set out requirements for Grahams team to work in partnership with Integrated Care Boards and Partnerships. The winter plans were overseen by the Merton Health Care Together Partnership for Merton and they continued to review their Better Care Fund spending.

The report highlighted challenges over the winter months but this year they had a longer period of time to plan for this. Paragraph 5.6 to 5.9 talked about the precautionary measures taken to protect the most vulnerable in terms of the identification of COVID 19. The vaccination rollout was to begin on 11th September, alongside the annual flu vaccine, a new shingles vaccine and MMR vaccinations for children and young adults who returned into primary, secondary school and university.

Three discharge summits were held with St Georges Hospital to look at the existing transfer of care hub and a new model of what was called the Care Transfer Hub. The number of participants had been increased to ensure the voluntary sector was involved and they continued to look at how to best include housing advise and social workers. The plan was to have this in place before winter 2023 to maximise the opportunity to work together and discharge people safely from hospital as soon as they were medically fit.

There were several projects detailed in 7.5 of the report which included developments proposed by CLCH (Central London Community Healthcare) to reuse some of the capacity at Heathlands for rehabilitation at home, which was due for sign off at the next Merton Health and Care Together Committee. Paragraph 9 detailed an integrated children and young people’s commissioning group and a degree of joint commissioning with local authority as part of children’s community services contract with CLCH. Paragraph 9.4 had a description which would be built into the current structure exercise which looked at joint commissioning.

Mark confirmed that the principal of the Heathlands development was to rehabilitate people at home but to do that they needed to understand what the impact was on other services across the sector, which was happening at present.

Mark also highlighted the importance of vaccinations, particularly as there was a decline in COVID vaccine uptake which was a worry. Russell Styles (Director of Public Health Community and Housing) reiterated this point and highlighted that COVID and Flu vaccinations were available at Nelsons as well as the Wilsons. They were in conversation with pharmacies and there was going to be a walk in service at the Merton Civic Centre.

In response to questions, the following was stated:

•         Cllr Fraser extended her thanks for the comprehensive report and expressed that she was pleased about the plans for early discharges.

•         Virtual wards consisted of a multidisciplinary team of people who dealt with a higher level of severity cases. The patient would be discharged from hospital early and go into the service which would medically optimise the patient at home. Merton offered a face to face service which was different to the rest of south west London. They encourage the acute trust to utilise their capacity to enable more discharges, more information could be circulated to the board.

•         An integrated post with Children Services which worked across both the ICB and the local authority was agreed.

•         The RSV vaccination was approved but there was no further information available at present on the RSV rollout, although they believed an announcement would be made in December or January.

•         John Morgan (Executive Director of Adult Social Care, Integrated Care and Public Health Community and Housing) highlighted that the system was challenged at present. There had been several strikes within the NHS which  effected waiting list times and the flow of patients. This also had a knock on affect to adult social care. They saw large numbers of extra discharges from hospital coming through adult social care, with a 22% increase from April to July which put a large strain on the entire system. They continued to have concerns about the winter months, particularly with the potential of a new strain of COVID. There was a huge amount of joint coordinated work which took place in preparation.

•         Russell Styles informed the board that care home residents and staff priority for COVID and Flu vaccines. As residents were sometimes unable to give consent themselves, they relied on relatives to do so which sometimes led to delays but once consent was given, they would receive the vaccinations. 2.86 was a new COVID variant which had one of the most significant changes since Omicron but was a variant under monitoring and not of concern.

RESOLVED: That the Board noted the report