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Working with our partners – Lancashire and South Cumbria Health and Care partnership
Since March 2020, CCGs in Lancashire and South Cumbria have continued to work together to respond to the COVID-19 (coronavirus) pandemic with local partners across the Integrated Care System (ICS) to manage the local response. Throughout 2021/22, the joint decision-making mechanisms continued to support the operational management of services and ensured consistency in partner, staff, patient and public communications.
NHS partners continued to work with Local Resilience Forums (LRFs) in Lancashire and Cumbria, which include partners from the NHS, local authorities, social care, education, police, fire and armed forces. Working together, these partnerships helped to manage the response to COVID-19, which this year focused on the changes to national guidance along with the rollout of the COVID vaccination and testing programmes, communicating key messages and continuing priority work programmes.
Hospital and Out of Hospital incident response cells in Lancashire and South Cumbria which were established in 2020/21 continued to operate under the North West Regional incident command structure.
The Hospital cell covered elective care, tertiary services, critical care, cancer, paediatrics, mutual aid and clinical prioritisation. The Out of Hospital cell co-ordinated the work of community services, mental health, learning disabilities and primary care. It also worked with social care, with a Care Sector sub-cell run jointly with the Lancashire LRF and with connections to Cumbria. A Joint Hospital and Out of Hospital cell chaired by Kevin McGee, Chief Executive of Lancashire Teaching Hospitals and the Provider Collaboration, was strengthened to enable collective system decision making with revised membership, which included the involvement of Directors of Adult Social Care from local authorities.
The Gold Command Winter Pressures Room was established in preparation for the second wave of the pandemic in 2020 and continued to support local NHS operational activity and winter pressures. As a tactical support service, it monitors and analyses pressure on individual trusts and organisations – including A&E attendances, COVID-19 cases, people awaiting a COVID test result before admission, staff sickness, bed capacity, discharge delays, and queueing ambulances. Data is looked at from a system perspective, and capacity is redistributed to where it is needed most.
Work at the command room, as well as the System Vaccinations Operations Centre (SVOC), is ongoing seven days a week through collaboration between all CCGs and trusts, NHSEI leads and ICS executives. It has made a phenomenal difference in terms of collaborative working and system thinking for the benefit of patients.
The Lancashire and South Cumbria Personal Protective Equipment (PPE) and Consumables Policy Group has continued to operate throughout 2021/22, coordinating the usage and capacity planning for health services across the region. Access channels to PPE became firmly established and normalised towards the end of 2020, with the development of the PPE Portal and this remains the case. The PPE and Consumables Policy Group has worked effectively as a joint forum for debating, testing and implementing approaches to the use of PPE, including ‘fit-testing’ of equipment and clear facemasks.
System-wide staff notices and information have been circulated to inform the wearing of face coverings across all healthcare settings (hospital trusts, GP practices, dentists), including information for the wearing of face coverings by patients and visitors. These have been re-circulated as necessary in response to changes in the national guidance on the wearing of face coverings.
Antigen testing has become firmly embedded within the national response to COVID-19. Routine asymptomatic testing programmes, using rapid lateral flow testing, have been established across the health and care sectors, in education and in workplaces. They have also become universally available to members of the public, who can order free lateral flow tests via the national testing portal, their local pharmacy or by having them delivered by post to their home.
New variants and infection rates have required constant amendments and updates to testing guidance and testing regimes across all these sectors, along with self-isolation periods, which have changed regularly. The Lancashire and South Cumbria NHS Testing Group, established in 2020, reviews the Testing Strategy for the NHS across the region regularly and issues the strategy and other testing notices and information to the Hospital and Out of Hospital cells, the LRF and other groups.
Lancashire and South Cumbria is one of the few areas across the country to successfully embed the LAMP saliva testing regime across its hospital trusts and these tests have become the primary asymptomatic staff testing programme. This was achieved by a close working partnership with the University of Central Lancashire.
Guidance on all aspects of testing, including travel and testing, education, the COVID Pass, self-isolation and other related issues have been updated regularly on the ICS website for members of the public to access, and circulated via the testing matrix to Hospital and Out of Hospital cells, and across the Health and Care Partnership.
The COVID-19 vaccination programme – the largest in history – was well established by April 2021, both nationally and across Lancashire and South Cumbria. The COVID-19 Vaccination Programme Board, established in November 2020, continued to provide oversight during 2021/22 as well as strategic direction to make sure the local offer met public need and was fit for purpose.
In addition to many fixed sites in Lancashire and South Cumbria, NHS teams have gone to extraordinary lengths to take the vaccine to different communities, with pop-up and mobile services, including buses and street teams, often delivered through partnerships with religious and community groups as well as council services. This hyper-local approach has proved invaluable to increase uptake in many health inclusion groups.
NHS teams have been able to react quickly as the programme expanded to under-18s, vaccinating children in schools, and then the rollout of boosters and also third doses for those whose immune systems mean they need more protection.
In response to the emerging Omicron variant of the COVID-19 virus, the government announced the acceleration of the winter booster programme. Capacity doubled in the space of a week with daily vaccines moving from 10,000 a day to 20,000. A call out for support saw a reinvigoration of the vaccine response with many volunteers and retired clinicians returning to support the booster programme.
Between April 2021 and March 2022, more than 3.5 million vaccinations have been given to people in Lancashire and South Cumbria. This includes 1 million booster vaccinations.
Partners including local councils, the military, fire and rescue service, police, local businesses, volunteers, returning clinical staff and many more have supported the delivery of the vaccine. More than 1,600 local people offered their support following an appeal for volunteers, and since the vaccination programme began, volunteers have logged almost 140,000 hours through Lancashire Volunteer Partnership.
The ICS led clear communication of public messages, including materials in different languages and formats, about the importance of being vaccinated and how to attend appointments safely.
Pulse oximetry at home and COVID-19 virtual ward services were launched across Lancashire and South Cumbria in 2020/21 to monitor vulnerable patients with COVID-19 in their own homes.
Local providers and GP practices continued to work together to provide the pulse oximetry at home or a COVID virtual ward service for eligible patients, identified as being particularly at-risk from the virus due to their age or a pre-existing condition. Patients were given a pulse oximeter and had regular contact from the service so they could measure the oxygen levels in their blood several times a day, which helps spot the early signs of silent hypoxia; when the body is starved of oxygen but without causing noticeable symptoms such as breathlessness.
This effective digital solution enables early treatment to be given – which both improves patients’ chances of recovery and ensures that they only go to hospital if necessary.
In response to the successful vaccination programme and the COVID-19 variants that emerged during 2021/22, the services have continually adapted their patient criteria so that those most at risk from complications are offered the service.
The services have also expanded to include a lighter-touch pathway for lower-risk patients, where patients are contacted by text message and offered a pulse oximeter to self-monitor their oxygen saturation levels at home during the course of their illness. This allows them to easily self-refer into the service or contact NHS 111 if they have any concerns.
|On the Fylde Coast CCG the COVID Oximetry@home service can support 90 people at any one time. Since inception the COVID Oximetry @Home service has supported 1404 people who have tested positive for COVID-19. Of those, only 115 people supported by oximetry at home were admitted to hospital.|
COVID-19 virtual wards remain in place and provide an enhanced level of virtual monitoring and care overseen by hospital clinicians, usually for those patients who are receiving treatment to help them recover from COVID-19 whilst in their own home. This enables people to be discharged earlier from hospital or can prevent a hospital admission altogether.
CCGs are considering how the remote monitoring offer and virtual ward concept could be extended for other conditions and using other monitoring devices.
CCGs are working closely together within a joint Adult Social Care and Health Partnership which was established under the joint cell. It has given a forum for senior NHS and the four upper tier local authority leaders to oversee integrated workstreams for Lancashire and South Cumbria. This includes key areas such as intermediate care and discharge, and strategic planning for the care sector that impact early intervention to avoid escalating needs and to facilitate system flow.
There have been extremely challenging pressures in the peaks experienced from COVID-19 during 2021/22, which has resulted in reduced capacity across the system from staff absences and outbreaks in care settings. The partnership has worked closely together to maintain capacity and support flow by commissioning additional capacity, keeping close contact with the sector to understand the daily position and flexing workforce. The excellent partnership working displayed and innovative approaches tested, such as the nationally recognised discretionary payments and support to informal carers as part of the discharge scheme, will now help to re-shape the intermediate system work as we go forward.
System reform: how partners are working together and preparing for the future
This year has seen significant national developments in relation to health and care reorganisation and emerging guidance for delivering integrated care for the benefit of our population and staff.
Integrated care systems (ICSs) are partnerships of NHS organisations, councils and key partners from the voluntary, community and social enterprise sector, working together across a local area to meet health and care needs, coordinate services and improve population health. CCGs are a key partner, and in Lancashire and South Cumbria, all ICS partners are working together to improve health and care services and help the 1.8 million population to live longer, healthier lives.
In line with the NHS Long Term Plan (2019), all parts of England had to be served by an ICS from April 2021. In Lancashire and South Cumbria, the ICS had been developing for a number of years – meaning that the partnership was already relatively mature.
The NHS England and NHS Improvement White Paper Integrating care: Next steps to building strong and effective integrated care systems across England (February 2021) detailed how ICSs and the organisations within them will work more effectively and more collaboratively in future.
From April 2021, a Strategic Commissioning Committee replaced the Joint Committee of CCGs, with a primary role to focus on delivery and decision making for the Lancashire and South Cumbria population with the authority to make decisions at a Lancashire and South Cumbria level. The Committee brings the leadership of the eight Lancashire and South Cumbria CCGs together with ICS strategic commissioning leaders who have collectively committed to improve and transform health and care services across the area, delivering the highest quality of care possible within the resources available.
To support the closedown of eight CCGs and the establishment of the Integrated Care Board (ICB) in Lancashire and South Cumbria, a number of sub-committees and groups were established to oversee the progress and deal with any challenges across the system. This included the ICS Development Oversight Group, the Place-Based Partnerships Development Advisory Group, the CCG Transition Board, the CCG Closedown Group and the HR Reference Group.
In April 2021, the ICS Chief Officer wrote to the CCG chairs and accountable officers, the Managing Director and Director of Operations at MLCSU and the ICS executives to set out a number of expectations and asks regarding system resources during the 2021/22 transitional year.
As part of the first stages of developing resource proposals to build a consistent model for the system-level and place-based teams, four priority areas were identified as ‘accelerator’ functions:
- Primary and community services integration
- Population health management
- Quality and performance improvement
- Communications and engagement.
Each of the functions worked collaboratively with their teams to design both proposals for a future operating model and an approach to transition throughout the year to align more closely with the proposed target operating models.
The Place Based Partnership (PBP) Development Advisory Group (DAG) oversaw the creation of a Maturity Matrix, which allowed a self-assessment process to take place, to understand the progress already made and further actions required. The Maturity Matrix was revisited throughout the year to measure the progress. The PBP DAG is also overseeing a piece of work to assist in defining the scope of services at place and system, based on the PBP Strategic Narrative which was approved by the ICS Board last year.
In May 2021, a ‘Delivering Integrated Care: Summary’ document was produced locally and signed off at the ICS Board, which set out the national context, proposed changes and what the changes mean for staff.
A single internal communications process was established across the eight CCGs in May 2021 and staff affected by the transition to ICB were invited to attend colleague briefings to receive updates and raise concerns or ask questions in July, September, November, January and March.
A national ICS Design Framework was published in June 2021, setting out expectations of how NHS organisations were expected to respond in the next phase of system development, including the anticipated establishment of statutory ICS NHS bodies and an ICS Partnership, subject to legislation.
Published in July, the Health and Care Bill (2021) defined the new NHS bodies as Integrated Care Boards (ICBs) which would replace CCGs, and the partnerships as Integrated Care Partnerships (ICPs).
Following a robust national recruitment process, David Flory CBE was confirmed as the Chair Designate of the NHS Lancashire and South Cumbria ICB in July 2021.
Following the ICS Design Framework, a number of national guidance documents were published, including a Readiness to Operate Checklist, HR Framework for Developing ICBs, CCG Close Down and ICB Establishment Due Diligence Checklist, Thriving places: Guidance on the development of PBPs, and ICS Implementation Guidance on Working with People and Communities.
A multi-agency Communications and Engagement Review Group was established in September 2021 to increase the efficiency of producing key communications materials to support developments in the ICS that require agreement by multiple partners.
Following a robust national recruitment process, Kevin Lavery was appointed as Chief Executive Designate of the NHS Lancashire and South Cumbria ICB in November 2021.
A national extension of the ICB establishment timeline was announced in December 2021, with a new date for establishment of 1 July 2022. Work continued through quarter four to reach a state of readiness for shadow arrangements to be in place from April 2022, whilst respecting the existing statutory arrangements. This mirrors the national approach, as the updated ICB Establishment Timeline confirmed ambitions to complete as many activities as possible by the end of March 2022, with exceptions related only to those actions that are dependent upon national guidance and/or legislation. For these, the intention is to have them completed by the end of May 2022.
Work continued with key workstreams to develop the leadership and governance arrangements and operating models for the Integrated Care Partnership, Place-Based Partnerships, Provider Collaboratives and the ICB. Work also continued to recruit to senior designate leadership teams for both the ICB and Place-Based Partnerships.
All NHS provider trusts are expected to be part of a provider collaborative in order to help set system priorities and allocate resources. In Lancashire and South Cumbria, a Provider Collaboration Board (PCB) was established with two provider collaboratives; an NHS Provider Collaborative and a Mental Health, Learning Disability and Autism Provider Collaborative. A wider range of provider collaboration board and strategic group colleagues helped develop a strategic narrative and supporting materials to support the PCB. These were approved in February 2022.
Throughout quarter four of 2021/22, an Engagement, Involvement and Coproduction Strategy for working with local people and communities has been in development for the Lancashire and South Cumbria ICS, through co-production with partners, stakeholders and public engagement. A strategy for implementing the partnership approach within the NHS ICB was also produced and both documents are scheduled to be taken to key decision-making boards in May 2022.