In our third article in a series on winter preparation, Kathy Oxtoby looks at Bedfordshire, Luton and Milton Keynes ICB and how it is prioritising resilience across the system
Patient safety and resilience are top priorities for Bedfordshire, Luton and Milton Keynes (BLMK) ICB as it enters the winter months.
‘Our aim is to ensure patient safety is maintained across all Urgent and Emergency Care (UEC) pathways, including patients awaiting a clinical response in the community’, says Georgie Brown, acting director of operations at BLMK ICB.
The ICB also aims to maintain ‘a resilient UEC system that grips escalation whilst avoiding a detrimental impact on elective care’, says Ms Brown.
A lot of this is a team effort, including using alternatives to emergency departments, such as an Unscheduled Care Coordination Hub (UCCH), a virtual ward, community care, primary care, and pharmacy capacity.
‘We believe there is greater benefit in supporting partners to work together for their local populations,’ says Ms Brown.
Acute trusts, community, primary care, local authorities, ambulances, VCSE, 111, and the ICB are all involved in planning. ‘It’s not in the gift of the acutes to manage this alone,’ says Ms Brown.
She adds that there has been a ‘strong senior leadership relationship development’ over the past three years.
‘This encourages openness of issues between partners and collective actions to address. The philosophy is we are all in this together,’ says Ms Brown.
The ICB is ‘working to ensure all resources are fully utilised to manage winter and support the needs of our residents, and to be a responsive and collaborative system to manage and respond to system pressure’, she adds.
Part of managing these resources is aided by the ICB-led system co-ordination centres (SCCs), which monitor real time performance and support health leaders to manage escalating pressures, looking at early warning triggers to identify pressures early.
Innovation
The ICB is also looking to various innovations to help with winter preparations and shift care away from the hospitals over the season, including piloting a mobile x-ray in the community to assess if residents who have fallen have a fracture and need hospital care.
The UCCH is also transferring care from the ambulance stack to avoid unnecessary conveyances to the trust, and they are using a ‘release to respond’ initiative to ensure acute trusts transfer patients into their A&E department as soon as possible (and no later than 45 minutes) to release the paramedics to manage other residents’ needs.
Virtual wards are being used by the ICB to care for individuals at home, with focus areas including frailty, respiratory and paediatric care.
Also helping this winter will be a new central Bedfordshire falls prevention service, to offer ‘a coordinated, evidence-based approach to reducing falls among older residents – improving outcomes, preserving independence, and reducing system pressure’, says Ms Brown.
New redirooms in acute hospitals will provide isolation space for patients with infections such as influenza, norovirus, MRSA, CPE, and C. diff, and will enable hospitals to isolate infectious patients without the need to close bays.
While new robotic arms will support dispensing of medications, shortening the time patients wait for their discharge medication and releasing hospital beds.
Flow through the system
Measures to ease system pressures will involve supporting flow throughout the system, not just in acute trusts.
‘Bottlenecks can occur if residents stay in community beds longer than is necessary. There will be a push on discharge planning as early as possible from short term assessment units to enable the resident to return to their permanent place of residence as soon as possible. This covers both physical and mental health needs,’ says Ms Brown.
The ICB is piloting a forecasting tool that allows the SCC to understand what the system pressures might be in three to five days’ time. The intent is to facilitate early intervention and avoid escalation.
Meanwhile, the same day emergency care at Bedford Hospital will enable patients to be assessed, diagnosed, and treated, where appropriate, on the same day of arrival, rather than being admitted to the hospital.
Vaccine strategy
Alongside shifting care away from hospitals, the ICB is also working on prevention through its vaccination strategy.
‘Ours is a system-wide vaccine strategy, including colleagues from public health and vaccination providers – GPs, community pharmacies, community trusts – which provides our vaccinations in schools and other outreach,’ says Ms Brown.
The strategy looks at all eligible cohorts, with a particular focus on frontline staff, care homes and housebound patients, children aged two and three, school age children, and pregnant women.
‘Easy access is the watchword’, says Ms Brown, with more than 90 pharmacies, 13 PCNs and all maternity providers are delivering vaccinations.
There will be close working with care home providers – 100% will receive an offer of vaccination support again this year. Last year 70-80% received a visit.
In terms of minority group uptake, Places will be working at a neighbourhood level to target groups, and PCNs with the lowest uptake will be identifying communities where patients do not readily respond to invitations. They will be doing community outreach and engagement and offering evening and weekend clinics across all PCNs.
Workforce
As well as prevention work and ensuring patients can access services, BLMK ICB is also working on deploying its workforce well.
The system ‘needs to ensure the current workforce are being used effectively’, says Ms Brown. ‘This may mean diverting resources away from planned care into unplanned care where there are emerging pressures.’
The ICB will be ‘working alongside our community and ambulance providers to ensure there is sufficient community capacity to manage the needs of individuals where a conveyance to secondary care is unnecessary’.
The repeated strikes in 2024/25 shaped resilience plans that help mitigate pressures where possible, says Ms Brown.
She says emergency preparedness resilience and response teams lead strike preparation sessions with partners and ICB leads to help understand challenges and prepare for them.
Acute trusts ‘maintain elective activity where possible, carefully balancing the safety of UEC pressures with the needs of those who have waited for their care’, says Ms Brown.
It’s all about planning, she adds.
‘There is pre-planning as far as possible, ensuring services such as 111, primary care and community services have sufficient resilience to manage increasing pressures,’ she says.
