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Lincolnshire Integrated Care Board shares its winter plans as demand is set to ramp up at Boston, Lincoln and Grantham hospitals




Health bosses have explained how they intend to care for us in the coming weeks – as they brace themselves for an influx of patients over the festive period.

Lincolnshire Integrated Care Board (ICB) has released its Winter Preparedness Plan to highlight the number of beds it has available, along with services it has introduced, in a bid to manage the high numbers of patients who will be seeking help in the coming weeks.

Reducing patient waits for ambulances and in A&E are among the key aims of the plan – but problems have already been reported in recent weeks with one frail elderly patient waiting five hours for a trolley to take her for an X-ray.

Inspectors found that staff were not administering medication correctly. Stock picture
Inspectors found that staff were not administering medication correctly. Stock picture

Additional help for care homes, providing services to help patients receive acute care at home, increasing the availability of same day GP appointments and reducing discharge delays are among the schemes suggested.

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And it needs to be ready as the festive period is always traditionally a busy time for the NHS with an increase of patients seeking help for respiratory problems between December 23 and January 5 each year.

Pilgrim Hospital in Boston
Pilgrim Hospital in Boston

Problems are created within hospitals at this time of year with too many patients arriving at the ‘front door’ and not enough being discharged to free-up beds due to challenges in the social care – which has also been experiencing challenges. These will further be exasperated by the junior doctors strike.

Chairman of Lincolnshire Care Association Melanie Weatherley is supporting the plan and has praised the Clinical Assessment Service (CAS) which allows care home staff to speak directly to a doctor or nurse who will decide what the best course of treatment is for an unwell resident.

Mrs Weatherley, who also praised the Lincolnshire system for its honesty and including social care in discussions, said: “The plan is really good but the execution is going to be the thing that makes it work or not.

Melanie Weatherley
Melanie Weatherley

“The access to CAS is phenomenal. Care home staff can speak directly to a clinician for advice rather than ringing 111. 111 has a checklist to follow and if it says send an ambulance, then they send an ambulance.

“A frail older person may not be best served by a trip to hospital.

“It has been fabulous to have that system available to care homes as someone from Lincolnshire, who may not be their doctor or nurse, but knows of them and the system so it is really reassuring. Care home staff feel that they have access to someone senior who will take responsibility for the decision.

East Midlands Ambulance Service (EMAS)
East Midlands Ambulance Service (EMAS)

“We have upskilled care home staff so they are able to answer the questions from the doctor or nurse. It is one of the best things that we have in Lincolnshire.”

The ICB’s plans states that the CAS has been in place for several years to avoid more 999 calls but extra investment has gone into the service this year to provide additional capacity and skill set.

A total of 80 care homes have received training to help use equipment to lift residents who have fallen but the plan also includes specialist nursing support for terminal patients.

The crossing outside Grantham Hospital A&E
The crossing outside Grantham Hospital A&E

The plan states: “We have an urgent care mental health community response in place to help also to support care homes to prevent their residents being unnecessarily admitted to hospital.”

Bed modelling

The report’s authors state the county’s system requires: 968 beds (936 adult and 32 paediatric) across Lincoln County, Boston’s Pilgrim and Grantham District Hospitals with an option to open 18 escalation beds during winter.

Plus the system will be using an additional 30 ‘active recovery beds’ with ‘wrap around therapy provision’ within care homes – creating an availability of 70 beds. There will also be ten complex behaviour beds to support patients with nursing requirements and an additional 11 community hospital escalation beds to support peak winter demand.

Lincoln County Hospital
Lincoln County Hospital

“The expansion of community capacity and increase in utilisation of community services is key in delivering our ambition to reduce reliance on acute services” the plan states.

“We know that increasing numbers of patients are accessing our Urgent Treatment Centres and demand across community services is growing.”

The ICB has undertaken modelling work to look at the number of adult beds which will be needed over the next five years – and has found a need to ‘slightly reduce’ hospital beds but increase capacity in the community.

Reducing the need to go to hospital with boosts to primary care

Increasing the availability of same day primary care appointments, the maximum use of the two hour urgent community response service and the implementation of frailty assessment in Lincolnshire are also included within the plan.

The ICB is also looking to increase the number ‘virtual ward’ beds – which allows patients to receive specialist care within their own homes – from 145 beds to 172 by March.

It has also introduced one of three Acute Respiratory Hubs to cover Bourne, Deepings, Holbeach, Gosberton and Swineshead areas.

The plan states: “For this winter we have implemented Acute Respiratory Hubs in three locations across Lincolnshire that will provide timely and appropriate care for service users with suspected acute respiratory infections. The key objectives of the Acute Respiratory Hubs being to provide same day access, treatment and advice as needed to service users and reduce pressures across the system by reducing demand for ambulance conveyance, GP appointments, Emergency Department attendances, and hospital admissions, for patients who can be appropriately managed in the community.

“The hubs have been sited where there is identified high demand for acute hospital attendances or admissions where there is a high prevalence of COPD or asthma.”

Tackling hospital waits

Schemes to help support hospitals treat and discharge patients are also included within the plan.

Senior clinical decision makers are due to be available at the hospital’s ‘front door’ in order to help reduce the number of patients experiencing long waits in A&E while clinical navigators will be ensuring that people arriving in ambulances are sent to the appropriate place on arrival.

East Midlands Ambulance Service has raised concerns about the time take to handover patients to A&E after losing thousands of hours but there are plans to ensure ‘rapid handover space’ so that people can access hospital care and not wait on unnecessarily on the vehicles.

Discharges play an important role in the flow of a hospital so health bosses have expanded its Transfer of Care hubs by increasing staff and operation hours to provide the ‘growing requirements’ for additional support patients need when they leave.

The plans also looked to get suitable transport during the winter months to ensure that patients can be discharged.

Mental health provision

A trained nurse is now based in the police force control room to provide support. Earlier this month, it was announced the Police and Crime Commissioner Marc Jones is working health and council teams on the Right Care, Right Person project which will see that people receive help from the appropriate service – and improve officer response times.

The ICB is also looking to expand its successful Mental Health Urgent Assessment Centre (MHUAC) to include children as well as adults.

The plan states: “The implementation of the MHUAC in Lincolnshire has been a great success and ensures that those patients with a mental health need only, do not need to attend our hospital Emergency Departments and instead they can attend a more appropriate environment which provides a better patient experience and improved outcomes.”

Take responsibility for your own health

Healthwatch is supportive of the plan – but say that people need to take responsibility of their own health.

A spokesman said: “The ICB’s winter plan shows a proactive approach to tackling the pressures of winter. The NHS and social care services already face high demand. This winter, pressure on care could be even more significant, and compounded by the existing backlog of care, the cost of living and ongoing industrial action by health professionals.

“The latest NHS data shows that a record number of people are waiting for care and there is no doubt that longer wait times can affect people’s willingness to seek care from the NHS. However, it’s vital people still come forward this winter for the healthcare they need.

“It’s important for Lincolnshire people to take responsibility for their own health and wellness, by staying as healthy as possible, looking after themselves and asking for support when they need it and use the right service for their needs. Also look for your neighbours, relatives and friends to help them stay healthy and seek help if they become ill.”

Have you needed treatment from the NHS recently? What has your experience been like? Post your views in the comments below.



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