Agenda and minutes

The Chairman welcomed everyone and confirmed the arrangements for the remote meeting.

Following Council changes, Mary Rayner was no longer a HOSC member and the membership had reduced by one.  The Committee expressed their thanks for her involvement and support.

No Apologies had been received.  

None.

Members of the public wishing to take part should notify the Assistant Director for Legal and Governance in writing or by email indicating the nature and content of their proposed participation no later than 9.00am on the working day before the meeting (in this case 13 November 2020). Enquiries can be made through the telephone number/email address below.

None.

Previously circulated

The Minutes of the Meeting held on 30 September 2020 were agreed as a correct record and would be signed by the Chairman.

The Chairman referred to the Minutes and asked whether the information requested had been received.  Members were informed that Scrutiny Officers would follow up the requests outside of the meeting.  

Attending for this Item were:

NHS England and NHS Improvement (NHSE&I)

Dr Ash Banerjee, Screening and Immunisation Lead (Public Health Consultant)

Dr Alex Cockburn, Public Health Speciality Registrar

NHS Herefordshire and Worcestershire Clinical Commissioning Group (CCG)

Jo-anne Alner, Managing Director (ICS Development)

Worcestershire County Council (the Council)

Dr Kathryn Cobain, Director of Public Health

Hayley Durnall, Public Health Consultant

Dr Banerjee talked through the Agenda report which, for this meeting, had focussed on childhood and flu vaccinations. 

Although NHSE&I was responsible for commissioning vaccinations, the CCG had a role to play in ensuring the primary care provision.  In addition, the Council had a role in promoting uptake, especially through the commissioning of school nurses and health visitors.

Childhood immunisations for pre-school children were delivered by GP practices at five scheduled appointments and further immunisations were offered in secondary school years 8 and 9.  In addition, the flu immunisation was offered in school in certain year groups.

Achieving 95% uptake in the childhood immunisation programme would achieve ‘herd immunity’ ensuring that the level of any outbreak was reduced.  This was particularly important for those who were not able to receive a vaccination.

Uptake in Worcestershire was consistently higher than both the West Midlands region and England and generally achieved the 95% target at age 1, but not at 2 or 5 years of age.  However, there had been a sustained slight drop in uptake nationally in recent years, especially as children grew older.  The reasons for this five year decline were unknown, however, could be related to the ease of access.

The seasonal flu vaccination was traditionally delivered between September and March through GP practices, NHS Trusts, community pharmacies and schools.  Eligible groups included those aged 65+ and under 65 years with an at-risk condition.  In recent years, the eligible group had expanded to include all children from school Reception year to Year 7.  For 2020/21 the Government had announced that those aged 50-64 were to be invited for the first time, however final details were awaited.  In addition, health and social care workers were eligible, however, that responsibility lay with the employer. 

Uptake in Worcestershire for 2019/2020 across all eligible groups was higher than England, with the 65+ cohort achieving a 74.8% uptake.  Early indications for 2020/2021 suggested that across all eligible groups there was a 10% increase in uptake.  National targets for uptake in 2020/21 had also increased to 75% in each eligible group.

The COVID-19 pandemic had impacted the school programme of activity since March 2020, when schools were closed to the vast majority of pupils.  It was anticipated that the backlog would be completed during the current academic year.  Other childhood immunisations had continued to be offered through GP practices, however, there were fewer attendances, which may result in overall uptake being lower than in previous years.

NHSE&I had several initiatives to increase uptake, such as schemes where GP practices were paid to telephone families whose children had missed appointments to encourage uptake, or  ...  view the full minutes text for item 999.

Attending for this Item were:

Herefordshire and Worcestershire Clinical Commissioning Group (CCG)

Mari Gay, Managing Director (Worcestershire)

Worcestershire Acute Hospitals NHS Trust (WAHT)

Matthew Hopkins, Chief Executive

Herefordshire and Worcestershire Health and Care NHS Trust (HWHCT)

Sue Harris, Director of Strategy and Partnerships

Mari Gay reminded Members that they had received regular reports, most recently on 30 September, updating them on the restoration of health services across Worcestershire.

Members were led through the presentation, attached to the Agenda, with a reminder that at the beginning of the COVID-19 pandemic, there was a national directive to cease non-urgent services and then more recently a drive to restore services, whilst maintaining COVID-19 safety measures.  The challenges involved were immense, however, there were also opportunities to work differently.  Patient numbers were now back to near normal levels, with a slight increase in mental health referrals. Across the whole system around 90% of services were being delivered, which was a national target. 

As the COVID-19 second wave was in progress, further challenges to the restoration of services were expected, especially as the number of COVID-19 cases in the County were rising.  The number of endoscopy procedures able to be carried out was reduced and therefore wait times had increased.  Likewise, patients waiting for non-urgent treatment, especially those waiting over 52 weeks, would also be impacted.  The CCG continued to work with the independent sector, although the central Government contract would now cease nationally on 21 December 2020, rather than March 2021 as originally expected.  Locally, commissioners were hoping to engage for a further six months with the independent sector as their services were vital to maintaining the restoration phase.   

Assessing WAHT bed capacity was complicated and changed on a daily basis, however, as an example, there were 71 COVID-19 positive patients earlier that day, with a number waiting for results and a number of beds needing to be kept empty to accommodate patients in the case of admission.  During the first wave of COVID-19, earlier in the year, on a particular day, there were 141 COVID-19 positive patients, taking up the equivalent of 309 acute beds.  Currently, around 250 beds were required, which was approximately 2/3 of what was required in Wave 1.  Furthermore, on day 45 of Wave 1, there were less patients than on day 45 of Wave 2, which suggested that Wave 2 would be longer. 

There was concern over the number of positive cases, especially in the north of the County and WAHT would potentially find it difficult to maintain non-urgent services.  Some West Midlands NHS Trusts had already ceased elective surgery again.  One key issue for elective surgery was the number of anaesthetists available, as they were needed in the Intensive Care Unit (ICU).  WAHT was currently using its surge facility, with 15 patients in ICU that day. 

Matthew Hopkins referred to page 5 of the agenda report (September in numbers) and highlighted some of the statistics, for example, numbers of appointments, Accident & Emergency (A&E) attendances, diagnostics and  ...  view the full minutes text for item 1000.

In view of Cllr Rayner no longer being a HOSC Member, Cllr Rogers volunteered to take on the Lead Member role for West Midlands Ambulance Service University NHS Foundation Trust, which the Committee endorsed.

Members had nothing to add at this time.