Agenda item

Attending for this Item were:

Herefordshire and Worcestershire Clinical Commissioning Group (CCG)

Mari Gay, Managing Director (Worcestershire)

Worcestershire Acute Hospitals NHS Trust (WAHT)

Paul Brennan, Chief Operating Officer

Worcestershire Health and Care NHS Trust (WHCT)

Sue Harris, Director of Strategy and Partnerships

A report and presentation had been circulated with the Agenda and was discussed, with the following points being highlighted:

·         The NHS continued to be in the incident management phase of the pandemic, ensuring that urgent services were being carried out yet the spread of COVID-19 was being minimised.  The approach taken across the Herefordshire and Worcestershire Sustainability and Transformation Partnership (STP) continued to ensure good quality provision for residents in the constraints imposed nationally as a result of the pandemic

·         There had been a system wide approach to communications and service delivery and demand had been managed well

·         The temporary service changes discussed at the 18 June HOSC across Worcestershire Acute Hospitals NHS Trust, Worcestershire Health and Care NHS Trust and Primary Care, were broadly still in place, with some, such as digital solutions, likely to become more usual as restoration of services improved and was in line with the objectives of the NHS Long Term Plan 

·         Safety of patients, public, staff and service users would always be a priority and all services were reviewing waiting lists to ensure priority was given to those at highest risk

·         Limiting the risk of transmission was vital, whilst considering how best to restore services, especially for patients who were most vulnerable and giving confidence to patients that settings were safe places to receive care

·         A continuous engagement approach had been adopted throughout the pandemic and Healthwatch Worcestershire had undertaken a number of surveys, results of which provided themes to support the restoration phase

·         The impact of the temporary service changes was monitored constantly and any decisions involving long-term service changes would not take place without following due process in regard of consultation and engagement.

In the ensuing discussion, the following key points were raised:

·         The use of private hospitals for NHS elective surgery would continue as per the national contract, which could perhaps be until the end of the financial year.  If so, the increased capacity throughout the winter months was welcomed

·         To date, 737 operations and 445 endoscopies had been undertaken privately, mainly diagnostics or surgery for cancer.  Bowel and breast screening had also been restarted

·         Non face to face consultations had increased from around 1,500 per month pre pandemic, to 15,000 in June.  This shift was expected to continue and become usual practice where appropriate, in line with the aims of the NHS Long Term Plan

·         Kidderminster Treatment Centre continued to operate as a ‘green’ site undertaking limited services.  With spare capacity, some patients waiting over 30 weeks for surgery were also being treated and the Minor Injury Unit based there had increased its opening to 8am to 10pm 7 days a week

·         Worcestershire Royal and the Alexandra Hospital would remain open for emergency activity only, however, some complex elective surgery which was unsuitable for the independent sector, would occur at the Worcestershire Royal, utilising the new Aconbury Ward block as a clean safe entry pathway involving self-isolation before admittance 

·         The WAHT hoped to be able to work with commissioners to eliminate the long wait times experienced by some patients in the past

·         In response to a query about the impact on death rates of potentially life-saving screening programmes being paused, it was explained that the balance of risk was considered at a national level and decisions were taken centrally.  The Committee was advised that all emergency, cancer and complex elective surgeries, such as vascular, had continued throughout the pandemic. Endoscopy was paused nationally, as it was seen as high risk, however, the guidance had now changed and procedures would be resumed from 3 August

·         There had been 275 confirmed COVID-19 deaths in the County’s acute hospitals since 17 March and none from 11 July to the time of the meeting

·         In response to a question as to whether anyone was looking into the unmet demand on outpatients, it was reported that no routine referrals were undertaken.  However, urgent referrals and cancer two week wait referrals were completed.  In a usual month, around 50,000 new and follow up outpatient appointments would occur, in June the figure was around 32,000, which showed the potential backlog anticipated

·         The CCG was doing a piece of work on demand and capacity across the whole system to inform recovery plans for all providers, however in doing so, it was shocked to learn that patients were not going through Primary Care and believed it was important to communicate to residents that Primary Care was open, especially if residents were concerned about their health.  The Committee agreed it was important to educate the public and stressed the importance of getting the message out that health services were open and not to put off contacting their GP

·         The County Council’s Public Health Consultant added that although it was important to stress to residents the need to seek health services, there was a continuous need to be cautious as the pandemic was not over.  Furthermore, there was an increased risk of transmission if further procedures or elective surgery was undertaken 

·         A Member asked about ambulance handover delays, to be informed that good flows had been maintained at the Worcestershire Royal Hospital and no patients had received care in the corridor.  The number of ambulances arriving at A&E were now broadly in line with pre-pandemic levels.

The Chairman of Healthwatch Worcestershire was invited to comment on the discussion and agreed with what had been said about the upcoming challenges in restoring acute services, especially if social distancing remained in place or there was a second spike.  The demands of winter would also add a level of uncertainty, which wasn’t to be taken lightly, however, it was acknowledged that future decisions would likely to be taken at a national level again.

In response, the CCG Managing Director was fully aware that the situation could change and if so, services may need to be paused again, which would further increase the demand once again.

Due to time constraints, the WHCT Director of Strategy and Partnerships agreed to provide the Committee with a written briefing on out of hospital community care and mental health.