Agenda item

In attendance for this item were:

 

NHS Herefordshire and Worcestershire Clinical Commissioning Group:

Mari Gay, Managing Director

 

Worcestershire Acute Hospitals NHS Trust:

Matthew Hopkins, Chief Executive

Becky Bourne, Head of Communications

 

Worcestershire Health and Care NHS Trust:

Matthew Hall, Chief Operating Officer

Sue Harris, Director of Strategy and Partnerships

 

Healthwatch Worcestershire

Peter Pinfield, Chairman and Simon Adams, Managing Director

 

The Chairman welcomed everyone and congratulated Worcestershire Acute Hospitals Trust (the Acute Trust) on emerging from special measures and invited comment from the Chief Executive.  The Chief Executive explained that the Care Quality Commission had recommended the organisation come out of special measures the previous September following its inspection in May/June, but only once a system-wide package had been put in place to ensure continued improvement. The NHS Improvement Senior Committee had signed off this recommendation, which was very good news for staff and patients and he also thanked all the Trust’s stakeholders for the part they had played, although there was more work to do.

 

Mari Gay, Managing Director of Herefordshire and Worcestershire Clinical Commissioning Group (CCG) referred to the presentation included in the Agenda which set out the temporary service changes made to allow services to be managed against COVID predictions and provided an update since the previous two updates to the HOSC on the guiding principles for future planning and services provided by the Acute Trust, the Health and Care Trust) and Primary Care.

 

Guiding Principles

The health system was now preparing for the future and in the case of a second surge of COVID, was in the better position of having early warning triggers and pre-agreed actions to take if required. However, this time it was planned to maintain more services than previously and the guiding principles were to:

·             Limit the risk of transmission of the virus to patients and staff, routinely using alternatives to face to face consultations where this was clinically possible and acceptable to service users

·             Enable clinicians to restore many of the services paused in response to phase 1 so that the amount of cancer surgery, planned care and specialist diagnostic activity was increased

·             Give confidence to the local population that healthcare settings were safe.

 

It would be important to maintain core essential services, cancer services, some diagnostic services and high category elective care such as urgent surgery, whilst restoring patient confidence to come forwards.

 

Worcestershire Acute Hospital Trust

Most face to face outpatient appointments had been suspended and independent sector hospitals (Spire, BMI, Dolan Park) were being used for elective surgery. It was pointed out that screening for breast, bowel and aortic aneurysms previously suspended nationally, had now resumed.

 

There had been some challenges in achieving 100% restoration of services because of COVID restrictions and extra measures needed to prevent infection which therefore reduced capacity.

 

Whereas urgent surgery had been maintained, elective care (planned surgery) had been suspended over 3-4 months, therefore nationally there would be long waits. Public confidence was another obstacle resulting in some members of the public deferring treatment, although as much reassurance as possible was being given.

 

Primary Care

As per national guidance to minimise risks to staff and patients during COVID-19, there remained the ability to offer online and video consultations across all practices in Worcestershire to ensure services were sustained. NHS 111 could also book appointments into all GP practices from Monday to Friday. On 14 September national guidance reiterated that Primary Care was required to ensure:

·                 clear information for patients about how to access services, that encouraged patients to consult where necessary and that face to face care remained available when clinically appropriate

·                 No practice should suggest that it was closed or that face to face appointments were not available

·                 Adjustments should be in place to ensure those who found it difficult to engage in virtual consultation were able to access appropriate care.

 

Worcestershire Health and Care Trust Update

The Health and Care Trust was working to restore services to near normal levels and following an audit of all locations, all were able to offer services. Face to face appointments had continued to be available throughout the COVID-19 period based on clinical need and patient preference and most services had settled into a mix which was sustainable. Some services had remained largely face to face with appropriate PPE for example podiatry, whereas other services had adapted strongly to new ways of working, for example 40% of consultations for Children and Adolescent Mental Health Services were now via video link with very good feedback.

 

A 24hour/7 day week access line for mental health enquiries had been made available through the website and the 50% increase in enquiries during COVID provided confidence that people were seeking advice.

 

Community hospital usage had changed slightly during COVID-19 as due to national discharge requirements people had been coming to them for sub-acute care and more reablement. Bed capacity had needed to be reduced slightly from 243 to 200 to accommodate social distancing, however capacity was now being restored.  Child development centres had re-opened, planned respite for adults and children had resumed and this week the two MIUs previously closed had reopened, with the option of booking through NHS111.

 

The Health and Care Trust was confident in achieving 100% restoration of Mental Health Services, and while initially some patients had wanted to defer treatment, activity levels were now up to pre-COVID-19 levels, and 40% of adult consultation was now face to face, having increased month on month from the previous level of 60%. Further work was taking place on how to respond to and plan for a potential surge in demand, although to date whilst there had been an increase in people experiencing anxiety and using the helpline, numbers with serious mental health concerns had not increased and this may be attributed to efforts to keep services as normal as possible compared to some areas in the region.

 

The Chairman invited discussion and the following main points were made:

 

·       Several HOSC members emphasised how pleased they were that the Acute Trust was now out of special measures.

·       The Chairman asked about capacity at the Acute Trust now that numbers of COVID-19 patients had reduced, what number of beds were now able to be used for elective work? The CCG representative confirmed that current bed numbers at the Acute Trust were 770 and explained that recently there had been very small numbers of COVID patients however, preparations were necessary for what may lie ahead. Commissioners were working hard to restore elective surgery but over the next few months a greater number of beds would need to be kept free, with use of the independent sector being key to maintain services. It was incredibly difficult to predict the future situation.

·       The HOSC Chairman asked whether all capacity in the independent sector had been used and was advised that during the first part of COVID, it was all available as part of a national contract. A further contract in June/July enabled NHS to access 75% of the independent sector, the other 25% being for private work. In Worcestershire, as much capacity as possible was needed and discussion was therefore ongoing between the CCG, the Acute Trust and the independent sector. 

·       A HOSC member reported positive experiences of accessing health services, but cautioned against overloading stretched outpatient services and raising public expectations since she had received a letter advising an appointment would be available by a specific date which upon enquiry was not possible – the CCG representative would report back this issue to inform future working.

·       Clarification was sought on plans for opening hours at Kidderminster MIU by a HOSC member who was aware of some residents’ confusion, and the CCG representative would verify this, but was aware that overnight provision was not currently possible.

·       Another member was reassured by the changes to Primary Care since residents had notified her about out of hours provision in Kidderminster, with some having been directed to Sandwell hospital by NHS 111 or being unable to access Primary Care at weekends. The CCG representative explained that general primary care provision was Monday to Friday, however several out of hours options were available through NHS 111, including an out of hours GP – she would verify why some residents had been directed to Sandwell hospital as if other options were not appropriate then Worcestershire Royal Hospital or The Alexandra should be offered.

·       The Chairman asked whether GPs had a list of patients who may struggle to engage in virtual consultation and what numbers were and the CCG representative emphasized that practices knew their patients and were getting the message out for them to contact the surgery if they needed to. Patient preferences depended on the individual practice, with some patients preferring face to face and others preferring remote consultation.

·       A HOSC member asked about the volume of elective surgery being cancelled or moved to the independent sector and how this was being monitored and was reassured that monitoring took place through a harm review process. The national contract with the independent sector was in place until the end of November, and locally more than the 75% allocation had been used. The representative would need to check exact numbers of cancellations but she also pointed out that some were triggered by patients themselves due to lack of confidence.

·       The Chairman asked whether continued envisaged use of the independent sector until March was around COVID-19 planning or to address backlogs of treatment and was advised that both were relevant.

·       A HOSC member reported that from his own experiences of contact with his GP practice, a telephone appointment was the standard offer.

·       A question was asked about monitoring unmet demand in order to know the scale and the potential problems ahead, and the CCG representative advised that the 52 week waiting list for elective care was already known to be a long wait. Modelling work was being done however scenarios could be very different therefore there was no exact answer yet – whilst appreciating the difficulties, the HOSC member suggested that a best/worst case scenario would help to manage patient expectations and the CCG representative would discuss this suggestion with communications colleagues.

·       The representatives present from Healthwatch Worcestershire were invited to comment and Peter Pinfield (Chairman) explained that since the earlier updates on restoration of services, he had felt the need to verify that the changes being outlined mirrored the experience of the public, for example on access to GP services. Unfortunately, many themes and concerns raised by HOSC members had been echoed through Healthwatch’s research data.

·       Simon Adams (Managing Director of Healthwatch) referred to three Healthwatch publications during COVID-19, which had been positively received. The report on people’s experiences of health and social care services had benefitted from nearly 2,500 survey responses. The other two areas of work had been to look at experiences of those with learning disability and autism and feedback from GP practices. Emerging themes included GP practice communication, fears around availability of future Mental Health Services and concerns about misdiagnosis through remote consultation. Lack of appointment times for GP consultation had been frustrating. The research indicated that patient experiences had not necessarily reflected the national and local CCG message that services were open for business, which was a concern. Overall experiences varied, which could be attributed to the different approach and resources of individual GP practices. Nonetheless, the NHS had responded well to Healthwatch’s reports and health officers were working hard to bring improvement.

·       Commenting on the feedback from Healthwatch, the HOSC Chairman suggested that future work on the consistency of patient experience of GP access could be helpful, and the CCG representative highlighted that GP practices were being carefully monitored particularly around the availability of face to face consultation.

·       Responding to the Healthwatch research, which included fears about access to Mental Health Services, the Health and Care Trust Chief Operating Officer explained that whilst referrals through Primary Care had dipped by 50% at the height of COVID-19, they had now returned to normal levels.

·       A HOSC member asked about the evidence behind the Health and Care Trust’s response to mental health services in light of its importance and historical long waiting times. The Chief Operating Officer explained that the evidence so far suggested that access to services and advice had been opened up through the 24 hour self-access line for mental health. This was not to say that an increase in serious mental health problems would not arise, for example as factors such as job losses took effect. The public was worried in general (about COVID) but in the main this was within the expected range.

 

Acknowledging that the Acute Trust’s Chief Executive had needed to leave the meeting, the Chairman requested the following information, which would help the Committee to understand the situation and trajectory in terms of how capacity and patient numbers were changing:

 

·       Number of patients being treated in the independent sector

·       Number of beds available in acute hospitals for routine operations and for COVID-19 patients

·       Number of operations cancelled

 

In addition, the following information and action was requested:

 

·         Kidderminster MIU opening hours

·         The CCG representative would report back issues to inform future working:

Ø  reports of patients being incorrectly directed to Sandwell hospital via NHS111

Ø  automated outpatient letter giving unrealistic timeframes

Ø  the suggestion to inform the public about potential waiting times in order to manage expectations.