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)

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 operations.  At that time, the average length of stay in hospital was 4 days.  There had also been an improvement (compared to other Trusts) in October of the number of patients waiting more than 4 hours in A&E, compared to September.  Maternity services had also been under pressure during the month, mainly due to workforce availability and known high numbers, with 441 births.

Residents were urged to ‘Think NHS 111 First’ to ease pressure on A&E and Members were asked to highlight this message.

WAHT had introduced a Recovery & Reset Programme, which would be embedded over time, however, workforce flexibility and digital innovations had already helped enormously.  WAHT had set aside £4.9m for technology infrastructure and work was already underway, with some grant funding due.

During the discussion, the following key points were made:

·         Members were very grateful for the courage and dedication of NHS Staff and thanked everyone for their efforts during the very challenging time

·         Of the 71 COVID-19 positive patients that day, 42 were at Worcestershire Royal Hospital and 29 were at the Alexandra Hospital in Redditch

·         There had been 1,500 new cases over the last 7 days, with the rise in numbers aged 60+ extremely worrying

·         Longer endoscopy wait times was due to the requirement of full personal protective equipment (PPE) being required for staff when undertaking aerosol generating procedures, which in turn affected overall capacity. Additionally, staffing numbers had been affected.  Although extra capacity was put in during 2019, the impact of COVID-19 measures had resulted in 6 to 8 endoscopies being carried out in a clinical session, rather than the usual 12.  Evesham Community Hospital was currently in use and further sites were being considered, however, staffing would continue to be a constraint

·         Concern was raised about delays in cancer diagnostics, with some Members reflecting on individual stories.  The concerns were shared by WHAT, however, Members were reminded that in March, a national directive was given to all NHS organisations to cease all non-urgent services.  Data suggested that the backlog would take 12 to 18 months to return to pre-pandemic levels

·         Residents who were concerned about delays or had queries were encouraged to contact the Patient, Advice and Liaison Service (PALs) and were also urged to make contact with their GP or their Consultant if they experienced new symptoms or a deterioration  

·         Members appreciated the overview of September 2020, however asked for comparative figures for other months, something which the Chief Executive agreed to provide

·         Nationally, there was an expectation to restore 90% of pre-pandemic activity

·         To stress the challenges ahead, it was reported that in February 2020, no patient was waiting over 52 weeks for an operation and less than 12 were waiting over 40 weeks (against the 18 week target), however, based on current data, the number of patients needing to wait 52 weeks could be 2,000 by March 2021

·         WAHT vacancy rate was dropping, currently 8%, with less than 12% turnover.  The work with Worcester University was seen to be crucial for the future, although physical space on the hospital sites would continue to be a challenge.

Sue Harris referred to the agenda report in relation to HWHCT, where restoration of services was currently at 90%.  Digital innovations were ongoing.  Patient feedback around what worked well was important and although video contact would continue, face to face contact was preferred for first assessments.  Promotion and marketing of the ‘Now We’re Talking for Healthy Minds’ campaign had resulted in 1,200 self-referrals.

The Community Mental Health Transformation programme, covering around 50% of Worcestershire, launched on 1 October rather than 1 April.

The predicted surge of referrals to the Child and Adolescent Mental Health Service (CAMHS) had yet to occur, however, referrals were currently at pre-pandemic levels.  There were no waiting time issues for CAMHS.

The Community Paediatrics service had seen a significant rise in referrals and although there was no current waiting time, it was suggested that there could be a capacity issue in 3 to 4 months.

HWHCT was in daily contact with health colleagues to manage services across the County, with options to deliver additional services from community hospitals where possible.  In addition, the Neighbourhood Teams were working closely with paramedics to provide home support rather than conveyance to hospital

HWHCT that day had 8 COVID-19 positive patients across 3 sites and all Community Hospitals were open, supporting residents to ‘Think NHS 111 First’.

In response to a query whether patients required an appointment for A&E, it was explained that there had been some use of this in the County, however, there was no national campaign at present.

Representatives from Healthwatch Worcestershire were invited to comment on the discussion and made two main points:

·         Healthwatch surveys continued to show a variance in access to a GP across the County

·         The presentation and discussion were a fair reflection of the real challenges facing the NHS.

The HOSC Chairman asked those present whether there was a feeling of when the Wave 2 peak in COVID-19 cases would be, to be informed that the Acute Trust was potentially expecting their peak to be w/c 29 November 2020, however, in Wave 1 the peak was earlier than predicted. 

The Director of Public Health added that the health system was monitoring the situation on a daily basis and that the coming weeks would depend on the actions of residents.  Key messages had not changed and were for everyone to limit contacts, adhere to social distancing and to wash their hands frequently.

When asked what would be most helpful, the WAHT Chief Executive echoed all the key messages and encouraged people to follow all of the guidelines, to not go out or go to work if symptomatic and to book a test.  If eligible, residents should also have the flu vaccination.  In addition, if residents felt unwell, or had other health concerns, then not to delay in reporting to the GP or Consultant.

The HOSC Chairman thanked everyone present for a very helpful update in very difficult times and on behalf of Members, thanked all NHS staff.