Agenda item

In attendance for this item were:

NHS Herefordshire and Worcestershire Clinical Commissioning Group – Simon Trickett, Chief Executive

Worcestershire Acute Hospitals NHS Trust - Paul Brennan, Chief Operating Officer and Deputy Chief Executive

Worcestershire County Council – Dr Kathryn Cobain, Director of Public Health

Simon Trickett, Chief Executive of NHS Herefordshire and Worcestershire Clinical Commissioning Group (CCG) referred to the presentation slides included in the Agenda which provided a high-level overview of the Covid-19 vaccination programme and next steps in restoring services.

The vaccination programme in Worcestershire had been very successful, and consistently one of the best performing in the country, and he paid tribute to everyone involved especially the primary care networks and GPs. Everyone was aware that immunisation was key to emerging from the pandemic and the programme was therefore likely to be the most important task in colleagues’ careers. Vaccines were being provided at three large scale vaccination centres, 12 GP-led sites and community pharmacies, a network which had worked well and was therefore likely to continue for the foreseeable future.

Updated vaccination figures were provided, and as of the end of 7 March, 338,000 first doses had been administered across Herefordshire and Worcestershire, equating to 51% of the adult population, and more than 75% of those over 50, which were really important figures. Cohort six was now being vaccinated, which included any adult with a long-term health condition who was eligible for a flu vaccine. Vaccine supply could be adapted, for example, since vaccination figures were slightly lower for Redditch, more vaccines would be allocated. 

There had been some problems with vaccine supply in January/February, when weekly vaccinations administered totalled 25,000 to 35,000, but a significant increase in supply was now anticipated, therefore the schedule moving forward would be 55,000 to 65,000 doses per week across Herefordshire and Worcestershire, which was really positive. In general, vaccine take-up was very high, almost 100% in many cohorts, and the CCG would continue work with Public Health and district councils to address the hard to reach groups such as black and ethnic minorities and homeless people, where an adapted approach was being taken.

The new phase of administering second doses was progressing well and it was hoped that by the end of March all of those aged over 50 would have received their first dose, ahead of the national target, with all adults having access to a second dose by the Summer. Nationally, it was anticipated that Covid vaccines were here to stay and that further vaccines would be needed in the Autumn.

As the local situation continued to improve and the really challenging level of demand for intensive care started to reduce, there was increased focus on the NHS recovery programme and health partners were working together to align capacity. Priority areas included urgent and cancer care, clinical assessment and diagnostics for patients on waiting lists, addressing health inequalities in recovery and ensuring Long Covid symptom support.

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

·       HOSC members paid tribute to the excellent vaccination programme which, had been very well received by residents.

·       It was confirmed that vaccination take up amongst health and care staff was very good (over 90%), with some younger staff less inclined since they felt less at risk - there was a concerted effort to address this and national requirements for individual discussions with relevant staff and review of their role.

·       In response to a query about long-term plans for ensuring patient access to vaccines arising from concerns from Wyre Forest residents about being directed to Dudley and querying why the Bewdley surgery was not being used, the CCG representative agreed that accessibility was important and while initial modelling had been based on the national requirement for everyone to have access within a 45 minute journey, most people were much closer. It had been necessary to consider overall resources for example to facilitate telephone and face to face GP appointments.  Most vaccination sites would stay open for the next phase of vaccination, however he suspected there would be a move to more reliance on mass vaccination sites closer to the Summer, especially as younger age group cohorts were more able to travel. Local access would continue to be reviewed and community transport had been a helpful facility in Wyre Forest.

·       Regarding the move to clinical assessment and diagnostics of patients on waiting lists, a member asked for views about the potential for unmet demand and how this would be handled?  He was advised that in general GP referrals had been much lower in the past 12 months, which was an expected consequence of patients not approaching their GP.  The demand position should soon become clearer and the focus would be on reviewing assessed needs of those who had been on waiting lists for example for a year, and while some referrals may no longer be needed, a clear concern was for those conditions which had deteriorated.

·       Waiting times for treatment following diagnosis depended on the condition concerned and this would be a focus for the coming weeks - the system prioritised urgent appointments or treatment and use of the independent sector had been helpful.

·       The CCG representative agreed the importance of early diagnosis to avoid storing up problems for the future and encouraged all councillors to encourage people to come forward.

·       Regarding out of area people’s access to vaccines, it was explained that where contact was through GPs this was within the CCG control, however a lot of people from outside Worcestershire were using the national booking system, which ran in parallel. This caused some issues for example people being contacted by their GP as well as receiving a letter for the mass centres. Worcestershire’s large vaccination site (Three Counties Showground) was a great site and with the increased supply of vaccines, would have capacity for approximately 9000 doses a week.

·       Any vaccine supply issues were down to national supply and factors such as manufacture and transport but after a stuttering start, there was confidence in local delivery capacity moving forward.

·       Comment was invited from Simon Adams, the Healthwatch Worcestershire representative present, who praised the vaccine rollout, but also cautioned against the distance to access vaccinations becoming a health inequality issue, a point which was acknowledged by the CCG representative as something which would be kept under review – he also explained that while a journey of within 45 minutes was the national guide, he would be surprised if most people needed to do half this distance.

·       The work and take-up of events by Wyre Forest Health Partnership was praised.

·       It was noted that if someone did not take up the offer of a Covid vaccine, the offer remained open to them.

·       The Council’s Director of Public Heath welcomed the positive feedback about the vaccine rollout and echoed the CCG comments about its huge importance in moving forward. She stressed the importance of people taking up their vaccine offer, which was so effective and reduced transmission of Covid.

·       Paul Brennan, the Worcestershire NHS Acute Hospitals Trust representative provided an update on numbers of Covid patients in Worcestershire hospitals, which had moved from 141 during the first peak (April 2020) to significantly higher numbers of 269 during the second (January 2021) peak.  At one point, of the Trust’s 761 general acute beds (excluding critical care, maternity and paediatrics), just under 400 were being used for Covid patients or those being cohorted. There had been a gradual reduction in cases, linked to the impact of the vaccine and increased adherence to lockdown. There were now 76 Covid patients in hospitals, plus five cohorting and just over 130 of the 761 beds were allocated on the Covid pathway, which was a much improved position. Critical care had been the biggest challenge, with six critical care units being required instead of the usual two, and this had now reduced to four. The previous day, the Trust’s alert level had been reduced from five to four, however Covid would be an ongoing challenge for the health and care system and he suspected the need to maintain designated inpatient areas through the Summer if not through to the Winter.