Agenda item

Attending for this Item were:

Herefordshire and Worcestershire Clinical Commissioning Group (HWCCG)

Emily Godfrey, Associate Director of Programme Management

Worcestershire Acute Hospitals NHS Trust (WAHT)

Paul Brennan, Deputy Chief Executive and Chief Operating Officer

Herefordshire and Worcestershire Health and Care NHS Trust (HWHCT)

Sue Harris, Executive Director of Strategy and Partnerships

Worcestershire County Council (the Council)

Kathryn Cobain, Director of Public Health

Update on Health Services during the COVID-19 Pandemic

The Associate Director of Programme Management took the HOSC through the Report, highlighting the following key points:

·         The NHS had continued to provide urgent and non-urgent treatment throughout the COVID-19 pandemic, whilst taking steps to protect patients

·         The pressure on staff, beds and equipment combined with enhanced infection protection and social distancing had resulted in patients waiting much longer for treatment

·         The COVID-19 vaccination programme had been a success, meaning that the NHS was in a position to refocus its efforts on a recovery plan ensuring that priority was given to patients in most need of urgent treatment

·         The national NHS Operational Planning guidance, released on 25 March 2021, had resulted in a single Herefordshire and Worcestershire reset and recovery plan taking into account the strategic goals of the NHS Long Term Plan

·         The local Plan included areas such as agreeing key priority risk areas, financial and workforce challenges, embedding learning from the pandemic and communication strategies at all levels

·         Senior Leaders from across the Herefordshire and Worcestershire health and social care economy were meeting weekly to oversee the delivery of the Reset and Recovery Plan as a system, mindful that COVID-19 would impact the programme for some time.

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

·         A Member asked about the GP provision for Tenbury in particular the difficulties in the GP practice wishing to expand into to the Hospital due to an increase in population, yet the indicative costs being prohibitive.  In response, it was reported that discussions were ongoing, but conversations, especially around finance, would become easier when the Integrated Care System (ICS) was in place

·         When asked what assumptions were made when the Reset and Recovery Plan was written, Members heard that meetings were taking place daily to ensure plans could progress, however, at the time of writing, COVID-19 cases in Worcestershire were at around half of the England figure.  At the time of the HOSC, the figure was much higher, with around 330 new community transmitted cases each week.  Plans were in place for a third wave of COVID-19

·         The number of COVID-19 patients being admitted to Hospital was small, although admissions had doubled in the previous 10 days.  If NHS projections were accurate locally, the restoration of services may need to be paused.  It was noted that all admitted patients had received at least one dose of the COVID-19 vaccine

·         Length of stay was now also significantly reduced.  In Wave 1, average length of stay was 12 days, in Wave 2 it had been 11 days and at the time of the HOSC it was around 4 days.  As of 19 July 2021, the 2 Acute Hospitals had 16 COVID-19 positive patients, 2 of which were in Intensive Care, however, across the two sites, 34 beds had been designated COVID-19 beds

·         When asked whether the situation was replicated across Primary Care and Community healthcare, the Executive Director stated that the picture was broadly the same across the whole system, with the number of Staff having to self-isolate increasing

·         A Member raised a local issue in relation to a potential location for a pop-up vaccination centre.  The Associate Director agreed to investigate and provide a response outside of the meeting

·         Mental Health referrals were increasing slowly, however the HWHCT was not currently seeing a massive shift

·         A Member was aware that some patients were paying for diagnostics privately resulting in quicker NHS treatment.  The HOSC was told that waiting lists for treatment were reviewed weekly and the independent sector continued to be used significantly to increase capacity for scanning, endoscopy and elective surgery.  Siting a mobile endoscopy unit at Kidderminster was also being investigated.  In addition, a Community Diagnostics Hub was being developed, utilising community resources to a greater extent 

·         Throughout the pandemic, the Cancer 2 week wait pathway had been maintained, however, it was noted that during Wave 1 and Wave 2 fewer patients were referred.  Recently, there had been a significant increase in Breast Cancer referrals

·         Members were concerned about digital exclusion as not all patients had access to electronic devices, mobile phones or the internet.  The NHS was mindful of this for both Consultant and GP remote consultations and a working group had been set up to ensure that every aspect of each Plan addressed digital inequality.  The Associate Director reported that digital consultations should add value to the process, not add another step for the patient.  It was agreed that a Report on digital exclusion would be brought back to the HOSC in due course

·         Some Members gave examples of differing experiences of gaining access to Primary Care, concluding that the service should not be so varied.  As an area of concern, it was agreed to add GP Access to the Work Programme

·         In response to a query about future capacity, for example the resources needed to manage long-covid patients or support babies born during the pandemic, the HOSC noted that there was already a clinic for long-covid patients with a Plan in development which could be shared with Members when finalised.  In addition, Maternity recovery plans was a particular area of focus

·         A Member asked how the NHS would measure the success of the national programme of ‘Getting it Right First Time (GIRFT)’ designed to improve productivity.  The concept, which was led by clinicians, had been in place for a number of years, however, calculations were made to determine the optimum number of operations in a typical day and data could be compared to benchmark Worcestershire against other areas

·         When asked how long it would take to clear the backlog, Members heard there was a significant number of patients waiting for diagnosis and treatment.  WAHT’s view was that it would take 3 years to return to pre-pandemic levels.  When asked what the HOSC could do to assist, it was stated that advocating infection control, the use of masks and maintaining social distance would help keep hospital beds and staff available for longer

·         There was scope to outsource procedures to other areas, however, the national picture was similar.  In relation to Cancer services, depending on the nature of treatment, for safety a patient may be referred to Birmingham, Coventry or Gloucester for example.  Furthermore, a patient may choose an out of County Hospital for a GP cancer referral.

Temporary Service Changes

It was reported that the majority of services had now been reinstated, although not always delivered in the same way as pre-pandemic.  A small number of temporary service changes remained.

·         Athelon Ward, Newtown Hospital, Worcester – in response to COVID-19, patients on the Ward, for older adults with functional mental health illness, went home with a bespoke ‘Hospital at Home’ service.  Continuous monitoring and evaluation of patient and carer experience had taken place, with positive results.  If results continued to be positive, HWHCT had a view that a formal consultation process may commence later in 2021

·         Garden Suite Ambulatory Chemotherapy Unit – the Garden Suite was relocated from the Alexandra Hospital in Redditch to Kidderminster to ensure that WAHT could continue to provide chemotherapy whilst doing everything possible to protect patients from the risk of COVID-19 infection.  Capital funding was made available to refurbish a disused area at Kidderminster for the Garden Suite from its temporary base in a theatre recovery area.  The Hospital was now operating at maximum theatre capacity to keep elective surgery running.  The status of the move continued to be temporary and no permanent decision would be made without formal consultation with patients, the public and the HOSC

·         Kidderminster Minor Injuries Unit (MIU) Opening Hours – WAHT kept the MIU open throughout the pandemic, but not at the usual 24/7 hours of operation.  From March 2020 it was 8am to 8pm daily and from July 2021 8am to 10pm each day.  No permanent decision on future opening hours would be made without appropriate patient and public participation, however, it was anticipated that a view would be formed later in 2021 as the WAHT believed that the current opening hours probably met the need of residents.

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

·         Some Members were extremely concerned about the potential permanent move of the Garden Suite suggesting that WAHT had already made the decision.  The Deputy Chief Executive gave assurance that the relocation was still temporary and no decision had been made

·         In response to a question that chemotherapy should always be offered close to home, it was noted that if the temporary move had not taken place, the service would have stopped.  A Member asked whether there was a case for a Suite in both locations, however, this was not a realistic option due to workforce challenges

·         A number of factors would need to be taken into account, including transport links, before WAHT came to a view about the future location of the Garden Suite.  Furthermore, if the view was to make the temporary move permanent, a formal consultation process would need to take place, which would include attending HOSC.  The Deputy Chief Executive suggested that a view may be formed by the end of 2021

·         The Cabinet Member with Responsibility for Health and Wellbeing commented on the 31% increase in A&E attendance.  MIU attendance had dropped by around 37%, with Members suggesting that residents were confused about what services were available where and when as MIU operating hours and services varied across the County.  Local MIU communications had recently been published and it was agreed that these should be shared with the HOSC for distribution to all County and District Councillors

·         A Member asked whether there was scope to standardise MIU opening hours and services, to be advised that there had previously been a trial of 8am to 8pm, however, there had also been challenges over staffing levels

·         Attendance at Kidderminster MIU for the period April to June 2021, was similar to the same period in 2019, with 2,000 patients seen in June 2021, compared to 1,500 in April 2021

·         A Member was concerned about staffing levels at Kidderminster MIU and A&E at the Alexandra Hospital in Redditch knowing that a large event was taking place locally in the following days, the first weekend following COVID-19 relaxation of rules.

The HOSC Chairman invited the Managing Director of Healthwatch Worcestershire to comment on the discussion and the following main points were made:

·         In relation to concerns about digital exclusion, there had been huge success with the pop-up vaccination centres around the County

·         In relation to concerns about GP access, the GP Annual Survey had recently been published, with Worcestershire satisfaction increasing.  Healthwatch had received a lot of patient feedback in recent months and had published a Report for Quarter 1 activity, which would be shared with Members

·         In relation to Cancer Services, patients always had a choice on where to receive treatment and some patients chose out of County hospitals as robotic equipment was available.  In response, the WAHT Deputy Chief Executive reported that the Trust was looking at options to acquire a robot.

The Chairman thanked those present for an informative discussion and the Committee’s appreciation for the hard work, dedication and commitment of NHS staff in such challenging circumstances was noted. 

The HOSC agreed that:

·         A report on Access to GP Services would be added to the Work Programme

·         A report on Digital Exclusion and Inequalities would be added to the Work Programme

·         A response to a local query about the potential location of a pop-up vaccination centre would be provided

·         The developing Plan for long-covid patients would be shared with HOSC when available

·         A report on Healthwatch Quarter 1 activity would be shared

·         Publicity material for MIU opening hours and services would be shared with HOSC so that Councillors could promote in their own areas, including with District Councillors.