Agenda item

Joint report/presentation of Staffordshire Secondary Care NHS Providers, Clinical Commissioning Groups and Staffordshire County Council  

The Committee considered a joint PowerPoint presentation/report (slides attached at Appendix A to the signed minutes) by the Chief Executive of University Hospitals of North Midlands NHS Trust (UHNM), Chief Executive Officer of University Hospitals of Derby and Burton Foundation Trust (UHDB), Chief Executive of Royal Wolverhampton NHS Trust (RWT), Chief Executive of Midlands Partnership Foundation Trust (MPFT), Accountable Officer of Staffordshire Clinical Commissioning Groups (CCGs), Cabinet Member for Health, Care and Wellbeing, Staffordshire County Council (SCC) regarding the impact of the 2020 Covid-19 pandemic on each organisation’s Winter Plans for the 2020/21 season.

Paul Bytheway (Chief Operating Officer), UHNM; Duncan Bedford (Executive Managing Director), UHDB; David Loughton (Chief Executive), RWT; Jennie Collier (Managing Director, Staffordshire and Stoke-on-Trent Care Group) MPFT; Marcus Warnes (Accountable Officer), Staffordshire CCGs; Johnny McMahon (Cabinet Member for Health, Care and Wellbeing) SCC and; Simon Whitehouse (Director), Together we’re Better (Sustainability and Transformation Partnership (STP) for Staffordshire) were present at the meeting.

All NHS secondary care trusts were required to produce Winter Plans aimed at ensuring services were configured towards:- (i) preparedness; (ii) prevention and; (iii) protection of the local population against the major avoidable ill-effects of winter on health. Members had previously expressed serious concern over the additional pressures likely to be experienced by Trusts during the 2020/21 season owing to a surge in demand exacerbated by the Pandemic.

The presentation slides circulated to the Committee in advance of the meeting gave detailed information regarding:- (i) Phase Three National Restoration and Recovery Priorities; (ii) Restoration and Recovery: Waiting Lists Update; (iii) Assumptions this Winter informed by Data relating to Accident and Emergency Attendances, Primary Care Appointments, NHS 111 Analysis; (iv) Areas of Focus; (v) Mental Health; (vi) Planning for Covid-19 Surges; (vii) Communications and Engagement; (viii) Risks and Mitigations; (ix) National Discharge Service: Policy and Operating Model; (x) Discharge Pathways – System Success; (xi) additional submitted Trust specific information.

Following an introduction from the Director, Together We’re Better in which he referred to the uncertainty surrounding the future of the outbreak and emphasised Health and Care’s overwhelming priority to keep people safe by:- (i) reducing the length of time spent in hospital; (ii) preventing admissions; (iii) increasing community capacity; (iv) supporting care homes; (v) working collaboratively and; (vi) implementing the enhanced NHS flu-vaccination programme, Members scrutinised and held the organisations to account over the scope, timeliness and details of their Plans, asking questions and seeking clarification where necessary.

In response to requests for clarification regarding support for care homes, recruitment of General Practitioners (GPs) and mental health service provision, the Managing Director, MPFT referred to joint working already undertaken with the County Council to provide additional targeted support to Staffordshire Care Homes at the start of the pandemic which would continue throughout the winter and through the recovery phase. Hospital Trusts were receiving additional funding to support existing discharge models aimed at reducing the length of admissions and mental health services were being bolstered through additional investment identified in the Long-Term Plan. The CCGs Accountable Officer acknowledged current difficulties in recruiting Doctors to General Practice (GP) and highlighted a new multi-disciplinary teams’ model which had been adopted in response. This model sought to provide a holistic approach to care through vertical integration services and better signposting to non-acute Trust secondary care at GP surgeries.

The Chief Executive, RWT added that vacancy rates for Doctors were currently low at his Trust and referred to the success of vertical integration in reducing demand. The Chief Operating Officer of UHNM confirmed a similar position at his Trust. However, whilst the vacancy rate was currently 15% for nurses this would hopefully be addressed by an intensive recruitment campaign during the next three months. He went onto to refer to the challenges they faced in respect of recruitment to medical wards and emphasised the importance of supporting existing staff to keep well and motivated. The Executive Managing Director, UHDB spoke of the importance of an providing an efficient testing regime for staff and paid tribute to their work and commitment during the pandemic.

The Director, Together We’re better stressed the importance of co-ordinating communication across Health and Care in respect of:- (i) service provision; (ii) the importance of wearing personal protective equipment and following hygiene advice and; (iii) promoting the enhanced NHS vaccination programme in order to reduce demand for services over the winter period. In response to a question regarding the proposed closure of the Knivenden Partnership which provided occupational therapy vocational rehabilitation service in Leek, he undertook to obtain a formal response from the Chief Executive of North Staffordshire Combined Healthcare NHS Foundation Trust for the Member concerned.

The CCGs Accountable Officer explained the position with regard to funding for Health in Staffordshire during the short, medium and long terms. Additional funding had been provided by Central Government during the first four months of the Covid-19 outbreak. Whilst funding in the short term was not a cause for immediate concern, the position with regard to the second half of the year was currently being finalised. With regard to the long term, there was a deficit of approximately £165m across Staffordshire CCGs which would have to be addressed in due course, in line with NHS England’s expectations. However, in-year performance was currently a break-even position.

A Member expressed his concern regarding pathways to discharge, particularly in respect of Care Homes and the ability of the County Council to provide timely care packages so that delayed transfers of care could be avoided. He went on to pay tribute to hospital staff and sought re-assurance that appropriate measures were in place in to support their welfare so that services could be maintained. In reply, the Managing Director, Staffordshire and Stoke-on-Trent Care Group, highlighted the revised discharge guidance referred to in the slide presentation. Health’s focus was on supporting patients to return home, as quickly as possible and all Partners were confident this could be achieved. The Director of Health and Care added that approximately 75% of hospital discharges were to a home setting whilst 25% were to step-down beds/residential care settings. Although the position in Staffordshire was better than in other areas in the Country, there was scope for further improvement. All patients would ideally be discharged without requiring further care. However, bed occupancy rates in Staffordshire Care Homes were currently lower than had been the case pre-covid and the care market was currently resilient.

The Chief Operating Officer, UHNM highlighted the additional measures his Trust had implemented to maintain access to Covid-19 tests by staff. The Director of Health and Care explained the testing regime currently in place in Staffordshire Care Homes and said that delays in obtaining test results were being addressed by Central Government.

In response to a question from a Member regarding social isolation and its detrimental impact on mental health, the Managing Director, Staffordshire and Stoke-on-Trent Care Group, MPFT acknowledged the scale of the issue caused by the pandemic. However, she referred to the valuable contribution made by the voluntary sector and highlighted a role for County Councillors as community leaders in combating this problem.

A Member cited difficulties which had been brought to her attention by local residents who had experienced difficulties in obtaining winter flu vaccinations owing to a lack of appointments at GP surgeries. In response the Accountable Officer explained that an enhanced programme of vaccinations was being implemented for the 2020/21 season to include the over 50 age group and others. Whilst vaccinations would be given on an appointment only basis, some practices had commenced roll-out sooner than others. With regard to routine appointments with GPs, although surgeries had not closed during the pandemic, appropriate social distancing measures had been implemented to reduce the risk of transmission. However, the reduction in the number of patients contacting/visiting surgeries had been noted. He went on to request details of any specific problems which had been brought to the Members’ attention so that he could take any necessary action. 

Another Member referred to delay’s he had experienced in receiving appointments at ophthalmology clinics together with the problems faced by patients waiting for eye surgery during this time. In reply representatives from Health referred to the difficult balance between maintaining access to face to face appointments by patients and reducing their risk of contracting Covid-19. The Chief Operating Officer, UHNM acknowledged the issues faced by his Trust in this area. Their Ophthalmology Department was currently running at 80% capacity compared to the position pre-covid. Although there was no easy solution to the problem, the Trust were investigating the possibility commissioning additional capacity from the private sector. The Executive Managing Director, UHDB commented that his Trust had also experienced similar issues although they had recently implemented a new triage system aimed at reducing the backlog. Their Orthopaedic Department was also faced great challenges despite additional operating theatre capacity being acquired.

Further discussion ensued on the 2020/21 flu vaccination programme and Health’s ability to complete appointments within the available timescale given the pressures created by the Covid-19 pandemic. The CCGs Accountable officer acknowledged that the task was ambitious. However, he was confident the first cohort ie over 65-year olds and vulnerable groups would receive their appointments as a priority and without delay. Unfortunately, those in the second cohort would have to wait longer for their appointments but supplies of vaccine were readily available. Whilst it was hoped all those eligible would choose to be vaccinated, it was not mandatory and every effort would be made to achieve as near to 100% take-up as possible through an effective media campaign.

A Member commented that better use could be made of Patient Participation Groups in helping to disseminate information about the above-mentioned campaign. Also, it was critical to keep people informed, particularly those in the second phase of the vaccination programme who might experience delays.       

In response to concerns expressed by the Committee, the Cabinet Member for Health, Care and Wellbeing undertook to:- (i) investigate the possibility of introducing a mental health element into training received by Staffordshire care workers and; (ii) ensure elected Members were included in the communication initiative to support the vaccination programme in an effort to maximise take-up.

The Chairman then thanked Health and Care for their attendance, an interesting an informative presentation and the opportunity to provide constructive scrutiny for the benefit of residents of the County.

RESOLVED – (a) That the report/presentation be noted.

(b) That the impact of the 2020 Covid-19 Pandemic on the implementation of NHS Winter Plans be closely monitored and any further scrutiny be undertaken at the appropriate time, as necessary.