Agenda item

To receive an update and presentation from the Coventry and Warwickshire health and care system.

Adrian Stokes spoke to a circulated report and presentation. COVID-19 had created an unprecedented situation, which the Coventry and Warwickshire health and care system had responded to with significant pace.

The response to COVID-19 was being managed in four phases:

·       Phase 1 – Service change (immediate response to COVID-19)

·       Phase 2 – Restoration (6 weeks from May to July)

·       Phase 3 – Recovery (to March 2021)

·       Phase 4 – Reset (2021/22)

The covering report explained the role of the Reset Co-ordination Group (RCG) to oversee the Restoration, Recovery and Reset Programme. It listed the correspondence and guidance from NHS England and Improvement (NHSEI), which had been adopted, alongside the local decisions taken, with fast-track transformation initiatives, resilience measures and the need to suspend some services, whilst delivering other services virtually.

Looking to the future, maintaining the transformation would assist with meeting the short to medium term challenges of restoration and recovery, whilst providing for reset of the local health and care system to be more effective and sustainable.

The presentation included slides on:

•        Context

•        Ongoing backdrop of Covid-19

•        Starting v stopping

•        Productivity paradox

•        Partnership working strengthened

•        Locking in innovation

•        The Health and Care Partnership graphic

•        A flowchart showing the phased approach to restoration, recovery and reset

•        Phase two priorities

•        Essential services

•        Test, track & trace

•        Care homes

•        Mental health

•        Takeaway messages

•        All phases happening simultaneously =

•        complexity

•        Level 4 response running into winter

•        Partnership working – “fleet of foot”

•        Communication is key

Anna Hargrave gave a precis of the circulated report, speaking about the service changes required, key learning points, the ability to respond quickly and the impact of these changes on communities. Currently, a period of evaluation of the quality and equality impacts of the required changes was taking place. This included drawing on the survey by Healthwatch Warwickshire (HWW) and through targeted work with specific groups. This would lead to the next phase of planning to look at service restoration, addressing inequalities, needs assessment and the establishment of a system-wide group to focus on addressing inequalities. It would include discussions with the NHS workforce and undertaking risk assessments for staff deemed at risk. There was a need to understand the impacts of Covid-19 and to lock in changes, whilst being mindful of both quality and equality.

Questions and comments were provided, with responses provided as indicated:

•        Ensuring that the revised provision included traditional face-to-face services, as well as making use of technology. Some patients value the relationship with their GP and/or would be less comfortable discussing certain conditions remotely. This reflected the feedback commissioners had received and there was no target percentage for virtual appointments. This was about offering a choice and maintaining a balance.

•        Noted that there had been 80,000 GP appointments online.

•        Questions about the impact of the pandemic, in terms of waiting lists, demand and capacity.  This was an area for further detailed research, with a suggestion to undertake such research via a small group of councillors. 

•        A point about developing stronger communities with healthier lifestyles, so people were more able to cope when subsequent viruses occurred. It was asked how the NHS would make use of the HWW survey in designing future services and ensuring the patient voice was included.

•        Covid-19 had found any weak spots in infection control. Hospitals, especially George Eliot Hospital (GEH), had made improvements and transmission rates were now virtually at zero. It was important not to lose the learning from what had been put in place.

•        A concern about demand and capacity, with reference to some hospital waits being over 52 weeks. It was questioned how this would be addressed.

•        Covid-19 had highlighted health inequalities in some areas and amongst some sections of communities. It was suggested that a report be provided to a future meeting of the committee, to identify inequalities and the strategies proposed to address them.

•        Reference to a presentation at Nuneaton and Bedworth BC from GEH. Covid-19 test results were being received within 2 hours which assisted with infection control. Having such turnaround times at all hospitals would be helpful, especially during the winter period.

•        An update was sought on staff changes within the local health workforce.

•        Mental health was a significant issue. Data was sought on the numbers of people requesting help and whether there were any backlogs in services.

•        The impact of wider determinants of health such as poor diet and lack of exercise. There is a need to encourage healthy lifestyles to provide resilience.

•        Context that there were only four patients with Covid-19 in the three Warwickshire hospitals. This had been the approximate number over the last 10 days. A concern at the slow pace of service recovery given the low number of Covid-19 patients in hospital. There were several reasons for this comprising lost capacity, due to the need to separate patients with Covid-19, infection prevention and control (IPC) slowing service delivery and emergency admissions were now operating at a higher than normal level. These all impacted on routine elected procedures.

•        Praise for the comprehensive recovery and restoration plan. The points on addressing health inequalities were welcomed, it being suggested that when this item was revisited, it should cover both service provision and health outcomes.

•        From the HWW survey, many people had said they received lots of information, but poor communication. There could be barriers to communication, examples being for deaf people, or those who were visually impaired. Information needed to be timely and accessible. 

•        Many respondents to the HWW survey listed mental health as the top priority. Examples were given of the types of issues people were experiencing. When determining future commissioning, there was a need to consider the legacy of mental health issues and the number of new cases presently unknown to the health sector.

•        The Chair asked for HWW to share its survey findings. An offer was made to discuss the survey findings at a future committee meeting.

•        Reference to winter pressures, the number of flu cases that were often seen and if this coincided with a spike in Covid-19 cases, it was questioned if there was staffing capacity both for the acute and nightingale hospitals.

•        Adrian Stokes summarised that some of the questions above concerned performance data such as waiting lists and GP appointments. This was available at a granular level for each speciality and across each hospital site. The suggestion for a separate session to discuss this was useful. The current data showed many positives, examples being reductions in waiting times for diagnostics and the cancer pathway.

•        Anna Hargrave responded to the points about inequality and mental health concerns. Commissioners did not want to prejudge what was needed and had met with HWW to discuss how best to engage, including with the voluntary and community sector (VCS). It could not be assumed that the previous service offer would deliver improvements, and this was an opportunity to reset, also to look at how to communicate and the role of the VCS was critical in supporting local communities.

•        On IPC, there was concern that reverting to previous arrangements would result in future problems. It was questioned if there was scope for innovation to make IPC more efficient, to reduce lost capacity. Any advances in IPC should be kept under review.

•        Several members emphasised the importance of IPC. A suggestion to have a further briefing note or session on IPC, to examine the lessons learned. There were links to stronger communities, in responding both to Covid and future viruses. A need for collaborative innovation and connection between the NHS, the different tiers of local government and the VCS. The VCS could provide infection control locally and investment was needed into communities to do the IPC on the ground, which in turn linked back to inequalities in communities.

•        A question if changes would be made to the flu pathway, given the similar symptoms initially. This would be important, especially during the winter period and would present additional challenges when patients presented at hospital.  Speedy diagnosis and effective streaming were key. Triage arrangements were also raised, including work with the 111 service on ‘talk before walk’ and planned messaging to encourage take up of the flu inoculation.

•        Discussion about Covid-19 diagnosis and pathways for treatment when people arrived at the A&E department. It was suggested that people should be directed to the Nightingale hospitals instead and only be transferred to a regular hospital if they didn’t have Covid-19.  A particular concern was patients who were not showing symptoms.

•        The Nightingale hospitals had been procured nationally in response to the pandemic and operational protocols were needed. Further aspects discussed were staffing, the need for a system to be put in place, the potential for Covid type viruses to occur for many years to come and the need to ensure that other services were not impacted.

•        There were member observations about living with Covid and similar pandemics, the findings that primary care services were now being used more reasonably, but similarly some people may be deterred from visiting NHS services. The elements on reset were referenced and there would be key learning for example on integrated care. There is a need to encourage people to be tested and to give the public confidence that hospitals are safe to use.

The Chair confirmed that he had noted the various issues raised and he thanked the speakers for the information provided.

Resolved

That the Committee notes the presentation.