To receive an update from representatives of the Staffordshire and Stoke-on-Trent Clinical Commissioning Groups
Minutes:
The Chair welcomed the representatives from the local Clinical Commissioning Groups (CCGs); Ms Nicky Harkness, Managing Director (South East Locality), Mr Lee Squire, Associate Director of Commissioning and Dr Shammy Noor, Chair South East Staffordshire and Seisdon CCG to the meeting to provide an update on the impact of COVID-19 on planned care, including operation waiting lists and outpatient appointments, cancer treatments (screening, waiting lists and diagnosis) and a brief overview of winter preparedness / plans.
Dr Shammy Noor reported that at the start of the COVID-19 pandemic the CCGs were directed to free up the maximum possible inpatient and critical care capacity, including the postponement of elective procedures for three months, however other emergency and clinically urgent care should continue, as well as the preparation of large numbers of inpatients requiring respiratory care and the redeployment of staff as required. It was reported that this was an unprecedented situation, with no modern comparisons.
As a result of the required prioritisations leading to the suspension of non urgent procedures, there had been an increase in the number of people waiting for planned care procedures, including an increase in the number of patients waiting over 52 weeks to be seen form referral. Additionally there had been a reduction in the number of people being referred in to secondary care from GPs, which reflected a combination of patients’ fears about COVID-19 and a reduction in outpatient appointments. The performance within Staffordshire reflected the national position with over 2 million patients on waiting lists.
Following the initial COVID-19 impacts, both the University Hospitals of Birmingham (UHB) NHS Foundation Trust and the University Hospitals of Derby and Burton (UHDB) NHS Foundation Trust had provided the CCG with prioritisation plans which included elective surgery being scheduled where possible in COVID free elective centres for UHB, and for the continued prioritisation of cancer care and urgent/ emergency care and prioritising patients according to clinical need for UHDB.
Mr Lee Squire updated the Committee on the current position in the South East Locality of Staffordshire. In July 2020 there was further national direction from NHS England to bring services back to more normal levels and to prepare for winter demand pressures. This involved working collaboratively and utilising digital technology where possible. In terms of the waiting lists in the South east Locality for both UHDB and UHB the trends were similar and this local performance was also reported to be similar to national performance. Patients were reviewed on clinical priorities and called in for treatment according to these.
In terms of cancer services during COVID-19, at UHB these were relocated to Solihull Hospital, and at UHDB the Nuffield centre in Derby was utilised. It was reported that none COVID-19 related patient levels were starting to recover to pre-COVID-19 level, and that 100% of patients’ urgent cancer referrals were seen in the 2 week target period.
Mrs Nicola Harkness provided an update on winter plans including the national priorities:
· Accelerating the return of routine services before winter, including achievement of business as usual activity by October 2020 and the acceleration of cancer, diagnostics, outpatients activity, primary care and enhanced support for care homes;
· Preparation for winter including delivery of NHS 111 First and ensuring the national discharge pathways were followed to help patients return home from hospital.
In terms of areas of focus these included:
· Increasing primary care capacity
· Delivery of the extended flu vaccine programme
· Managing acute capacity and flow, including looking at community provision as well as NHS 111 First
· Discharge Planning to ensure that there is wrap around support services available when patients are ready to be discharged.
It was reported that one of the key positives which had resulted from the response to COVID-19 was the collaborative working which had developed and which would continue.
The Committee sought and received clarifications from the CCG representatives on the following:
· Whether given the social distancing rules in place, there was expected to be a lower level of instances of flu this winter. It was reported that the evidence from Australia was that their flu season had been significantly delayed, however, this may not be the case in the UK, and whilst social distancing measure were in place in the UK the instances of COVID-19 were continuing to rise.
· How the death rate from COVID-19 in this second wave, compared to that at the start of the pandemic in March / April. It was reported that whilst the death rate was significantly lower in this second wave that would be impacted by the increased availability of testing, which had not existed at the start of the pandemic. Furthermore, the death rate was now reported to be creeping up, and therefore it was too early to make any judgement in this regard.
· How COVID-19 had impacted on the funding of NHS trusts. It was reported that all budgets were being set centrally and the allocation was based on previous years and on demand from modelling. It was expected that the position would be clearer in February 2021.
· Whether there was a staffing problem to manage and what contingency plans were in place to address this. It was reported that staff in the NHS had worked above and beyond and mental health and wellbeing plans had been put in place.
· How both patients and clinicians had responded to the digitalisation of service delivery. It was reported that patients had responded very positively to digital delivery and there had been little resistance. One area to continue to keep under review was to ensure the effectiveness of this when used with patients, and what was appropriate to do digitally and when face to face consultations were necessary.
· Whether the correct balance had been struck between managing the COVID-19 pandemic and the ongoing service delivery for other health conditions. It was reported that whilst the guidance had been clear that urgent service delivery would continue the data showed that there had initially been a reduction in cancer referrals, however this had been short lived and had been reversed. Furthermore, decisions and choices had been predicated on models and predictions available at that time and that in this second wave there would be further information to use.
· How the prioritisation process worked for more routine treatment. It was reported that there was a national prioritisation process which was clinically led.
The Committee thanked Mrs Nicola Harkness, Mr Lee Squire and Dr Shammy Noor for their attendance and presentation and asked that the Committee’s thanks to all their staff for their work be passed on.
The representatives then left the meeting.