Agenda item

Report and presentation of Andrew Harkness, Chief Transformation Officer and Rose Uwins, Senior Communications and Engagement Manager, NHS Coventry and Rugby and Warwickshire North Clinical Commissioning Groups (CCGs)

The following representatives from the Health partner organisations have been invited to the meeting for the consideration of this item:

Simon Gilby, Coventry and Warwickshire Partnership Trust (CWPT)

Andy Hardy, University Hospitals Coventry and Warwickshire (UHCW)

Andrew Harkness and Rose Uwins, Coventry and Rugby CCG

Rachael Danter, Coventry and Warwickshire Health and Care Partnership

The Board received a briefing note of Andrew Harkness, Coventry and Rugby and Warwickshire North CCGs which provided an overview of the monitoring, recovery and restoration plans for non-Covid services in Coventry. The Board were also provided with a presentation from Andrew Harkness and Simon Gilby, Coventry and Warwickshire Partnership Trust. Andy Hardy, University Hospitals Coventry and Warwickshire provided an update from the perspective of the hospital. Philip Johns, Coventry and Warwickshire CCGs, and Rose Uwins Coventry and Rugby and Warwickshire North CCGs also attended the meeting along with Councillor K Caan, Cabinet Member for Public Health and Sport and Councillor M Mutton, Cabinet Member for Adult Services.

The briefing note indicated that on 31st July, 2020, NHS England wrote to Trusts and Clinical Commission Groups in indicate the start of Phase 3 of the Covid response and the need to restore services following the first wave of the pandemic. The letter outlined the national expectations for the restoration of services within the NHS under the following headings:

i) Accelerating return to ‘normal’

ii) Preparation for winter alongside possible Covid resurgence

iii) Reflecting Covid lessons-learnt and embedding positive change.

The briefing note detailed these expectations.

As a system the local health service was recovering services well and, as of the week commencing 25th November, the majority of services were now coming close to or even exceeding the levels from the same period the previous year. In particular, a restoration plan was in place in respect of Community Mental Health Services; levels of diagnostic activity were back at or exceeding levels normally expected for the time of year, with referrals returning to previous pre-Covid levels; all elective surgery services had been restarted and GP services were being restored in line with the guidance; A and E attendances were lower than the same period last year and dental services were being restored in line with national guidance.

The briefing note provided data on outpatient, day case and electives activity for Coventry and Warwickshire along with specific details of the two week wait pathways and the sixty two day wait pathways for cancer services. Assurances were provided about the recovery progress. The Board were reminded that a lot of patients chose to defer cancer treatment in the first Covid wave, thus extending the period of time before treatment.

Further information was also provided on the restoration and supporting access to GP services in the city. The Board were informed of the significant changes to the delivery of primary care introduced to protect the health and wellbeing of both patients and staff. All practices moved to a ‘total triage’ model, along with a digital first approach. Reference was made to the CCG campaign to help ensure that the public in all demographics understood that GP services were available to them which included media campaigns. The treatment routes for patients with potential Covid-19 or confirmed positive patients was highlighted.

With respect to Dental Services, most practices were providing face to face care and 90% could offer aerosol-generating procedures through the use of enhanced infection control measures and PPE, however capacity to see patients was still very restricted. The management of urgent patients and those in vulnerable groups was still the priority for many practices. The Board noted that there were 93 Urgent Dental Centres across the Midlands providing urgent care for patients without access to a practice.

Andrew Harkness commenced the presentation for the CCG with a summary of the Phase 3 restoration which also included statistical details for the following service areas: cancer; diagnostics; outpatients; elective; and urgent and emergency care. The current situation regarding GP appointments was highlighted and an update was provided on the Community Covid-19 vaccination, in particular the wider roll out by the GP led Primary Care Network. There were currently 5 PCNs across Coventry and Warwickshire vaccinating those 80 and over, care home workers and vulnerable NHS staff. Coventry’s first site was the Keresley Green Medical Centre with more sites to follow during December and into 2021. 

Simon Gilby, CWPT, presented on the issue of mental health, with key issues being that demand was returning to 2019 levels at a slower rate than anticipated after the first wave; referrals received were complex cases; significant use was being made of digital video platforms to sustain service delivery; and modelling had been undertaken to provide some guidance on future Covid generated demand from the first two waves.

Statistical information was provided for the referrals to the Mental Health Community Services including comparison data and details of the contacts undertaken. Crisis referrals had shown an upward trend at the start of the pandemic, followed by a fall which was probably due to transformational changes implemented during this time. CWPT was still accepting a greater proportion of referrals indicating that changes had been having a positive impact with inappropriate referrals being signposted to an appropriate service at an earlier stage. CAMHS referrals had also shown an upward trend since the start of the pandemic.

Andy Hardy, UHCW, reported on the background to Margaret Keenan being given the first Pfizer Covid vaccine in the world at the city’s hospital. He reported that the hospital had now vaccinated over 2,000 people in the three priority groups which included 1,000 care home staff. A second vaccination centre was about to be opened on the hospital site. Currently there were 107 patients with Covid at the hospital, with 14 in intensive care. Whilst numbers were rising they weren’t near the high numbers of the first peak of the pandemic. Attention was drawn to the lessons learnt from treating earlier patients which meant that less people were now requiring intensive care support. Additional information was provided on the work to reduce the backlogs of patients requiring treatment that had arisen over the spring/ summer months.

The Board were informed of the excellent partnership work across the local health and care system.

Members questioned the representatives on a number of issues and responses were provided, matters raised included: 

•  Support for all the excellent work undertaken by the partner organisations present since the start of the pandemic

•  What work was being undertaken by CWPT to ensure people with mental health issues accessed services at an earlier stage to prevent them from presenting with complex problems

•  Clarification and further details about the waiting times for CAMHS appointments

•  Were there any areas where there were gaps in service provision which were giving cause for concern from the CCG perspective

•  What was happening about weigh-in services in the community

•  Information about the success of hospital discharge and the use of blue beds and support for the work of the Adult Social Care teams

•  An acknowledgement of the need to protect and support the mental health of staff working across the health and care system

•  A concern about local residents being advised that they can pay for some medical treatments when they should be available on the NHS

•  A concern that patients are deferring treatments/ appointments because of fears about catching Covid-19 and what happens when this occurs

•  Clarification about how the local podiatry service was operating and emergency eye clinics

•  Clarification about the roll out of Covid-19 vaccinations across the city and details of the communications campaign to encourage take up with particular reference to the BAME communities, including assurances that the vaccine is safe

•  Support for the voluntary care workers across the city for all they have done during the pandemic

•  What lessons had been learnt to date during the pandemic that would help the health and care system to cope if further problems arose after Christmas and was there enough resilience to maintain services

•  Were there any concerns that Brexit might impact on the supply chains for the vaccine

Members placed on record their thanks and support for all the work being undertaken by all the staff in the health and care system during the current pandemic, including the voluntary sector.

RESOLVED that the content of the briefing note, presentation and oral update be noted.