Agenda item

Report of Phil Johns, Coventry and Warwickshire CCGs

The Board considered a report of Phil Johns, Coventry and Warwickshire CCGs which provided an update of the work done to date on NHS recovery and restoration in response to the NHS Phase 3 letter from NHS England, and also gave an update on the impact on this restoration due to the latest surge in Covid-19 cases in the last few weeks.

The report indicated that at the end of June activity levels across most NHS services were at around 30-40% of pre-Covid-19 levels. The focus of the NHS was to protect cancer and clinically urgent workload and meant that routine non-clinically urgent cases were as a result delayed and waiting times for routine elective surgery increased nationally as well as locally. The NHS over this period saw a tremendous amount of service transformation in developing new green and red pathways.

On July 31, 2020, NHS England wrote to trusts and clinical commissioning groups to indicate the start of “Phase 3” response to Covid-19 and the need to restore services following the first wave of the pandemic, outlining the national expectations for the restoration of services within the NHS. Prior to the latest increase in Covid-19 cases and the renewed stress they had placed on both health and social care, the systems restoration was doing well. The report included the last summary of performance before the new year. Information set out the final week of December 2020 compared to the same week in 2019. This confirmed the trends seen in terms of restoration across the system, with activity levels at or above the same period last year. The system had used the ‘window of opportunity’ before the winter to restore services, and to mitigate the negative impact on health services to patients during the first wave of Covid-19.

The report also referred to referrals indicating that there were still significant challenges in terms of waiting times for routine care, with long waits for routine care and many patients waiting over 52 weeks for treatment. Pre-Covid the Referral to Treatment (RTT) target nationally was that 92% of patients on an 18-week RTT pathway should wait for less than 18 weeks. Both at a national level and in Coventry and Warwickshire, RTT performance fell dramatically when Covid-19 first appeared. Performance had been improving again month on month since July but had been hampered by the growth of long waits, especially for those who had waited for over 52 weeks. The details of referral waits on a monthly basis was set out in the report. Figures showed that, from a low point of RTT falling to 39.4% against the 92% target in July, as activity had been restored RTT performance increased month on month to a present position of 66.1%. However, the number of people waiting over 52 weeks had also increased.

The Board noted that the eradication of elective long waits would be a priority both for the NHS nationally and for the system locally once Covid-19 was under control. Within that, the priority remained to address cancer and clinically urgent cases first, with longest waits next. It was pleasing to note that referrals for elective care were now generally back to levels pre-Covid.

The report concluded with an update on restoration through the second Covid surge.  Whilst progress on restoration during the window of opportunity before winter had been good, it couldn’t be assumed that this progress would continue between now and the end of March 2021. There was the surge in Covid-19 cases, with more new cases being confirmed in the first weeks of January and more patients in hospital with Covid-19 than in the peak of wave one. Only when the R rate fell below 1 could we then expect to see reductions in hospital admissions.

This latest increase in Covid-19 cases was placing even greater strain on the ability of NHS services to continue to restore normal non-Covid services, and it was anticipated that there would be some reversal in level of restoration of services, especially for non-clinically routine cases, between now and the end of March 2021. However, the service was in a far better place to maintain services in this second/third wave of Covid-19 due to the development of green non-Covid pathways, the use of same day services, and use of virtual appointments, established in the first wave.

Members enquired about the current position for cancer patients and it was clarified that the most urgent cases were being prioritised for treatment, while the waiting times for other cancer patients were likely to increase.

RESOLVED that the contents of the report be noted.