Agenda item

Presentation from Nina Morgan, University Hospitals Coventry and Warwickshire, Melanie Coombes, Coventry and Warwickshire Partnership Trust and Jo Galloway, Coventry and Rugby CCG

Report of Phil Johns, Coventry and Warwickshire CCGs

The Sub Group received an update from Jo Galloway, Coventry and Rugby CCG and Nina Morgan, University Hospitals Coventry and Warwickshire on the NHS Covid capacity and recovery.

Jo Galloway referred to the report of Phil Johns, Coventry and Warwickshire CCGs ‘NHS Recovery and Restoration Update’ which had been circulated to members and was considered by the Health and Wellbeing Board at their recent meeting on 25th January. The report 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” of our 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 Sub Group 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.

Nina Morgan reported on the three main areas of focus for the hospital: the hospital response to the demands of the second wave; an overview of the vaccination programme; and the health and wellbeing of the hospital staff.

The Sub Group were informed that at the peak of the first wave on 6th April there were 161 Covid patients at UHCW, on the 19th January the number was 262 patients, which reflected the rapid increase in patients at the end of December, early January. While the numbers of new infections were now decreasing, this hadn’t yet happened in relation to patient numbers. There were currently 215 covid patients at the hospital. At the peak there were 11 covid wards which had now reduced to 9. There were 3 critical care areas which were helping the national crises. 

In relation to vaccination, there were two covid clinics on site at the hospital and over 24,000 vaccinations had now been delivered, this included 9,000 care home staff, 5,000 care home workers and 9,000 UHCW staff. In additional nearly 1,000 out-patients who were 80 and over had been vaccinated. Second vaccinations would be offered during March.

The Sub Group noted that there was a good Health and Wellbeing programme for staff at the hospital which involved a number of initiatives. These included an increase in rest areas; additional psychological support; a wellbeing drop-in; and boost boxes of treats. In addition, additional support was being given to managers to help them to support their staff.

The Sub Group enquired about the latest position of the local Nightingale hospital and the situation regarding hospital discharge to blue beds at care homes and insurance. Clarification was sought about the arrangements for second jabs for out-patients who had been vaccinated at the hospital.

The Chair, Councillor Caan expressed his support for the measures that had been put in place to look after the health and wellbeing of the hospital staff.

RESOLVED that the update on NHS Covid capacity and recovery be noted.