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 monitoring, recovery and restoration plans for non-Covid-19 services in Coventry.

The report indicated that in the first half of 2021 there had been two events which had had a significant impact on our restoration of services, firstly, the second wave of Covid cases over December to February, and, secondly, the increasing Covid cases in the last few weeks in June related to the Delta variant. The system had been selected as a pilot site for NHS England’s “Accelerator” programme which aimed to accelerate the restoration of elective care services. The expectation of this programme was for pilot sites to undertake additional activity and transformation of services so that by the end of July 2021, elective care activity, as measured by value, reached 120% of what it was in July 2019. To support this pilot, the system had received £10m to support the expansion of capacity to deliver elective care. This was supported by the national Elective Care Recovery Fund (ERF) which provided additional revenue to systems who achieved delivering over 85% of activity levels seen in 2019-20. Associated with this, the system had developed expansion plans for increasing diagnostic activity through community diagnostic hubs.

The Board were informed of the key areas of activity/focus as follows:

i) Recover the maximum elective activity including increasing electives including outpatients to at least 120% of 2019-20 levels by the end of July 2021.

ii) Cancer delivery to restore cancer services including immediate management of 104+ day waits, reducing 62 day and 31 day waits.

iii) Restoration of service delivery in primary care and community services, including backlog of childhood immunisations and cervical screening, programme of structured care home reviews, and all GPs to continue to offer face to face appointments as well as remote triage and video.

iv) Expanding and improving MH/LD services including increasing investment in line with the Mental Health Investment Standard; allocation of funding to core Long Term Plan (LTP) priorities.

v) Preparation for management of any Covid resurgence and preparedness for general increase in emergency activity. In addition, preparing for winter, with activities being detailed in the report.

vi) Reflecting on Covid lessons-learnt and embedding positive change and continuing to support staff, and continued action on inequalities and prevention: a People Plan 2020/21 had been published with some specific objectives to address inequalities.

The report provided an overview of the restoration of services indicating that services were recovering well,  and, as of week of 21st June 2021, the majority of services were at or above the levels from the same period in 2019-20, which was well above the activity seen last year during the first Covid surge. Examples highlighted included almost 1.1million Covid vaccinations being given across Coventry and Warwickshire by the end of June 2021; levels of diagnostic activity were back at or exceeding levels normally expected for this time of year, and referrals had returned to previous pre-Covid levels; all outpatients services and elective planned surgery had been restarted and were increasing in line with provider operational plans to support the elective accelerator programme; and GP appointment levels were back at and exceeding levels seen in 2019-20.

The Board were informed that A and E attendances were lower than this time last year but there were high numbers of attendances at the main casualty sites, and there was an increase in admissions above numbers experienced pre-Covid. In relation to cancer, the 2 week wait referral was at 170% of the level reported in the same week in June 2019-20 pre-Covid and the 62 day week pathway referrals were at 100% of pre-Covid levels.

The report set out further details of outpatient, day-case and electives activity.

The report also included an update on restoring and supporting access to GP services including setting out how the primary care model was rapidly adapted, in line with national guidance, to safely deliver services to patients in Coventry and Warwickshire. Further information was provided on the current situation. All practices were open across Coventry. For those patients who needed to be seen face to face, and were not potential Covid-19 positive or confirmed positive, face to face appointments were available at all practices in Coventry, following the initial telephone triage. GP appointments were back at or exceeding pre-Covid levels. Increased numbers of patients were having appointments on the day or the day after, with 63% occurring on the day or the day after, which was well above the national position of 55%. Appointments were primarily during the working week (Monday to Friday). 50% of these appointments were face-to-face and 61% of the appointments were with GPs rather than other clinical staff, compared to a national position of 52%.

The Board noted that General Practice was continuing to deliver the vaccination programme in addition to seeing patients and restoring services.

“Hot Hubs” were still being used for potential covid-19 or confirmed positive patients to ensure that patients were still able to seek the treatment they needed or referred onward if urgent treatment was required. Transport for those unable to make their own way to the Hub was also in place. Surge and escalation plans were in place to ensure appropriate capacity and capability in order to respond to the current pandemic demands.

Members informed of concerns of residents about the availability of face to face GP appointments. Concerns were raised about patients were attending A and E because they were unable to get a face to face GP appointment. It was suggested that additional communication was required for patients on waiting lists, including prevention measures that could be undertaken to prevent an escalation of problems prior to treatment. It was clarified that when patients presented for vaccination, the opportunity could be taken to discuss any wider health issues. Members also asked for examples of the additional activity and transformation of services under NHS England’s Accelerator programme.

RESOLVED that:

(1) The contents of the report be noted.

(2) Consideration be given to communications concerning prevention measures, where people are on long waiting lists for treatment to provide help to support the patients and, if possible, prevent / reduce deterioration.

(3) Details of the situation at A and E and walk in centres where patients are turning up because they can’t get a face to face appointment with their GP be sent to members.