Agenda item

Updates from the council and the Bath, Swindon and Wiltshire Clinical Commissioning Group (BSW CCG) on activity to mitigate the impact of the coronavirus in Wiltshire will be provided at the meeting.

The most recent COVID-19 update report to the council’s Cabinet is attached. This was considered on 2 February 2021 so verbal updates on more recent developments will be provided.

All four of the council’s select committees are monitoring COVID-19 and to avoid duplication members are invited to focus their questions and debate within thisselect committees’ remit.

a)    Emma Legg, Director for Access and Reablement, provided an update regarding the current position for adult social care.

Work has continued to take place closely with system partners in order to support discharge and flow. There has been an increase of people returning home from hospital, with referrals into the Home First Pathway having significantly increased since last year. Additionally, an increased number of beds in local care homes have been commissioned to meet demand over the past months. The focus is now on de-escalation following some challenges in January and February to get into a stable position.

A new service has launched with Carer Support Wiltshire, which is a hospital liaison service, working with hospital staff and others to support carers through and after discharge. This has the aim of reducing stress for carers and is available at all three of the local hospitals.

There has been an increased demand in front door services for adult social care, with contact numbers higher than previous years; these increases are being monitored to determine longer term impacts. Mental health services continue to support people and Wiltshire Health Space is accommodating individuals from both BaNES and Swindon, in order to reduce pressure across the wider mental health system. However, the number of Mental Capacity Act assessments that are being completed remains significant.

Residential and nursing care homes in Wiltshire have seen an improved picture with staff and patient numbers falling, for example there was a 66% reduction in cases for the week ending 21February. However there has sadly been an increase in deaths in care homes with 30 new deaths reported in 7 days in the period up to the 16 February.

The Chairman invited comments and questions which included the percentage completion for care home vaccinations and where case rate breakdowns could be found for Wiltshire. In response to questions, it was noted that numbers and percentages are information which can’t be provided as it is NHS data which is careful released. Additionally, it was clarified that case rate breakdowns can be located on gov.uk website.

b)    Elizabeth Disney, Wiltshire Chief Operating Officer at the Bath, Swindon and Wiltshire CCG, provided a presentation from the CCG on COVID-19.

The presentation outlined the current context of the pandemic for both Adult and Children’s services; with admissions for Covid reducing for adults, whilst still seeing internal infection issues and being aware of the risk surrounding future variants. Additionally, during January, commissioned capacity was increased across Wiltshire to support the Covid surge seen in hospitals. The Health services have not seen significant numbers of children requiring medical treatment for Covid related symptoms and the focus of the response has been to minimise the impact of restrictions rather than of Covid itself.

Data was provided for the Salisbury Foundation Trust Hospital, Great Western Hospital and Royal United Hospital from 19 February 2021. This data was used to monitor hospital capacity and to prepare for best, middle and worst-case scenario projections. The data suggested an improved position from January.

The update provided an overview of the current situation regarding the issues faced by both Acute and Community Services. Such issues for Acute Services included significant pressure from staff sickness; a large outbreak experienced by Avon & Wiltshire Partnership (AWP) adult mental health provider which caused an impact on service due to inpatient bed closures. Regarding the issues faced by Community Services; minor injury units have now re-opened with a bookable service after closure due to redeployment; all community services are operating but with some at a reduced level due to staffing; after an initial decrease in referrals to CAMHS this has now reversed with referrals via Single Point of Access being very high.

The current outlook was reported that health and social care services have continued to offer health and wellbeing support to staff and services are currently awaiting national planning guidance on the direction for recovery, where it is expected that areas of focus will be outlined.

Following the cancellation of elective surgery, a clear Patient Tracking List (PTL) tool is now accessible in order to determine and prioritise the demand and level of need for surgery across the broader population. This prioritisation system features 4 categories, with priority 1 and 2 surgery continuing to go ahead. Additionally, the Elective Care Board has work planned with includes understanding the harm that may have been caused by delays.

The presentation shared data on the current recovery performance, with percentages of completion against what was planned. A notes column was used to provide context to why the percentages were at the level that they were at. The percentages were as follows; Day case and inpatient elective performance 71%; Outpatients firsts 85% and follow ups 80%; Diagnostics 123%.

The officer provided a BSW vaccination summary, which reported that all BSW care homes had been visited by 24 January and additionally it is planned that there will be half a million vaccinations by Easter.

In summary, there has been a change in the picture for demand, with there being a need to manage the impact and level of Covid, but also a requirement to turn attention towards preserving capacity for health service needs that are not directly associated with Covid-19.

The Chairman invited comments and questions and it was clarified in regards to the adult care purchasing exercise that the other three local councils were liaised with in regard to the nature of additional capacity and how this might be acquired and shared as no single locality could manage this on its own.

Clarification was sought regarding the outbreak experienced by AWP. It was noted that the outbreak took place at predominantly at Fountain Way, Salisbury and the impact was felt not only in South Wiltshire, but also on Salisbury Foundation Trust Hospital and other parts of service as there was a knock-on effect in terms of beds that were closed and staff redeployment internally.

Regarding the recovery of service providers, it is anticipated that the next financial year of April 2021 to March 2022 will be a different year in terms of immediate health priorities and the changing nature of people’s health needs. The next year is being sighted as an opportunity to treat as many people as possible and with ring-fenced funds available, decisions need to be made on how to use these funds to make a difference to both those who need services now whilst also being sustainable.

Expansion of the number of vaccination facilities was queried, and it was clarified that there are 2 large vaccination sites, with 27 sites in total meaning that residents are no more than 10 miles away from a vaccination site. The conversation regarding vaccination facilities is of a shifting nature and conversations are on-going about working in different settings as in summer venues could require the use of their sites.

It was acknowledged that the management of allowing health service staff to recover is a difficult situation to balance, in regard to allowing individuals periods of rest whilst there is a demand to deliver. Currently a lot of strategic work force planning is taking place on a national and regional level is taking place to determine what is needed in order to meet expectations and demand.

In conclusion, it was;

Resolved:

To note the update provided from the Council and CCG.