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Agenda item

Covid and System Recovery

To receive a presentation Elizabeth Disney (Wiltshire COO, BSW CCG), Lucy Townsend (Corporate Director of People, Wiltshire Council), Jo Cullen (Primary and Urgent Care, BSW CCG), Lucy Baker (Service Delivery, BSW CCG), Myfanwy Champness (Children’s Commissioning BSW CCG), Robert Holman (Head of Commissioning Specialist Services, Wiltshire Council), Emma Legg (Director of Access and Reablement, Wiltshire Council) and Helen Jones (Director of Joint Commissioning, Wiltshire Council).

Minutes:

The Board received a presentation which focused on Covid and planning for the future. Elizabeth Disney (Wiltshire COO, BSW CCG) introduced the presentation and updated that the NHS had identified the following national priority areas for recovery:

1.     Supporting the Health and Wellbeing of staff

2.     Delivering the NHS Covid vaccination programme

3.     Building on what has been learned during the pandemic to transform the delivery of services

4.     Expanding primary care capacity

5.     Transforming community and urgent and emergency care

6.     Working collaboratively across systems to deliver these priorities.

 

In addition, the Board noted comments on the following matters:

 

  • It was queried whether reduced collective NHS demand and improved community wellbeing was embedded within a priority. It was clarified that these areas are embedded throughout the nature of the work that is being undertaken to respond, for example expanding primary care.
  • The importance of prevention was stressed and that through a population health management approach data can be used to target areas.

 

Primary Care – Jo Cullen (Primary and Urgent Care, BSW CCG). The presentation covered the following areas:

 

·       BSW Covid Response Primary Care Offer was approved by the CCG last summer with a confirmed contract and funding for GPs. There is a commitment for Primary Care practices to deliver the most appropriate care to patients until September to provide stability.

·       The National Standard operating procedures for GPs was updated in May to support restoration of services in line with the roadmap out of lockdown.

·       May 2021 saw a 76% increase in the number of appointments compared to May 2020. Reports show that in May 2021 59% of appointments were face to face compared to 38% in May 2020.

·       Key messages from primary care were outlined including the perception that practices were not open; backlogs are starting to be caught up on; GPs are busy due to the total triage system; there is aconcern not to miss seeing patients who need to be seen, for example cancer patients.

·       A vaccination summary was provided with half of staff working in primary care delivering vaccinations. So far 1,114,001 vaccines have been delivered as of June 2021 with staff working to a deadline of 19 July for ages down to 18.

 

In addition, the Board noted comments on the following matters:

 

·       It was queried how patient anger and frustration is being manifested. A number of individual practice complaints have been seen as well as comments on social media and patients going to MPs. A briefing has been sent out regarding this.

·       There is concern regarding the implications of restrictions easing on 19 July and how the public will react to this. GPs will still be under different restrictions to other places such as supermarkets.

·       GPs have been busier than any time before in the past 5 years, for example on one day there was 4,000 calls to a practice. As a rough estimate, 50% of the calls received in primary care are related to low level anxiety in the general public, with the rest being serious medical problems.

·       There has been concern that the current level of demand cannot be met with the current available resources.

 

Elective Care – Mark Harris (BSW CCG). The presentation covered the following areas:

 

·       The current position for Elective Care in comparison to that of normal capacity in 2019/2020 was outlined with services performing well with their current capacities; examples being MRI and CT scans running at near normal.

·       Nearly 30% of outpatients are being delivered virtually and GPs are making 1,700 advice and guidance calls a month to avoid hospital admissions and referral to hospital appointments.

·       Referral levels are nearly at normal levels with evidence of a backlog with waiting list sizes 17% higher than before Covid.

·       The key issue identified has been long waiters with typically 5 or less patients waiting more than 52 weeks for first treatment rising in March but now dropping by 34% in June. Cancer access times are a focus with 77% of patients seen within 2 weeks.

·       Planned improvement actions that have been taken and planned were outlined including the clinical prioritisation of waiting lists; a system review of harm; work to join clinical teams to target capacity gaps in hospitals; additional capacity commissioned.

 

In addition, the Board noted comments on the following matters:

 

·       It was recognised from the RUH Bath perspective that the amount of activity may increase which will also be impacted by an increase in cases as well as staff being off.

 

Adult Community Services – Clare O’Farrell (Interim Director of Commissioning BSW CCG) and Helen Jones (Director of Joint Commissioning, Wiltshire Council). The presentation covered the following areas:

 

·       Wiltshire Health & Care recovery priorities were outlined including supporting the NHS Covid vaccination programme; focusing on Hospital discharge; supporting the health and wellbeing of staff and Long Covid clinics.

·       Plans for improvement were outlined including focusing on the Ageing Well programme; use of digital technology; closer integration with Primary Care Networks in local integrated neighbourhood teams as part of the Wiltshire Alliance.

·       The reopening of Minor Injury Units, specifically Chippenham and Trowbridge.

·       Challenges and risks for adult community services were identified including system flow pressures; staffing redeployment; acuity of patients and increased demand for community teams.

·       Council services continue to support discharge pathways and there has been an increased and sustained demand for adult care services with an 11% increase in contacts into the Advice and Contact service. There is an increasing complexity and acuity within the community.

 

In addition, the Board noted comments on the following matters:

 

  • It was questioned whether this increase in complexity and acuity will continue. This is hard to determine though it currently could be explained by a cohort of patients who have since come forward who did not during the lockdown period.

 

Children’s Community Services – Clare O’Farrell (Interim Director of Commissioning BSW CCG). The presentation covered the following areas:

 

·       Wiltshire Virgin Care recovery priorities were outlined including the meeting of all waiting time targets with the exception of paediatric Audiology; aims to bring down the waiting list times across BSW for autism assessments; meeting the needs of a significant increase in referrals as well as increased level of contacts and queries.

·       Wiltshire recovery priorities were outlines with a focus on children’s hospices which had been disrupted during the pandemic.

 

Hospital Discharge Policy (HDP) – Clare O’Farrell (Interim Director of Commissioning BSW CCG). The presentation covered the following areas:

 

·       Hospital Discharge Policy was introduced in March 2020 and then updated in August 2020. National funding has been made available to support the policy and will run until quarter 2 (September 2021).

·       Examples of what HDP has funded were provided including live in care packages, additional community respiratory services and virtual frailty wards in care homes.

·       The strategic opportunities of using HDP were highlighted including an increase in out of hospital care; evidence of investment with outcomes and progress as well as building relationships around effective change and improvement.

·       There is no clear national position on the continuation HDP funding after September 2021. Wiltshire ICA has developed a funding plan to cover 2021/2022.

 

All age mental health – Lucy Baker (Service Delivery, BSW CCG) and Claire Edgar (Director of Learning Disabilities & Mental Health, Wiltshire Council). The presentation covered the following areas:

 

·       An overview of where mental health services currently are including an increased rate of referrals since lockdown eased; increased acuity across all ages and services; national shortage of PICU and CYP tier four beds.

·       A listening event took place in order to understand the views of people, families, carers, supporters and staff.

·       An overview of partnership working in Wiltshire including Herbert House Wellbeing beds; Riverside Sanctuary; New Intensive Outreach support; 3rd Sector Mental Health Discharge allocation in Wiltshire; Additional community Mental Health wellbeing beds; Challenge map event and Demand and Capacity mapping.

·       It was noted that there is work to be done regarding suicides, Children and Young People as well as reaching and treating eating disorders earlier.

·       The transformation across the country relating to mental health regarding the Community Mental Health Framework and how this transformation will look. For example, recruitment, pilot sites and integration of services.

·       A comparative example was given to show the change caused by the transformation between the current pathway and the proposed CSF model.

 

In addition, the Board noted comments on the following matters:

 

  • It was questioned what enables integration and what were the lessons learnt from integration and partnership working which could be done as a Board.

·       It was acknowledged that one of the greater challenges had been to understand the differing roles and responsibilities of partners; therefore stressing the importance of partnership working and how services deliver in different ways.

 

Decision – The Wiltshire Health and Wellbeing Board noted the wide range of work underway and endorsed the proposed approach.

Supporting documents: