Mark Harris Director of Commissioning (BSW CCG) to update the committee on current elective care waiting lists within Wiltshire and outline future opportunities as the system transitions from response into recovery.
Minutes:
Mark Harris, CCG Director of Commissioning, provided an update on the actions taken to reduce waiting lists and improve capacity.
It was noted that across the CCG infection control requirements had reduced bed capacity when compared to 2019/20 levels. The number of outpatients and referrals had now returned to pre-Covid-19 levels and that diagnostic capacity compared favourably with other CCGs. Notably 29 percent of outpatients were now being seen virtually. GPs were also using the Advice and Guidance procedure to liaise with consultants to establish whether referrals were necessary.
However, despite a recent increase, the number of inpatients, those staying overnight, was still only at 82 percent of 2019/20 levels. Waiting lists had also increased significantly being 17 percent higher than before Covid-19. Furthermore, the number of patients waiting over a year for treatment had increased dramatically but had reduced by 34 percent since March 2021.
Measures being taken to improve capacity included a review of the age, gender and ethnicity of patients on waiting lists to analyse potential health inequality issues exacerbated by the pandemic. Joint Clinical Teams were working to transfer patients between hospitals to increase capacity, including with independent hospitals. The officer also reported that the RUH had recently acquired the Circle Bath facility (now Sulis Hospital) in order to improve facilities on site.
During the discussion the following points were made:
• Councillors reported concerns from constituents about the number of consultations being undertaken online rather than in person. They also asked about what they could do to reassure residents about the quality of online appointments. It was reported that GPs and hospitals were operating according to a nationally mandated procedure requiring, where appropriate, them to offer alternatives to face-to-face consultations. However, it was also noted that the number of GP in person consultations was increasing and that a hybrid system of appointments was being adopted. A GP present acknowledged the challenges posed but also stressed that there were some advantages of online appointments, particularly in a rural county and for working age residents. It was stressed that ultimately the decision about the nature of the appointment would rest with a clinician.
• In response to questions about cost the Director of Commissioning noted that, due to a block contract with the acute trust, it was not possible to provide a breakdown of the costs of individual appointments, but the costs of online appointments were the same in terms of clinical time and may improve administrative efficiency.
• Responding to questions about the success of the hospital discharge policy representatives from the CCG noted that the longer that older people spent in hospital the worse their outcomes tended to be. The discharge policy, although often necessitating complex care arrangements, had allowed patients to be assessed in their home environment and enabled them to gain greater independence. It was explained that a plan was in place for the remainder of the year. However, long term funding was uncertain, and a lack of overnight nurses did limit the number of patients able to be discharged.
• It was reported that a hospital discharge support unit was run with Wessex Care to complement the support given to discharged of Covid-19 patients. Wiltshire had been successful in reducing the infection rate. Although government funding for rapid testing was welcome, limited money to implement rigorous protection infection control measures had restricted the capacity of care homes in the discharge process.
• Discussion turned to the future of the vaccination programme including whether it was more cost effective to vaccinate the public at large centres or smaller surgeries and whether the public were being directed to be vaccinated in the most cost-effective way. It was noted that the CCG’s Vaccine Implementation Team were setting out proposals for the booster programme and that cost would be one of the factors taken into consideration alongside preference and accessibility.
• It was asked what plans were in place to mitigate the impact of potential future pressures, such as an increase in flu cases, on clearing the waiting list backlog. It was explained that plans were in place to allow for the continuation of elective care, including work on demand and capacity modelling. An option considered was to take up more capacity in independent hospitals as had been the case during earlier stages of the pandemic.
Resolved:
To thank the Director of Commissioning for the update, noting the current position and actions to reduce waiting times.