Agenda item

10:20

This item will provide a report on the key issues for the Oxfordshire system.

Janet Phillips spoke in favour of a local test and trace system.  She noted that the Government had put £22 billion into the centralised organisation named NHS Test and Trace which was actually a string of private companies with no prior experience of testing and tracing.  She believed that the model was fundamentally flawed and that the only way to fix testing and tracing was to hand the money and the work over to the experts in our local public health bodies.  She called for support for a motion on local test and trace coming before Oxford City Council on 30 November and urged those from other parts of Oxfordshire to put similar motions to their own councils.

Councillor Jane Hanna supported the call for local test and trace system and said that she regretted the lack of a boost for local public health funding in the Government’s recent financial settlement.  She noted the high level of deaths among those with learning disabilities, especially in the 18 to 40 age bracket who were 30 times more at risk of death.  She urged that they be prioritised when vaccines become available.

Nick Maynard, Surgeon and Oxford University Hospitals Cancer Lead, summarised the situation with cancer services which he said had performed better through the pandemic than in other areas of the country.  The services that have had the greatest difficulties are the breast cancer and breast symptomatic services and the colorectal service and a lot of effort has gone into tackling those with robust action plans in place.

All cancer pathways have been reviewed.  The risk/benefit balance may have changed for some given the risk of COVID infection.  The harm reviews of changes to the pathways have not found that any obvious harm has resulted.  There have been no reductions to services in the second COVID-19 wave.

Ruth Wilcockson, Managing Director, Thames Valley Cancer Alliance, added that OUH not only provided more capacity but also provided leadership through the crisis.  The Alliance was supporting improved data including live dashboards to monitor where patients were on their pathways.

Nick Maynard and Ruth Wilcockson responded to questions from members of the committee as follows:

·         At first there was no data on risks and then only anecdotal evidence.  A national scoring system was introduced.  For example, patients requiring major thoracic treatment were a particularly high risk should they get COVID.  Only one cancer patient contracted COVID during the first wave and that was right at the beginning.

·         Endoscopies had been maintained at a lower rate with a comprehensive triage system.  There had been a review of those that had been postponed which had not shown any evidence of harm.  The main concern was the drop off in referrals at the start of the pandemic which meant that more people would be coming in quite late.

·         Staff who had to self-isolate could still work with remote outpatient clinics.

·         Screening services developed a backlog which was being worked through, prioritising the most urgent.  They were back to sending out new appointments and were working above normal capacity to clear the backlog.

The Chairman thanked staff who had worked heroically to deliver cancer services throughout the pandemic.

Ansaf Azhar, Director for Public Health, gave the latest statistics on new COVID-19 cases.  The Oxfordshire figure for the previous week was down 40%.  That was the week in which one would expect to see the first effects of the recent lockdown but it was too early to say if the reduction would continue.

The local contact tracing system had been running for one month and was led by the district and city councils.  Almost 500 cases had been contacted – about 50% of those referred from the national system.  More than half were students.  The two universities had been exemplars in how they had dealt with it.

Ansaf Azhar responded to questions as follows:

·         The COVID tiers were decided nationally but they did welcome local insight.

·         He could always use more resources but was broadly satisfied with the current situation.  More resources would be needed if mass testing was planned and when vaccinations start.

·         Mass testing can add value in an area with a high rate of infections but there can be a significant number of false positives causing people to self-isolate when not necessary.  It was more likely to be used in priority groups.

·         It was difficult to measure how many people were isolating correctly.  There were elements of fatigue and not taking it seriously.  He hoped that news of vaccinations would help people to see that there is an end in sight.

Tehmeena Ajmal, Winter Director, Oxford Health, outlined the plans for vaccinations.  They will be delivered in four different ways: large testing centres capable of administering 1,000 to 1,500 vaccinations a day; community centres in areas of around 30,000 people; hospital centres for their own staff and roving units for people who are housebound or for care homes etc.

It was being coordinated across the BOB area (Bucks, Oxon and Berks West) for logistical and staffing reasons with local multi-agency teams in place too.  The priority groups were being worked out nationally and had not been finalised yet.  It was expected that it would be: care home patients first, over 80s, then health and social care staff.  There was currently no transportable vaccine and given that many of the vulnerable are house-bound that provided a problem.

It was important to remember that people need 2 vaccinations 28 days apart.

There will be local discretion on the choice of sites.  There will be one large site in each of the three counties as well as around 20 other sites linked to Primary Care Networks.

Stephen Chandler, Corporate Director for Adult & Housing Services, responded to issues raised under the Winter Plan:

·         He confirmed that the actions marked as due to be completed by the end of October have been completed and the winter plan is working well.

·         It was hoped to have next year’s plan ready and the resources committed by the end of June.  This was necessary in order to recruit successfully for the larger aspects of the plan.

·         The Mental Health helpline worked very well last year and he was confident it would continue through winter this year, although there were concerns about the staffing levels and a possibility that staff may need to be prioritised elsewhere.  He AGREED to provide more information about that after the meeting.

·         The A&E Delivery Board reviews the metrics on the winter plan at its monthly meeting.  He AGREED to bring that data to the next Committee meeting.

·         Staff across the sector were undoubtedly tired but were encouraged to take leave and limit meeting lengths.  Absence levels were lower than previous years which illustrated just how committed staff were.  The infection control grant included funds to ensure that staff can access sick pay.

Sara Randall, Chief Operating Officer, OUH, also responded on a number of issues:

·         She AGREED to provide more information after the meeting on the respiratory mobile unit and the situation regarding funding.

·         All out-patient clinics were all now open.  There was a robust 52-week harm review.  There were now 2,753 patients waiting over 52 weeks.  Urgent cases were prioritised and they had not seen any evidence of harm.  There were systems in place to triage new referrals.  She AGREED to provide information on the harm reviews.

·         A group had been set up with clinicians from the four specialties that have had the greatest difficulty in reopening to look at the baseline data and examine when pathways could be opened up.  She AGREED to bring an update on this issue to the next Committee meeting.

The Chairman repeated his request from the last two years that a weekly report on metrics be sent to members of the Committee to monitor the Winter Plan.  He noted that Members were receiving weekly updates on Delayed Transfers of Care and COVID-19 and he felt that the ability must be there to provide a dashboard on the Winter Plan.

Yvonne Rees, Chief Executive, AGREED to discuss this at the System Gold meeting.  She was more concerned than ever about capacity this winter with talk of mass-testing and mass-vaccination.  She also assured members of the Committee that the situation regarding Brexit is being closely monitored.  There will be a lot of messaging on that in the coming weeks.  Cabinet also gets regular reports on staffing vacancies.

The Chairman thanked officers for the report and updates and particularly commented that the presentation on the latest COVID-19 statistics was well judged and easy to understand.

It had been planned to show the video “Working Through a Pandemic” as part of this item but there was not sufficient time.  It was AGREED to put a link to the video on the Council website alongside the agenda pack.