Agenda item

10:20

An overview of the approach and impact of the virus on health services and health partners.

Liz Peretz, Oxon Keep Our NHS Public, advocated local testing as the best approach to tackling the spread of Covid-19.  She said that such schemes had worked in Durham and Sheffield and were advocated by the World Health Organisation.  She believed that local GPs, hospital trusts and the universities were ready to step up and provide such a service and she called on the local leadership to back this approach.

Councillor Jane Hanna stated that communities were anxious as the lockdown eases.  The questions surround how hotspots will be identified, how the return to work and school will be handled and if hospitals will be using risk assessments for vulnerable workers.  Test and trace will be crucial and she asked if all the necessary data was available in a timely way to make it work.

Yvonne Rees, Chief Executive, introduced the item.  She stated that the update reflected the fact that the country was still in the response stage and was now slowly transitioning to the recovery stage – however it should be recognised this stage would be as, if not more, challenging than the preceding months. She emphasised that Oxfordshire has responded to the crisis as a system - with all partners working together putting our residents’ and patients’ wellbeing at the heart of our activity.

Sam Foster, Chief Nursing Officer at Oxford University Hospitals Trust, on behalf of Chief Executive Dr Bruno Holthof, started the presentation.  She outlined a patient story and the impact on staff when the system had to double, and double again, its capacity.  Patients were nervous about being in hospital, as were their relatives who sometimes came in to seek their discharge.

Supplying PPE was very challenging.  The hospitals operated under the national response framework as is still the case.

Dr Ben Riley, Managing Director of Community Services at Oxford Health, described the two big challenges facing services: they had to establish new services to handle Covid-19 while at the same time reconfiguring all other services and premises.  At the start there were no guidelines and the thinking evolved day by day.

Mark Stone, Chief Executive of South and Vale District Councils, added that it was important to recognise the amazing response from the community and voluntary sector.  The councils on their own could not have responded to all of the needs.

Yvonne Rees emphasised that the system had been agile and recognised and implemented on-going learning during the crisis - this is normal practice but much can be taken forward and will inform the ‘new normal’.

Stephen Chandler, Corporate Director for Adult Services, described how partnership working was structured.  There was a care homes cell with a dedicated contact route.  They captured the views of care providers and the Care Alliance.  They were able to respond to the challenges of PPE and work on post-discharge services to avoid re-admission.

Ansaf Azhar, Corporate Director of Public Health, presenting data on the pandemic emphasised that this was a snapshot and the situation changed constantly.  Oxfordshire had around the national average number of cases per head of population.  Urban areas had a higher number of cases due to the denser population but had a lower death-rate because the average age was lower.

Councillor Alison Rooke asked if there was any data on the relationship between hospital discharges and care home cases.  She would also like to see statistics comparing Oxfordshire with other similar counties in the south east region rather than the national averages.

Ansaf Azhar responded that there were massive variations in testing uptakes which made such comparisons difficult.  The indications were that Oxfordshire had higher testing rates.  The county also has a high proportion of older population.

Stephen Chandler emphasised that government guidelines on discharging were followed to the letter and updated when necessary.  No care home had been forced to take anyone – they were either reassured on their concerns or an alternative was found.  The majority of those discharged went home as shown by nearly 1500 additional home care hours in May compared to March.

Councillor Laura Price said that there was a lack of information on the timings of when measures were taken.  It was also not possible to tell national from local decision making.  She wanted to know if clinical leads were happy that they were able to make decisions on clinical information or did they feel constrained by national guidelines.  She also thought that the voices of lower paid staff were missing.

Stephen Chandler responded that decisions were taken on the basis of information available at the time.  The majority of patients were discharged to home and additional capacity became available as self-funders cancelled services and more family members were available at home.

Sam Foster added that NHSE guidelines came out at a fast rate – mostly about treatment, staff deployment, PPE and risk assessments.  The Royal Colleges produced sometimes conflicting information – particularly on PPE.  Oxfordshire had the advantage of having some people working on the national guidance.  She was satisfied that they were able to make decisions on clinical information – autonomy remained with the clinicians.

City Councillor Nadine Bely-Summers stated that the lockdown exacerbated difficulties for people with mental health problems.  They had difficulties accessing medication because mental health was not regarded as a reason to get delivery.  Not allowing visitors to inpatient mental health facilities also added to anxiety.

Debbie Richards, Director for Mental Health and Learning Disabilities, Oxford Health, responded that they continued to deliver all mental health services though they had to revise how that was done.  They worked with GPs and care teams to identify those with highest needs and advised local community groups on how to help.

They understood the impact of banning visitors but most of the buildings in question are 19^th century buildings with little room to facilitate the necessary social distancing.  There were no deaths in any patient units.

A 24 hour mental health helpline was established very quickly, aided by the South Central Ambulance Service.  It was staffed by specialist workers so callers were not handed off from one person to another.  The ambition is to have specialised staff available in the ambulance control room 24/7.

They are currently working with colleagues in education and social care to prepare for the return to school.  None of the responses mentioned could have been delivered without the help of the voluntary sector and partners.

Barbara Shaw noted the reference in the presentation to dealing gradually with backlogs and expected surges and asked for more information on that.  She also asked why the number of deaths in care homes in West Oxfordshire was higher and if there was any learning from that going forward.

Stephen Chandler cautioned against making comparisons without taking account of the local contexts such as age distribution.  Approaches are being updated every week on the basis of the latest learning.

Diane Hedges, Deputy Chief Executive, Oxfordshire Clinical Commissioning Group, reported that, with all of the extra measures that needed to be put in place to protect patients, productivity with out-patients was down to about 30% while operations were running at 60-70% of normal.

There is now a huge backlog of non-Covid work to get through.  Cancer care will be prioritised.  Those who are shielding and waiting for procedures should talk to their GPs especially if there is any change in their condition.  There is increasing collaboration with Bucks and Berks to support each other and efforts will be made to expedite those who have waited longest.

Dr Alan Cohen asked if the impact on those who cannot access online services such as older people and BAME communities has been assessed.  He also asked if Primary Care Networks had delivered or were GP Federations better able to handle the needs.  In addition, he asked what form a review was likely to take and who would be involved.

Diane Hedges responded that triage was in place to assess contacts which were mostly coming in by telephone.  Language lines had already been in place before the pandemic.  All practices had access to e-consult services.  The crisis accelerated collaboration on all fronts including both PCNs and Federations.  There was huge enthusiasm for staff to engage in problem solving.

Dr Ben Riley added that about 20 to 30% of patients need a face-to-face consultation.  Some were provided with home visits.  Practices set up safe zones for those who needed to visit with separate entrances and waiting room.  They have also been pro-actively contacting vulnerable patients such as asthma sufferers.

Yvonne Rees assured the Committee that there would be a review of activity at some point but that they were still dealing with the crisis and only now moving into the recovery phase.  The presentation included information on governance which includes the Health and Wellbeing Board as we move into test and trace phase.  She suggested having a discussion about what the Committee needed going forward to enable it to scrutinise the issues at future meetings (ACTION).

District Councillor Paul Barrow asked about decision-making around discharges to care homes and why some refused patients.  He added that there was a belief that community hospitals could have played a part in assisting in the crisis.

Stephen Chandler responded that decision-making happened the same way as it always does – it was centred on the needs of the individual patient.  It was ultimately a decision for a care home whether to accept.  They were concerned about suitability of individuals, levels of staffing, shielding, PPE access.  The government promised supply of PPE but it didn’t come when promised.  The Council purchased £1m worth itself.  There is now a care home tracker in place which will help to identify any outbreaks and other issues such as staff availability.

Councillor Mark Cherry noted how community pharmacies have been dependent on volunteers to deliver.  He asked how they were going to be supported when people start returning to work and there is less availability of volunteers.  He also asked if officers were satisfied that they have the capacity to test and trace when pubs and restaurants reopen on 4 July.

Ansaf Azhar responded that history has shown with such pandemics that there is always a second peak but they will do everything they can to prevent it.  It will be different with different levels of transmission.  Test and trace has been in place for centuries to deal with notifiable diseases.  The scale however will be massive.  Health Protection Boards have been set up and have drafted local outbreak plans.  All stakeholders are represented.

Diane Hedges agreed that community pharmacies played a massive and largely unsung role.  They are looking at different ways of prescribing to reduce the need for repeat visits or deliveries.  It is one of the learning points that needs to be taken forward – how that system can be supported.

The Chairman reiterated the thanks to all organisations involved in the Covid-19 response – all those who worked and volunteered.  He said that there will be a discussion outside the meeting as to the next steps and how HOSC can be a part of the review when it takes place.

He asked if some examples of where new learning led to changes of practices could be provided after the meeting (ACTION).