Agenda item

10:40

 

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

 

·         Some key learning/changes delivered during the COVID-19 response stage

·         NHS – update on “restart” activity e.g. primary care services

·         Winter planning*, which will include flexibility for a second COVID wave

 

* Report will be circulated in the Addenda.

 

The Chairman introduced the item stating that, by agreement with the Chief Executives of Oxfordshire County Council and the Oxfordshire Clinical Commissioning Group (OCCG), this will be a standing item on the Committee’s agenda until COVID-19 ceases to be a substantial problem.

 

Liz Peretz, representing Keep Our NHS Public, stated that local test trace isolate and support schemes are necessary if we are to navigate our way through the pandemic. She was much encouraged by comments from the Director of Public Health that we are moving towards a local scheme – run in harmony with the national one.  A number of people such as active, retired staff from the NHS and local authorities want to offer their services as tracers and contactors.  She asked the Committee to ensure that this will happen in Oxfordshire.

 

Councillor Jane Hanna supported the call for local testing.  She believed that the national system was not working with many people in her area of Grove and Wantage unable to access tests.  She had also heard reports of people seeking testing at the Dalton Barracks site mingling due to the absence of signage.  She was also concerned with the lack of engagement with the public and asked what the plan is for engagement, which will become particularly important if there is a second wave or difficulties with supplies of medicines or equipment following Brexit.

 

The Chairman stated that he wished to deal with the Winter Plan separately and concentrate on the overall COVID situation first.

 

COVID-19

Diane Hedges, Chief Operating Officer and Deputy Chief Executive, OCCG, described the plan to restore services to near-normal levels.  With GP services there had been a move away from face-to-face contact and separation of COVID and non-COVID patients.  A lot of work is going on to bring numbers back up towards normal.  There will be a challenge with the increased numbers seeking flu vaccination.

 

Community services have been reopening premises getting people back in safely.  There is a move towards community hospitals providing more support for out-patient services.

 

There has been a lot of new learning across the system most particularly around using digital solutions and the need to improve engagement around inequalities, for example with BAME communities.  The OCCG has laid out an extensive engagement plan to help understand the patient experiences.  Healthwatch has been very helpful in this regard.

 

Ansaf Azhar, Corporate Director for Public Health, outlined the current situation.  The numbers of cases are rising across Europe.  In Oxfordshire the Health Protection Board, involving all partners, meets weekly.  There is also a surveillance unit analysing data on a daily basis, giving an early warning of problems.  It also provides a dashboard where the public can see the number of cases at a district level.

 

There have been two areas of concern: East Oxford in July and more recently among young people.  These were tackled by expediting testing through local mobile units.

 

He recognised the frustration with availability of testing.  He is working with the BOB partners (Bucks and Berkshire West) at providing key-worker testing.  There is likely to be a high demand for testing as we enter the flu season.  A task and finish group has done a lot of work with the universities on the safe return of students.  A local enhanced system of contact tracing will be ready to start in mid-October.  This needs to be authorised by the national system and will focus on cases where the national system has failed to contact.

 

In summary, while they are escalating issues such as testing to a national level where necessary, they are also working on local and regional solutions.  It is a fast-changing picture but they will react decisively when needed through the strong governance structure.

 

The Chairman welcomed the provision of local testing to tackle clusters and added that it was evidence of how the Oxfordshire system was learning as the situation develops.

 

Councillor Mark Cherry asked that the council communications teams promote the track and trace phone app and the importance of flu vaccination as much as possible.

 

Councillor Laura Price was critical of the national online booking system for tests.  There were a lot of bugs in the system and it often failed to provide the necessary QR code at the end.  She also asked about visiting in care homes and hospitals.  The former depends on the individual care home.  Many people have had a prolonged period now with no visits.  People can be a long time awaiting an assessment in hospital with no visits allowed.

 

On the test booking system, Ansaf Azhar acknowledged the problems outlined.  Much of it was related to the national limit on the number of tests.  Areas with a high number of cases were being prioritised.  Oxfordshire currently has a lower rate so it is more difficult for people to access testing.  He has escalated the matter particularly in relation to the return of students.

 

The issues of care home visiting have been discussed nationally.  The current evidence indicates that visiting is not a problem but it is curtailed in homes where there are more than one case.  Visiting is particularly important in end-of-life (EOL) cases and he would not like to see a blanket ban introduced.

 

Stephen Chandler, Corporate Director for Adult Services, acknowledged that there is a risk either way – a risk of infection versus the risk of detrimental impact of not being able to see loved ones.

 

Sam Foster, Chief Nurse, Oxford University Hospitals, added that while there is the ‘rule of 1’, there is discretion allowed regarding patients who have carers; with learning disabilities or mental health issues; and EOL.  The government has enabled local trusts to make their own decisions.  Family liaison teams are building relationships with families.  All staff have been provided with iPads to enable patients to teleconference.

 

Members of the Committee asked for more communication around visiting policies and Sam Foster AGREED to provide the Committee with more information about the family liaison team and teleconferencing options.

 

City Councillor Nadine Bely-Summers stated that people in East Oxford find it difficult to access testing and get results quickly.  They cannot work or go to school while they are waiting for results.  She suggested that there should be more local communications on outbreaks.  She also believed that, in relation to the cluster at BMW, there were too many different agencies involved.

 

Ansaf Azhar responded that the Public Health team was a small team receiving a large number of queries.  The operational cell includes representatives from districts, police, GPs, hospitals, laboratories etc.  Each is responsible for messaging to their own sector.

 

When there is a local outbreak, there is a clear communications plan.  Mobile testing is brought in.  He believed that the BMW outbreak was handled well in cooperation with the City Council – everyone was tested within half a day.

 

He stated that he was not happy with the national situation on testing which is why he is working towards local and regional solutions.  The government has announced that financial support is available for people self-isolating and losing income.

 

Barbara Shaw noted that communications on GP services varies.  It is difficult to get face-to-face visits.  She believed that EOL services are overwhelmed.  She would like more information on excess deaths.  She also asked if it was possible that dental services could cease again.

 

Diane Hedges acknowledged that the situation for GP surgeries is challenging.  All initial contact has to be by phone and then face-to-face consultations are available where necessary.  They are working with Healthwatch and Patient Participation Groups (PPGs) to make this work.

 

She is not aware that EOL services are overwhelmed but if anyone has any evidence of that she would like to receive it.  Hospice facilities have been extended and more people are being supported at home.

 

The OCCG does not oversee dental services - they are commissioned by NHSE.  Her understanding is that services are returning to normal.

 

Ansaf Azhar responded on the point of excess deaths.  This is being monitored because it takes into account deaths that may be occurring indirectly from COVID-19.  The Oxfordshire figures are in line with the national trend.  They are also watching non-COVID deaths which rose at the peak of the pandemic but have now reduced.

 

The Chairman AGREED to pursue the dental issue outside of the meetings for now.

 

Dr Alan Cohen noted that the GP federation in Oxford (OxFed) will cease trading.  He asked what would be the implications; if a similar situation might occur in the north of the county; the impact on Primary Care Networks (PCNs); if money assigned to the federation will continue to be spent on primary care; and if there is nothing between PCN level and county-wide level.  He also asked if the high number of transfers from hospital to care homes without COVID screening had any impact on the number of cases in care homes.

 

Stephen Chandler replied that he did not have the transfer figures to hand but they had already been presented and he AGREED to circulate them to the Committee and would be happy to take any questions Committee members may have after seeing them.

 

Diane Hedges agreed that the closure of OxFed was disappointing.  OCCG are working with them on the transfer of services and staff.  There will be changes to the dynamics of funding flows but the money will stay within primary care.  Developing PCNs is the key to shaping future services.  The federation in the north is still vibrant and there are other ways of delivering services at a level between PCN and county-wide.  It was AGREED to follow up on the OxFed issue between meetings.

 

Councillor Alison Rooke asked about the availability of flu vaccines.  Ansaf Azhar responded that this was a regional and national issue.  At this time last year there had been a take-up of 4,000 through community pharmacies in the Thames Valley region and this year it is already 17,000.  He has raised it with the local health resilience partnership.

 

Diane Hedges added that NHSE is buying as much vaccine as it can.  People should not be concerned that it has run out – more is arriving all the time and another cohort is expected in November.

 

District Councillor Paul Barrow asked if there was now a standard protocol for care homes and a standard protocol for discharges from acute hospitals to care homes.  He also asked if care homes who previously refused to accept transfers will now be pressurised to take them.

 

Stephen Chandler responded that there had been a standard discharge protocol since April.  There must be a negative COVID test result before discharge can happen.  Infection control protocols are evolving.  They are addressing the risk of staff transferring infection.  There is a low level of risk in Oxfordshire but he is monitoring it closely.  The government have announced a further allocation of £5.4m for infection control in Oxfordshire.

 

He did not believe that any of the stories about care homes being pressurised relate to Oxfordshire but if anyone has evidence of it, they should let him know.  Most patients are now discharged to home and if not, then to hub beds rather than directly to a care home.

 

Jean Bradlow asked what the impact of COVID had been on immunisation and screening programmes; the plans to catch-up; and onward referral for cancer screening programmes.

 

Ansaf Azhar agreed that there had been a reduction in numbers though he did not have the specific numbers.  The increase in provision of preventative measures is part of the recovery plan.  They will be more targeted towards groups where the uptake has been lowest.

 

The Chairman asked that the issue of cancer referrals be addressed under Agenda Item 10.

 

Winter Plan

The Chairman asked if there is likely to be less flu this year given that all of the measures people are taking to reduce the spread of COVID-19 should also reduce the spread of flu.  He emphasised that he would still urge everyone to get the flu vaccine anyway.

 

Ansaf Azhar responded that we do not know how effective current measures will be.  Even if there is less flu the burden of COVID on the system will still be very high.  There is also the question of amplification if somebody has flu and COVID.

 

Stephen Chandler noted that the government had published a winter plan for adult social care on the previous Friday and the local winter plan would need to be updated to account for that.

 

It was AGREED to take the Winter Plan as an item at the next Committee meeting but that the updated Winter Plan could be circulated to Members at any time and did not need to wait until the next meeting.

 

The Chairman asked the Chief Executive if a letter from the Committee to the Department of Health on the issue of testing would help.  Yvonne Rees responded that every channel possible is being used to escalate the matter.  A letter from the Committee will support the Director for Public Health and will be listened to.  There is a problem with laboratory capacity at the moment and new labs will not come on stream until the end of October.

 

It was AGREED that the Chairman will write to the Department of Health.  The Chairman thanked all of the officers across the system for coming to the Committee and responding to their questions.