Agenda item

To receive a presentation from David Evans, Accountable Officer for Telford and Wrekin CCG.

The Health and Wellbeing Board received a presentation from David Evans, Accountable Officer for Telford and Wrekin Clinical Commissioning Group on the moving from restoration to system recovery and the new normal following the COVID-19 global pandemic. Mr. Evans provided a verbal executive summary on the following topics which were referenced in the presentation received by the board:

·         Framework for planning & managing the stages of the pandemic.

·         The 8 tests that Shropshire, Telford and Wrekin must meet.

·         The Shropshire, Telford and Wrekin Integrated Care System principles and expectations.

·         Capturing innovation.

·         Learning captured through triple lens.

·         Methods of information gathering to inform learning about impact of changes.

·         Timescales for assimilating learning.

·         Recovery & new normal governance structure.

·         System strengths in response to COVID-19.

Members noted that there had been a reduction in the number of people attending A&E during the COVID-19 lockdown period, resulting in less unnecessary trips but also the avoidance of legitimate medical emergencies.  Members questioned how to get the balance right moving forward. Mr Evans responded by agreeing that A&E had seen at least a 50% reduction in attendance at certain points, and that moving forward the NHS needed to ensure the correct messages were put out so that some behaviour exhibited in the lockdown was retained. He stressed that the public also needed to know that the NHS had been open for business as usual for the last three or four and to still attend if you had a medical emergency.

Members asked about the work that had been done with the care sector in relation to a potential second wave, and provided anecdotal evidence of other good practices that had been taken up by care homes in other areas of the West Midlands. Mr. Evans responded by saying that all patients are tested for COVID-19 before discharge and are told to self-isolate for 14 days. Some challenges were presented for patients receiving continued care in care homes. Some care homes have set up separate wings so that they can take patients returning from hospital can reside there. Mr Evans continued by saying that a particular area of challenge for care homes surrounded the patients returning to care homes who suffered from Dementia and may had unknowingly walked out of that wing and cross infected other patients. Mr Evans concluded by saying he believed that there would be recurrence in the prevalence rate at some point within the next five or six months.

Members were keen to understand why the borough of Telford and Wrekin had seen a lower percentage in deaths in care homes due to COVID-19 compared to other local authorities. Mr. Evans was unsure on the answer for this and indicated that Liz Noakes, Director for Public Health at Telford and Wrekin Council may be better equipped to answer the questions. Ms. Noakes picked up on this question and said that the Telford and Wrekin average was just below the West Midlands average in terms of deaths in care homes due to COVID-19 and that this hadn’t been properly investigated yet. However, Ms. Noakes did make reference to three particular points. The first related to the measures that had been taken by the care homes themselves in terms of closing admissions and staffing. The second was a proactive approach to supporting the care homes in the response to an outbreak led by Public Health England, but also support to avoid an outbreak in the first place and finally, a measured approach to discharges. Both Ms Noakes and Mr Evans believed that care homes in Telford and Wrekin needed to be applauded for their response to COVID-19.

Members noted the great work that had been done in the community in partnership with local care providers, and wondered if there could be a commitment that on the relooking of how the borough offers healthcare services across Telford and Wrekin, that more community based partnerships were created. Mr Evans responded by saying that both he and the Telford and Wrekin Clinical Commissioning Group (CCG) were committed to keeping what had gone well in response to COVID-19 and learning from the experiences that didn’t. This included a shorter term plan for preventing hospital admission as well as a more co-ordinated and joined up approach for the short, medium and long term approach to the prevention of ill health for the population.

Members welcomed the innovation and digital advancements that had been picked up by GP’s through the pandemic, but wondered if further detail could be given to the Board about those advancements and a timeline for them to be introduced. Mr. Evans responded by agreeing to bring a plan with details of digital advancements at a later date.

Members referred to the plans for NHS involvement in care homes after COVID-19, and believed that a more radical change could be made with further presence of the NHS in care homes. Mr Evans responded by saying that every care home in Telford and Wrekin had a clear identified clinical lead to provide clinical advice and there were plans for this moving forward. Similarly, Dr Jo Leahy, Chair of Telford and Wrekin CCG said that care homes already received support from the multi-disciplinary team lead by Shropshire Community Health NHS Trust and would continue to provide support. Ms. Noakes added that this is something that was introduced as a project in the Telford and Wrekin Integrated Place Programme.

Members added anecdotal evidence which reflected some challenges faced by a care home in Walsall, which was forced to accept a patient from a hospital but hadn’t been tested. Likewise, due to staff shortages and the risk of the spread of the infection, Dementia patients had been locked in their rooms to stop them from wandering around the floor. Mr Evans offered a point of clarity in response to some of the points raised, which was that any patient discharged from a hospital in Telford and Wrekin had to be tested before discharge and that they need to self-isolate in whatever capacity they leave in whether to their own home or to a care home or a in a community hospital and this guidance came out roughly four or five weeks ago.

Members referenced more anecdotal evidence in which an individual in Birmingham with some learning disabilities had seemingly slipped through the net for care as she had been told that she was not bad enough for care and that her Ulcers were not bad enough for the district nurse to visit and therefore not receiving any care. The concern was that individuals in semi-individual environments have ceased to receive any sort of care.  Mr Evans was disturbed to hear about the individual and was happy to have a conversation outside of the call but was unsure if it was something that had happened in Telford and Wrekin. He added that some services in health and social care had been suspended and had hoped that some residents hadn’t become more vulnerable due to this, but it was something the CCG would need to look into.

Member wished to pay tribute to the multi-disciplinary and multi-agency work that had been exhibited in response to COVID-19 and wanted to credit everyone in Telford and Wrekin for this. However, restoration of services was important, but perhaps more so was the reformation of services to incorporate the good which had been learned during the pandemic and to get rid of the bad. The Member also mentioned that Healthwatch Telford and Wrekin had undertaken several task and finish groups relating to patient experience, which had highlighted that patients were fearful in going to the GP or A&E and only did out of desperation due to pain. The Member concluded by saying that all members of the board had a duty to push the message that the NHS was open for business as usual. Mr Evans agreed that it was important to push the right message to public regarding GP’s and A&E. He followed this by saying that GP’s had started giving advice for patients to phone ahead of visiting the GP as they had started to create designated areas for COVID-19 positive patients or suspect COVID-19 positive patients and designated areas for COVID-19 free patients. Mr. Evans concluded that as part of the wider restoration process was to create COVID-19 free sites in the community, some actions have already undertaken such as moving phlebotomy services and urgent care centres out of the hospital.

This item was concluded with the news from a Member in which the Council had received extremely good feedback from the regional panel for its submission for the Council Support Plan. The regional panel had also identified nine areas of good practice which would be recommended to other local authorities.

RESOLVED – that the contents of the presentation be noted.