To receive a report from Steve Trenchard, Interim Director for Transformation, Shropshire, Telford & Wrekin CCG’s.
Minutes:
The Joint Health Overview & Scrutiny
Committee (JHOSC) received a presentation from Steve Trenchard,
Interim Executive Director of Transformation, Shropshire, Telford
& Wrekin Sustainability and Transformation Partnership on the
recovery and restoration of services post COVID-19 in Shropshire,
Telford & Wrekin. The presentation covered the following
topics:
· Recovery planning.
· The 8 tests Shropshire, Telford & Wrekin must meet.
·
Making visible system changes: transformation
oversight during COVID-19
- Phase one: central record of change
across System to inform restart position.
·
Making visible system changes: transformation
oversight during COVID-19
- Phase two: informing system models post COVID-19.
· Understanding crisis-response measures.
· Caring for our people: psychological support.
· Support offer.
· Looking back at Shropshire, Telford and Wrekin principles
· Shropshire, Telford and Wrekin Integrated Care System principles & expectations
· Shropshire Telford and Wrekin, Sustainability and Transformation Plan, Long term Plan vision.
· System strengths in response to COVID-19.
· Recovery & new normal governance structure for Shropshire, Telford and Wrekin system.
Members asked the following questions and received the below
responses.
Members asked the Interim Executive Director for Transformation
about the amount and type of support that had been offered to
domiciliary care sector during COVID-19 in Shropshire, Telford and
Wrekin. The Interim Director for Transformation responded by saying
that the system had offered support into domiciliary care and care
homes, that both local authorities were a part of this support and
that the People System Plan highlighted that.
Members recognised that staff support had been
covered in the presentation, but wanted to know more about the
staff burnout in Shropshire, Telford & Wrekin hospitals,
whether there were any particular types of staff and what could be
done to help them.The Interim Executive Director for Transformation
invited Nigel Lee, the Chief Operating Officer of Shrewsbury and
Telford Hospitals NHS Trust (SaTH) to respond to this question. The
Chief Operating Officer emphasized that this was something that
Shropshire, Telford and Wrekin had tried to address as a system, as
a number of different types of staff had been affected by COVID-19,
but noted that those working in acute care and COVID-19 wards had
been particularly affected. The Chief Operating Officer outlined
the care package that been put together to support staff such as
psychological support, along with additional expertise provided by
the mental health trust, other companies and the workforce team at
SaTH. He concluded by saying that staff were encouraged to take the
appropriate leave during the summer in order to recuperate.
Members asked about the Phase Three letter that was sent out to all
NHS system leaders by Sir Simon Stevens, Chief Executive for NHS
England and Amanda Pritchard, Chief Operating Officer for NHS
England, especially in regards to acute care and how those
requirements could be met:
· In September at least 80% of their last year’s activity for both overnight electives and for outpatient/day case procedures, rising to 90% in October (while aiming for 70% in August);
· This means that systems need to very swiftly return to at least 90% of their last year’s levels of MRI/CT and endoscopy procedures, with an ambition to reach 100% by October.
· 100% of their last year’s activity for first outpatient attendances and follow-ups (face to face or virtually) from September through the balance of the year (and aiming for 90% in August).
The Chief Operating Officer for SaTH responded
by saying that the targets were a challenge due to the additional
infection prevention control checks that were needed between seeing
patients. However, noted that David Evans, Accountable Officer for
Shropshire, Telford & Wrekin Clinical Commissioning Group (STW
CCG) and other system leaders had been working hard with NHSEI on
accessing additional capital and support. The Chief Operating
Officer provided the example of the West Midlands Cancer Alliance
of cross border working.
Members asked what would happen if the targets
as set out by the Phase Three letter were not reached. The Chief
Operating Officer for SaTH responded by saying that SaTH were
committed to working with the system to reach the aforementioned
targets. The Accountable Officer for STW CCG added that it was not
known at the time what would happen if they were not met, but was
sure they would be under increased scrutiny from regulators. The
Accountable Officer for STW CCG said that the system would be
continuing to use the Nuffield Hospital to deliver the elective
agenda and was more comfortable that it would be easier to achieve
cancer related targets with the use of the West Midlands Cancer
Alliance.
Members welcomed the use and uptake of digital consultations in
general practice surgeries, but also expressed their concern that
it may not be accessible for some groups. The Accountable Officer
for STW CCG responded by saying that by April 2021, all GPs would
have to offer digital or virtual consultations but that was not the
only option available for patients.
Members inquired about the status of the
Winter Plan and when it would be available to come to the
committee. The Interim Executive Director for Transformation
responded by saying that the basic elements of the winter plan had
been completed, but the key challenge was to align the winter plan
with the restoration of services and refreshing the system plan.
The Accountable Officer for STW CCG highlighted that SaTH had
roughly lost 75 beds in its capacity due to social distancing
measures, that the overall system was challenged for productivity
due to infection prevention control measures and the changing of
PPE which reduced the rate diagnostic procedures could occur. The
Accountable Officer for STW CCG believed that SaTH MRI/CT and
Endoscopy procedures were running at 50% to 60% of pre-COVID-19
levels.
Members were keen to understand the use of brought in capacity, in
particular to Nuffield Hospital, and whether it was being used to
its full capacity. The Accountable Officer for STW CCG responded by
saying that the Nuffield Hospital was being used and that
colleagues were meeting with Nuffield Hospital to find out exactly
how much capacity can be used for the winter period moving
forward.
Members asked about the reduction in bed capacity because of social
distancing requirements in response to COVID-19. The Interim
Executive Director for Transformation responded by saying the bed
reduction was critical, however this was mitigated by a new pilot
initiative where people were encouraged to “talk before you
walk” into the Emergency Department and made better use of
NHS 111 and had a strong suite of community services which managed
patients coming through the front door of SaTH.
Members asked about the collegiate working that had been undertaken
with neighbouring system. The Accountable Officer for STW CCG
responded by saying that mutual aid agreements had been created with the Staffordshire health system and a
new document outlining a continued mutual aid agreement was in the
works. Therefore he was confident moving forward in the cross
boundary working between systems. Likewise, with the Worcestershire
and Herefordshire system, informal discussions have occurred and
there was a recognition of the cross border working which happened
both ways. Similarly, the Accountable
Officer for STW continued by saying that there were active
discussions with Powys Health Board as they were a member of the
silver command group.
Members asked about the apparent reduction in
the financial capacity available for the system in responding to
COVID-19. The Accountable Officer for STW CCG replied by saying
that they had not heard directly but noted that the STW CCG put
forward a substantial bid like many other CCG’s and that they
couldn’t all be funded.
Members asked for a summary on the level and type of activity that
had occurred in both SaTH sites pre-COVID-19, during and
current. The Chief Operating Officer
for SaTH said that during the initial response to COVID-19 there
was an overall reduction in activity, and that during the
“recover” period there was a rise to about 80% of
pre-COVID-19 levels. Likewise, he added that there was some
disparity between Shropshire and Telford & Wrekin, with
Shropshire returning to and above pre-COVID-19 levels of A&E
activity and ambulance usage, whereas Telford and Wrekin was
slightly below. He said that this was partly in due to that fact
that trauma services had temporarily moved to Robert Jones and
Agnes Hunt Hospital.
Supporting documents: