Agenda item

To receive a report from Steve Trenchard, Interim Director for Transformation, Shropshire, Telford & Wrekin CCG’s.

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.