Agenda item

To receive a report from the Director of Adults and Health which presents an update on winter pressures across the health and care system, including and during Covid-19.

The Director of Adults and Health submitted a report presenting an update on system winter and resilience planning and the actions taken during the third peak of the Coronavirus pandemic as it affected the Leeds NHS system. The report outlined how the system – NHS and social care services dealing with urgent care, inpatient care and discharge and rehabilitation community services –remained flexible in response to winter pressures, Covid-19 infection rates and the consequent impact on health and social care services. Additionally, the report highlighted the governance system in place and the close and effective interaction between the Bronze, Silver and Gold groups, ensuring that information flow and decision making remained swift and effective.

The following were in attendance:

·  Councillor Fiona Venner - Interim Executive Member for Health, Wellbeing and Adults

·  Cath Roff - Director of Adults and Health

·  Victoria Eaton - Director of Public Health

·  Shona McFarlane - Deputy Director Social Work and Social Care Services

·  Helen Lewis - Director of Pathway Integration, NHS Leeds CCG

·  Mike Harvey - Deputy Chief Operating Officer, Leeds Teaching Hospitals NHS Trust

·  Sam Prince - Executive Director of Operations, Leeds Community Healthcare NHS Trust

The Executive Member introduced the report, highlighting the impact of the unique requirements of Covid-19, such as social distancing measures, on the treatment of Covid-19 and the impact on wider health service provision.

The Board received a presentation in three parts. The Director of Pathway Integration, NHS Leeds CCG; introduced the first segment and highlighted the following key points:

·  The system operating principles which placed an emphasis on working together to share data and plans; address system challenges; to maximise the skills and capability of the collective workforce and ensure clear lines of communication across all levels.

·  The command and control structure.

·  Long term planning undertaken during Summer 2020 which included winter scenarios and risk assessments, with an initial ‘worst case’ identifying areas of greatest pressure - plans had focussed on admission avoidance; reduction in length of stay; alternatives to continued stay in hospital; additional Covid and critical care capacity within LTHT and cohort arrangements within LYPFT.

·  The need to identify the Covid-19 status of a new patient quickly in order to allocate treatment appropriately and safely.

The Deputy Chief Operating Officer, Leeds Teaching Hospitals Trust, presented the second segment and highlighted the following:

·  Advice received from SAGE and modelling informed planning on a weekly basis for Covid-19 capacity, taking into account prevalence and local case rates; and the rate and ability to discharge patients.

·  The April peak saw 247 beds in use for Covid-19 patients, the 2^nd wave peak was 320 in November and currently there are approximately 240 patients in the hospital.

·  The pressures of care, in terms of the numbers of patients, type of care required, pressure on staff to provide care and the physical space required to accommodate Covid-19 patients and the restrictions that brought.

The Deputy Director, Adults and Health, Social Work and Social Care Services, introduced the third segment of the presentation. The following key issues were highlighted:

·  The Home First and Discharge to Assess principles embedded in the approach used throughout the pandemic.

·  Changes to the Social Work structure made in conjunction with Leeds Community Healthcare NHS Trust had supported more patient discharges to home and community, leading to teams being both hospital and community based.

·  Daily review meetings were implemented to ensure system flow and sharing of data and communication channels using effective multi-disciplinary working across social care, therapy, nursing and community services.

·  Increased Home Care capacity meant fewer and shorter delays in discharge from hospital, thus releasing bed capacity.

·  Social work systems were in place to ensure people who are admitted to a community bed through a ‘light touch’ approach in LTHT are quickly supported to go home first, and only by exception admitted permanently to residential or nursing care.

Additionally, the following matters were brought to Members attention:

The importance of the Mental Health Service - acknowledging increased demand and expectations of the Service as those admitted displayed an increased acuity and as there was little flexibility in acute bed provision, Covid-19 brought additional space requirements which had a negative impact on the service available.  The Service had responded by working West Yorkshire wide to use all available capacity and by enhancing intensive home treatment teams to enable people to stay safely at home. Staffing had also been prioritised to the areas under the greatest pressure.

Impact of Covid-19 on surgery and outpatients - Elective surgery had been significantly impacted by the pandemic and capacity fluctuated depending on the pressures from Covid-19. Although urgent cancer surgery continued throughout the pandemic, the Board were provided with an outline of the number of patients currently on a Cancer Pathway and waiting more than 62 days from referral to treatment.

Members discussed a number of matters, including:

The focus of the impact of the Pandemic on staff - although the public expressed support for NHS staff and carers, the pressure on staff brought by the failure to suppress the pandemic was not felt to be widely understood. Members suggested that hearing directly from staff would enable the Board to gain an understanding of stress, effect on mental health, staff vacancies and the impact of ‘Long Covid’ alongside an outline of how staff will be supported during the period of service and staff recovery. The Board also acknowledged the impact of loss and bereavement on Care Home staff who have cared for residents over long periods, and on those non-community care staff who were redeployed into the community to meet the care challenge presented by the pandemic, particularly those who had not experienced end of life care pathways before.

Covid-19 testing for patients – the Board heard that, due to improvements in technology and processes, the waiting time to receive a result had reduced to 30 minutes – this was essential to ensure new patients are tested so they can be assigned care and a bed if needed. Care can be provided in relevant areas under a red amber green system; with 9 red wards across Leeds; patients are tested daily for 5 days to minimise risk.

Standards of care within ‘own home’ – An increased number of people now choose care being provided within their own homes and it was confirmed that there were no concerns regarding own home care standards. Close working between Social Workers, Home Care Providers and Community Healthcare professionals was being piloted to develop a good joint approach. It was acknowledged that there had been issues in the past achieving ‘good’ rating; but with new ways of working and ‘spot checks’ this had improved. Some Home Care Providers had previously struggled to recruit and retain staff, but that was less of an issue now.

Flu vaccination uptake – In acknowledging that there had been an increased uptake of the flu vaccination, it was agreed that more detailed data reflecting age and ethnicity on a ward level basis would be provided to Board Members.

In conclusion and on behalf of the Scrutiny Board, the Chair extended thanks to staff; Third Sector and volunteers, working in hospitals; care home and community settings for the tremendous effort in supporting patients of Covid-19 and patients requiring care.

RESOLVED –

a)  That the contents of the report and accompanying presentation, along with Members comments, be noted;

b)  That the information requested from Members (as set out above) be provided.