Purpose of the report: The Select Committee is to review a follow-up report that outlines performance against the key themes included in the original Winter Pressures report, presented to the Select Committee in October 2019. The Select Committee will also ensure that appropriate measures are in place for Winter 2020-21, and it will scrutinise the ongoing work being done to improve the take up of appropriate vaccinations in Surrey for residents, NHS staff, partners and those who interact with the system.
Olive Aherne, Area Director, Richmond Fellowship
Karl Atreides, Chair, Independent Mental Health Network
Jane Chalmers, Director of Delivery (Financial Recovery), Surrey Heartlands
Helen Coe, Recovery Director, Surrey Heartlands
Nick Markwick, Co-Chair, Surrey Coalition of Disabled People
Jackie Raven, Associate Director of Urgent and Integrated Care, Surrey Heartlands
Professor Helen Rostill, Director of Mental Health, Surrey Heartlands
Kate Scribbins, Chief Executive, Healthwatch Surrey
Karen Thorburn, Director of Performance, Surrey Heartlands
Key points raised during the discussion:
1. The Director of Performance introduced the report, highlighting key issues including:
a. The significant impact caused by the second wave of Covid-19 that had begun in autumn 2020;
b. There had been over 182,000 attendances to A&E in winter 2019/20, which was an increase of 9.4% compared to 2018/19;
c. The number of attendances to A&E had dropped significantly when the lockdown began in March 2020;
d. Performance over winter 2019/20 had deteriorated compared to Surrey Heartlands’ results in previous years, but was favourable against the England average;
e. Ambulance handover had improved and was performing well;
f. In order to ensure in-person work could continue where appropriate, Covid-secure measures had been put in place, including PPE;
g. A campaign to encourage the public to take up the flu vaccination had commenced;
h. In winter 2020/21, it would be important to balance business as usual, the Covid-19 second wave and recovering backlogs.
2. A Member expressed concern about a statistic in the report that in March 2020, NHS 111 calls answered within 60 seconds had dropped to a low of 12%. How much longer than 60 seconds did it take to answer these calls? Was it significantly longer (for example, one hour), or only a matter of seconds? The Director of Performance said that every year, the service conducted modelling and learning to ensure there was more than 100% staffing to ensure that all 111 call volumes could be covered. The Associate Director of Urgent and Integrated Care stated that she would provide the information requested on the duration of waiting times for 111 calls to be answered. She added that the 111 service would focus on recruitment and increased home working to ensure there was resilience in future.
3. A Member requested data on the time between a service user calling 111 or 999 and the service user being seen or treated by a doctor or consultant. She had heard anecdotal evidence of people waiting many hours for an ambulance to arrive. The Director of Performance agreed to provide this information.
4. The Chair of the IMHN asked what provisions would be put in place over winter considering that bed capacity had been reduced in the Abraham Cowley Unit and Langley Green mental health hospital (in West Sussex, close to the Surrey border). The Director of Mental Health stated that there was a short-term arrangement in place at the Elysium site in Surrey for people who had been on the Abraham Cowley Unit wards. Surrey and Borders Partnership (SABP) also continued to provide services with other partners. The Chair of the IMHN suggested that service users should be involved and consulted wherever possible.
5. A Member remarked that there had been supply issues with the flu vaccine. The Director of Performance responded that primary care organisations usually ordered their flu vaccine stock a year ahead, meaning it had not been possible for them to take Covid-19 into account. There had been a lot of publicity about providing free vaccinations to 50-64-year-olds, leading to an increase in demand; a decision on this would be made nationally in November. For now, the focus was on vaccinating at risk groups, such as those with underlying health conditions. The Director of Performance acknowledged that some practices had lacked supplies of the flu vaccine. Although the logistics were difficult, Surrey Heartlands had ambitions and clear plans on making sure that it could supply sufficient vaccines in winter 2020/21.
6. The Co-Chair of the Surrey Coalition of Disabled People indicated that, while staff working in care homes were tested weekly for Covid-19, there were no regular testing requirements for domiciliary care staff, leaving their clients vulnerable. The Director of Delivery (Financial Recovery) acknowledged that domiciliary care workers were not required to be tested weekly, but there were limits on what could be enforced locally, so for the time being domiciliary care workers had to book tests through the government website like most members of the public. The Director of Performance agreed to check whether domiciliary care workers were considered key workers and would therefore be prioritised for Covid-19 tests.
7. The Chief Executive of Healthwatch Surrey asked how hospital discharge would work during the second wave of Covid-19. The Associate Director of Urgent and Integrated Care replied that, while discharge would often occur more quickly due to the pandemic, it was still fundamental that the patient was safe when leaving the secondary care environment and that discussions were had with the patient and their carer. Appropriate onwards support for each patient post-discharge was arranged quickly and reviewed at a later date. The Associate Director emphasised the importance of placing people and conducting assessments in their own homes when possible, where they would often feel safer, as this led to better outcomes.
8. The Chief Executive of Healthwatch Surrey highlighted the issue of digital exclusion with regards to the shift towards digital avenues for health and care due to the Covid-19 pandemic. For example, a significant proportion of GP appointments were now conducted over telephone or video call, even though 7% of the population did not use digital pathways. The Director of Performance acknowledged that some people would not feel comfortable accessing services digitally. She was keen that safe access to services continued to be provided, particularly now that a second wave of Covid-19 was occurring, and she agreed to feed this issue back to primary care services.
Actions/further information to be provided:
1. The Associate Director of Urgent and Integrated Care to provide details on the duration of waits over 60 seconds for 111 calls to be answered;
2. The Director of Performance to provide data on the average time between a service user calling 111 or 999 and being seen or treated by a doctor or consultant;
3. The Director of Performance to check whether domiciliary care workers are counted as key workers and therefore prioritised for Covid-19 testing.