Agenda and minutes

Members are asked to declare the existence and nature of any Disclosable Pecuniary Interests in respect of any item of business to be considered at the meeting.

No declarations of interest were made in items on the agenda.

The Panel is asked to confirm as a true record the Minutes of the meeting of the Health Liaison Panel held on 10 November 2020 (to follow) and to authorise the Chairman to sign them.

The Minutes of the previous meeting of the Health Liaison Panel held on 10 November 2020 were agreed as a true record and the Panel authorised the Chairman to sign them subject to the following amendment:

Councillor Bernice Froud to be listed as ‘present’.

Daniel Elkeles: Chief Executive, Epsom & St. Helier University Hospitals NHS Trust

Trevor Fitzpatrick: Programme Director for Building Your Future Hospital, Epsom & St Helier University Hospitals NHS Trust

The Panel received an update from Dr James Marsh, Medical Director, Epsom & St. Helier University Hospitals NHS Trust on the current position in regards to COVID-19 in-patient admissions.

Dr Marsh advised on the following data related to Covid-19 pressures:

·                     Epsom and St. Helier University Hospitals NHS Trust have treated 2,900 Covid-positive patients since the beginning of the pandemic

·                     The first surge in the spring of 2020, was half the size of the second surge.

·                     The second surge peaked in the second and third weeks of January 2021 with the Trust treating 280 Covid-positive patients. This represented 45% of all beds.

·                     Critical care increased from the usual base-line provision of 13 beds at St Helier and 8 beds at Epsom, to the provision of 46 beds.

·                     South West London Elective Orthopaedic Centre (SWLEOC) was converted to be able to provide 26 of these critical care beds.

·                     The beds served their normal catchment area of Epsom and parts of the surrounding Surrey boroughs and districts, as well as helping to support other hospitals across London, particularly North West London, who were under significant pressure.

·                     The Trust also provided 40 beds to those patients requiring non-invasive ventilation. 20 of these were based at SWLEOC.

Dr Marsh advised the Panel that fortunately, over the course of the last few weeks, there has been a significant reduction in admissions, with the Trust now treating 55 Covid-positive patients across both Epsom and St Helier sites. Four patients are in critical care, and the beds used to provide non-invasive ventilation are now back to their usual capacity with just 3 beds being occupied.

At its peak, Dr Marsh advised that Epsom and St Helier admitted 237 new patients in the course of a week. Over the past 7-days, the Trust has seen just 17 new patients. This is the combined effect of lockdown, and the vaccination programme. Hospital pressures are manageable with beds available across the two sites.

Some staff remain re-deployed to intensive care, but at its peak, 200 staff were deployed to support intensive care.

Dr Marsh advised the Panel that the focus of the Trust is now recovery, with three key areas:

(1)          Staff recovery

(2)          The de-escalation of intensive care provision, and the acute pressures

(3)          Increasing capacity for planned care.

Dr Marsh advised the Panel that of priority is staff recovery. Staff need to have time to rest and throughout March 2021, will have suitable access to annual leave, and time to reflect, both individually and as part of a team. Line managers are being trained to provide support and to recognise staff under stress.

Programmes of work are being set up including group facilitated sessions, and access to staff wellbeing services and self-help. Five clinical psychologists have also been assigned to those teams under the most pressure and the feedback so far has been that this has been valuable.

Staff efforts will also be recognised in virtual awards.

In respect of planned care, whilst consultations have continued with  ...  view the full minutes text for item 7.

Dr Hilary Floyd: GP Partner and Co-Medical Director - Surrey Downs Health and Care

Lorna Hart: Deputy Managing Director, Surrey Downs Integrated Care Partnership

Dr Hilary Floyd, Surrey Downs Health and Care, advised the panel that at present, a significant issue for primary care was that many of their patients were not attending appointments.  This has resulted in some, particularly those with long-term health conditions becoming very unwell. Primary care is therefore looking at how they can increase appointments for those with long-term conditions, and are using a risk stratification to ensure those at greatest risk are seen first.

Primary care networks are also utilising additional resources that are now available.

The Covid oximetry at home service is also being used to monitor blood oxygen levels in patients who have Covid and who may be at higher risk of developing hypoxia and needing urgent hospital admission. This is being rolled out in partnership with Surrey Downs Health and Care, and across the 4 areas of Surrey Downs. Long Covid services also continue to operate.

Dr Floyd advised the Panel that primary care also continues to look at health inequalities, with a focus on patients with learning difficulties, ensuring the vaccination programme is targeting these individuals. Each Primary Care Network has access to the GP Integrated Mental Health Service and this has been especially valuable in respect of anxiety, depression and stress-related mental health that has seen an increase.

The main message primary care wishes to convey is that it is open to see patients and will be moving to offer a lot more face-to-face appointments.

Dr Floyd updated the Panel on the vaccination programme.

Dr Floyd reflected on the local service (the GP hub), located at Epsom racecourse, and the roving vaccination teams that have been visiting care homes, those unable to leave their homes, and those with a learning disability, and supported living schemes.  

The GP vaccination hub is co-located with CSH at the racecourse and Dr Floyd thanked the support of Surrey County Council, Epsom and Ewell Borough Council and the Police in getting up and running. The site is also well supported by volunteers in being able to sign-post patients, and offer them transport.

The roll-out is proving effective and they are now about to start inviting cohort 7 for vaccination. Dr Floyd confirmed that to date, 100% of each cohort had received an invitation, with approximately 90% in each cohort taking up the vaccination.

Patient feedback and experience has been positive.

Dr Floyd commented that when the racecourse re-opens for racing, a new site will need to be secured and they are looking into this at present.

Mr. Bill Cassidy presented to the Panel on collaborative working, and the work being done to reach out to communities that may find it difficult to engage in the vaccination programme.

Mr. Cassidy also assured the Panel members that for the small percentage of those in the eligible cohorts who have not taken up the vaccine, further attempts are being made to contact them. 

Barriers identified to taking up the vaccination offer include language, vaccine misconceptions and religious reasons.

Mr. Cassidy advised that  ...  view the full minutes text for item 8.

Steve Flanagan: Chief Executive Officer, CSH Surrey Board

Mr. Steve Flanagan, CSH Surrey Board, presented to the Panel on the mass vaccination centres and opened his presentation echoing the thanks extended by all in the collaborative working.

Mr. Flanagan advised the Panel that the mass vaccination centre opened on 11 January 2021. The site was one of the first in the Country and attracted significant media attention.

The site started with administering up to 600 vaccinations per day, and is now fully operational and offering up to 1,500 per day. The site just had its busiest day with 1,648 vaccines in one-day. They are looking to achieve the target of over 2,000 over the course of the next few weeks.

Mr. Flanagan advised the Panel that they are offering a hybrid model, vaccinating both younger and older cohorts.

The site had (at the time of the presentation) administered 55,000 vaccines, and as a provider, had also managed to vaccinate 89% of its staff. 

The site is very well staffed and whilst there was an initial issue with staff training and the level of qualification needed based on the offer of Pfizer vaccines, this eased with the use Astra Zeneca vaccines. The site was initially only able to use healthcare professionals to administer the Pfizer vaccinations, but due to school closure were able to utilise school nurses in the early stages.

The site also received unbelievable support from St Johns, and from the local community.

The mass vaccination centre has had various challenges in respect of the lead-in time, and the complexities of the programme. Parking, traffic, workforce sustainability, the national booking system and adequate storage for vaccines have all presented challenges. These have been overcome and the centre is now able to use trained but non-medical staff for administering vaccines. The centre also had adverse weather conditions over one period, however despite this, 90% of those with appointments attended. 

Mr. Flanagan advised that some emerging issues are those attributable to people trying to secure a vaccine when they are not yet eligible. As the program moves to vaccinate younger cohorts however, these can be administered more quickly and as such they will look to vaccinate between 2100-2300 per day.

In respect of the site, this will close for preparations for Epsom Derby, on the 16 May, and the centre will move operations to Sandown until end of August. This move will allow them to try different models, such a ‘drive-through’ administration.

Mr. Flanagan ended by reflecting on the efforts of everyone involved and that the centre has been a model of continuous improvement.

A question was asked about the vaccination service at Nonsuch Mansion, and whether this provided services for residents of Surrey or London. Dr Floyd confirmed that this would be part of London and so the facility was not open to residents of Surrey.

In response to a question about the locations for the second vaccines, Mr Flanagan advised that there was some uncertainty around booking as the  Sandown site  had only just been confirmed as  ...  view the full minutes text for item 9.