Dr Ruth Charlton (Joint Medical Director) presenting on the following:
• The future of Epsom and St Helier University Hospitals NHS Foundation Trust in respect of new leadership, a brief overview of on-going developments, and any new initiatives or services for future consideration
• Winter pressures: The current picture and plans in responding to Covid-19, and the anticipated rise in influenza and other winter-borne illness
Minutes:
The Panel received presentations on the following matters:
a) The future of Epsom and St Helier University Hospitals NHS Foundation Trust in respect of new leadership, a brief overview of ongoing developments, and any new initiatives or services for future consideration.
b) Winter pressures: The current picture and plans in responding to Covid-19, and the anticipated rise in influenza and other winter-borne illnesses.
The Chair advised the Panel that Dr Ruth Charlton will not be providing the update on the future of Epsom and St Helier University Hospital Trust at this evening’s Panel. This will be covered at the Panel in March 2022 by the newly appointed CEO.
Dr Charlton advised that at the present, and as anticipated, the Trust is managing:
· An increase in Covid cases alongside the normal winter virus.
· A surge in virus in children
· Its recovery in respect of planned care and elective surgery.
Dr Charlton advised that an immediate challenge is doing this work with an already fatigued workforce.
Dr Charlton advised that during the Spring/Summer period they had seen normal levels of A&E attendance however since this time, the numbers of presentations have steadily increased up to 250 patients a day. This is compounded by the fact that such high numbers cannot be accommodated in the building.
However, of some reassurance, the number of patients they need to admit is not increasing.
In terms of Covid, the numbers fluctuate with Epsom and St Helier currently having 52 patients admitted with Covid. Dr Charlton advised, however that routine testing of patients has commenced, and therefore Covid is not always the primary reason for admission. The numbers in critical care are now small and this is largely due to the vaccination rollout.
In planning for winter pressures this year, what has changed is the level of collaborative working and that the Covid response would not have been as successful without partnership working. Additional funding is available this winter, however it is workforce fatigue that presents the greatest challenge.
Dr Charlton advised the Panel on the new ways of working in respect of linking in with other partners and Trusts, assessing the availability of beds and getting an understanding of the situation across the hospitals. Working as a system has been and continues to be instrumental in managing the pandemic.
There continues to be a lot of modelling in respect of the provision needed. It is difficult when no-one knows how the pandemic will change, or how the vaccination programme will continue to impact. Epsom historically plans for 6 critical care beds, and St Helier 13. It is anticipated that the beds at St Helier may need to increase to 22 beds.
In respect of winter investment Dr Charlton touched on the following matters:
· Point of care Covid PCR testing and investing in a rapid PCR testing machine to help identify Covid at the earliest convenience.
· An increase in hospital porters. Dr Charlton advised that the new layout of the hospital to accommodate Covid patients has meant it takes a longer to move around the hospital, so this is a vital provision.
· Sourcing additional medical staff.
· Opening the surgical assessment unit.
Staff who don’t need to be located in A&E (administration staff) have been moved to porta cabins, to allow office space to be turned into clinical space. It has also been necessary to increase oxygen stores and flow to the Hospital, using the Elective Orthopaedic Centre to support this.
In respect of priorities, Dr Charlton advised that the central government’s priorities are closely aligned to the Trusts and are as follows:
· Health and wellbeing of the workforce
· Vaccination programme
· Transforming services
· Expanding primary care capacity in addressing health inequalities
· Transforming urgent and emergency care and reducing the length of stay
With regards to transforming urgent and emergency care, this includes all services across pathway (including the ambulance service), and a 10-point plan is in place to improve the recovery of all services.
There is also a review of the use of 111. Dr Charlton stated that a lot of people are not aware that there is access to emergency appointments via this route and this stops people having to stand and wait in A&E. There is also the need to look at how people flow through A&E and the hospitals, including the speed at which test results are received.
Support for children and young people is being looked at with the impact on mental health very apparent.
Infection control continues to align itself to national policy. The retention of face masks, social distancing, isolation areas, and changes to the hospital layout remain; this includes different access and egress points.
Preparing and protecting staff throughout the winter is paramount. Very sadly the trust lost 6 members of staff to Covid and the impact on staff has been and continues to be significant. Dr Charlton advised on the priorities for staff over this time. The Trust has also awarded all the staff who worked over the course of the pandemic a medal and certificate, offers free meals and car parking to staff, and has ensured a clinical psychologist is available if needed.
In respect of A&E waiting times, work is being done to reduce these. 12-hour wait times are highly unusual however can still occur when a bed is being awaited. This is further impacted by a bed needing to be in the right wards in respect of isolation and clinical status. However, Epsom and St Helier remains one of the highest performing A&E departments in respect of wait times.
The Trust are anticipating an increase in children’s viruses due to not having been exposed to viruses over a 12-month period, alongside a significant rise in children and young people’s mental health.
The Trust has reviewed the 52-week wait for those diagnosed, to having surgery. This number has been reduced from 1000 to 170 which is close to pre-Covid numbers, and this is partly due to the whole system working together to carry out these procedures. Virtual appointments are still happening however face-to-face appointments are resuming.
The referral rate for urgent care has increased to 120% which compares to pre-pandemic levels. Elective work therefore continues to present additional pressures.
The following questions were asked:
a) How has the disruption caused by the self-isolation requirements of staff been addressed by the Trust.
The reasons for the staff absence are due to a variety of reasons. Staff are off due to being physically vulnerable themselves, those who contracted Covid and those who have been in close contact. Whilst for the general population this has been partly addressed by the vaccination programme, for NHS staff this does not apply, and a risk assessment must be undertaken as well as a mandatory PCR test. A safe return to work is heavily determined by the staff member’s role and those patients they may encounter.
b) Whether the government announcement on mandatory vaccination will further impact the issue raised regarding staff retention.
Dr Charlton advised that this mandate is from Spring 2022. This gives more time to work with staff and to understand vaccine hesitancy. Almost 90% of staff are vaccinated and whilst some staff may still not wish to be vaccinated, there is a degree of optimism about vaccine uptake.
c) The uptake of the flu vaccine given the strains this year are likely to be stronger.
Dr Charlton advised that a vaccination centre for Covid vaccines is being run on site and this will administer both flu and Covid vaccines together. A 7-day a week service has been offered, including cover of night shifts. Dr Charlton advised that those staff who are not wanting to be vaccinated and who are unable to work on certain wards due to clinical risk, have been re-deployed to administer vaccines.
d) The use of 111 with people attending A&E for an assessment and being diverted away from GPs.
Dr Charlton advised there is a perception that it is hard to get a GP appointment, whilst GPs can offer different ways of being seen. There are some people who will always want to be seen face to face, and straight away and so A&E is often where they go as they know this can be guaranteed. The Trust is collaborating with primary care so they can ensure patients with low-level symptoms do not attend A&E unnecessarily, but it is accepted more work is needed as a system.
It is accepted that the way healthcare is accessed has changed significantly and that part of the solution may be to better promote 111 where appointments can be secured without delay.
It was noted that the pressure on services and staff is unprecedented, with incidents of abuse being reported, and the impact this has on staff recruitment and retention.
Dr Charlton advised that the Trust is working on creative ways to recruit and retain staff. The challenging behaviour seen in A&E comes from the time-pressures to see the patients. There is now an infrastructure in place at weekends to support staff with this.
e) Whether the 120% referral rate referred to earlier, is attributable to patients not being able to get a face-to-face GP appointment.
Dr Charlton advised that the 120% was reflective of many things. The referral rate was reflective of those referred for elective surgery, and that as this was paused over the course of the pandemic it is the case that these will have increased. Dr Charlton advised that they are not seeing people being referred inappropriately. GPs are working incredibly hard, and the increased referral rate is the result of the health needs post-pandemic.
A Councillor reflected on children and young people’s (CYP) mental health and the delay in accessing mental health services, and what support will be put in place for those young people.
Dr Charlton advised there was a lot going on nationally to address this issue. In Spring 2020 the magnitude of the impact of CYP was felt. There is funding available, and it is being looked at as to where this funding should be aimed with schools being one beneficiary, alongside CAMHS.