Agenda item

To provide an overview of the response to the pandemic by the Integrated Care System (ICS).

Dr Amanda Doyle, Chief Officer, Lancashire and South Cumbria Integrated Care System (ICS) advised that she had been the lead for the out of hospital cell response to Covid-19, with Peter Murphy, Director of Nursing, Blackpool Teaching Hospitals NHS Foundation Trust responsible for the in hospital cell response. As part of the out of hospital response, there had been a move to a digital first primary care service in order to isolate and treat covid positive patients. Community capacity had also been increased and support provided to NHS England in order to improve tracking and carry out testing.

Dr Doyle referred to the ‘Test and Adjust’ report which had asked a range of questions to gather the views of local partners and staff to the covid response. Most feedback had been positive and the response of staff to the pandemic was praised. She added that messaging to the public as the pandemic moved into phases two and three must be clear to mitigate risks of a potential second wave of infections. There was particular concern that a second wave could coincide with winter which was already a busy time for the NHS.

During the pandemic, many operations and forms of treatment had been put on hold which had resulted in significant waiting lists. Due to increased infection control requirements such as social distancing, there would be a reduced capacity in hospitals to allow spacing of patients; and procedures would take more time due to the application of personal protective equipment (PPE). The challenges had been identified and work was ongoing to plan and mobilise services including a large flu vaccination programme and the possibility that a vaccine for covid would be delivered in the winter.

Mr Kevin McGee, Chief Executive, Blackpool Teaching Hospitals NHS Foundation Trust commended the partnership and cross system work both inside and outside of the NHS and highlighted the focussed step up of capacity in the hospital at the start of the pandemic. Capacity had been significantly increased in critical care and at the peak of the crisis there remained free beds in the unit. He noted the national problems with acquirement of PPE and confirmed that there had been no issues at Blackpool Victoria Hospital due to local organisations working together to secure the necessary equipment.

In relation to future planning, Mr McGee highlighted concerns relating to the physical and mental impact on staff across the ICS and the impact of a second wave of infection during the winter on their wellbeing. He added that preparations were ongoing for winter and managing capacity with the added complications of seasonal flu and pneumonia.

Mr Peter Murphy reported that there were currently 10 patients with covid in Blackpool Victoria Hospital (BVH). There had been 220 deaths in the hospital of patients with confirmed covid and 461 patients had recovered in hospital and been discharged. Mortality rates at BVH were significantly better than other hospitals nationally. Mr Murphy cited the team work of staff and problem solving that had allowed the delivery of outstanding care. He cited one of the most difficult decisions to take as that of preventing visitors to the hospital and highlighted the role the staff had taken in order to provide bereavement and end of life care with patients and their families at the centre. He reported that there had sadly been one staff death from within the hospital.

Mr Ben Butler-Reid, GP Clinical Director, ICS advised that all 36 primary care practices had remained open during the pandemic, all had access to the required PPE and funding to operate within a safe environment for patients and staff. Practices had taken a digital first approach with patients being triaged by phone and only invited into the practice where necessary. All services were being delivered, however, the number of patients allowed in the practices had been reduced due to social distancing requirements.

The presentation of the report was concluded with Dr Doyle highlighting the concern that some people had not sought help and treatment when needed either due to fear of the virus or in their wish to prevent burdening health services. There had been a significant reduction in people presenting with symptoms requiring investigation. There was also a concern that there would be a negative impact on long term health inequalities and outcomes and work was ongoing to identify how best to address these concerns.

Members noted the survey undertaken of residents and queried how more people could be encouraged to respond. Dr Doyle noted that a poor response to surveys was a regular problem and that alternative ways of targeting local groups were utilised to gather as much input as possible.

The Committee raised concerns regarding the potential of contracting covid whilst in the hospital setting and in response Mr McGee advised that infection control had been increased and numbers of cases in the setting were tracked and monitored on a daily basis. Mr Murphy added that there were a number of complexities around testing, with some false positive and false negative results. The organisation had taken steps to reinforce key messages regarding infection prevention and control. There had been some small outbreaks in the setting and measures had been taken to contain and control these outbreaks.

In relation to care plans, it was queried whether the plans would be reviewed again as many families continued to provide higher levels of care than prior to the pandemic. Dr Doyle responded to advise the Committee that many people in receipt of regular care had been asked to shield or isolate due to the risks to them of contracting covid. It was therefore necessary to minimise their contact including with district nurses. Improvements had been made to the remote monitoring of vital signs such as oxygen saturation during the pandemic and it was important to maintain such improvements in patient care. Dr Neil Hartley-Smith, GP Clinical Director, ICS added that care plans were not a static document and would be regularly reassessed to ensure they continued to be based on the patient’s needs.

The Committee considered the use of technology in triaging and assessing patients and noted the potential inconsistences between different GPs and queried whether a record was being held of when phone or video appointments were utilised rather than face to face visits. Dr Butler-Reid advised that the decision on how to assess a patient was down to individual doctors and there could be many reasons that one choice might be made over any other. Every practice in Blackpool had been instructed to continue home visits and face to face appointments when needed. It was noted that where the patient was considered vulnerable to the virus that it was important to keep them safe. It was concluded that there were many complexities in determining how best to treat a patient and it would be difficult to draw any conclusions from any quantitative data collected.

In relation to staff morale, Mr McGee was asked whether the Council could do anything to help staff at the Trust and reduce the pressure they were under. He advised that despite the pressure they were under, morale of staff was good. The support received from the local community had been welcomed. He added that messaging to the public was of high importance to ensure they understood the need to continue social distancing and maintain high levels of hygiene to prevent further cases where possible.

Members noted the backlog of operations and treatment caused by the pandemic and queried the timescales to reduce the backlog. In response, Dr Doyle advised that extensive planning and modelling was ongoing. Funding had been received from Government to increase capacity and additional equipment had been provided. Planning was ongoing for the worst case scenario in regards to winter and it was hoped that backlogs could be significantly reduced by the end of the year, however, it would be subject to many nuances including the desire for patients to attend the hospital for routine operations and the need for all patients to isolate for 14 days prior to admission.

In regards to the emergency department, Members noted the reduced usage during the pandemic and queried whether there was any learning that could improve the appropriate use of the department in the long term. Dr Doyle referred to a pilot scheme named ‘Think 111 First’ which was a national initiative being piloted in a number of areas including Blackpool. She noted that 70% of attendees at the emergency department travelled by their own means rather than by ambulance. The public would be encouraged to call 111 who would make an appropriate appointment for the person either in the emergency department if required or with another more appropriate option such as a GP.

In response to further questions, Dr Doyle advised that there had been a significant increase in the number of mental health presentations. She advised that helplines had been set up and additional services provided online. It remained a significant pressure on services due to the impact on mental health of the lockdown and virus, and also to the mental health of those in the middle of a lengthy recovery to full health after contracting the virus.