Agenda item

6.1  Members gave consideration to a report Update on the Planned Care Workstream of the Integated Commissioning Board .

6.2  The Chair welcomed for this item:

  Siobhan Harper (SH), Workstream Director – Planned Care

SH stated that Andrew Carter, the SRO for the Workstream, had to give his apologies as he had been having technical difficulties connecting to the meeting.

6.3  SH took members through the highlights of the report.  The focus of the Workstream had been on recovery and restoration of services post the peak months of the Covid-19 pandemic and ensuring people were accessing the care they needed. She explained how they had established Acute Provider Alliances across the NEL patch where the key providers had formally come together to deliver elective care and to ensure that they all met the stringent infection control guidance under Covid so that operating theatres, for example, can be kept Covid free.  There were plans for developing surgical hubs for low acuity and high volume conditions and there will be designing sites for specific surgeries to help deliver the restoration of elective care, as per the rigorous targets set for them by NHSE as part of the national recovery.  She also drew Members’ attention to the fact that cancer surgery did actually continue during pandemic and many did get treatment e.g. from private providers via Barts Health.  There were however serious delays in more diagnostic parts of the care pathways e.g. endoscopy, because there were restrictions on how many patients could be seen in one day.  She added that cancer screening services had been reinstated and women were being encouraged to ensure they have their checks.  Another issue for the Workstream was the fact that many were experiencing symptoms of “long Covid” and were finding recovery quite difficult.  Together with partners in primary care and mental health they were developing Covid specific pathways for patients whose conditions are complex, multi-faceted and which present in many ways.

6.4  Members asked detailed questions and in the responses the following was noted:

(a) The Chair suggested that there was scope for a communications campaign by Public Health in relation to ‘Long Covid’ and the long lasting health ramifications for many people of the virus. 

(b) The Chair asked whether ‘virtual by default’ in primary care was exacerbating the digital divide and what action plans were in place to support those who are on the wrong side of this divide and feel they are being locked out of the system.

SH replied that the ICB’s IT Enabler Group, led by the Digital Team at Hackney Council, were working on a number of fronts on this for example there was a piece of work on maximising opportunities to learn about digital world, there was a specific project on helping those with learning disabilities to access additional hardware and work was being done in Mental Health services involving supporting clients to use their personal budgets to purchase the equipment they need.  She added that the health services locally were very mindful that the digital divide posed a real risk to services because only those who know how to navigate the systems can get access.  They were looking at this in detail and asking Providers to monitor the situation.  It was important not to make assumptions that people have the equipment or that they have the space to even receive a private video call with a medical practitioner.  DM added that the policy across NEL on managing in the Covid era was not ‘digital by default’ but rather ‘digital when appropriate’. This helped them to identify where digital solutions worked and to have appropriate pathways in place for this for those who needed them. The Chair added that in the Council there was a similar challenge in relation to school children and how they can accessed learning and there needed to be more joined up services here.

(c) Members asked if report writers could be more careful about the use of confusing acronyms.  SH apologised and stated she would ensure more attention to this in future.

(d) Members asked about the high variances in prescribed medicines and GPs role in offering cheaper alternatives.

SH replied that the cost of generic vs prescribed medicines was an ongoing one.  They did encourage GPs but they generally feel that GPs are now more mindful of prescribing costs because of the requirements to deliver best value and to offer more equitable and effective medicines. MR added that in the clinical system in use in GP Practices there was a prescribing formula embedded in it which, among other things, offered equivalent medicines which would be less expensive, thus saving money from the prescribing budget.  GPs will usually go with the least expensive options but there are occasions where it is medically necessary to prescribe a patient a particular branded item.  Member commented that her GP asked her if she wanted the less expensive item.  SH added that GPs have got used to being more efficient with resources and that they try to engender these commissioning modes of thinking without making it onerous on the doctors.

(e) Members asked about the centralisation of surgical hubs and whether a proper consultation document would emerge proposing which forms of elective care will go to which sites.

SH replied that the Acute Providers Alliance would be bringing something along these lines to a future meeting of the INEL and ONEL JHOSCs.  She added that Jane Milligan at the C&HCCG AGM had made a commitment that the changes as a result of Covid-19 weren’t substantive and that if there were any long term arrangements as a result of the pandemic then they would be properly consulted on and Equality Impact Assessments would be undertaken etc.  These arrangements were an attempt to clear the long waiting lists which had built up in the NEL system because of the pandemic and for example in C&H alone there had been 17000 people on the outpatient waiting lists.

(f) The Chair asked what specific plans as regards transport were being put in place to support patients who will have their elective treatments, for the present, mov3ed to a more remote site.

SH replied that a lot of thought had gone into this.  Initial Infection Control Guidance for patients had been very stringent e.g. all patients asked to self- isolate for two weeks prior to surgery, this had lessened and as part of the initial conversation with patients, they would be looking at transport. Also, with day care procedures for example you cannot attend unless you have someone to accompany you home.  A lot of attention was given to this as part of the re-booking process for those awaiting operations, she added.

(g) The Chair asked if they had an estimate of when elective care might get back on track, notwithstanding the current impending threat of a possible second wave.

SH replied that the situation was fluid because of the potential of a second wave but re-iterated that there were no plans to close services as had been done back in March. That had been a unique situation and there shouldn’t be the same impact this time on waiting lists.

6.5  The Chair thanked SH for her report and for her attendance.