Agenda item

4.1  Members gave consideration to a briefing paper NHS NEL Health Update.

 

4.2  The Chair stated that there would be four elements to the item and he welcomed the following to present their sections:

 

a) Provider performance, collaboration update and introduction to Group CEO

Shane DeGaris (SD), Group Chief Executive of Barts Health and BHRUT

 

b) Winter Planning, Resilience

Zina Etheridge (ZE), Chief Executive Officer, NHS North East London,

Siobhan Harper (SH), Transition Director - Primary Care, NHS NEL

 

c) System pressure and urgent care and enhanced access to primary care

Siobhan Harper (SH), Transition Director - Primary Care, NHS NEL

 

d) Vaccinations update (including Covid-19, Flu, Mpox, Polio and MMR)

Diane Jones (DJ), Chief Nursing Officer, NHS North East London

 

He added that the slides also included an update on Community Diagnostic Centres, which was just for noting, as this had been dealt with in detail at the previous meeting.

 

4.3  Shane DeGaris (CE of Barts/BHRUT) took Members through his presentation on provider performance, collaboration update, staffing update.

 

4.4  The Chair asked what the issues were at Queens and King George V that had made their situation more challenging.  SD explained that there were several factors. King George V had double the number of  ambulance arrivals than the Homerton but half the number of in-patient beds. There was also considerable variation on primary care availability and a broader issue in that there was great variation across the system on delayed discharges of care.

 

4.5  The Chair asked if these issues were structural and if, simply, more beds were needed. SD explained that the focus was on helping patients not to have to go to A&E in the first place and looking at other things they can do at urgent care centres. He described Project Snowball about ensuring that processes are more efficient inside the hospital and the issues around sharing risk so other departments can assist with the burden.

 

4.6  Cllr Masters asked how practical it was to get somebody into an alternative site in the community overnight and also commented that if the Acute Trusts were offering these elements of extra support to staff didn’t this imply that they were not paying them enough. SD replied that it was more difficult to discharge at weekends and the ability to have community care packages over 7 days and a 7 day service was crucial. On pay, they were beholden to national pay reviews for substantive staff and so they are trying to help those who need additional support. He explained the operation of the REACH system which helped and operated until 10pm but admission prevention can’t take place later.

 

4.7  ZE took Members through the presentation on winter planning and SH took Members through the presentation element on resilience, system pressure and urgent care and on enhanced access to primary care.

 

4.8  The Chair commented on the need for better communications on the Enhanced Access Service and what was being done to convince patients about this new approach because there was a lack of confidence in 111 and hence people end up at A&E.  SH explained that 14000 people had responded to their engagement when shaping the Enhanced Access Service. It is an ongoing comms challenge she added.  There is a debate on balancing same day access for some vs continuity of care for others and she added that A&Es are not the best experience for those just requiring primary care.

 

4.9  Cllr Adams described the situation of struggling to get a GP appointment and being directed to A&E and Cllr Masters asked about the role of GP Assistants and Digital Transformation Lead, asking what qualifications and responsibilities they have and what training they receive.  SH replied that the GP Assistant and Digital Facilitator roles would be administrative not clinical roles and they have not been rolled out locally yet. There is a great variance in GP performance across NEL and this is a concern and the aim now is to work at a peer to peer level to improve the offer she added. 

 

4.10  Cllr Sweden asked about integrating urgent care centres with A&E and whether we were going to lose the former.  SD explained that at hospitals we have urgent care at the front door and unless you have really effective integration, patients can have poor experience. There are two different sets of triage so no proper integration of information and this needs to be addressed.  He added that no urgent care centres would be lost.

 

4.11  Cllr Patrick asked what was new about the Anticipatory Care plans? ZE explained it's what they do each winter and it was something brand new but a rather development of the service to make it more responsive and focused on prevention.

 

4.12  The Chair asked whether thought was being given to a more comprehensive Out of Hours Service service that blends better with the NHS 111 service, as a better wrap-around service, as the previous service in Hackney had been. SH explained that the focus was to deliver on the Fuller Report which noted the need to balance same day access demands with providing continuity of care.  It was time to think about new models of day time primary care and the out of hours arrangements across NEL still varied considerably. She added that opportunities are not the same as they used to be in terms of commissioning directly from GP Groups. She added that was important that they improve both the perception and the reality that people can get seen, so that public confidence can be increased.

 

4.13  Cllr Virdee asked about the ageing profile of GPs and what was being done to recruit new GPs to ensure the system was fit for purpose and what was being done to move forward with new technology to help manage waiting lists. SH explained that they were looking at all digital solutions as well as E-consultations and fixing the problem of people waiting too long on telephones.  Staffing was a major concern and there was a major focus on workforce at NHSE.  The way GPs are working is changing, many want to be sessional GPs rather than Partners so the whole model was changing rapidly.

 

4.14  The Chair asked about delayed discharges of care and how the NHS is supporting councils and the care sector financially. ZE replied that she was very concerned about the sustainability of social care this winter. She cautioned that NHS and local authority finances were very different and detailed how they were piloting schemes on enhanced domiciliary care for example. This would explore if they can train and pay domiciliary care workers to do tasks normally done by NHS staff.

 

4.15  The Chair asked because there was more in the system during the pandemic was it easier for mutual aid (between trusts) to work well then and how could that be built on.  SD replied that practical mutual aid works well on a day to day basis to manage patient flows. The back end of the pathway was more of a challenge however and, in the Royal London for example, they had many out of region patients which added another dimension to the problem.

 

4.16  Cllr Brewer asked about the timetable for development of Community Diagnostic Centres discussed at the previous meeting.  ZE undertook to provide further detail.

 

ACTION:

ZE to provide a future timetable for roll out of next CDCs.

 

 

4.17   Diane Jones (Chief Nurse, NHS NEL) give a presentation on the vaccinations update. Currently they were 5 running simultaneously in primary care sites as well as vaccination sites. There had been a supply issue for the mpox vaccine but it had been resolved and they were now using a more targeted approach. On polio, they had issued 97% of invites to all those eligible and uptake so far was 22%.

 

4.18  Cllr Adams asked about covid vaccinations and a revelation in a Pfizer exec report to an EU body that their covid vaccine had never been tested for transmission and why therefore were people being forced to have a vaccine passport.  DJ explained that taking the vaccine doesn’t prevent you from transmitting the virus to somebody else but it greatly reduces severity. Whether vaccine passports are being requested is down to individual establishments, she added. Cllr Adams asked about the difference between the vaccines in terms of transmissibility levels. DJ explained that it’s about the wellbeing of individuals and it’s advisable to have the vaccine as transmission rates are lower where there are people who have been vaccinated. If everyone is building up a level of resistance the transmission rate will be lower, effects are less likely to be severe and it is less likely that a person will require hospitalisation.

 

4.19  Cllr Sweden asked where you can get mpox vaccine in NEL patch and about people falling through the cracks in terms of accessing the 4th Covid vaccine. DJ explained how they managed the mpox vaccinations when there was a temporary shortage of stock and how people can get their follow up Covid vaccines. She undertook to circulate an updated list of sites.

 

ACTION:

DJ to provide a list of sites (links) where you can access the mpox vaccine. 

 

 

4.20   The Chair questioned whether it would be more efficient to achieve a greater uptaker of the polio vaccine if it was done by schools. DJ explains why that didn’t work in the past and the rationale.  The parents had to be there with the young person etc. The cohorts for polio included  pre school age also. 

 

4.21  The Chair asked about the viability of setting up a clinic at the end of school day. DJ explained they can do them after school times for those age groups who are eligible or at pharmacies.  The feedback from families was that the vast majority wanted to go to a practice nurse within a primary care setting, she added.

 

4.22  Cllr Adams asked what percentage of children in NEL were not up to date with MMR.  DJ replied that they had a backlog of 2000 but could provide a further breakdown.

 

ACTION:

DJ to provide the % of people in NEL whose MMR vaccines are not up to date and the national comparison.

 

 

4.23  The Chair asked what targeted comms work was being done in Hackney and Walthamstow following the discovery of presence of polio in the sewage system. DJ replied that City and Hackney and WF were the targeted areas.  Texts, outreach, talks with community leaders, letters in a range of languages and also through informal networks were being used. Cllr Masters enquired that, as there hadn’t actually been one case in England, how was it found to be present in the first place. DJ explained that strains of virus had been found in sewage indicating it was coming from individuals who had not been in contact with health services either primary or secondary care. Cllr Virdee asked if it hadn’t been detected yet in people presenting to the health services was the NHS giving parents the right kind of information and was the response proportionate. DJ replied that it depended on how the message was perceived. There was a real risk among those communities so the question is how you assess that risk.

 

4.24  The Chair thanked the officers for their reports and their attendance.

 

RESOLVED:

  That the reports and discussion be noted.