Agenda item

The Committee will hear from the leads within the Buckinghamshire Integrated Care Partnership on the delivery of the winter plan, in particular how residents have accessed services over the last few months, the flu and Covid vaccination programmes, the impact of the second wave on services, staff wellbeing and an update on the recovery plans.

Members will also hear about the Discharge2Assess model and explore the impact of early discharge on health and social care, particularly during the Winter months.

Presenters:

Mr N Macdonald, Chief Executive, Buckinghamshire Healthcare NHS Trust

Mr D Gibbs, Chief Operating Officer, Buckinghamshire Healthcare NHS Trust

Mr R Majilton, Deputy Accountable Officer, Clinical Commissioning Group

Cllr A Macpherson, Cabinet Member for Adult Social Care

Cllr G Williams, Cabinet Member for Communities and Public Health

Mrs G Quinton, Corporate Director, Adults, Health and Housing

Dr J O’Grady, Director of Public Health

Papers:

Report attached

Mr N Macdonald, Chief Executive, Buckinghamshire Healthcare NHS Trust, advised that the infection rate was still very high in Buckinghamshire and the new variant of Covid was the driving cause of the pressure on the NHS. 

During November, the new variant accounted for 5% of Covid cases; last week it had risen to 72%.  Firstly, the critical care units were operating at 150-200% above normal capacity and there were other patients who were less unwell but still required hospital treatment and was almost double the number of the peak on 7 April 2020.  There were currently 6-7 in-patient adult Covid wards at Stoke Mandeville Hospital.  There had been a lower than expected demand for patients with flu, but the pressure far exceeded what was normally seen in the winter.

The second challenge was to safely manage people in hospitals which had implications in terms of the number of patients seen.  The third challenge was the workforce as health care workers were 30% more likely to contract the virus and approximately 10% of nursing rosters were affected.  There was significant pressure on the ability to maintain the level of activity.  The medium and long-term mental health impact of working in such an environment would cause staff to become exhausted.  The pressures were replicated in the ambulance service, community nursing, primary care and the care sector.  The largest flu vaccination programme had been completed and the NHS was now being asked to establish the largest ever vaccine programme. 

The Chairman asked N Macdonald to pass on the Committee’s thanks to all the frontline workers and his team.  The following points were raised and discussed by members of the HASC

• The Chairman asked what led to the major incident being declared by the Leader of the Council in December 2020, what assistance could be expected and what were the ramifications.  N Macdonald advised that the NHS had been working in national major incident mode since November/December 2020.  The Council’s decision followed triggers set out by the Council’s own measures and would enable the Council to pull on further mutual aid support, redeploy staff, maximise safe capacity in the adult social care sector and reduce non-urgent pressures.
• In response to being asked whether a facility such as the Olympic Lodge would be set up to ease capacity in the hospitals; N Macdonald acknowledged that there was increasing pressure on the nursing and care home market and stressed that patients needed to be discharged safely.  All available options were being considered.
• A Member requested the data on the number of Buckinghamshire residents who were in phase one of the vaccination programme and the timeframe of the delivery of the vaccine for the first two groups in phase one.  Dr Kent stated that first vaccine was carried out in primary care in Buckinghamshire on 14 December 2020 and that the programme was now in week 4.  There were approximately 65,000 residents in the initial two cohorts; and a further 50,000 in the other four cohorts making a total of approximately 115,000 residents to be vaccinated by the middle of February 2021. 
• The Member also asked how many sites had been set up and how many more would be rolled out.  Dr Kent explained that the vaccination programme consisted of hospital hubs, PCNs and mass vaccination sites; currently, the PCNs were the main source of delivery.  As of this week, five sites had been set up and three more were due to open week commencing 11 January 2021.  The level of GP uptake was good with almost all the practices having signed up or agreed to sign up.  However, there were two variables; NHSE had to approve the site and allocated supplies; BHT was not able to order its own supplies.  Confirmation was awaited of the amount of vaccinations to be delivered for week commencing 11 January.  An additional hospital hub had been requested in Amersham but NHSE had not yet approved the site.  Confirmation was also awaited on a mass vaccination site at Buckinghamshire New University.  When asked why the sites had not been organised earlier; Dr Kent reiterated that sites had been put forward but were awaiting approval from NHSE. However, he anticipated that an additional three sites would be live next week. The mass vaccination sites were confirmed but timing and supply of the vaccine were being handled centrally.  It was noted that Buckinghamshire only had 40% of GP sign up in December 2020 which was lower than the other authorities within the ICS.  The Chairman asked why the GPs had been slow to sign up and Dr Kent stated that he had written to all the practices including offering to hold one to one discussions to better understand the challenges but now 46 out of 48 practices were either signed up or in collaborative agreements.

He went on to explain that the GP contract for the vaccination programme was a national contract and GPs were independent contractors with choice about whether they chose to sign-up.  It was agreed that there was a need to monitor the progress of the vaccination programme.  One of the Members recommended holding a special HASC meeting with representatives from Public Health England and NHS England to ensure Buckinghamshire residents were receiving the best service. 

• In response to being asked how many residents had received the vaccine; Dr Kent advised that as of 4 January 2021 approximately 30,000 vaccinations across the system had been undertaken; 8,000 of those were Buckinghamshire residents.  Around 115,000 residents in Buckinghamshire needed to be vaccinated by the middle of February 2021 in order to meet the Government target and Dr Kent was confident there was the capacity to deliver, provided the supply was maintained.
• The Chairman advised she had received a text message from her GP surgery saying not to contact the surgery as they did not know when the next delivery would arrive. The message was a concern and the Chairman asked what pressures were being used to ensure enough vaccine was received.  Dr Kent reported that he had no visibility on how supplies were allocated; he was pushing daily, and the region was allocating supply. It was a fast-moving picture and Dr Kent confirmed he had been in touch with MPs to request them to contact the relevant minister.  Concerns were raised around the clarity of the public communications around the vaccine programme.  Dr Kent confirmed that this was handled regionally by the NHS who had embargoed certain information until launch date.
• Dr Kent confirmed that patients did not have a choice of which vaccine they would receive.
• In response to whether there was any data on reactions to the vaccine; Dr Kent advised that initially there were a couple of allergic reactions on the first day and there was a national reporting system for recording reactions.
• Dr Kent highlighted that there were many challenges in setting up the sites and explained that due to the volume of vaccinations and the need for waiting 15 minutes in a socially distant environment, most GP practices were not suitable sites.  Buckinghamshire Council was aiding with the logistics of setting up new sites and volunteers were being used for example in front of house duties.  Asking primary care to provide the vaccination service whilst maintaining core primary care services was a challenge.
• In response to being asked why pharmacies were not being used as vaccination sites; Dr Kent explained that pharmacies were commissioned by NHSE and four community pharmacies in south Buckinghamshire would provide the vaccine at the end of January/early February 2021. 
• Further concern was expressed over the roll out of the vaccination programme in Buckinghamshire as it had been announced on the radio that the vaccinations were going well in Oxfordshire.  It was thought that there were many other locations which would be suitable such as village halls or the Chess Medical Centre and could have been used since the start. The Chairman acknowledged that the programme was beholden to the NHS, but it was worrying as to why it was so slow in Buckinghamshire compared to neighbouring authorities.  Dr Kent advised he was trying to understand why GPs had not signed up earlier and believed some of the GPs found the enhanced specification (the vaccination contract) challenging.  Eight sites would be running by week five and all the PCNs would be on board; this was an achievement due to the Christmas and New Year period and was a considerable amount of work for Primary Care to take on.
• A Member asked if the GPs administered the vaccines or could pharmacists be used to help at the centres.  Dr Kent stated that the GPs would provide clinical leadership and a presence at the site, but most centres were using nursing and other trained staff to carry out the vaccinations, as well as GPs. 
• In response to a question on whether private hospitals were still being used for non-covid patients and which services had closed; D Gibbs advised that there was minimal activity in the private sector but BHT was still looking to the private sector to support as much as was appropriate.  BHT was continuing to treat priority one and two patients i.e. the most clinically urgent patients which included cancer treatment.  A small number of operations had been cancelled but the patients had received new dates. Work was being undertaken with clinical teams to prioritise patients and some of the out-patient clinics had been reduced in order to release staff.  BHT was endeavouring to keep as much activity open as possible but there could be further reductions as demand grew over the next few weeks.  Referrals were still being received from GPs.
• Dr Kent confirmed that local clinical discretion could be used in deciding whether residents’ second vaccinations were carried out as planned after that national policy changed on 30 December 2020.  However, from 11 January 2020 all second doses would be deferred to twelve weeks after the first dose as it was better for two people to have the first dose than one.
• The Chairman requested that the vaccination updates be shared with the HASC Select Committee. 
• One of the Members stated she expected GPs to follow the code of ethics not their contracts.  The member also expressed concern over who was ensuring that elderly residents were able to get to the site and asked who was co-ordinating the transport.  Dr Kent explained that the Corporate Director for Communities at Buckinghamshire Council was co-leading the co-ordination to ensure all the cohorts were covered.  Once the care home residents’ vaccinations were complete the roving model would carry out vaccinations for the housebound.  It was the GP’s discretion as to whether a couple would be vaccinated at the same time if they straddled two different cohorts.
• In response to whether the vaccination programme ran from 9.00 am to 5.00 pm; Dr Kent advised that the centres were open at 8.00 am and often did not close until late in the evening in order to ensure the vaccine was used up.

The Chairman summarised that she would follow up with Dr Kent and N Macdonald for regular updates and thanked them for everything that had been undertaken.  Cllr Angela Macpherson’s information would be circulated to the committee members.

ACTION: Liz Wheaton