Agenda item

Update on vaccination roll out – a presentation will be provided by Kate Holmes, Chief Finance Officer, Buckinghamshire Clinical Commissioning Group.

Health and Care Survey – A verbal update will be provided by David Williams, Director of Strategy, Buckinghamshire Healthcare NHS Trust.

Update on impact of COVID-19 on Health Provision (including cancer) – a verbal update will be provided by Andrew McLaren, Divisional Chair of Surgery and Consultant Surgeon, Buckinghamshire Healthcare NHS Trust.

Kate Holmes, Chief Finance Officer, Buckinghamshire CCG, provided a presentation (see slides 11-16, appended to the minutes).  K Holmes advised that the vaccination programme was being led by the Buckinghamshire, Oxfordshire and Berkshire West (BOB) Integrated Care System with Buckinghamshire Council supporting the process.   There was a mixed model for delivery, which consisted of hospital hubs, GP led locations, community pharmacies and mass vaccination centres.  The Pfizer and Astra Zeneca vaccines would be offered to the nine priority groups agreed by the Joint Committee for Vaccines and Immunisations; the target had been met to offer the vaccine to all those in cohorts 1-4 by 15 February 2021 and the programme had moved on to cohorts five and six.  All nine cohorts should be completed by May 2021.  Approximately 6,000 residents had recently been identified as ‘shielded’ and would be contacted regarding their vaccination.   A community transport hub was in place, Community Impact Bucks provided support where needed and the Community Engagement Team were linking with voluntary groups.  The vaccine supply was on a ‘push’ model and was working well.  Targeted communication was key to promote a positive take up of vaccinations and the message remained that the NHS would contact residents and social distancing rules still needed to be followed even after vaccination.

The following key points were raised in discussion:

• Following a query on whether GPs were contacting patients with underlying health conditions; K Holmes clarified that letters had been sent to the over 65s to invite them to book at a mass vaccination or community pharmacy site and GPs would contact patients who were extremely clinically vulnerable.
• It was confirmed that cohort six was extremely large and that people needed to be patient and wait to be contacted.
• Dr Zaib was working proactively to increase the vaccine uptake amongst the black, Asian and minority ethnic (BAME) community.
• The role of the volunteers was recognised; there had been a fantastic response from the community with 86 volunteers having been mobilised.
• It was confirmed that carers came under cohort six.

Vaccine Equalities Sub-Group

Dr Jane O’Grady, Director of Public Health, referred to slides 7-10, appended to the minutes and advised that the sub-group had been set up to address potential inequality of uptake of the vaccine.  The sub-group would look at the data and monitor the uptake of the vaccine in Buckinghamshire in the nationally agreed priority groups and make recommendations on what was required to address inequalities in COVID-19 vaccine access and uptake. A range of activities were being carried out and behavioural insight approaches had been used to support the vaccine programme.

The following points were raised in discussion:

• It was noted that key groups e.g. rough sleepers were being encouraged to register with a GP, but a mobile unit would be beneficial.
• After being asked if the voluntary, community and social enterprise section (VCSE) had been involved in the sub-group; Dr O’Grady confirmed that the sub-group had carried out work with the Community Engagement Team and the VCS to identify if a particular group was under-represented.
• Concern was expressed over some of the information on social media that would be difficult to penetrate; the importance of using bite-size communications for key groups was emphasised.  The Chairman advised that there was a BAME community network and that communications were being developed.

Update on impact of COVID-19 on Health Provision (including cancer)

Andrew McLaren, Divisional Chair of Surgery and Consultant Surgeon, Buckinghamshire Healthcare NHS Trust, provided a verbal update on cancer services and elective surgery. 

Cancer Services

A McLaren stated that it was recognised that the pandemic was a huge event and the Government message for everyone to stay at home had resulted in a drop of 80% in the number of people who were referred on urgent cancer pathways by their GPs - however, the number had picked up over the summer.   There had been a reduction in the number of operations carried out, but cancer surgery, diagnostic tests, chemotherapy and radiotherapy treatment had continued and the target for seeing urgent referrals within two weeks and receiving treatment within 62 days had been good at almost 90% for December 2020.  Some patients had experienced a delay during the first wave but less so in the second wave.  Patients had been reassured that it was safe to come to hospital and there had been only one incident of a patient acquiring Covid-19 in the green zone area in Stoke Mandeville Hospital in the past year.

Elective Surgery

Elective surgery was proving to be a big challenge; the Trust had been doing well before the pandemic but had now reduced the amount of elective operating carried out in order to provide emergency care to Covid patients which had resulted in an increase in the elective waiting list. There were just over 30,000 people waiting for elective surgery which included approximately 5,000 who had been on the list for over 52 weeks.  Work was being carried out on how to work in the future and how to recover the services and provide a slick process for getting patients through the system.  There were still more patients in hospital than in the first wave peak and more in intensive care and the current focus was on looking after these patients and those on the cancer pathway.  A McLaren provided assurance to the Board that every person on the elective waiting list and cancer pathway had received a review.

The following points were raised in discussion:

• It was noted that the elective pathway was a side effect of the pandemic, but patients were regularly reviewed as to their clinical need.  The screening pathway was now on track.
• The impact the pandemic had caused on the workforce needed careful consideration; staff required appropriate rest and recuperation time.

Health and Care Survey

David Williams, Director of Strategy, Buckinghamshire Healthcare NHS Trust, provided an update on phase two of the community engagement exercise.  D Williams stated that the survey had focussed on four themes; healthy lifestyles and reducing health inequalities; community services; keeping people safe and digital appointments.  The second phase focussed on in-depth one to one interviews and workshops to reach those people who were unable to access the online survey.  There had been a good representation and D Williams acknowledged that the Trust needed to learn about different ways of gaining views from the community.  The following key points were highlighted:

• Digital appointments were working well, but there was concern that face to face appointments would not be available in future; however, D Williams advised that face to face appointments would be provided when required and that this point needed to be widely communicated with information on when a digital appointment was appropriate.
• It was evident that there was a sense of trust in the A&E service and more work was required to build up trust in the 111 service if people were to be booked into urgent care via this pathway.
• Community Services – integrated care and the ‘home first’ philosophy was well supported.
• Residents did not want to be preached at regarding healthy lifestyles and choices and recommended increased education in this area for children and families.

D Williams summarised that there was a general sense to communicate services to the population via multiple means.  The report and the results would be discussed at the Integrated Care Partnership Board and then shared with HWB colleagues.

ACTION:  David Williams