Agenda item

To receive an overview on the HIOW system approach to COVID and work completed as part of the Local Resilience Forum response.

To receive Trust specific written updates from:

a.    Hampshire Hospitals Foundation Trust

b.    Southern Health Foundation Trust

c.    Portsmouth Hospitals Trust

Representatives from Hampshire and Isle of Wight (HIOW) organizations provided an overview of service changes and highlighted developments during the pandemic.  

Members heard that healthcare organizations and staff appreciated the “thanks” they had received and have been working hard with colleagues in Social Care, Police, and Fire.  All have been grateful for the public’s help in adjusting how they accessed services.  Residents adapting quickly and following the guidance has been key.  

The pandemic has been a major incident and one that has been ongoing for a long period of time.  The aim has been to prepare and plan for the reasonable worst case scenario whilst hoping for the best.  Capacity has been provided where needed and managed in new ways.  Changes that have been on the list for years, took place in 2-3 weeks.  It was imperative to maintain critical services and restore them, e.g. carefully rescheduling operations, considering PPE and social distancing needs.  Patients were quite anxious initially to come into the hospital, but the hope is that there has been a shift in thinking and they now feel safer returning.  

In order to exit the lockdown safely and prevent a second outbreak, the guidance and safety measures need to be followed.  While numbers have dropped, Covid is still active.

Different agencies have been working well together in unifying understanding and action.  Covid outbreaks have been less clear and building urgency in communities has been critical.  Maintaining critical services in the priority areas of support have been key, including protecting the vulnerable and keeping them safe and maintain public order. 

Work must continue in that perspective and with effective precautions.  Careful plans are now being put into place for a new normal while watching out for the next wave.  The reasonable worst case is still on everyone’s minds and they are ready for quick and critical fact-based decisions even with scant information but in the right context.  

The real thing is often never quite like the exercise and Covid has had a life changing impact.  However, it has been a privilege to come together with colleagues and organizations focused on issues as one team while maintaining the sovereignty of each team.  

Upon clinical reflection, there have been about 2 million people affected including those who have been tested and those whom providers suspect may have been infected.  There are high numbers of patients in some areas, fewer in others. There has been a fairly uniform experience overall with anxieties about outbreaks and hotspots.  Approximately 5-10k residents have died naturally and 1400 of those of Covid in Hampshire and Isle of Wight.  Many were elderly and frail so there has been some crossover in those areas.  

Hospital resiliency was maintained, and capacity was always available against anticipated numbers.  This is a tribute to the integrated work that goes on with partners and the community response.  

While there has been some alarm about care homes, work with social care and care home colleagues continues alongside the restoration of critical and then elective services.  Acute care has actually increased and back to 67% of non-critical care and finding new ways of working.  

In response to questions, Members heard:

The numbers are based on people who have tested positive and the total mortality rate is between 0.05-1%. 

Lessons learned continues to be ongoing in terms of managing 111 calls and wait times, helping residents who are avoiding care and procedures for fear of Covid, and cancer patients missing treatments, among others.

Due to the pace and knowing very little at the beginning in terms of how it affected people, 111 did struggle but extra staff were allocated relatively quickly to help cope.  Plans are in place to be able to manage this winter, regardless of a second wave.  

With more knowledge and understanding of the disease, it is clear now how hospitals need to work and the mechanisms needed to cope better.  There is no complacency in planning ahead for the future.  While there were frustrations, difficulties, and uncertainty initially, the focus now is genuinely working out how best to deal with the backlog and move forwards.  There is critical evaluation of how things worked and sharing between acute Trusts with a huge amount of learning and more responsive services.  

Initially, there were challenges with district nurses visiting care homes and residents, but they were back in action very rapidly.  

There was an amazing response for returners as well and they were able to quickly join services.  

In terms of certifying deaths, there were different processes in place, and this would need to be taken back to report on further details at the next HASC meeting.  

There has been local anxiety about the route of discharge into care homes, but only a handful of cases have been identified where transmission occurred in this way.  Infections have been minimized as much as possible with robust testing in place.  

Using agency staff has been critical but there has been national media attention in this being a potential vector.  Work is being undertaken currently to better understand and address the issue.

The HIOW Local Resiliency Forum (LRF) has been grateful for public order and confidence.  Work is being done in surrounding LRF areas and across borders nationally and locally.  There has been a top-down led response from No 10 with policies filtering through the system.  

It is not possible to police a way out of this nor those kinds of resources available.  One can imagine how communities would response to being policed in that way.  If people take risks or act inappropriately against safety recommendations, they must be reminded of the focus and this is incumbent on everyone.  Liaison is in place across borders with impact assessments and continued learning with all partners.  The system of LRF is designed for this within the local context of operation.

Mental health during lockdown is a worry especially for those suffering from mental health issues who would generally use centres but could not access these services.  Many services could not act without GP referrals or were overburdened.  A central number for help would be useful.  A joined-up approach is being followed but details can be brought back to the HASC to provide reassurance regarding the provision and access of services.

In terms of community care and the suspension and impact on some services, the details have to be brought back to the HASC in the future, as some service suspensions were done at the height of the pandemic and are now being reinstated.  

Members acknowledged that the plan is a living document and expressed their gratitude for the many endeavours to fight this pandemic and save lives. 

RESOLVED -   

That the Health and Adult Social Care Select Committee:  

a.  Noted this briefing and consider the next steps outlined in Section 13. 

b.  Noted the Trust specific written updates.

c.  Requested an update in 9 months’ time. 

The committee had no further questions regarding Trust-specific updates. 

The Chairman called a 10-minute break at this time. 

Cllrs Thornton and Cooper left at this time.