Agenda and minutes

To consider and approve the minutes of the previous meeting held on 03 September 2020, as a true and correct record of the proceedings.

The minutes of the meeting held on 3 September 2020, were approved as a true and correct record of the proceedings.

To receive declarations of interest from Members in respect of items listed on the agenda.

There were no declarations of interest.

To receive questions relating to items of business on the agenda from members of the public or press who are present at the meeting.

The Chair confirmed that no questions from members of the public or press had been submitted.

To consider whether the press and public should be excluded from the meeting during consideration of any part of the agenda.

The Chair confirmed that there was no reason to exclude members of the press or public from observing any of the items of business on the agenda.

To receive an update in respect of preparations for provision of adult care during the winter months.

Consideration was given to a place presentation illustrating the system winter plan. A winter plan is developed each year in anticipation of the winter months and the associated increase in demand from flu. This year, however, the plan also incorporates preparedness for COVID response as well. The learning from the first wave of COVID has informed preparations for the winter months. The presentation described in depth the preparations in place in primary care, acute care, flu response, social care delivery, care home support, and staff support—all of which were integral to the winter response.

The presentation went on to summarise the key challenges faced across Rotherham this winter, including the risk of further bed reductions due to cohorting flu and Covid-19. The presentation illustrated the pressures of social care provision, in particular, as the home care and reablement resource strives to meet demand. Anticipated workforce challenges were also identified, specifically, self-isolation, sickness, morale and mental health concerns. As the pandemic continues, inability to recruit to key capacity was expected to create especial challenges for the acute wards. Challenges also existed related to the Emergency Care Centre, and further difficulties were described around managing elective care amid the pressures of COVID combined with the seasonal winter surge. The flu programme would also need to be prioritised along with changes to GP hubs. It was noted that the plan has actions in place to mitigate the above risks. The various programmes and signoffs were described which are responsible for delivering these actions.

In discussion, Members requested clarification around any overlap in symptoms of flu and those of COVID-19 that could lead to confusion. The response conveyed that the uptake of flu vaccine is positive and that demand is high. The pharmacies are waiting for another round of vaccinations to be delivered. The rates of flu nationally are very low, which could perhaps be attributed to social distancing and hand washing measures. It was asserted that the presentation with each kind of virus is different, and these patients will not be mixed up. It was encouraged that people get the flu vaccine first before getting the forthcoming COVID-19 vaccination. 

Members sought additional assurances that provision of urgent dental care was available. Officers noted that this was an NHS England question outside their remit, but that the answer could be found and related to Cllr Fenwick-Green.

Members also requested assurances around A&E demand versus capacity. The response from Partners explained that the A&E department was under considerable pressure and has been for several months, so much so that some elective patients had had to be cancelled in the previous week. For example, 17 people were awaiting a bed on the day preceding the meeting, with about 80 people awaiting treatment. Some services were being moved into outpatient centres, and the movement of ophthalmology will create more available surface area. People are asked not to attend unless in emergencies, and there are people on the doors to help with admitting.

Members also requested  ...  view the full minutes text for item 111.

To receive a presentation on the transformation of primary care with respect to GPs and Primary Care Networks and the resulting implications for patients.

Consideration was given to a presentation by the Rotherham CCG in respect of changes to GP and Primary Care Networks. The new long-term plan included the transformation of the Primary Care Networks—six of which are in Rotherham. Practices had been working together in terms of telephone systems, hot and cold site visiting, etc. These strong relationships also strengthened multidisciplinary working across all the networks. Funding had been received to recruit for 48 more posts added since this time last year. Care navigations had therefore been streamlined so that patients received their care appointments quickly. None of the extended access had been utilised since March, so this had been converted into hot and cold services. Population needs had been assessed by geographical area, to try to identify and meet better the needs of the patient population on a more granular level. With these arrangements, clinicians could support their practices even if they were self-isolating at home. Funding had also been put in place to look at the conditions most affected by COVID.

The update further showed that COVID had accelerated progress with telephone triage. Most people prefered video consultation, which was also supported by the Rotherham Health App. It was noted that the information was also recorded efficiently. The login and the triage processes had also been streamlined to minimise the impact on clinicians. If there were particular issues, the Primary Care Network had been able to mobilise to respond.

A new home visiting service had also been deployed since July. This service also supported care homes. The entirety of this service had been moved to hot visiting, while the GPs continued to do cold visiting. It was noted that the entire place has responded powerfully to the demanding circumstances. Details were presented as to measures in place to prevent transmission and to maintain safety. Tele-dermatology was a further area of innovation. Ophthalmology had also been adapted to continue to provide services to people throughout COVID. Details were provided as to the measures in place to ensure high quality care is provided to care homes during COVID.

Details were provided as to progress with Clinical Thresholds. The priorities had included provision of rapid access to smoking cessation, weight management, etc., for patients who needed to have surgery but were not quite fit enough to have that surgery. It was noted that some invasive procedures, especially in trauma and orthopaedic areas, were able to be avoided because when the patients lost weight, they no longer needed the procedures. The new practice, with positive results so far, was to schedule people for surgery and health optimise at the same time, instead of deferring scheduling until health optimisation had taken place.

In discussion, Members requested clarification as to how it was that one practice belongs to the PCN associated with a different geographical area of the Borough. The response illustrated that this association reflected the relationships of the branch sites and reflects the contracts. Assurances were provided that there was no impact on the  ...  view the full minutes text for item 112.

To receive a verbal briefing in respect of provision of respiratory services.

Consideration was given to a verbal update from the CCG in respect of Respiratory Services. Prior to COVID, the team with the commissioners had worked on a new process designed to care for people at home, looking after people as a day case, or preferably at home whilst providing rehabilitation at home. This process was intended to free up beds in the hospital and in breathing space service area. This programme had unfortunately been a casualty of COVID. Despite the hindrances presented since March by COVID, the respiratory service had implemented some new approaches such as providing more support to people who need additional help with Respiratory conditions as well as Complex Patient Case Management. All referrals now came through the central intake system which was always open so that care could be accessed quickly anytime. Some people, it was noted, virtual services do not work for, and the team was working with those people, but entire classes of face to face rehabilitation could not currently be scheduled for safety reasons. The team would still offer home care, and a home support team for COVID recovery would be going live soon. The spirometry and testing process ha d greatly slowed by COVID safety measures, but it was noted that it did continue. It was emphasised in conclusion that the teams had worked hard to keep the service going.

Resolved:-

1.    That the update be noted.

To receive a verbal update in respect of provision of hospital maternity care.

Consideration was given to a verbal update on maternity services. The overall rating for the service following the transformation programme has remained the same, amber. 28% in February and 27% in September. The teams had to stop due to COVID-19, reducing the number of face to face conversations and limiting visitors, which is understood to be unpleasant for service users.

The service had reviewed this and had tried to restore normal levels of visitation for the time being, but it is really difficult due to COVID. So far the government hasn’t asked the service to change the way it is working with maternity and mothers. So far, the service had not had to go back to phase 1 actions. They hope to be able to get to 35% by March, and the service is optimistic.

Resolved:-

1.    That the update be noted.

To receive a verbal update regarding the provision of Ophthalmology services at Rotherham Community Health Centre.

Consideration was given to a verbal update on the move of Ophthalmology Services to the Community Health Centre. The building work was not possible during the first phase of the pandemic, partly due to movement of COVID positive patients through the area. Screens were added, but this did slow down the process. The move was therefore delayed by two weeks. Work had been completed and signed off by building contractor and surveyors, additional equipment was in place and emergency pathways for patients with eye injuries had been agreed with A&E. At the time of this update, the first clinic was scheduled for the following Monday. It had been previously agreed not to charge for parking, but it has been noticed that a lot of cars are in the car park that do not belong to patients.

Resolved:-

1.    That the update be noted.

To receive a verbal briefing in respect of recent activities by Healthwatch.

Consideration was given to a verbal update from Healthwatch. Two new members of staff were now in post: Engagement Officer and Campaigns and Research Officer. Work on the discharge from hospital tying in with work by Healthwatch England and the CQC had also been completed, and powerful case studies from local residents had been compiled. The report would be available to the public very soon. Reflections on the drive through flu vaccine programmes were also being collected for inclusion in a forthcoming report. Currently, scoping activities were underway for a study on care homes in which residents have not been able to have visits with family members and loved ones. This study comes as part of the national attention on mental health in care homes that is currently underway. A newsletter is underway with the first edition forthcoming.

In discussion, Members requested further information regarding technology available to residents to be able communicate with relatives and loved ones? The response confirmed that technology would be considered, certainly as it was relevant for collecting the data and perspectives of care home residents as well.

Resolved:-

1.    That the update be noted.

To consider any item(s) which the Chair is of the opinion should be considered as a matter of urgency.

The Chair confirmed that there were no matters of business urgently requiring attention at this meeting.

The Chair announced that the next virtual meeting of the Health Select Commission will be held on 10 December 2020, commencing at 2 pm.

The Chair confirmed that the next virtual meeting had been scheduled for 10 December 2020, at 2:00 pm.