Agenda item

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 clarification around how many patients contract COVID in hospital during treatment for some other condition. Partners confirmed that everyone admitted to hospital is tested. Anyone testing positive is separated into their own area or into a COVID designated ward. There have been a handful of individuals who have tested positive several days after being admitted, and if that happens, they are immediately separated. This was noted as being on par with the national picture.

More information was also requested around what happens when the allocated beds for COVID are full. The response conveyed that a ward was opened in particular for COVID to ensure the availability of empty beds on a COVID ward. Each time high demand for COVID beds was received, the hospital opened another ward for COVID by first moving the COVID negative patients to a different area to clear the ward for COVID. At the time of this update, partners were readying to open a third ward for COVID.

Members also asked whether it was expected that the new restrictions would have an impact on the pressures in the hospital? Officers responded that the new restrictions absolutely would have an impact on reducing transmission between households. This would also reduce the need for hospitalisation, which would keep the hospitals from being more and more COVID occupied. Partners had seen a marked increase in COVID patients: 100% increase over a matter of three to four days. Therefore, partners were very hopeful that the measures would indeed help.

Members asked for more information about the risks and effects of contracting both the flu and the COVID-19 viruses at the same time. The response emphasised the importance of getting the flu vaccine so that this scenario would not be encountered. The goal was for people to be well and not get flu. Partners had performed scenario testing to see if the systems could cope with a flu pandemic, and now a COVID pandemic. National Health advice suggested that the viruses do not work together, but it was acknowledged that if anyone were to get both, the individual would be very ill indeed. Anyone with either virus would be isolated in any case.

Members requested clarification whether the flu programme was currently behind. Officers averred that, compared to where we were at this time last year, numbers were actually ahead. Currently the programme awaited a letter from Central Government announcing the next stock of vaccines to arrive for distribution. Each partner had a flu programme and an action plan, and all of these were monitored very closely. It was noted that tier 3 areas would not be prioritised, because Rotherham, from a national numbers point of view, had already achieved the necessary uptake required. It was noted that these distributions were determined by Central Government and NHS England.

Members also inquired whether Rotherham patients would be cared for in Rotherham hospitals or would be sent elsewhere. The answer averred that 90% of Rotherham patients were from Rotherham. If there were a large influx of patients, some patients may be moved to Nightingale Hospital which was not yet in use, but was still in preparations in case of need. It was noted that 10-12 staff members from all the local hospitals had been asked to volunteer, and the 12 Rotherham staff members who volunteered previously would be asked to do so again if possible.

Details were also requested around the percentage of the hospital workforce that had had COVID-19, and whether there were sufficient supplies of PPE. Partners responded that these numbers are recorded, COVID and non-COVID sickness. Sickness was usually at 7-8% during the winter, but was 4% at the time of the update. The number of staff off work for contact isolation, track and trace isolation, recovery from the virus, etc., was around 11%,  which was somewhat high. Assurances were provided, however, that PPE was plentiful, supplied by a push system of stock replenishment. The equipment does vary by manufacturer, but there is plenty of it.

Members also asked for more information around where and how they could reliably get a flu jab. The response provided clarification that some GP practices opted to offer the flu jab through the drive through, but not all were prepared to do it that way. Positive feedback from the drive through route would inform decisions next year, however. There were a range of different routes. Some pharmacies were asking people to come back because they did not have access to the vaccine at that time, but people were being asked to come back and keep trying.

Assurances were requested that any patients who would potentially be sent to the Nightingale hospital, who would likely be those who were most gravely ill, would have access to their family members. Assurances were provided that those patients who would be moved would be those who were stable enough and unventilated, because it is too dangerous to move a ventilated patient. It was expected that, if Nightingale has to be used, the numbers sent there will be few and these would be stable patients.

Clarification was also requested as to why COVID patients were kept in the same hospitals as other patients. The response conveyed that previously, Hallamshire had been the designated hospital where COVID patients were taken, which worked fine for the first five weeks, but the numbers had gone up so quickly that Hallamshire would soon be overwhelmed, decimating their ability to provide specialist services to all of South Yorkshire. A special door had been designated for COVID patients coming into the hospital. What the hospital calls ‘blue’ or very, very clean wards were being maintained for cancer services, orthopaedic elective, and haematology wards. These exceptionally clean wards would be maintained as long as possible. As COVID numbers increased, however, that means there would be fewer non-COVID areas in the hospital, but efforts were being made to maintain those ‘blue’ areas.

Assurances were also requested that proactive steps were being taken to ensure that the system meets the needs of people who cannot connect to digital services. The response from Primary Care partners conveyed that digital services were but one of the avenues that were available now. Many services have converted to telephone and video to protect patients and staff within practices, but for those who cannot access those, face to face would be provided as the default, as well as in first and second visits. Digital inclusion projects had been undertaken to help improve access to digital services, and whilst these efforts were currently on hold, it was noted that this was an area of focus.

Members raised the possibility of natural air purification techniques. The response noted that this kind of trial would be outside the remit of Public Health, the Council and its partner organisations.

Resolved:-

1.    That the update be noted.