To receive a joint presentation in respect of demand management and surge planning for winter 2021-22.
Consideration was given to an update presentation in respect of progress against objectives outlined in the 2021/22 Winter Plan. The presentation included updates on successes and challenges associated with delivery of health and social care provision during the Omicron surge. The presentation was provided by the Executive Place Director representing Rotherham Clinical Commissioning Group (CCG) as well as the Deputy COO of The Rotherham NHS Foundation Trust (TRFT).
In discussion, Members expressed interest in more information around how the delivery of the vaccination scheme may have created pressure on primary care provision. The response from the CCG representative described strategic government directives that had allowed routine work in primary care to be put on hold temporarily. Sustainability of the primary care programme was identified as an area of ongoing effort.
Members also asked how staff sickness had been managed in view of changing guidelines around isolation periods for staff. The response from the CCG representative noted the variation in interpretation and application of changing guidelines across primary care services during the pandemic, but certainly movement to 5 days will have helped pressures. The representative of TRFT described a significant previous peak relative to current much lower numbers of staff sickness due to COVID-19.
Further detail was requested around impact of the pandemic on cancer care, elective care. The response from the TRFT representative described waits at the peak of the pandemic in Wave 1 and identified the significantly lower current position, which places the Trust among the leaders in the local ICS in terms of recovery. The response noted that all urgent cancers had been treated. The Trust had been identified at one point as the most improved Trust in terms of elective care recovery, with a current position at around 80%.
Members noted the positive uptake of the Rotherhive programme and requested further information around mental health provision, specifically in respect of discharge planning, mental health support for primary care, surge planning for young people’s mental health, and mental health support for staff. The response from the CCG representative noted the challenges during recent times of higher demand associated with provision of beds, discharge support, and placements outside the Borough which are challenges on acute as well as mental health pathways. In view of rising mental health presentation in the system, examples of strategic interventions and signposting services were identified, such as Rotherhive, which implement digital modes of provision to increase capacity. The digital offer for children and young people had included the introduction of an online resource platform known as Kooth. Challenges around eating disorders were described, and measures designed to bolster capacity were identified. With regard to the support for staff, the representative of TRFT outlined a range of wellbeing support measures that had been implemented since the beginning of the pandemic and highlighted the importance the Trust places on collecting staff feedback. Response rates to staff surveys had been the highest recorded at the Trust, 8% over the peer average.
Clarification was requested around the rate of primary care patients seen daily. The response from the CCG representative identified the November/December 2021 position on average among 28 practices was 68% back to face-to-face delivery. There were 15,000 more contacts during November 2021 than during the same period pre-pandemic. The core service had been utilising face-to-face and non-face-to-face delivery to maximise capacity. Comprehensive extended access rates in Rotherham were currently at 95% utilisation. Hot home visiting and hot site care had been running at similar levels.
The numbers of patients placed outside the area and young people placed outside the area were requested and the answer offered outside the meeting.
Members requested further assurances around the effects of delayed routine care creating additional future pressure. The response from the TRFT representative described the Trust’s assessment system around bed availability, and the points during the pandemic at which the Trust provided or requested help from other area Trusts to alleviate bed pressure. This often involves diverting an ambulance from one Trust’s A&E to another. The parameters involved include acuity, length of stay, and where the patients will go when they are well enough to leave the hospital but not yet well enough to go home. Successful work had been undertaken in this area with the Integrated Discharge Team. Figures were cited on the volume of patients at points in the pandemic relative to the current volume. Aware that acuity can rise as patients wait for care, the Trust was able to avail the private sector to augment capacity and reduce waiting lists during the first year of the pandemic. The use of private hospitals was discontinued in November 2021, when the Trust became able to meet the need using internal capacity. It was expected that pressures of this nature would continue in the long-term with adverse implications for health inequalities as well.
Further information was requested around intermediate care. The response from the Acting Director of Adult Care Housing and Public Health described the rationale for investment that had been made to bolster the reablement service during COVID-19. The response noted challenges and successes associated with delivering the reablement service during the pandemic.
Members expressed interest in knowing more about improvements in respect of ambulance handover times. The response from the TRFT representative described where delays can occur and the efforts that have been undertaken to ensure the best possible flow through the Trust.
1. That the report be noted.
2. That medicine management be added to the work programme.