I have been asking a number of questions of the NHS and Social Care for a few weeks, some of which have been answered and some haven’t…

I do appreciate officers are very busy right now.

This briefing arrived yesterday evening.  I have a number of questions relating to issues including community hospitals,  finances, care homes and dentistry.  I know my colleague, Martin Shaw, also has many questions.  Devon residents are asking me questions, quite rightly about a range of issues.

Devon County Council’s Health and Adult Care Scrutiny Committee is the only legal check on local health and social care services and right now we need to be doing our job on behalf of local people.

I have asked again for an online Health and Adult Care Scrutiny Committee meeting to take place asap. The next one isn’t due until 16 June and I believe we need one before then.

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Health and Social Care Overview and Scrutiny Committee Briefing

 

 

Introduction

Produced at the request of councillors this briefing is intended for those involved in Scrutiny of Health and Social Care. The guidance and supporting materials on COVID-19 are frequently being updated nationally and this briefing is intended to provide the latest updates from the NHS perspective.

 

Over the past month staff and colleagues across the Health and Care system in Devon have been responding tremendously to make sure that all of our patients and vulnerable people are looked after in the same caring way we strive for, and we are immensely grateful for that.

 

They are doing a lot to plan for the peak of covid-19, as well as run services as normally as possible for those who need our support.

 

Hundreds of staff, including many staff from Devon CCG, have been redeployed and retrained to undertake duties at the front line. We have come to expect that NHS staff will go above and beyond to do the right things for patients, but their response during this challenging time is one we can be proud of.

 

We also owe a debt to the fantastic voluntary and business sector in Devon who have provided huge support in the response to the pandemic. Not only have they helped vulnerable people in our communities, but they have they provided over 21,000 pieces of protective equipment (PPE), including the manufacture of gowns and visors, and offered accommodation, parking and transportation. This support has really had a positive impact.

 

Local Figures

 

Covid cases – As at 23/04/20
Devon Plym Torbay Total
Cumulative cases (PHE) 581 227 161 969
Covid deaths – As at 23/04/20
UHP RD&E TSD NDHT Total
Cumulative deaths (NHSE/I) 55 29 25 12 121
 

Bed Occupancy and Delayed Transfers of Care – As at 23/04/20

 

Northern Eastern Southern Western
Bed Occupancy 46% 51% 48% 62%
DTOC 3 16 0 20

 

Critical Care Position

The position on critical care services in Devon is stable, currently critical care bed occupancy stands at around 50% and, with additional surge capacity identified, the County is prepared to deal with any increases in patients who require intensive care.

 

Currently there are 47 patients occupying Critical Care beds of which 16 patients are confirmed Covid-19 positive.

 

There are 105 beds currently ‘open’ giving an occupancy rate of 44.8%.

 

 

Core beds Surge beds Open Total Beds Open Beds Occupied Bed Occupation rate
NDHT 8 0 8 2 25%
RD&E 25 0 25 17 68%
UHP 42 8 50 24 48%
T&SD 10 12 22 4 18%
Devon 85 20 105 47 44.8%

 

NHS Here for You

A campaign will this week launch to advise the public that the NHS is still operating for non-covid patients. This is deemed necessary as –

  • Attendances have fallen by more than a third at emergency departments across Devon, in line with national trends.
  • Trusts report reduction in admissions for cardiology, paediatrics and ED​
  • At all hospitals, the numbers of people being admitted with serious problems such as heart problems and strokes are substantially reduced, suggesting that some cases are not being diagnosed.
  • Primary care reporting decrease in attendances for childhood immunisations, screening and INR monitoring
  • Decrease in presentation for suspected cancer and two week wait referrals (just 25% of normal referral rate what we would normally see)
  • Torbay Hospital report cardiac admissions down 50%, suspected cancer referrals down 80% and ED attendance down 65%.
  • Communications colleagues are developing key messages for speciality areas e.g. cancer, stroke/MI, paediatric attendances, childhood immunisations, screening and regular blood monitoring in primary care
  • This will include media plan, social media, toolkit for primary and secondary to use for messages, paid advertising which will run on Heart FM this week alongside social media channels.

 

PPE across health and social care system

  • Stocks of fluid resistant surgical gowns are running relatively low in some trusts in Devon, although the situation here is better than many other parts of the country.
  • Hospitals, community and GP practices and the CCG continue to work together to share stock and this means that have enough as a county for the time being.
  • We expect national replenishment in due course but also have our own plans, we are trying to do what we can locally ahead of any delivery.
  • A digital stock monitoring platform is planned in Devon, which all providers have agreed to use. The CCG would mandate which stock to put on the platform. This system would help ensure more even distribution across the system and to help support smaller providers.
  • Local businesses are also helping with alternative ways of procuring and developing PPE locally, such as making gowns.
  • RD&E is laundering some types of gowns for reuse but an experiment to launder single use gowns has shown they cannot be safely laundered in Devon.

 

Staff Testing

  • There is an excess of staff testing capacity and we are working to increase the number of staff going through the sites.
  • There are established drive-through testing facilities available in Plymouth (Seaton Barracks – commissioned by PHE) and in Barnstaple, at the McDonalds site on Eastern Avenue (run by NDHT).  Both of these facilities are currently offering staff testing.
  • Work is now ongoing to establish a staff testing site in Exeter at the Honiton Road Park and Ride; this site is anticipated to open later this week, again commissioned by PHE.

 

CCG Workforce

  • The CCG has redeployed over 100 staff to external organisations, including hospital providers, Livewell, Devon Doctors and NHS 111. The CCG also has over 160 staff whose role has been temporarily re-purposed due to the COVID-19 crisis.
  • More than 50 members of the Devon Referral Support Services (DRSS) team have been redeployed to become NHS 111 call handlers.
  • From 23 March 2020, when the date the Prime Minister announced strict measures to reduce the spread of the disease, CCG staff have been working from home where possible.
  • Many CCG staff worked the Easter bank holidays to provide essential support to frontline services, where bank holiday provision was also stepped up

 

Supporting Adult Social Care

  • We are already working closely with our partners to support the delivery of the adult social care action plan announced by the government last week. This includes ensuring that all those being discharged from hospital to a care home have been tested for COVID-19.
  • The Care Quality Commission is leading the Adult Social Care staff testing programme. CQC’s role is specifically to support the logistics of providers requesting a slot for staff to be tested. Individuals can only be tested if they have a pre-booked appointment that is allocated in advance. CQC staff send providers an invitation email with a link to an online booking form and information on who can be tested. Public Health England deliver the tests.

 

Community Hospitals

  • As part of our plans to prepare for increased demands on hospital beds, we have considered what extra capacity might be available in a small number of local community hospitals.
  • We have been working with local authority colleagues on the use of Community Hospitals for “step down” bed-based care for non-covid positive patients, alongside temporary sites in hotels and universities, the CCG is ensuring appropriate primary and nursing care support is available.
  • Discussions and options are still under discussion as part of wider escalation planning and we are working with our dedicated staff teams to agree where these temporary arrangements would offer the most benefit to patient care and best support the NHS at this exceptional time.
  • Some Community Hospitals are being utilised as Covid-19 Primary Care Hubs as detailed below.

May Bank Holiday Arrangements

  • As over the Easter period. the May bank holiday (Fri 8 May) will be a normal working day across the NHS.

Access to Emergency Dental Treatment

  • Urgent Dental Care (UDC) systems are being created by NHS England to provide care for people with urgent and emergency dental problems.
  • Exeter and Barnstaple sites will open this week
  • Each patient will be assessed and triaged depending on a number of factors, and their care managed accordingly. Patients will only be seen after a referral via the triage system. Drop-ins are not permitted.  For our area, centres are in Plymouth, Torbay, Barnstaple and Exeter.  People who have a dental practice and use it regularly should contact their dentist by phone to seek a referral. All NHS dental surgeries should be accessible by phone, even though their doors are shut. People who don’t have a dentist should call the dental helpline on 03330 063300 or email accessdentalhelpline@nhs.net  Out of usual surgery hours, people should call NHS111.

 

Primary Care

  • As of 7 April, more than 90% of the county’s practices had signed up to the eConsult online platform, which allows patients to access services from their smartphone, tablet or computer. In March 2020, more than 34,000 eConsults were processed by practices in Devon, up from 18,446 in February and 15,166 in January. At the same date, about 2,200 video consultations took place in a week, up from a baseline of near zero two weeks previously.
  • Hundreds of laptops have been provided to practices by the CCG to help run digital consultations.
  • GPs are being asked to consider whether a patient requiring a routine referral to secondary care has the capacity to re-present at a later date. If they don’t have that capacity, GPs can continue to use the electronic referrals service through DRSS where they will be passed on to secondary care for assessment. Urgent and emergency cases and cancer two-week-wait referrals continue as normal.
  • GPs and pharmacies and pharmacies opened on the Easter bank holidays, following national direction.

 

COVID-19 Primary Care Hubs

  • Groups of GP practices are setting up dedicated sites where symptomatic patients who require a more in-depth assessment, or people from self-isolating households, can be seen and treated for the virus and other conditions.
  • To keep patients and practice staff as safe as possible, and in line with government guidance, patients with symptoms of COVID-19 may be directed to ‘COVID-19 primary care hubs’ if they need to be seen.
  • These facilities are being set up in various suitable settings.
  • Patients must only attend a COVID-19 primary care hub if they have been asked to by their practice – walk-ins will not be accepted. Patients should continue to contact their practice in the normal way (online or by phone) and if they need to be seen, they will be given instructions about where to attend.
  • Covid-19 Primary Care hubs now active include –

 

  • Western
    • Devonport Health Centre, Plymouth
    • Tavyside Clinic, Tavistock
    • Chaddlewood Surgery, Plympton

 

  • Eastern
    • Walrond Medical Centre, Beer
    • Ottery Hospital
    • Culm Valley Integrated Health Centre, Cullompton
    • Okehampton Surgery
    • New Valley Surgery, Crediton
    • Exmouth Hospital
    • Whipton Hospital
    • Tiverton Hospital

 

  • Southern
    • Teignmouth Hospital (does not include use of beds)
    • Cricketfield Surgery, Newton Abbot
    • Chelston Hall Torquay
    • South Hams Hospital, Kingsbridge

 

  • Northern
    • Petroc College, Barnstaple

 

NHS Nightingale Hospital Exeter 

  • A new NHS Nightingale Hospital will be opened in Westpoint Exeter to provide 200 extra beds for patients with coronavirus symptoms if needed.
  • The five hospitals in Devon and Cornwall will provide the majority of care for critically ill patients with coronavirus and have plans in place to increase their critical care capacity up to 500 beds across both counties.
  • The facility, which is expected to be ready for the first patients, if needed, by early May, will provide a regional resource of 200 beds for Devon, Cornwall and neighbouring counties to meet the care needs for patients who are seriously unwell due to their coronavirus symptoms.
  • NHS Nightingale Hospital Exeter will be hosted by the Royal Devon and Exeter NHS Foundation Trust. It will be run as a system level model to ensure resilience across the Devon, Cornwall and wider South West region, with a sub-structure of geographically aligned clinical networks.
  • The set-up of the new facility will be led by Phillipa Slinger, lead chief executive for the Devon Sustainability and Transformation Partnership.

 

Finances 

  • During the daily Downing Street press conference on 2 April 2020, Secretary of State Matt Hancock announced that NHS trusts nationwide would see £13.4 billion of historic debt written-off. This is of course welcome for the Devon system.
  • Further details on this are anticipated in due course and CCG finance colleagues will be assessing the implications of this for CCG finances and for the wider Devon system as part of the ongoing work on COVID-19.

 

Better for You, Better for Devon – update

  • Publication of Better for Devon, Better for You – Devon’s Long-Term Plan – has been postponed in light of the Covid-19 outbreak. A revised schedule will be agreed with NHS England and NHS Improvement and will be shared in due course.

 

Service Changes and Clinical Pathways

  • All new and previously agreed and communicated changes can be found here. Changes are listed by locality and new changes are highlighted in yellow.