Below is the latest (received today) briefing from Devon’s NHS to Devon County Council’s Health and Adult Care Scrutiny Committee.

My fellow Independent colleague, Cllr Martin Shaw and I have been asking for an urgent online scrutiny meeting before the one on 16 June, to ask questions about these issues and many others.

It has been agreed instead, to have a webinar, where councillors can ask questions in advance.  This is likely to take place during the final week of May. It is as yet unclear who will be involved in this.

On the whole the briefing is very reassuring and shows that the NHS in Devon is coping well and infection rates and deaths remain comparatively low, compared with elsewhere in the country.

The next Health and Adult Scrutiny Committee will take place on 16 June and will be available to view online afterwards…..

 

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.

 

So much has changed in the two months since the head of the NHS, Sir Simon Stevens, first wrote to us with an overview of the initial plans for the first phase of the response to managing health services during the pandemic.

 

CCG staff have been professional, flexible and willing to support the system-wide COVID-19 response. 120 CCG employees have been redeployed externally and at least 280 others are working in temporarily adapted roles within the CCG. As we move into the next phase, work is now underway to plan the recovery and restoration stage of the COVID-19 response

 

At the end of April we received further communication for Sir Simon outlining the approach for restoration and recovery, with some services commencing again. As we develop the local approach to restoration, we will keep you informed through these briefings.

 

We are currently planning a webinar for all councillors in Devon to update you on the NHS response. This will likely take place w/c 25 May 2020 and invitations will follow through local authority colleagues.

 

Local Figures

Covid cases – As at 12/05/20 (PHE)
Devon Plym Torbay Total
Cumulative cases (PHE) 775 335 210 1321
Covid deaths – As at 11/05/20 – source: NHS Statistics
UHP RD&E TSD NDHT Total
Cumulative deaths (NHSE/I) 75 42 34 18  

169

 

 

Bed Occupancy and Delayed Transfers of Care – As at 12/05/20 (Local Monitoring)

Northern Eastern Southern Western
Bed Occupancy 53% 54% 60% 66%
DTOC 0 11 2 31

 

NHS Nightingale Hospital Exeter

  • The NHS’ newest hospital will now be built on the site of a former retail unit on the outskirts of Exeter.  Earlier plans had indicated that this hospital would be based at Westpoint.
  • The lower than expected COVID-19 transmission rates in the SW combined with updated modelling of care needs also shows that a smaller site would be a better use of resources and enable the NHS in the South West to use the site for a longer period of time if needed.
  • Our Nightingale hospital will be a regional facility providing care and treatment for patients from Devon, Cornwall, Dorset and Somerset. Capacity remains available in hospitals throughout the region to provide care for patients with coronavirus, as well as other patients who may need urgent and emergency treatment, with our Nightingale hospital standing ready if and when needed.

 

Testing in Devon

  • Led by the Peninsula Pathology Network, trusts in Devon and Cornwall have agreed a shared approach using a combination of in-house and nationally run testing sites to provide quick results, reduce journey times and enable better data collection.
  • Testing is by appointment only and arrangements for getting a test vary depending on who you work for. NHS employees at trusts and CCGs are encouraged to contact their employer in the first instance for an appointment. Each of the four acute trusts in Devon has drive-through facilities for health and care staff, by appointment. The sites are:
    • Sandy Park, Exeter – Royal Devon and Exeter NHS Foundation Trust
    • McDonald’s, Barnstaple – Northern Devon Healthcare NHS Trust
    • On site at Torbay Hospital – Torbay and South Devon NHS Foundation Trust
    • On site at Derriford Hospital – University Hospitals Plymouth NHS Trust
  • The other drive-through testing sites in Devon – at Seaton Barracks, Plymouth, and Honiton Road Park and Ride in Exeter – are run by the Department of Health and Social Care (DHSC).
  • Mobile testing units (MTUs), run by the military, are linked to these DHSC-run facilities and attend different parts of the county at different times. All DHSC sites, including those which are mobile, are for a wider group of essential workers are also by appointment only. Although health and care staff can use these facilities, we would recommend they use the in-house provision above as results are faster and journey times are likely to be shorter.
  • Due to the nature of the mobile testing sites, days and times of operation vary, check the online portal for availability.

 

Primary Care

  • A huge collaborative effort by Primary Care colleagues has been undertaken to establish Covid Primary Care Hubs across the localities of Devon. These sites have been set up to allow a safe and dedicated pathway for patients with suspected “COVID” meeting certain criteria.
  • Some Hubs now live and seeing patients.  Other hubs not live but are in place should demand increases require them.
  • Thanks to the population maintaining social distancing and adhering to restrictions, we have not seen peak originally forecast for early May. However, it remains important we have sites like this ready, as Devon could experience a peak of demand, dependent on the government approach to the easing of lockdown restrictions.
  • Weekly Primary Care webinars each Friday continue to be well attended.

 

PPE across health and social care system

  • Stocks of PPE remain stable across Devon.
  • 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.

 

Referrals

  • Primary care colleagues are being asked to continue to make two-week wait cancer, urgent and routine referrals to secondary care as normal, using ‘advice and guidance’ options where appropriate.
  • Where referrals have been received by DRSS and reviewed in line with the latest pathways, these will be passed on to secondary care, but patients with routine referrals may not be seen for some time.
  • Referrals will be sent to the nearest acute provider unless a specific alternative hospital is indicated in the referral. The CCG and providers are working to restore routine and non-urgent activity following advice guidance received by NHS England.

 

Support for Care Homes

  • The CCG is working with general practices and community health service providers to support to all CQC registered care homes.
  • Throughout the pandemic the CCG has worked with Local Authority colleagues to ensure adequate PPE supplies are available in the social care sector.
  • Infection Prevention and Control – 16 staff from our Continuing Healthcare Team are providing addition support and training in care homes. This includes hands on support with infection prevention and swabbing. The service will be available across all localities.
  • The CCG has taking the lead in providing weekly webinars for social care staff across Devon.

 

Shielded Patient List updated

  • NHS Digital have provided the latest release of the Shielded Patient List (SPL).
  • Nationally, the list has now grown to include approximately 2.2m patients who meet the shielding criteria. Across Devon we have seen our list grow by an additional 8,340 patients, with 1,654 removed as a result of ongoing review by their GP practice.
  • The summary below shows the current list of patients identified as recommended for shielded, across Devon by locality.

 

By locality Shielded Patient List size
Eastern 13,265
Northern 7,984
South Devon and Torbay 11,507
Western 13,759
Total 46,515

 

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 welcome, but not unexpected move, does not mean there will be a new funding stream of available cash in our system. The health service in Devon still spends beyond its allocation and the system must continue to work toward financial balance.
  • Trusts in Devon have had a mix of historical revenue and capital debt written off as in the table below –
Trust name Total (£’000)
University Hospitals Plymouth NHS Trust £141,984
Northern Devon Healthcare NHS Trust £20,003
Torbay and South Devon NHS Foundation Trust £17,731
Total £179,718
  • The debt will be written off by the conversion of loans to equity in the form of Public Dividend Capital (PDC). PDC is a form of long-term government finance which usually comes with an annual charge attached, typically around 3.5%. A review is underway by the Department of Health and Social Care and NHS England / Improvement to consider the impact of a lower PDC rate.
  • Further developments on this issue are anticipated over the next few months 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.

NHS Here For You campaign

  • As a result of the pandemic there is a potential increase of people dying at home with non-COVID related diseases due to observing lockdown restrictions and fears they might catch the virus
  • Attendances have fallen by more than a third at emergency departments across Devon, in line with national trends and trusts report reduction in admissions for cardiology, paediatrics and ED​
  • Primary care reporting decrease in attendances for suspected cancer, childhood immunisations, screening and blood monitoring
  • A local strategic communications plan sets out the specialties that require additional focus and key messages, for use in wider targeted publications. Key messages include:
    • All Devon GP practices offer telephone, video or online consultations
    • Many secondary care specialities offering video and telephone consultations
    • Some services moved off-site (e.g. chemotherapy)
    • Both primary and secondary care have measures in place to protect people who need to attend for face-to-face – social distancing arrangements, PPE, designated sites for COVID symptomatic patients
    • Remote access to health advice is available through other digital services – HANDI paediatric app, NHS App, 111 online
  • Further key messages that focus on reassurance for GPs to use during telephone triage and secondary care to use in appointment invite letters that are site/clinic specific.  These would include ‘What to expect’ lines:
    • Social distancing measures in place
    • PPE for staff and patients
    • Longer time and spacing between patients
    • Clear instructions about where to go on arrival
    • Designated areas for COVID symptomatic patients
    • Testing and temperature checks