The Committee considered a report of the Leicester, Leicestershire and Rutland (LLR) Health and Care System which informed of how the NHS system had managed Covid-19 and the extra pressures over winter 2021/21. A copy of the report marked ‘Agenda Item 8’, is filed with these minutes.
The Committee welcomed to the meeting for this item Andy Williams, Chief Executive, LLR Clinical Commissioning Groups (CCGs), Tamsin Hooton, Assistant Director of Urgent and Emergency Care, LLR CCGs, Caroline Trevithick, Chief Nurse, WLCCG and Rebecca Brown, Acting Chief Executive, University Hospitals of Leicester NHS Trust (UHL).
Arising from discussions the following points were noted:
(i) The winter pressures plan was led by the Urgent and Emergency Care Group whereas the Covid-19 pandemic resilience arrangements were overseen by the Local Resilience Forum arrangements working alongside the Health Economy Strategic Co-ordinating Group and supporting sub-groups. It was agreed that after the meeting a flow diagram would be circulated to members to show how all these groups interlinked with each other.
(ii) In the early days of the Covid-19 pandemic there had been concern on behalf of the NHS that some people were not attending Emergency Departments due to Covid related concerns even when they had a genuine medical emergency which required attendance at the Emergency Department. Since then attendances at Emergency Departments had risen as messages had been publicised encouraging people to still attend Emergency Departments if they had a genuine need for the service. However, the mix of patients seen in Emergency Departments had now changed. The amount of patients being seen in Majors was the same as before the Covid-19 pandemic whereas the number of patients with minor injuries was lower. The reduction in minor injuries was believed to be because due to the lockdown restrictions people were being less active and not getting involved in risky outdoor activities.
(iii) During the pandemic initiatives had been put in place to enable EMAS staff to better provide clinical advice and enable patients to access alternative care pathways. This resulted in fewer than 50% of patients seen by EMAS being taken to hospital. These initiatives would continue after the Covid-19 pandemic had ended in order to keep Emergency Department attendances low.
(iv) Due to the Covid-19 pandemic there had been less face to face appointments at GP Practices and members suggested that this could have resulted in an increase in attendance at the Emergency Department. It was also queried whether the lack of face to face appointments could have resulted in underlying health issues being missed by GPs whose only contact with patients was over the telephone. In response it was explained that there had been some positive effects of the additional telephone appointments in that GPs had been able to spend more time talking to patients and therefore were able to identify a patient’s needs better. However, the members’ concerns were acknowledged by the CCGs and reassurance was given that a large amount of work had gone into addressing the issues arising from less face to face appointments. The CCGs and UHL were aware that whilst some performance targets were being met there could be a hidden backlog of patients that had not come forward for treatment and so work was taking place to assess the possible hidden harm resulting from the pandemic.
(v) During the Covid-19 pandemic there had been a drop in the requirement for social care, wrap around and reablement services but it was expected that demand would increase again as the impacts of the pandemic abated.
(vi) In response to concerns raised by members regarding the amount of elected procedures that had been delayed due to the Covid-19 pandemic reassurance was given that regular welfare checks had taken place with the patients that were awaiting an elected procedure. The NHS was using the private sector to help carry out the procedures. It was acknowledged that it could take up to two years to catch up on all the outstanding elected procedures and the NHS intended to be open and transparent with the public regarding this situation. The LLR system would be working with the rest of the region to help reduce the backlog. Dealing with patients that required cancer procedures was the main priority.
(vii) UHL and the CCGs acknowledged that staff had faced extreme pressures during the pandemic and reassured that support was being provided to staff and consideration was being given to how to tackle sickness rates.
(viii) When the new NHS 111 telephone service went live in LLR in September 2020 there was no national IT system for booking patients who required care in an Emergency Department (ED) into time slots in the Leicester Royal Infirmary ED. Despite this the LLR system met its targets for booking patients into ED. Subsequently a national IT solution for booking patients into ED was set up and it went live at 4pm on Thursday 4 March 2021.
(ix) The 111 First programme aimed for 20% of unheralded attendances at ED or urgent care centres to be re-directed elsewhere, either through the patient calling 111 or by triage at the front door of the ED. The programme had met this target every week so far.
(a) That the update on how the NHS system in LLR managed Covid-19 and the extra pressures over winter 2020/21 be noted;
(b) That LLR CCGs be requested to update the Committee with the results of the further evaluation work into the changes to the NHS 111 service;
(c) That LLR CCGs be requested to provide the Committee with a flow diagram relating to the resilience response structures which had been in place during the Covid-19 pandemic.