Agenda item
Brent NHS and Covid 19 Response and Recovery
This report provides an overview of the operational response by Brent’s local NHS to the COVID-19 pandemic and the recovery plans and operational recovery, including planning for a possible second wave.
Minutes:
Sheik Auladin (Managing Director, Brent CCG) introduced the report which provided an overview of the operational response by Brent’s local NHS to the Covid-19 pandemic and the recovery plans and operational recovery, including planning for a possible second wave. He drew the Committee’s attention to key aspects of the report including mortality rate and data analysis, the immediate response, the Covid-19 recovery phase, lessons learnt, and financial implications, noting that many factors were complex and intersectional. He highlighted that at the beginning of the pandemic in March 2020 during the immediate response, NHS England had issued guidance for acute trusts to prepare to manage capacity and ensure facilities were there, therefore non-elective and non-urgent patients were discharged to create capacity in the system. At the same time in the CCG GPs were informed to start seeing patients by e-consultation, which he advised was easy to do as GPs had begun e-consultations pre-Covid. The recovery phase for GPs required them to offer face to face appointments and operate 100% capacity while following the guidelines. Work was being done to ensure the flu vaccination campaign was underway and well-established, with faith establishments supporting the message to get vaccinated. A Covid escalated care planning hot-hub was launched on 27 March 2020 to manage and see Covid-symptomatic patients and care and monitor them in the community instead of putting pressure on hospitals. The hub continued to operate at a low level and remained in place to escalate if needed. Sheik Auladin advised that learning had shown more efficient use of NHS resources when all partners and providers worked together, including the local authority, acute hospitals and all CCGs and providers. He added that there was now work underway at both a national and local level addressing health inequalities. A substream of work involved the CCG working with primary care networks and 10 GPs to tackle health inequality issues in Church End and Alperton, looking at a new model of work for a multi-disciplinary approach in relation to managing long-term conditions, including mental health, specialist nurses and GPs. The model was in its very early stages but there had been good response from all major providers.
The Chair thanked Sheik Auladin for the introduction to the report and invited comments and questions from the Committee, with the following issues raised:
The Committee heard that Northwick Park was at the forefront during the early stages of the pandemic and was the second busiest A & E in London, so there were challenges regarding the number of places in critical care facilities. Northwick Park had been supported by the system, particularly Royal Brompton Hospital, with the transfer of patients to receive critical care. There was positive news coverage about the response to Covid, with community testing noted and innovative treatments and drug regimes used for Covid patients, such as CPAP oxygen use. Simon Crawford (Deputy Chief Executive, London and North West Hospitals Trust) advised the Committee that Central Middlesex Hospital, GPs and UTC were now running and had been for some time. There were safe segregated pathways for patients to access and testing was done immediately if there was a suspected Covid case, with isolation if needed, and anyone attending hospital had their temperature taken and were required to wear a mask, sanitise and social distance. The focus of the past 3 months had been on the recovery of diagnostics, outpatients and surgical procedures. Those attending for surgical procedures were tested for Covid-19 3 days prior to the procedure, with surgery only going ahead if the result was negative. At the time of the meeting there were 12 Covid patients in Northwick Park. In Imperial College Healthcare NHS Trust there were similar precautions in place and a large amount of work had been done with Lay partners about how to communicate the actions taken and pathways in place.
The Committee queried whether the antigen testing centre in Brent was linked to national laboratories, as nationally there was limited testing capacity. Sheik Auladin confirmed that the antigen testing site was linked to the national laboratories and the local provider for diagnostics, GDL, had not reported any issues. Regarding testing, Committee members requested the number of testing centres in Brent and whether it was sufficient to meet the demand in Brent and wanted to know how often testing was carried out, particularly in care homes. Dr MC Patel (Chair, Brent CCG) advised that testing had been an issue, such as people being offered tests away from where they lived and there was a need to ensure all essential workers had access to rapid testing, therefore this had been raised as a concern at North West London Chairs meeting. Practices were being encouraged to do regular testing, which they were responsible for, and in care homes the government had set a minimum of 28 days for residents and weekly for staff. Dr Melanie Smith (Director of Public Health, Brent Council) advised that in the last few weeks testing had fallen short of demand but the re-introduction of testing in care homes was now being seen. With regard to Brent residents on the whole getting tested, there was evidence that around a quarter of those being tested should not have been getting tested, therefore there was an important role for the Council to play regarding messaging on who should get tested. It was anticipated that the situation would be resolved two or three weeks from the Committee meeting. The Public Health Department in Brent was working with the Department of Health to increase access to testing and on new models including home testing kits to increase capacity.
The Committee asked about pathways of care and how Covid-19 was impacting, and had impacted, certain pathways. Specifically the Committee asked for the numbers of the non-urgent waiting list in July 2019 and then July 2020, how many 2 week cancer referrals had been done in July 2019 and then July 2020 and what the current care pathways were for those seeking medical attention for changed bowel habits, breast lumps, and a new continuous cough that had lasted for 3 or more months. NHS colleagues agreed to provide written responses on the data requested, but advised that they were monitoring what these were pre-Covid and now. Waiting lists had gone up but were now being focused on. There was a target to get back to 90% of elective care by October and in London and North West Hospitals Trust that was at around 68% at the time of the meeting. Dr MC Patel advised that there were established care pathways that had not changed, and now that hospitals were re-opening 2 week cancer referrals and non-urgent referrals ought to be seen as they were pre-Covid. For changed bowel habits, an urgent patient should be seen within the national targets (2 weeks, or 48 hours for very urgent patients), and hospitals appreciated GPs doing some tests before referral as this was a good screening tool. Simon Crawford advised that they had contracts with the independent sector including Clementine Churchill Hospital and London Clinic who had clean Covid pathways and some cancer patients had been taken there. Those critical pathways had been facilitated as much as possible throughout the pandemic even if they were not delivered on site and consultants had reviewed all prioritisations on waiting lists. Claire Hook (Imperial College Healthcare NHS Trust) advised that they had been able to prioritise and treat all urgent patients (those who fell into categories 1 or 2 of the Royal College guidelines) throughout the pandemic through cancelling routine surgery. The Royal Marsden was in the process of reinstating services and treating more patients. Due to the number of people being referred onto waiting lists the list sizes had decreased by around 50% for cancer referrals. Those numbers were now restoring and services were set up to accommodate those referrals as they entered the pathway, although there may be delays in the pathway getting to diagnosis. The focus was on ensuring diagnostic services and surgical services were running as soon as possible.
The Committee noted that, in comparison to nationally, Brent had done well to keep Covid in care homes under control, and queried what Brent had done differently. Simon Crawford advised that when patients stabilised and no longer needed to be in an acute hospital arrangements were made for an appropriate discharge through the discharge hub set up in early April 2020, with all patients who were discharged supported with appropriate packages of care. It was ensured that care home staff knew the status of a discharged patient so that they could support appropriately.
A query was raised regarding oxygen line connections at Northwick Park Hospital, to which Simon Crawford highlighted that Northwick Park had never run out of oxygen and the referral to using CPAPs in the report was regarding an alternative pathway to support specific patients with presentations and who did extremely well on oxygen rather than mechanical ventilation. When the critical care bed capacity was increased there was a requirement to pipe more oxygen into those areas and capital works were undertaken to do that in a co-ordinated process. He expressed there had been a co-ordinated process across ICS with readiness to respond to winter and Covid.
The Committee queried whether planned digital access to GPs would be by choice and not default. During the pandemic GPs had been told to move to e-consultation, and Dr MC Patel explained that now the message was clear from NHS England that GPs should offer digital consultation if appropriate, however GPs should make a clinical judgement on the best course of action. He expressed that if a patient wanted a face to face appointment they should be offered one. Simon Crawford clarified that the vast majority of ‘digital’ or ‘virtual’ clinics were done by telephone consultations.
Regarding the new pilot project looking at a new model of care for the areas of Church End and Alperton, Sheik Auladin confirmed that while it had been spoken about by several colleagues during the meeting it referred to 1 model of care where all partners came together for the benefit of the health of local residents and to manage health inequalities in the Borough. Regarding access moving forward, there were 10 Primary Care Networks in Brent therefore the plan was to have 10 GP access centres.
The Committee noted how many services had closed during the early stages of the pandemic, such as the memory clinic, with some services such as IAPT moving online, and noted there were no online services for Asian languages. The Committee queried what plans were in place for the future with regard to social care and how community organisations could be involved in that plan. Robyn Doran (Chief Operating Officer, Central and North West London NHS Trust) informed the Committee that she was part of the 3rd sector Working Group for Mental Health where colleagues had come together regarding Covid. Community Mental Health Teams had carried on delivering services with 2/3 of work face to face and 1/3 online and had supported care home staff and the homelessness team with clients in hotels. The decisions to close services were unprecedented as staff were severely affected by Covid, with around 1000 out of 7000 staff off sick, shielding, or caring for others at any one time, therefore quick decisions were made prioritising what services would stay open. The dementia care service was stepped down along with other services and IAPT already operated online. There was agreement that things needed to be moved back to face to face as that was patient preference, and Robyn Doran offered to pick up specific issues with Committee members. Dr MC Patel noted that work was being done with Healthwatch on a community project, with a baseline analysis of various organisations and a list of community organisations being brought together. Community engagement meetings had notified colleagues of groups they did not know about so they would be making contact with those groups. The pilot project spoken about aimed to send health teams into the community to work with those people who did not typically engage with health services to deliver essential health screenings where required.
Regarding resident engagement, Rory Hegarty (Director of Communications and Engagement, North West London CCGs) felt that it was very important to engage with local residents. Each provider was responsible for the changes to their service and it was important for residents to be informed of changes and be clear of information when they attended a service. Where that was not happening Rory Hegarty asked to be informed so that they could work on messaging. There was now a very clear protocol for getting the message out for providers. Rory Hegarty advised that routes for hearing the patient voice included the weekly Healthwatch meeting and the Community Voices programme that had focused on BAME communities during the pandemic. Members of the Committee hoped to see further partnership with the voluntary sector and local organisations, bringing together clinical aspects and social care. This was a priority for the NHS Communications department.
Access to healthcare was a concern for Committee members and health colleagues alike. Committee members noted that councillors were picking up many of the issues surrounding access, and felt that frontline staff were creating barriers, particularly for those with language barriers. Dr MC Patel agreed that there was a problem with access that needed to be addressed and moved forward.
The Committee queried reference in the report to a ‘talk before you walk’ pilot. Lesley Watts (Senior Responsible Officer, North West London Health and Care Partnership) advised that this meant talking to a health professional to get advice before going to A & E. Discussions on the pilot had only just begun therefore Lesley Watts offered the Committee a written answer.
As there were no further questions, the Chair thanked Committee members and health colleagues for their contributions and drew the item to a close.
Supporting documents:
- 6. Brent NHS and COVID 19 Response and Recovery, item 7. PDF 469 KB
- 6a. Appendix 1 - Phase 3 Letter Summary of Priorities and Actions, item 7. PDF 73 KB