Agenda item

Notice of items to be raised under this heading must be given in writing to the Head of Executive and Member Services or her representative before the meeting in accordance with Standing Order 60.

9a. Follow up on Winter Pressures – Risk Management of System Pressures

Simon Crawford (Deputy CEO, LNWUHT) provided an update on the winter pressures at the local acute trust – London North West University NHS Healthcare Trust. He highlighted that the Trust had been exceptionally busy over the winter period which had been exacerbated by the challenges of the 7-day Junior Doctor Strike, which had meant cancelling elective appointments and procedures. Across the Trust, safe rotas were maintained during that time but there were a number of days ambulatory services were diverting staff into A&E departments to support the emergency pathway. On a daily basis, Northwick Park Hospital continued to receive the highest number of ambulances across London at an average of 170 a day from 23 December 2023 to 10 January 2024. During the bank holiday weekend following Christmas, there had been 70 empty beds made available in preparation, but this had been followed by a busy two weeks which put the Trust under a large amount of pressure. There had been an unprecedented number of patients waiting in corridors to be assessed and patients were being sent to wards before a bed was ready so they were waiting in ward corridors for other patients to be discharged. Northwick Park operated daily on the Full Capacity Protocol on Opal Level 4, with senior staff supporting A&E departments. Ealing was under similar pressure. Staff were redistributed across sites to support safer staffing ratios within emergency departments and in-patient wards. The Transfer Teams had been mobilised within emergency departments to support the move of patients and ensure they were monitored and kept safe. Additional Discharge Support Teams were available over the weekends who were well supported by Brent Council through an additional social worker to support packages of care and placements. The Trust had been able to open some temporary beds in emergency department units to maintain the balance of safety, and support same day emergency care as much as possible as well as alternative pathways which prioritised patients who could be assessed quickly.

Dr Haidar provided an update on the support primary care had provided during the pressurised period. He acknowledged the challenging period and highlighted that all partners had aimed to work as one system and have strategies in place for hospitals to manage demand with the support of primary care and the community team. The Primary Care Team had opened PCN hubs on three Sundays throughout the Christmas period to take some pressure away from acute settings, and with Adult Social Care supporting discharges, it had showed how working as one team together as a borough-based partnership could make a positive difference to residents. There were learnings from the period, such as for the primary care team to work better in terms of communications to inform colleagues in the acute sector of plans such as opening hours over the holiday period. The London Ambulance Service had asked GPs to not request ambulances or refer patients to emergency departments where it was possible for the GP to see and treat the patient, instead asking for an increase in the capacity for GPs to visit patients where possible rather than requiring an ambulance.

Patrick Laffey (Deputy Director of Operations, CLCH) provided an update on how Community Services had supported the Acute Trust during winter pressures. He highlighted there had been a focus on supporting the acute flow and discharge, with local beds in Brent accessible for the whole NWL system. There were strong relationships with Brent Council to enable that to happen with a strong and mature relationship to facilitate discharges from Brent and Harrow. The Community Healthcare Trust had demonstrated flexibility, where possible, to take patients into community rehabilitation beds where they might normally not fulfil the criteria and had put in new pathways including stepping up colleagues from the community services to provide care to patients who might otherwise go into hospital. Now the focus was on how those new ways of working could be converted to business as usual, as demand was increasing year on year.

Tom Shakespeare (Director of Integrated Care Partnership) informed the Board that the next steps would be to reflect on the schemes that had been put in place and how they could be embedded into the system. Joint work was happening with LNWUHT and Harrow to evaluate discharge and what was driving the pressures.

The Chair thanked colleagues for their updates and offered appreciation on behalf of the Board for the staff working across the health and social care sector for their work over the winter period.

9b. Measles Update

Dr Melanie Smith (Director of Public Health, Brent Council) provided an update on measles. She explained that there had been national coverage on measles recently, prompted by the fact that, nationally, MMR immunisations rates were the lowest they had been for ten years and there had been significant outbreaks of measles in the West Midlands. Locally, MMR immunisation rates were increasing, but were still well below the 95% level needed for herd immunity. The UK Health Security Agency had modelled that London was at risk of a significant outbreak of a size that would have an impact on the NHS.

The local response had been to amplify and communicate national messages which included; 

• measles remains a serious disease, particularly for babies, during pregnancy, and for people who were immunocompromised
• measles was very infectious with contacts of an infected case that were not vaccinated having a 90% chance of developing measles and,
• vaccination was safe and effective.

The local response also focused on messaging that there was a free Porcine Gel vaccination alternative available at request and with no shortage of supply. This message had not been disseminated nationally but would be locally. Messages had already been translated into  Somalian and a Romanian language, with a video was in production, as those were the communities where it was known vaccination rates were particularly low, although Dr Melanie Smith highlighted they were not the communities most at risk of catching measles as that was everybody.

The Public Health team was lobbying the NHS to introduce MMR immunisation alongside Covid and Flu immunisations with the roving team at community catch-ups. The immunisation was usually administered by primary care and so GPs had been asked to step up their efforts to vaccinate the community. Dr Haidar added that there would be a meeting the following week to discuss operations and strategies for delivery.

The following points were made in response to the update:

• The Board noted that this was the second outbreak of measles following the outbreak around ten years previously. They asked whether councillors could lobby, through London Councils, for the government to introduce a national campaign around the importance of vaccinations, dispelling the myths around various different vaccinations that made people hesitant to receive vaccination. Dr Melanie Smith confirmed that there would be a national communications campaign commencing, which the Council would disseminate messages from whilst ensuring they were presented in a way that resonated with Brent’s communities.
• The Board asked whether the MMR immunisation could be administered through schools in the same way that flu and HPV vaccines were. Dr Melanie Smith agreed that it was possible to do MMR catch-ups in schools, but the issue was with capacity within the school aged immunisations service. Consent was also an issue, so the immunisations team had tried to target catch-ups in schools to those with particularly low vaccination rates or where there were measles cases.
• The Board asked how refugees and asylum seekers were being supported to ensure they have vaccinations. Dr Melanie Smith explained that Brent was doing particularly well and thanked primary care colleagues for the outreach work they did with refugees and asylum seekers, with a reasonable response from those communities.
• In terms of the primary care plans for outreach, Dr Haidar advised that he would work with the immunisations co-ordinators from primary care as well as public health colleagues and borough leads to support outreach. A schedule was being created to provide capacity to deliver this work as urgent. Community leads and community organisations were also helping with outreach to those with health inequalities, and he hoped to utilise the vaccination bus to supplement the work.
• In response to how local pharmacies could play a role in MMR vaccination, Dr Melanie Smith explained that there was a local willingness for pharmacies to vaccinate within a nationally inflexible system and Public Health teams continued to lobby for that. The Chair highlighted that this could be picked up at member level to support lobbying.
• Locations where the community could access MMR vaccinations would be communicated in due course.

The Board agreed to note the need for a national vaccination campaign and for NHSE to initiate a catch-up campaign. Councillor Nerva and Dr Melanie Smith would write a joint letter to request this at a national level.