36.1. The Committee considered a report providing an update on the NHS response to Covid-19 in East Sussex.
36.2. The Committee asked why there has been a sudden increase in the rate of Covid-19 infections in the Hastings and Rother area.
36.3. Darrell Gale, Director of Public Health, said that the Public Health Team had seen the rate of infection beginning to increase in Hastings and Rother prior to the start of the November lockdown. The rate slowed after two weeks of lockdown but figures from the 30th November, just prior to the lifting of the lockdown, showed a high rate of increase that continued to rise throughout the week. Due to the timing of this increase, the infections must have taken place prior to lockdown being eased.
36.4. Having investigated the cause, the Public Health Team found that 50% of cases in Hastings and Rother were random and likely caused within households, rather than originating from a specific location or event. The other 50% were traced to care homes, hospitals, and schools, however, the infections in these places were originating from households and just being identified in these locations through testing of staff. Darrell Gale explained that care home staff are regularly tested and can be isolated very quickly before transmitting the virus to residents, who have been less affected than staff.
36.5. The Director of Public Health added that the Public Health team has issued communications to the residents in Hastings and Rother in response to the outbreak telling them that they now have a high transmission rate that is increasing and that they need to stop any behaviours that they were doing when they thought they were in an area with a low number of infections. He said that this included not doing things that are permitted in Tier 2 unless you have to; avoid or leave any areas that are too crowded; and that the easing of restrictions over Christmas should be treated with extreme caution and not be seen as an instruction to meet with lots of people or travel across the country. He added that Tier 2 only leads to a levelling of infection rates and that the rate over Christmas will undoubtedly increase infection rates. The Director of Public Health warned that if people nationally wish to avoid a further lockdown in the new year, they should consider whether it is necessary to meet during Christmas.
36.6. The Committee asked for an update on how East Sussex Healthcare NHS Trust (ESHT) was coping with the increased rate of infections.
36.7. Joe Chadwick-Bell, Chief Executive of ESHT, said the Trust has seen a sharp rise of cases, particularly in the last week. The Trust now has 61 positive cases as of 9th December – 16 in Eastbourne District General Hospital (EDGH) with 2 in the Intensive Treatment Unit (ITU); 36 cases in Conquest Hospital with 4 in the ITU; and 8 cases in community beds. Some of these are new admissions and some are from cross-infections (or acquisitions) within the hospital settings, although it is difficult to determine whether infections that emerge during hospital stay within the first five days were caused in the hospital, or acquired in the community but the patient was asymptomatic and tested negative on admission.
36.8. The Chief Executive said that in response the Trust is looking to increase ventilation on some wards by keeping windows open. The Trust is also trying to balance ongoing elective admissions with demand for Covid-19 patients, taking into account the need to carry out urgent surgery and recovering from the delays to surgery caused by the first outbreak of Covid-19. NHS England expects trusts to maintain 90% of activity compared to last year. ESHT is at 83% of day-case surgery activity compared to last year, and 85% when including the independent sector capacity. Inpatient surgery, where a patient has to stay overnight, is at 91% of 2019 activity or 98% of 2019 activity if use of the independent sector capacity is included. Outpatient are at 87% of 2019 activity for first appointments and follow-ups are at 95%. In trying to balance Covid-19 response, winter pressures, and the recovery programme, however, the last two weeks have been extremely challenging and the hospitals are at full capacity. The Trust is, however, working well with the rest of the healthcare system to identify more out of hospital capacity to alleviate the pressures, for example, hospitals elsewhere in Sussex.
36.9. Joe Chadwick-Bell added that the walk-in activity to A&E is down on last year and ESHT is seeing some positive impact from NHS 111 First, which allows booking of A&E appointments via 111. Non-elective admissions are around the same as 2019 in Conquest but are 6% up at the EDGH.
36.10. The Committee asked how the Covid-19 immunisation programme might be rolled out in East Sussex.
36.11. Jessica Britton confirmed that the first cohorts to receive the vaccine are the over 80s, care home residents, care home staff, and health care workers. It will then be rolled out to the wider population based on age and risk level.
36.12. Darrell Gale explained that the Pfizer vaccine is a logistical challenge to administer without wasting doses due to the difficulty transporting it at -70C, the large boxes containing 975 doses that it is supplied in, and the need to use up the boxes fairly rapidly once opened. This makes it difficult to travel to care homes to administer the vaccine directly to care home residents.
36.13. Jessica Britton said that vaccinations will begin this week at the Royal Sussex County Hospital (RSCH) and all other hospital sites will follow in the coming weeks. The hospital hubs will vaccinate the over 80s attending hospital outpatient appointments or being discharged home after a hospital stay; hospital staff; and social care workers. The CCG is working with care home providers to ensure care home staff are invited to receive their vaccines.
36.14. Joe Chadwick-Bell added that ESHT will be ready from Monday 14th December, should the vaccine be delivered by then, to begin the vaccinating programme. The Trust needs 1,000 vaccinations per site peer week to deliver it to this first cohort. Sites have been identified at both hospitals and the Trust feels it is prepared to meet the logistical challenge.
36.15. Jessica Britton said that the next step will be for Primary Care Networks (PCNs) to confirm which GP practices within their areas will be used as vaccine sites. The first of these sites will begin operating in the next few weeks and will be rolled out in a phased approach.
36.16. The Executive Managing Director of East Sussex CCG said that the final step will be the opening of the mass vaccination centres as further supplies of the vaccine come on stream. Sussex Community NHS Foundation Trust (SCFT) is leading the recruitment and training of additional staff to deliver the vaccines at these centres and elsewhere. Recruitment of people who can deliver the vaccine has begun and it is expected that volunteer marshals will also need to be recruited for the mass vaccination centre that is expected to open at the Brighton Centre.
36.17. The Committee asked whether the Helenswood site will continue for testing and what the capacity was of the testing sites
36.18. Darrell Gale confirmed that the site will continue into the medium term, although the lease is expiring some time in 2021. The Director of Public Health explained that this is not a concern as, if it is necessary to leave, there will be plenty of time to identify another testing site. In addition, there is a mobile testing site at the Pelham car park in Hastings. Darrell Gale said Helenswood can process several hundred people per day and Pelham site between 200 and 300. The sites, however, are currently only at 25-40% of capacity, despite Hastings having the highest testing rate in East Sussex, and there is now sufficient lab capacity to meet demand. He urged anyone with even the mildest symptoms to be tested, especially those who have been in contact with someone who had the virus, as it is an effective way of helping to contain the outbreak.
36.19. The Committee asked about how anti-vaxxers or hard to reach or sceptical residents will be reached.
36.20. Darrell Gale said that the vaccination programme is providing information upfront to those who may be querying the decision whether to get vaccinated, for example, good scientific evidence is being put into easy to understand, lay language to help counter those who are anti-vaccine. The approach being used is to show the first vaccines being delivered to ordinary patients in their 80s or 90s rather than celebrities, as it is vital to normalise the vaccine.
36.21. The Committee asked how Covid-19 had affected the distribution of the flu vaccine
36.22. Darrell Gale said it had a positive effect on the uptake of flu vaccine. When someone has a flu vaccine, they may not be able to have a Covid-19 vaccine for a time afterwards and they will be asked about that when they are due to have the Covid-19 vaccine. Jessica Britton confirmed that the flu vaccine was being rolled as normal with normal uptake but would need to be managed alongside the Covid-19 vaccine when that is more widely available. Joe Chadwick-Bell confirmed that ESHT staff’s vaccine uptake was 81% at last recording, including 99% of nursing staff, which is the highest recorded rate.
36.23. The Committee asked whether the two hospital sites could provide a wider range of outpatients services to reduce the need for patients to travel from one town to the other.
36.24. Joe Chadwick-Bell said the priority of the Trust is to fully utilise the space available to ensure that there are red and green flows for non-elective patients who are Covid-19 and non-Covid-19 positive and a completely separate pathway for elective patients (super green) where patients are tested before they are admitted.
36.25. As a result, the Trust will not put services that are currently delivered on a single site onto both sites because there would not be the staff or space to do that. If there is a long waiting list at one site, they will be offered a number of appointments including on other sites, although a large number of outpatients appointments are undertaken via phone or video, so there is no need to travel. She said she would check the current site specific wait times to check there is no imbalance.
36.26. The Chief Executive of ESHT said it is more likely that services will be consolidated rather than provided on both sites, for example, it is possible that non-day case orthopaedics could be consolidated onto a single site for a few weeks in order to safely continue elective surgery.
36.27. The Committee asked for confirmation that Do Not Resuscitate orders are being discussed with patients.
36.28. Joe Chadwick-Bell said that Covid-19 has not changed the criteria for patient Respect forms. Respect forms are put in by medical staff based on discussions with the patient and/or relatives based on their likely health outcomes over a period of time. It is up to medical staff whether they think one should be completed, however, the Trust expects Respect form to be discussed with patients and relatives if one is completed. The Chief Executive of ESHT said she had seen complaints from people where they said they had not been consulted, however, it turned out upon investigation that these discussions had been very clearly documented in the notes. Joe Chadwick-Bell clarified that the Do Not Resuscitate order is part of the Respect form and that this element, in accordance with case law, will be agreed with the patient and or their family, depending on their capacity and wishes.
36.29. The Committee RESOLVED to:
1) agree to consider a further update on the NHS response to Covid-19 at the next meeting;
2) request confirmation of the number of patients currently on the outpatient waiting lists at both hospital sites.