Agenda item

22.1.    The Committee considered a report providing an overview of the East Sussex Winter Plan for 2021/22.

22.2.    The Committee asked how the NHS would deliver the new vaccine programme following the Omicron outbreak.

22.3.    Darrell Gale, Director of Public Health, said his view of the new variant was one of caution but not deep concern, as a lot of work is already being done to reduce the delta variant’s impact. He said the announcement to increase the booster programme in response to the Omicron variant has caused some confusion amongst residents, as it is not the case that people can just turn up at a vaccine site to receive the booster; people need to wait to be contacted by the NHS.  This is because not everyone is eligible yet and the vaccine programme cannot just double its capacity of vaccines, slots and staff overnight. Jessica Britton, Executive Director of East Sussex CCG, added that all residents will be eligible for the booster by the end of January and that to date 70% of those in Sussex over the age of 40 who are eligible have already had the booster. The Executive Director said the additional demand across the whole of Sussex for all patients who will eventually be eligible for a booster is 625,000 additional vaccines between now and the end of January. Currently 80-90,000 are delivered per week, meaning operations would need to be scaled up to deliver 120,000 per week to meet the target and plans are being developed to achieve this.

22.4.    The Committee asked about the progress of vaccines for patients in their own homes who are clinically vulnerable.

22.5.    Jessica Britton said the NHS is continuing with the Housebound programme and is on target to ensure all people who were part of the initial programme receive their booster by the end of December using additional resources provided to the Primary Care Networks (PCNs). Darrell Gale confirmed the Greater Wealden PCN will have completed all of its Housebound boosters by the weekend.

22.6.    The Committee asked what the NHS can do to improve the resilience of the care home sector and how oversees recruitment will get round the cap on visas.

22.7.    Mark Stainton, Director of Adult Social Care, said that the biggest issue facing the home care and care home sector is workforce. East Sussex County Council (ESCC) is providing information and support to providers individually and as a sector during the winter period. This includes using central government funding to provide both home care and care home providers with financial aid to support their resilience over the winter period that is designed to help them retain the workforce they already have. ESCC also has joint recruitment initiatives with the care sector providers including a Department for Work and Pensions pilot, the Armed Forces Network, and oversees recruitment all designed to tap into parts of the employment market not yet utilised to the fullest. The oversees recruitment is in areas with an established health but not care market to try and get qualified nurses and includes Albania, Romania and the Far East. The potential employees seem willing to work sufficient number of hours per week to enable them to exceed the government threshold for obtaining a visa. The Council has also commissioned a bus to tour East Sussex advertising care roles.

22.8.    Joe Chadwick-Bell added that the NHS is supporting social care by working closely together as a system and ensuring end-to-end care is in place. Specific activities by the NHS include the Enhanced Care in Care Homes regional funding, which funds registered nurses to support care homes; additional funding to expand the 2-hour Crisis Response Service to avoid patients attending ED or being admitted; and funding for Same Day Emergency Care that means people avoid the need for a hospital admission and subsequent requirement to find them a long-term social care placement.

22.9.    The Committee asked whether the number of school children with COVID-19 is increasing and what guidance is available locally to mitigate levels of infections.

22.10.  Darrell Gale explained there is a weekly monitoring of all COVID-19 outbreaks in schools and the majority of COVID-19 infections in East Sussex are within young age groups with the largest the 10-14 age group, many of whom are not eligible for vaccines yet. The Director of Public Health explained there are no national requirements yet on mask wearing or for Christmas events at school so, prior to the Omicron variant emerging, he and the Director of Children’s Services wrote a joint letter to all headteachers, and then all parents and guardians, setting out:

•           an expectation that schools issue advice to their pupils on face coverings in all communal areas and decide whether or not to proceed with Christmas events;

•           a message to parents that if they missed a vaccine for their 12-15 year old that they get it re-booked;

•           a message to schools that they accommodate vaccines as smooth as possible as it can disrupt teaching; and

•           a reminder that parents and children take lateral flow tests, and a PCR test if necessary, and log all results, including negative results.

22.11.  The Committee raised two specific issues around COVID-19 booster vaccines. The first was whether booster vaccine clinics were definitely taking place locally in Seaford and that patients who were eligible were being informed; the second was whether it was appropriate to invite people to the Hastings vaccination centre for a booster at a time prior to the centre opening, resulting in people queuing outside in the cold.

22.12.  Jessica Britton said she would check with the CCG’s Vaccination Team about both of these issues.

22.13.  The Committee asked how NHS 111 might be used to meet the healthcare demands over the winter period.

22.14.  Katy Jackson, Director of Systems Resilience, said that there is a large media campaign nationally to encourage people to use NHS 111 and pharmacists rather than attending an ED or GP appointment where this is appropriate. Pharmacists are open over the weekend, can issue emergency prescriptions, and provide treatment for minor ailments. Joe Chadwick-Bell added the digital healthcare provider, Livi, has been commissioned to provide a further step in the process of a patient calling 111 and being advised to go to ED. Where the NHS 111 Clinical Assessment Service (CAS) has given a patient a disposition that involves attending the Urgent Treatment Centres (UTCs) at the hospital EDs, a GP working for Livi can call them and in the majority of cases should be able to resolve the issue over the phone, whether it is providing advice and guidance, a prescription, or booking a non-urgent GP appointment. This should help to reduce the number of patients attending EDs and will be online before Christmas. 

22.15.  The Committee asked how the Winter Plan could be delivered given the current pressure on ED, and lack of bed capacity.

22.16.  Joe Chadwick-Bell agreed winter will be a busy and difficult time and said the main priority over the winter period for ESHT is to keep patients and staff safe. This will be achieved by reducing demand on the EDs, for example, through enhanced care in care homes; pathways to allow ambulances to request that the 2-hour Crisis Response Teams respond to a call rather than attending and conveying the patient to hospital; additional digital capacity from Livi; and additional workforce recruited to the UTC. The Chief Executive added that the ED has more staff than ever and that the main issue is bed space for patients who need admitting. To counter this, the Trust is increasing Same Day Emergency Care as much as possible and where clinically safe to do so to avoid the need to admit patients; and introducing a range of initiatives to improve the flow of patients through the hospital using national best practice and lots of support from senior management, including the Board of Directors.  

22.17.  The Committee asked how the system could achieve 30-minute ambulance handover times given the current pressures on the service.

22.18.  Joe Chadwick-Bell said the figure of 30 minutes is a very ambitious goal but is based on national targets. There is a national expectation of there being strictly no delays over 60 minutes and of trusts aiming to avoid any over 30 minutes. The figure of 30 minutes is to allow crews to handover patients to the hospital trust in 15 minutes and then spend 15 minutes doing paperwork and cleaning the ambulance. ESHT is committed to assisting SECAmb achieve this goal and is planning to introduce “Fit to Sit”, which is a pathway that allows ambulance crews to drop off patients in the ED waiting area rather than on a trolley if it is clinically safe to do so. Jessica Britton added that the CCG monitors how trusts are improving hospital handovers and confirmed learning is shared across the county.

22.19.  Katy Jackson further added that SECAmb is working to improve handover times by having a member of staff present in the EDs to support the handover process; avoiding unnecessary conveyances by increasing the number of patients treated in the community either via ‘Hear and Treat’ and ‘See and Treat’; and analysing calls to see how the Trust can better communicate when to call 111 rather than 999.

22.20.  The Committee asked whether the reasons given for the temporary closure of Crowborough Minor Injuries Unit (MIU) were legitimate, and whether more could be done to reopen the MIU in time for February 2022.

22.21.  Jessica Britton stated it was not the intention of the CCG to permanently close the MIU and the closure will be reviewed on a regular basis. The NHS is balancing available resources against a number of services that need to be provided safely and effectively, including delivering the children’s vaccination programme (which the provider of Crowborough MIU is conducting) and maintaining access to urgent care services. Prior to the closure of the MIU, Sussex Community NHS Foundation Trust (SCFT) had challenges staffing its three MIUs in a sustainable way whilst maintaining infection control measures that keep staff and patients safe. The temporary arrangements now allow the Trust to maintain urgent care at Lewes UTC and Uckfield MIU in a safe and sustainable manner and are able to support an increase in numbers of patients. The CCG is also in dialogue with MTW about the impact of the closure of Crowborough MIU on the Tunbridge Wells Hospital ED, with no current significant impact reported.  The Executive Director said she would fully respond to the queries raised in writing, particularly around the feasibility of using spare capacity in the Crowborough Hospital as an alternative location for the MIU.

22.22.  The Committee RESOLVED to:

1)         Note the report;

2)         Request a written response from the CCG on the questions raised about the temporary closure of the Crowborough MIU;

3)         Respond to the queries set out in 22.11; and

4)         Request a report on Hospital handovers at the March meeting.