Agenda item

(To receive a report from Simon Evans, Health Scrutiny Officer, which advises the Committee of the response taken by the NHS in Lincolnshire to Covid –19.  Senior Management representatives from NHS Organisations in Lincolnshire will be attending the meeting)

The Chairman highlighted to the Committee that this item as detailed on pages 19 to 22 of the report pack related to the NHS's direct response to Covid-19; and that the impact of Covid-19 on other services and plans for the restoration of services would be considered under item 6 of the agenda.

The Chairman advised that there were four contributors for this item: John Turner, Chief Executive, Lincolnshire Clinical Commissioning Group (CCG), Andrew Morgan, Chief Executive, United Lincolnshire Hospitals NHS Trust, Maz Fosh, Chief Executive, Lincolnshire Community Health Services NHS Trust and Tracy Pilcher, Director of Nursing, Lincolnshire Community Health Services NHS Trust.

The Chief Executive of Lincolnshire CCG advised the Committee that the Covid-19 pandemic had presented the biggest challenge to the NHS since its establishment.  Thanks were extended to all NHS staff, care workers and support staff in the county for their exceptional work over the last few months.  Thanks were also extended to the people of Lincolnshire for adhering to the government guidance, and for their continuing support, through the 'Thursday night appreciation clapping' and the individual notes of support received.

It was noted that Lincolnshire continued to have a low number of covid-19 cases per 100,000 population.  It was noted further that the rate for Lincolnshire was 147.9 cases per 100,000 population compared to the England rate of 273.2 and the East Midlands rate of 192.3 per 100,000.  It was however highlighted that Lincolnshire had two areas within the county that were above the Lincolnshire average and these were Boston and South Holland, and that the other five areas were beneath the Lincolnshire average.

It was reported that as of 16 June 2020, there had been a total 1,136 positive cases of Covid-19 notified in the Lincolnshire population; that 14 patients were still in hospital; that there had been a total of 140 hospital deaths in ULHT hospitals, a small number in community hospitals and mental health services in the county; and that there had been a total of 302 discharges accumulatively from ULHT hospitals.

The Committee noted that as a result of Covid-19, there had been some key temporary changes to NHS Service provision; these changes were detailed on pages 20 and 21 of the report pack.

The Chief Executive of United Lincolnshire Hospitals Trust confirmed that the incident was being well managed and that Trust had kept emergency care and services available.  The Committee noted that the issue of restoration on non Covid-19 services was currently being reviewed; but that this was dependent on whether there was a second wave of Covid-19.  The Committee was advised that the Trust had cared for 470 inpatients so far, 42 of which had received intensive care, it was noted that the length of time for intensive care had varied, with one patient having been in intensive care for a total of 81 days.  The Committee was advised further out of the 470 inpatients, 318 patients had been able to be discharged. 

The Chief Executive for Lincolnshire Community Health Services NHS Trust reported that over 340 patients had received care in the community and that currently three patients were receiving care in community hospitals; and that there had been three deaths in hospitals operated by Lincolnshire Community Health Services.

During discussion, the Committee raised the following points:

·         Appreciation was extended for all the work that had being undertaken by the NHS staff, ambulance staff and all supporting services locally and across the country;

·         Issues accessing national data - The Committee was advised that the Director of Public Health was having difficulties obtaining data relating to the wider testing scheme, which was known as Pillar 2, but this data was now starting to become available. Confirmation was given that all other data had been readily available and had been shared across the country.  It noted that all data received would help Lincolnshire understand the impact of Covid-19 on the population of Lincolnshire;

·         Clarification was sought as to how decisions were made. The Committee was advised that on 17 March NHS England had issued clear instructions as to what the immediate response to Covid-19 was required to be (Phase 1); and then on 29 April 2020 a subsequent letter was then received as to what needed to be done for Phase 2.  (It was noted that these letters were in the public domain).  It was highlighted that in Lincolnshire the CCG and the Trusts all worked very closely together, and some decisions had also included collaboration with primary care, care homes and home care.  It was noted that all decisions taken during Covid-19 had been shared in the first instance.  Clarification was provided that each area was responsible for their individual services;   

·         Clarification was sort as to why on page 20 of the report pack; Grantham Hospital had not been included in the list as a key temporary change in NHS Service provision.  The Committee noted that the report related to the response period and was correct at the time the agenda was despatched.  It was noted further that all NHS Chief Executives met on a daily basis and reviewed options and decisions.  Clarification was given that any inference that changes at Grantham Hospital were permanent was false, the changes proposed by the United Lincolnshire Hospitals NHS Trust Board on Grantham Hospital were temporary and this had been confirmed by the Board at their meeting on 11 June 2020;

·         Clarification was sought as to how deaths were recorded, as this appeared to vary from country to country.  The Committee was advised that in the UK there had been a move to refine data recording, as there were some inherent challenges.  Reassurance was given that the recording system adopted in the UK was one of the best in the world;

·         Support provided for staff who were now working at different sites i.e. were at Grantham but were now working at Boston. A further question was asked whether staff had the necessary Personal Protective Equipment (PPE); and whether sickness rates had increased.  The Committee was advised that a significant amount of work had been done as a system to provide staff with health and wellbeing support; and this support was also available in primary care and in care homes.  Confirmation was given that there had not been any occasions where PPE had run out.  The Committee was also advised that staff generally had been flexible and responsive in filling the gaps resulting from staff being on sick leave and having to self-isolate.  The Committee was advised for those staff having to work from a different site there was financial support.  It was highlighted that any changes had been assessed on the skill level required and confirmation was given that there had been no job loses, and no staff had been furloughed.  The Committee noted that a daily dashboard enabled managers to identify how many staff were off as a result Covid-19, and how many were shielding.  Information relating to the level of PPE supplies was also available.  It was highlighted that any staff redeployed would receive the necessary training.  Confirmation was also given that sickness levels had gone down, however, at Pilgrim Hospital, Boston sickness levels were slightly higher than at other sites;

·         Current situation in relation to patients being able to obtain routine scans – The Committee was advised that in the absence of specific details of this incident, there had been some delays in diagnostic screening through the managed phase; and that waiting times had lengthened. Confirmation was given that this was one of the services it was hoped would be back working as part of the restoration phase;

·         The need to make the best of community support and promoting the need for self-care.  The Committee noted that more progress had been made over the last few months with regard to integrated care at a local community level, and this was an area that had been identified in the Long Term Plan;

·         How Lincolnshire providers worked with other NHS providers of services to Lincolnshire residents, such as North West Anglia and Northern Lincolnshire and Goole.  The Committee was advised that each Trust had received their letter of instruction from NHS England/NHS Improvement and had their own Trust Boards.  Confirmation was given that there was good liaison between other NHS providers and that communication was conducted on a regular basis; and that relationships between Trusts were good, as this was fundamental for a county response; and 

·         A question was asked whether information contain on Page 27, section v, part c of the report pack was still correct, that there were no significant concerns with staff sickness or availability.  A further question was asked as to the number of staff unavailable for work through sickness or unavailability.  The Committee was advised that currently that there was a low level of sickness leave.  At the height of the response 20% of staff had not been available for work; and that this figure was now at 0.1% of staff not being available.  The Committee noted further that on 16 June 2020; 323 staff had not been available for work due to sickness and shielding.  This was compared to the peak of the response when on 27 April 606 members of staff had not been available; the 7 May 538 members of staff had not been available; and 15 May when 430 staff had not been available.  The Committee were reminded that the national objective had been for the NHS to support staff to stay well and stay at work, which was why some staff had been re-deployed and had been assisted by the in-house health and wellbeing provision. 

RESOLVED   

That the Committee's gratitude be recorded to all NHS staff, key workers and volunteers in Lincolnshire on their response to Covid-19, and for the Committee's condolences to be extended to the families who have lost loved ones.