Agenda item

(To receive a report from Lincolnshire Community Health Services NHS Trust,   which enables the Committee to receive an update on Covid-19 and the Louth and Skegness Urgent Treatment Centre engagement exercise.  Tracy Pilcher, Deputy Chief Executive and Director of Nursing, Allied Health Professionals and Operations will be in attendance for this item)

The Committee gave consideration to a report which provided an update from the Lincolnshire Community Health Services NHS Trust (LCHS), concerning Covid-19 and the Louth and Skegness Urgent Treatment Centre (UTC) Engagement Exercise.

The Chairman invited Tracy Pilcher, Deputy Chief Executive, and Director of Nursing, Allied Health Professionals and Operations, to present the report which was detailed on pages 19 to 61 of the agenda pack.

The following two Appendices were attached to the report, for the Committee to consider:

·       Appendix A – Covid-19 Trust Board report to the Board of Directors of Lincolnshire Community Health Services NHS Trust Board – 12 January 2021; and

·       Appendix B – Louth and Skegness UTC Engagement Findings report to the Board of Directors of Lincolnshire Community Health Services NHS Trust Board – 12 January 2021.

The Committee were advised that LCHS were continuing to respond effectively to the Covid-19 pandemic level 4 national emergency which had come into force from 5 November 2020.  It was highlighted that one of the key elements of the response to Covid-19 was the delivery of an effective vaccination programme.  The Committee was advised that the NHS had commenced the national vaccination roll out of the first vaccines on 8 December 2020.  The United Lincolnshire Hospitals NHS Trust (ULHT) was one of the first 50 hospital hubs to have been approved to commence vaccinations with the Pfizer/BioNTech vaccine.  The Committee was advised that LCHS was working with the Lincolnshire system in developing the mass vaccination sites, which would be working alongside the hospital hubs and the Primary Care Network (PCN) locations to maximise delivery to the Lincolnshire population.

The Committee noted that LCHS had commenced testing of asymptomatic staff with the introduction of lateral flow testing.  It was noted further that so far there had been approximately a 1% positivity rate.  At the present time LCHS had 20 staff self-isolating.

It was reported that integrated urgent care services were a key component of the LCHS response to Covid-19, and that the Clinical Assessment Service (CAS) had been instrumental in supporting patients to be cared for safely at home, and ensuring that patients were only conveyed to hospital if absolutely necessary.  It was noted that CAS capacity had been increased to support the rise in the number of calls through to CAS from East Midlands Ambulance Service crews on scene.  This initiative had commenced at the beginning of November 2020, and had been a direct impact on ambulance conveyance levels. 

It was reported that the Grantham Urgent Treatment Centre was still open as a 24/7 walk in facility.  It was noted that activity had remained stable since the service had been transferred, with referrals to Emergency Departments being predominantly below 5%.

It was highlighted that as part of the restore programme, Gainsborough Minor Injuries Unit had now re-opened as a UTC, offering a comprehensive range of urgent care services to the local population, including booked appointments and home visiting.

The Committee was advised that the organisation had agreed to pilot an approach with an East coast practice in relation to same day urgent primary care.  This would then allow GP practices and PCN's to release capacity to support the Covid-19 vaccination programme, as well as support the delivery or urgent primary care services to the local population.  The pilot had commenced on the 18 January 2021, with 20 booked appointments a day being provided to primary care, alongside the UTC services at Skegness hospital. 

It was reported that as part of the Lincolnshire system bed management plan, the organisation had continued to deliver an effective patient flow response.

Appendix B provided the Committee with the results of the Louth and Skegness UTCs Engagement findings.  The key messages arising from the engagement were detailed on page 45 of the report pack.  The Committee noted that the feedback received highlighted a number of concerns, some of which could be addressed quite quickly.  It was noted that all the information gathered would be used to help shape any emerging proposals for the urgent treatment centres opening hours after March 2021.  Reassurance was given if there was to be a permanent change to service delivery; a formal consultation would be carried out

During discussion, the Committee raised the following points:

·       Some concern was raised as to the distance that some vulnerable individuals were being asked to travel to receive their Covid-19 vaccination.  The Committee was advised that as more local hubs became available; this situation would improve over the coming weeks as it was the ambition for everyone to be within a ten mile radius of a vaccination hub/centre. 

·       The need to reinforce the message of Hands, Face, Space;

·       Clarification was sought regarding the 5% of patients being referred to EDs.  The Committee was advised that this figure was the number of patients referred by LCHS to EDs, and did not include patients who chose to go direct to an ED.  The Committee noted that the longer term focus for Grantham Hospital was to provide a greater range of services;

·       Some concern was raised that although the Grantham UTC provision was 24/7, some patients had been advised to call 111 first.  The Committee was advised that patients were encouraged to ring 111 first so that they could be given advice and sign posted to the correct service;

·       One member enquired whether vaccinations for staff in the NHS and other care settings were mandatory.  The Committee was advised that staff were encouraged to have vaccinations, but it was not possible to make it mandatory;

·       Some concern was expressed regarding the discharge of patients into care homes.  Reassurance was given that patients were not discharged direct into care homes.  The Committee was advised that Community Hospitals and designated care beds played a significant part of Lincolnshire's response to people who were Covid-19 positive and being discharged from hospital.  The Committee was advised that designated beds had been commissioned by the County Council.  Confirmation was given that hospitals were aware of designated beds, as were social workers;

·       The percentage of LCHS staff vaccinated and the percentage of staff not available for work.  The Committee was advised that currently between 60 and 70% of LCHS staff had received their first vaccination.  The Committee was advised that currently 19 staff were off work with either Covid-19 or Covid-19 related issues.  The Committee noted that LCHS staff who were shielding were working from home, for example providing online consultations;

·       The impact on other patients of Louth Hospital having a Covid-19 ward for patients.  The Committee was advised that the hospital was providing support to the patient through the 14-day isolation period; and that this did have an impact on other services being provided;

·       Whether the temporary opening hours at Louth and Skegness UTCs would be continued beyond 31 March 2021.  The Committee was advised that the situation was continually monitored and that the matter would be reviewed in February 2021;

·       Page 46, 5^th bullet point, stated that stakeholders would be involved in developing the future UTC & integrated urgent care offer. One member enquired who the stakeholders would be? It was reported that a range of stakeholders would be approached which would include NHS commissioners, the local population, Healthwatch, and the Health Scrutiny Committee for Lincolnshire;

·       Page 51 of the report, second paragraph stated that the overnight closure was determined not to have had a noticeable impact on increasing patients attending, Boston, North Lincolnshire or Goole.  Concern was expressed that this decision had been determined at a time when tourism to the area was practically non-existent compared to normal years.  Further concern was expressed that the engagement exercise had been conducted during a pandemic, and that the results of this exercise would help shape future provision.  The Committee was advised that any changes to future provision would consider information from a range of years, as 2020 was not representative for example of activity in Skegness.  Reassurance was given that there would be more comprehensive engagement.  The Committee noted that capital investment was going to be made to upgrade the UTC at Skegness; and

·       One member stressed the need to make sure that members of the Health Scrutiny Committee for Lincolnshire were kept fully informed of when new local vaccination centres/hubs became available across Lincolnshire.

The Chairman on behalf of the Committee extended thanks to the Deputy Chief Executive, and Director of Nursing, Allied Health Professionals and Operations for attending the meeting and providing the Committee with an update.

RESOLVED

1.    That the Committee's support and thanks to all staff at Lincolnshire Community Health services NHS Trust for their efforts in delivering NHS services in Lincolnshire be recorded.

2.    That the report from Lincolnshire Health Services NHS Trust on Covid-19; and the Louth and Skegness Urgent Treatment Engagement Findings report be noted.

3.    That a request be made for members of the Health Scrutiny Committee for Lincolnshire to be kept informed when new local vaccination hubs/centres become available across Lincolnshire.

4.    That a further Covid-19 update be received at the April meeting.