Agenda item

The Committee considered a joint report of the Head of Integrated Strategic

Commissioning (County Durham Integrated Community Care Partnership and the Head of Adult Care (Durham County Council) that provided an overview of the actions of the County Durham Care Partnership’s response to the COVID-19

pandemic, in the period up to 10th June 2020 and highlight the plans for recovery and future service delivery.

 

The Head of Adult Care outlined the challenges and opportunities across, adult

social care and commissioning, primary care, acute hospitals, care

homes, mental health and learning disability services during the COVID-

19 pandemic and action taken.  He acknowledged that the pandemic had had a huge impact in County Durham that had engaged the Strategic Partnership to merge and work together to respond.  Working practices changed rapidly with some services being suspended and some being ran in different ways with less face to face interaction and more meetings carried out virtually using technology and software like Microsoft Teams.  He advised that suspended services had now restarted but clinical priorities had changed and modifications had been put in place within the restoration and transformation stage. Significant focus had been placed on the private sector and care homes throughout the pandemic to ensure they were supported and supplied with training, advice, PPE equipment and financial support where needed.  Although the first peak of the pandemic had been overcome there were concerns of a second and third peak but services were mindful and had put things in place to operate in an integrated way should this happen.

 

The Chief Executive (CDDFT) updated the committee that a daily call system had been established that involved senior leaders meeting virtually on a regular basis to share intelligence and problem-solving challenges as they arose.  With effective mechanisms and working closer together senior management were available seven days per week, twelve hours per day throughout the pandemic.  She advised that the workforce had changed rapidly within 4-5 days rather than 2-3 months in normal ways of working.  Policies were clarified around hospital discharges meaning that if patients were medically deemed fit they would be discharged from the ward within hours.  Principles had not changed but the system did things faster to keep up with the constant changes. She noted that services had developed unusual ways of working to manage staff working from home to ensure service continuity with flexibility being crucial.

 

 

 

 

 

The Head of Integrated Strategic Commissioning stated that there had been a new integrated commissioning team established in March 2020 but the normal development of the team had been paused due to Covid 19.  She noted that this joined up working had been beneficial for the health and social care sector with calls being made to providers to ensure they were supported and provided with PPE when they had struggled to get supplies. There had been a collaboration between the partnerships to share information and work together to discuss issues and find resolutions in relation to the outbreak.

 

The Head of Integrated Strategic Commissioning informed the committee that GP surgeries had changed to a total triage model to limit the number of patients going into surgeries with video and telephone consultations taking place instead that increased the amount of appointment slots offered.  Patients who were shielding or self-isolating were identified so they could register for additional help and support.  She added that agreements were put in place to allow data sharing across primary care networks to allow a more flexible way of working. 

 

The Head of Integrated Strategic Commissioning notified the committee that various changes had also occurred in acute hospitals with increased critical care capacity, wards separated into Covid-19 and non Covid-19 wards, additional hospital beds created and changes made to discharging policies.  The main challenge now was restarting services to ensure patient and staff safety was at the forefront with outpatients reopening in July and others shortly following suit.  She added that hospitals would not be able to work to the same capacity as before. Work would start to emerge around the new services for the Shotley Bridge Hospital with engagement work to be carried out in the Autumn. She agreed to keep members updated.

 

The Head of Integrated Strategic Commissioning stated that there had been challenging times for the ambulance service with a huge number of calls to the 111 service.  Additional vehicles were used including third party providers with response times increased due to social distancing rules and the time it took to disinfect vehicles before they could be used again.  Care homes were monitored throughout the pandemic with support being provided in numerous areas around finances, PPE equipment and redeployment of staff if there were staff shortages.  She advised that Mental Health and Learning Disability Services continued to take referrals throughout the pandemic and had also adapted to new ways of working with a crisis number put in place for both adults and children to use should they need it.

 

The Chair felt that the work carried out had been exceptional and it had displayed greater partnership working to put the good of the community at the forefront.

 

 

 

 

Councillor Temple welcomed reassurance that there was still a commitment to the Shotley Bridge project.  He was concerned that past milestones had not been met as it had been stated that a business case would be produced by June 2020 and put out to consultation in September 2020.  He was aware that the Covid 19 pandemic had created a huge impact on organisations but he believed that local residents would appreciate a time scale of when the consultation would commence.   He appreciated that local members had been kept well informed but it had been under a veil of confidentially that could not be shared with the public.  He felt that the wider people needed to know.   

 

The Head of Integrated Strategic confirmed that communications would be sent out to local residents with an update on the Shotley Bridge Hospital project after the meeting.

 

The Commissioning and Development Manager (NHS County Durham CCG) acknowledged that there had been a few challenges with the timeline for the Shotley Bridge Hospital project due to purdah and Covid 19 that had left the model and the implications to be reviewed.  She noted that some engagement work had taken place in the Autumn of last year with things changing to reflect what people had put forward that had been built into the solution.  She felt that the timeline had been set back by approximately six months but work had been carried out behind the scenes.  She informed the committee that communication would be sent out after the meeting and the reference group that had been set up to look at the project was aware of commitment.

 

Councillor Temple thought that the work of the NHS partners and Durham County Council staff was fantastic.  He understood that it was a challenge and questioned what might have been done better with regards to action over the pandemic.  He referred to paragraph 51 in the report that highlighted figures of patients discharged from hospital and asked how many had not been tested before being discharged.  He had recently been sent information that quantified that 16 had not been tested before discharge. He had reservations regarding the information that he had received and what was contained in the report.  He questioned what the real proportion of people had been discharged into care homes without knowing if they had Covid 19 infection. 

 

The Corporate Director of Adult and Health Services recognised that the number of deaths in care homes was a sensitive area and it was complex around data sources and the time of data received.  She was aware of the data that Councillor Temple had received and confirmed that the data was specific to County Durham Foundation Trust discharges.  She explained that data contained in the report referred to all hospital discharges not just data regarding Darlington.  She clarified that the data was from two different sources and that was why there was a difference in the figures.

 

The Chief Executive (CDDFT) made it clear that the figures were from the Trusts data and of the 16 patients who were not tested came in line with the new national guidance that came into effect after 18 April 2020.  She had examined the information and it was unclear if two of the patients had been tested or not as the results were not added to the system.

 

The Corporate Director of Adult and Health Services acknowledged that it had been a challenging time and things may have been done differently in terms of data collection. She highlighted the positive message on how well partners had responded and the action they had taken.  She informed the committee that the situation was constantly being reviewed and work was ongoing with flexible arrangements to be able to adapt to all guidance that was issued from the government. 

 

The Head of Integrated Strategic Commissioning recognised that the main challenge throughout the pandemic was technology and being able to ensure that everyone had access to it especially in the NHS with secure emails. She remarked that the specialist nurses within the infection prevention control team had proved invaluable with the support that they had offered. Support had been given to everyone via virtual training to guarantee that contact was made on a regular basis with the Acute Trust and mental health trust providing additional support to schools.  She commented that Durham had fared well with technology unlike other authorities who had experienced issues.

 

Councillor Temple was relieved that clarity was given over figures and data collected and that it came from a wide range of hospitals.  He admitted that he could have done things better in the past as he had never asked the direct leadership of care homes their views on items even though they were a huge part of the committee’s work.

 

The Corporate Director of Adult and Health Services notified the Committee that Durham also worked with Sunderland and South Tyneside NHS FT and North Tees and Hartlepool NHS FT when dealing with hospital discharges into County Durham and suggested that information in this respect be sought from wider NHS FTs.

 

Councillor Tucker referred members to paragraph 59 in the report regarding the national and regional social care recruitment campaign through the County Durham Care Academy.  She was amazed that there had been so many applicants which had been encouraging but she pointed out that hospitals, GP’s, Care providers and Domiciliary Care had always struggled with issues with staffing.  She wanted to know what career or training progression there was in place to ensure that was enough staff in the future.  She was concerned that the age range got higher with senior positions and speculated what could be done to encourage the young generation to remain working in the care sector long term.

 

 

 

The Head of Integrated Strategic Commissioning assured the committee that the health service had the work force in the care programme pre the Covid 19 pandemic.   She advised the committee that data had been collected to understand the impact and pressure Covid 19 had placed in the work within the care sector due to staff self-isolating or shielding and to establish what needed to put in place to resolve them.  There were a range of models of care and delivery through integrated partnership working and work was in progress around care homes to ensure they were sustainable for the medium to long term for care delivery.

 

Councillor Tucker referred members to paragraph 64 of the report regarding appointments in GP surgeries. She had found it helpful knowing that people had ascertained appointments in different ways through the system that may have been difficult prior to the Covid 19 pandemic.  She was relieved that shielding and self-isolating patients had been considered to ensure all patients could seek help and guidance should they need it.  She queried if the new system had been effective.

 

The Commissioning and Development Manager (NHS County Durham CCG) responded that a survey was being undertaken across Sunderland, South Tyneside and County Durham ICP to evaluate the new ways of working to see what impact these had on all staff.  She agreed she would share the findings with the committee once finalised to build on the effectiveness and efficiency of the new models of working.

 

The Head of Integrated Strategic Commissioning reiterated that there had been new models of working introduced to cope with the Covid 19 pandemic to ensure all options of care were covered.  She explained that there was a trade-off for GPs and nurses by looking at trends in different areas and redeploying staff accordingly.  She added that GPs and nurses in quieter surgeries had been redeployed to work in hospitals like in Chester le Street which had worked well and had clinical value or within the 111 service where calls had increased.  The pressure in different areas allowed staff to be moved around the system to have service continuity that also showed how all services could work together differently in the most effective ways possible to make a difference.

 

Councillor Bell was curious about the NHS estates and the capacity of space to create more beds at Bishop Auckland, Richardson and Sedgefield Hospitals.  He thought that hospital estates charged money and wanted to know if there was capacity to expand or whether estates were grossly under used to configure services adequately.

 

 

 

 

 

 

 

In response to Councillor Bell the Head of Integrated Strategic Commissioning replied that estates had to be paid for whether they were used or not.  She advised that government guidance and legislation meant that ways had to be addressed to deliver the same services but in fewer ways as not to leave a large footprint when delivering services from bigger estates.  She noted that Covid 19 had been around for some time and services had to be configured for the medium term for changes to be beneficial to see what could be kept for the longer term.  She acknowledged that estate charges were an issue along with staffing but this was being monitored to ensure knowledge was acquired to know how to deliver services in the future.

 

The Chief Executive (CDDFT) reiterated that having several community hospitals had been advantageous and the additional estates enabled the creation of 400 extra beds which had been helpful as they were paid for regardless. She added that within the community hospitals like Shotley Bridge, Chester le Street and the Richardson different models of working had been implemented to accommodate the staffing of different buildings within the estate with Orthopaedic Surgeons running A&E services and retired consultants returning to run the Bishop Auckland out patients service. She noted that at the peak of the outbreak there had been less patients than anticipated that did not require the additional 400 beds.  She was unsure if there would a second wave of the pandemic or as Winter approached if the seasonal flu virus would have an impact on casualties but either way services needed to be scaled up to ensure there were physical bed spaces available if required.

 

Councillor Batey thanked everyone for their hard work.  She welcomed the outbreak local plan and wondered if lessons had been learned from experiences so far.  She was concerned that business premises were to reopen and questioned if the Infection Prevention Control Team would provide advice and guidance to businesses like community centres for them to stay safe when reopening to the public.

 

The Director of Public Health responded to Councillor Batey that the Infection Prevention Control Team did not offer direct support to the community.  She added that there were teams within the Council that offered support and guidance and risk assessments to businesses that community centres could tap into. She felt that the IPCT had come into their own within the health care facilities and special education care.  She highlighted that the role of the local councillor could be built upon to ensure advice and guidance was circulated to the public and places like community centres to help them reopen safely with due care and attention. 

 

The Chair considered the impact that the Covid 19 pandemic had had on funerals.  He felt that the impact on families should also be reflected upon.

 

 

 

Councillor Tucker thought that it was would be helpful if all members were given information on who to contact regards premises reopening to the public safely as this would also help after school clubs reopen when schools returned in September.

 

Councillor Wilkes referred members to paragraph 51 in the report as he was concerned with the discharge figures relating to people discharged from hospital into care facilities.  He was aware how sensitive the topic was but wanted to know whether all patients discharged freed beds and why there was a need to discharge patients back into care homes if testing had not taken place.  He was troubled that County Durham had one of the highest death rates in care homes due to the Covid 19 virus.  He queried if there had been any analysis of data for care homes and the correlation between discharged patients and those care homes who had seen a high number of corona virus related deaths.

 

The Chief Executive (CDDFT) stated that data was collected based on patients admitted to hospital and discharged to the address that was given on admission to hospital. She confirmed that data was composed of every discharge since March 2020 into social care homes within Durham and Darlington. She noted that if a patient presented at A&E but was not admitted to stay overnight in a hospital bed then this information was not recorded.

 

The Head of Integrated Strategic clarified that all factors were required to be examined in relation to deaths in care homes as outbreaks were not down to discharging patients from hospitals alone.  She stressed that some care homes had admitted no patients to hospital but still had an outbreak of the virus.  She advised that there was no evidence to suggest that discharged patients brought the virus into care homes as asymptomatic staff could be the cause.  She stated that it would be impossible to prove the correlation between patients discharged and the number of deaths in care homes.

 

The Head of Adult Care stated that in his experience although he was not an expert into the spread of infectious diseases knew that there were several multi-faceted reasons as to why care homes had experienced such high deaths but they would never know why the infection found its way into the facilities. 

 

The Corporate Director of Adult and Health Services stressed that a lot of work had gone into the safety aspects of care homes within County Durham ensuring that staff followed all guidance that had come from government to remain safe.  She found that it had been a challenging time for all concerned and thanked everyone involved for all their dedication to ensure safety was paramount.

 

 

 

 

Cllr Wilkes referred to paragraph 50 in the report that mentioned significant financial assistance to care providers since the start of the pandemic.  He was concerned that some care homes had been asked to sign new funding agreements and queried whether Officers had shown these documents to Cabinet Members before being sent out to providers. He added that the first agreement had been sent out on 15 April 2020. 

 

The Chair referred members to the letter attached to the report at appendix 5.

 

The Corporate Director of Adult and Health Services notified the committee that care providers were not required to sign any documents in relation to additional Covid19 funding. In addition, Councillor Hovvels, Cabinet Members and Opposition Leaders had all been updated throughout the whole process.

 

Councillor Wilkes asked again whether the funding documents or the wording of the documents that had been sent out to care home providers had been shown to Cabinet Members initially before they were sent out. 

 

The Corporate Director of Adult and Health Services stressed that the council had followed all government guidance in relation to Covid 19 and had kept all members updated.  

 

Resolved

    (i)  That the report be noted;

    (ii)  That the work of the County Durham Care Partnership in response    to the COVID-19 emergency be acknowledged;

    (iii)  That the strength of relationship and partnership working in County            Durham which has been invaluable during this period be                       acknowledged;     

    (iv) That the outstanding efforts and response of all staff, volunteers                 and residents to the COVID-19 emergency be recognised.

 

The Chair of the Adults Wellbeing and Health Overview and Scrutiny Committee proposed a number of additional recommendations. It was further:-

 

Resolved

(i) That the immense contribution local communities had made to the     response and the cooperation of County Durham residents          throughout this unprecedented situation be acknowledged.

    (ii) That the contribution the council’s employees and strategic partners             had made to the response be acknowledged.

    (iii) That the Local Outbreak Management plan be subject to regular                 reporting to and monitoring by the AWHOSC be agreed.