Agenda item

Report of Director of Integrated Community Services, Durham County Council.

The Board received a report from the Director of Integrated Community Services which provided an update on Winter Planning Arrangements (for copy of see file of minutes).

The Director of Integrated Community Services gave a detailed presentation in terms of the demand pressures being faced, along with the measures being put in place to respond to these.  It was noted this included information as regards: surge and cold weather plans; increased demand in comparison to 2019; higher influenza infections and child RSV infections; social care; primary care; community services; acute care; mental health, the North East Ambulance Service (NEAS); Public Health; the Council’s Technical Services in relation to highways; vaccination; and working together.

The Chair noted that the Government had published guidance with extra funding to support additional capacity however, given the demand on services that the Director of Integrated Community Services outlined, he asked what Partners could do to ensure residents used the most appropriate care, for example promoting the use of local pharmacies instead of presenting to secondary care and Accident and Emergency.

The Director of Integrated Community Services noted that the first step was self-care, one looking after oneself and utilising the local pharmacy or GP where one felt unwell in the first instance.  He added that only then utilising acute services such as Accident and Emergency as appropriate.  He noted there were many services available to help care and keep people safe over the winter period without having to attend Accident and Emergency.  He noted one area for improvement was communicating with the public the options that were available in terms of staying well over winter and support such as urgent care, extended GP hours and mental health support were available.

The Associate Director of Operations, County Durham and Darlington NHS Foundation Trust, Wendy Quinn explained that, in terms of managing demand on Accident and Emergency, it was very important to note that the discussion around people not needing to attend Accident and Emergency had been had by many people and that spot checks had shown that a lot of sick people, that needed to be seen, were attending Accident and Emergency.  She added that while it would be preferable if they were not in Accident and Emergency for as long a period, those people needed to be seen.  She noted, however, that there was a number of people that could receive services elsewhere and that the Acute Trust worked closely with

Primary Care and Community Care colleagues in terms of alternatives being offered, including signposting people to different areas.  She added that was an area that was worked on very hard, to create capacity to see people, albeit not providing additional physical capacity, i.e., bed spaces.  She noted one of the alternative services, currently operating at Darlington, with work ongoing to create capacity at Durham, was same day emergency care.  The Associate Director of Operations noted that it had proven to be very successful, and it was accepted that while continuing to communicate as regards when to go to Accident and Emergency, a number of people would still attend Accident and Emergency that may not need to.  She added that, building on the learning during the pandemic, the service was looking at how to better deal with those slightly less sick people outside of Accident and Emergency to free up capacity.

The Vice-Chair, Dr Stewart Findlay noted that there were more sick people attending Accident and Emergency that ever before and added that the CCG were looking at the reasons why that should be.  He explained that the most likely explanation was that the management of chronic disease which, by and large, stopped during the pandemic.  He noted that those with chronic disease were the last people you would wish to be in a waiting room with the potential to catch COVID-19.  He added that a lot of the monitoring that would have taken place via Primary Care had virtually stopped or was being carried out  online or on the phone, and there was some evidence that was having an impact on people’s health and so more acutely ill people were presenting at Accident and Emergency.  He reiterated that Accident and Emergency should be reserved for those that are critically ill and that the first choice for those feeling unwell should be their local Pharmacist, their GP, the 111 helpline and then to attend Accident and Emergency as a last resort, of course unless one had an obvious emergency.  He explained that GPs had been busier over the last few months than they had been at anytime since records began around five years ago.  He noted that there had been a higher number of contacts and there was the additional pressure of delivering vaccinations, however, the number of face-to-face contacts with GPs was starting to increase, though the number of telephone contacts had increased hugely. 

Dr Stewart Findlay explained that many GP telephone systems were unable to cope with the volume and added that the CCG were looking as to whether they could help GPs in terms of improving their telephone systems and also looking at increasing the number of administrative staff to ensure calls could be answered with either a solution or a promise of an appointment or a call back.  He reiterated that it was a whole system approach to winter, which included vaccinations against COVID-19 and influenza.

The Chair noted that Elected Members would be happy to send out communications to their communities on the appropriate services to access to help alleviate pressures on the system. 

Councillor R Bell noted the comments relating to vaccination against COVID-19 and influenza and recalled hearing that around 20 percent of those admitted to hospital had not had a COVID-19 vaccination.  He added that if that was correct then it must present a significant risk to staff working in hospitals.  He asked if those people would be offered a vaccination while attending hospital or challenged as regards why they were not vaccinated.  The Associate Director of Operations explained that if a person attended Accident and Emergency and was to be admitted, they would receive an ID NOW test which would show if they were COVID-19 positive or not and they would be isolated accordingly.  She noted that if a person had not received a COVID-19 vaccination it would not affect that person being admitted and treated, however, there were challenging conversations with people as regards the risk of catching COVID-19 in hospital.  She reiterated that admission would never be refused, however, information as regards the risks would be given and some people then may wish to take up the opportunity to be vaccinated and some still may not.  Dr Stewart Findlay added that if a person had caught COVID-19 they were unable to receive a vaccination for 28 days, and therefore it was often too late at that stage to vaccinate and sadly of those dying in hospital, many were unvaccinated.  The Strategic Manager Outbreak Control, Joy Evans noted in relation to those testing positive for COVID-19 that were unvaccinated, that they would receive a text after 28 days to inform them they could access the vaccine. 

The Chair asked what support mechanisms were in place for the staff within these health and care roles, as they must be under extreme pressure.  The Director of Integrated Community Services noted staff across all areas of health and social care had been working very hard over the last two years of the pandemic and noted there were four elements.  He noted one was leadership, letting staff know that it was alright to say that they were not alright and needed support, and explained that was best when leaders were visible and available to listen.  He gave examples of the Chief Executive of Durham County Council, John Hewitt, having ‘Ask John’ sessions with staff and the Executive within the Trust having regular Facebook sessions with staff. 

He noted an example of a day specifically for health support workers and the Chief Executive of the Trust, along with other senior staff, having attended Richardson Hospital at Barnard Castle to give thanks and support, and to listen and say it was alright not to be alright.  He added other practical services and steps had been put in place, such as TRiM (Trauma Risk Management) which allowed for self-referral, offered peer support and options for both psychological and physical support.  The Director of Integrated Community Services noted a third element was support via terms and conditions, an example being care home staff that had been supported via funding for additional payments.  He noted other examples with the Local Authority and Trust offering wellbeing days.  He added that the thanks of the public were also important, with cards and support helping to make a positive difference and provide a boost for morale.  He noted that many care staff were not based within buildings and worked out in the community and there was therefore a need to focus on their health and wellbeing, with processes in place.

The Chair noted the thanks of the Board to all those health and social care workers.

Resolved:

That the report and presentation be noted.