Agenda item

The Committee received a presentation by S Jacques, Chief Executive County Durham and Darlington NHS Foundation Trust and M Laing, Director of Integrated Community Services County Durham Care Partnership (for copy of presentation, see file of minutes).

The presentation provided Members with information on lessons from winter 2022/23; priority areas 2023/24; funding 2023/24; managing winter pressures together; plans and items in development.

The Chief Executive County Durham and Darlington NHS Foundation Trust indicated that since publication of the papers, Government had announced an additional £800 million funding to assist in winter and discharge planning nationally with £3.5 million for Durham and Darlington. She also reported that additional beds that were not in their plan had been opened at Bishop Auckland Hospital. She stated that this was a good example of learning to be flexible and building on the work done during COVID, where they opened a number of wards at Bishop Auckland Hospital to relieve pressure on the two main hospital sites. It was also reported that the Same Day Emerging Care facility at Durham had opened a few weeks ago.

Following the presentation, Members’ questions were invited.

Councillor Quinn asked for an update on the uptake of the flu and COVID booster vaccines.

The Chief Executive County Durham and Darlington NHS Foundation Trust responded that the uptake was not as good as last year. They did have questions around the data that was pulled from different sources, but there was slightly less uptake certainly with staff more around flu but the uptake was not as good as hoped. They were commissioning some work from their communications team to supplement the national campaign as they knew that vaccination was effective and reported that they currently had 23 patients in hospital with COVID and a few weeks ago had their first patient for a long time with COVID in ITU.

The Director of Integrated Community Services, County Durham Care Partnership referred to vaccinations in care homes and indicated that at the end of October they were the best performing in the region. He continued that 75% of all eligible residents in care homes had been vaccinated and they offered COVID and flu vaccinations to staff in care homes and at the end of the month they expected the uptake in care homes to be 85%.

In response to a question from Councillor Early on risk factors, the Chief Executive County Durham and Darlington NHS Foundation Trust indicated that patients admitted with COVID they planned at levels between 50 and 55% and have been below this consistently for all of this year. If there was an increase in flu cases leading to the system becoming overwhelmed, their plan was set against those risks. There was a number of different risk factors such as a snowy winter but their plan was designed to respond to any surge. One of the key elements in their plan was to respond to a surge quickly wherever that may be. She continued that there was a big list of risks but reassured Members that they used the risks in preparation for the plan.

Councillor Howey referred to staffing and asked if they were still using temporary staff.

The Chief Executive County Durham and Darlington NHS Foundation Trust responded that they predominantly used bank staffing and indicated that the majority of the bank staff already worked for the Trust. They had been successful over the last couple of years with recruitment from local graduates and overseas recruitment and had over 340 oversees staff working for them and this recruitment started just before COVID. They were less reliant on agency workers but used some for theatres but the numbers were low. From a medical perspective they had some local agency staff but not as many as a couple of years ago. The seven-day services had been beneficial for patients but also made jobs more attractive and they had been successful in growing their medical workforce and the seven-day services allowed them to do this further. She continued that over time the usage of agency staff would fall and they did get monitored on their use of agency staff and were below the target line.

Councillor Howey referred to Bishop Auckland Hospital and asked if the Hospital was being used to its full potential.

The Chief Executive County Durham and Darlington NHS Foundation Trust responded that they had opened Bishop Auckland Hospital to the public and was very different to where it was five years ago. They had a learning centre and the ward adjacent to this contained the extra beds referred to previously that they had opened up. They had a hospital that allowed you to flex that was beneficial during COVID and reassured Members that they were using Bishop Auckland Hospital to its full potential. They had expanded the amount of elective work and were doing some endoscopy in theatres currently and had a development that would see additional endoscopy. She stated that Bishop Auckland Hospital was a great facility and sees over 30,000 urgent care patients a year.

Councillor Jopling referred to GP surgeries and how difficult it was to obtain an appointment and how everything starts with a doctor. She continued that at her surgery it was a nine day wait for an appointment. She stated that this delay was causing infections to get serious if having to wait nine days and stated that this could result in an increase in hospital admissions.

The Chief Executive County Durham and Darlington NHS Foundation Trust responded that primary care was an important element of the health care pathway and the Trust had invested in primary care. The ARI Hubs were designed to take people with respiratory illness which peaks over winter and would free up some space in hospitals and GP surgeries. In Durham, the co-location of the same day urgent care of GP services with A&E allows a greater degree in flexibility in patient pathways.

Councillor Hovvels referred to the issues with pharmacies that had risk factors in terms of planning as you could now receive vaccinations at pharmacies but are now at risk due to government funding. She continued that rural areas, in particular relied on pharmacy services and was linked to GP appointments, she indicated that she was concerned about pharmacies closing that would add pressure onto the health service.

The Chief Executive County Durham and Darlington NHS Foundation Trust responded that the Trust were keeping an eye on the situation but they were limited by what was determined nationally with funding. She commented that dentists were carrying out other checks on patients and commented how difficult it was to obtain a dentist appointment. They were working closely with pharmacies and looking to support where they can in whatever way they could.

Councillor Johnson referred to GP accessibility that was a post code lottery and that some areas were waiting nine days or two weeks for an appointment where other parts could get an appointment the same or following day which does not seem fair. He commented that it would be nice to have some NHS dentistry services available.

The Chief Executive County Durham and Darlington NHS Foundation Trust indicated that they were working closely with GPs and would feed back. She indicated that they do step in and have some urgent care services who would provide GP practices slots under certain circumstances.

The Director of Integrated Community Services County Durham Care Partnership indicated that more resources were going into urgent care response to alleviate some pressure from GP practices. Where surgeries had gaps with nursing staff, they would use community nurses when they were not on shift.

Councillor Higgins referred to respiratory hubs which were a good idea and indicated that he was concerned that some GP surgeries would prescribe emergency packs but other wouldn’t. Patients know when they need to take the medication and the packs covered a seven-day period.

The Director of Integrated Community Services County Durham Care Partnership would feed this this back and advise Councillor Higgins accordingly.

Resolved: (i) That the information contained in the presentation be noted.

(ii) That the Committee receive a further winter pressures update in Spring 2024.