Agenda item

Local health and care services are facing unprecedented challenges including increasing demand across all delivery settings. Additionally, the workforce continues to be reduced in capacity and is fatigued, with many professions continuing to work in settings constrained by the requirements for robust infection control.

This Committee will hear from local NHS leaders about this situation and will offer an opportunity to discuss this and also any specific issues that may have been raised previously and are now changed in the context of the pandemic.

The Accountable Officer, NHS Vale of York Clinical Commissioning Group, and the Chief Executive, York Teaching Hospital NHS Foundation Trust gave a verbal update on the current challenges facing health services in York. Alongside them to respond to questions were the Director for Primary Care, NHS Vale of York Clinical Commissioning Group, the Director of Public Health, City of York Council and the Clinical Chair of the Vale of York CCG.

During the presentation of the update, it was noted that:

·        Health services will be managing with Covid-19 for the foreseeable future.

·        There were currently 37 Covid patients in York hospitals, with the rate of admissions growing, and that there were 5 patients in critical care.

·        Resources for the recovery plan were finalised for the first half of the financial year, but funding would be allocated for the second half in late summer/September.

·        The national ask for 2021-22 was to prioritise the most clinically urgent (P1/P2) patients for example surgical and cancer treatments, to reduce waiting times and to get to 95% of 2019-20 elective activity levels.

·        The total waiting list was increasing in size, but at a lower level than the expected modelled trajectory – there had been a significant increase in demand as Covid-19 levels reduced.

·        The numbers of patients waiting 52 weeks and P2 patients waiting over 4 weeks were decreasing, with a peak of 2,500 people waiting 52 weeks down to 1,488 at the end of June. Initial cancer treatment wait times were also reduced.

On elective activity levels, it was reported that:

·        In the first half of 2020/21, almost all elective activity ceased, however the expectation for the second half of that year was to continue to try to deliver elective activity wherever possible while managing pandemic response.

·        96% of planned elective inpatient activity was achieved in the second half, and 108% of planned levels was achieved between September 2020 and March 2021.

·        In July 2021, two theatres were opened to focus specifically on resuming planned elective orthopaedic activity.

·        There were risks in maintaining the current trajectory, in that urgent care demand was higher than pre-Covid levels; that GP referrals could not be maintained at the current level which would increase backlog; that prioritising P2 patients would cause those waiting the longest for treatment to continue to wait; that there were staffing challenges across all services due to a variety of factors including self-isolation and that there was a risk of the current increased levels cancer fast track referrals continuing (the highest ever number of such referrals had been recorded in 2021).

·        There were several actions being taken, such as the Building Better care Programme, the Cancer Delivery Group and the Outpatient Transformation Programme.

On activity in the primary care sector, it was reported that:

·        The primary care community were focused on restoration/recovery plans, but had been interrupted by each wave of the pandemic. Staff were fatigued and susceptible of ill health.

·        There was an unprecedented demand which was outstripping supply.

·        There had been an increase in activity since the pandemic and that total activity was beyond what it was at the beginning of 2020, however methods had changed.

·        Currently, roughly 60% of services were provided face to face, and 40% done by telephone triage.

·        GPs were maintaining social distancing and the usage of PPE, and were asking for the continued use of facemasks and regular handwashing.

·        There were staff shortages due to self-isolation and annual leave – some were catching Covid despite being double vaccinated, but many could continue to work despite isolating due to the investment in telephone triage facilities.

·        The average weight gain in the las 18 months was ½ stone, or 7 lbs. Health optimisation options for those whose weight was preventing them from being offered surgery was discussed.

On issues around mental health, it was reported that:

·        The normal way of working on mental health was considered to be no longer sustainable. Therefore, a Mental Health Summit was called for leaders in all sectors to attend. This resulted in an action plan in three phases – short-term, preparation for the coming winter and a new model of care from next year.

·        As part of these discussions, leaders had met with Members of Parliament and with those communities most affected for talks on the issues faced and were attending the Health and Adult Social Care Policy and Scrutiny Committee for member’s support and ideas to aid in creating bespoke offers for individual areas that members represent.

·        There was more demand around mental health, especially in the areas of anxiety and depression.

In response to questions from members, it was noted that:

·        There were automatic reminders/notifications sent out to those on waiting lists e.g. when their appointments are changed, though it could not be guaranteed that all communications were received by patients. The importance of ‘Waiting Well’, of preventing deterioration of patient health while on the list, was emphasised with an acknowledgement that more work needed doing around it.

·        While it was desired that as many people as possible engage digitally with healthcare services to alleviate telephone waiting times etc., digital services were not the only path open to patients. It was noted that many practices set aside time after peak calling hours to contact digitally excluded patients directly.

·        Significant data collection was needed to be collected in order to understand to natural plateau of demand after the current surge.

·        New systems for trying to understand unmet need included digital practices such as recording the number of telephone calls terminated while patients were waiting in the queue.

·        There had not been a noticeable shift in NHS patients turning to private healthcare due to high levels of demand in NHS services, however it was noted that large amounts of private capacity had been bought up by the NHS during the course of the pandemic.

Break between 18:49 and 18:58.