Agenda item

The Health & Social Care Sub-Committee will be provided with an update on the response of the health and care services in the borough to the pressures caused by the winter season and the Covid-19 pandemic.

The Sub-Committee considered a report set out in the agenda supplement for the meeting, which provided an update on the response of local healthcare services to the impact from winter pressures and the covid-19 pandemic. An introduction to the item and the questions of the Sub-Committee were answered by the following representatives from health and social partners:-

·         Agnelo Fernandes – GP Borough Lead for Croydon – South West London Clinical Commissioning Group

·         Rachel Flowers – Director of Public Health at Croydon Council

·         Matthew Kershaw – Chief Executive at Croydon Health Service NHS Trust & Place-Based Leader for Health

·         Annette McPartland – Corporate Director of Adult Social Care & Health at Croydon Council

·         Lee McPhail – Chief Operating Officer at Croydon Health Service NHS Trust

·         Hilary Williams – Service Director at South London & Maudsley NHS Foundation Trust

During the introduction provided on this item the following points were noted:-

·         The borough was slowly seeing a plateauing of the latest covid wave, with 120 patients in the Croydon University Hospital (down from 140 at the time the report was written), including 8 in intensive care.

·         The best way for the public to assist the NHS was to continue to adhere to the guidance such as ‘Hands, Face, Space, Fresh Air’ and taking up the vaccine offer.

·         There had been 600,000 covid vaccinations delivered in Croydon including 60,000 at the hospital as well as the wider provision from GPs, pharmacies and mass vaccination centres.

·         The vaccine rate in certain parts of the borough remained lower than others, with work continuing on finding different approaches to encourage take up.

·         Mandatory vaccination for health and social care staff would take effect from 1 April 2022, with work on the implementation of this mandate underway.

·         The Elective Centre set up at Croydon University Hospital had helped to manage the number of people waiting for treatment, but the levels had understandable dropped during the recent omicron wave. However, the service was now on the way to returning to pre-omicron levels and was likely to be fully up to speed by early March.

·         There had been an increase in the number of unwell patients needing care, which placed pressure on the whole of the healthcare system. To help manage capacity, improvements were being made to the assessment and treatment of patients, including same day emergency care to help people avoid stays in hospital.

·         Tribute was paid to the excellent partnership work between health and social care teams to manage and maintain the flow of patients through the health system as well as possible. It was highlighted that the social care discharge team was working across the healthcare system in London to manage the discharge of patients into the borough.

·         Most care home residents had now received both vaccinations and a booster.

·         The borough was seeing covid outbreaks in educational establishments, but the Public Health team was working with the Education Service to maintain face to face teaching as much as possible.

·         Evidence had indicated that although the omicron variant was significantly less harmful than the delta variant, there was a higher risk of hospitalisation for people who were unvaccinated.

Following the introduction to this item, the Sub-Committee was given the opportunity to question the information provided. The first question related to the reasons affecting hospital discharge, to which it was confirmed that the speed of discharge could be impacted by a range of factors. These included the complexity of a case particularly if specialist care was required, covid had impacted upon the availability of care beds and staff availability, particularly during the pandemic, could slow the discharge process

It was highlighted that Inner London boroughs often discharged patients into the borough due to the greater availability of care homes beds in Croydon. However, this had an impact on the health and social care system in the borough. The Social Care team worked with the discharging authority to ensure the discharging authority was paying for the cost of care and managing safeguarding issues.

It was questioned whether there was any evidence to indicate that people were more hesitant to seek treatment as a result of the pandemic. It was confirmed that the pandemic had seen a level of hesitancy in people presenting. During the summer, when covid rates were low, numbers had returned to a more normal level, but the recent omicron wave had reduced this again. It was highlighted that the level of referrals had remained consistent over the past twelve months and the waiting times for both operations and diagnostic services in Croydon were better than other areas in South West London. The number of patient presenting with mental health related issues had increased during the pandemic, which was placing pressure upon mental health services.

It was questioned whether there was significant numbers of patients visiting the Accident & Emergency (A&E) department who could have been treated elsewhere in the healthcare system and how was this being managed. In response it was advised that there was always a level of activity in A&E when there may be more appropriate pathways, but it was important to ensure that people were not discouraged from seeking treatment. The A&E department did stream at the front door to try to ensure that patients visited the right place for their needs. Reassurance was given that the number of people visiting A&E unnecessarily was not a major challenge for the system, unlike managing the flow through the system.

As the number of people accessing health care through the 111 service had dramatically increased over the past year, it was questioned if this service was performing as expected. It was advised that the channel shift to accessing healthcare through the 111 service was helping to ensure that people were directed to the right place for their needs. As a result of learning during the pandemic, further refinements were being made to this system, which would benefit any future covid waves and the system as a whole.

In response to a question about the risk of people in professions that may require home visits, such as salespeople, spreading covid-19, it was highlighted that covid was a communicable disease and as such if people had concerns they could answer the door wearing a face covering and require people to stay outside, as there was a lower likelihood of transmission in the open air.

Concern was raised about the number of staff who may be lost from the health and social care system as a result of the vaccine mandate and whether there had been an assessment of the impact upon the ongoing delivery of services. It was advised that it was still too early this stage to definitively state the potential impact upon services as staff were still making their decisions on whether to take up the vaccination or not. Work continued with staff to understand their reasons for vaccine hesitancy and to provide support to enable them make an informed decision. Not all staff would fall within the scope of the mandate and a panel had been set up to determine which roles were in scope, if this was disputed. At present the mandate would affect approximately 350 out of 4,000 staff for the Croydon Health Service NHS Trust and there was approximately 40 out of 807 staff in secondary care who may also be affected.

Care home staff, domiciliary care staff and front-line social workers were also covered under the vaccine mandate. At present 96% of care home staff and 77% of domiciliary care staff had been vaccinated.  There was a small percentage of social care staff unvaccinated and work continued to encourage vaccine take-up.

Following the discussion of this item the Chair thanked those in attendance for their engagement with the questions of the Sub-Committee and also thanked all staff working in health and social care for their hard work throughout the pandemic.

Conclusions

At the end of this item the Health & Social Care Sub-Committee agreed the following conclusions:-

1.    There was significant reassurance provided that the health and social care system had worked effectively together throughout the pandemic, which was reflected in Croydon being seen as a model of partnership working.

2.    The thanks of the Sub-Committee was given to all the health and social care workers in the borough who had ensured that the system had risen to the significant challenges presented by the pandemic.

3.    It was agreed that given the challenges presented to the health and care system by hospital discharge, performance in this area should be kept under review by the Sub-Committee over the next twelve months.