Covid Incident Response Status
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Agenda item: 8 Paper no: 5 Title of Report: Covid Incident Response Status: TO NOTE Committee: Governing Body Date: 28/04/2021 Venue: Virtual meeting Presented by: Elaine Newton, Director of Planning and EPRR/AEO Executive Lead sign Karen McDowell, ICS COO/ Deputy CCG AO Date: 19/04/2021 off: Stephen Haynes, Covid Transition Consultant Elaine Newton, Director of Planning and EPRR/AEO Author(s): Plus inputs from Subject Matter Experts, e.g. Covid testing and vaccination programme Governance Conflict of Interest: None identified The Author considers: Previous Reporting: A previous report on Covid Incident Response was presented to (relevant committees/ Governing Body in January 2021 forums this paper has previously been presented to) Freedom of Open – no exemption applies. Part I paper suitable for Information: The publication. Author considers: Executive Summary This report presents a high-level summary of the Covid Level 3 incident response, both across Surrey Heartlands Integrated Care System partners and with the Surrey Local Resilience Forum to reflect the multiagency effort. It headlines the issues that have presented throughout the second wave, and the transition in March 2021 from a level 4 to a level 3 NHS incident. The paper also highlights how the response continues to be managed and any risks mitigated. This paper also covers the headline updates for the Covid-19 testing and vaccination programme across Surrey Heartlands. Governing Body 28/04/2021/ Covid Incident Response Page 1 of 11 Implications What is the health • Objective 1: Continue to work towards achieving sustainable impact/ outcome and systems. is this in line with the • Objective 2: Develop collaborative working and organisational CCGs’ strategic change, at both place and scale. objectives? What is the financial/ Costs attributable to Covid incident response have been logged resource required? and submitted for Covid reimbursement budget What legislation, • Civil Contingencies Act 2004; policy or other • NHS Act 2006 (Sec 252A) as amended in Health & Social guidance is relevant? Care Act 2012 sec 46; • The Health Protection (Coronavirus, Restrictions) (England) (No. 4) Regulations 2020 – grants the Government emergency powers; • NHS England EPRR Framework Is an Equality Not for this paper specifically but for programmes e.g. Covid Analysis required? Vaccination programme Any Patient and N/A Public Engagement/ consultation required? Potential risk(s)? A partnership risk log is being maintained for Incident (including Management Group (SHCCG) and Covid Management Group reputational) (LRF). Top line risks relate to ICU capacity (forward look), Mental Health provision (esp. CAMHS), staff welfare and wellbeing. There are notable risks to Public Health if this programme is not delivered effectively. Recommendation(s) (1) TO NOTE the report and work underway. Next Steps (1) Revised incident battle rhythm for Incident Management Group (IMG), Local Resilience Forum (LRF) and Strategic Coordinating Group (SCG) (2) Incident Coordination Centre (ICC) review of hours and operating model (3) Local and regional debrief process and lessons learned. (4) Preparations for potential future waves and Covid variants Governing Body 28/04/2021/ Covid Incident Response Page 2 of 11 Covid Incident Response 1. Regional and Surrey Heartlands ICS perspective 1.1. The impact of the pandemic on hospital bed capacity and NHS services across the South East region and across Surrey Heartlands Integrated Care System (ICS) has continued on a downward trajectory over the last quarter of 2021. 1.2. Surrey Heartlands, in common with the NHS nationally, has moved into recovery and restoration phase of operations to manage the delivery of elective care and deal with the usual increases in demand over the winter period. 1.3. Attendance rates at A&E departments and subsequent admissions are now broadly in line with seasonally expected levels. A short spike in demand has been noted at some of our A&E departments from patients presenting with post vaccination concerns, this now appears to have eased. The numbers of patients in Surrey Heartlands hospitals with a Covid diagnosis has reduced to below 1% of our total bed base, with those in ITU accounting for low single figures. 2. Surrey Heartlands – our local challenges and forward look Local Challenges: 2.1. To relieve staffing pressures and protect clinical safety for patients at the height of the pandemic impact, over 50 ITU patients were transferred out of area for intensive care. It is pleasing to report that all but 6 of those individuals have been repatriated into Surrey or have been discharged from hospital care. The remainder are awaiting clinical clearance for transfer due to their acuity. 2.2. Surge capacity for ITU in our 3 hospitals has been returned to normal configuration and total occupancy in the units is currently around 75% to 80% of capacity. 2.3. With an eye to the future potential for subsequent wave activity, our Urgent and Emergency Care team in conjunction with regional ICS colleagues are undertaking a statistical modelling process. The modelling provides three different scenarios based in epidemiological factors, adherence to social distancing and vaccination uptake/ programme effectiveness. Furthermore, each system (by provider) has been asked to set out their capacity plans for any future surge, in terms of Covid and non Covid bed configuration, mindful of the potential impact on recovery and the imperative to maintain throughput of electives alongside. 2.4. An additional workstream being undertaken led by the regional NHSE&I Adult Critical Care clinical lead is working to identify an increase in ICU bed numbers from the current 3 ICU beds per 100,000 population to 7 ICU beds per 100,000 (Surrey Heartlands continues to fall short of the 10 ICU beds per 100,000 required). This workstream project has not yet identified to Surrey Heartlands any proposals regarding this plan or the potential timeline, potentially this may affect the numbers Governing Body 28/04/2021/ Covid Incident Response Page 3 of 11 of ICU beds in the SE plan and the mutual aid planning process within Surrey Heartlands for future wave(s). 2.5. The ICS is working to ensure the provision of timely and equitable access to Post Covid Syndrome (‘Long Covid’) assessment services. Learning to date has enabled us to have in place the necessary pathways for those individuals who have been found to have specific psychological or medical needs and increase capacity where the need is identified. In parallel, we continue to grow the SH communities’ programmes to support the social and emotional needs of post COVID 19 individuals to empower self-care. Post -COVID Outpatient Clinics are available, and Oximetry@Home is currently being delivered through 3 Virtual Wards at ASPH, RSFT and SASH, and through the Oximetry Monitoring at home by Primary Care (one service in each ICP geography). There are currently 201 patients (as at 25-Mar) within the service across Surrey Heartlands. Patients monitored over the past few weeks have been gradually reducing across all the ICPs. 2.6. Sickness levels and the wellbeing of our NHS staff remains challenged at this time given the prolonged and inherently stressful nature of the pandemic response. Covid related sickness has however, reduced across all our providers, including the ambulance service, community and social care partners, primary care and mental health services. As of the 15th of April, of 499 staff absences across the ICS, some 136 were noted as Covid related, equating to 27% of the total. For illustration the table below shows the position in the Surrey Acute hospitals. 2.7. To support our own staff in terms of their mental health and overall wellbeing several initiatives are underway. The Workforce Resilience Hub, delivered by Surrey and Borders Partnership supports teams and individuals via number of pathways to access help in dealing with stress, pressure, remote working and loss among other issues. More than 500 staff have reached out to these services since January 2021. Governing Body 28/04/2021/ Covid Incident Response Page 4 of 11 2.8. The mental health system is continuing to experience significant pressures which have undoubtedly been exacerbated by the Covid 19 pandemic and the protracted periods of national lockdown. Factors such as employment and financial insecurities, isolation, disruption in routine, school closures and home working are likely to impact negatively on the emotional wellbeing of many Surrey residents. 2.9. We are continuing to experience adult mental health care demand and acuity challenges across the Surrey system many of which can be adjudged to relate to the constraints imposed by pandemic lockdown. The table below highlights the key pressure points. There is significant collaborative work underway to manage sustained pressures in the mental health system at this current time. OPEL1 escalation calls are in place to review daily pressures and these have helped individual case discussions. Since the end of March 2021 additional support has been taken to focus on daily bed flow. From a Child and Adolescent (CAMHS) perspective the challenges are increasing exponentially with specific concern around eating disorders cases. Referrals into services are up by 28% (up 20 to 91) compared to same period last year (Jan-Mar), with urgent referrals up by 283% (up by 17 to 23) compared to same period last year (Jan-Mar). Substantive staff to support these patients remain below plan level by 25% (5wte’s) Currently these vacancies are backfilled with agency and seconded staff. The national picture is similar to the Surrey situation at this time. In response to this the ICS is part of 3 times weekly CAMHS tier 4 incident cell meetings led by NHSE&I regional clinical colleagues. Continuing to manage response, recovery, and risk. 1 OPEL – operational pressures escalation levels framework Governing Body 28/04/2021/ Covid Incident Response Page 5 of 11 Forward Look: 2.10.