Hywel Dda
Community Health Council
CEREDIGION LOCALITY COMMITTEE MEETING
SUBJECT: Minutes of the Virtual Hywel Dda CHC Ceredigion Locality Committee meeting held on 28 January 2021 at 10:00am
AGENDA ITEM: 4a
DATE: 29 April 2021
Ratify Discussion Decision
Present: Cllr Elizabeth Evans (Chair) – Hywel Dda CHC Ceredigion Locality Chair Hugh Hughes (HH) – Hywel Dda CHC Ceredigion Locality Member Jarrod Thomas (JT) – Hywel Dda CHC Ceredigion Locality Member Prof Gabrielle Heathcote (GH) – Hywel Dda CHC Ceredigion Locality Co-opted Member Gwenda Williams (GW) – Hywel Dda CHC Ceredigion Locality Member Carol Bainbridge (CB) – Hywel Dda CHC Ceredigion Locality Member Diane Richards (DR) – Hywel Dda CHC Ceredigion Locality Member Marj Fogg (MF) – Hywel Dda CHC Ceredigion Locality Member
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In attendance: Peter Skitt (PS) – Hywel Dda University Health Board County Director Ceredigion Jina Hawkes (JH) – Hywel Dda University Health Board Primary Care Lead Sam Dentten (SD) – Hywel Dda CHC Deputy Chief Officer Gwen Clements – Hywel Dda CHC Public and Patient Engagement/Monitoring & Scrutiny Management Officer James Davies (JD) – Member of the Public
Apologies: Donna Coleman – Hywel Dda CHC Chief Officer Cllr Alun Williams – Hywel Dda CHC Ceredigion Locality Vice Chair Patricia Bates – Hywel Dda CHC Ceredigion Locality Member Catrin Convery – Welsh Ambulance Services Trust Locality Manager Ceredigion Mansell Bennett– Hywel Dda CHC Chair
Declarations of There were no declarations of interest. interest:
Action CERLC 1 – Welcome & Apologies
Cllr Elizabeth Evans (Chair) Hywel Dda CHC Ceredigion Locality Chair welcomed all present to the meeting and one member of the public. Apologies were noted.
Sam Dentten (SD) Hywel Dda CHC Deputy Chief Officer informed the committee that Cllr Alun Williams Hywel Dda CHC Ceredigion Locality Vice Chair being the public spirited person he is will be joining Borth surgery to help with the roll out of the vaccine. CHC regulations means he will have to step down from his CHC role during his employment with the surgery.
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Diane Richards (DR) Hywel Dda CHC Ceredigion Locality Member asked if she would be able to volunteer with the roll out once her partner has received his vaccination.
SD confirmed there would need to be a discussion with the member to ensure there were no conflicting issues.
Gabrielle Heathcote (GH) Hywel Dda CHC Ceredigion Locality Co-opted Member confirmed she had received her first vaccination and also offered to volunteer with her local surgery.
The Chair agreed to move item 5 on the agenda to accommodate HDHB representatives as they had an urgent meeting shortly after their update.
CERLC 2 – Update on NHS Services within Ceredigion
Peter Skitt Hywel Dda University Health Board County Director Ceredigion delivered an update on the report provided for the meeting:
Bronglais Hospital: There are currently eight Covid-19 positive patients contained on Y Banwy ward. This is a sign of improvement as a few weeks ago it had been up to 20-30 patients. Urgent surgery has started back up on a reduced number of patients. Bronglais is the first hospital in HDHB to start urgent surgery operations.
There is a shortage of staff due to sickness and isolating. Agency partners have stepped up in the interim significantly. Bronglais continues to have red and green areas as mandated by the Welsh Government. Screening services have resumed in Hywel Dda.
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The waiting list have significantly grown in the last year. Predictions are it will take up to 7 years to catch up to where they were. PS said they are working through possible solutions but there is no quick fix.
Field Hospitals: PS confirmed they are continuing to prepare the Plascrug Leisure centre in Aberystwyth for potential use by 15 February 2021, should capacity be needed. The main issue is staffing the field hospitals, however there has been a positive response from the agencies.
Primary & Community Services: PS confirmed he is not directly involved with the delivery of Covid-19 vaccinations but to ensure there is no wastage any last minute cancellations are filled by NHS staff who can attend the clinic at short notice within 20 minutes. PS commended all the community staff who have been delivering and administering the vaccines across our communities despite recent bad weather conditions.
There has been an increase in the community profiling beds across Ceredigion from 240-250 to 306 yesterday. Keeping people at home has increased significantly during the pandemic.
Jina Hawkes (JH) Hywel Dda University Health Board Primary Care Lead delivered a verbal update on community services.
Palliative care has increased significantly and the demand for bereavement services. Many people have not been able to be with loved ones at the ‘end of life’ stage and funerals in some cases. Staff have been first hand being with patients during such difficult times.
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HDUHB has appointed Attain to undertake a baseline review against the National Palliative and End of Care Life Partnership 6 key ambitions, and associated evidence base, in order to produce a report which will highlight areas of good practice, any areas of disparity and inequity and provide recommendations to inform future strategic development for the population. Jill Patterson has been appointed as the Executive Lead for Palliative Care for HDUHB, this will help raise the profile at board level and future investment.
Tregaron Hospital: The beds have increased to 20, yesterday there were 13 occupied and some further discharges were expected. The main challenge remains staffing.
Cardigan Minor Injuries Unit (MIU): The HB have worked closely with the Local Authority and Social Care to commission services to support local homes and care homes. The MIU temporarily closed to allow staff to be redeployed to support the community and Tregaron hospital. JH noted Carmarthen & Pembrokeshire partners had acknowledged the excellent partnership working in Ceredigion to ensure community services continued despite recent challenges and a great example of partnership working.
The Chair expressed her gratitude to the community teams after personally seeing patients and staff at a local residential home in Aberaeron, who had contracted the virus.
Hugh Hughes (HH) Hywel Dda CHC Ceredigion Locality member thanked all the health board staff and their teams for their sterling work. HH concurred with PS on the GP roll out of the vaccine and pulling out all the stops. However as a CHC member he has been contacted by members of the public regarding, 79-89 age group who have not received their appointments and worried how they will travel to a mass vaccination centre.
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HH understood Ceredigion Council employees had been prioritised for the vaccine ahead of Joint Committee on Vaccination and Immunisations (JCVI) and called on the Government to be open and transparent.
PS had recently been involved in a discussion about identifying critical workers noting Council gritting drivers are crucial to ensure our road are safe but they are not on the JCVI list as priority. PS noted the vaccination delivery system is changing every day.
Carol Bainbridge (CB) Hywel Dda CHC Ceredigion Locality Member reiterated HH comments regarding 75-80 age group and their concerns. The vaccination centre is not on a bus route and this demographic are vulnerable to be using public transport.
CB noted the increased mental health issues currently experienced by people. PS agreed to notify CB once the meetings resumed as currently they are on hold.
The Chair confirmed she was not aware of the location of the Thomas Parry, mass vaccination centre. The committee confirmed it situated on the Coleg Ceredigion campus in Aberystwyth. It was noted that many people are afraid to leave their homes and often rely on others for transportation. The Chair agree to follow up bus access from the town centre with the Council.
Action Point 1 – The Chair to follow up providing a bus EE service to the Thomas Parry vaccination centre in Aberystwyth.
GH noted Borth surgery had sent out letter to patients two weeks prior to receiving the vaccinations so people could arrange transportation. GH also noted the issues with supplies of the vaccines and the balancing act and variations across the country.
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HH concurred with all the comments made and the comments about the Pfizer and AstraZeneca vaccine being deployed. He acknowledged this is out of our remit but should be fed up the line to address the 75+ age groups and more imaginative ways of delivering the vaccine. Welsh Government targets are way off and the implications are massive.
GH asked if the Pfizer immunisation gives people a reaction and is this a problem. PS confirmed every vaccine has side effects. All the health workers have been given Pfizer vaccine and he recognised there can be a reaction but the potential benefits far out way the negatives. Swapping vaccines around Wales is not easy and Pfizer is generally used for mass vaccination to increase delivery.
Marj Fogg (MF) Hywel Dda CHC Ceredigion Locality Member noted she was unable to book a vaccination slot in Carmarthen recently and then directed to Prince Philip to book, but all slots were taken. As a palliative care respite worker this is obviously of concern. Her local GP in Llandysul have not started any vaccination clinics but neighbouring surgeries have. This is naturally causing anxiety and panic within the community. PS agreed to contact the surgery.
Action Point 2 - PS to contact Llandysul surgery PS regarding vaccination clinics.
Jarrod Thomas (JT) Hywel Dda CHC Ceredigion Locality Member queried if students return to University but have received their first vaccine at home would they be given a different second vaccine. PS confirmed both vaccines will be given by the same centre. JT noted the risk of long distance travel involved for some students.
James Davies (JD) Member of the Public reinforced local concerns following a Council public meeting confirming 200 Council staff were receiving the vaccine, apparently including staff who are working from home and others in their twenties.
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JD said how damaging this had been for people who are waiting and entitled to a vaccine. Vaccinations should be given on a risk basis rather than queue jumping. PS could not comment whether this was fact or fiction but confirmed when patients do not attend an appointment NHS staff are offered the appointment and have to arrive within 20 minutes. HDHB has the lowest rate of wastage in Wales of the vaccine. PS confirmed the regulations are robust stipulating who can and can’t receive the vaccine. The Chair confirmed the guidelines are very broad. If the Council have identified staff for the vaccination it’s unfair for them to have the backlash. PS did note at the start of the vaccination roll out for staff some members of the public accessed the slots online, this was addressed quickly.
PS confirmed there is lower take up of the flu vaccination in Ceredigion compared to other parts in Wales. It’s not surprising some people are reluctant to have the vaccine.
PS & JH left the meeting.
The Chair noted the pertinent comments made and they are a reflection of what our communities concerns are.
Transport will be an issue and clear communication is vital.
SD recently met with the HB primary care contact to discuss the latest vaccine roll out. Group 3, 75-79 age group will attend mass vaccination centres. Public Health Wales sent out letters 22 January 2021 to this group however, the letters were not ideal and some translation is incorrect. The venue, date and time of their appointment is provided and a contact number to cancel.
The two mass vaccination sites in Ceredigion are the Thomas Parry site in Aberystwyth and Cardigan leisure centre. To add to the complexity of this there are new computer systems and overcoming some of the logistics of GP’s supporting the next groups. Surgeries have had to reduce some services to accommodate the vaccination roll out.
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The Chair confirmed GP’s are requesting clearer guidelines to follow.
JT asked if taxi drivers are eligible for vaccinations. The Chair did not think they were high risk group or bus drivers.
Action 3 – The Chair to follow up if taxi / bus drivers EE are part of the priority group.
GH agreed with JT saying this is a very pertinent point as many 75-79 years category use taxi / public transport.
SD confirmed the Pfizer vaccination will used at the mass vaccination sites to accommodate storage. The AstraZeneca is more flexible and used by GP’s / community teams. The Pfizer vaccination once defrosted has a short time span to be used. Once the vaccines are manufactured if a batch does not reach quality standards it cannot be used and this delays the dispatch and clinics have to be reshuffled as a result causing further delays.
GH noted she had not received a date for her second vaccination. CB noted NHS staff had to travel to Cardigan for their vaccinations resulting in 100 mile round trip for some and car sharing was not an option.
HH confirmed on the 9 January 2021 Borth surgery had not received any information when they would receive the vaccine to initiate the roll out. There has been a lack of Government communication and strategic planning, no contingency plans in place raises serious questions affecting local planning and delivery. Possible local resources have not been approached like Aberystwyth University IBERS who have facilities to store the Pfizer vaccine. Public Health Wales could have utilised PCR testing at the IBERS centre.
The Chair confirmed each GP surgery was required to submit an expression of interest to administer the vaccination. Not all of the surgeries did initially. PS has since approached them to take part in the roll out.
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MF asked for clarity as to the location of the field hospital in Aberystwyth. SD confirmed the leisure centre in Aberystwyth and Cardigan leisure centre in the south of the county. There are no plans to open the Cardigan centre currently.
JT asked if the Pembrokeshire Bluestone field hospital was operational. SD confirmed both Bluestone and the Carmarthen field hospitals were operational, this is down to the fact Ceredigion has more community beds. The Chair noted unless there is sufficient staff the centre will not be able to open.
GH asked how well the community and domiciliary care is working in Ceredigion. The Chair confirmed they are under extreme pressure with staffing. SD noted Cardigan minor injuries had recently closed so staff could be deployed to support the 300 community profiling beds. GH queried if the CHC had received any feedback from patients receiving domiciliary care. SD confirmed the national survey has captured many Covid-19 experiences and the majority are from HDCHC patients.
JD confirmed there are directions to the vaccination centre as you drive into Aberystwyth for patients to follow.
The Chair noted Pat Bates (PB) Hywel Dda CHC Ceredigion Locality Member question if there is a contact number for the vaccination centre in Cardigan. As mentioned there is a contact number on the letter published by Public Health Wales.
CERLC 3 – Minutes and Matters Arising
a) Minutes of the previous meeting The minutes of the virtual Ceredigion Locality Committee meeting held on 4 November 2020 were confirmed as a true and accurate record with the exception of Page 9 CC should read CB.
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b) Matters arising from the Minutes and Action Points
There were no matters arising from the minutes.
Please see Table of Actions
Action point 1 – SD confirmed he had dealt with an issue raised by a member of the public.
CERLC 4 – Hywel Dda CHC Chair’s Briefing
In the absence of Mansell Bennett Hywel Dda CHC Chair the Chair gave a brief update on the HDCHC Chair’s report.
Meetings continue to be held fortnightly between MB, HDCHC Chief Officer and Chair and Chief Executive of the HB.
As a CHC we continue to keep an eye on HDHB transformation programme.
CERLC 5 – Locality Chair & Deputy Chief Officer Briefing
The Chair noted her attendance at recent Executive / Service planning meetings and welcomed member’s attendance.
SD confirmed the Chief Officer and HDCHC Chair hold weekly meetings with Welsh Government officials and local concerns are raised.
SD explained a pilot recently developed in Cardiff for patients attending A&E. This pilot is a cultural change and required people to phone first before heading to A&E. The plan is to role this system out in HDHB later this year as 111 is currently in place.
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CERLC 6 – Welsh Ambulance Services Trust Update
Due to significant pressures Catrin Convery (CC) Welsh Ambulance Services Trust (WAST) had sent apologies but briefed SD.
SD confirmed the majority of ambulance crews in Ceredigion consisted of a WAST paramedic and military driver. There continues to be delays with handovers but not too bad at Bronglais hospital.
WAST have recently recruited 8 technicians and 3 paramedics. The majority of staff have received the Covid- 19 vaccine.
Members noted their concerns about a large cohort of patients who are waiting for treatment and the increasing waiting lists will only add to their detreating health needs. The Chair added as a result of increased waiting list people are turning to their GP putting additional pressure on this service. SD agreed that it would be important to scrutinise the services being put in place for this cohort of patients.
CERLC 7 – Engagement Update
The engagement team continue to raise the profile of the CHC by publicising and highlighting our online surveys.
A spreadsheet has been developed noting local groups and community council virtual meetings for the senior officers and Executive to consider.
The engagement team are looking into developing small informal focus groups.
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CERLC 8 – Ceredigion End of Year
Members were asked to think about planning the year ahead activities as we draw to the end of the financial year of 2020/2021. All visits and engagement have been put on hold since the pandemic. As we go into the new financial year the CHC has a statutory responsibility to continue to monitor all service change and this has significantly grown with 120 currently being monitored.
The Executive recently discussed using the coffee morning sessions as an informal chatting / catch up session to share ideas and form our questions to the HB. Ceredigion unlike Carmarthen & Pembrokeshire members welcomed this approach. HH asked if members of the public could join the coffee morning meetings. SD agreed this would be something the engagement team were looking to develop but access to personal emails etc. needs to be considered.
GC loss access to the meeting.
The Chair thanked all for their attendance at the meeting, which included the one member of the public.
Date of next meeting & close
Date: 29 April 2021 Time: 10:00am
The meeting closed at: 12:20pm
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