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Hywel Dda Community Health Council Hywel Dda Community Health Council CEREDIGION LOCALITY COMMITTEE MEETING SUBJECT: Minutes of the Virtual Hywel Dda CHC Ceredigion Locality Committee meeting held on 4 November 2020 at 10:00am AGENDA ITEM: 4a DATE: 28 January 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 Patricia Bates (PB) – Hywel Dda CHC Ceredigion Locality Member Carol Bainbridge (CB) – Hywel Dda CHC Ceredigion Locality Member Diane Richards (DR) – Hywel Dda CHC Ceredigion Locality Member Page | 1 In attendance: Peter Skitt (PS) – Hywel Dda University Health Board County Director Ceredigion Catrin Convery (CC) Welsh Ambulance Services Trust Locality Manager Ceredigion Mansell Bennett (MB) – Hywel Dda CHC Chair Sam Dentten (SD) – Hywel Dda CHC Deputy Chief Officer Leanda Wynn (LW) – Hywel Dda CHC Public & Patient Engagement Officer Gwen Clements – Hywel Dda CHC Public and Patient Engagement/Monitoring & Scrutiny Management Officer Christine Hirst - Hywel Dda CHC Administration Officer Ian Bell (IB) – Member of the Public George Holloway (GH) – Member of the Public Apologies: Donna Coleman – Hywel Dda CHC Chief Officer Ben Lake – Member of Parliament for Ceredigion Cllr Alun Williams – Hywel Dda CHC Ceredigion Locality Vice 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 introductions were made. This included two members of the public. Apologies were noted. Page | 2 CERLC 2 – Locality Chair & Deputy Chief Officer Briefing EE advised members that the HDCHC continues to be the eyes and ears of the community. Despite the offices being closed, officers are working from home. Sam Dentten (SD) – Hywel Dda CHC Deputy Chief Officer informed members that although Hywel Dda University Health Board (HB) are endeavouring to reinstate services, there is the prospect of a second wave of the pandemic. SD further advised that a key7 aspect of current CHC work is ensuring that public feedback is brought back to the HB and Welsh Government (WG). CERLC 3 – Hywel Dda CHC Chair’s Briefing Mansell Bennett (MB) – Hywel Dda CHC Chair gave an update on the HDCHC Chair’s report. Meetings continue to be held fortnightly between MB, Donna Coleman HDCHC Chief Officer and the Chair and Chief Executive of the HB. Covid-19 statistics to 31 October 2020 - 70 patients across Hywel Dda tested positive. Rates of infection: Carmarthenshire 163.2 per 100,000 16% positive Ceredigion 31.5 per 100,000 6.3% positive Pembrokeshire 52.5 per 100,000 6.5% positive Infections in hospitals - 3 in Ward 9 BGH, which are now under control. The Quarter 3/4 plan has been put forward to the HB and this will be scrutinised at the Executive and Services Planning meetings. Page | 3 The HB are looking for a sustainable Test, Trace and Protect system. The HB are continuing their strategy for elective operations and have established 20 sessions per week at Werndale Hospital. Eluned Morgan Minister of the Senedd has taken responsibility for the new Citizens’ Voice Body (CVB). This is progressing slowly due to Covid and the WG appointee being on sick leave. Further details will be available following the next meeting. Anticipated start date is now April 2022. Ian Bell, Member of the Public queried whether the CHC was content with the outsourcing of NHS care to private companies, such as Sodexo. SD advised that where there are planned changes to services there is a specific procedure laid out by WG guidelines, that the CHC seek to ensure the HB abide with. However, during times of pandemic, changes that are brought about swiftly fall under the banner of urgent change. This is necessary for HB’s to have the flexibility to change services that are operationally vital. The CHC is keeping a log of all service changes so that concerns from the public can be fed back to the HB and to WG on a weekly basis. CERLC 4 – Minutes and Matters Arising 4a) Minutes of the previous meeting The minutes of the virtual Ceredigion Locality Committee meeting held on 12 August 2020 were confirmed as a true and accurate record. Page | 4 4b) Matters arising from the Minutes and Action Points There were no matters arising from the minutes. Please see Table of Actions Action Point 1 A&E delays in triage for paediatric patient. Peter Skitt (PS) – Hywel Dda University Health Board County Director Ceredigion advised members that there had been delays across all specialities in the preparation of areas between each patient, due to Covid-19. Action 2 Misleading medical advice via e- consult on condition. This has been raised with the team and lessons have been learnt. Early e- consults did not always achieve the desired outcome. This is now improving. Action 3 Poor antenatal care experiences. Discussions have been held with the Head of Antenatal Services with regard to several areas of concern, including follow ups with breastfeeding. Systems are now in place to deal with this. Covid-19 testing feedback for maternity patients has also been discussed. The Chair advised that concerns still remain for older people who are not on the internet or have difficulties expressing themselves on the telephone to a health professional. People are presenting more to A&E as they cannot obtain a GP appointment. Page | 5 CERLC 5 – Update on NHS Services within Ceredigion PS delivered an update on the report provided for the meeting. There are now 11 positive Covid-19 patients in BGH. All contacts have been isolated. Although admission rates for Covid-19 patients are currently low in the Ceredigion area, the HB is building up its response, due to increasing numbers in surrounding areas. Powys, Gwynedd and Carmarthenshire are all increasing in the numbers of Covid-19 positive patients. BGH is re-enacting the Covid-19 plan with the Red and Green division being reinforced, and a new ambulatory triage care unit will shortly be introduced. The winter plan is in place with additional doctors and nurses working both in the community and acute care. Dr Ian Thompson, a Care of the Elderly Consultant has been recruited and the post of Respiratory Consultant is currently being advertised. Additional Senior Advanced Nursing posts have also been recruited in BGH. A colorectal consultant has also been recruited and will begin working at BGH in January 2021. Elective theatre operations resumed in July 2020, with a specific protected ward. BGH operating theatres have been opened up to the whole of the Hywel Dda region to ensure urgent cancer treatment is available when needed. There has been a slight reduction in the length of stay for patients due to close collaboration with local authority colleagues and support services. Page | 6 There are gaps appearing in the district nursing services within the community, due to a number of staff having to self-isolate. There is also a rise in the number of patients being treated at home. 2 contingency plans are in place; the expansion from 13 to 20 beds in Tregaron Hospital, and Enfys Fach residential home in Llandysul to reopen with 26 beds, for step down or residential care. PS advised members that Sodexo worked closely with the HB on the provision of field hospitals, 2 of which can be utilised if needed; one in Cardigan, the other in Aberystwyth. Members discussed the report and raised several questions, which were clarified as follows: The majority of positive Covid-19 patients are on Y Banwy ward in separate isolation rooms, with a facility in ITU if needed. There is potential to use the leisure centre in the early stages of Covid-19, next year if necessary. There are currently sufficient supplies of Personal Protective Equipment (PPE) in Ceredigion. Advanced Nurse Practitioners (ANP) have been recruited to cover BGH, with advice and guidance from stroke specialists in other centres. The recruitment of a Neurologist is proving difficult however, clinics in Hywel Dda are covered by Neurologists based in the Swansea Bay area. A post is being advertised for Acute Medicine and it is hoped this will attract a Consultant with an interest in Stroke. False negative Covid-19 tests are rare as they are usually false positive. Page | 7 A second batch of flu vaccine will be available to prevent any shortages. Communication with parents through schools regarding flu vaccinations, particularly for children with underlying health conditions, is good. There is a national Primary Care framework that has been sent out regarding the therapeutic treatment of patients with long Covid-19 and this is being developed. The policy for elective surgery is for self-isolation 14 days prior to surgery and 14 days following surgery. There are some delays in care package provision across Ceredigion particularly in the more rural areas. Currently in BGH, there are 6 people waiting for care package provision. The Borth Gofal central call team is working to find providers to enable safe discharge from hospital. The facility for face to face contact within the Sexual Health Service is in place if deemed necessary by the senior clinician in charge of triage. There is no timescale for the reopening of open access clinics due to Covid-19. The HB is in the process of planning the delivery of elective and scheduled care. However, Covid-19 has resulted in a reduction in bed numbers, particularly in Glangwili Hospital (GGH). To facilitate this, a temporary hospital structure or build is being explored, similar to that in Cardiff & Vale.
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