Council Leader and Chief Executive meeting 9 July 2020 9 July 2020 1 Contents • Context and Covid-19 current position • Changes to services to ensure safety • Strengthening borough relationships • How do we work together most effectively on this? • Appendix A: Changes in detail by site • Appendix B: Out of Hospital and mental health summary priorities 2 Context and Covid 19 current position NHS Context • NHS policy is that areas will work as a single ICS (Integrated Care System) • This includes health and local authority health related services • There will be one CCG to support each ICS • There is a move away from the commissioner/provider split within health care • Borough based partnerships for the provision of care are a key building block for the ICS • The challenge for systems is that there is no legislation directing these changes • As an ICS we are establishing a Partnership Board with LA CEO, DASS and Director of Public Health membership • Our proposal is that this LA Leaders’ meeting is a formal part of our governance, meeting every 1-2 months, ensuring accountability, debate, development of ideas and transparency. • Wherever possible, decisions about care delivery will be taken at Borough-level, supported by the ICS setting strategic context, sharing best practice and undertaking assurance • Our focus will be directed by our joint work to reduce inequalities experienced by our residents 4 Transitional ICS Structure 20/21, during Pandemic 5 We continue to actively manage and monitor Covid admissions to our hospitals • The total number of suspected / confirmed COVID-19 patients admitted to NWL providers has reduced since April and there is a continued low level of admissions through May & June. Although a small increase in week which is being monitored. Our main focus is on restoring services and encouraging people to use, these whilst actively managing within a Covid environment Elective care • In April 2020 there were 52,655 people in NW London waiting for surgery for over 18 weeks. This compares to 22,667 a year earlier. An increase of 130% Diagnostics • Prior to COVID 99.5% of patients were seen within 6 weeks. • In April 2020 62% waited more than 6 weeks. Endoscopy • We need 7500 hours of appointments to treat everyone waiting for an endoscopy. • By the end of the year we estimate this will have grown to over 17500 hours of appointments. • We need to increase endoscopy capacity by 130% to see all these patients, given the reduced number we can now scope per session. We are actively developing and implementing plans to treat these patients. Working as a system to maximise the use of our resources. We are also sourcing additional modular facilities and will maximise our use of private sector capacity. However, staffing is our limiting factor. 7 Demand for urgent care is increasing but is below expected levels, an active programme of support is in place for care homes A&E attendances • For June 2020 A&E attendances in NW London were 54,808 compared to 94,106; this is a 42% reduction • Some will have sort treatment elsewhere eg from GPs, changes in life style will have impacted admissions (improvement in air quality, change in leisre activities) however, it is clear that others are not yet comfortable in attending hospitals for urgent care needs Mental health Referrals to crisis teams for adults (figure1) and CYP (figure 2) have been increasing overall in June and referrals to Liaison Psychiatry Teams have increased from mid-April (4 week av. 40). Support to care homes • Clinical teams have been supporting care homes through a series of visits. 107/140 care homes for older people have been visited in phase 1 (41 declined) • Phase 2 (commenced 22 June): to date 64/148 Learning Disability and Mental Health care homes have been contacted and 34 visited • During the pandemic over 3500 residents were tested – local arrangements are now in place • 1492 staff were tested from 14 March -5 May 2020 through the Wembley centre – local arrangements are now in place • All CQC registered care homes have received infection prevention and control training • Testing arrangements for all discharged from hospital to home care have been agreed. 8 Therefore the NHS continues to operate in a level 4 pandemic emergency as we plan our recovery - restoring services whilst safely managing Covid • Our priority is keeping patients and staff safe while delivering high quality, equitable services. • We need to keep patients who we know, or suspect, have Covid-19 separate from those who we know do not. We are working as a single system across NW London to create Covid-protected sites and/or Covid protected areas within sites. • Waiting times for planned services have grown significantly. We are urgently starting to deliver all non-emergency elective services that have been suspended since the start of the outbreak. • Patients are not accessing NHS services because they are afraid they may catch the virus in hospitals, A&E and urgent treatment centre waiting rooms. 40-70% are declining to come in for procedures. • We are organising our services differently whilst we are still dealing with the pandemic and we estimate that our services will be 40% less productive than before. • We want to address the increase in inequalities caused by Covid. • We are making some changes to our services – driven by best clinical practice, ensuring patient safety 9 Changes to services to ensure safety Reviewing service changes • We recognise that we made changes to services quickly; this was necessary to keep patients and staff safe • Other service changes are still being developed in order to treat the maximum number of patients safely • All changes will be regularly reviewed as we go forward, however, we are unable to commit to a timescale for restoring usual services • Some changes can now be reversed eg routine appointments have restarted; however, we anticipate that some of these new arrangements will need to be in place for up to 2 years. • We will be able to consider restoration when: • We have treated the backlog of patients waiting for screening, diagnostics, outpatients, endoscopy and surgery • The infection rate is negligible • We have an effective vaccination • In some circumstances we may see improved outcomes from these new ways of working and we will want to engage with you as to how we embed the changes • We commit to being transparent and discussing these with you as we continue to respond to the emerging situation 11 • We commit to being transparent and discussing these with you as we continue to respond to the emerging situation Temporary changes we have made in recent months to ensure safe services Acute hospitals Area of change Why did it change Current status Suspension of overnight services: Under regular review and challenge as part of • Surgery at Ealing Hospital • Staff shortages and staff redeployed the planning for return to business as usual. • Western Eye Hospital A&E Plan in place to for staggered restart following Diagnostics suspended during Covid -19 to: approval of covid /non covid pathways. - cope with emergencies and cancer Will add capacity through mobile scanners, Suspension of routine diagnostics. cases only. independent sector and development of - Due to reduction in staffing numbers community hubs. who were affected with Covid-19. • Staff redeployed to support Covid • Routine referral: reopened 22/6 inpatient activity. • Virtual appointments in place (phone & video). Suspension of routine outpatients and • Social distancing and reduction of risk • Urgent physical appointments only elective services . for patients / staff. • Elective surgery: restarting across all • NOTE: 2WW and Urgent activity was provider for clinically prioritised patients. maintained Children’s ambulatory care at Clinical safety and to allow staff Under regular review and challenge as part of Hammersmith Hospital open for clinical redeployment the planning for return to business as usual. referral only. Elective care suspended. Urgent care Elective care commencing centred at Chelsea Paediatric surgery focussed at Chelsea and focussed at Chelsea and Westminster to and Westminster. Under regular review and Westminster free capacity needed for pandemic challenge as part of the planning for return to response. business as usual. Full detail by hospital is provided in Appendix A 12 Temporary changes we have made in recent months to ensure safe services Urgent and primary care Area of change Why did it change Current status Temporary closure of Hammersmith UTC Soho Walk-in Centre Pinn Walk-in Centre The number of people attending reduced and St Charles Urgent Care Centre the move to telephone triage meant walk in No plan to change at this time. Under regular Mount Vernon MIU centres not right care setting. review and challenge, Staff redeployed to support the Covid-19 Parsons Green Walk-in Centre is by booking response. only Screening programmes now restarting and Guidance to prioritise highest risk groups recovery plans in place to address backlog Suspension of screening services however diagnostic and follow up capacity and resume business as usual constrained Recovery programmes in place throughout June, July and August to address backlog 13 Temporary changes we have made in recent months to ensure safe services Mental health Area of change Why did it change Current status Gradual reopening is taking place. CNWL and WLT consolidated beds onto a reduced number of sites to maintain safe staffing • Oaktree Older Adults Unit now has 8 older and level of service at the remaining inpatient adult beds. Vincent Square - currently open to units, emergency hubs and other critical 8 patients (from 15) to allow for social services. Patients who continue to require distancing. Day patient and assertive inpatient care have been transferred to the other Consolidation of inpatient community outreach in operation.