The Scrutiny Support Officer submitted a report the purpose of which was to introduce senior representatives from the local NHS to provide an update on the impact of Winter Pressures on local health services during the 2011/2012 winter period.
In order to assist deliberations a series of questions had previously been forwarded to the local NHS representatives which focussed on how the local NHS coped with winter pressures, resilience of processes, lessons learnt, involvement of emerging Clinical Commissioning groups and uptake of vaccinations amongst at risk groups and staff.
The Chair welcomed senior representatives from NHS Tees who highlighted the key points as demonstrated in a PowerPoint presentation provided to the Joint Committee.
In general and in the national and local context for the winter period 2011/2012 there had been very low influenza incidence after a relatively mild winter and good weather conditions. The Joint Committee was advised however of very high incidence of diarrhoea and vomiting and Norovirus across the North East and UK. As a result there had been staff pressures in Community Hospitals (South Tees). Additional funding had been provided to North Tees and Hartlepool NHS Foundation Trust and South Tees Hospitals NHS Foundation Trust to open winter beds. It was also confirmed that County Durham and Darlington Foundation Trust had received extra funding and that a winter debrief session on the outcome of the winter period would be held on 23 April 2012.
The Joint Committee was advised that in overall terms the local NHS had coped well with winter pressures during the 2011/2012 winter. Daily sitreps and reporting had ceased on 10 April 2012. Members were advised however of hotspots which included such areas as:-
(a) Vaccination uptake - at risk groups and staff;
(b) Delayed transfers of care identified early on and examined on a case by case basis and recognition that one of the main reasons for this had been capital repair work being undertaken at Carter Bequest Hospital which had impacted on the availability of beds;
(c) Norovirus/diarrhoea and vomiting;
(d) A & E capacity in busy periods;
(e) Bed capacity/ward closures;
(f) Trusts mutual aid/ambulance policies across the North East had been implemented when necessary and had worked well.
In terms of lessons learnt it was acknowledged that there had been a high uptake in the level of staff vaccination. It was recognised that there was a need to ensure that provider NEEP plans were consistent across the system which would aid mutual support. The need to get Clinical Commissioning Groups (CCG) aware and on board with such issues was acknowledged.
The involvement of the emerging CCGs with inter planning/winter resilience included invitation/attendance at Tees Urgent Care System Group since summer 2011; attendance at winter update weekly to Executive Team/CCG Leads meeting; invitation to SHA 2011/2012 Winter Debrief; and Local Medical Committee involvement.
Statistical information was provided on the uptake figures for vaccinations amongst 65 year olds, at risk groups, pregnant women; and amongst staff.
The NHS target for many years had been a threshold of 70% which the Tees Valley areas had all exceeded. Of particular note was Redcar & Cleveland achieving 78.5% and Middlesbrough at 76.3%. Members were advised that the figures in relation to the at risk groups were generally higher than in previous years most of which were around 50%. In relation to the uptake amongst pregnant women Members referred to concerns which had been raised regarding the safety aspects of taking such vaccines. In response, the Joint Committee was given an assurance that work would continue with GPs and midwives regarding the safety in taking such vaccines.
In overall terms the uptake rates amongst staff was reported to be higher than in previous years. It was reported that for the North Tees and Hartlepool NHS FT it had been 75.4% the sixth highest across the Northern Region. It was reported that for the Tees, Esk and Wear Valleys NHS FT it had been 51.2%, for South Tees Hospitals NHS FT 50.8% and for County Durham and Darlington NHS FT 49.9%. The Joint Committee noted that the highest uptake of 88.6% had been Royal Liverpool and Broadgreen NHS FT and the lowest at 29.4% had been the North East Ambulance Service FT.
An indication was given that arrangements would be put in place to cope with pressure in relation to the Olympic Games including the local torch processions.
In response to Members comments regarding the high level of uptake amongst staff at North Tees and Hartlepool NHS FT and the benefits of sharing information on lessons learnt it was confirmed that the level achieved had been acknowledged and a presentation was to be given to other North East providers. Members suggested that it would be helpful if such information was made available to the individual health scrutiny committees. As part of the measures to increase awareness, reference was made to the importance of focussing on the benefits of the vaccine to the staff themselves and to the patients/services users around them.
Given the nature of the work undertaken Members expressed concerns at the comparatively low take-up by the North East Ambulance Service NHS FT. It was pointed out that the spread of staff across the region and shift patterns were factors which impacted on the take-up of vaccinations.
Members referred to the professional network which existed which provided a systematic approach as to when particular issues arose. Clarification was sought as to what the future arrangements would be in such circumstances. Although it was noted that steps were being taken to ensure every contingency plan was in place it was too early to determine if such action would be effective. Specific reference was made to the important role of scrutiny through the transition period and in the future such as requesting information of future and outcome of winter plans. An indication was also given of the functions of various bodies such as Public Health England, Health Protection Agency, Health and Wellbeing Boards and NHS Commissioning Board. It was acknowledged that Clinical Commissioning Groups needed to be clear as to the development of their structure and commissioning support arrangements. An indication was given of various meetings to which CCGs had been invited to attend such as those with the PCTs and an event with the Strategic Health Authority to be held on 11 May.
AGREED as follows:-
1. That the senior representatives of NHS Tees be thanked for the information provided which was noted.
2. That a letter from the Chair and Vice-Chair on behalf of the Joint Committee be forwarded to the North East Ambulance Service NHS Foundation Trust regarding the low take-up of the flu vaccine and any action they propose to take to address the matter.
3. That a further update on seasonal flu and winter preparedness be provided in due course.