Agenda item

The Health & Social Care Sub-Committee is asked to note the content of the presentation on the winter challenges facing health and social care services and consider: -

1.    Whether the main challenges facing health and social care services in the borough have been identified,

2.    Whether it is reassured that the appropriate controls and mitigation are in place to manage these challenges.

The Sub-Committee considered a report set out on pages 57 to 84 of the agenda, which provided an overview of the work of health and social care partners to ensure the increased pressure on services brought about by the winter and the covid-19 pandemic could be effectively managed.

Following an introduction to the item, summarising the information set out in the report, the Sub-Committee was provided the opportunity to question the information that had been provided.

As the covid-19 vaccine booster roll out was being coordinated by the NHS nationally, it was questioned whether this was leading to confusion on a local level. It was confirmed that GPs had an excellent partnership with the vaccination team at the hospital and were able to redirect people as needed. A vaccine helpline had also been set up in Croydon, which people could be referred to if they were experiencing issues booking their booster.

Given the recent announcement from the Government that vaccination would become mandatory for healthcare staff from April, it was questioned how this would impact upon the hospital, with 20% of staff not being vaccinated. It was confirmed that the implications from the vaccine mandate were still being worked through, as the guidance had not yet produced. The current approach of CHS was focussed towards persuading staff to take up the vaccine.

As there was a significant push to educate the public on the need to take up the vaccination, it was questioned whether other measures, such as hand washing, needed the same level of education. It was confirmed by the Director of Public Health that communication needed to continue as it had done in the preceding 18 months of the pandemic.  It was emphasised that should anyone be unsure of getting vaccinated, there were reliable sources of information online, which did not include social media.

It was questioned whether services were seeing the expected increase in mental health need as a result of the pandemic. In response it was advised that at present there was no modelling available to evidence that there had been an increase, but there was an awareness that the pandemic was having an impact. It was possible that the number of people seeking mental health support could increase further, but it was hoped that measures put in place with the voluntary sector may help to manage the numbers requiring hospitalisation.

It was questioned whether there were any care homes in the borough at risk as a result of the vaccine mandate. It was advised that there had been a lot of work with care homes to encourage the take up of the vaccination. The Council worked with providers where there were concerns about the vaccine, but there were no homes with a large cohort of unvaccinated staff. The work of the Commissioning team with care homes to encourage vaccination was commended. 

In response to a question about how Croydon Health Service NHS Trust (CHS) was managing the capacity in its Accident and Emergency (A&E) department at the Croydon University Hospital, it was acknowledge that the pandemic made managing capacity more difficult. Capacity issues were also a key reason for ambulance handover delays, although Croydon was performing better than others in this regard. There was closer integration between the urgent treatment centre and A&E which enabled the available space to be flexed as needed and additional staff had been put in place to handle assessment and triage before cubicles were ready. CHS was exploring options within its estate to identify possible options for providing increased capacity in A&E.

It was confirmed that the hospital discharge process in the Croydon system was much more connect than in other areas, with the ability to flex capacity as needed. However, although the discharge process was well managed, it did not completely mitigate against the potential risks as pressure could build rapidly. The A&E department was there area where the pressure was felt most, but the South West London system worked together to redirect ambulances to help manage capacity issues.

Given the health care system was massively under pressure, it was questioned whether this needed to be communicated with the public to manage expectation on waiting times. In response it was highlighted that any such message would need to be delivered on a national level. There was also the risk that any such messaging may dissuade people from seeking treatment, when anyone with a problem should be encouraged to contact the NHS.  Public Health and NHS colleagues met every two weeks to discuss public messaging, with agreement that any communication needed to be clear and concise.

At the conclusion of this item the Vice-Chair thanked the partners who had attended the meeting for their engagement with the questions of the Sub-Committee.

Conclusions

At the end of this item, the Health and Social Care Sub-Committee reached the following conclusions:-

1.    It was agreed that from the information provided there was significant evidence of a high level of coordination between partners in preparation for the winter. However, the next few months were still likely to present a significant challenge.

2.    It was reassuring that there had been work with the voluntary sector to prepare for an increase in mental health need as a result of the pandemic, but it was agreed this would be revisited by the Sub-Committee to ensure demand remained manageable.