Agenda item

The Sub-Committee will be provided with a verbal update on the ongoing response of local health and social care services to the covid-19 pandemic.

An update on the work within the Adults Service to address the Council’s budgetary challenges will also be provided in this item.

The Sub-Committee is asked to review the information provided, with a view to:-

1.    Considering what conclusions to make from the information provided.

2.    Considering whether to make any recommendations.

The Chief Executive and Place Based leader for Health, the Director of Integration and Innovation Health, Wellbeing and Adults and the Director of Public Health outlined the details in a Presentation.

Following the presentation, Members were given the opportunity to ask questions.

A Member asked what lessons had been learnt with regards to care homes and the high number of deaths in the first wave and if there were any areas of weakness that had been identified as still requiring attention. The Director of Public Health informed the Committee that she was now the Association of Directors of Public Health lead around care homes across London. There had been a lot of useful learning around care homes since the beginning of the pandemic and there was a strategic care homes group that met on a regular basis that consists of commissioners, GP’s and other Public Health professionals. The group engage in conversations around lessons learned, rapid regular routine testing of workforce and what else can be done to ensure reduced numbers of Covid within care home and domiciliary care settings. This way of working and building of relationships was also evident within children’s social care and its care homes. More work needed to be done to areas of improvement such as information on how people can improve and maintain their health as well as infection control. There was also work to be done on improving services for people with mental health affected by Covid and access for families to visits their relatives in care homes. Officers added that one of the biggest challenge was in the management of the winter emergency workload and well as increased Covid hospital admission that may occur. The risk around the impact on staff must also not be underestimated.

In response to a Member question on what steps had been taken to improve community access to GP’s which was severely impacted and restricted by the first wave of Covid, and the challenges of a virtual service officers said that the facility for patients to have face to face appointment where needed was in place. Whilst virtual consultations were in place and were offered in the first place for primary and secondary services and worked well for some people and conditions or different stages of treatment, complicated diagnoses in primary or secondary care that require face to face appointment were  and mould still go ahead. The opportunity of offering a convenient responsive service on a virtual basis for patients was valuable. The important lesson learned from the first wave was maintenance of access to face to face appointment through the use of sensible precautions put in place.

In response to a follow up question on the COVID Vaccine and how challenges around capacity for the nationwide roll out was being mitigated, officers said that the magnitude of getting the whole population who qualify for the COVID vaccine vaccinated was realised and there was specific work underway to identify workforce to carry out the administrative and support function that was required.

A Member questioned what support was being offered to staff as we enter the second wave to mitigate the risk and impact that resulted in staff burnt out of the stressful and challenging time experienced in the first wave of Covid. Additionally what was being done to improve staff morale and address issues with staffing levels? Officers said that staff wellbeing was of most importance and without the workforce services would be undeliverable. Staff were being consistently, openly communicated and engaged with through twice weekly webinars to keep them updated with issues and to answer questions. Mental health provision was in place for staff through the creation of a separate space away from the frontline. There had also been a health and wellbeing week event. It was acknowledged that there were still issues with staff morale as a result of having experienced difficult times and there was still more of that to come and it as important of the leadership of each department to have sight of difficulties and ensure that everything is being done to address issues by working together to navigate through this exceptional circumstance. There was a recruitment hub in place for health services across acute providers in South West London to create a greater capacity to help with recruitment which was still at early stages.

A Member raised concerns regarding the learning disabled community who were as equally vulnerable to COVID as most of the other vulnerable sects of the community , in particular the Autistic community  who were prone to mental health episodes that could be compounded that the events of the current time. It was asked how confident we could be that this group was been identified and responded to by appropriately trained medical and ancillary staff in the appropriate manner.  Officers acknowledged that it was important to be aware and understand the challenges and impact of Covid on this vulnerable group. Whilst the service realised the importance of tailoring it response to this group in an appropriate manner, there was still a lot of work to be done on awareness and responding appropriately. In particular improving staff training and skills in identifying and addressing particular needs of vulnerable people.

In response to a Member question on what was being done to encourage people with health issues to present who would have been reluctant for various reasons to present to services, officers said they were working to communicate that the NHS was open and for them to come forward to get the treatment they need. Work was underway to tackle the back log of treatments and to continue to keep communicating the message that all aspects of the service was open.

A Member asked what was being done to address challenges with patient access to dentistry service and the possible impact on the rest of the health service. Officers said that restrictions were placed on some areas of the service due to the nature of treatments and concerns around the spread of COVID. The appropriate precautions had now been taken and those treatments had now been bought back into place. At present it was not known what the impact this may have had on identification of head and neck cancers due to lack of visits to dentists.

The Sub-Committee responded to the question asked by officers on what reassurances they would need to provide to Members on the changes being made on how resources would be managed across the NHS and Local Authority by stating that communication through all stages of activity was key. In particular the opportunity to understand new commissioning arrangements as well as implications and provide feedback. To understand the equalities and diversity impact of decisions.

The Char thanked officers for their attendance and engagement at the meeting.

The Sub-Committee came to the following conclusions:

1. There remained concerns in backlogs caused by access to dentistry which was severely restricted during the first lockdown and the impact this may have caused in delays for referrals for diagnosis of Cancers of the throat and mouth.
2. It was important that services continued to assess and adapt to ensure that the wider community was able to adequately access primary care services as required, in particular those in the community that were not able to access services through advanced technological means.
3. In light of the scale of delivery as well as the administration involved to enable the delivery of the Covid-19 vaccination at the appointed time, it was evident that there would be significant challenges in delivery capacity.
4. Further consideration must be given to the impact and consequences of Covid-19 on the vulnerable sections of the community, in particular the effects on people with learning disabilities such as Autism whose susceptibility to other issues such as Mental Health issues would be compounded by the recent events.
5. Health and Social care should continue to build on the work that was doing to improve staff morale and increase the services and support offered to staff to manage their mental health.