The report of the Health and Care System Executive Board, (Document “D”) explains that the challenge posed by COVID-19 has amplified the health needs of our population.  Document “D” highlights the existing strengths and weaknesses of our health and care system and reveals future actions required to meet the needs of the people in the District.

Recommended –

That the report be noted.

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The report of the Health and Care System Executive Board, (Document “D”) explained that the challenge posed by COVID-19 had amplified the health needs of the local population.  Document “D” highlighted the existing strengths and weaknesses of the health and care system and revealed future actions required to meet the needs of the people in the District.

The summary of the report explained that the challenge posed by COVID 19 had amplified the needs of the population and equalities between people.  Health, care and wider system relationships had come into their own; differences had been set aside and better results had been achieved by working together.  Plans to ensure that those ways of working would continue were outlined. A Member questioned if those plans involved the establishment of new forums or groups and it was explained that integration would be through service design and joined up governance.

It had been acknowledged that optimising supply alone would not meet demand and better ways of avoiding and addressing needs were required. All teams would include a number of clinical leads and a community lead to link and challenge

To avoid and address needs arising in the first place, prevention would include an end to end approach.  An example was provided with regard to pollution which would consider everything from air quality to the need for ventilation and everything in between. 

 A Member questioned if the Health and Care System Executive Board were supportive of the ‘Act as One’ approach and if funding would be in place. It was confirmed that the planned approach had received a warm reception by the Health and Wellbeing Board. 

The Chief Executive, Bradford Teaching Hospitals NHS Foundation Trust, reported that the opportunity to transform had come from necessity through COVID-19.  It had provided a renewed impetus to make tangible progress. It was explained that the collective intelligence of all who were representatives of health care in the district had been valued and the benefits of those partnership had been the speed with which issues could be addressed during the pandemic.

Members questioned how physically tired the staff were and what measures were in place to bolster their mental health.

The report revealed that there had been a significant increase in the demand and acuity in mental health services and a Member questioned what measures were in place to help people who had regressed during the pandemic and to address the needs of people who were struggling but not known to care services.  In response it was explained that it was essential to keep communicating and to work with organisations to allow people to live a good life.  There was a good network in place and communication, including social media, made people aware of services to help.  It was acknowledged that the Voluntary and Community Services (VCS) had experienced an increase in demand and it was important to ensure that the VCS  were not put under too much pressure.

Members questioned how much confidence there was that some of the new ways of working were better and how improvement would be monitored. He referred to the increased use of IT systems which had been forced by the pandemic and, as this had become the new normal, he questioned how its effectiveness would be assessed.   In response it was acknowledged that some of the IT solutions were welcomed but not all patients had access and they were aware of those issues. 

A Member referred to poorer outcomes and that not all conditions could be treated using IT.  He was concerned that GP’s who could not physically assess patients were telling some patients to attend Accident and Emergency Units.  A Member who had worked in health care in the district for a number of years believed that the previous Bradford Health Authority structure had worked well and dispersed organisations now needed to come back together. 

Priorities for recovery contained in Document “D” were questioned and a Member expressed concern about unmet clinical need and in particular that for cancer services.  He suggested that, despite deficits in funding, additional capacity to that available in previous years would be required to attend to the backlog and he requested that such information on that demand and capacity be highlighted in future reports.

In response to questions about cancer services the Chief Executive, Bradford Teaching Hospitals NHS Foundation Trust, explained that it was known that during the pandemic people did not present, as they had in the past, to the hospital as urgent cases.  Engagement with primary care had also reduced and it was felt that people were fearful of attending hospitals and reluctant to burden GP’s.  The initial route for fast access for treatment had reduced significantly and a number of patients were waiting for treatment. Patients were not, however, waiting beyond the Royal College of Surgeons waiting time parameters for specific interventions.  

Members were advised that the physical estate at Bradford Royal Infirmary had been reduced due to the continued use of Nightingale Wards.  The additional cleaning and sterilisation needed together with the requirement for personal protective equipment (PPE) had also impacted on capacity.

The report revealed that independent sector capacity, at the Yorkshire Clinic and Optegra hospital, had been contracted during the pandemic and mainly focused on cancer, endoscopy and urgent eye procedures.  The extent and capacity of that sector was queried. 

In response to questions it was reported that the Oncology and Chemotherapy services had been ‘lifted and shifted’ to the Yorkshire Clinic to provide a safe environment for vulnerable patients. A number of Endoscopy and Haematology clinics had also taken place at the Yorkshire Clinic and 43 eye operations at Optegra.  The independent sector had increased the availability of ventilators to address the anticipated need for  equipment and staff resulting in increased critical care capacity.   It was confirmed that the independent sector would continue to be contracted as plans for recovery were implemented

Members were aware that Mental health services had always utilised the independent sector to supplement NHS services.  Although activity had increased in the demand for mental health services it was still lower than usual. Good feedback had been provided from electronic solutions and local IAPT (Improving Access to Psychological Therapies) would continue. 

The Programme Director, Health and Care System Executive Board, explained that the next phase in recovery would include proactive measures to identify people requiring support and promote easy and safe access to the services available. Members were reminded that there was an update on primary medical care scheduled for consideration at the next meeting.

A Member referred to lots of support being provided by local communities and it was acknowledged that there were many people to be thanked for their support during the pandemic. 

Resolved  –

That an update on the Health and Care System be scheduled into the Committee’s Work Programme for consideration at a future meeting. 

ACTION: Overview and Scrutiny Lead