Meeting documents

To receive the presentation.

The Committee heard a presentation from Somerset CCG summarising the measures they have taken to confront the emergency, beginning with the Phase 1 - Level 4 Major Incident on 30^th of January which caused a change in their way of working.  The three main risks they had to deal with were PPE availability, Covid outbreaks in care homes, and testing of patients and health care staff.  They are now moving to Phase 2 – Recover, Restore and Transform, which will cover a period of 12-18 months.  The temporary service changes that have been made to respond to Covid were discussed, including:

• More telephone and video triage at GP surgeries
• Instituting primary assessment centres for safety (e.g. Burnham on Sea)
• Closure of inpatient beds at some locations with consolidation in fewer locations
• A 24-hour mental health support line for all of Somerset
• Access to specialist support for health care professionals and nursing homes for consultation
• Specialist (acute) service changes including increased testing, use of more digital technology, the relocation of chemo treatment from Yeovil to St Margaret’s Hospice, and the standing down of routine dental services.

In response to questions from Members, it was stated that all temporary changes will be reviewed and evaluated to determine if they will be continued; therefore, the best of the new working practices will be maintained, while other services may return to normal.  Once this evaluation has taken place, it will be reported to the Committee.  As regards video consultations with GP surgeries, CCG are informally gauging opinion from GPs as to its efficacy, but it was agreed that there is a need to do a formal consultation.  It was noted that a timeline of the dates when all of the temporary changes were made is available.  It was pointed out that as far as dealing with Covid in care homes, support had been high from an early date and exceeded the response from neighbouring counties; they worked with Public Health and contacted all care homes several times a week.

With respect to their April-May performance, it was noted that the national reporting process had been paused, but that:

• There was a 65% decrease in referrals to secondary care, although by the end of May/beginning of June there was a resumption of normal primary care
• From April to June, elective surgery was paused, so waiting times have increased; in response, they are prioritising cases and sending urgent cases to specific hospitals
• With respect to outpatient appointments, 30% were delivered virtually
• Cancer referrals were 70% lower than pre-Covid levels (62% lower nationally)
• There was a reduction in Emergency admissions

In order to ameliorate these issues, the independent sector will be maximised, the restoration plan will include additional capacity and prioritisation of diagnostics, GPs will have access to consultants including in geriatrics, and they are targeting a definitive 62-day maximum period between diagnosis and start of treatment for cancer patients.

In response to a query with respect to statistics on whether delayed cancer referrals have a higher rate of confirmation of diagnosis (known as the "conversion rate"), the presenter said she would enquire if statistics were available, although it may be too early as several months of data are required.  Statistics on other major medical issues during the past few months (sepsis, DVT, C-difficile were raised along with cancer) will be brought to the next meeting.  When asked if there will be proactive work to encourage people to come forward for cancer diagnosis, it was stated that more details will be provided later, but they are doing everything to provide both diagnosis and treatment/ operations and are following national campaigns.

The Somerset Scrutiny for Policies, Adults and Health Committee thanked the CCG andlooked forward to the next report with respect to the re-opening of services, the changes in service that will be maintained, and the statistics requested.