Minutes:
The Hillingdon Hospital NHS Foundation Trust (THH)
Ms Patricia Wright, THH Chief Executive, advised that, in April 2020, the highest number of inpatients testing positive for COVID-19 had been 100. At its peak in January/February 2021, this figure had risen to 160-170. In the three months from December 2020, the number of critical care beds had been increased from 9 to 15. THH staff had responded magnificently despite high levels of sickness and whilst also juggling personal responsibilities such as home schooling. A programme of support had been put in place for the health and wellbeing of staff, particularly in relation to mental health.
THH had built a strong relationship with Hillingdon Health and Care Partners (HHCP) and had worked closely together to improve things such as discharge planning. It was noted that the number of patients testing positive for COVID-19 had started to reduce but increased from 80 on 1 March 2021 to 89 on 2 March 2021.
Ms Wright advised that she had been in post since the beginning of December 2020. Her Executive Team was now complete and had been planning to develop the recovery plan in response to recent regulatory issues and scrutiny.
It was noted that the redevelopment of Hillingdon Hospital was a three-stage process: Strategic Outline Case (SOC), Outline Business Case (OBC), Full Business Case (FBC). This process usually took about five years but was being expedited. The SOC had been signed off by the Treasury in October 2020 and it was anticipated that the OBC would be submitted in August / September 2021. 1 in 500 drawings of what the development might look like had already been produced – 1 in 200 drawings would be needed for the OBC.
Upfront funding had been secured for the provision of two modular buildings which would help with decanting patients from existing wards during the redevelopment project: Modular North would include two wards plus critical care and would be on line by the end of March 2021; and Modular South would include paediatrics and would be in place by September 2021. Once these modular buildings were functional, the existing single level huts could be cleared from the site. A programme of refurbishment was also underway in the hospital tower block.
Hillingdon Health and Care Partners (HHCP)
Ms Caroline Morison, Managing Director of HHCP, advised that the exceptional integrated working that had taken place with regard to the vaccination programme in Hillingdon had already been highlighted in the two previous reports. This had included work between the local authority and THH around the discharge hub.
Joint working had been undertaken to reach as many people as possible in the Borough as quickly as possible to administer the vaccine. Consideration was now being given to the longer term impact of COVID-19, for example mental health for children and young people, the impact on resilience and developing neighbourhood working. Work would be needed to develop the Joint Health and Wellbeing Strategy to deliver priorities and address the inequalities that had been brought to light by COVID-19. It would also be important to align the transformation programmes of each of the partners so that these were not progressed in isolation.
Hillingdon Clinical Commissioning Group (HCCG)
Mr Richard Ellis, Joint Lead Borough Director at HCCG, advised that a lot of work had been undertaken to support general practice into resuming the referral of patients into secondary and specialised care which might have been suspended during the pandemic. Primary and secondary care had been working together to reduce the number of elective referrals to THH.
Consideration was being given to long COVID and how this condition might be supported. Work would also be undertaken in partnership with organisations such as H4All regarding the social and mental health pressures resulting from the pandemic.
It was noted that, from 31 March 2021, HCCG would form part of North West London CCG (NWLCCG). Work would continue with the local authority and other partners on a place-based / Borough basis. The commissioning of dentistry, optical and pharmaceutical services would move to the CCG, elements of which would need to be considered by the Health and Wellbeing Board.
Dr Goodman stated that general practice was open for business and should not be turning patients away. An increasing number of GP consultations were being undertaken virtually / remotely and would continue. However, for things like cervical smear tests and child immunisations, these were still being done in person. Condition management appointments for things such as diabetes would resume from 1 April 2021. It was anticipated that the digital contact options that had been brought in would remain once the pandemic was over but that face to face consultations would still be available for those who did not have access to, or were not so au fait with, technology.
London Borough of Hillingdon (LBH)
Mr Dan Kennedy, the Council’s Director Planning, Environment, Education and Community Services, advised that positive steps had been taken with regard to working with NWLCCG and opening up the conversation locally. Mr Kennedy had met with the head teachers from some of the schools in the Borough to talk about reopening plans. Testing had been organised and parents had been contacted with information about the reopening. Notices continued to be displayed in schools to remind everyone to keep their distance, wash their hands and cover their faces. The schools appeared to be well prepared for reopening on Monday 8 March 2021.
Ms Sandra Taylor, the Council’s Director Provider Services and Commissioned Care, noted that the success of the roll out of the vaccination programme in Hillingdon could not have been managed so well without supportive collaboration which had reaped real rewards. It would be important to now use the learning from this experience to prevent slipping back to old ways of working and instead continue to make improvements to things like hospital discharge.
With regard to social care, the Council had not used the easements that had been open to it. Consideration would now be given to doing face-to-face assessments as soon as guidance permitted. Work would continue with regard to managing the health and wellbeing of staff and service users.
Ms Sharon Daye, Consultant in Public Health at LBH, advised that public health had been working with all partners. The whole system had been working together to contain the virus and protect the population. The partnership work undertaken in Hillingdon had been looked upon favourably by Public Health England.
Central and North West London NHS Foundation Trust (CNWL)
Ms Vanessa Odlin, Director for Hillingdon and Mental Health Services at CNWL, echoed the comments that had been made regarding the collaborative work that had been undertaken in Hillingdon. She noted that discharge had been a big issue for CNWL from a mental and physical health perspective. A pull out model had been adopted which meant that processes from physical health had been adopted in mental health. Services had been flexed to manage inpatient capacity to support patients discharged from Hillingdon Hospital including the Hawthorne Unit. Although the discharge of some patients could be complex, Ms Odlin was confident that the right people were now communicating to resolve these situations as quickly as possible. Ms Taylor advised that getting out of hospital and back into the community made a difference to patients’ recovery. It would be important to ensure that the services available in the community were the right services to meet individual needs.
HHCP‘s high intensity user programme had been looking at putting measures in place to help these frequent service users. These measures could include interventions from the Rapid Response Team or use of the Coves crisis service for support to people in crisis.
There had been an increase in presentations to CAMHS. A triage telephone line had been set up for professionals to call and a crisis line for young people to call would soon be in place. Further details of how his crisis line would be publicised would be brought back to a future meeting. In Hillingdon, the duty team capacity had been doubled to support the response but this would be a temporary measure. Consideration had also been given to the support that needed to be put in place for young people aged 16-25 and support had been put in place for staff, particularly for those who were working from home and perhaps shielding.
It was noted that the pandemic had created opportunities for partners to improve pathways and move forward. Mr Morison advised that it would be important that these advancements were not undone. The Integrated Care System would need to articulate what good looked like and target resources and energies into the children and young people programme as one of the top priorities. The right models would need to be in place to look at early intervention and prevention work.
Healthwatch Hillingdon (HH)
Ms Lynn Hill, Chairman of HH, advised that the survey coordinated by HH to look at the concerns of individuals regarding the vaccine had received around 5,600 responses. The feedback received had indicated that hesitancy had been in relation to a wide range of issues including: diabetes, pregnancy, DNA tampering, biological tagging, etc. As a result of this survey, work had been undertaken to dispel these myths.
Young Healthwatch had undertaken research and compiled a list of 14 information and service providers that did not require a professional referral to seek support. They had produced a short promotional video to highlight these services.
Further work would be undertaken with regard to delayed appointments and patients’ inability to access dental services.
RESOLVED: That the updates be noted.