The Board received the Recovery and Management of System Pressures update.
This provided an overview of the coronavirus (Covid-19) recovery programme and management of system pressures in Harrow, which were: Primary Care, Hospital based care, and Social Care.
The Harrow Health and Care Executive met weekly, and collaboratively planned the recovery efforts. They had worked to manage system pressures, with the health, wellbeing and experience of Harrow residents at the fore.
For Primary Care, changes to GP contracts would introduce the following in 2022-2023:
1) a change to the existing contractual requirement that 25% of appointments could be booked online to a more targeted requirement that all appointments which did not require triage were able to be booked online, as well as in person or via the telephone – further guidance was awaited;
2) from October 2022, Primary Care Networks (PCNs) would be expected to provide bookable appointments between 6.30pm-8pm weekday evenings, and 9am-5pm on Saturdays; and
3) appointments at those times must use the full multidisciplinary team and offer a range of general practice services, including routine services such as screening, vaccinations and health checks, in line with patient preferences.
For Hospital based care, there had been leadership changes with the appointments of a new Chief Executive Officer and Chief Operating Officer, as well as Chair of the NWL Acute Providers. Admissions due to Covid-19 were falling, with very few patients needing critical care. There had been a successful deployment of new antiviral treatments, with a hub at Northwick Park. About 6% of admitted patients had incidental Covid-19, with possible signs of community rates rising. The ongoing vaccination effort had seen 47% the eligible Harrow population boosted. The expansion of permanent critical care capacity to 36 beds had been made.
The consolidation of the protected elective surgery hub at Central Middlesex Hospital (CMH), with plans to further develop Orthopaedic and other high-volume activity was also done, as well as the relocation of colorectal services to CMH and consolidation of elderly care at Northwick Park Hospital.
For Social Care, demand remained high with 60 new requests per week - up 24% on pre-pandemic levels. Teams were unable to complete work quickly enough to avoid growing queues and backlog. There were more than 200 people in the community waiting to engage with the Team, and more than 3 months of work queued up with people.
Before the Covid-19 pandemic, an average 9.5 new clients a week received Care Act eligible support out of hospital. The equivalent figure currently was 13.1. It took on average more than 2 weeks before the community team had capacity to begin working with citizens who had been discharged from hospital.
Due to very high caseloads, staff were unable to complete annual reviews on every citizen. Safeguarding enquiries (investigations) remained high compared to the previous two years. Complexity of needs for people with learning disabilities through the pandemic was leading to significant increases in the cost of supporting them. The average increase in costs was £337 per week from £200 per week before pandemic.
The Board was concerned about the consistency of service offer across Harrow’s PCNs, especially for the elderly, and those who were digitally challenged. It was advised that PCNs were required to respond adequately to the needs of communities, and supporting PCNs in that regard was one of the goals of partners. Further updates would be provided at a later meeting, including how to ensure that Harrow residents received consistent quality access and outcomes across Harrow’s PCN services.
The Board was also concerned that repeat prescriptions could only be done online or in-person, and not over the phone. This impacted negatively on those who were digitally challenged. It was acknowledged that that was an issue. However, it was not peculiar to Harrow, and was nationwide. PCNs were going through challenges providing adequate access to the public, and it was important that these were addressed.
The Board thanked officers for the update.
RESOLVED: That the update be noted.