Agenda item

UPDATE FROM OXLEAS NHS FOUNDATION TRUST

Minutes:

The Sub-Committee received a presentation from Adrian Dorney, Associate Director – Oxleas NHS Foundation Trust (“Associate Director”) and Lorraine Regan, Service Director – Oxleas NHS Foundation Trust (“Service Director”) providing an update on the impact of the Coronavirus pandemic.

 

The Service Director advised Members that the Oxleas NHS Foundation Trust had very much been in ‘command mode’ during the pandemic, and an instant command centre and clinical senate had been established. The governance structure of the Trust had changed, with the executive teams taking part in daily phone calls, and the sending out of bulletins to staff three times a week. The importance of frequent communication with teams had been recognised early on, as staff were understandably anxious.

 

A PPE hub had been established extremely quickly. The Trust had not been in the position of supplies running out, but there had been a couple of times when stock levels had been low, and mutual aid had been provided by other London hospitals. The implementation of PPE had followed the national guidance, and a steer was given as to how it should be used in mental health settings. It was noted that the PPE experience of mental health staff was quite different – they were not used to working in an environment where PPE was usual, and they had responded remarkably well. The Service Director informed Members that there had been daily monitoring of the workforce, allowing them to have a clear idea of how many staff were off due to COVID-19, and redeployment opportunities were provided to protect vulnerable staff.

 

The Associate Director informed Members that in terms of community services, work had been undertaken to risk stratify caseloads. This ensured that those service users needing to be were seen face to face, whilst minimising this where possible to protect them. They had also worked to maximise the use of other methods of contact, including telephone and video calls with service users. It was noted that, overall, this had been well received by services users, and the ease of access had reduced the incident of appointment ‘no shows’ during the pandemic.

 

Essential contacts, either via home visits or within their offices, were carried out adhering to social distancing regulations, and PPE was used in line with the guidance received. As a large number of service users were being seen remotely, fewer were visiting the offices for their appointments, which allowed a safe space to be provided. They had also been able to maintain essential clinics for those service users requiring injections and blood test monitoring. These had been managed by providing service users with timeslots at points when there was the fewest amount of people in the building, allowing them to be seen quickly, and leave.

 

The Associate Director advised that where possible, partial assessments had been undertaken remotely, doing as much as they were able to so that a backlog of patients did not build up. They were now in a position to just complete the face to face elements of the assessment, and this would commence as soon as was practically possible. It was noted that at the start of the pandemic, not all the required IT set-up had been available to deliver easy remote working for staff, however the laptops and access points had subsequently become available very quickly. Home working was now established, and the Trust would be well prepared if there were to be a second peak, and the need for remote working.

 

With regards to inpatient and mental health liaison services, the number of beds for mental health usage had been reduced during the pandemic. This was to minimise the number of people in a close environment, as well as the risk of transmitting COVID-19. There had been system-wide thinking and releasing bed availability meant that it could be used across the local health care system. There was high level involvement in admission decisions, to ensure that the most appropriate admissions were made. Those service users that were felt able to cope at home were not admitted and were instead provided with support from the Home Treatment Team. The bravery and commitment of these staff to continue to deliver this service was highlighted.

 

The Mental Health Liaison Team had provided support to the A&E department and wards of the PRUH. During the pandemic, iPads had been utilised by the team to carry out remote assessments of patients on the wards, which was a new and effective approach. For those that had not been able to utilise this, PPE had been worn where necessary to undertake face to face contact. Daily senior management video calls had also been undertaken with colleagues at the PRUH regarding the A&E department and levels of demand – these would continue as they had been extremely effective. Throughout the pandemic there had been a reduction in footfall, which was thought to be an impact of the media and government warnings around not attending hospitals unless necessary. There had been a reduction in March and April, which was followed by an increase once the government guidance changed. However, it was noted that there had not been an unmanageable swell.

 

The Associate Director highlighted that they had utilised the ‘attend anywhere’ appointment platform for psychology, which allowed service users easier access to their outpatient appointments with consultants and medics. This was an offer provided as a result of the COVID-19 pandemic which would be taken forward following its success. Specialist psychology and mental health nursing had also been provided on site at the PRUH for their staff, which could also be accessed by LB Bromley staff. This had been welcomed by them and was felt to be very effective and showed the joint thinking across the partner organisations.

 

The Service Director emphasised that throughout the pandemic the referral pathway had continued, but at a slightly lower rate, which had allowed some of the backlog of cases to be cleared. More staff were returning to the team bases in a controlled way, with environmental and individual staff risk assessments being carried out. Most staff were working on a rota basis, with some days working from home and others in the office. It was expected that staff would remain working like this until at least the end of the year.

 

A Member highlighted the use of online remote psychotherapy and psychology, and asked if service users had found this beneficial, and if there was likely to be continued demand. The Service Director said that the feedback received had been really positive, and some cohorts of the service user population, particularly young men, had engaged much better through this remote service. It was noted that they were aware that this did not work for everyone, and extra safety measures were put in place for those that were not able to engage with this technology. The Associate Director said that there had been a variety of feedback, some of which had shown that older adults may have had more difficulty in engaging in this way. It would however add to, and strengthen, the choice of services on offer to patients, which was a positive outcome.

 

In response to a question, the Associate Director said that if a service user had issues with digital access, it would be included as part of their care plan. Due to the pandemic, it had not been possible to undertake a large-scale mapping exercise of caseloads, but learning would be taken from this period.

 

The Chairman led Members in thanking Adrian Dorney and Lorraine Regan for their presentation to the Sub-Committee.

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