Agenda item

APOLOGIES FOR ABSENCE AND NOTIFICATION OF SUBSTITUTE MEMBERS

Minutes:

The Chairman welcomed Members to the virtual meeting of the Health Scrutiny Sub-Committee, held via Webex.

 

Apologies for absence were received from Councillor Angela Page – Executive Assistant for Adult Care and Health and Roger Chant.

 

The Chairman informed Members that Dr Angela Bhan – Borough Based Director, SEL CCG had recently been unwell, and on behalf of the Sub-Committee wished her a speedy recovery.

 

 

UPDATE FROM KING’S COLLEGE HOSPITAL NHS FOUNDATION TRUST

 

The Chairman welcomed Jonathan Lofthouse, Site Chief Executive – PRUH and South Sites (“Site Chief Executive”) to the meeting and thanked him for attending at short notice to provide an update on the King’s College Hospital NHS Foundation Trust.

 

The Site Chief Executive informed Members that since the beginning of December, the PRUH and South Sites had seen a marked increase in the number of COVID-19 presentations, and this had continued at pace. On the 24th December 2020, the PRUH Campus had around 250 COVID-19 positive patients, which was a higher volume than at the absolute peak of the first wave of the pandemic. Numbers had remained steady between Christmas Day and New Year, but had then been followed by a further spike. The most significant day for the PRUH had been the 8th January 2021, on which they had been housing and caring for 297 COVID-19 positive patients, including 18 receiving fully ventilated Level 3 care in ITU and a further 20 receiving Level 2 high dependency care. It was stressed that these were extreme volumes of patients.

 

Since the 8th January, there had been a small reduction in the numbers, which statistically would be considered a downward trend, and as of that day there were 275 COVID-19 positive patients across the PRUH and South Sites (with some being nursed at the Orpington Campus). Currently, there was the capacity to respond to the daily ebb and flow of patients, with only a very minimal number of ITU Level 3 patients having been transferred to Denmark Hill to received more intensive and complex therapy.

 

In response to a question, the Site Chief Executive said that when comparing the previous six weeks with the peak of the first wave, the rate of presentations with COVID-19 was 51% higher. This highlighted the marked impact of the second wave, and indicated that the virus was significantly more virulent. However, over the last six weeks there had not been the same need for ventilated Level 3 beds which the PRUH had experienced during the first wave. Presently, there were 18 of these beds open, compared to 28 beds during Wave 1. As a result of the learning taken from the first wave, new and different interventions were being used early on in a patient’s admission, such as CPAP positive pressure ventilation. It was too early to say if they would see the same number of deaths that occurred during the first wave, but the number of presentations had been significantly higher, resulting in a far greater impact. With regards to oxygen usage, there had recently been a peak on their system, however they had still been well within tolerance levels. The current oxygen flow to the 550 beds was running at 71%, so there was still plenty of reserves. It was noted that when a patient in ITU was fully ventilated it did not use any more oxygen than positive pressure ventilation.

 

The Trust had redeployed 243 staff from non-critical and back-office roles, such as clinical and non-clinical education staff, to support frontline healthcare workers. These staff were providing clinical support by delivering care to patients, and non-clinical support by checking ward stocks and making beds. The Trust had continued to offer a range of support to staff through their Wellbeing Hub, which offered a sanctuary for some “downtime” and provided psychological welfare support. This was extremely important as staff were working under immense pressure in an unpleasant and hostile environment. The Site Chief Executive highlighted that staff across the Trust had been affected by COVID-19, with 1,259 staff (around 10% of the workforce) currently absent. Of this cohort, 362 had a confirmed COVID-19 diagnosis, whilst the others were required to either shield or quarantine.

 

As a health system, the Trust had worked closely with Bromley Healthcare and the LBB Social Care team, who had provided a huge amount of interactive support to move patients through the hospital as quickly and appropriately as possible. There were no concerns regarding delays, and any patient in the PRUH or Orpington Campus undoubtedly needed to be there, receiving care until they were fit and stable. There had not yet been the requirement to access the regions Nightingale Hospital, which was located at ExCel London, which was being used as a ‘step-down facility’ during the second wave of the pandemic. It was noted that this was largely due to the strength of the Orpington Campus, which was being utilised as a ‘step-down facility’ locally.

 

Since the 24th December 2020 other activity at the hospital had been very limited, with operations only taking place for life and limb threatened cases, and this would remain the situation going forward. Members were advised that a national decision had been made to restrict several urgent cases, including some cancer services. This had been a very rigid instruction, which the Trust had already started to soften by bringing in a very small number of cancer patients that week. Whilst this was a concern for both patients and clinicians, they would respond as quickly as they could to progressively increase this number.

 

In response to a question from the Chairman, the Site Chief Executive advised that a range of patient groups had recently been discussed with him. Due to the downward trend in the presentations of COVID-19 positive patients, it was anticipated that urgent cancer and elective cases could start to be brought in. Any operations that were cancelled had been clinically reviewed at the highest level, and operations would be rescheduled at the PRUH or Orpington Campus during the next week or so.

 

The Site Chief Executive advised Members that the PRUH had originally been selected as one of the 50 national vaccination centres to deliver the Pfizer COVID-19 vaccine, which they had been administering since the 8th December 2020. In collaboration with the Clinical Commissioning Group (CCG), it was decided that the PRUH would invite individuals in the over-80’s cohort that had been under the care of the hospital between September – December 2020. This had created an initial “order book” of recipients whilst the CCG prepared their model for delivering vaccine support. The PRUH was not currently delivering any “new” vaccines to the over-80’s, as the Primary Care Networks had now taken over vaccinating the general population. However they were continuing to vaccinate NHS, Social Care and Council staff.

 

In response to a question, the Site Chief Executive said that when the 50 vaccination centres had been initiated, the national instruction had been that the second dose of the vaccination should be given between 21 and 28 days after the first, for any population group. Subsequently, central government had changed this instruction, as allowing more of the general population to receive a vaccine sooner would reduce the overall burden of COVID-19. There was also emerging clinical evidence from the government that a greater gap between the two doses strengthened the vaccine in the body. It was unfortunate that central government had amended its guidance, and therefore two different services were being delivered to the population. The Site Chief Executive acknowledged the frustration of Members and their constituents, but the PRUH was just applying the national instructions. The Portfolio Holder for Adult Care and Health noted that this issue was not unique to the PRUH, as she was aware that this had also been the case at Beckenham Beacon Hospital, with some constituents having already received their second dose of the vaccination.

 

Members were informed that during late December 2020, there had been an issue whereby residents were unable to access the PRUH by telephone over a three day period. The Site Chief Executive noted that this had been due to an issue with an external switchboard, which needed to be resolved by an external contractor, and had therefore been out of their control. This had now been resolved and they were continuing to respond to new vaccination requests for NHS, health and social care workers; follow-up vaccinations for the initial cohort of over-80’s; and patients requiring emergency treatment.

 

Members passed on their thanks to the Site Chief Executive, and his staff, for all the work they had been undertaking, and enquired if any further support could be provided by the Council, and residents. The Site Chief Executive acknowledged this kind offer, but advised that they just needed them to continue to amplify the government messages around social responsibility; maintaining social distancing; and the wearing of facemasks. It was noted that the Trust were very fortunate to have ample stocks of PPE and welfare provision, and hospital charities had been providing other items to staff, such as hand cream. It was highlighted that due to the distinct restrictions within the working environments of the hospital site, and whilst acknowledging they were very kind offers, they did not want to receive food donations as they were difficult to distribute.

 

On behalf of the Sub-Committee, the Chairman thanked the Site Chief Executive for attending the meeting. It was agreed that an official message of thanks from the Sub-Committee would be drafted and circulated to staff across the Trust.