Agenda item

Mark Cheung, One Bromley Programme Director – SEL CCG (“One Bromley Programme Director”) provided an update on the development of Long Covid services in Bromley.

The One Bromley Programme Director advised that the recovery time for patients that suffered from Long Covid was extremely varied. Although most patients would make a recovery within 12 weeks, sometimes symptoms could last much longer. It was highlighted that the chance of having long-term symptoms was not related to how unwell a patient had been, and Long Covid could also affected those who had been asymptomatic. The National Institute for Health and Care Excellence (NICE) guidelines defined Long Covid as “signs and symptoms that develop during or after an infection consistent with COVID-19, continue for more than 12 weeks and are not explained by an alternative diagnosis”. It was noted that the CCG were also looking at how to support patients still suffering 4 weeks after the onset of symptoms.

The range of symptoms was extremely varied and included:

-  extreme tiredness (fatigue);

-  shortness of breath;

-  chest pain or tightness;

-  problems with memory and concentration ("brain fog");

-  difficulty sleeping (insomnia);

-  heart palpitations;

-  dizziness;

-  pins and needles;

-  joint pain;

-  depression and anxiety;

-  tinnitus, earaches;

-  feeling sick, diarrhoea, stomach aches, loss of appetite;

-  a high temperature, cough, headaches, sore throat, changes to sense of smell or taste; and

-  rashes.

The One Bromley Programme Director informed Members that symptoms could be experienced individually or in clusters; could overlap; and could change over time to affect different parts and systems of the body. It was highlighted that learning was still being taken from this, but some studies estimated that around 10% of patients could suffer from Long Covid. As the illness was multifaceted, so were the treatments. This would involve a number of specialties including respiratory; cardiology; neurology services; and several therapies. The One Bromley Programme Director highlighted that one symptom of Long Covid was depression and anxiety which required support from colleagues in Mental Health services. It was essential to have an integrated approach to addressing the support provided to patients via the One Bromley partnership.

The One Bromley Programme Director advised that a post-COVID pathway was being developed in line with recent national guidance, and in conjunction with the other SEL boroughs to ensure there was a consistent offer. The pathway had four different elements, and patients could go back and forth to whichever was the most appropriate:

-  GP / primary care (patient identification, assessment and investigation);

-  self-management;

-  community services; and

-  acute services (specialist input, hospital services).

In GP support / primary care, resources and funding were already in place to support identification and assessment of patients, and a referral form and protocols had been developed. The One Bromley Programme Director noted that a condition stipulated was that face to face appointments were required in order to make a comprehensive assessment. With regards to acute services, a specialist post-COVID syndrome assessment clinic had been established at the PRUH from April 2021 – holistic assessments were undertaken, including respiratory or neurological symptoms to rule out serious underlying conditions, and patients would then be referred on. It was anticipated that a community model would be developed in the coming months, which would receive referrals from GPs, the hospital and other partners. The proposal included the establishment of virtual weekly Multi-disciplinary team meetings, integrated with primary, secondary care and mental health services. Patients would receive a comprehensive holistic assessment which would determine whether they were suitable for self-management; the offer further monitoring and support; or direct face to face interventions. Patients that were suitable for self-management could access the Your COVID Recovery website, which had launched nationally last summer – other platforms were being considered across SEL, and support was also available from the Bromley Well services. The One Bromley Programme Director stressed the importance of continuing to monitor, adapt and record the outcomes of the data that supported this work, and the need to work with partners to share information which would inform how services were developed going forwards.

A Member congratulated the One Bromley Programme Director and his team for the work undertaken in relation to Long Covid services, which was well in advance of what was being seen across may other parts of the country. As highlighted, Long Covid was independent of the severity of infection and it was queried if this message would be used to reinforce the need for people to get their vaccinations. The Bromley Borough Director advised that this message was not being used as much as it could be – they did not want to be too alarmist, and it was noted that they were still trying to understand more about the syndrome. It was not a feature of national, London or SEL communications campaigns, however consideration could be given as to how this message was used. It was further noted that although children may not suffer an illness, they could be subject to Long Covid.

In response to a question, the One Bromley Programme Director said that capacity had been built into the pathway based on 10% of the number of COVID-19 patients, and further details could be provided to Members following the meeting. Data would continue to be monitored and used to scale services up or down as demand required.

A Member noted that the four pathways would put a differential amount of pressure on health services and asked if there was an assumption as to the proportion of patients that would go through each. The One Bromley Programme Director said that this was not currently known, however this was partly due to the way in which it the services had been set up. The national priority was to establish the specialist units, whereas in Bromley the thought was to direct patients through the community pathway first, as it could escalate referrals up to acute services. It was noted the patients with Long Covid were being seen via these pathways, and pressures on therapy services were already being reported.

Jonathan Lofthouse, Site Chief Executive – PRUH and South Sites informed Members that the number of NHS staff not functioning in their routine role due to Long Covid was now relatively small and an individual case management issue. With regards to the patient population, there were varying schemes, across both King’s and Greater London, including Long Covid clinics and research. It was suggested that further information regarding referrals could be provided to Members following the meeting.