(Councillors Gilmour and Krizanac left at this time)

Alex Degan (Primary Care Medical Director, NHS Devon ICB) introduced the National Seasonal Immunisation Programme to the Committee, and highlighted the following points-

a)    While led by the ICB, the Seasonal Immunisation Programme was a systems effort with collective work from Local Authorities, Primary Care networks, Pharmacies, and NHS England;

b)    Plymouth had a large Community Pharmacy offer, with a high proportion of pharmacies registered to deliver the Seasonal and Covid vaccine programme; 

c)    Devon had developed a Health Inequalities Cell (HIC) to examine vaccine uptake among the population. The HIC helped promote vaccine outreach among communities of low uptake such as those living in deprivation, or with mental illness;

d)    The Devon Autumn Covid Vaccine programme had started in September, and included 3 large vaccine centres, 19 Primary Care Networks and 53 Community Pharmacies, as well as delivering vaccines to 480 care homes and 300 outreach clinics;

e)    Uptake of the Covid vaccine in Devon was exceptionally high compared to national averages, with 50% of the eligible population vaccinated, and 55% vaccinated for Flu. This season a new approach would be undertaken to co-administer the Covid and Flu vaccinations together, as there was medical evidence that this was safe, and this would help alleviate staffing demand pressures;  

f)     Devon performed highest nationally for the number of visits carried out in Care Homes to deliver the vaccine programme.  97% of homes in Devon had been visited already, and the remaining 3% had dates scheduled;

g)    The National Vaccination and Immunisation Strategy was due to be launched in the next few weeks. Following this, the ICB  would be required to develop its own local strategy across its networks.

In response to questions from the Committee, it was reported that-

h)    While Covid vaccinations had initially been administered through a priority system, prioritising high risk demographics and vulnerable individuals, there was now no order of precedence. Last year, 72% of all eligible people had been vaccinated in Devon. It was anticipated that this year’s vaccination programme would see close to 70% vaccination coverage by the end of the programme;

i)     Nationally, uptake of vaccinations had been lower this year than previously. There were no shortages of vaccine availability however, lower take-up this year was largely attributed to vaccine fatigue. Covid was now seen by many as less serious, and not essential in daily life, such as during the peak of the pandemic;

j)     There was a lower uptake of Covid vaccinations amongst health and care workers, which was concerning due to the vulnerable nature of the clients they worked with. Programmes of engagement were being undertaken to encourage staff to take up vaccinations however, among hospital staff, uptake was higher;

k)    The Seasonal Vaccination Programme was subject to change due to unforeseen and emerging circumstances. This year, the vaccination programme was brought forward on advice of the JCBI, due to the presence of a new strain of Covid-19;

The Committee agreed-

1.    To request further information regarding the outreach programmes and vaccine opportunities for sex workers in the City, who often felt excluded. 

(Councillor Nicholson left at this time 16:27)

Chris Morley (NHS Devon ICB), Sarah Pearce (Livewell SW), Rachel O’Connor (Livewell SW) and Mel Wilson (Livewell SW) delivered the ‘Systems Plan for Winter’ to the Committee, and highlighted the following points-

l)     The ICB had undertaken a thorough evaluation of last year’s performance, and conducted learning from last year’s winter programme. This had seen many successes, with numerous new schemes launched in response to emerging pressures, which helped manage demand and capacity. This was evidenced in the success of Care Hotels, the Made Event, and additional capacity brought in across the system during Covid. It was now vital to return to normal services, but maintain established capacity and performance;

m)  Significant work had been undertaken to improve ‘admissions avoidance’ through supporting people to remain in their communities. This had seen use of: The Acute Respiratory Infection Hub, additional resource for ED, enhanced signposting, the Plymouth Safe Bus, wrap around support for care homes, enhanced work with primary care and community crisis response teams, and numerous community schemes;

n)    While last year had seen positive increases in capacity through the utilisation of additional agency staff to support workforce pressures, this was expensive and not sustainable long term. Additionally, there had been a series of short term funding pots last year however, these were often ‘ring-fenced’ and could only be targeted towards a narrow pre-defined scope, often within tight time pressures. There was now a need for strategic long-term plans so that future changes did not destabilise the system;

o)    All of last year’s schemes had been analysed for efficiency and value, and lessons learnt would influence future programmes and commissioning of services;

p)    The National Opel Framework had been refreshed this year, providing a consistent approach to scoring acute hospital status. The new framework did not include recognition of ‘community triggers’ as it had previously, and proactive work was being undertaken to develop this locally;

q)    A pilot programme, the Care Coordination Hub’, was due to be launched shortly, focussing on admissions avoidance by providing medical advice and signposting when someone was at risk of escalation to hospital. This would be staffed by a Dr, and a Paramedic from SWAST, enabling care homes and other providers to call medical professionals before conveying patients to ED;

r)    To meet expected winter demand, it was vital that ‘No Criteria to Reside’ performance met its 7% target however, there was also a desirable target of 5%. The ‘Made Event’ had demonstrated capability, with both Plymouth and Devon attaining the 7% target however, it was recognised that Cornwall’s performance still required improvement;

s)     Modelling work had been undertaken to map winter capacity and demand. Last year, predictions had calculated a 2% increase in demand however, presentations at ED had increased by up to 13%. ‘No Criteria to Reside’ performance currently averaged 14%, which equated to approximately 120 beds. This year, it was expected that seasonal illness would peak early at around week 26. It was also anticipated that seasonal illness would be consistent with pre-Covid levels, with a less-severe peak;

t)     In modelling of the worst-case scenario, it was anticipated that the peak would see a bed deficit of 150 beds. There were ongoing measures to increase this capacity, with the Royal Eye Infirmary creating an additional 35 beds, enhanced capacity for care at home, and the expansion of virtual wards. With all measures in place, it was anticipated there would still be a deficit of 30 beds during the winter illness peak.

In response to questions from the Committee, it was reported that-

u)    The ‘Choose Well Campaign’ aimed to signpost people to the most appropriate care facility, and discourage attendance at ED unless it was life-threatening; 

v)    Mental Health services had developed a good offer within communities. These provided a 24/7 instant access service through the Primary Care Team and Crisis Response Team, reducing demand on ED;

w)   A Surge plan had been developed for winter, which pre-planned demand and capacity scenarios so that appropriate actions could be taken efficiently. This was a key part of the escalation process, enabling the movement of resources to services/areas in demand;

x)    GPs were recognised as a critical ‘front-door’ to services, and partnership work had been undertaken with surgeries as part of an improvement plan in preparation for winter;

y)    Staff sickness and industrial action were unknown variables which could affect winter plans however, Surge plans were in place to protect elective capacity across winter. Lessons learnt from previous years were vital for preparations, enabling management to be proactive in planning and adaptation to demand pressures;

z)    The Urgent Crisis Response Service had a national target of 2 hours to assess someone at risk of admission into hospital. Plymouth routinely overachieved on this service; In the past 2 weeks, there had been 43 and 53 referrals respectively, reducing demand on ED.

The Committee agreed-

1.    To recommend that councillors promote the ICB ‘Comms plan’, and Choose Well Campaign amongst their wards and residents;

2.     Note the reports.