To receive questions or statements on the business of the Committee from town and parish councils and members of the public.
Please note that public speaking has been suspended during the Covid-19 crisis. Each question or statement is limited to no more than 450 words and must be electronically submitted to email@example.com by the deadline set out below. The question or statement will be read out by an officer of the Council and a response will be sent to the person submitting the question or statement following the meeting.
All questions/statements and the responses will be published in full within the minutes of the meeting.
The deadline for submission of the full text of a question or statement is 8.30am on Monday, 29 June 2020.
Please note that in view of the public's interest in this subject and because of their pertinence to the topic being scrutinised, multiple questions have been accepted from individuals for this meeting.
Questions from Claudia Sorin - Responses by Public Health
The World Health Organisation has told constituent countries repeatedly that testing, track and isolate is the key to proactive management of COVID 19. There are many concerns about the national programme, including long waits for results, results going missing, and results coming back void. I understand that Dorset’s Public Health database showed in June that thousands of test results are still awaited, some from as long ago as February.
In some areas effective local test, track and isolate schemes have been set up, which use existing public health/GP structures – such as those for managing sexually transmitted diseases. These local schemes have several advantages over the national scheme including:
· councils had no control over private organisations' charges although they had intervened in two situations with the result that the approach had been withdrawn. Care homes would have to evidence how they were spending the additional funding and if this was not appropriate the support would stop;
· there had been significant changes in the home care market with regard to complexity and increased demand. People preferred to remain at home and working with providers gave an opportunity to promote Home First models with better outcomes for residents. Advice had been given to care providers on how to reduce the risk of infection being transferred between visits and transport support provided;
· DCCG had supported the roll out of infection control training to all care homes, home care providers, personal assistants etc. This continued as the risk of Covid-19 remained;
· joint working would continue. There were common agreed principles for the Home First programme, which aimed to keep people in their own homes for as long as possible, with appropriate support, and help them to return home more quickly from hospital.
Could the Joint Health Scrutiny Committee please advise:
1) Considering the advantages of local testing and tracing schemes as outlined above, will Dorset Public Health consider setting up a local scheme in Dorset, over which they would have much greater control?
2) How does Dorset plan to manage test, track and isolate?
3) The Chair of the Health Select Committee commented last week that “We do not know where about two thirds of new infections are happening, so we cannot feed them into the test and trace process”. What are Dorset’s plans for finding asymptomatic carriers?
4) How will those in insecure employment be supported to self-isolate?
5) Given concerns about asymptomatic carriers, and the Chair of the Health Select Committee’s further comments last week that about one third of new infections are of people who have caught C19 in hospital, or in care homes:
- are there plans for regular routine weekly testing of NHS and care staff, including those caring for people in supported living in the community?
- are there plans for regular weekly routine testing of hospital inpatients and care home residents?
6) Considering the advantages of local testing and tracing schemes as outlined above, will Dorset Public Health consider setting up a local scheme in Dorset, over which they would have much greater control?
We already work closely with the regional health protection team at Public Health England to respond to positive cases and their contacts. As local outbreak management plans are developed, this will set out our plans to respond to cases and outbreaks in different settings, including local testing.
Our local outbreak management plan sets out how Dorset Council and its public health team will work closely with Public Health England regional health protection team to respond to positive cases and their contacts identified by NHS Test and Trace. It is published on the Dorset Council website (30 June – link to follow).
Testing for asymptomatic COVID-19 cases is carried out in health care settings and in care homes currently. This is identifying low numbers of asymptomatic cases. In addition, if there was any local outbreak, more widespread testing would be undertaken to identify whether asymptomatic transmission was an important factor.
Local outbreak management plans are being developed that set out how we will provide support for people to self-isolate under different circumstances. This will be by extending the support offered via voluntary sector groups to people who have been shielding.
No not at this point in time.
No, all hospital inpatients are tested prior to admission or on admission and then prior to discharge if they are going on to a high risk closed setting eg to a care home or prison setting. Whole care home testing is available to care homes but at this point there is
Questions from Lisa Weir - Responses from the Dorset Clinical Commissioning Group
Infection control is crucial in managing COVID 19. Given that, according to the Chair of the Health Select Committee on 24th June, and based on SAGE data, around 1/3 of new infections are caught in hospitals or care homes, hospitals have been asked by NHS England what can be done to separate C19 patients from other emergency inpatients.
In Dorset, in the first C19 wave, mums-to-be were able to access maternity care in a separate building at Poole Hospital.
Having two A&E’s in the East, at Poole, and at Royal Bournemouth Hospitals, meant that we had more emergency beds during the first wave than we will have if there is no longer an Accident & Emergency department at Poole, as, at this point the Clinical Services Review is clear that emergency admissions at Poole will cease. Having two A&E’s in the East would also give the Hospital Trust the option, in future, to treat C19 emergency patients in one hospital, with non C19 emergency patients treated in the other hospital.
Under the process for scrutinising the Clinical Services Review, the plans were referred to the Secretary of State, and the Independent Panel who advised the Secretary of State have suggested that “A&E Local” is a “possible viable option” for Poole Hospital. What is A&E Local? Health Services Journal clarified in October 2019 that A&E Local is a full A&E that is closed overnight,* and the model of a full A&E closed overnight has been in operation for some years at Weston Super Mare.
In January, Richard Drax MP asked the Health Minister to reconsider the loss of emergency care from Poole. Following the Independent Panel’s advice, also received in January, Swanage, Bridport, Portland and Weymouth Town Councils and Corfe, Worth, Langton and Arne Parish Councils have written to Dorset Health Scrutiny requesting that Dorset Council support the A&E Local model for Poole.
Could the Joint Committee advise:
- What are the infection control plans to safeguard Dorset patients - older patients, patients with long term conditions, BAME patients, mums-to-be and newborns – and to meet NHS England guidance of separating C19 patients from other emergency patients during any future wave of this pandemic, or during any other pandemic?
- Whether the Joint Committee have arrived yet at any position in terms of support for A&E Local?
Infection control plans have followed national guidelines and best practice. Covid positive patients have been separated wherever possible, however with a long incubation period for the virus this effects the testing process, so it is not possible to say that someone is Covid ‘free’. Our hospitals use stringent ‘universal precautions’ for infection prevention and control including, but not restricted to, PPE (personal protective equipment), social distancing, increased cleaning and decontamination of equipment. Emergency patients are segregated on admission and there are processes in place for elective patients to test and shield prior to surgery. In primary care we have created “hot and cold” sites to separate people who are suspected of having C19. We will continue to provide electronic consultations where practicable to prevent unnecessary visits to healthcare premises.
Questions from Chris Bradley - Response from the Dorset Clinical Commissioning Group
The need for Dorset acute beds to be freed up for Covid 19 patients: the consequences for Care Home residents and planned operations patients
Due to the need to free up acute hospital beds for C19 patients, Government Guidance from 19th March encouraged the Care Sector to accept patients discharged from hospital and patients who had become unwell in their own homes, reserving hospital beds for ‘acutely sick’ patients. There was no requirement to test patients moving into care homes: indeed, Government Guidance encouraging Care Home to take patients stated:
“Some of these patients may have COVID-19, whether symptomatic or asymptomatic. All of these patients can be safely cared for in a care home if this guidance is followed.”
Freedom of Information Act requests show that 270 people were discharged from Dorset hospitals, untested, into Dorset Care homes.
The Office for National Statistics database shows that, at 29 May 2020, 329 people had died of COVID 19 in Dorset. This includes 157 patient deaths in Dorset care homes, a slightly higher number than the 154 patients who have died of C19 in Dorset hospitals.
In addition to concerns about patients arriving in care homes with C19, there have been ongoing national issues in relation to timely access to adequate PPE, particularly in Care Homes. The need to free up acute hospital beds for C19 patients has also meant that planned operations have been cancelled, including some urgent cancer operations, which have been postponed.
In any future waves of C19 or indeed any other pandemic, could the Joint Health Scrutiny Committee advise what will be done to ensure:
- we have enough acute and critical care beds to cope with a second C19 wave, or, indeed, another pandemic? Current planning indicates that there will be no emergency care beds at Poole, and 74 less acute beds at Dorset County. Although beds at Bournemouth Hospital will increase, there will be 245 less acute beds over our three Dorset hospitals*.
- we have enough acute beds to maintain planned operations?
- no one who is infected is either discharged from acute hospital, or admitted from home, into a care home?
- there will be timely access to adequate PPE for carers?
Could the Joint Health Scrutiny Committee also advise what the plans are to resume planned operations, what the backlog is, and when it is expected that we will catch up to where we were before the pandemic, given that, even at that time, people were waiting much longer times for planned operations than they were, say, 10 years ago?
The future plans for East Dorset has more critical care beds than the current provision. No health system is permanently established to cope with a pandemic level of service requirements, hence why the Nightingale Hospitals were introduced to cope with huge surges in demand.
The halting of planned operations was a clinical risk judgment, balancing the benefit of the procedure versus the risk of catching Covid for both the patient and the NHS staff. Emergency procedures and being prepared for a surge in very ill patients with Covid took priority for beds due to the potential for large numbers of patients requiring them. Services requiring no beds at all took a similar approach, i.e. dental services.
National guidelines were followed in relation to discharges. However with a long incubation period for the virus this effects the testing process, so it is not possible to say that someone is Covid ‘free’, hence PPE (personal protective equipment) and distancing measures are used for all patients. All patients leaving hospital going to a care home and admissions to a care home are tested for Covid prior to admission.
National guidelines were followed in relation to the PPE.
Planned operations are gradually resuming, but this remains a clinical risk judgment, balancing the benefit of the procedure versus the risk of catching Covid for both the patient and the NHS staff. PPE (personal protective equipment) and distancing measures remain a factor for stepping services back up. It is too soon to say when the NHS will have caught back up with the pre Covid position, especially considering we are still in the pandemic/major incident phase.