Agenda item

Resolved: the committee agreed to refer its views to Mayor and Cabinet in the following terms:

Given the concerns expressed about centralised and outsourced services, the committee recommends to Mayor and Cabinet that Lewisham Council adds its voice to those of other councils demanding funding and support from central government to establish a locally-led test and trace system embedded within the Council, its public health team and primary care. The committee asks Mayor and Cabinet to make the representation necessary to make its voice heard on this issue.    

Tom Brown (Executive Director for Community Services) and Lewisham health and care partners (Donna Hayward-Sussex, Service Director, SLaM; Angela Helleur, Chief Nurse/Chief Operating Officer, LGT; Simon Parton, Chair, Lewisham Local Medical Committee) introduced the report and the following key points were noted:

1.1      The Lewisham health and care system recovery plan sets out what local health and care partners intend to do to continue and accelerate our efforts to tackle inequalities and improve health and wellbeing in Lewisham.

1.2      Key priorities include: early intervention, supporting prevention, building community resilience, supporting our hospitals and care homes, and looking after our residents’ mental health.

1.3      This includes children and young people, those in crisis, those with long-term conditions, those living in increased poverty and therefore more prone to the negative impacts of the wider determinants of health, and our staff.

1.4      Health and care partners are also utilising the opportunities presented digital growth to further reduce barriers to accessing services.

1.5      The focus of Lewisham and Greenwich NHS Trust’s (LGT) plans for recovery include: to fully restore cancer services; to restore 90-100% of elective activity by October; to optimise use of the independent sector; and to implement stringent infection prevention control procedures. The Trust is also working closely with other acute providers in southeast London to maximise equity of access.

1.6      The South London and Maudsley NHS Foundation Trust (SLaM) introduced a number of measures during the pandemic, including: providing mobile phones to patients to help stay in touch; creating “hot” and “cold” wards for patients depending on their Covid diagnosis; and working with social care to identify and care for the most vulnerable patients.

1.7      The Trust is now looking to resume its community transformation programme, which is about working closer with GPs and sharing patient information.

1.8      Working with LGT the Trust has set up a new assessment function to see more patients presenting with mental health issues outside of the emergency department, and this is being increased to six rest bays this autumn.

1.9      In terms of inequalities, the Trust is currently working with partners and colleagues to create BAME-specific, culturally sensitive services and interventions. The feedback from service users has been that services can be very difficult to access and leave.

1.10   During the pandemic GPs mobilised a range of consultations methods, including via the phone and internet. GPs also continued to provide face-to-face consultations and quickly created “hot sites” where patients could be safely assessed with the appropriate PPE.

1.11   GPs also worked with local partners to support shielded patients and to reach out to other vulnerable groups who may not have access to the internet.

1.12   For the second wave GPs are looking, in particular, at how they can continue to support vulnerable and isolated patients, and those with long-term conditions, in a safe environment.

1.13   Dr Simon Parton also noted his thanks to NHS commissioning colleagues who provided GPs with the capacity to deal with the pandemic by pausing on some of their GP contractual obligations.

1.14   Dr Simon Parton also thanked local patients for their continued understanding during the pandemic.

There was a discussion and the following key points were noted:

1.15   The independent sector was commissioned by NHS England Improvement to provide capacity while acute NHS hospitals paused most of their elective work. As the independent sector didn’t have patients with Covid they were able to protect their pathways. The contact for this was agreed at NHS rates.

1.16   Local health partners are engaging with the independent sector as part of recovery plans to reduce waiting lists.

1.17   It was also noted that the Council, Lewisham Homes, Phoenix Community Housing, and other registered providers, did a lot of work to identify and reach out to other vulnerable people using a wide range of methods.

1.18   During the pandemic GPs identified shielded and vulnerable patients by using an algorithm and searches on their IT systems. They reached out to patients over the phone, messaging services and the internet to reassure patients that they were still there to support. GPs were also able to identify those patients they weren’t reaching digitally and create other ways of contacting them.

1.19   One of the things SLaM has done, working with GPs, to improve access to acute mental health services is to introduce joint triage on GP systems so that people can get the appropriate support quicker. This has reduced waiting times for mental health services by 25 days.

1.20   SLaM noted that it is beginning to see an increase in those presenting at hospital emergency departments who have not been in contact with mental health services before. The partners in the mental health alliance are working to provide a joined up response.

1.21   SLaM is aware that black communities do not access mental health services readily and this is an area it is focusing on in partnership with the community.

1.22   There is concern about the long-term impact of the pandemic on children’s mental health and there are plans to include children’s mental health in the mental health alliance so that interventions and support can be developed collectively.

1.23   While LGT is trying to encourage digital consultation, it is recognised that it is not for everybody. Face to face consultations are still available for patients who may have an issue.

1.24   While no one yet knows the extent of the second wave of Covid, LGT and other health partners’ intention over the next six months is to continue to provide all services.

1.25   GPs are using digital platforms as a tool but these should never be seen as the only option.

1.26   There are plans to re-open the intensive support (ISR) day service in Ladywell in the coming weeks, depending on the Covid risk level. The ISR service provides support to those carers under the greatest strain. Alternative services and outreach services have also been offered and provided to others who may normally use day services.

1.27   A representative of the Save Lewisham Hospital Campaign recounted a recent poor experience with the NHS 111 service and argued that it showed how a centralised and outsourced service is failing Lewisham and national residents.

1.28   The representative asked the committee to join the national call for test and trace services to be embedded locally and to ask the council to add its voice to those of other councils demanding funding from central government to support the building back of a locally led test and trace system embedded within public health, the local authority and primary care.

Resolved: the committee agreed to refer its views on test and trace to Mayor and Cabinet.