The Sub-Committee noted that the Council (i) and its health partners are responsible for commissioning and delivering appropriate care, support, and assistance to people with learning disabilities that live in the Borough; (ii) is committed to enabling people with learning disabilities to maintain their independence with services ranging from giving advice and information through to long-term residential care.  The main points of the discussions arising from the questioning on the presentation maybe summarised as follows:

The Sub-Committee:

v  Was reminded that a Health scrutiny challenge session took place on the 10^th March 2020 reviewing “How health and social care is supporting adults with a learning disability to live independent lives in Tower Hamlets”, focusing on three main areas of the Learning Disability Strategy: Health, Accommodation and Employment.

v  Noted that due to the impact of the pandemic, the Sub-Committee were interested in revisiting the same three areas in February 2021. An updated report that included an impact assessment of the pandemic for the learning disability population was discussed at the Health & Adults Scrutiny Sub-Committee meeting.

v  Noted that a report was taken to Cabinet on the 15th December 2021, that included an update and action plan based on all recommendations from both the March 2020 and Feb 2021 Health & Adults Scrutiny Sub-Committee meetings.

v  Was advised that work to take these forward has continued throughout the pandemic with progress made in these areas reflected within the action plan.

v  Noted that the NHS will now be offering a mixture of face-to-face, telephone and online GP appointments, and were reassured to hear that if patients need to be seen face-to-face, they will be.  The Sub-Committee indicated that the NHS should (i) continue to offer face-to-face appointments; (ii) design a new service model which needs to be planned carefully and with close engagement with those communities who will be most affected.

v  Noted that It's always important to the Royal London that they hear from patients whether the feedback is good or not. As whilst the Royal London is proud of its customer service, it is accepted that sometimes they fall short of the mark and if this has happened and a patient has  experienced poor service, the Royal London wants to know so that they can deal with any concerns as quickly as possible. As the sooner they are told then the sooner they can assign someone to investigate the complaint and resolve it.

v  Noted that the NHS use a P5 category that identifies any patient as having requested to remain on the waiting list but to defer treatment because of their concerns about COVID-19.

v  Noted that during the spread of COVID-19 hospitals had to postpone non-emergency operations to avoid putting patients at risk and ensure that hospital resources, beds, and equipment are available to treat patients who are critically ill with COVID-19.  However, the NHS as it has gradually reintroduced planned operations have produced advice for patients waiting for surgery to address concerns and provide guidance on how you can prepare for your operation.

v  Noted that surgical teams discuss with patients the benefits and risks of surgery as part of your shared decision-making, before going ahead with your operation. This will include consideration of any risk to you from delaying treatment. If you are in a high-risk group for contracting COVID-19, or if you have serious underlying medical conditions, it may be suggested that your operation is deferred until later, when it would be safer for you.

v  Noted that the Boroughs hospitals are taking every possible measure to minimise any risk of infection. This includes training hospital staff on how to limit the spread of the virus through frequent hand-washing and social distancing within local hospitals; regular deep cleaning; use of personal protective equipment; testing staff and patients for COVID-19; and treating patients who have symptoms or who have tested positive for COVID-19 in separate units or areas. 

v  Was informed that whether a patient is having a discussion about a rescheduled operation or having an initial pre-operative assessment with a member of the surgical team, this consultation may take place online or by phone, rather than face-to-face, to limit the number of people coming to hospitals while COVID-19 is still present in the community. In addition, any visits to hospital should only occur when absolutely necessary, such as when urgent scans or other examinations are required.

v  Noted that North East London Integrated Care System (NEL ICS) over recent years partners and stakeholders have changed how they work and plan services to bring health and social care services closer together for the good of the communities that they seek to serve.  This has been highlighted by the ongoing coordinated response to Covid-19 where NHS organisations, local councils and community groups are all working together to provide the care for communities in an efficient, effective, and joined up way. Not only does this provide the best experience for the local population, but it also makes sure the best use of vital resources.

v  Was advised that patient information would only be shared where it facilitates care for an individual and it is legal to do so. This sharing requires the patient to be informed and provide them with an opportunity to object. This includes (i) all providers and agencies involved in a person’s care, including the role that carers and family may play and (ii) sharing relevant information on admission to and discharge from different care settings.

v  Agreed on the importance of the Trusts family contact centre during the pandemic that allowed families who could not visit their loved ones to stay in touch with them.  The centre has allowed families to receive regular updates during this time on how their loved one are doing, to pass on messages to patients if they cannot be reached directly and to help them arrange virtual visits using video calling.  All contact being through a nominated next of kin or the nominated contact person for reasons of patient confidentiality and was developed in consultation with multi faith forums, community leaders and general practitioners.  This dialogue proved to be particularly of importance with regard to (i) the Trusts general wards where families could not visit their relatives and visiting rules had therefore be changed; and (ii) clinicians who were in a constant discussion with patients and general practitioners to improve communication and open up those lines of dialogue so that patients are not having to go to their back to their general practitioner to ask questions.

v  Noted that the Trust are working with the Patient Welfare Association and Healthwatch to discuss future the development of communication pathways and would be happy to give an update to the Sub-Committee at a future meeting it that was felt to be helpful.

v  Agreed that it would welcome such an opportunity to discuss future the development of communication pathways and agreed that this should be added to the Sub-Committees Action Points.

v  Noted that the backlog for care needs to be considered as there has been over the pandemic fewer referrals for hospital with more patients having their conditions managed by their general practitioner or in the community.  This has meant that it is unclear as to how many more people will be in need urgent or routine care  Therefore, even with the positive news of a vaccine, the impact of Covid-19 on waiting times for NHS patients will be felt for years to come. As in spite the best efforts of hard-working staff, there simply is not the capacity to get through the backlog quickly. With current staffing levels it will be a challenge just to keep up with demand, let alone reduce the backlog.

v  Agreed as a direct result of shutdowns of medical services over the period of the pandemic now the NHS faces a huge backlog of non-COVID-19 care. In addition to hospital care, the impact is also being felt by those trying to access GP care.  Accordingly, that this issue should be added to the Sub-Committees Action Points.

v   

As a result of a full and wide-ranging discussion on the issue’s raised the Chair (i) thanked all those attendees for their contributions to the discussions; and (ii) moved and the Sub-Committee RESOLVED to:

v  Noted the progress made since March 2020 against the initial challenge session recommendations.

v  Noted the presentations and updated action plan; and

v  Agreed the addition to the Sub-Committees Action Points of (1) communication pathways; and (2) the impact of Covid on those trying to access hospital and GP care.