Throughout the COVID-19 pandemic, Clinical Commissioning Groups throughout Lancashire and South Cumbria have worked effectively with their local partners across the Integrated Care System (ICS) to manage the local response, enabling joint decision making towards the operational management of services and ensuring consistency in partner, staff, patient and public communications.Local Resilience Forums (LRFs) were formed with representation from across the ICS including NHS, local authorities, social care, education, police, fire, and armed forces as well as the voluntary, faith and community sector. They worked together to manage the response to COVID-19, including personal protective equipment (PPE), rolling out testing and vaccination programmes, supporting vulnerable communities, communicating key messages, and continuing priority work programmes.
One of the first responses was the setting up of Hospital and Out of Hospital incident response cells in Lancashire and South Cumbria. The cells’ earliest priority was securing the capacity to deal with the first peak through mutual support and agile response to pressures. During the second phase, they restored the delivery of frontline elective clinical services. Working arrangements were designed to lock-in positive changes in care models, operational processes, and data sharing. Both cells operated under the North West Regional incident command structure.
The Hospital cell covered elective care, tertiary services, critical care, cancer, mutual aid and clinical prioritisation. The Out of Hospital cell co-ordinated the work of community services, mental health, learning disabilities and primary care. It also worked with social care, with a Care Sector sub-cell run jointly with the Lancashire LRF and with connections to Cumbria. A Joint-Cell brought these two groups together supported by system-wide functions such as: workforce, digital, communications and engagement and included clinical representation, military support and representatives from North West Ambulance Services. Shared sub-cells covered the key areas of testing, digital strategy, PPE and clinical supply, and planning – the latter involving close liaison with Business Intelligence colleagues. The cells and sub-cells continue to meet regularly and produce regular updates for partner organisations, MPs, and councillors.
The Gold Command Winter Pressures Room was established in preparation for the second wave of the pandemic. Its initial purpose was to support local NHS operational activity and Out of Hospital services facing winter pressures. As a tactical support service, it monitors and analyses pressure on individual hospital trusts and organisations – including A&E attendances, COVID-19 cases, people awaiting a COVID test result before admission, staff sickness, bed capacity, discharge delays, and queueing ambulances. Data is looked at from a system perspective, and capacity redistributed to where it is needed most.
Work at the command room, as well as the System Vaccinations Operations Centre (SVOC), is ongoing seven days a week through collaboration between all CCGs and trusts, NHS England and Improvement (NHSEI) leads and ICS executives. It has made a phenomenal difference in terms of collaborative working and system thinking for the benefit of patients.The Fylde Coast Integrated Care Partnership is represented in the Gold Command structure and information is shared to manage the local response.
As the availability of personal protective equipment (PPE) was identified as a key issue in April 2020, the Lancashire and South Cumbria PPE and Consumables Policy Group was established to ensure a consistent approach to PPE usage and inform capacity planning for hospitals. This was soon extended to cover PPE policy for primary and community care, ensuring a consistent system-level approach.
The start-up of a local manufacturing route in late June provided a sustainable and reliable supply, as well as creating around 100 new jobs in Preston. A re-usable gown service provided another sustainable source, which was also promoted and used nationally. These initiatives complemented good practices such as the day-to-day careful monitoring of stock and the management of allocation.
The LRF supported in distributing PPE to nursing and care homes, informing all organisations and groups about the process for ordering stock. Public guidance about appropriate PPE use was kept updated on the Lancashire and South Cumbria ICS website and shared through social media.
A successful rollout of COVID-19 antigen testing took place across Lancashire and South Cumbria, covering NHS and social care staff, patients, care home residents and the public – including though workplaces. A Lancashire and South Cumbria NHS Testing Group worked with the LRF and the Hospital and Out of Hospital Cells. Partners collaborated to organise and implement COVID-19 testing across the region, which included PCR, Lateral Flow and LAMP testing, rapid tests for patients in acute hospitals, setting up regional and local testing centres, plus mobile testing units. The armed forces also helped nearly 200 local businesses and organisations establish rapid testing of their employees.
Asymptomatic testing was also rolled out, with the aim of preventing transmission and community spread. Originally introduced in NHS trusts, Lateral Flow tests are now being used for regularly testing essential workers and members of the public who are most at-risk from the virus. As part of the full re-opening of schools in March 2021, additional opportunities for asymptomatic testing were made available for households and bubbles of school pupils and staff.
Both the Fylde Coast CCGs work in partnership with the two main upper tier local authorities serving the population: Blackpool Council and Lancashire County Council respectively. The CCG has been an active partner in the development and delivery of health and wellbeing strategies in both areas. Delivery against the Strategies in 2020/21 has been significantly impacted by the COVID-19 pandemic.
Both Health and Wellbeing Boards reviewed their responses to the pandemic on an ongoing basis to ensure partners supported the public and each other in a way which minimised health inequalities as far as possible. Both Health and Wellbeing Boards have contributed to the Incident Management Recovery Plans developed by the Local Resilience Forum. The CCGs have played a crucial part in this process.
In November 2020, a COVID-19 Vaccinations Board was set up to provide oversight to the COVID-19 vaccination programme in Lancashire and South Cumbria, as operating procedures, decisions and guidance emerged nationally. The team supported the coordination and development of various vaccination sites and provided strategic nursing and pharmacy capability.
With the support of partners, East Lancashire Hospitals NHS Trust acted as lead provider to recruit staff to support the large vaccination centres. The centres are additionally resourced with members of CCGs, NHS Midlands and Lancashire Commissioning Support Unit, hospital trusts and wider system colleagues.
Since December 2020 to the end of March 2021, around a million people in Lancashire and South Cumbria have been vaccinated – including more than 97 per cent of over-70s. Vaccines have been delivered at 11 hospital hubs, 36 GP-led Primary Care Network (PCN) vaccination centres, 12 pharmacy-run centres, seven large vaccination sites, and care homes, as well as to housebound residents. A new risk assessment tool (QCOVID®) helped identify an additional 19,000 adults potentially at a high risk from COVID-19, who were then prioritised to receive the vaccine.
Partners including local councils, the military, police, local businesses, volunteers, returning clinical staff and many more have supported the delivery of the vaccine. More than 1,300 local people offered their support following an appeal for volunteers, and a total of 50,000 volunteer hours have been undertaken so far (up to the end of March 2021).
The Fylde Coast CCGs started their COVID-19 Vaccination Programme on 4 December 2020. We now have seven GP Primary Care Networks (over nine Local Vaccination Sites) and three Pharmacy Networks (over three Local Vaccination Sites) plus a Mass Vaccination Site at Blackpool Winter Gardens which went live on 25 January 2021.
There are four main delivery arms on the Fylde Coast:
- Primary Care Networks (PCNs)
- Community Services Care Homes Team (acting on behalf of the PCNs)
- Blackpool Teaching Hospital NHS Foundation Trust
- Winter Gardens – Mass Vaccination Site
The CCGs are facilitating a well-run and well managed programme from all our delivery partners and across the Fylde Coast we host a weekly delivery partners meeting where all partners can share and learn from each other.
Blackpool Teaching Hospitals NHS Foundation Trust (BTH) Community Services have supported Primary Care Networks in the delivery of the COVID-19 vaccine to care home residents and housebound patients across the Fylde Coast. Staff from the neighbourhood care teams, care home team and other community services have been redeployed to support the vaccine programme to ensure the population are vaccinated in line with the national trajectories.
On the Fylde Coast up to April 2021 we have vaccinated over 60 per cent of our adult population with that growing every day. We have followed the Joint Committee on Vaccination and Immunisation (JCVI) guide closely on vaccinating Cohorts 1- 9 which includes our care homes, housebound, homeless and those most at risk of catching COVID-19. We have vaccinated over 90 per cent of our Health and Social Care staff and are now well underway with second dose vaccinations.
There has been a focus on clear communication of public messages, including materials in different languages and formats, about the importance of being vaccinated and how to attend appointments safely. Insight research started in early 2021 to understand views and attitudes towards the vaccine within health inequalities groups and vulnerable communities to inform adjustments in messaging and approaches.
COVID virtual wards
COVID-19 virtual wards were launched to monitor vulnerable patients with COVID-19 in their own homes. Hospital trusts, GP practices and local providers worked together to provide the pulse oximetry at home service for eligible patients, identified as being particularly at-risk from the virus due to their age or a pre-existing condition.
The service on the Fylde Coast commenced on 16 November 2020 and was designed by the CCGs to reduce the risk of COVID positive patients deteriorating as a result of silent hypoxia, through the monitoring of their oxygen saturation levels.
Patients are given a pulse oximeter so they can measure the oxygen levels in their blood several times a day, which helps spot the early signs of silent hypoxia; when the body is starved of oxygen but without causing noticeable symptoms such as breathlessness.
Locally the service is delivered by Fylde Coast Medical Services (FCMS) working alongside system partners Blackpool Teaching Hospital Trust and Primary Care Clinicians. The service is provided virtually using a digital solution and telephone contact, so patients remain in their own homes (or usual residence e.g. Care Home).
The service receives referrals from GP practices in the Fylde Coast and from consultants at Blackpool Teaching Hospital NHS Foundation Trust to a COVID Virtual Ward.
Up to 31 March 2021 the service on the Fylde Coast has seen over 500 referrals with just 10 per cent of patients being admitted to hospital.
Patients using the service have said:
- The support received was amazing and so reassuring.
- I applaud everyone that has worked tirelessly to keep us all safe during this pandemic.
- I would like to thank the nurses that kept ringing me daily to check my mother was ok
- I felt more at ease knowing that my readings were monitored as I was worried that I would end up in hospital.
- I would have been much worse without their care and genuine concern. I would like to tell them thank you so much. You got me through it.
This effective digital solution enables early treatment to be given, which both improves patients’ chances of recovery and ensures that they only go to hospital if necessary.
Designated settings (safe discharge from hospital)
CCGs have worked with local authorities collaboratively across Lancashire & South Cumbria to put in place a network of ‘designated settings’ for COVID-19 care. These settings ensure that all people requiring admission to a care setting or back to their own care home can be discharged from hospital safely, which helps to reduce the spread of the virus within other care settings.
A ‘designated setting’ allows the resident to undergo the necessary period of isolation, which could be up to 14 days. Working with providers and our community, CCGs developed these settings across seven of the eight CCG areas in Lancashire and South Cumbria, but allowing access to settings from all CCG areas, with the first ones in place from November 2020.
Lancashire County Council and Blackpool Council hold the contracts for the services commissioned from the care homes involved, but the costs are being recharged via the CCGs to the National Discharge Fund. CCGs commissioned the associated medical oversight/input into their homes. They were inspected before the service commenced by the Care Quality Commission (CQC) to make sure the policies, procedures, equipment and training were in place to maintain infection control and support the care needs of residents.
On the Fylde Coast we have worked with local partners to identify designated setting facilities at two locations.
Long COVID service
In October 2020, NHS England/Improvement launched its five-point plan to support people with post-COVID-19 syndrome (also known as ‘Long COVID’).
Working across Lancashire and South Cumbria local Integrated Care Partnerships (ICPs) have been working to create a Post COVID-19 Service for patients with signs and symptoms that develop during or after an infection consistent with COVID-19, and are not explained by an alternative diagnosis
On the Fylde Coast the service launched in March 2021 with a local team based at Blackpool Teaching Hospitals NHS Foundation Trust.
The service has been developed on a tiered approach to the management of Post COVID-19 syndrome which is weighted by the level of intervention necessary for each patient from Tiers 1 – 4.
Tier one – Self-management
Tier two – Generalist assessment & support via GP practice.
Tier three – After GP referral to the holistic assessment hub at Blackpool Victoria Hospital the patient commences a treatment plan which may include referrals to specialist services such as pulmonary rehabilitation, pain management and dietetics should it become necessary.
Tier four – Complex patients will receive specialist input and rehabilitation through a regional multi-disciplinary team led by Lancashire and South Cumbria NHS Foundation Trust.