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Apologies for Absence
Apologies for absence were received from Councillors Jonathan Caleb-Landy and Mercy Umeh, and Co-optee Keith Mallinson.
Declaration of Interest
If a Councillor has a disclosable pecuniary interest in a particular item, whether or not it is entered in the Authority’s register of interests, or any other significant interest which they consider should be declared in the public interest, they should declare the existence and, unless it is a sensitive interest as defined in the Member Code of Conduct, the nature of the interest at the commencement of the consideration of that item or as soon as it becomes apparent.
At meetings where members of the public are allowed to be in attendance and speak, any Councillor with a disclosable pecuniary interest or other significant interest may also make representations, give evidence or answer questions about the matter. The Councillor must then withdraw immediately from the meeting before the matter is discussed and any vote taken.
Where Members of the public are not allowed to be in attendance and speak, then the Councillor with a disclosable pecuniary interest should withdraw from the meeting whilst the matter is under consideration. Councillors who have declared other significant interests should also withdraw from the meeting if they consider their continued participation in the matter would not be reasonable in the circumstances and may give rise to a perception of a conflict of interest.
Councillors are not obliged to withdraw from the meeting where a dispensation to that effect has been obtained from the Audit, Pensions and Standards Committee.
There were no declarations of interest.
(a) To approve as an accurate record and the Chair to sign the minutes of the meeting of the Health, Adult Social Care and Social Inclusion PAC held on Wednesday, 4 March 2020; and
(b) To note the outstanding actions.
The minutes of the previous meeting held on Wednesday, 4 March 2020 were agreed as an accurate record.
This report provides a summary of the key actions that Adult Social Care services undertook during Covid 19 pandemic.
At the request of the Chair that Items 4 and 6 be considered together.
Item 4: Summary of ASC’s Response to Covid-19
Lisa Redfern provided a summary of key work undertaken by Adult Social Care and Public Health, jointly working with the NHS and H&F CAN volunteers. This had been a time of significant challenge, but excellent work had emerged which had saved lives and protected residents. There had been much learning gained by Council staff and volunteers working jointly and effectively at pace on several areas in an agile manner.
The Council had worked hard to provide social care and support for residents. Four months ago, a situation where people could telephone if they were lonely or isolated, seven days per week, could not have been envisaged and this was a remarkable achievement. Lisa Redfern expressed how proud she was that local volunteers had triumphed demonstrating what could be done with the right attitude. This paved the way and offered a blueprint for working collaboratively in the future.
The Council had improved relationships working closely with the NHS which led to a great deal of innovation and improved relationships. There had been many gaps in the provision of PPE (personal protective equipment, and unclear test and tracing protocols, but the successful delivery of local solutions had won the day. There was an urgent need for social care reform and the pandemic had exposed weaknesses in the care system demonstrated by the crises in care homes.
Covid-19 had shown there had been no regard for care home staff and residents or staff. Social care reform was not just a matter of funding; it was about ensuring parity of esteem between health and social care provision. Lisa Redfern was of the view that there had been no “protective ring” around care homes implemented by central government. Testing patients discharged from hospital into care homes had formed part of the H&F, local solution.
Lisa Redfern expressed concern that test and tracing nationally appeared rudderless. Locally, a team had been established by Linda Jackson and Dr Nicola Lang to work with environment colleagues and staff at Imperial College Healthcare NHS Trust.
Professor Tim Orchard concurred and felt that to state that there was a “protective ring” around care homes stretched the truth. Work that had been done with care homes and clinicians around infection control based at Charing Cross hospital had been very helpful. He recounted the experience of Lombardy which pre-pandemic had one of the best, acute healthcare systems in Europe but had run out of beds in March 2020. In addition to dealing with PPE shortages there had been a shift in focus, and they were forced to make decisions about which patients could be treated in intensive care units (ICU). In principle, he was of the view that discharging patients was not a concern if they did not have symptoms, but, recognised that the circumstances of patient discharge had not been properly thought through.
Professor Orchard also ... view the full minutes text for item 4.
PUBLIC HEALTH UPDATE FOR HISPAC
This discussion aims to focus on how health partners have sought to protect residents and staff in care homes in the Borough through testing for Covid 19, working closely with the Council.
Dr Lang provided an update on the work carried out by Public Health which covered three main areas: care home testing, testing in schools and Covid-19 BAME issues. Dr Lang expressed her thanks to the support provided by Imperial clinicians that had stepped up to work collaboratively across nine different specialities to help form multi-disciplinary teams which included professors, virologists, senior matrons, paediatricians and epidemiologists. The group had been generous with their time and expertise, for which Dr Lang expressed her thanks.
A rigorous testing regime was established which included repeat testing. The work of the group had solidified and produced considerable guidance in response to a unique situation, with patients being discharged and readmitted to a care home. The generosity of all those involved became an immensely powerful force that had unified around a common purpose to find a solution to an urgent situation.
Describing the work on testing with schools, five H&F primary schools in a national Covid-19 study which Dr Lang regarded as a helpful corollary around increased school attendance. A piece of work to address the concerns around the disproportionate numbers of BAME groups affected by Covid-19. This included work with H&F GPs, smart messaging on YouTube planned on Type 2 diabetes. Dr Lang and colleagues had also met with a local Somalian group and began to engage with faith groups, facilitated with the help of Aysha Esakji (Community Coordinator, Safer Neighbourhood and Registrar services, Housing).
Councillor Lloyd-Harris sought further details about the national school’s study that the five H&F primary schools were participating in.
The selection criteria in choosing the schools to participate included the percentage of BAME pupils. Keith Fernandez (Workforce Development Officer, Children’s Services) had moved quickly to analyse BAME data to identify suitable schools.
Councillor Coleman stated that the Health and Wellbeing Board had set in train several strands of work that targeted the impact of health inequalities on BAME groups and stated that report from Public Health England and its recommendations would be taken forward by the Council. Local work would be undertaken to consider the evidence that would indicate the positive impact of Mutual Aid Groups, H&F CAN and community groups and how this was harnessed to support residents.
Jim Grealy commended the work undertaken on BAME and Covid-19 related concerns and the remarkable support offered by Imperial. The levels of deprivation and poverty experienced by BAME groups in poorer parts of the Borough had been recognised as contributory factors in the high rates of Covid-19 amongst BAME groups and Jim Grealy asked about the kind of work that could be undertaken to alleviate poverty. He also expressed an interest in any advice offered to shielding groups regarding mental health and wellbeing.
Dr Lang concurred that deprivation was a huge factor, coupled with overcrowded housing. The Office for National Statistics had analysed data indicating a link between the lack of outdoor space (garden) and BAME groups. People who lacked access to an outdoor space were more ... view the full minutes text for item 5.
Implementation of Test and Trace
This discussion will focus on the work around Covid 19 test and tracing, and plans for implementing this process locally and nationally.
Lisa Redfern provided a verbal update on arrangements to implement test and trace protocols.
When the concern around the vulnerability of care homes had become apparent, a programme board had been established about two months ago, which included Dr Lang, Linda Jackson (Chair), colleagues from environmental health teams to collectively address this. A local system had been successfully implemented.
Lisa Redfern queried as a fundamental failure why the UK had not nationally adopted a test and trace app model, as implemented in places such as Germany. There were still cases of people being discharged from hospital (regardless of support needs) without being tested and therefore lacked information as to whether they were infected by Covid-19. She firmly believed that the lack of a functioning app would limit test and trace protocols as tracking one case of Covid-19 took considerable input.
Linda Jackson provided more detail about the work of the programme board which included officers from across the Council. The group was required to formulate detailed local outbreak control plans which would focus on support for vulnerable groups such as rough sleepers, care home residents, anywhere where there were high numbers of people would congregate.
Working with Imperial colleagues, they had exceeded the brief and had additionally developed plans for e.g. travellers, sheltered housing or residents in homes of multiple occupation. National information had been poor on this and sharing data for safety reasons to inform the plans was not regarded as a breach of data confidentiality and Linda Jackson was confident that this would meet public expectation as the minimum standard required to ensure people were kept safe.
They had tested the outbreak control plans and worked closely with NHS colleagues and GPs to develop them further so that plans could be quickly activated. A communications strategy had been planned which involved the Leader writing to residents of the Borough, language translations and being proactive in advocating the importance of test and trace so that vulnerable communities could be protected. Dr Lang had also proactively engaged with local faith groups to that information about test, trace and prevention was being communicated.
Dr Lang described her work with Public Health England. Each day, data was provided with the anonymised and sparse details of any cases identified within the Borough. The incomplete data on each patient resulted in a fragmented picture of people who had tested positive. Dr Lang briefly outlined Pillar 1 to 4 tiers and the complexities of the testing arrangements, but the difficulties of data sharing meant that it was harder and more time consuming to identify residents.
Bringing together Imperial and Public Health information alleviated data sharing issues, uniting patient details with the post code and building the identity of the Covid-19 positive individual. Pillar 1 testing included those who had tested positive through the NHS, either in a hospital or at a GP site. Pillar 2 were tests conducted through drive through hubs or with a home testing kits. Both pillar 1 and 2 data were ... view the full minutes text for item 6.
The Committee is asked to consider its work programme for the municipal year 2020/21.
Councillor Richardson invited members to contribute suggestions for the work programme and offered the option of meeting virtually.
That the report be noted.
Dates of Future Meetings
Wednesday, 2 September 2020
Wednesday, 4 November 2020
Tuesday, 26 January 2021
Tuesday, 30 March 2021
The date of the next meeting of the Committee was noted as 2 September 2020.