Agenda item

Covid-19 Update

This verbal report from the Director of Public Health, Director of Covid-19 Response & Recovery NHS Colleagues provides an update about the following areas:

·       Test, trace and isolate – findings, next steps

·       Vaccination – prioritisation and distribution

·       Covid-19 and winter planning – NHS readiness, resident well-being

Minutes:

Linda Jackson and Dr Nicola Lang provided a joint verbal update on the Council’s activities in response to Covid-19.  Linda Jackson outlined the work and impact of the contact tracing programme which had gone very well.  Tracing data provided consisted of those individuals whom NHS contact tracers had been unable to contact.  By comparison, the H&F programme had successfully contacted 99% of this group, achieved by a combination of door knocking and phone calls.  Councillor Coleman observed that the rate nationally for contact tracing was 60% and that of the cohort that the Council had been asked to trace, the rate was even lower at 40%.  It was commented that the lack of impetus at a critical, earlier time would have made a significant difference and that it had been a disastrous government failure to not introduce local contract tracing and other preventative measures sooner.

 

Members of the Board commended Linda Jackson and her staff, regarding the results as an excellent achievement and a positive example of local expertise and knowledge being applied so successfully, under difficult and challenging circumstances. 

 

H&F were one of the first London councils to undertake lateral flow testing and had rolled out a targeted testing programme in care homes, with residents and staff, GPs and GP practice staff, with the possibility that this might be further extended to include sheltered housing schemes and in tandem with PCR (polymerase chain reaction) testing, in line with government guidance. The main difference between the two tests was that there was greater likelihood of a false negative with the lateral flow test. This combined approach allowed for testing in care homes.  It was reported that the vaccination programme both locally and nationally was being led by the NHS.  The local CCGs were working to help roll out vaccination programmes in a planned way and the mantra “hands, face, space” was still very much relevant in terms of prevention and awareness of the priority need for infection control.  The Liverpool mass testing programme was currently underway and although a decision had been taken to not adopt the same approach, Linda Jackson confirmed that they had an in depth understanding of local needs and were able to work with the local communities.  High risk, vulnerable groups had been identified and a planned and phased roll out would be undertaken with care homes, followed by primary care networks.  There were also plans to train staff as swabbers.  It was confirmed that the council currently had enough test kits. 

 

In terms of the flu vaccination, Dr Nicola Lang confirmed that the rate of uptake had not been as high as was hoped and that corrective action to address this was in progress through improved communications utilising social media and that Public Health were engaged in work with local faith communities.  Rates had been poor, but as Lisa Redfern observed, there had been a slight improved during the past two weeks evidenced by a 2% increase in uptake.  The need for closer monitoring was accepted and following discussion it was agreed that the issue would be considered at the next Health, Inclusion and Social Care Policy and Accountability Committee meeting on 26 January 2021.  Janet Cree concurred and pointed that rates of uptake were low across all cohorts but particularly low in the under 65 age group who were at risk. 

 

Vanessa Andreae reported that the rate of uptake had surpassed figures for the previous year which represented huge progress given the need for social distancing.  Councillor Coleman commented that the borough had one of the lowest uptake rates in London and that other councils had largely managed to maintain better uptake rates.  Councillor Quigley recounted her experience of trying to arrange for a flu vaccination given that she was currently shielding.  She asked if it was possible for volunteers to be used in helping to deliver the vaccine to those who were shielding at home.  Philippa Johnson made it clear that this could not be considered a viable approach.  Qualified health professionals and district nurses were required to ensure the safety of both staff and residents.  There were also complexities around storing and administering doses effectively that needed to be considered

 

Merril Hammer acknowledged that although there had been improvement the uptake remained shockingly low, not just amongst the under 65s but there were also low rates for the over 65s within H&F, with overall figures across all cohorts disturbing.  The rates for primary care staff was at 50% and Merril Hammer enquired what action other CCGs had taken to get better uptake rates. Janet Cree agreed that the rates for health staff was disappointing and responded that the CCG had consistently shared best practice and learning with other CCGs.  They had worked consistently over the past five years to improve rates, working with the Board, primary care networks and the wider North West London system.  Whilst she recognised the seriousness of the issue there was no easy solution.  Dr James Cavanagh cautioned that there was a struggle to understand individual choices around vaccination and testing and the right to make such choices.  These could be inexplicable, but it was important to take the time to empathise with where these beliefs are coming from.  This might also be a big challenge when it came to the Covid vaccine.  Vanessa Andreae added that she had anticipated a bigger, national campaign but this had not been evidenced to date so this may require localised communications utilising, for example patient feedback groups.  However, she did not think this was question of access (unless shielding) and that there was little anecdotal evidence to support this.

 

Merril Hammer reported that Imperial were actively engaged in trying to address low uptake amongst Trust staff, given that they had a role in protecting patients.  Imperial to build this into terms and conditions for newly appointed staff suggesting a more proactive approach.  Dr Cavanagh reflected that this would make it harder to attract and recruit staff and that it was an individual right to refuse a vaccine.  In response to a question from Sue Spiller, it was confirmed that the flu and Covid vaccine required a 7-day gap between administration although this might change given future advancements in epidemiology.

 

Councillor Coleman enquired if it was possible to apply the methods used to successfully reach those that were unreachable and whether the CCG could  apply these.  Linda Jackson confirmed that they had considered behavioural sciences and that this had been discussed with the CCG who were keen to explore this further.

 

Jim Grealy observed that H&F was not distinct from most of the other West London boroughs and asked if it was possible to commission some comparative research to understand and identify factors for low uptake locally and what other boroughs were doing with greater success.  Councillor Coleman summarised that there appeared to be a collective commitment to improve uptake but that this was not reflected in the results and that there was a need to address the feedback from under 65’s indicating a lack of trust in vaccines.  Councillor Coleman commented that although the Joint Committee for Vaccination and Immunisations (JCVI) amended priority lists he queried whether GPs had local flexibility to vary this.  Pippa Nightingale explained that there was a national team supporting clinicians in the delivery of the vaccine as determined by the JCVI according to a health and age driven criteria.  Within NWL there had been pragmatic agreement to allow greater freedom to be exercised by clinicians at a local level.

 

Dr Lang had previously reported on the work of the newly re-established H&F Immunisation Working Group, where the themes for childhood immunisations were similar to adult vaccinations.  Specific focus groups had been conducted and there were overwhelming views such as, for example, the belief that the vaccine will insert a tracker, which was concerning.  Dr Lang confirmed that this work could be considered more fully at the HISPAC meeting in January.  Some progress had already been made through effective engagement with the local Somali community and agreement to use more effective channels of communication such as WhatsApp rather than letters and Dr Lang was determined  things should improve.

 

In concluding the discussion Councillor Coleman expressed concern about vaccine prioritisation being determined inclusively.  It was important to continue to develop the engagement work initiated by Dr Lang working with opinion formers within each community to build trust in the council.  Jim Grealy commented that whilst most residents would take a positive view of the Covid vaccine others might need encouragement and he suggested that the council considers using advertising banners that had proven to be  successful in communicating key information across the borough.

 

ACTION: That HISPAC receives a report on the work of the Immunisations Working Group supported by the Director of Public Health.

ACTION: That the Directors of Covid-19 and Public Health explore the potential of using banners to communicate information about vaccine uptake.

 

RESOLVED

 

That the verbal report and actions be noted.

 

Supporting documents:

 

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