For the Committee to receive a verbal update from the Director of Public Health on Covid-19, with a focus on vaccination.
Minutes:
6.1 Councillor Richardson introduced this item which was a verbal update provided by Sue Roostan and Dr Nicola Lang. Sue Roostan took questions and Dr Lang followed up with a brief update on phase three of the borough’s vaccination programme.
6.2 Councillor Richardson recognised that the borough had one of the lowest vaccination rates in North West London and asked what was being done to address this. Councillor Ben Coleman reported similar concerns about the most recent developments which included the closure of the mass vaccination centres, the indecision of NHS England about pharmacies operating as vaccination hubs and a shortage of vaccinators. Residents were limited to four pharmacy locations offering a Covid vaccination. There were also variations in reporting, with the borough’s progress reported differently by both NHS Foundry System and NWL Integrated Care System. Whilst planning was ongoing the cumulative affect presented a difficult picture which ignored the point that making vaccination simple and easy was a proven approach, for example, using pop buses.
6.3 Sue Roostan confirmed that there were some data anomalies in the calculations and where the borough was placed in the league tables, but the borough was middle of the pack in terms of NWL figures. The borough was offering the vaccines to those that were eligible in line with the JCVI delivery programme (Joint Committee for Vaccination and Immunisations). Booster vaccines were being offered, in addition to first and second doses, working with the local authority to implement a targeted approach, in partnership with GP practices.
6.4 There was not a shortage of vaccinators but there was a requirement to have a minimum number of registered healthcare professionals on site when vaccinators were working, and this was a significant issue. In addition to being responsible for the preparation of the vaccine and overseeing the clinical work of the vaccinators, they were also responsible for participating in the primary care recovery work and supporting pop ups and vaccine buses, supported by the local authority and Imperial staff. A vaccine bus at the Claybrook, and the Stephen Wiltshire facilities had been very well received. While concerns about low take up were understandable it could not be attributed to low resources. There were currently five pharmacies with a further eleven expected to be authorised and functioning shortly. There were also four primary care network (PCN) sites. Low take up was attributed to vaccine hesitancy but there had been significant and ongoing work being undertaken by the NHS and the local authority to tackle this.
6.5 Councillor Coleman highlighted that there had been three pop ups that had not gone ahead at the Claybrook, Shepherds Bush Market and at the Lyric Theatre because there were no vaccinators available. Mobilising at short notice also made things very difficult. Sue Roostan accepted this criticism and explained that they were also supporting the school’s vaccine programme, at the same time, prioritising 12-15-year olds, within a short period of time ahead of half term. This required short term adjustments to the management and delivery of pop up vaccine clinics. Whilst the process was imperfect there was a lot of effort going on in the background to trying and improve the situation. The difficulties were not limited to hesitancy but overconfidence in those who had received two vaccine doses.
6.6 Dr James Cavanagh reported that the vaccination site at his practice had been operating below capacity for three days. This was very different to that of the initial campaign when people were lining up an hour early to receive their vaccine. He acknowledged the need to establish staff and coordinate resources efficiently and at the same time offer the booster vaccine, in advance of winter pressures.
6.7 Victoria Brignell asked for data on the percentage of care workers who had been vaccinated and a breakdown of figures for those who had been vaccinated in care homes employed by agencies and those directly employed by disabled people through the direct payments scheme. A second question was asked about the number of people who were clinically vulnerable and who might delay their booster jab as they already had appointments for flu jabs and were concerned about the timing of this. Sue Roostan explained that the data was available and could be shared following the meeting, but the coverage varied between providers, for example, with some private sectors vaccination for care workers working with the clinically vulnerable was mandatory. Dr Cavanagh confirmed that both the flu jab and the Covid jab could be administered on the same day and that this choice but there were issues for those that were immunocompromised. Considerable work had been done to vaccinate residents and care workers in care homes and that the borough was one of the top performers in this area.
ACTION: To provide data on the percentage of private and public sector agency staff, and direct payment employees.
6.8 Lisa Redfern confirmed that the borough’s performance on vaccinating in staff and residents in care homes was the second highest in London. With the exception of one nursing home, there was almost 100% coverage. It was possible to retrieve data about the number of those who were employed by the direct payment scheme and it was suggested that this could be by email. It was likely that the number of care home staff was higher as the vaccine roll out began earlier and because of the mandatory nature of vaccination staff working with the clinically vulnerable.
6.9 Concurring with Dr Cavanagh’s earlier observation about slower take up Keith Mallinson asked how information about how to obtain a booster jab was being communicated and advertised. It was also concerning to note the lack of enforcement on public transport regarding mask wearing, or indoor shopping areas such as Westfield and Kings Mall. Councillor Amanda Lloyd-Harris endorsed Councillor Coleman’s comments, and that it should not have come as a surprise that pharmacies would be needed to deliver Covid vaccines, given that vaccination hubs were being decommissioned and this indicated a lack of foresight and planning. She asked what incentives might be put in place to encourage vaccine take up, given the low rates of take up within the borough, for first, second and booster jabs, and the schools vaccine programme. Jim Grealy was also concerned about the lack of enforcement on public transport and was keen to understand how the booster would be promoted as there appeared to be less urgency about people obtaining a booster jab.
6.10 Despite a significant increase in flu jab take up, Dr Cavanagh highlighted the risk of a return to a culture of not having the flu jab and he drew a comparison with current pattern of Covid vaccination take up and a similar trajectory in declining figures whereas the long term expectation was that it should become a routine part of self-health care. There was a gradually evolving narrative of returning to “normality” and a campaign was required to reinforce message about the greater risks of not vaccinating. A further added concern was about the pressure on practices to return to in person appointments. Social distancing was hard to maintain in the average practice waiting room when clinically vulnerable patients must be distanced from, for example, coughing young children. Sue Roostan responded to the questions raised:
• Communications – A national communications strategy was anticipated to promote the booster campaign which had already started locally.
• Public transport – It was disappointing to see that enforcement had been relaxed and that fewer passengers were wearing masks, and that this was a matter for TfL.
• Pharmacies – H&F CCG did not commission pharmacies but had been pushing for some time now to increase the number of pharmacies able to provide the vaccine, but this was within the jurisdiction of NHS England. Locally, assistance had been offered to pharmacies by pharmaceutical advisors to expediate and increase current capacity. It was hoped that a further seven would be brought on stream.
• A communication’s strategy would help drive up demand, and capacity was in place to meet this. A planned and targeted focus was being developed, working closely with colleagues within the local authority.
• Flu vaccine take up – This was poor across the borough and work was being undertaken with a combined approach to also address Covid take up with the intention to co-administer vaccines.
6.11 Merrill Hammer commented on the issue of booster jabs which had already been raised and that there was a need for stronger, consistent messaging in the form of a local campaign using leaflets and posters, about when people were eligible for their booster (six months after a second dose). Unclear messaging was a concern, as was the lack of alternative options for those who could not access digital appointments. Sue Roostan confirmed that a text message would only be sent to those who were eligible and also met the six-month criteria. It was acknowledged that communication could be more consistent and that more could be done to improve messaging and that this required conversations at a local level with the council. For example, regular updates on the council website and text messages from GP practices. In the discussion that followed, members anecdotally reported inconsistencies in who was receiving messages, those being invited for boosters when they were not eligible and vice versa. Councillor Richardson felt that there was considerable variation in individual experiences and that addressing inconsistencies in communication was critical.
6.12 Councillor Coleman pointed out that a different approach by moving provision from large hubs to a pharmacy might have made it easier for people to get vaccinated. Vaccination buses had been successful through a targeted, hyper-local focus with buses placed in Normand Park opposite the Clement Atlee estate making it a quick and easy process. The use of pharmacies had been strongly argued for by the borough and other councils. While the feasibility of this had been initially contested, NHS England had recently reversed their position. Although there would eventually be more pharmacies within the borough on stream, Councillor Coleman felt that NHS England let the borough down and that more pop up buses and vaccinators were required. Sue Roostan agreed that the buses had proved to be popular in targeted communities with low vaccine take up, but these had been relatively low numbers ranging from 10-30 and there was a need to use resources efficiently. Councillor Coleman pointed out that Dr Lang and Lisa Redfern had advocated an approach that targeted those who could not leave their homes or were clinically vulnerable, with little response. Having nineteen vaccinated on a bus was good and Councillor Coleman questioned the logistics behind what would be the most efficient use of valuable resources. Sue Roostan responded that they could not offer a door to door service because of the resources required. Dr Cavanagh observed that the intent was the same, to achieve a balanced approach in getting most people (including the vulnerable) vaccinated within the available resources which was an evolving process.
6.13 Councillor Coleman acknowledged this however, it appeared that billions were being spent on purchasing the vaccine, but the vaccination process itself was being delivered on the cheap. He stated that he had not formally been presented with the argument that it was not feasible to provide a door to door service but argued that there were groups that felt unable to attend PCN sites who did not meet the criteria of clinically vulnerable. Sue Roostan confirmed that a request from Councillor Richardson that data on this be provided and presented at the next HISPAC meeting to help inform a pilot piece and this was agreed. Councillor Coleman suggested that information reported anecdotally was followed up and highlighted concerns about working within the Integrated Care System, particularly on local H&F vaccination in the context of historically poor take up rates.
6.14 Councillor Kwon enquired if people will be invited for their booster jabs in waves (as per the JCVI eligibility groups) or what people could do if they had not yet been contacted and were expecting an offer to book their appointments. Dr Cavanagh offered an assurance that there was not a shortage of the vaccine in the borough but that eligible patients would be contacted by GP practices in line with the data and information in patient records. Although an automated system was in place Dr Cavanagh advised that if a person had not been contacted after the six-month period had elapsed then they should contact their GP practice. He acknowledged that there might be mistakes in the system, but the vast majority would receive a timely notification. Dr Cavanagh explained that he would be open to any suggestions as to what further measures could be put in place to improve vaccination.
6.15 Expressing her concern that the CCG would not mandate a door to door approach, Merrill Hammer referenced the work of Imperial College NHS Healthcare Trust on vaccine hesitancy and whose board had advocated a door to door approach. She concurred with Councillor Coleman and argued that those who were more resistant to being vaccinated had just as great a need as those who were housebound.
ACTIONS: 1) That data be compiled to demonstrate the number individuals that might benefit from a door to door service;
2) That the members of the committee who had been invited to book their booster jabs before the six month period had elapsed share the details with the Chair, who will provide this to Sue Roostan; and
3) That the process of obtaining the booster jab be included in the agenda for the next meeting.
RESOLVED
That the committee noted the report and actions as set out.