For the Committee to receive a verbal update from the Director of Public Health on Covid-19 and Director COVID-19 & Lead for Afghanistan refugees, with a focus on Covid vaccination.
Minutes:
5.1 Councillor Richardson welcomed Janet Cree, Linda Jackson and Dr Nicola Lang to the meeting to provide a verbal update. Dr Lang reported that the rate of infection for H&F was 239 per 100k people which was slightly lower than the London average at 253 per 100k, placing the borough as the 19th highest rate in London. There had been 335 cases confirmed in the past seven days reflecting an identified pattern spanning the previous few weeks.
Infection rates had been highest within the 11-16 age group but were decreasing slowly across all groups. There had been a number of outbreaks at the start of the Autumn term and a reduced number following the half term break. The rates for the over 60’s cohort were higher than the rest of London at 167 per 100k people. Testing rates were good but the positivity rate was 5 cases reported as positive for every 100 PCR tests, higher than previously recorded so this was being closely monitored.
5.2 Anticipating winter pressures, the focus had moved towards administering the booster jab for over 50’s in medical risk groups, and health and social care staff. Dr Lang advocated for social distancing protocols, continued mask wearing in indoor and crowded spaces with limited social contact and good hand hygiene. She also encouraged flu as well as booster jabs which would be key to maintaining lower rates of illness. Linda Jackson reported that the number of pharmacies delivering vaccines had increased to 11 and also encouraged the take up of flu and booster jabs.
5.3 Janet Cree confirmed that there were four PCN sites (White City Community Centre, Brook Green Medical Centre, Hammersmith Surgery and West Kensington Tenants Hall) and briefly referenced Matt Meads role in supporting GPs in providing vaccinations in the borough. Operationally, vaccinations had begun focusing on practice registration lists, aligning with the eligibility criteria. It was important to maintain business as usual and balance practice activities with managing the recovery process post Covid. The increased number of pharmacies widened the geographical area covered and lessons had been learned from the delivery of pop-ups. The increase in pharmacy capacity would enable the delivery of more vaccine doses and also allow opportunities to vaccinate those who had not had either their first or second dose. The increase also compensated for the decommissioned Novotel site. The PCN sites together with CLCH had also begun to deliver vaccines to those that were housebound in addition to supporting the school’s programme. Janet Cree reported that there was also capacity in neighbouring boroughs. In terms of vaccination figures, 65% of the borough population had received their first dose and 59.4% had received their second dose. Focusing on invited, registered patients, 20% had received their booster jab. A local booking system operated alongside a national booking system, but the latter was accessible to anyone who was eligible. This ensured that local capacity was utilised and could also opportunistically administer first, and second doses offered to walk-in appointments which PCNs were keen to encourage. The national system also directed people to book appointments through the 119 NHS helpline.
5.4 Jane Cree provided further details about vaccination visits to all but one care home, but there were some residents who had not met the booster jab eligibility criteria. Vaccination of those who were housebound was being undertaken by CLCH alongside PCN sites. Jane Cree cautioned that the observation time required for Pfizer meant that the process was slower as each housebound visit took longer to monitor compared to AstraZeneca.
5.5 Working closely with the local authority roving teams were visiting local schools and a schedule of co-ordinated visits had been extended to 19November 2021. Roving teams would also continue to support pop ups and resume vaccination buses, particularly at the Claybrook site. It was recognised that this initiative had been very successful in supporting residents with mental health conditions.
5.6 Flu clinics were also underway and being delivered in line with stock delivery dates, co-ordinated at national level. There was some variation in terms of rates and availability, and these were organised with strategic variations across the borough and CCG area with one in particular experiencing a delayed delivery of vaccine stock. PCNs had prioritised care homes to vaccinate residents and those that were housebound, co-ordinated by CLCH. As of the end of the previous week, it was reported that 19,000 flu immunisations had been delivered across the borough, representing around 16.5% of the eligible population and 80% of care home residents. Compared to the previous year, significantly higher numbers had been vaccinated but immunisation rates in general continued to be challenging.
5.7 Councillor Richardson recognised that operational and strategic factors would impact on take up rates and welcomed the news that vaccine buses would be reintroduced. Also welcomed was the shift away from a centralised system to a local focus although it was a concern that this had taken so long manage.
5.8 Co-optee Victoria Brignell explained that she had requested data regarding the percentage of personal assistants employed by disabled people under the direct payment scheme had been vaccinated, and secondly, what the impact of mandatory vaccination for social care staff might be on staffing levels. Janet Cree apologised for not having the information available and gave an assurance that this would be provided. It was confirmed that there were no immediate issues regarding staffing levels, but this would be checked.
Co-optee Keith Mallinson raised again the issue of public transport and the inability of Transport for London (TfL) to enforce mask wearing. Linda Jackson shared his frustration and stated that the borough had worked hard to promote good practice however repeated requests to TfL had been ineffective. The government’s plan B may change this by introducing mandatory mask wearing and the director of public health had also explored legal options for enforcement.
5.9 Co-optee Jim Grealy commented that pupils and schools had been placed under significant pressure by anti-vaxers. Given the variation in vaccination take up between schools, he enquired if it was possible to identify the factors for this and who controlled the process, the schools or NHS. A second question was a concern about the 35% of the population who were unvaccinated. Given that Covid as a condition remained, he asked what was being done to encourage vaccine uptake for those who did not accept the earlier offer. Keith Mallinson mentioned that retail outlets continued to offer good advice and guidance about good hand hygiene but suggested that the council or CCG write to local retailers and to encourage enforcement of mask wearing.
5.10 Janet Cree confirmed that there were variations in take up across the borough and that the CCG continued to work with and advise schools with the support of Children’s Services and the local authority and to also manage anti-vaccine activity with the police. Control of the vaccine process was subject to consent and co-ordinated by schools. Careful sequencing was required to capture everyone who had consented and children who had been infected were required to wait four weeks before they could be vaccinated so repeat vaccine sessions were planned. This was ongoing and underpinned the “evergreen offer” meaning that the vaccine offer would be self-renewing. The rate of uptake was gradually increasing for both the first and second doses of the vaccine, with an additional 1125 who had received both doses, and which encouragingly reflected a significant and iterative increase. Matt Mead clarified that the 65% of people that had been vaccinated comprised of those aged 12 and over. Within the 1-9 JCVI cohorts, there was 76% take up and reflected graduated take up across the groups.
5.11 Councillor Lloyd-Harris noted that the four PCN sites were located in the North of the borough and asked why Fulham had not been mentioned. She enquired about the care home that was yet to complete booster vaccinations and when the booster jab would be available to book through the NHS app. Matt Mead explained that during the first wave, there had been a site located in Parsons Green however, services needed to continue so an alternative site at West Kensington Tenants Hall had been secured. The four main delivery sites would be supplemented with satellite clinics or pop ups. A refinement of the local offer was being considered, which might include Parsons Green. The care home mentioned had been later in the scheduling so some residents were not eligible at the time and would be revisited. Further information about when the booster jab would be accessible through the NHS app was not available.
5.12 Councillor Coleman said that it was difficult for people to navigate the Covid vaccine pathway. He felt that the details about pharmacies being able to provide vaccines options had not been clearly communicated. Having the NHS card with details of when both doses had been administered would in theory make it possible for people to walk in and receive the booster jab. He enquired why it was not possible for the booster jab appointments to be arranged through GP practices. He also sought clarification about whether the Covid and Flu vaccines could be co-administered and felt that it should be possible to offer these more efficiently. Janet Cree responded that invitations to book a booster jab opened at five months after a second dose through the national booking system. Current invites from GP practices were issued according to the eligibility criteria but there were complexities in terms of the sequencing.
5.13 Matt Mead confirmed that there had been discussions at PCN level but that this was a matter of aligning with the national messaging. A person would receive notice of eligibility to book online 152 days after a second dose which allowed for a 30 day window. The CCG was working with PCNs to ensure that there was clear communication about the changes. It was not confirmed whether practices would be sending text alerts to invite people to book a booster jab. This would require further conversations about the feasibility of a local system and how this might align with the national booking system. An added complexity was that there could be dynamic and logistical changes to the national system which would require co-ordination locally.
5.14 Janet Cree continued that in terms of co-administrating both Covid and Flu vaccines there would be some variation depending on the location of the site or pharmacy and also capacity, but it was possible to administer both at the same time depending on the variables. A single system was not available to allow you to book both at the same time, but it was possible for sites and pharmacists to check your eligibility as a walk in if a person presented their Covid vaccine cards. It was also helpful if a person had their NHS number to enable electronic verification. Councillor Coleman sympathised as the CCG was forced to work with a poorly planned and implemented national system.
RESOLVED
That the verbal report was noted.