This report will include an update from the Director of Public Health and the Director of Covid (Lead for Afghan Refugees) on the boroughs Covid response, and health partners, with particular reference to the support provide to residents experiencing long covid symptoms:
- Flu vaccine uptake
- Covid vaccine uptake
- Support for those with long Covid symptons
Minutes:
5.1 Councillor Ben Coleman welcomed NHW health colleagues who provided a Covid update against the background of the government response on the emergence of the highly transmissible Omicron variant of Covid-19.
5.2 Sue Roostan explained that the timing of the meeting was welcome given the Prime Minster’s announcement on 12 December 2021 to offer vaccinations to all by the end of December. Logistically a range of measures would need to be implemented to support the additional requirement. A group of health and local authority officers would work within the borough partnership to deliver the offer and manage the vaccine roll out. The speed of the announcement presented difficulties in mobilising resources to deliver the expected increase in excess of 200k vaccines per week by the end of the year.
5.3 This was a huge task and require considerable resources utilising a mixed local delivery model with four borough hubs, clinics and pop ups, and 10 community pharmacies. It would be supported by focused communication messaging and engagement. Sue Roostan clarified that some clinical and administrative changes were currently being considered by government which would support a rapid delivery of the programme, some of which concerned vaccine supply and the removal of the Pfizer, 15 minute wait time, post vaccination. This would enhance the through flow of people, speed up the process and increase capacity. In terms of capacity, it was reported that pharmacies at this time could offer 8-10 slots per day. It was anticipated that this would be used to capacity soon and lifting the cap on pharmacies was an additional option to consider (it was later confirmed that it was highly unlikely any more pharmacies will be approved).
5.4 There would a focus on vaccinating those in care homes and who were house bound, and progress on this had been positive. House bound vaccinations had routinely continued, supported by primary care district nurses, although this could be speeded up if the 15 minute time was lifted. Non-essential CCG down would be stepped down from their current roles and redeployed to support vaccination delivery sites and military support would also be mobilised. In the context of military support, Lisa Redfern highlighted the size of the Northwest London Integrated Care System (ICS) footprint supporting 2.3 million people across the region, making it one of the largest ICS programmes nationally.
5.5 Councillor Patricia Quigley received an assurance from Sue Roostan that the decision to remove the requirement for a 15 minute waiting time would be a clinical decision taken by the Chief Medical Officer balanced against the need to locally deliver over 200k vaccine doses weekly. In response to a follow up question from Councillor Coleman, Vanessa Andreae briefly explained that in her clinical experience there was a very low probability of a person having either an anaphylactic or vasovagal (fainting) reaction. The 15 minute wait time would not be removed if it was not safe or in the best interests to do so.
5.6 Jim Grealy referenced the significant figure of 200k people and asked what the current shortfall in numbers were, which Sue Roostan agreed to provide following the meeting. Clarification about the technical problems with the booking system was sought, most likely prompted by a sharp increase in demand for bookings following the government’s announcement. To set the ask in context, in a successful week, 130k doses had been given in one week, and so the requirement was to almost double this over the next two weeks. Definitive plans would be formulated within the coming 24-48 hours to mobilise vaccine sites.
ACTION: Sue Roostan to share figures about the short fall between the number vaccinated and those yet to be vaccinated in the borough
5.7 Councillor Coleman reminded the meeting of previously raised concerns about the closure of pop up sites, capacity and the lack of vaccinators. Sue Roostan explained that in the previous week pharmacy capacity had been 70% utilised and that there had been availability at both 145 King Street and the West12 Shopping Centre sites. However, any spare capacity could become quickly absorbed and other clinical priorities would be reduced in order to increase the capacity to deliver the booster programme. It was clarified that there would be a movement of staff and resources around the system to ensure that the hubs were staffed but that there would be no “new” vaccinators. Janet Cree added that it took time to redistribute and co-ordinate staff resources who were currently engaged in other clinical activities. The NHS had issued a call to trained vaccinators and volunteers and this would ensure staffing for the next three weeks.
5.8 Councillor Coleman recognised the inherent difficulties in responding to a challenging and unpredictable situation and asked how long it would take to mobilise resources to provide booster vaccines within the borough. Sue Roostan confirmed that two hospital sites at Hammersmith and Charing Cross hospitals would shortly go live with extended hours to deliver the booster offer This would be publicised following confirmation.
5.9 DI Luxan Thurairatnasingam commented on the pattern of vaccine take up and with some groups likely to refuse vaccination. Similarly, there were difficulties experienced by those who were unregistered, homeless or asylum seekers in getting vaccinated. Sue Roostan was unable to provide an exact figure as to the unvaccinated proportions within the borough however, there was a local offer to vaccinate non-visible and vulnerable health groups within the population, without the need to be registered. Dr Lang confirmed that there was great provision for schoolchildren and younger people, the homeless and those accommodated in local refugee hotels.
5.10 There had been many conversations about vaccine hesitancy, and it was acknowledged that there would a small percentage that would continue to refuse the offer. Tackling this was an ongoing challenge and would take time to address. It required a hyperlocal approach and the CCG had worked with Dr Nicola Lang’s team to support this work. Currently, 61% in the borough had received a first dose, compared to approximately 90% nationally, and 20% had received a second dose compared to 40% nationally. Dr Lang felt that there was a change in attitude, with communities now coming forward. The message provided to a recent faith forum meeting had been that it was never too late to get vaccinated. The emergence of Omicron had prompted a change of view and it was encouraging to see 70 or 80 people a day receiving their first dose. Sue Roostan reported vaccine uptake data for the week ending 10 December, with 676 receiving a first dose, and 924 receiving a second dose. The offer of the vaccine was “evergreen” meaning that it would be available at any time, for the benefit of those who changed their minds.
5.11 Glendine Shepherd reported that there had been a positive uptake of the vaccine offer those who were homeless, and this was significantly higher than average compared to other local authorities which was a positive and well regarded achievement. Much had been done to mitigate including the provision of self-contained accommodation. At the last rough sleepers count only two individuals had been found and both had declined the offer of accommodation.
5.12 Vanessa Andreae addressed an earlier comment about providing vaccinations to those that were house bound. She had recently arranged home visits for five of her patients, which included a family group of which three vulnerable members of the same household had non-visible learning disabilities, who lived in poor housing accommodation and were reluctant to venture out of the house. It had taken three consecutive afternoons of her time to arrange for them to receive their first dose of the vaccine. Those with learning disabilities would not usually be included within the definition of house bound however, Vanessa Andreae clarified that in her experience of running pop up clinics for her learning disabled patients, there was a need to continuously review this approach and support identifiable needs as they emerged. This was constrained however, by the 15 minute waiting time. Other hindrances included limited space and one way flows in surgery waiting rooms which made it challenging to deliver vaccination at pace.
5.13 Given the anticipated removal of the 15 minute wait time Nadia Taylor sought further clarification and assurance about safe storage and transportation protocols for Pfizer vaccines and whether their efficacy would remain. She also enquired about the training offered to vaccinators and what it involved. Sue Roostan confirmed that the protocols for storing and transporting Pfizer vaccines was stringent and included the use of cool bags and boxes. Any unused vaccines were discarded and disposed of, and the difficulties in managing this for house bound and care home visits was noted. It was also confirmed that it was not necessary for a vaccinator to be a clinician and that the training involved online, and practical training underpinned by a competency framework. Volunteers were also needed to help with the safe storage and transportation of the vaccine once they had been trained in line with strict pharmaceutical protocols. Councillor Coleman queried the lack of requirement to be a clinician in order to vaccinate, as he had been repeatedly advised that this was necessary. It was confirmed that clinical qualifications were not necessary, provided vaccinator training was successfully completed. Candidates for training were often students or non-clinical CCG staff and the delivery of training sessions required logistical planning.
5.14 Vanessa Andreae’s approach to vaccinating those with non-visible disabilities was welcomed and commended by Councillor Lucy Richardson. She asked if there was a policy in place to allow the siblings of those with learning disabilities or for families to receive their vaccinations at the same time, or if this relied upon the discretion of the GP. Sue Roostan welcomed this approach and confirmed that it could be possible to arrange for a whole family to be vaccinated at the same time if the individual members fell within the eligibility cohorts. The JCVI (Joint Committee for Vaccination and Immunisation) framework had constrained intuitive delivery due to the need to adhere to the strict eligibility requirements. However, if each family member met the eligibility framework and 3 months had elapsed from their second dose then this would be feasible. Additionally, Vanessa Andreae confirmed that a family member who had not had their first or second dose could also be accommodated at the same time, depending on the circumstances.
5.15 Caroline Durack described what working life was like for GPs, and how this might be affected by the recent announcement. There had been a considerable increase in activity to mobilise delivery plans through the Primary Care Network (PCN) hubs. There were significant concerns about the impact on staff and there were still many surgeries with staff on sick leave and in recovery from long Covid. Concerns about negative tabloid and social media coverage about access to primary care which was anticipated to resume following this current wave of vaccinations were also highlighted. GP practices needed support at this time, particularly as it would be necessary to redeploy staff to mass vaccination sites. Working closely with the CCG to plan and deliver online training, she explained that it was possible for anyone to be supported to undertake training as a vaccinator.
5.16 The issues around support for primary care staff were explored, Councillor Coleman offered support and stated that health staff were currently working under significant pressure without respite and that vitriolic attacks were unhelpful and unfair. Caroline Durack added that there were concerns about staff retention across the borough was a pre-existing issue and which hindered swift mobilisation. England currently had the lowest number of practice nurses per head of population and the GP Federation were currently involved in a piece of work which aimed to address this. It was noted that the NWL ICS was one of the largest nationally serving 2.3 million people. There was support for escalating a request to NWL to increase the number of military support teams allocated to the area from 2 to 3, and a further request for trained vaccinators. It was recognised that the mobilisation of limited resources in a way that was both strategic and agile was the challenge.
ACTION: Sue Roostan to escalate a request for increased military support and additional resources through NWL channels
5.17 DI Luxan Thurairatnasingam observed that there was a need to counteract the misinformation about vaccination, vaccine content and the negative influence of anti-vaxers. Sue Roostan explained that there was a wealth of information available on NHS and UK Health Security Agency (previously known as Public Health England) websites about vaccine content but acknowledged that many people did not trust “official” sources of information.
5.18 Given the recent emergence of Omicron it was becoming clear that it would take longer than three weeks to manage the roll out of boosters as well as first and second doses. Jim Grealy asked what messaging, support and advice was being offered to local businesses about prevention measures. Dr Lang acknowledged that ensuring compliance with safety protocols such as mask wearing and social distancing was difficult, however businesses were being reminded and supported by H&F Environmental health officers to undertake checks, monitor and provide advice and support. Posters had been commissioned with messaging provided in key languages: English, Polish, Arabic, Somali and Farsi. These would be located at strategic points around the borough. Dr Lang observed that there had been a change in behaviour since the pandemic began and that this was reflected in a lower level of compliance with preventative measures such as mask wearing.
5.19 Councillor Coleman sought further information about flu vaccine uptake. Sue Roostan confirmed that figures for flu vaccine uptake were not as strong as for Covid vaccination and significant efforts were being made to address this. The co-administration of flu and Covid vaccination had been previously discussed by the Board and it was confirmed that refreshed data about this was expected. It was noted that the CCG had queried whether the borough’s pharmacy data had been included in the Whole Integrated System Care (WISC) dashboards. Data for 2021 showed an uptake of 22%, lower than the previous year’s take up which was 36% so there was much work to be done. By contrast, the take up in care homes was at 80%, and GP at Hand was at 28%. There was an opportunity to co-administer the flu vaccine, to offer or promote it at the same time as the booster programme.
5.20 Councillor Coleman shared his experience of receiving a booster jab and suggested that he should have been asked the question as to whether he would like a flu jab at the same time. There was also anecdotal evidence to indicate that requests for co-administering the flu and booster jab were being declined and that it was important to ensure that it was being offered. Sue Roostan acknowledged that further work was necessary to understand systemic vaccine hesitancy. Lisa Redfern cautioned that it should not be assumed that people have an awareness about vaccine booking systems as even some staff within the NHS lacked awareness.
ACTIONS: Vanessa Andreae to follow up about how those who were vaccinating could explore having a flu jab with the person receiving the booster jab; Jo Ohlson to follow up with ICS colleagues on the issue of NHS staff awareness about flu jabs.
RESOLVED
That the verbal update and arising actions were noted.