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Local Outbreak Engagement Board

(Health and Wellbeing Board sub-committee)

Monday 22nd February 2021, 1.00pm

Present: Councillor Matthew Winnington (Chair), Councillor Judith Smyth, Cllr Jeanette Smith, Councillor Suzy Horton, Roger Batterbury (Healthwatch), Helen Atkinson (Director of Public Health), Dr Linda Collie (Portsmouth CCG), Stef Nientowalski (Shaping Portsmouth), Louise Wilders (HIVE Portsmouth), Richard Lee (Assistant Director- Regulatory Services, PCC), Claire Currie (Consultant in Public Health, PCC), Matthew Gummerson (Strategic Lead for Intelligence, PCC), Alison Jeffery (Director of Children, Families and Education, PCC), Natasha Edmunds (Director of Corporate Services, PCC) Kelly Nash (Strategy Unit, PCC).

Apologies: Dominique Le Touze (Consultant in Public Health, PCC)

 

1.Notes of last meeting (25th January 2021)

The notes were agreed as accurate record of the meetings.

2.Local Intelligence Summary

Matt Gummerson provided an overview of the latest data and key messages.There have been 296 new infections in the past week (now have 13,532 people with at least one positive covid-19 test result (lab confirmed or lateral flow device).    The 7-day rate per 100,000 population for the city is now 137.7, a drop of 32% over the last week (compares to 95.5 in Hampshire, and 89.3 in the wider SE region).  The rate is coming down in all age groups.

In terms of pressure on the hospital system, this is stable overall, with reduced ambulance delays.  G&A bed occupancy is 92%, with 263 covid-positive patients in the hospital.  Workforce absence has improved at 5%.  ITU occupancy remains high, with 28 confirmed covid patients, and surge capacity till in use.  There have been 185 covid admissions or in-patient diagnoses in the last 7 days.

There have been 256 deaths since the end of October, with 11 deaths in the last 7 days.  This means that there have now been 336 covid-related deaths since the beginning of the pandemic, and deaths in the city remain higher than average for the time of year.

Some preliminary analysis has now been carried out on deaths in the first wave in the city.  This shows that Portsmouth has a lower rate of Covid-19 mentioned deaths compared to England and other local authorities.  Almost all covid deaths in the first wave were in hospital or care homes, and covid was the cause of 14% of deaths in each.

2/3 of deaths were amongst men, and given that there are more women in the elderly population of the city, this is significant.  42% of deaths were in the 85+ age group, and less than 10% were in the under 65s.  Portsmouth patterns broadly match national data.

Helen Atkinson added that there was greater impact on the care homes sector in the first wave and that has been taken account in the second wave, for example, strengthening the national IPC and PPE guidance.  There has also been changes in the national discharge policy and guidance from the hospital into the care sector.  Also, more guidance has been provided care home visiting and testing.  Taken together, all of these measures should have had an impact on the second wave.  Portsmouth has had fewer outbreaks in care homes in the second wave, even though there has been an increase in the transmission of COVID via the UK variant which shows an indicator of success in protecting the most vulnerable residents in care homes.

Dr Collie: data relies on good testing results but some concern that the traditional symptoms seem to be different in the new variant – are there indications that the criteria for testing will change?  Helen Atkinson reported that the testing regime has expanded and asymptomatic testing is also now available too.  PHE did review the key symptoms for symptomatic testing eligibility bit decided not to change the guidance nationally.

Cllr Smyth said that it is not clear why on the daily measures reported in the press, the deaths are reported as amongst those with a positive covid test in the last 28 days – Matt Gummerson reported that there are a number of caveats on daily reporting, and local analysis is more detailed and includes all of those with covid as an underlying cause.

The Chair thanked Matt for the presentation, and asked that thanks be recorded to all of the team involved in the detailed analysis.

3. Director of Public Health and Head of Regulatory Services UpdateHelen Atkinson reported that the Prime Minister is due to make an announcement this afternoon at 3.30pm in the House of Commons, with press briefing at 5pm. Regulations on May elections are expected to be laid on first week of March; regulations easing lockdown on 15th March.  More detail on content of relaxation expected this week, and a series of webinars over the next week on various aspects.  All schools opening for all students on March 8th; and two people expected to be able to meet outside.  From the 29th March 6 people will be able to meet outside.  Key point is that this is likely to be a single national approach and not into a regional tiered system at this stage.Nationally, there are 11 LA areas that have identified cases or clusters of South African variant and where surge testing has been put in place.  Important to note that this is not due to an increased risk but is surveillance testing to understand more about the SA variant through genomic typing.

Helen also outlined some additional work from the modelling cell looking at likely progression in the area as we come out of lockdown – expectation that the vaccination programme will have some impact on this but likely to see further surges over the next year.  Will be continuing to plan for testing, tracing and vaccination to become business as usual activities over the next year.

Richard Lee reported that there has been a period of stability because the regulations haven’t been changing, but this will be different as the lockdown eases.  Expecting more outdoor activities and travelling to be on the radar soon – likely to be too early for non-essential retail and hospitality businesses.  Reports of non-compliance from the public have dropped dramatically, and overall business compliance is good, but where there is a problem, enforcement is being taken.  4676 interventions since October, roughly 320 interventions a week.  The team now has clear information about where there has been poor performance and will be able to target future support and engagement accordingly.

4.Testing Programme Update

Helen Atkinson provided an update on testing in the city.Following the report at the last meeting that a bid was to be submitted to establish a community asymptomatic testing site, a very tight timetable was achieved to turn a site around after DHSC approval.  Soft launch was last week with PCC staff only to test in advance of HIOW booking going live and wider communications.  The site will provide asymptomatic testing for all critical workers who have to leave home and come into contact with the public.  Wide range of workers covered and also includes volunteers; will cover blue light services and retail and transport workers, and PCC have also been communicating with the wider business community via the business engagement team.

Site is now available 8am – 8pm and has capacity for testing over 2000 people a day.  Appointments are available through the HIOW appointment system.  The process has been quite inflexible for the first phase, as DHSC have applied strict criteria about what we need to see.  We will now be starting work to put in a further bid to DHSC for more flexibility for community testing and looking at other areas to see how we can achieve more flexibility, for example, workplaces and mobile testing.  DHSC are not allowing local areas to do home testing with lateral flow devices (except for primary school staff, Care home Staff and the NHS) but this may change over time.

Day care staff are now included in the whole care home testing programme, and it has now been confirmed that that personal assistants will also be able to be tested.  Other testing in the city includes the university, naval base and more information should be available soon for testing in schools.

All local authorities have been responding to the pandemic as an emergency and moving staff around, but it was noted that we will need to start to consider how these sites and facilities will be staffed as a business as usual, for example, when redeployees return to their day jobs.

Cllr Winnington reported that he had attended the site for a test as he was eligible through his day job, and that the testing process was very smooth.  It was agreed that there is a need to get the information out far and wide regarding eligibility, and it was agreed to supply this to councillors.  Helen Atkinson confirmed that it is not the intention that anyone attending the site should be turned away, as lots of information is on the appointment system etc about eligibility.

Helen Atkinson also noted that the University have been providing their expertise to help to get the site up and running and PCC staff have been able to go to the university site, and recorded formal thanks.  It was also noted that the university are also helping with the data return.

5.Local contact tracing

Helen Atkinson reported an update on the local contact tracing scheme.It was noted that some staff have now been recruited to the team as we were previously using volunteers, and there was a need to ensure sustainability.   We have been seeing a slight reduction currently in cases referred as confirmed cases drop, but it may be that we see an increase again as asymptomatic testing ramps up.

We are seeing a higher percentage of cases completing with the authority than the national threshold for effectiveness (80%); there is an ongoing national discussion about whether local authorities will be taking on more contact tracing.  Partnership with the HIVE has now started to help contact and support residents over 70.

6.Vaccination programme

Claire Currie provided an update In relation to vaccination.Nationally, cohorts 1-4 have all been invited and cohorts 5 – 9 currently due to be completed by 15th April (all those aged 50 and over).

In Portsmouth there is a hospital hub at QA, focused in frontline health and care staff; community site at St James’s, 2 community pharmacies, and 1 GP site from each PCN, focusing on cohorts 5&6 currently.   As at 17th Feb, 47021 people had received a first dose, with 3966 also receiving their second dose.

A great deal of surveillance is taking place alongside the programme, and emerging evidence of effectiveness indicates some cautious optimism.

Further work is also underway with HIOW partners to think about how we optimise uptake amongst specific groups in the population which might be harder to reach through usual healthcare routes, for example homeless people, and people with learning disabilities in supported housing settings.  Work is also taking place around communications and vaccine hesitancy, progressing plans to put in place a post to lead and co-ordinate the work, initially focusing on optimising uptake among black and minority ethnic groups.

It is important to note that all messages around hand, face and space remain important after vaccination.

Louise Wilders noted that there seems to be confusion across the system and public about how to access vaccines, for example, how to make contact with the GP or the community hub.   Is this a risk that vaccination numbers will drop as confusion takes hold? What influence can be brought to bear?  It was agreed that there is a need for better co-ordination.  It was recognised that some of the issues and challenge arise because there is no go ahead from the DHSC yet to move down the cohorts, which means that there is oversupply locally and this means that the zero waste policy is being used rather than calling more people forward in cohort order.  Claire undertook to feed the need for greater clarity back via the HIOW forums.

Roger Batterbury asked what will the process be like for the second vaccine.  Also, noted that Goldchem are advertising vaccination as a walk-in for over 65s.   Dr Linda Collie noted that there are some differences around when people are being called forward for the second dose, as is dependent on when supply is available.    Cllr Smyth – noted that the Goldchem signage is not necessarily suggesting open access, but is ambiguous.  She reported that from personal experience, both St James’s and Goldchem feel undersubscribed, although very well organised.  More consistency is required.

Alison Jeffery – just to share the discussion in the LRF last week that a key issue is managing the “push” system for supply, although this is expected to ease.  Issue of surplus vaccine is an issue currently and there are some challenges around how the zero waste policy is being applied in different areas.

Cllr Winnington summarise the discussion as reflecting the issue about needing to try and sort out locally issues within a national system. It was agreed that more local discretion and communication is required.

7.Test and Trace support payment report

The LOEB noted the briefing report provided, and received an update that since the report was written, it has been confirmed that MHCLG will be funding a top-up to the discretionary element.  This is welcome, but work will continue to emphasise the challenges with the scheme and ensure it is properly funded.

8.Assurance report

The Board received the report which covered:

Local context – updated with the information taken from the data reporting

Local activity – bringing together a range of information about what our work is telling us about our preparedness

Assurance to PHE

Key risk, which in this case relate to the new variant, and cases resulting from the relaxation of restrictions at Christmas. There were no questions, and the Board noted that on the basis of information and evidence that they have received, they have a high degree of assurance on local arrangements.

9.Any other business

There was no other business.

10.Future dates

Future meeting dates were noted and it was also agreed to schedule further sessions on the same cycle through to August.