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Local Outbreak Engagement Board

(Health and Wellbeing Board sub-committee)

Tuesday 15th December 2020, 2.00pm

Present: Councillor Matthew Winnington (Chair), Councillor Judith Smyth, Cllr Jeanette Smith, Roger Batterbury (Healthwatch), Helen Atkinson (Director of Public Health), Dr Linda Collie (Portsmouth CCG), Steve Labedz (Portsmouth Education Partnership), Stef Nientowalski (Shaping Portsmouth). Richard Lee (Assistant Director- Regulatory Services, PCC), Dominique Le Touze (Consultant in Public Health, PCC), Claire Currie (Consultant in Public Health, PCC), Kelly Nash (Strategy Unit, PCC).

Apologies: Councillor Suzy Horton, Matthew Gummerson (Strategic Lead for Intelligence, PCC), Alison Jeffery (Director of Children, Families and Education, PCC), Natasha Edmunds (Director of Corporate Services, PCC).

  1. Notes of last meeting (23rd November and 1st December – extraordinary meeting)

The notes were agreed as accurate record of the meetings.

  1. Local Intelligence Summary

Helen Atkinson provided an overview of the latest data and key messages.

Portsmouth’s case detection rate over the last 7 days was recorded at 174.5 across all age groups, an increase in 43.2% over the last 7 days.  In the over-60s age group, the rate was 111.5, an increase of 21.6%.  The positivity rate for tests in the city is 6.1%.  There is no single metric to capture pressure on the NHS, but there are significant pressures in the NHS in the SE region, specifically in Kent.

The rates in Portsmouth are now below those for the wider SE region (197.3) but slightly above those for the whole of England (173.3).  The high SE rate reflects some very high infection rates in Kent (notably in the Medway and Swale local authority areas).   In Portsmouth, rates are highest amongst the 30-44 age group, but lowest for the 60+ group.  Rates in 12-16 year olds have started to reduce – infections in this age group have been closely linked to 2 secondary school outbreaks.

Covid-19 related activity at QA has increased over the last 7 days – PHU continues to be under significant pressure, along with the wider HIOW system.  There have been 59 covid-related deaths since the end of October at QAH. Overall death rates in the city have been broadly in line with those expected (using the average seen over the last five years with one exception in November when this dropped).

Cllr Smith referenced recent media coverage regarding a new strain of the virus, and wondered what the implications are.  Helen responded that it is very early to know and that analysis will be published in the next couple of weeks.  However, this is not unique to the UK, and is also not unusual to see new variants of viruses in pandemics situations over time.

Cllr Smyth asked what the expectation was for the post-Christmas situation, given that we had not seen a sustained improvement in infection rates after the recent lockdown.  Helen confirmed that it is expected that we will see a deteriorating picture, and that there will be very significant NHS pressures.  It is really important that people continue to be careful over the Christmas period.

Cllr Smyth also asked if there is likely to be differentiation in the Tier system across the county.  Helen responded that this is possible, and that Tiers are determined by government , so whilst areas can feed their data and information into decision-making, they are then allocated tiers nationally.

The Chair thanked Helen for the presentation.

  1. Director of Public Health and Head of Regulatory Services Update

Helen Atkinson provided the following updates:

  • University of Portsmouth – The University provided a helpful update to the Health Protection Board last week around the plans for students to depart the city- the arrangements for testing and departure had been successful, and there is some learning around the use of lateral flow devices. It is good news that the university testing had identified very few positive cases.
  • Testing – we are still awaiting confirmation of a third testing site for the city. The Portsmouth College mobile test unit was in the city in December for a weekend.  There is now lots of planning for the use of lateral flow testing in care homes, and schools.
  • Local contact tracing – Dominique le Touze reported progress on the local contact tracing arrangements and reported that the local team are receiving around 25% of the cases that test positive each day. They are only needing to rely on local data in around 10% of cases. The service continues to run on a 7 day basis, but PHE are going to take over for the Christmas period.

Roger Batterbury asked how reliable the lateral flow tests are – Dominique explained that they are being used in very specific settings and circumstances and are adequate for those purposes.  Andy Biddle explained that they have been sent to a number of care homes, and there has been feedback that the guidance for administering is unrealistic for some of these settings – but that the tests should only be seen as one part of a range of measures that include handwashing, PPE, and regular cleaning of areas.

Richard Lee reported that new legislation was introduced on 2nd December, and this enables local authorities to serve various notices on premises, including improvement notices, immediate restriction notices and restrictive notices.  Most premises are compliant, but there have been some examples of significant non-compliance.  The team are also seeing fewer reports of non-compliance, and there is a sense that a degree of “compliance fatigue” has set in.  The most common area of non-compliance is disregard for household mixing rules.

There have also been some reports of bogus compliance officers – members of the board were asked to report any concerns that they hear about this to Richard Lee.

  1. Test and Trace Payments

Kelly Nash provided an overview of the report from Natasha Edmunds, Director of Corporate Services.

Cllr Smith noted that Table 1 of the report suggested that successful applications to both the main and discretionary schemes seemed low at 161/103. And asked if this suggested the criteria were too stringent.  Kelly said that she would arrange for a written statement on this issue to be circulated to the Board.

The Board were asked if they were supportive of using the COMF grant to top-up the available funds for the discretionary scheme, and it was agreed to support this, with Cllr Smith making clear that this needed to be dependent on being satisfied around the criteria.

  1. Covid-19 discharge pathways and designated sites

Andy Biddle reported that a pathway for discharge and designated sites for discharge has been agreed for HIOW and endorsed locally by the Health Protection Board.

Andy explained that designated settings are where someone can go if they need a care home but are Covid-positive.  Portsmouth has the “Gunwharf Unit” and had been taking people into that setting.  No formal guidance had been provided  on the cointing time period for isolation e and due to importance of  enabling flow out of the hospital it has been decided to propose  that we will continue to count anytime in hospital as positive as part of the 14 days.

Cllr Smyth asked if this linked to people with longer term impacts from covid needing to receive care – Andy replied that this picture is still unclear and will take a year or so to become apparent.

  1. Vaccinations

Claire Currie provided an overview of the vaccination programme.

Implementation has now started, through 50 hospital hubs including QA, and this will be scaled up through a blended delivery model, and as other vaccines come online.  The second phase will be through community and primary care, with a third phase through vaccination centres.

Communication is nationally managed, and will be focusing on generating confidence, and identifying trusted voices to reach out to communities.  There will also be locally tailored messages, and would be looking at local insights.

Roger Batterbury asked if younger people in the hospital would be vaccinated on discharge. Claire suggested that the vaccine was limited and needed to be targeted at older age groups.

Dr Collie reported that the primary care hubs in the city will start delivering in the week.

  1. 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 increase in infection rates.

Cllr Smyth noted that the board is working well in terms of providing assurance and thanked all those involved for their work.  The importance of staff taking leave over Christmas was reiterated.

Steve Labedz also reported that schools have been under huge pressure and Cllr Winnington recognised this, and the work of all partners.

  1. Any other business

Richard Lee reported that PESAG had confirmed the intention to continue requesting robust risk assessments confirming covid-safety at least six weeks in advance.