To hear an update on the winter response to Covid.

The Chairman explained that he wanted to hold this additional Health and Wellbeing Board meeting to allow discussion on the winter response to the Covid-19 pandemic and also the national flu campaign.

 

Tessa Lindfield, Director of Public Health, gave some background to the current situation in RBWM. So far, there had been 2,549 cases overall which was 106 cases per 100,000 of the population (for the week of 26 November – 2 December). The second lockdown had come at the good time for the borough as cases had been rising rapidly, and while there was a data lag cases had started to decrease since the lockdown was introduced. The number of cases for those in the 60+ category had increased by over 76% since the week before, which was largely due to outbreaks in care homes. 13 RBWM residents were currently in hospital, with an average age of 68. Looking at deaths in the borough, a total of 151 residents had died with coronavirus since March. The all-cause mortality rate was around 6% higher than would be expected in a normal year, with the current all-cause mortality rate being in line with what would be expected. Cases across the borough could also be broken down into individual wards, but overall across the whole pandemic figures across the borough were fairly even.

 

Looking at the current restrictions, RBWM was now in Tier 2 along with the rest of Berkshire other than Slough, which was in Tier 3. The tiers were designed to stop household mixing and reduce the rate of transmission. There would be a slight change of the rules at Christmas, with families able to form a three household Christmas buddle. This would be allowed from 23^rd – 27^th December and would enable families to be together for Christmas, although the rules should still be followed. Between 2,000-2,500 students would be returning to RBWM over the Christmas period, with students advised to travel home between 3^rd and 9^th December and testing had taken place on many campuses around the UK to ensure that the virus could be contained. Tessa Lindfield said that if the eight main behaviours/rules were followed, the transmission rate would remain low. It was important that people were careful over the Christmas period and ensured that they saw as few people as possible.

 

Councillor Rayner joined the meeting.

 

The Chairman said that it was important that everyone tried to limit the requirement for contact with others so that the virus did not spread further.

 

Caroline Farrar updated the Board from the perspective of Frimley Health and Care.

 

•       Locally the NHS continued to focus on responding to the pandemic, winter and restoring services which were paused during the initial wave and the associated backlog of those waiting to be seen.

•       The priority remained on addressing the needs of the most vulnerable in the community and addressing the direct and indirect impact of Covid-19.

•       Significant progress had been made in recovering backlog activity.

•       Planning for the delivery of the Covid vaccination programme which was due to commence in the coming weeks.

•       The use of technology as way of accessing the NHS had increased exponentially over the last 6 months.

•       GP practices were working together to set up Covid-19 Local Vaccination Services in Maidenhead, Windsor and Bracknell (covering the Ascot population), as well as high priority backlog activity including learning disability and mental health physical health checks, long-term conditions checks, and childhood immunisations and cervical smear tests.

 

Caroline Farrar discussed some of the figures, with outpatient level recovering to the level it was last year in August. However, since then it had remained below that level. A&E levels remained lower in November than the same period last year. Wexham Park Hospital had high numbers of people requiring critical care related to high numbers of community infections in the Slough area.

 

•       The Covid-19 pandemic had a significant impact on the delivery of NHS services and on the behaviours of many members of the public in terms of how they accessed healthcare services.

•       It was important to ensure that Emergency Department crowding did not return to pre-Covid levels. This was about protecting patients from the risk of infection, making sure EDs were able to cope with additional winter/potential Covid demand, and to improve patient experience by providing more efficient and effective service delivery and outcomes.

•       This meant that how people access parts of urgent care was changing, with ‘111 First’ helping them to get the right care, in the right place, more quickly.

•       Throughout the pandemic, general practice had remained open and should be the first point of contact for patients seeking same day care when their surgery was open.

•       It should be encouraged that all patients continued to use their registered practice for advice and care.

•       When a GP practice was not available (such as evenings or weekends) it was encouraged to ring 111 or use https://111.nhs.uk.

•       People who needed urgent, but not life-threatening, care were being asked to contact NHS 111 before going to A&E. This would reduce waiting times and support social distancing in waiting rooms.

•       The new arrangements would keep patients safe and allow them to maintain social distancing.

•       From 24^th November residents were able to have an appointment booked for them at a local primary or community service or a nearby A&E if it was needed following contact with 111.

•       Arrangements would not change for people with life-threatening illnesses or injuries who should continue to dial 999 and anyone who arrived at A&E without calling NHS 111 would still receive medical care, with those needing emergency treatment prioritised.

•       General practice remained open as usual for telephone, online, video and face-to-face appointments.

 

Some considerations needed to be taken forward from the first wave of Covid in March:

•       When infection rates rise, pressure on hot services would increase.

•       Learning from Wave 1 about the significant hidden harms from suspending services, particularly for at risk populations and higher risk conditions.

•       RBWM practices vary in size from 3,000 to 19,000 list size. Numbers of staff at higher Covid risk also vary by practice and this would all impact on resilience.

•       Ongoing impact of infection prevention and control measures on primary care capacity.

•       Understanding of backlogs of care continued to improve.

•       Increased emphasis on targeting health inequalities and prevention required changes in culture and operating models.

 

•       Face to face consultations had dropped considerably during the first lockdown but then climbed before dipping again during the second lockdown. On 10 November general practices were asked to urgently prepare to contribute to the Covid-19 vaccination programme by vaccinating their usual cohorts of patients. This was supported by a General Practice Covid Capacity Expansion Fund with £1.8m funding available across the ICS until the end of March 2021 – to support practices to continue to deliver their usual levels of activity, including reducing backlogs of care with a focus on the most at risk populations.

 

Councillor Baldwin commented on the usage of A&E and asked if the trends seen in the past could be tracked and then modelled going forward, particularly on things like licensing and public policy.

 

Caroline Farrar said that it would be interesting to look at the data in this way. She said that there had been a greater reluctance from the older population to be admitted to hospital during the pandemic.

 

Kevin McDaniel, Director of Children’s Services, gave an update to the Board on the situation in schools and with young people in care. Schools had reopened to all students in September and since then all state funded schools in the borough had stayed open throughout the term. The experience for each school would be different, with primary schools remaining relatively unaffected. However, in secondary schools there had been many confirmed cases which could take out whole classes and year groups through the need for self-isolation. Remote learning had been implemented well by schools and this was especially important for year 11 and 13 who had exams next summer. Schools had shared good practice and worked well in conjunction with public health services when needed. The biggest challenge had been adapting to changes in the guidance on cases and outbreaks. Attendance had been around 90%, it would usually be around the 96% mark.

 

Looking at social care, there had been an increase in referrals in September, with the number of children on protection plans rising by 30%. This number was now decreasing, with the initial increase probably due to a lack of early intervention work which had been impacted by lockdown. Kevin McDaniel passed on his thanks to foster carers, with not a single placement being broken. Work was also being done with the judicial system and any children that needed court intervention would be able to receive it. The Winter Response Scheme was important for families that were struggling financially, with £30 a week available.

 

The Chairman reiterated the point on foster carers and said that they had been amazing throughout the pandemic. He said that Clive Haines had gone above and beyond to ensure that everything in schools ran smoothly.

 

Councillor Stimson asked what information was available so far on the vaccine roll out, for example what venues might be used.

 

The Chairman said it was too early to confirm any specific details. The vaccine needed unique storage requirements which would prove to be a challenge. It was hoped that other vaccine candidates would also eventually be approved and deployed and they would be easier to store.

 

Caroline Farrar left the meeting.

 

Huw Thomas, Clinical Lead for RBWM, said that the vaccine was something to get excited about. Over 80s would be offered it first, while it was likely that there would be one main location in each of the main towns of Maidenhead and Windsor. Ascot would probably use the vaccine centre located in Bracknell. There was a chance roll out could start before Christmas but it was more likely to be in the new year. The main logistical issue at the moment was transporting the vaccine into care homes.

 

Councillor Stimson asked if there was any way to help in her role as a councillor. She asked for an explanation on what the ‘bubbles’ were.

 

Tessa Lindfield said that there was a Berkshire Communication Group that tried to ensure there was a consistent message being sent out to residents. The Chairman said that it was important to empathise that the guidance needed to be followed.

 

Councillor Baldwin commented on the vouchers available to families to spend in supermarkets and asked if they were anonymous vouchers. Kevin McDaniel explained that families received a code which could be redeemed on the Eden Red website. This would give them a shopping voucher for use at their chosen supermarket, with the voucher being no different to a standard shopping gift card.

 

Hilary Hall, Director of Adults, Health and Commissioning, gave a presentation on the Outbreak Engagement Board. The Board was currently meeting weekly and one of its key purposes was to ensure that there was good communication and engagement with residents. Key strands of the communications activity included:

·         Focus on the “hands, face, space” message.

·         Targeted communications in areas of highest cases.

·         Focus on importance of testing and self-isolation.

·         Promotion of self-care messages.

·         Promotion of flu vaccinations, in liaison with health.

·         Promotion of data on the Berkshire public health website – www.berkshirepublichealth.co.uk

 

In terms of engagement, the Outbreak Engagement Board had seen:

 

•       Recruitment of community champions – 70 in total – to ensure messages were disseminated as widely as possible and also to get feedback on issues that needed more clarity.

•       Berkshire-wide insights survey undertaken to understand how residents wanted to receive messages in order to strengthen the work going forward.

•       Six interviews with Asian Star FM with community leaders and radio adverts also running. Families Magazine – advert running in latest edition and COVID-19 info in ATRB alongside broadcast communications.

•       Additional resource recruited to the Communications Team as of 7 December to support better engagement with communities and residents.

 

Hilary Hall also provided an update on adult social care over the winter period.

 

•       Steady increase in referrals following the end of the first lockdown.

•       Likely to increase as a result of hospital discharges over Christmas and New period.

•       Workforce was resilient.

•       Expansion of reablement service in order to support more people remaining in their own homes.

•       More integrated work with health through the Primary Care Networks and Locality Access Point.

 

Provider market:

•       Strong market in the borough.

•       A number of void beds, predominantly in older people’s care homes, but most voids pre date Covid.

•       Infection Control Grant had been paid to care homes and community providers.

•       Requirements around PPE, cohorting of staff and employing same agency workers, if they were continuing, would have significant financial implications for providers.

•       Emerging issues around insurance.

•       New requirements around vaccination.

•       Routine testing was being rolled out to domiciliary care providers

•       Care home visitor guidance over the festive season.

•       Continuing to build on strong relationship with Berkshire Care Association.

 

Community Engagement and Technology:

•       New opportunities had emerged to engage with community groups and communities generally – particularly around providing support for residents.

•       Opportunities to use emerging technologies to support residents to stay in their own homes.

 

East Berkshire:

•       Strong alliances across the three East Berkshire authorities – across adult social care, children’s services and health.

•       A number of joint commissioning projects had been completed and more are planned.

•       Consistency around guidance and approach, particularly to the care market, had been very beneficial through Covid and winter.

 

Councillor Coppinger said that a number of day centres had been closed due to lockdown. He asked if there were any programmes available at the moment to people who used them.

 

Hilary Hall said that a number of day centres had now reopened. They had tried to run a full range of activities, especially utilising online tools and resources.

 

Councillor Baldwin asked if the issues around insurance was a short term spike or if it would have a long term impact.

 

Hilary Hall said that it was difficult to say but it was something that was being seen nationally. She hoped that it was a short term spike but there was concern that it could be a long term implication.

 

The Chairman thanked all officers, NHS staff and those in the education system that were doing all they could in difficult circumstances. Teams had shown dedication and professionalism throughout the pandemic which ensured that residents were getting the best possible services. The Chairman also thanked Huw Thomas for all his hard work.