Councillors and committees

Agenda item

COVID-19 LOCAL OUTBREAK CONTROL PLAN UPDATE

The report details progress on Surrey’s Local Outbreak Control Plan including key outcomes and milestones to date, challenges and next steps going forward.

 

 

 

 

 

 

 

Minutes:

Witnesses:

Ruth Hutchinson - Director of Public Health (SCC)

Caroline Chapman - Senior Public Health Contact Tracing Lead (SCC)

Martyn Munro - Senior Public Health Lead (SCC)

Jack Healy - Public Health Lead (SCC)

NeginSarafraz-Shekary - Public Health Principal (SCC)

Naheed Rana - Public Health Consultant (SCC)

Jane Chalmers - COVID Director, Surrey Heartlands

Gavin Stephens - Chief Constable of Surrey Police

Liz Uliasz - Deputy Director - Adult Social Care (SCC)

Patricia Denney - Director - Quality and Performance for Children, Families and Learning (SCC)

Mary Lewis - Cabinet Member for Children, Young People and Families (SCC)

Key points raised in the discussion:

1.      The Director of Public Health (SCC) provided an update on the national context, noting that:

·         There would be a big announcement by Government on 22 February concerning the lockdown exit roadmap and gradual easing of restrictions such as more pupils being on site at schools.

·         As a result of the roadmap, regional conveners had noted that there was an expectation that there would be major revisions to the LOCP with an update to the LOCP needed by the end of March, Surrey’s LOCP published last summer had been updated approximately every eight weeks depending on national changes.

·         It was announced on 16 February that an extra 1.7 million people in England would join the 2.3 million on the shielding list those ‘clinically extremely vulnerable’. The change was as a result of new modelling published in the British Medical Journal, the new assessment tool took into account multiple risk factors of catching Covid-19 and becoming gravely ill.

·         The national guidance on shielding had not changed, due to be republished on 21 February it would instead be extended to 31 March, individuals added to the list would be notified and it meant that an extra 820,000 adults aged 19-69 would be prioritised for a vaccination.

2.    The Senior Public Health Contact Tracing Lead (SCC) provided an update on local contact tracing, noting:

·           The journey that a case took through the system from day zero when it arrived in which there was eight hours for the individual with a positive case to complete their details online. There was then twenty-four hours for the national Test and Trace system to complete the contact tracing. By day three, if contract tracing by the national system was unsuccessful the cases would be passed to the local system and in Surrey there was five days of local contact tracing up to day seven the end of the journey. 

·           That the advantages of local contract tracing were that:

-     the local contact tracers themselves were Surrey residents who understood the challenges facing fellow residents.

-     there was an option to ring back or reply by email to the local contact tracers increasing the success rate particularly if those contacted were ill during the initial contact.

-     the advice and welfare support offered by the local contact tracers was through the Customer Services team (SCC) who had access to a range of different support services available utilising volunteers such as dog-walkers.

-     the training for local contact trainers was a week and a half as it was comprehensive not just on the Contact Tracing and Advice Service (CTAS) itself but also advice and support and how to manage difficult situations.

-     the ratio of contact traces to team leaders was good with team leaders supervising five or so contact traces which will give them plenty of scope to support the contact tracers.

-     face to face contact tracing was being trialled for two areas in Surrey for those few cases who had not engaged online, responded to the twenty-four hours of national contact tracing and had not responded to the local team; via an environmental health officer through home visits providing isolation advice and encouraging telephone contact to be made in that moment with the contact tracing team.

-     family groups could be contact traced in one call.

·         Local contact tracing had been rolled out across the whole of Surrey via the Customer Services team (SCC) with support by the public health teams.

·         The combined national and local contact tracing of cases across Surrey was 86% of cases daily and between 10-16 February 2021, the local contact tracing service reached 71% of cases that the national team was unable to contact within twenty-four hours.

·         Surrey had been invited to participate in a hot spot pilot beginning on 3 March covering two districts within Surrey for two weeks initially, using local contact tracing for the whole period after the eight hours had passed for the individual with a positive case to complete their details online.

3.      A Board member welcomed the success of local contact tracing and the pilot but noted the national problem of some individuals not going for a test nor complying with self-isolation and asked what the scale of the situation was in Surrey.

-        In response, the Director of Public Health (SCC) noted that in Surrey the average was that approximately 86% of those who had a positive test engaged with the local contact tracing service, which was slightly above the average and the team was confident it could increase that level.

-        The Senior Public Health Contact Tracing Lead(SCC) noted that it would be difficult to assess the level of those who did not go for a test despite having symptoms and noted that the feedback from the local contact tracing service was that the tracers were overwhelmed by how people wanted to engage in order to support their families and their communities.

-        The Chairman added that it was a difficult question to answer in terms of those not going for a test despite having symptoms, but noted confidence in the testing resources stood up by the Council with its key partners.

4.      The Senior Public Health Lead (SCC) provided an update on symptomatic or Pillar 2 testing concerning those who thought they had Covid-19 symptoms, noting that:

·         There was a Regional Test Site (RTS) in Guildford which was a drive-through testing centre, with good regional provision in Chessington, Heathrow, Twickenham and Gatwick.

·         The Local Test Sites (LTS) operated in dense urban areas offering walk up and cycle to testing and tended to have more resource to spend longer with individuals to talk them through the testing process if needed. Currently there were LTSs in Egham, Guildford, Farnham, Hersham, Woking, Camberley and Epsom, with a Spelthorne LTS to follow.

·         There were also Mobile Testing Units (MTU) which were deployed around the county, rotated across the boroughs and districts and additional MTUs were deployed to areas with increasing rates of infection.

·         Home test kits were also delivered directly to individuals’ homes for them and their families so that they could self-test, tests were posted and results were via the Test and Trace system.

·         The number of tests registered on the national system: between 30 December 2020 - 5 January 2021 was 24,815 tests via the RTS, LTSs and MTUs and 5,422 home tests with a turnaround time range of 31-45 hours; compared to 6,429 tests via the RTS, LTSs and MTUs and 7,393 home tests between 8 February - 15 February 2021 with a turnaround time range of 15-27 hours.

·         The recent increase in home testing between 8 February - 15 February 2021 could be attributed to the surge testing or Operation Eagle in which there were 3,430 in Egham.

·         There were other testing routes for care homes, extra care and supported living, and domiciliary and healthcare workers. Provisions for those settings were rapidly changing and also included asymptomatic testing too. 

5.      The Public Health Lead (SCC) provided an update on the targeted community testing programme or asymptomatic testing in Surrey, noting that:

·         Targeted community testing used the lateral flow device tests which give a quicker turnaround of results with processing taking about half an hour, rather than the PCR test used for symptomatic individuals which could take up to a day due to the lab processing needed. 

·         Individuals self-administered their swab and results were processed on site which are uploaded onto the national system and the results were sent to the individual by text message or email after they left the site.

·         Asymptomatic testing was available to anyone living or working within Surrey who must leave home to work, small and medium sized public sector and private sector businesses, charities, voluntary groups and any educational and childcare settings which did not have access to symptom-free testing through other national routes such as those led by the Department of Health and Social Care including care homes, schools or institutional testing for businesses with fifty employees or more; participants must also be symptom-free and not self-isolating at the time.

·         The online booking system was live on the website where tests could be booked at one of the sites - up to two weeks in advance.

·         Twice weekly testing was encouraged in line with the other national led symptom-free testing programmes.

·         There were currently three asymptomatic testing sites in Spelthorne, Epsom and Woking and those areas were chosen as the initial sites based on epidemiological data across the pandemic and demographics.

·         There were also three pharmacies delivering asymptomatic testing with an additional twenty-two pharmacies to deliver testing within the next week with future plans to extend that provision.

·         There was a need to ensure flexibility with regards to Surrey’s programme of asymptomatic testing to complement national asymptomatic testing programmes.

·         Further information was available online including FAQs.

6.      The Public Health Principal (SCC) provided an update on Covid-19 and BAME communities, noting that:

·         The RNAs last summer collected feedback from BAME communities to understand their experiences of Covid-19, what worked well in what could be done better in terms of the Council’s response.

·         BAME groups had been disproportionately impacted by Covid-19 with evidence showing that they were at greater risk of both hospitalisation and mortality.

·         The key attributing factors suggesting why the BAME population was disproportionately impacted were linked to:

-       pre-existing health conditions such as cardiovascular conditions, diabetes and high blood pressure which tended to be more prevalent.

-       a higher tendency to work in frontline and in low pay jobs, increasing the risk of exposure.

-       poorer access to healthcare services compared to other population groups due to number of factors that could be cultural behaviour or relating to previous experiences with those services.

·           That the issues noted above needed to be contextualised with regards to pre-existing inequalities pre-pandemic, discrimination and racism were highlighted in the RNAs as significant drivers that had resulted in the disproportionate impacts and reduced the level of trust.

·           Although addressing pre-existing health inequalities was a long-term action, key immediate actions as a result of the BAME RNA included: building capacity within Surrey’s BAME community charity organisations through the Surrey Minority and Ethnic Forum and a post had been joint funded with Surrey Heartlands for a Health and Race Wellbeing officer who would act as a conduit and trusted voice to transmit key messages to BAME communities.

·           A key issue highlighted in the BAME RNA concerned the lack of information available in different languages, noting the work of the Communications team (SCC) with Woking’s Imam to ensure that messages were culturally appropriate - as it was vital that both symptomatic and asymptomatic testing was accessible.

·           Another key issue highlighted in the RNA was the lack of ethnicity data collection as without knowing where Surrey’s BAME populations were it was difficult to tailor interventions and design engagement and data collection formed a key workstream within the health inequalities group and was one of the key factors highlighted in the NHS’ Phase Three letter.

·           In collaboration with public health teams and health colleagues work was being done to extend the NHS Health Check locally, it was a national programme that identified people with high risk of cardiovascular disease and it was a priority that it be accessible to Surrey’s BAME groups both for primary care and workplace settings; as well as making sure that all BAME staff had received a comprehensive risk assessment and clear action plan in order to support those that were working in frontline occupations.

7.      The Chairman picked up a comment in the Teams chat asking if there was anything that could be learnt from the QCOVID data exercise in relation to supporting Surrey’s BAME communities such as around testing.

-       In response, the Public Health Principal (SCC) recognised the importance of collecting ethnicity data for positive Covid-19 tests and those receiving a vaccination. Noting that although there was a tick box to fill regarding a person’s ethnicity not everyone had filled that box due to a number of reasons such as not associating themselves with that specific tick box or being worried about disclosing ethnicity data and not knowing where it was being stored.

-       The Public Health Consultant (SCC) noted that one of the urgent actions from the NHS’ Phase Three letter and requirements from the health sector to reduce health inequalities was to improve the data recording of the ethnicity at hospitals and other systems. Building trust, ensuring clear communications on data collection was key as well as the accountability to improve data collection within the system and make every contact count.

8.      The COVID Director for Surrey Heartlands provided an update on the vaccination rollout programme, noting that:

·         Excellent progress had been made in Surrey Heartlands with the vaccination rollout programme, from 8 December 2020 when the first vaccination was administered at the Royal Surrey Hospital up to 18 February 2021 over 260,000 vaccinations had been administered in Surrey Heartlands and the vast majority were first doses.

·         The percentages of vaccination delivery for some of the key priority cohorts 1-4 was over 90% for older adult care home residents and from age 70 upwards. Although the programme was moving on to cohorts 5 and 6 those who had not taken up the vaccine in the earlier cohorts would continue to be encouraged to do so.

·         6 February 2021 had been the best day to date when 9,535 vaccinations were administered across Surrey Heartlands and their best week saw over 50,000 receiving the vaccine.

·         Regarding Surrey Heartlands COVID-19 Delivery Plan a strong start had been made through delivering vaccines through hospital hubs, local vaccination services (PCNs), the large vaccination centre at Epsom Downs Racecourse, two community pharmacies in Guildford and a roving team to support the housebound and those in care homes.

·         Both the Pfizer-Biontech and AstraZeneca vaccines were being used and had been delivered safely with an extremely low volume of clinical incidents.

·         The delivery of the programme had been a real partnership effort across the NHS, local authorities, local partners, voluntary services and volunteers at the vaccination sites.

·         Key challenges of the rollout continued to be around supply and allocations particularly concerning the second dose supply which would begin to be delivered later in the month as well as moving the programme into a business as usual approach going forward.

·         The governance structure had been refined to highlight the decision making, operational and assurance boards and groups centred around the Surrey Vaccinations Programme Delivery Board chaired by the Senior Responsible Officer, Surrey Heartlands with involvement by the Chief Executive (SCC) and noted the inclusion of Frimley via the Frimley ICS Covid Vaccination Programme Board.

·         In response to the letter from the Secretary of State for Health and Social Care and the Secretary of State for Housing, Communities and Local Government on greater determination by local government going forward, the delivery plan had been condensed into fifteen points of delivery on a continuum from incident management to business as usual.

9.      A Board member noted the fantastic partnership endeavour throughout the vaccination programme across the system including borough and district councils. Progress had been made and the challenge would be to convert the current activity into a business as usual going forward.

10.   The Board member further noted that one of the proposals going forward was for a large mass vaccination site as the rollout extended to cohorts 5-9, noting the merits but asked for further detail on the impacts such as the difficulty in travel concerning the Gatwick option.

-        In response, the COVID Director for Surrey Heartlands noted that there was consideration being given to a regional super site for the South East and the possible location was Gatwick. A decision on that was imminent and had been discussed last week by the COVID Vaccinations Steering Group. The view of the Steering Group was reflected in a recent regional meeting in that whilst regional capacity could be useful particularly regarding ‘cohort 10’ which was the rest of the adult population, that regional super site should not be at the expense of using the existing local delivery model which provided accessibility for hard to reach residents.

11.   The Chairman noted that it was an opportunity for Board members to comment on that option, noting that Gatwick would be a challenging location to reach for some residents and welcomed the continued use of the local model.

12.   A Board member strongly supported the use of the existing local model as well as the possible Gatwick regional super site, noting that more travel went against the green agenda which should be viewed in conjunction with the health agenda.

13.   The Chairman highlighted a Board member’s comment in the Teams chat asking whether the large vaccination centre at Epsom Downs Racecourse would continue.

-        In response, the COVID Director for Surrey Heartlands noted that the centre at Epsom Downs Racecourse would continue until early May with a further discussion to be had as Epsom Jockey Club were looking to have their facilities back for the Derby in early June so the premises would need to be vacated for a short period.

-        As a result they were working on plans around the use of the estates to make sure that everything was in place until 3 May which was the next milestone for the rollout to cohorts 5-9, with a further strategic conversation about the estates beyond that date to follow and a conversation on the Gatwick option might play into that in terms of the capacity needed.

-        The Chairman noted the further comment in the Teams chat noting that a location in the centre of the county would be sensible given the transport challenges around Gatwick and asked for the COVID Director for Surrey Heartlands to keep the Board updated on the decision around the Gatwick option.

14.   The Chief Constable of Surrey Police provided an update on enforcement, noting key headlines which included figures accurate up to 26 January 2021:

  • 11,632 Covid-related incidents were reported to Surrey Police.
  • 790 Fixed Penalty Notices (FPNs) since the start of the first lockdown on 23 March 2020, although there had been an increase in recent weeks with 363 FPNs since the latest lockdown beginning 4 January 2021 and 109 FPNs in the last week. The number showed the high compliance rate of residents, noting the success of Surrey Police’s use of the Four Es: engage, explain, encourage and enforce.
  • The use of the Four Es was vital particularly as there had been many changes in the national regulations and enforcement was a last resort, in Surrey there had not been the same level of mass gatherings or unlicensed music events and parties compared to other areas, with only three £10,000 fines issued to date.
  • That the Home Office had issued additional surge funding of just under £400,000 to help with Covid-related issues with a recent further extension to that funding, allowing Surrey Police to maintain its internal command structure via Operation Apollo which supported the work of the LRF, as well as some dedicated high-visibility patrols by a police sergeant and six police constables to particular Covid-related incident hot spots working with local authorities and licensing authorities of the problem premises.
  • The recent discussion at the national gold group highlighted the risks around easing out of national restrictions as peoples’ tolerance levels were lowering and some were not adhering to the current restrictions running the risk of fines in order to get their incomes moving again.
  • A recent theft from the large vaccination centre at Epsom Downs Racecourse in which four arrests had been made and items seized. 

15.   The Chairman queried why the amount of FPNs since 4 January 2021 and in the last week was high.

-       In response, the Chief Constable of Surrey Police explained that compliance levels were waning, noting the national communications of expectations for the future including the easing of restrictions. The current restrictions were clear as people needed a lawful excuse to leave home and enforcement statistics had risen with approximately 900 FPNs to date.

16.   The Chairman noted the future easing of restrictions and rise in FPNs, asking if there was a plan in place to mitigate that and asked whether Board members could help collectively to support that issue.

-     In response, the Chief Constable of Surrey Police noted that the issue had been discussed at the LRF’s Strategic Coordinating Group, noting the need to carefully tailor communications ensuring that people adhere to the current restrictions, welcoming the partnership support from Board members across their different agencies and areas of influence, and importance of public health messages such as that one in three people were asymptomatic and to behave as if you had the virus.

17.   The Deputy Director - Adult Social Care (SCC) provided an update on Adult Social care, noting that:                                                  

·           Care homes:

-     there was good news as the data was showing a decrease in positive cases, outbreaks and deaths as well as increasing vaccinations. Today, the number of homes with four positive cases dropped to six, the capacity tracker would continue to monitor that situation and supporting the care homes with infection control, quality assurance issues.

-     in terms of Surrey’s in-house homes it was an improving picture and staffing levels were improving also.

·           Winter pressures:

-     had primarily been generated by Covid-19, the system was under pressure and ASC had been supporting the daily Incident Management Group calls and Area Directors were working on a locality basis to make sure that the system was supported around the acutes, flow and teams continued to work seven days a week to support hospital discharge as it was vital to get people back to their own homes rather than having a care home placement.

·           Mental health:

-     pressures remained noting acuity and demand, and across the age groups in children's and adults. Surrey Heartlands Mental Health Emergency Response Service with representatives from all partners, district and borough councils, ASC, Childrens, Families and Learning (CFL), commissioners and providers. There were eight pillars of work to address the issues around supporting the workforce and schools. The two pillars that ASC was jointly leading on were accommodation issues and hospital flow.

·           Over the last year there had been a 32% increase in the work going through to ASC and although it was a busy time, there was a whole system approach to managing and supporting staffs’ welfare such as through the Resilience Hub launched by the Surrey and Borders Partnership NHS Foundation Trust (SABP) and included staff in the provider market not just health or social care staff.

18.   The Chairman noted the positive change in the decrease in Covid-19 cases in care homes as well as the key updates on mental health and the ongoing pressures within ASC, noting the Council's commitment to improving mental health outcomes and working with key partners and thanked the Deputy Director - Adult Social Care (SCC) for her work.

19.   A Board member noted that vaccinations of care home staff was causing concern nationally and asked what Surrey’s position was and what the vaccination percentage was for those caring for older people.

-     In response, the Deputy Director - Adult Social Care (SCC) noted the vaccination percentages for cohort one covering care homes was above 90%; where there had not been vaccinations in care homes it was possibly due to a Covid-19 outbreak as people could not be vaccinated until twenty-eight days afterwards.

-     Older people aged 80 plus again had a vaccination percentage of over 90% and those caring for them such as healthcare workers, social care workers, home based care providers, supported living carers were in cohort two which had a good vaccination uptake across providers, noting the joint partnership work with the Surrey Care Association and the Skills Academy.

20.   The Director - Quality and Performance for Children, Families and Learning (SCC) provided an update on the Children, Families and Learning (CFL) directorate, noting that:

·         Wider impacts of Covid-19 on educational settings:

-     over this last year the tremendous work that schools had done in terms of remaining open for our vulnerable children, children with Education, Health and Care (EHC) plans and children of key workers.

-     during the lockdowns, the Department for Education’s return figures showed that there was a higher percentage of children with an EHC plan who had been attending school with an attendance percentage of 24% compared to the national attendance rate of 16%. Looking at the overall figure of vulnerable children the attendance percentage was 31% during the lockdowns compared to 11% nationally.

-     those figures in Surrey had been achieved through joint working between children's social care and education, weekly meetings to encourage in school attendance and school absence was monitored closely through a RAG (Red-Amber-Green) rating system.

-     the lack of routine for autistic children had been problematic and in some cases had led to a breakdown in their school placements and at the start of the school term there had been a large increase in request for parents who were seeking for their children to be electively home educated, the service was working with each one of those parents to try to promote the benefits of remaining within a school system.

-     referrals to the Children's Single Point of Access (C-SPA) had increased although the rate had stabilised compared to last year.

-     adaptable leadership within the schools, head teachers were faced with a range of challenges due to changing guidance and at any given time across the whole system up to two-hundred teachers were self-isolating, and dealt with balancing classroom learning and remote learning.

-     some of the schools were as much as 80% full and schools provided assistance to children's social care acting as the ears and eyes over Surrey’s vulnerable children.

-     teachers in Special, Education, Needs and Disabilities (SEND) schools were being vaccinated and the service still made the case for all teachers being vaccinated.

-     regarding children’s social care, the service was trying to maintain face to face contact with those children where it was safe to do so.

·           Family economic hardship and the impact of coronavirus:

-     families with children of school age had been hit hard by the pandemic financially, with many parents losing their jobs or were furloughed and looking for employment was difficult whilst balancing childcare.

-     there were few opportunities for young people who wanted to leave the education system into employment.

-     there was an increase of those children eligible for free school meals, although the stigma was a challenge.

-     there was an increased level of mental health problems both in parents and in children, noting that self-harm in children had increased in the last eighteen months, there was a higher level of suicide in the teenage population and there were more incidents of injuries to babies compared to previous years - such issues were reflected in national figures.

·           Demand and crisis in Children’s Mental Health Services (CAMHS):

-     because of the demand CAMHS were reaching out and trying to work closely with parents and children, working alongside colleagues in schools and there was a range of support available including online facilities and additional clinical support for those children who may present at a local hospital.

·      Emotional Wellbeing and Mental Health Contract (EWMH):

-     the EWMH contract went out to tender and was awarded on behalf of the provider Alliance would come into force in April 2021, noting the optimism that there would be an improvement in terms of support our young people going forward and the backlog would be cleared before the new contract came into place.

21.   The Cabinet Member for Children, Young People and Families (SCC):

·         Welcomed the report on CFL being presented to the Board, echoing the public question concerning cohorts that had been particularly badly affected by Covid-19 and noted that young people were one of those cohorts.

·         Noted that young people had responded well and complied with the restrictions.

·         Noted that the impact on young people had been significant, schools had been important partners in terms of supporting the most vulnerable.

·         Highlighted the thematic review: Deaths of Children and Young People through probable suicide 2014-2020 presented to the Health and Wellbeing Board last September by the Surrey Safeguarding Children Partnership that showed that self-harm was an early indicator of adolescent suicide.

·         That regarding CAMHS, the 45% increase in self-harm and 66% increase in eating disorders with increases in serious cases requiring hospitalisation reported to the digital provider Kooth.com. 

·         Noted the importance of keeping Surrey’s young people in mind and put in a plea to lobby for teaching staff to get recognition for their hard work throughout the pandemic, that they should get vaccinations so that schools could be kept open so as not to prolong the isolation and harms faced by young people out of school.

·         Commended the work of the Director - Quality and Performance for Children, Families and Learning (SCC) who led the group who had worked on ensuring good attendance with higher results than the national data.

·         That when schools went back in September the attendance of Surrey’s Looked After Children was above 90% and praised the efforts of Surrey’s foster carers of which four hundred had been vaccinated, who continued to support children’s education with support of the Surrey Virtual School and others. 

22.   The Chairman welcomed the updates on CFL and the work undertaken across the directorate.

23.   The Public Health Principal (SCC) agreed with the importance of the data on young people and that they were an important cohort, noting that the Public Health team (SCC) had established a Mental Health and Children Suicide Prevention Group which looked at the thematic review findings and had recently obtained Sustainability and Transformation Plans (STPs) wave four funding for suicide prevention which would be used towards a self-harm pathway review.

24.   The Director - Quality and Performance for Children, Families and Learning (SCC) noted the importance of the thematic review highlighted the key factors which increased risk in terms adolescent suicide such as parental breakdown, children on the Autism Spectrum Disorder (ASD), who had experienced a significant event as well as poverty.

 

RESOLVED:

The Board:

1.    Noted the report.

2.    Would continue to provide political oversight of local delivery of the Local Outbreak Control Plan.

3.    Would continue to lead the engagement with local communities and be the public face of the local response.

4.    Members would ensure appropriate information on the programme and on COVID-19 in Surrey is cascaded within their own organisations and areas of influence.

 

Actions/further information to be provided:

1.    The COVID Director for Surrey Heartlands will keep the Board updated on the decision around the Gatwick option concerning a proposed vaccination regional super site.

 

Supporting documents: