Agenda item

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

 

The Board’s updated Terms of Reference are also provided.

 

 

 

 

 

 

 

Witnesses:

 

Ruth Hutchinson - Director of Public Health (SCC)

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

Jack Healy - Public Health Lead (SCC)

Gail Hughes - Public Health Lead, Programme Manager – COVID-19 (SCC)

Gavin Stephens - Chief Constable of Surrey Police

Sinead Mooney - LOEB Chairman; Cabinet Member for Adults (SCC)

Rebecca (Bex) Pritchard - Chief Executive Officer of Surrey Care Association

Clare Curran - Cabinet Member for Children and Families (SCC)

 

Key points raised in the discussion:

 

1.      The Chairman referred to the updated Terms of Reference, noting the additions to the Board membership going forward of the proposed Cabinet Member for Health (SCC) and the Chief Executive Officer of Surrey Care Association.

2.      The Director of Public Health (SCC) introduced the report and provided updates on:

·         The National Easing of Restrictions in England:

-       noted the delayed move to Step 4 of the Government’s roadmap out of lockdown to 19 July 2021.

-       on 21 June 2021 Step 3 restrictions would remain apart from rules in relation to wedding and civil partnership ceremonies, and celebrations, funerals and commemorative events following a death, care home visits and domestic residential visits for children.

-       providers of those services were being supported in those settings with regards to those changes.

·         Local Outbreak Control Plan:

-       which had been republished recently and met the national accessibility requirements.

-       a Sector Led Improvement peer review had been undertaken with Buckinghamshire and East Sussex, with a productive session on 19 May followed by the final report after key amendments were made in light of feedback, such as greater transparency around testing for high risk groups and the inclusion of coincidence and common exposure reports - the peer review was circulated to the Board on 28 May.

-       in response to the Chairman’s comment requesting an update on an outstanding action from April's Board around the outcome of the Sector Led Improvement peer review, the Director of Public Health (SCC) reiterated the point above and asked that the peer review be re-circulated to the Board members.

·           Variants of Concern (VOC) (national):

-       that the Delta variant had recently become the dominant variant in the United Kingdom; it was estimated to be between 40 and 80% more transmissible than the Alpha variant driving the rapid increase in case numbers.

-       early data demonstrated a slight increase in the risk of hospitalisation, but the evidence continued to emerge - that increase was not yet seen in Surrey - and because of the vaccination programme most cases were in young people, which did not always manifest itself in hospitalisations; however it impacted primary care, education and the economy.

-       information on VOC and Variants Under Investigation (VUI) was published in the weekly coronavirus full summary report.

-       that the surge testing due to begin on Friday in Reigate and Banstead was as a result of a request as Surrey was highlighted as a possible Enhanced Response Area (ERA), having received the Enhanced Support Package (ESP) due to high rates of the Delta variant in around half of the Boroughs and Districts predominantly in the north of Surrey. It was decided at the Gold decision making meeting that those Boroughs and Districts would not become ERAs, instead surge testing would be run in Reigate and Banstead.

-       ERAs were on the GOV.UK website such as Manchester, with Hounslow located closest to Surrey.

-       that additional resource was provided and aggressive action was taken on emerging variants such as the Delta variant, the public health actions on VOCs included the standing up of IMTs for areas of concern, working with partners to review Covid-secure measures and put in place further control measures such as targeted testing and promoting communications intensifying them where necessary.

·         Managed Quarantine Service (MQS):

-       delivered by the Department of Health and Social Care, applying to anyone who had travelled from or passed through a country on the Red List.

-       two hotels in Surrey remained for the MQS and were located near Gatwick airport.

-       Steering groups manage the work of the MQS, recognising that they could get busier going forward due to increased travel and more countries added to the Red List.

3.    The Vice-Chairman asked why surge testing was targeted at Reigate and Banstead which was second and falling concerning the reported official case rates, noting that it was vital for communications to explain the reasoning for surge testing which would identify more cases. 

-       In response the Director of Public Health (SCC) recognised that surge testing by discovering more cases, would increase the case rate and noted the volatility of the pandemic shown through the recent rise of cases in Reigate and Banstead - noting the outbreak in one secondary school and subsequent spread within households and the community - an Incident Management Team (IMT) had been stood up.

-       The Director of Public Health (SCC) added that one difference of the recent surge testing programme in Reigate and Banstead was that testing would cover all ages, noting the dual message of getting tested and registering for a vaccination.

4.      The Senior Public Health Contact Tracing Lead (SCC) provided an update on Contact Tracing:

·      which was an important tool to break the chains of transmission particularly as cases were rising again.

·      the Surrey Contact Tracing Service local team received just under 100 cases a week between 7-21 May 2021, doubling between 22-28 May 2021, doubling again 29 May-4 June 2021, with a further rise between 5-11 June 2021 - with 107 cases alone on that Monday.  

·      it had been difficult to manage that volatility in numbers despite having flexibility within the team and reluctantly some cases had to be handed back to the NHS Test and Trace service national team.

·      as a result, actions were put in place to mitigate that re-occurrence such as bringing in a further six contact tracers by 7 July, with people to help out on weekends and using capacity from the testing team in terms of call centre staff.

·      local contact tracing through the Surrey Contact Tracing Service was being completed for most cases, between 27 May-2 June the NHS Test and Trace service national team reached 92.2% of cases in England and in Surrey between 31 May - 6 June 95% of cases were reached by the local and national teams - the figure had been up to 97% in the last few weeks.

·      attributable to Surrey’s success was the use of Environmental Health Officers over the past three months who completed face-to-face contact tracing for those cases not contacted via telephone, reaching 50% of the difficult to reach cases equivalent to twenty-two cases.

·      New to the Surrey Contact Tracing Service was:

-       a computer system arriving by late July - Integrated Tracing system (ITS) - in which Surrey was an early adopter.

-       that Surrey represented the South East on the ITS Board.

-       the Outbreak Identification Rapid Response (OIRR) and iCERT tools regarding capturing data on where an individual may have caught Coronavirus and where they might have been whilst having Coronavirus, via postcode coincidences and common exposures in order to take action.

-       Vaccine Confidence Calls, using spare capacity in the team with call handlers contacting individuals needing extra support in making an informed decision about having a vaccination - noting a trial in one GP surgery to measure its effectiveness, supported by a behavioural psychologist to provide insights into designing a script.

5. Regarding the Vaccine Confidence Calls and the trial, the Chairman asked whether the Senior Public Health Contact Tracing Lead (SCC) would agree that there was real value in commencing that trial in areas with a lower uptake.

-       In response the Senior Public Health Contact Tracing Lead (SCC) recognised the value of the trial which would commence in an area of the highest need with a low uptake. She highlighted that the local contact tracing team were mostly Surrey residents who were motivated to support their fellow residents. 

-       The Senior Public Health Contact Tracing Lead (SCC) noted that due to the challenge of the increasing numbers of cases to be mitigated through a recruitment plan, she was hopeful that the trial would commence in early to mid-July and the Board was to be kept updated. 

6. The Chairman welcomed the update on the outstanding action from the April Board which was to give an update on the outcome of the face-to-face contact tracing service.
7. The Public Health Lead (SCC) provided an update on testing:

·         Symptomatic testing:

-       there had not been any major policy changes since the last Board update; anyone with the three major symptoms of Covid-19: fever, cough or a change in sense of smell or taste could get a PCR test by visiting a testing site, or by ordering a home test kit through booking online or by calling 119.

-       changes to note regarding local testing capacity were that the Regional Testing Site in Chessington was now closed, an additional Local Testing Site had opened in Camberley.

 

Dr Pramit Patel joined the meeting at 3.09 pm

 

·      Asymptomatic testing:

-       symptom-free rapid lateral flow testing:

o   for individuals without the three major Covid-19 symptoms, testing was open to all adults and secondary school aged children recommended twice-weekly even for those who had been vaccinated - positive results would be followed up with a confirmatory PCR test result.

o   the local authority led rapid lateral flow testing (Targeted Community Testing - TCT) stream had undergone a change in the last couple of months: the five different TCT sites across the county offering assisted lateral flow testing had now closed due to a change of policy towards ensuring capacity for underrepresented and disproportionally impacted groups.

o   assisted rapid lateral flow testing could be booked at twenty-five community pharmacies for anyone over the age of 16 who lived, worked or studied in Surrey and since the last Board the Mobile Testing Unit (MTU) had become operational.

o   the collection and delivery of home rapid lateral flow self-test kits from NHS Test and Trace sites, community pharmacies participating in Pharmacy Collect and the delivery of home testing kits by booking online explained the policy change noted above.

o   there were also other nationally led symptom-free rapid lateral flow testing streams in educational settings, care settings, NHS settings and a number of workplaces.

-       Symptom-free tests:

o   the Surrey Testing Cell continued to take requests with regards to PCR testing in certain circumstances, concerning outbreaks, individuals being moved between care settings and in certain vulnerable and high-risk settings.

o   contacts of cases who were contacted by NHS Test and Trace and members of households of cases can have a single PCR test while self-isolating whether or not they had symptoms; primarily to identify VOCs.

o   messaging regarding the testing of contacts during their self-isolation was being given to schools in Surrey in areas of concern and with outbreaks.

o   NHS Test and Trace was undertaking a large study to investigate the use of daily rapid lateral flow tests as an alternative to self-isolation for contacts of confirmed cases.

·         Testing for foreign travel:

-       the introduction of the traffic light system: red, amber and green list rules for travellers entering England, each with different testing arrangements.

-       the update was in response to the action from the last Board regarding Board member questions:

o   one of which was whether the tests were free or were at an individual's expense, currently tests were to be arranged at an individual’s own expense through one of the Government's approved private providers.

o   the second question related to the type of test required, whilst not specified the minimum standard of test would likely be a PCR test.

-       the red, amber and green lists applied to those entering England, other countries had their own testing rules and individuals should refer to the Foreign, Commonwealth and Development Office (FCDO) for travel advice.

-       regardless of what list a country was on, arranging a test three days prior to arrival back in England was required as well as taking a test on or before day two after arrival back in England - a further test was required on or after day eight arriving back from amber and red list countries.

-       quarantine after arrival at home was required for amber list countries, whilst quarantine after arrival was required for red list countries through managed quarantine hotels. 

-       the Test to Release scheme allowed people who had travelled to an amber list country to take a test on day five after arrival into England and if negative the quarantine period could end before the full ten days required.

·         testing in response to VOCs:

-       had been covered in previous items and updates.

·         future planning:

-       in relation to testing locally, more capacity was moving to TCT and surge testing in response to VOCs.

-       concerning TCT, work was underway on developing an outreach testing model for the local authority led rapid lateral flow testing by engaging with partners across the county in various settings and with trusted community members to set up testing run by service providers.

8. The Chairman welcomed the updates on the action from April’s Board concerning the eligibility of asymptomatic testing, the types of tests required for foreign travel and their expense, highlighting the large costs of the tests from the Government approved providers.
9. The Public Health Lead, Programme Manager – COVID-19 (SCC) provided an update on the Community (COVID) Champions programme noting that:

·         she had taken over support of the programme.

·         the programme was established in November 2020 and currently nine out of the eleven Boroughs and Districts in Surrey had either fully or partially launched their programme.

·         the aim of the Champions programme was to disseminate simple and accurate current information on Covid-19 to the public.

·         it was locally led by the Boroughs and Districts via coordinators, with central support by the Public Health team (SCC) which produced weekly briefings to the coordinators to be cascaded to the Champion networks. 

·         seven Boroughs and Districts ran regular webinars which provided an opportunity for the Champions to hear from the local authority and health partners to ask questions, gathering system intelligence around concerns. 

·         Phase Two of the programme included:

-       a recruitment drive to increase the number of Champions, to expand diversity and encourage retention of existing Champions - as coordinator feedback indicated that many Champions had lost interest.

-       greater engagement with third sector voluntary organisations, using funding to place coordinators within the third sector.

-       an evaluation of Phase One through reviewing the outcomes, lessons, learnt and areas for development; a funding application had been sent to the National Institute for Health Research and the Board will be kept updated. 

-       a more targeted approach to specific cohorts and settings was needed, such as younger people and areas with low vaccine uptake or testing.

-       the inclusion of general health and wellbeing messaging and support.

·         that the new Public Health England campaign resources around the Step 3 update of the roadmap was available online. 

10. The Chairman asked whether there was anything that the Board could do in terms of supporting with the recruitment of Champions.

-       In response the Public Health Lead, Programme Manager – COVID-19 (SCC) noted that the programme was working better in some Boroughs and Districts than others, noting that some had lost momentum and she was working to understand why.

-       The Public Health Lead, Programme Manager – COVID-19 (SCC) added that Woking and Tandridge were yet to establish a programme and welcomed support from the Board in terms of removing barriers to set up the programmes.

-       The Chairman would engage with Environmental Health Officers at Woking Borough Council following up their interest in establishing the programme there.

 

Tim Oliver left the meeting at 3.28 pm

Lisa Townsend left the meeting at 3.28 pm

 

11.   A Board member asked whether the role of the Champions was voluntary or whether they were employed, and if so by whom.

-       In response the Public Health Lead, Programme Manager – COVID-19 (SCC) explained that the coordinators were employed by the Borough and District Councils whilst the Champions were volunteers.

12.   The Board member further asked to what extent were the Champions engaged in the Covid-19 Communication Plan, noting their apparent key role in social media and communicating messaging.

-       In response the Public Health Lead, Programme Manager – COVID-19 (SCC) noted that the Champions were linked into the Covid-19 Communications Plan and cascade, the most recent briefing developed by the Public Health team (SCC) included the resources from the Communications team (SCC) to be cascaded through the network of coordinators, then on to the Champions and their communities.

-       The Chairman added that the Champions programme was set up following the Board’s establishment and the programme was based on best practice from areas such as Birmingham and parts of Central London which harnessed community engagement and community leaders in disseminating information on Covid-19.

13.  The Chairman requested that a future written update be provided summarising the strengths and weaknesses of the programme across the county, and whether there was a model template that could be provided to Borough and District Councils without the programme.

14.   The Chief Constable of Surrey Police provided an update on enforcement, noting that:

·         there had been few of the £10,000 Fixed Penalty Notices (FPNs) issued in Surrey.

·         numbers remained stable compared to the last update at April’s Board, with just below Covid-related incidents related to Surrey Police since March 2020, as well as 1,582 FPNs.

·         the changes in the regulations in May made some of the enforcement activity more difficult to judge, large indoor gatherings would be problematic and so he welcomed the support of Surrey communities as there had not been any incidents.

·         gatherings of up to thirty outdoors was permissible.

·         there had been some uplift in policing demand in responding to incidents as a result of the new Managed Quarantine Service, which had been resourced. 

·         Government funding continued to be provided to ensure the continued enforcement of any Covid-related regulations.

·         more generally Surrey Police had seen exceptionally high levels of emergency calls as in recent weeks there had been several days that had seen 999 levels back to what had not been seen since June 2008; hoping that demand in the next few weeks would stabilise as people adjusted to the freedoms whilst responding to the communications about the need for caution.

15.   The Chairman highlighted the comment in the chat box congratulating the Chief Constable of Surrey Police, Gavin Stephens, for his personal recognition on the Queen's Birthday Honours List 2021 receiving the Queen’s Police Medal (QPM).

16.   The Chairman noted the apologies from the COVID 19 Vaccination Programme Director, Surrey Heartlands ICS regarding the Vaccination Roll-out update, noting the completed action provided - that there were no plans to stand up the vaccination regional super site option at Gatwick.

17.   The Chairman as Cabinet Member for Adults (SCC), provided an update on Adult Social Care noting:

·         the current stability within the service in terms of COVID-19, with continued engagement with partners in the sector and regular meetings in order to escalate any concerns.

·         the challenging past year and resultant effect on mental health, noting the formation of the Surrey Mental Health Partnership Board which presented its recommendations to the June Health and Wellbeing Board.

18.  The Chief Executive Officer of Surrey Care Association noted that in relation to care homes:

·         Covid-19 outbreaks were extremely low at 0.1%.

·         That on 21 July the Care Quality Commission (CQC) would publish details on care home deaths between 10 April 2020 - 31 March 2021 with data to be shared at local authority and individual care home level.

·         the Government's consultation on vaccinations for social care staff working in care homes concluded in the mandating of vaccinations; the Public Health Principal (SCC) and health colleagues were working with the remaining few vaccine hesitant care staff - there was a concern that some staff would leave and that could put pressure on safety quality and recruitment going forward. 

19.   The Cabinet Member for Children and Families (SCC) highlighted the:

·         positive news about no reported closures of schools or settings due to COVID 19 coronavirus since the start of the Summer Term in April, as well as the high level of school attendance.

·         support given to schools by Surrey County Council included financial support to families who were experiencing economic hardship and food poverty - welcoming the work of the regional food banks.

·         partnership with the international Charity, Binti to tackle period poverty in Surrey and eradicate the stigma, ensuring the availability of free period products through all Surrey’s libraries and other locations across the county.

·         work in tackling poverty being addressed by the Health and Wellbeing Board.

·         new Emotional Wellbeing and Mental Health contract which went live on 1 April 2021 including the Thrive Framework for System Change. It was still early days to assess the performance of that contract, noting the expected long period of high demand.

20.   The Chairman sought an update on the outstanding action from the April Board around addressing the difficulty of getting dental appointments for Looked After Children and Care Leavers.

-       In response the Cabinet Member for Children and Families (SCC) noted that the issue was on the Corporate Parenting Board’s radar, ensuring that it would be followed up and an update to be provided at the next Board. 

 

RESOLVED:

1.      Noted the report and the updated Terms of Reference (Annex 1).

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 Committee Manager (SCC) will re-circulate the Sector Led Improvement peer review to the Board members.

2.    The Board will be kept updated on the trial at one GP surgery to measure the effectiveness of the Vaccine Confidence Calls.

3.    Board members will provide support as appropriate to helping with the recruitment of Champions across the county and the removal of the barriers in relation to the setting up of the Community (COVID) Champions programmes in Woking and Tandridge.

-       The Chairman would engage with Environmental Health Officers at Woking Borough Council following up their interest in establishing the programme there.

4.    A written update will be provided at a future Board summarising the strengths and weaknesses of the Community (COVID) Champions programme across the county and a possible model template that could be provided to Borough and District Councils without the programme.

5.    The Cabinet Member for Children and Families (SCC) will follow up the action concerning the difficulty of getting dental appointments for Looked After Children and Care Leavers with the Corporate Parenting Board, providing an update at a future Board.