Agenda item

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

 

 

 

 

 

 

 

Witnesses:

Ruth Hutchinson - Director of Public Health, Surrey County Council

Dr Charlotte Keeble - Covid Vaccination Programme Director, Surrey Heartlands Integrated Care System

Jane Lovatt - External Testing Cell Lead, Surrey Heartlands Clinical Commissioning Group and Surrey County Council

Naomi Grieve - Test and Trace Manager, Surrey County Council

Adam Letts - Public Health Lead, Surrey County Council

Alison Mason - Senior Public Health Lead, Surrey County Council

Rebecca Pritchard - Chief Executive Officer, Surrey Care Association

Yazmin Castillo Munoz de Hodgson - Project Support Officer, Surrey County Council

 

Key points raised in the discussion:

National and Local Update: Covid-19 Response: Autumn and Winter Plan / LOMP

 

1.      The Director of Public Health (SCC) noted:

·         since the LOEB last met the COVID-19 Response: Autumn and Winter Plan 2021 was published in mid-September and was the overarching national policy consisting of Plan A and Plan B, and signalled a shift coming out of lockdown.

·         Plan A: is the current national policy which outlined a comprehensive approach consisting of five areas to manage Covid-19 over autumn and winter 2021/22 through:

-       ‘building our defences through pharmaceutical interventions’ - such as vaccines;

-       identifying and isolating positive cases to limit transmission’ - through testing;

-       ‘supporting the NHS and social care’ - looking at long COVID, noting a piece of work in Surrey Heartlands;

-       ‘advising people on how to protect themselves and other’ - through communications and guidance;

-       ‘pursuing an international approach’ - managing risks around international travel and working together to help vaccinate the world.

·         within Plan A, a key part was Covid-19 safer behaviours and actions - it was vital for Surrey to continue to be creative with communications.

·         Plan B: was the contingency to be enacted if the NHS comes under unsustainable pressure - there were currently no thresholds to trigger the move to Plan B such as around the number of hospital admissions or deaths; and like Plan A, Plan B was to be enacted nationally, there was no indication of a return to enacting a response at a local or regional level.

·         Plan B would be a shift and the four key areas would be:

-       ‘face coverings compulsory in some settings’;

-       ‘powers to introduce vaccine passports’;

-       ‘encourage people to work from home’;

-       ‘communicating the need for caution’.

·         the Covid-19 Contain Framework should be read in the context of the COVID-19 Response: Autumn and Winter Plan 2021, the Framework sets out the key responsibilities about preventing, managing and containing outbreaks.

·         that every upper tier local authority was required to have a Local Outbreak Management Plan (LOMP), it was constantly updated to reflect the Plan and Framework.

·         Surrey was aiming to publish version 15 by 10 December 2021 following approval by the Emergency Preparedness, Resilience and Response Board (EPRR) and circulation to the LOEB; version 15 of the LOMP sought to increase its longevity and take a business as usual approach, so it would look different to previous iterations. 

 

Covid-19 Vaccination Programme

2.    The Covid Vaccination Programme Director (Surrey Heartlands ICS) noted:

·         that refreshing the data in the written update, she would be presenting the latest published data.

·         phase three of the vaccination programme was dynamic in respect of recommendations for expanding the eligible cohort agreed by the Joint Committee on Vaccination and Immunisation (JCVI).

·         phase three at present was to complete all booster vaccinations for eligible cohorts and to continue to provide the ‘evergreen’ offer so that anyone can receive their first dose of the vaccine at any time, providing vaccines to immunosuppressed individuals, vaccinating 12-15 year olds and 16-17 year olds.

·         since the written update the JCVI has advised that in addition to those aged over 50 years of age, all adults aged 40-49 years (cohort 10) should be offered a booster vaccination six months after their second dose.

·         since the written update the JCVI has advised that a second dose of the vaccine should be offered to 16-17 year olds, given at an interval of 12 weeks or more from the first dose.

·         that as of 16 November 2021, Surrey Heartlands has delivered 1.64 million vaccinations at sites across its system - 14 local vaccination services, 1 mass vaccination centre at Sandown Park Racecourse, 19 community pharmacies and 3 hospital hubs that stand up and stand down - whilst there is good coverage, a challenge is to respond to new JCVI in terms of vaccine delivery with different workforce requirements for different cohorts.

·         another challenge particularly for the smaller sites, has been to respond to the national push to make sure that both walk-in and booked appointments are provided - the Surrey Heartlands website was constantly being refreshed to advertise those sites with walk-ins available.

·         Surrey Heartlands was delivering a large number of booster vaccinations and take up was high - Surrey Heartlands represented the second highest take up across the South East region.

·         as of 8-14 November 2021, 703 first doses were given as part of the evergreen offer - for those age 18 years and above - 50% of those individuals were aged between 18-39, reinforcing the importance of youth engagement as highlighted in item 7 and Surrey Heartlands continued to encourage vaccine take up through different community communication channels.

·         of the cohorts eligible for the booster dose there was a 71.5% take up response for cohorts 1 to 9; which was 4.4% above the regional average.

·         the national booking system recently allowed people to book their booster vaccination appointment one month prior to their eligible date.

·         that initially the local vaccination sites offered different ways for people to book a vaccination appointment which was difficult to navigate, now that a large majority of the Surrey Heartlands sites have transitioned onto the national booking system it was easier for people to book online.

·         the ambitious target set nationally to vaccinate eligible care home residents and staff by 11 November 2021, in Surrey Heartlands 98% of care homes had been visited and all their eligible residents had been vaccinated - seven homes were left to visit - all have a booked date to be visited - as on the day of the visit residents were unable to be vaccinated because they were in isolation.

·         as of 17 November 2021, just under 18,000 16 to 17 year olds had received their first vaccine dose or an 67.6% uptake, with the aim to reach 75% - communications played a vital role to reinforce the message to take up the vaccine.

·         that the guidance regarding vaccinating 12 to 15 year olds was that primarily a school-based vaccination service should be offered which was a challenge to manage alongside the scheduled flu nasal vaccinations, in response the school immunisation services organised a programme of activity and visits to each and every school in Surrey to deliver the vaccination programme - as at 17 November 2021, 14,800 vaccinations have been given in schools.

·         vaccinations through the school-based vaccination programme model had become more flexible in that additional vaccination clinics in community settings could vaccinate 12-15 year olds in order to boost capacity and speed up the delivery.

·         the national drive to boost vaccinations, ‘the Big Weekend’ of vaccinations 27-28 November 2021 to increase uptake of the first and second doses; around ten additional clinics across Surrey Heartlands had been identified and more information and communications on how to via book through them would be released in the next few days. 

·         the 86% uptake of the booster vaccine of those that are eligible in the immunosuppressed cohort, that uptake reflected 74% of that total eligible population for vaccine take up. Whilst that uptake was high, a pathway across the system was being looked at where people could self-refer into a local Surrey site to receive their booster vaccine, the current system was that eligible individuals were sent a letter after being identified through their GP practice.

3. The Director of Public Health (SCC) emphasised the need to be agile and responsive, managing the vaccination programme so as not to exacerbate health inequalities - highlighting the importance of Surrey’s Equality Group for Vaccinations which oversees the vaccinations equality delivery plan and the Equality Impact Assessment (EIA) - shared across the South East as an example of good practice - which looked at under-served communities and those with the lowest confidence; community engagement and outreach were vital.

 

       Covid-19 Testing

4. The External Testing Cell Lead (Surrey Heartlands CCG and SCC) noted:

·         that the symptomatic testing offer was for anyone with symptoms, who could book a PCR test delivered through:

-       roving Mobile Testing Units (MTUs) which move to locations where case rates are highest;

-       Local Testing Sites (LTSs) around Surrey which were fixed and there were currently six across Surrey located in more densely populated areas and were accessible by walking in;

-       regional drive-through testing sites (RTSs): Guildford, Heathrow, Gatwick and Twickenham.

·         that the asymptomatic testing offer was for anyone without symptoms, testing was through rapid lateral flow tests. Since the written update the guidance had changed with the Government encouraging people to take a rapid lateral flow test if they were going to be experiencing high risk that day:

-       spending time in crowded and enclosed spaces; or

-       before visiting people who are at higher risk of severe illness if they get Covid-19.

·           rapid lateral flow tests are available at pharmacies around Surrey for collection, they can be ordered online and were delivered through Agile Testing Units (ATUs).

·           the focus of asymptomatic testing was on Under-Represented Groups (URGs) and Disproportionately Impacted Groups (DIGs) from our community - areas were mapped across the county, encouragement and education on testing was key.

·           as of the week of 25 October 2021 40,000 tests had been delivered, half of those were delivered through the ATUs.

·           that upon receiving a positive rapid lateral flow test, individuals must get a PCR test to confirm the result.

·           referring to a Board member’s earlier comment about whether there was data around the compliance of rapid lateral flow testing in schools both in Surrey and London; she explained that it was not a data set that was currently collected nor was the number of rapid lateral flow test kits handed out and noted that there was likely more testing going on in schools than the number of tests results registered online.

·           the map showing the deployment of testing units in Surrey between 8-14 November 2021.

·           the breakdown of the number of pillar 2 PCR tests by testing site or home testing kit, covering the four weeks up to 12 November 2021 for symptomatic individuals. There were approximately 2.7 times as many tests were taken at MTUs, LTSs and RTSs, then at home.

 

Local Contact Tracing

 

5. The Test and Trace Manager (SCC) noted:

·         that local contact tracing was vital for breaking the chains of Covid-19 transmission.

·         Surrey’s Local Contact Tracing (LCT) team operated the ‘Local 24’ model, whereby if the national NHSE team are unable to contact individuals within 24 hours, then those positive case were passed to Surrey’s LCT team.

·         that the LCT team was managing a high number of cases, despite that on average the team was able to complete around 78% of cases that were referred; in the last week the team was dealing with an average of 180 new cases per day.

·         that there were currently twenty-six FTE members in the team with further recruitment underway, with the additional capacity the hope was to revert back to ‘Local 4’ - a phased process targeting areas with the highest Covid-19 case rates.

·         that between 4-10 November 2021 the LCT team which was averaging a success rate of around 78% saw a dip to 74% as a result of data issues with the national team that week, which affected all local authorities.

·         Surrey’s success rate in the South East region was impressive.

 

 

High risk settings:

-    Education and Early Years Settings

6.    The Public Health Lead (SCC) noted:

·         that the Council continued to provide ongoing support to schools, early years settings and universities throughout the easing of Covid-19 restrictions and colleagues held twice-weekly educational data meetings to review trends and highlight outliers.

·      the Government priority is that education settings deliver face-to-face high-quality education to all children and young people.

·      that the recent focus has been on implementing proactive baseline measures as outlined in the Department for Education’s Schools Covid-19 operational guidance and where necessary, implementing additional reactive measures in response to outbreaks, which is outlined in the Contingency Framework.

·      that some measures that were previously routinely in place have now diminished.

·      outlined the baseline routine prevention measures for Surrey’s education and early years settings and the additional temporary measures that following consultation, could be brought in during the event of an outbreak.

·      that students and education staff who are close contacts of a positive case are exempt from the requirement to isolate if they are fully vaccinated or under the age of 18 years and six months; those contacts are strongly encouraged to have a PCR test.

·      that schools continue to promote the twice weekly symptom-free rapid lateral flow testing for all of those eligible.

·      that Surrey’s universities have been supported with the vaccination process in relation to national guidance, FAQs and information on finding the nearest vaccination centre; the University of Surrey and Royal Holloway, University of London ran successful pop-up vaccination sites on their campuses during term return.

 

-    Care Homes

7.    The Senior Public Health Lead (SCC) noted:

·         that the new regulations came into force on 11 November 2021 which required any staff or any persons deployed in care homes to be fully vaccinated unless exempt.

·         that the Public Health team (SCC) is working closely with care homes to make sure that they understand the operational guidance and to increase the vaccination uptake, training had also been provided.

·         there had been targeted interventions through Surrey Minority Ethnic Forum (SMEF) and GP led conversations to those staff who were vaccine hesitant.

·         for staff in care homes self-isolation exemptions are in place, if identified as a close contact they must be asymptomatic, following the prescribed testing routes and adhere to Infection Prevention Control (IPC) measures in place.

·         that the provision of free Personal Protective Equipment (PPE) to health and social care providers has been extended until March 2022.

·         that the Public Health team (SCC) was continuing to offer IPC training.

·         that the Care Homes COVID-19 Outbreak Oversight Group continue to meet weekly, this week there were zero outbreaks in care homes.

·         that care homes were supported through ensuring that they had business continuity policies in place including a plan for surge capacity.

·         that a process had been set up for information sharing with the Care Quality Commission (CQC).

·         the Public Health team (SCC) when required provided support on managing hospital discharges.

·         the publication of the Adult social care: COVID-19 winter plan 2020 to 2021 which outlined the national support available for the care sector and the actions for local authorities, the NHS and providers.

8. The Chief Executive Officer (Surrey Care Association):

·         welcomed the significant support to care homes provided by the Council and the Surrey Heartlands CCG, however some challenges remained including the IPC measures that relatives visiting loved ones have to go through such as undertaking a rapid lateral flow test and wearing PPE, in contrast with the restrictions eased in the community; she emphasised the need to reinforce the messaging to keep loved ones safe in care homes.

·         that as a result of the new regulations which came into force on the 11 November, some providers found that some staff decided to leave and a challenge encountered was around visiting professionals forgetting to bring the evidence needed of their own vaccination status if visiting a care home.

-       In response, the Senior Public Health Lead (SCC) noted that the Public Health team (SCC) was aware of the issue around visiting professionals and was working with the Surrey Heartlands CCG to release a communications piece to primary care and community professionals to highlight that evidence of their vaccination status was needed when visiting care homes.

·         looked forward to receiving the next tranche of IPC funding from the Council.

·         welcomed the update that there were no outbreaks in care homes this week, which was a testament to the joint working underway.

 

Variants of Concern

9. The Senior Public Health Lead (SCC) noted:

·         that there were four current Variants of Concern (VOCs) and nine Variants Under Investigation (VUIs).

·         the Delta variant was predominantly the main variant in England and the Delta sublineage AY.4.2 accounts for a slowly increasing proportion of cases in the UK; vaccine effective analysis did not suggest a significant reduction in vaccine effectiveness concerning that sublineage.

·         national data and Surrey data on the variants continued to be reviewed.

 

Community (COVID) Champions

10. The Project Support Officer (SCC) noted:

·           that ten of the eleven borough and district councils now run Community Champion schemes - with Woking recently joining, Tandridge remained outstanding. 

·           that there were over 250 Community Champions across Surrey.

·           that over 45 Covid-19 briefings had been delivered since November 2020.

·           that a Community Champions county-wide webinar had been established at met in October; the next meeting was scheduled for 15 December 2021.

·           that key messages around Covid-19 such as testing, vaccinations and safe behaviours continued to be shared, as well as on health and wellbeing.

-       an example of a recent briefing shared with Community Champions was highlighted, it was written in Plain English to be disseminated into communities via social media or traditional methods of communication.

·           that community voice was crucial, feedback from the Community Champions and their communities was gathered and actions were taken.

-       quotes from Community Champions were highlighted.

·           the continuity plan with six specific outcomes to be achieved during the next year:

-       focus on the delivery of the COVID-19 Response: Autumn and Winter Plan 2021/2022.

-       fortnightly (COVID-19) briefings.

-       disseminate key messages - for the Community Champions to cascade among their networks.

-       bi-monthly countywide webinars for the Community Champions.

-       offer new development opportunities for Champions - training.

-       exploring opportunities to widen the network of Champions - working with external partners such as Central Surrey Voluntary Action, Surrey Coalition of Disabled People and internal partners such as Active Surrey who would be presenting at the next webinar.

11.  The Chairman welcomed the presentation and would look to see what she could do to help get Tandridge District Council on board with the Community (COVID) Champions scheme. 

 

RESOLVED:

The Board:

1.      Noted the report.

2.      Would continue to provide political oversight of local delivery of the Local Outbreak Management 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 Chairman will look to see what she can do to help get Tandridge District Council on board with the Community (COVID) Champions scheme.