Agenda item

The Director of Public Health (DPH) has a statutory duty to work with system partners to develop and ensure delivery of the COVID-19 Local Outbreak Management Plan (LOMP). The LOMP outlines how Surrey County Council (SCC) and system partners continue to work together to prevent the spread of COVID-19, manage outbreaks and support and protect residents. In Surrey, delivery of the LOMP commenced at the beginning of July 2020. This report details recent progress on the delivery of the plan including key outcomes, challenges and next steps.

 

Witnesses:

 

Ruth Hutchinson - Director of Public Health, Surrey County Council

Lorna Hart - Covid Vaccination Programme Director, Surrey Heartlands Integrated Care System

Rheanna Mitchell - Covid-19 Testing Programme Lead, Surrey County Council

Lisa Andrews - Public Health Principal,Surrey County Council

Negin Sarafraz-Shekary - Public Health Principal, Surrey County Council

Yazmin Castillo Munoz de Hodgson - Project Support Officer - Public Health - Community Champions, Surrey County Council

 

Key points raised in the discussion:

 

1.    Before moving to the content of the item, the Director of Public Health (SCC) noted that the Public Health team (SCC) could not have done its job without the excellent support from the Communications team (SCC) and communication colleagues in health. She noted that lessons learnt would be taken away and would inform other areas of public health work going forward.

 

National Update: Living with COVID-19

 

2.    The Director of Public Health (SCC) noted that:

·         Since the last Board meeting the Government’s Living with COVID-19 plan was published on 21 February 2022 and the updated guidance - as opposed to legislation - was published by the UK Health Security Agency (UKHSA) on 1 April 2022.

·         The Living with COVID-19 guidance focused on protecting those most at risk and included advice for those with symptoms of respiratory infections including Covid-19, a positive Covid-19 test and their contacts, and for everyone on safer behaviours.

·         The plethora of high-level guidance could be accessed through the website links, provided for different audiences including for everyone, businesses, those who are clinically extremely vulnerable, those with weakened immune systems, childcare and education settings, and adult social care settings; and to be mindful that the guidance was regularly updated.

·         The NHS had produced the guidance for healthcare settings and testing for staff and patients.

·         There was also guidance around prisons, the NHS COVID Pass and around visa applicants.

·         Updated guidance was not yet published concerning those who are homeless, and the providers of accommodation for asylum seekers.

·         The Living with COVID-19 guidance for everyone remained the same in terms of the behaviours to reduce the spread of COVID-19 and other respiratory infections such as: letting fresh air in, washing hands and wearing a face covering in crowded spaces and getting vaccinated.

·         Continuing to promote the Evergreen offer would be vital as 15% of Surrey’s over 25 year olds had not had their first Covid-19 vaccine.

·         The Living with COVID-19 guidance for everyone included nine additional symptoms of Covid-19 that had emerged from evidence, in addition to the three main symptoms where testing had been required.

 

Gavin Stephens arrived at 2.33 pm.

·         As the focus was on the mix of respiratory illnesses including Covid-19 and as testing for Covid-19 was no longer widespread, people would not know for certain whether they have Covid-19; the broad list of symptoms were common to other respiratory illnesses and the guidance highlighted that those with any symptoms of a respiratory illness such as a high temperature should try to stay at home until the symptoms ease and to avoid close contact anyone at higher risk.

·         There were new national assets that reflected the guidance and local assets amplified the messaging in promoting safer behaviours.

 

Local update: Local Outbreak Management Plan

 

3.    The Director of Public Health (SCC) noted that:

·         As a result of the updated Covid-19 guidance the Surrey Local Outbreak Management Plan (LOMP) needed to be updated - currently at version 16. Board members would receive the revised version by 19 May 2022 which would also be published on Surrey County Council’s website.

·         The COVID-19 Intelligence Summary would continue to be published weekly and the LOMP going forward would reflect the changes in the guidance such as around surge testing from the local to national level.

·         Contact tracing ended on 24 February 2022 and she thanked Surrey’s Local Contact Tracing team for their hard work - based in Surrey County Council’s Contact Centre - and a closing report on what had been achieved and lessons learnt would be circulated to the Board in due course. 

4.      The Chairman expressed her thanks to the Local Contact Tracing team and welcomed the updates on contact tracing to the Board at previous meetings from the Senior Public Health Contact Tracing Lead (SCC).

5.      The Chairman highlighted the importance of the regular messaging going forward on living safely with respiratory infections including Covid-19.

 

COVID-19 Vaccination Programme

 

6.    The Covid Vaccination Programme Director (Surrey Heartlands Integrated Care System)noted that:

·         Overall Surrey Heartlands ICS had delivered 2.2 million vaccines since the start of the vaccination programme.

·         Surrey Heartlands ICS had entered a ‘planned surge’ period with the Spring booster programme for the over 75 year olds and had started delivery of vaccines to the 5 - 11 year olds ‘well’ population which had seen a high demand.

·         The booster vaccinations for 16 years plus were at 86% which was a higher uptake compared to the South East regional average and the second booster vaccinations were also slightly higher than the regional average - the South East was ranked in the top three regions nationally.

·         Immunosuppressed/third dose was at 94.6% of the eligible population and was at 65.2% for the booster dose.

·         The Surrey Heartlands Mass Vaccination Operating Model was submitted to the NHS in March 2022 and the operating model outlined the plan for 2022/23. The first phase was the Spring/Summer booster plan which was underway and phase two was the Autumn/Winter plan in anticipation of the Joint Committee on Vaccination and Immunisation (JCVI) guidance on a booster vaccination for eligible cohorts.

·         The Mass Vaccination Centre was moved from Sandown to Artington as Sandown is a working racecourse and Artington in Guildford was more central in Surrey.

·         Surrey Heartlands ICS was working with the Primary Care Networks (PCNs) to confirm enhanced service delivery for the Guildford and Waverley area, that population was being covered with the Mass Vaccination Centre and the care home and housebound population in that area were being covered with the PCNs.

·         The focus area moving forward was phase one delivery of the Operating Model which was the Spring/Summer plan through the Spring booster programme, vaccinations for the 5 - 11 year olds ‘well’ cohort, vaccinations for the 5 - 17 year olds that are clinically extremely vulnerable and continuing the Evergreen offer and equality and outreach planning.

·         The outreach plans were aligned with public health and the equalities plan and it was vital that the hard-to-reach communities and individuals are targeted at the same time as the general population.

·         Phase two planning for the Autumn/Winter plan continued to be developed and would go live in September, in line with the equalities plan and ongoing business-as-usual alignment to Making Every Contact Count (MECC) which the NHS were promoting through blood pressure, weight and pulse checks and utilising the available literature to support the prevention agenda.

·         Areas are of immediate focus were:

-       Equality and outreach planning: the £126,000 additional bid had been largely spent on geo-targeting and other areas.

-       The Spring booster programme: the rollout was going well with a good uptake, the older care home plans were in place and housebound and roving was underway and work was underway to address the concern that not all care home residents could receive their booster due to the amount of infection in care homes.

-       The 5 - 17 year olds clinically extremely vulnerable cohort: vaccinations were underway via the School Aged Immunisations Service (SAIS) at special schools.

-       The 5 - 11 year olds ‘well’ cohort were receiving their vaccine via the various vaccination sites and the demand was higher than anticipated; she would share links to the videos of children being brave and being supported on the process.

7.    The Chairman noted positive feedback from two residents in Stanwell who had recently received their Spring booster. She asked what the percentage was of residents across Surrey that have had their first Covid-19 vaccine and whether those who had not had their first vaccine could still receive it.

-       In response, the Covid Vaccination Programme Director (Surrey Heartlands Integrated Care System)explained that the Evergreen offer continued - and would do so throughout the summer - for any resident who had not yet received their first vaccine; she noted that she would look to put the percentage in the meeting chat before the meeting ended.

-       In a later comment, the Chairman highlighted that the Director of Public Health (SCC) had put the percentage uptake for the first vaccine in Surrey in the meeting chat and it was 85% for those over 12 years old and she asked how a resident could come forward to receive their first vaccine.

-       In response, the Director of Public Health (SCC) explained that information could be found on the NHS website titled ‘How to get a coronavirus (COVID-19) vaccine’, it was a case of finding a local vaccination centre and letting them know any special requirements; and stressed that those who had not received a vaccine would be welcomed.

 

COVID-19 Testing Programme

8.    The Covid-19 Testing Programme Lead (SCC) noted that:

·         Free testing for the general public ended on 31 March 2022 as part of the Government's Living with COVID-19 plan.

·         Members of the public who may still wish to be tested - but are not eligible for free NHS tests - would have to pay for their tests via a private provider.

·         There was no longer a role for Surrey County Council to distribute the free NHS tests for eligible groups, ordering and distribution routes would be managed nationally. The Public Health team (SCC) however would continue to work with its partners to ensure that there is a strong understanding of the new guidance and to provide local support.

·         Groups that would continue to be eligible for symptomatic testing included:

-     patients in hospital who are exhibiting symptoms;

-     people who are eligible for community COVID-19 treatments, such as those with people whose immune systems mean that they would be at higher risk of complications resulting from Covid-19 should they test positive;

-     people who work or live in what have been classified as high-risk settings where infection needs to be identified quickly to minimise outbreaks.

·         Groups that would continue to be eligible for asymptomatic testing included:

-       High-risk settings where infection can spread rapidly while prevalence is high;

-       High-risk settings during an outbreak, guidance was in place whereby staff in the event of an outbreak should contact the Health Protection team (SCC) who would provide bespoke advice.

·         The refreshed guidance has yet to include specific information on what resilience and response might look like in the future, however the Government had retained the ability to enable a rapid scale up of testing and the capability to test should there be a new health threat to emerge.

·         The rapid scale up by the Government included a national stockpile of LFDs, the ability to ramp-up those testing laboratories and delivery channels if required, and a revised surveillance capability; local authority settings would continue to have a health protection role and should focus on outbreak management priorities

·         Up until 31 March 2022 there was a testing programme in place in Surrey and a map was shown which highlighted the different testing sites across Surrey such as the static sites that were also supplemented by a number of mobile units. The mobile units expanded the geographical reach and enabled a greater responsive to the changing levels of prevalence.

·         Symptomatic testing settings closed at the end of March and in the run up to the closure there was a significant reduction in the utilisation of Surrey’s testing sites particularly as a result of the end of the requirement to have a confirmatory PCR following a positive LFD test. In March the use of the local testing sites had reduced averaging around 10 to 15%.

·         The Targeted Community Testing programme run between July 2021 and March 2022 sought to meet the needs of under-represented or disproportionately impacted groups and through a range of testing models, 740,000 LFD test kits were sent out to those residents. There had been positive feedback from partners including a charity supporting the homeless and isolated people in East Surrey.

9.   The Chairman noted that before the ending of the free testing there were many people trying to order tests online and struggling to do so. She asked how care home providers were finding it in terms of accessing the tests and whether there was a good stock coming through.

-       A Board member responded that:

-       For care homes and home care providers, the testing guidance came into effect on 4 April 2022, with the change from daily LFD testing to twice weekly LFD testing. LFD tests were still provided for social care providers, including day centres, care homes, nursing homes and home-based care providers, and supported living in particular cases.

-       Whilst Personal Protective Equipment (PPE) and testing remained free, the challenge from 4 April was that there was no further Government funding to pay care staff to self-isolate, as required under the latest guidance such as in the case of having any of the broad list of symptoms of Covid-19 and should stay at home and take a test if unwell.

-       Highlighted the testing process and noted that some care providers could not afford to pay people to self-isolate, they could only pay Statutory Sick Pay after the first three days. It had been identified as a serious risk in terms of compliance with the guidance and the retention of staff. The Surrey Care Association had raised the issue locally and a possible solution could be to use some of Surrey County Council’s remaining Adult Social Care Omicron Support Fund money to provide targeted support to providers to pay staff to self-isolate.

10.   The Board member noted that discussions were underway to address the above challenge and noted a later comment in the meeting chat that another change for care homes’ testing arrangements was that from 4 April 2022 visitors to care homes no longer have access to free tests unless they were providing personal care.

-       In response, the Chairman recognised the challenges raised and welcomed a future update on the issues.

 

Education and Early Years Settings

 

11.   The Public Health Principal (SCC) noted that:

·         The guidance for education and early years settings had been replaced by the ‘Health protection in education and childcare settings’ guidance.

·         The guidance provided advice on how to prevent the spread of respiratory infections including Covid-19, which diseases to vaccinate for, how long to keep children away from school should they become unwell, managing infectious diseases and cleaning the environment.

·         The guidance was broken down into six clear sections including guidance on different infections and described when to escalate in the case of an outbreak for example, to UKHSA colleagues.

·         Examples of communications assets were shown for under 18 year olds with symptoms, those had been shared with education settings. The updated guidance was communicated to all relevant settings by the Schools Relationships team (SCC) in its weekly email and updates were provided by the Public Health team (SCC) to settings ahead of the Easter break and most recently alongside guidance from the Department for Education.

·         Examples of communications assets were shown for under 18 year olds who test positive, whilst the guidance did not include the need for regular testing should a test be taken and the result be positive the advice was to not attend the relevant settings for three days compared to five days for adults.

·         Support continued to be provided to Surrey’s education and early years settings, the move was towards business-as-usual and the area schools officers could continue to link in with the Health Protection team (SCC). Escalation mechanisms and relationships remained intact such as with the Schools Relationships team (SCC).

·         The resilience of Surrey’s education colleagues over the past couple of years, despite the many challenges and quick responses needed.

 

Care Homes

12.   The Public Health Principal (SCC) noted that:

·         New guidance for Adult Social Care settings was published on 1 April 2022 and quickly came into effect on 4 April 2022, guidance concerned testing and infection prevention and control.

·         There had been significant changes, particularly to symptomatic and asymptomatic testing for staff:

-       Regarding asymptomatic testing in Adult Social Care settings, staff should test twice weekly via LFD testing and there was no requirement for asymptomatic testing for residents.

-       Regarding symptomatic testing in Adult Social Care settings, staff or residents who develop symptoms can do two LFD tests forty-eight hours apart and if the first one is positive there is no need to take the second one.

·         In terms of self-isolation for people who do test positive, they need to self-isolate for ten days and after the five days people they can end self-isolation providing that they have two negative tests twenty-four hours apart.

·         Outbreak testing remained the same and in terms of self-isolation, only people who test positive can self-isolate, or similarly people who test positive can be discharged from hospitals and be cared for in the care home settings.

·         There were a number of uncertainties and grey areas particularly in some of the guidance and she had been working closely with UKHSA and care homes to understand the key areas of concern or areas that lack clarity. 

·         She co-chaired the weekly Care Homes COVID-19 Outbreak Oversight Group meetings with the Infection Control Nurse. The meetings focused on outbreak management and were collaborative with representation from the Quality Assurance team (SCC), infection, prevention and control nurses and NHS care home leads; support was also provided around safeguarding and vaccination uptake.

·         In the Living with COVID-19 guidance, care homes had been recognised as a high-risk area in terms of needing extra support around access to testing, but also for vaccination prioritisation.

·         There was a national webinar following the publication of the new guidance, there were still some unanswered questions raised nationally which would be provided as Frequently Asked Questions (FAQs) and the Public Health team (SCC) was working with the care home leads to develop local FAQs.

·         She recognised the challenge raised by a Board member around paying care staff to self-isolate.

·         Free PPE for frontline health and care had been extended until 31 March 2023 or until infection prevention and control (IPC) guidance is withdrawn or significantly amended.

·         The Public Health team (SCC) was working closely with UKHSA to support care homes and potentially going forward, more frequent webinars might be held.

13.   The Chairman asked what the plan was for the Care Homes COVID-19 Outbreak Oversight Group to continue with its meetings.

-     In response, the Public Health Principal (SCC) noted that the meetings of the Group would continue as part of the recovery process.

14.   The Chairman welcomed that reassurance and asked who attended the Group from the care home provider perspective.

-       In response, the Public Health Principal (SCC) would follow up with a response on the care home provider representative.

-       A Board member noted that the Surrey Care Association had not been invited but had been willing to attend the Group to help to disseminate messages and reinforce communications.

-       The Public Health Principal (SCC) welcomed the Board member to attend the weekly Care Home Outbreak meetings and would ensure that she is sent the invites; she would follow up on the invitation to the Care Homes COVID-19 Outbreak Oversight Group.

-       The Chairman noted that on behalf of the Board it would be good for the Surrey Care Association to be involved in those meetings.  

-       The Covid Vaccination Programme Director (Surrey Heartlands Integrated Care System) highlighted that there was a regular joint Surrey County Council and ICS Care Homes Group which the Board member attended, as well as Public Health (SCC) and not that it would be important for the Surrey Care Association to be embedded into the Care Homes COVID-19 Outbreak Oversight Group.

 

Community (COVID-19) Champions

 

15.   The Project Support Officer - Public Health - Community Champions (SCC) noted that:

·         Thanked the Board’s Chairman for her support concerning the Community COVID-19 Champions programme.

·         She would follow up action A24/21 with the Deputy Leader and Cabinet Member for Finance and Resources (SCC) and hoped that Tandridge would join the programme soon.

·         The main focus of the programme was to empower communities and minority groups who have been disproportionately affected by the pandemic, through engaging directly with specific organisations while working with those minority groups.

·         Three agreements had been signed with Surrey Community Action, Surrey Coalition of Disabled People and Central Surrey Voluntary Action and an agreement with Catalyst would be finished shortly.

·         Through the agreements the programme is provided funding to support the part-time coordinator within those organisations to support the programme and increase the outreach and communications across the Champions network with a particular focus on the minority groups.

·         Building trust was crucial.

·         Whilst discussions focused around Covid-19 issues, different discussion topics included mental health support and obesity.

·         An evaluation framework had been established, which would be an important tool to evaluate the programme since it started and how it can improve going forward.

·         A county-wide Community Champions Forum was a key aspect of the programme and took place via webinars, the last webinar was at the end of February and the next webinar was to be held in early June - to be held face-to-face.

·         The last webinar in February focused on mental health and wellbeing, and was successful with over twenty participants including representatives from the Borough Councils, Community Champions from across the county and a representative from the Bangladesh community.

·         February’s webinar included an update on Surrey County Council’s Mental Health Awareness campaign, how to access information via the Healthy Surrey webpage, the services offered by Surrey County Council to support mental health and wellbeing, and free mental health training was made available to the Community Champions.

·         Spelthorne and Surrey Heath Borough Councils carried on with their own monthly Community Champions webinars.

·         Key messages following the Living with Covid-19 plan and guidance were being promoted with the Community Champions, with a focus on safe behaviours.

·         From March the briefing to Community Champions was distributed fortnightly from weekly, the briefing in late February to early March contained information to disseminate into the community on: Eating Disorder Awareness Week, childhood immunisation and emotional health and mental wellbeing.

·         An action plan was underway with the organisations to increase engagement across the county and to support specific activities around mental health and wellbeing, and included training for the Community Champions via Catalyst around addressing the stigma and discrimination around mental health.

16.   The Chairman welcomed the acknowledgement of her support alongside the Director of Public Health (SCC) on the Community Covid-19 Champions programme, which was an example of best practice from elsewhere in the country and she noted the success in Surrey. She thanked the Project Support Officer - Public Health - Community Champions (SCC) for her work and hoped that Tandridge District Council would join the programme.

17.   The Chairman noted that it would be great to see how the Community Champions continue to grow into their communities and she praised the many successes and positive feedback from Spelthorne on the Community Champions.

 

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.      Would ensure appropriate information on the programme and on COVID-19 in Surrey is cascaded within Board members’ organisations and areas of influence.

 

Actions/further information to be provided:

 

1.    Board members will receive the revised version of the Surrey Local Outbreak Management Plan (LOMP) by 19 May 2022, which will also be published on Surrey County Council’s website.

2.    Board members will receive a closing report in due course on what had been achieved and lessons learnt by Surrey’s Local Contact Tracing team.

3.    The Covid Vaccination Programme Director (Surrey Heartlands Integrated Care System) will share links to the videos of children being brave and being supported on the vaccination process.

4.    The Board member (Chief Executive Officer at Surrey Care Association) will liaise with the Public Health team (SCC) to provide a future update on the challenges to care homes and home care providers from the updated testing guidance which came into effect on 4 April 2022, to address the following:

a)    Some care providers could not afford to pay people to self-isolate if unwell with symptoms of Covid-19;

b)    Visitors to care homes no longer have access to free tests unless they were providing personal care.

5.    The Public Health Principal (SCC) will provide a response as to who the care home provider representative is on the Care Homes COVID-19 Outbreak Oversight Group.

6.    The Public Health Principal (SCC) welcomed the Board member (Chief Executive Officer at Surrey Care Association) to attend the weekly Care Home Outbreak meetings and will ensure that she is sent the invites; she will follow up on the invitation to the Care Homes COVID-19 Outbreak Oversight Group.