Agenda item

5.1  Members gave consideration to a presentation “Covid-19 update” in the agenda and also to an updated presentation from Public Health tabled at the meeting.

5.2  The Chair welcomed Chris Lovitt (Deputy Director of Public Health) who is new to the role and thanked him for deputising for the Director who had to give apologies. 

5.3  The Chair stated that many are requesting testing and so many can’t get them.  The key metric to watch now was hospitalisation levels.  He added that there had been some modelling the previous weekend which stated that by the next weekend the country could be at the same level of prevalence as in April. He asked Tracey Fletcher (Chief Executive, HUHFT) for an update from the acute sector perspective.

5.4  TF stated that as of that morning there was 1 patient in ICU with Covid-19 as well as 7 inpatients awaiting test results. They had not seen the same levels as BHRUT hospital.  They had seen a very small increase overall and they were in the midst of planning and reorganising to prepare for increased levels of admissions over the coming weeks.  In response to the Chair, she stated that they were in regular contact with the Public Health team and she had met with the Cabinet Member Cllr Kennedy also to discuss more frequent sharing of data from now on and he could be a conduit of information to the Commission Members also.

5.5  The Chair asked what was different this time than from the March-April period in relation to discharges of patients to care homes.  What improvements had been made. 

TF replied that they had a good record on safe discharges particularly in relation to Mary Seacole Home.  The key factor was how they worked with care home staff to minimise transfers and the risks during them.  Patients were tested through admission and before they are discharged.  She added that sometimes it would be more risky for vulnerable older patients to remain in hospital rather than go out to care homes and the key was to ensure that there were similar levels of infection control in place across both settings. 

5.6  CL took members through his presentation in detail.  The Chair thanked Public Health for providing greater triangulation of testing data by also including and comparing it with number of calls going into primary care, numbers contacting  NHS 111 and data on staff related absences.

5.7  Members asked detailed questions and in the response the following was noted:

(a) Members asked why the incidence in Shacklewell went from second highest to lowest in a couple of weeks.  They asked what was being done to ensure social distancing in shops and to enforce mask wearing on buses and what was the % success rate of test, trace and isolate in Shacklewell.

CL replied that the ward level numbers were small and availability of testing here was the key factor.  It was not possible to make conclusions about success at ward level based on these numbers, but he would examine the data further and reply in writing to the Ward Members.  They were focusing on wards where numbers were high and comparing it with GP data.  They had asked PHE for outbreak testing rather than routine testing in order to better contain these local outbreaks.  He added that a change in the guidance would be more helpful in providing greater clarity.  He stated that face coverings must be worn indoors in hospitality settings.  They were currently not mandatory everywhere in public but would become so.  He added that re shops Environmental Health was also playing a role and there would be an escalated approach to inform, visit, enforce, fine and close down, as necessary.  Regarding compliance with mask wearing on buses the levels of compliance appeared to be generally very good and concerns about this needed to be directed to TfL.  The messaging here had been clear for some time.

(b) Chair asked whether councils new role in test-track-isolate would mean that they were being left with the more challenging cases while the private providers running the national system pick off the low hanging fruit of more easier cases at that level.  He also asked whether more funding would be received to cope with the task and how the monitoring would operate.

CL replied that this was a very recent development.  The success rate for NHS Test and Trace in Hackney was not where it should be but we were not alone in this.  There were challenges around deprivation, English not as first language, and suspicion around the role private public partnerships involving organisations that do not have a good track record and on whom you would not want to place the NHS brand.  If the national system had been unsuccessful in contacting the index case than that information would be supplied to the local Public Health team and local contact centre staff and environmental health officers would try to contact the individuals using the records they have in the council, they might for example have a mobile phone number for the contact.  The previous day they had went live on this new system and had 6 cases referred and they had been able to contact 3 of them quickly. 

He added that he was keen to get the views of local NHS partners on how, after a few weeks if they had been unsuccessful in contacting certain cases, whether they could pass them to local NHS bodies to fill the missing gaps.  They would not be asking them to act on the information now but rather to give an indication about how effective contact tracing might be if further data could be shared.  Public Health had already received the national data sharing protocols, these were nationally driven and they had to go through a lot of stages to ensure that staff were sufficiently trained and that they locally have the required data protections in pace.  He added that they were using the Contact Centre staff who were very used to dealing with Hackney residents and, so far, the feedback from residents contacted had been very positive.  This should allow Public Health to reach all the individuals who need to be contacted and to help ensure that they are self-isolating.

(c) Members expressed concern re the point on p.24 that ethnicity data was not available for half the records referred to.  This was a worry considering the disproportionate impact of the virus on ethnic minority groups.

CL replied that it was indeed important to draw attention to poor recording of ethnicity data and he would take this back to the national system because data quality was crucial.

(d) Members asked why the 7-day incident rate in Hoxton and Shoreditch was so high and what the cause might be.  They also asked what the eligibility criteria would be for the £500 welfare payment to those on low incomes forced to self-isolate.

CL said that Hoxton was the 3^rd highest and while it was tempting to try to give ward level analysis it would be remiss to do that on the basis of these numbers.  The general point to be made was that the area had a younger population with higher levels of social mixing.  Perhaps the influx of students might be a factor as well as the recent better availability of testing, he added. If it persisted there would need to be more tailored interventions.  He added that they were looking at a similar picture across a number of other hotspots and high levels of socialising was a factor in generating higher numbers of cases.

On the £500 payments he stated that this guidance had been issued on Sunday and the Council was busy trying to implement aspects of that. He shared the link to the guidance document with Members.  It was important too that those who won’t be eligible don’t waste time in applying, he added. 

Cllr Kennedy commented that Professor Kevin Fenton (PHE London) had recently explained that in mid-August London had been testing 90000 a week but by mid- September this had fallen to 65000 a week.  This represented a huge drop off and a re-allocation of testing capacity away from London at a time when it was needed most.  On the £500 payment, he stated that the irony here was that you had to have a positive test to be eligible for it. So just as testing levels were falling rapidly people were required to prove a positive test to get the support they need to afford to self-isolate.

5.8  The Chair thanked CL and Public Health for their very detailed and helpful briefings.