Agenda item

The Sub-Committee will be provided with an update on the Croydon response to the Covid-19 pandemic. (To follow)

The Sub-Committee was provided with an update on the response in the borough to the covid-19 pandemic by the Director of Public Health, Rachel Flowers, along with an update on the vaccination programme from Matthew Kershaw, the Chief Executive and Place Based Lead for Croydon Health Service NHS Trust and Dr Agnelo Fernandes, the Croydon GP Borough Lead. Copies of these presentations can be found on the following link:-

https://democracy.croydon.gov.uk/ieListDocuments.aspx?CId=168&MId=2162&Ver=4

During the presentation, it was noted that the partnership working in response to the pandemic had been fantastic, with thanks given to the work of unpaid carers and the Public Health team. It was also noted that care providers in the borough were appreciative of the support provided by the Council to minimise the number of covid-19 cases in care homes.

Dr Fernandes advised that there had been a lot of energy expended by GPs in the borough to mobilise the six vaccination sites in Croydon and also gave thanks to the volunteers.  At present the vaccination programme was on track, providing the supply of the vaccines remained available. The 84 care homes for the elderly in Croydon had received vaccinations and work was progressing on providing vaccinations for the 43 homes for the learning disabled.  It was known that there was vaccine hesitancy amongst BME groups in the borough, with work underway to counter this by providing people with the correct information to make an informed decision.

Following the presentations, the Sub-Committee was provided with the opportunity to ask questions about the information provided. The first question highlighted the latest figures provided on covid related deaths in London, which indicated that the number of deaths in care homes had been lower than in the first wave. As such, it was questioned what had made the difference this time.

In response, it was highlighted that in the early stages of the first wave of the pandemic there was still many unknowns about covid-19. However, Public Health had advocated for testing in care homes at an early stage. During the first wave health and social care colleagues had worked with care providers on infection control and training, which had proven to be of benefit in the second wave. Croydon had some of the highest rates of testing in London, with care home staff and residents regularly tested.  The provision of additional funding had also helped to ensure that staff could be based at a single care home, rather than moving between different homes and increasing the risk of infection.

It was also questioned whether there was difference in the patients presenting at the Croydon University Hospital with covid-19 in the second wave. It was advised that although it was still predominately the elderly who required hospitalisation, more young people were being admitted requiring intensive care, than in the first wave. Underlying health conditions were still a major contributor to effects of covid.

This wave of the pandemic was also seeing a much greater part of the population catching covid, with more covid-positive patients in the community than the hospital. As a result the Rapid Response team had been enhanced to look after patients in the community. As testing was quicker than earlier in the pandemic, it was allowing issues to be addressed promptly. Staffing at both the hospital and in the community had been depleted due to people being infected with the virus, including some deaths.

As the pandemic was having a massive impact on people’s lives, which chimed with the health and care plan, it was questioned whether the plan would be revised? It was acknowledged that the disease had shone a light on health inequalities across the country, with research to understand the disproportional impact of covid underway. Although, at this stage health professionals were still learning about the wider impact of the virus.

Regarding residents living in sheltered accommodation, it was questioned what action was being taken to contact people who don’t have social media or lived alone, to ensure they received notification of the vaccine. It was advised that a range of different mechanisms were being used to raise awareness of the availability of vaccinations.

It was highlighted that feedback had been received from residents about the perceived lack of social distancing at the Fairfield Halls Vaccination Centre. It was acknowledged that concern had been raised in the early days of operating the Centre, but lessons had been learnt and addressed, with a system in place to ensure social distancing was maintained. The Centre was now working as expected.

In response to a question about the safeguards in place to prevent people being missed off the vaccination programme, it was advised that all GP practices were in the process of contacting residents over 80. If anyone over 80 had not been contacted about the vaccination, they should be encouraged to speak to their GP.

It was questioned whether there was a pattern to the delivery of the vaccine. It was confirmed that care home residents and staff would be the first to receive the vaccine, followed by the over 80s. It was highlighted that some residents may have received letters from the mass vaccination sites in Epsom and Central London, which may have added to the confusion. The vaccination programme was now moving on to the over 70s and other vulnerable residents.  The key limiting factor in the vaccination programme was the supply of the vaccine, with some centres not receiving weekly deliveries.

In response to a question about residents at risk of an anaphylactic shock, it was confirmed that this was covered under a standard question in the screening process. The Pfizer vaccine could be used with all other conditions apart from anaphylaxis, but the AstraZeneca vaccine which did not have an increased risk of causing an anaphylactic shock was becoming increasingly more available. The increased availability of the AstraZeneca vaccine was also a benefit for housebound residents, as it could be more easily transported.

It was questioned whether there would be the available capacity and supply if the time between the two doses was shortened. It was confirmed that there was a national discussion taking place on the timing of the second dose. Having a longer gap provided a good immune response and allowed as many people as possible to have some immunity with the first dose, rather than a limited number with greater immunity after both.  It was highlighted that the vaccination alone would not stop the pandemic and a coordinated response was required along with the continued use of PPE and testing.

As there had been variants of the disease identified, it was asked whether it was likely these would be covered by the vaccine.  It was advised that at this stage the disease was still evolving, with new information being learnt about the effectiveness of the vaccine all the time.  At the time of the meeting, early evidence indicated that the South African variant would be covered, but more evidence was needed to make any assessment of the Brazilian variant.

As it had been highlighted that vaccine hesitancy was an issue, it was questioned what could be done to tackle misinformation. It was confirmed that a communications plan had been developed to tackle misinformation, with local community groups being used as a mechanism for providing the correct information. On a wider scale, a national response was required to address fake news and address misinformation on social media.

As a follow up, it was questioned whether there had been any research to understand why there was a question of trust over the vaccine. It was confirmed that as soon as there had been a glimmer that the vaccine was coming, a team had been reviewing the evidence to understand why there was vaccine reluctance. The vaccine had only been available since December and it was understandable that some people may be reluctant due to the pace of change. Healthwatch London had also been very active in engaging with patients to try to understand their reluctance to have the vaccination.

In response to a rumour that the accident and emergency department at Croydon University Hospital had needed to close for 12 hours due to the demand for services, it was confirmed that the hospital would not close. However, it was often the case across South West London that non-emergency ambulances could be diverted to other hospitals to manage demand.

It was highlighted that there was public concern about delays with the delivery of post, given that notification of the availability of the vaccine was being confirmed via a letter. Reassurance was given that GPs were phoning people directly and where needed were contacting a patient’s relatives to organise their vaccination.

At the end of the item, the Chair gave thanks on behalf of the whole committee for the commitment and work of all involved in the covid response over the past months.

Conclusions

At the end of the items the Health and Social Care Sub-Committee reached the following conclusions:-

1.    The amazing work of the health and care professionals and volunteers could not be commended highly enough.

2.    The work to vaccinate care homes as a priority and to manage infection in that environment was excellent. 

3.    It should be reemphasised that the NHS remained open for patients who needed to access services.

4.    It was accepted that the delivery of the vaccine will define how quickly the vaccination programme could be rolled out.

5.    Vaccine hesitancy should continue to be addressed, with community leaders engaged in doing so. Steps should be taken to learn from the reasons for the hesitancy to inform any future vaccination programmes.

6.    There was a need to be able to scrutinise how changes are made to the health and care plans.