Agenda item

To consider and note the verbal update on COVID-19 Response and Recovery, including presentations to the Board on experiences, impact and next steps.

 

The Chair wanted this meeting to have a specific focus on Covid 19 recovery and renewal. When planning the content and meeting with officers, the Chair felt it was important to contrast where the Borough was, pre – Covid 19, with the impact of Covid 19 on communities and examine how this influences the work of the Board going forward.

 

The Chair referred to the Public Health England report on the disproportionate number of BAME deaths and infection rates. This document was disappointing as it ignored the findings of the community consultations and made no recommendations on preparations for a second wave.

 

The Chair continued to outline that this meeting would hear from a range of stakeholders and agencies. It was noted that Geoffrey Ocen, Chief Executive of the Bridge Renewal Trust, would be sharing the findings from the meeting held with the Council in the last month which involved a range of BAME organisations.  It was really important to have discussion on the wider context and refocus attention on structural inequalities in society.

 

The Chair referred to the tragic death of George Floyd and the resurgence of the Black Lives Matter movement which demonstrated the pent up frustrations not just in America and the UK but globally of the inequality and injustice faced by black communities. It was important, as a Board, to address these issues. There was an increase in local community tension and complaints of heavy handed policing and the borough was conscious of the difficult circumstances that were being operated in.

 

The Chair spoke about Covid 19 highlighting the systemic inequalities which required focus to address working in partnership with communities.

 

The Chair invited Dr Will Maimaris to facilitate this item which included presentations to the Board on experiences, impact and next steps.

 

Part 1 presentations from council and partner representatives would be on the impact of Covid 19 and discussing the learning from response to the pandemic.

 

Part two would be considering organisational perspectives.

 

1.            Introduction, cases & impact: Dr Will Maimaris -Interim Director for Public Health

 

Dr Will Maimaris started this part of the session which would be considering:

·         the local response to Covid 19,

·         the key learning points during the outbreak,

·         and what the key priorities will be going forward. 

 

It was also important to explore how the Board was going to work together in partnership to tackle the challenges. Dr Will Maimaris advised that the partner representatives of the Board, further shared the sentiments of the Chair on working with communities on tackling racism and discrimination.

 

Dr Will Maimaris reflected on the progress and position of the Board pre Covid 19 which included: significant leadership role in health and wellbeing, strong links in local communities, draft health and wellbeing strategy compiled with consultation about to start. This draft strategy would need to be updated in light of the Covid priorities of: living well, age well, integration, and mental wellbeing and considering how the place we live in affects health.

 

Dr Will Maimaris provided an update on the health impacts of Covid 19 in terms of diagnosis and deaths. At the end of May there had been 595 diagnoses of Covid in Haringey but these were predominantly in hospitals where there had been testing and this was likely to be an underestimate at this stage as the testing services had not been in operation for long.  The peak of cases was seen in April. At this present time, the number of cases were lower compared to the peak and there was now a good opportunity to plan and prevent future outbreaks.   It was noted that up to the 15^th of May, there were 253 deaths recorded and a majority of these were in hospitals and a small number in care homes.  Analysis of figures demonstrated that the borough was strong in recording deaths as Covid 19 related and the borough did not see a significant number of deaths from other causes.

 

The biggest risk factor for Covid 19 was age and frailty and long term health conditions. There was as link between deprivation, certain occupations, and the Bangladeshi and Caribbean communities had an increased risk. The risk to healthy young people below 50 was low and overall the risk of death of this disease was slow.  There was work with the care sector to prevent outbreaks and there had not been any outbreaks in the in the last period.

 

2.            Mental health: Tim Miller - Joint Assistant Director for Vulnerable Adults and Children Haringey Council and NHS Haringey CCG – summary of powerpoint presentation

 

Pandemic and lockdown had caused increased anxiety and feelings of isolation and this was more widely felt across the population. In  particular increase in loss and bereavement  support services  accessed including by  frontline staff affected by loss of people working with them.

 

Seen significant fall off in activity of some mental health services across the NHS, both self-referrals and talking therapy services for depression, anxiety, through to more specialist complex secondary mental health services. The services were now moving back to pre Covid levels of use.  Mr Tim Miller commended the borough partners for rapidly reconfiguring their work practices to keep services going for people who need it.

 

Work with Connected Communities and supporting welfare and co-ordinated work. Bereavement framework was in development with third sector and working with faith communities leading to a commissioning response.

 

A 24/7 crisis call service had been established and this was doing proactive work in supporting people and continuing advice on advocacy services.

 

Mental health services were working through backlog to create some capacity and to respond to the anticipated surge of increased mental health support in coming months. Other additional new services planned had been expedited to open such as ‘Safe Haven’ a non-clinical crisis service which was being set up between Haringey Mind and Haringey Council. It was noted that rough sleeping services had been mobilised and working across primary and secondary care to support homeless residents more widely.

 

3.            Shielded groups: Charlotte Pomery – Assistant Director for Commissioning – Haringey Council – summary of powerpoint slides

 

The clinically vulnerable group were particularly at risk of infections, there were 4600 identified by the government in the borough and this figure doubled when the GP practices identified further patients in this group.  It was noted that 41% were over 65 and 20% of this percentage were living alone. Data was displayed on the information held on the shielded cohort, low income family database, in east of the borough, predisposition in the east of the borough,

 

Support for this cohort was a mix of health and social care support and support around access to food. The Council would be discussing with partners taking forward a holistic model that met the needs of the shielded and vulnerable people, not just in their medical and health terms, but related to wider determinants including social isolation. There was planning on how partners develop this model as a future integrated service and this would link into how the Health and Wellbeing board were considering support to this group prior to Covid 19.

   

4.            BAME: Geoffrey Ocen – Chief Executive Bridge Renewal Trust – summary of presentation

 

There was a meeting on the 14^th of May with over 60  Voluntary Sector groups to consider the impact of Covid on BAME communities and for the Council and partners to further understand need on the ground level.

 

Geoffrey Ocen expressed that, prior to the death of George Floyd, there was understanding being established that minority ethnic groups were more affected by Covid. However, after the death of George Floyd, the racial element to the inequality of deaths came to the forefront and the deep stated discrimination that was experienced for many years also being  highlighted and decision making structures  challenged.  Good meeting  held between communities  and diverse  representation  of  Voluntary Sector groups at this meeting which  had compiled a nine-point action plan to address :

1.    Data evidence -  need to know more  to support communities - disappointing report from PHE and lack of recommendations. Pleased that Maria Kane looking at impact on BAME staffing.

2.    Funding to build resilience -

3.    Bereavement and mental health services

4.    Domestic Violence

5.    Communication and awareness raising

6.    Prevention and resilience building

7.    Shielding of BAME staff and communities

8.    Equitable access to services

9.    Digital Exclusion

 

Geoffrey Ocen shared  the following further information from this meeting with the Voluntary sector:

·         Providing funding to the voluntary sector as important to maintain capacity and provide services and reach the  communities that need to be reached.

·         Voluntary Sector pleased on access to Council funding coming through in June Cabinet. However, responsibility of all statutory partners to do more, especially NHS . He had seen in other boroughs that that the NHS had come up with a package of support and Bridge Renewal Trust was hoping to do more with charitable arm of the NHS. Geoffrey Ocen was working with the Tim Miller on mental health support and arrangements for a framework of training and support. 

·         There had been a rise in domestic violence against women and girls and VSC  had also seen intergenerational conflicts in families and older children.

·         Improving communications – understanding how to practically and meaningfully target services and reach the people we need to reach and developing some tools and mechanisms to do this.

·         Prevention and reliance building -  lacking in BAME communities and needed support

·         Shielding of BAME communities, staff - risk assessment of BAME staff welcomed.

·         Rapid trace and test system  - explore how this is communicated in BAME communities and helping people who will have to self-isolate.

·         Equitable access to services and this is where racism and structural inequalities lie and this manifests in certain groups not accessing certain services or  communities may not be ware of these services. This maybe a  structural issue  or unintentional.

·         Repair Trust  between police and communities  - needs to be reflected in the services

·         Digital exclusion – agreed having an online capacity and presence but also  having practical ways of reaching people on face to face capacity

 

Follow up to the meeting   - community expects urgent actions. The oversight  of these actions   should be through HWB and  CSP board. Geoffrey Ocen was taking work forward - small core groups of partners and engagement on this.

 

3.CYPS: Ann Graham   Director of Children’s Services Haringey.

 

Ann Graham presented on the impact the pandemic on of children and young people. Core messages of the presentation were:

·         Partnerships have remained strong and done good work to protect children and young people, to look after their outcomes.

·         Food poverty - Connected Communities addressed this and family in need supported this with cohorts that they knew in the borough.

·         Digital poverty already knows but the extension of this poverty was seen with children and young people. government offered laptops.

·         Working closely as a partnership and working with Haringey local safeguarding board to consider the safeguarding and protection issues that have emerged during this time. Increased meetings from quarterly meetings to fortnightly meeting and this had been instrumental in making sure that the relationships in the partnership were as strong and that issues were being addressed as quickly as possible. Benefits are routine to families to ensure safe and well.

·         Referrals to the MASH had dropped and this was immediately acted upon with benchmarking in the local area and this was taken forward as a national issue. It was noted that the case s that did come forward warranted swift intervention.

·         Worked closely with schools to ensure joint consistent messages to families.

·         Digital helped social workers access families but this was also found to be intrusive by some families.

·          Work with CAMHS rearranged to serve children and young people more swiftly.

·         There was a crisis line open 24/7 which is well received.  Noted that due to schools opening in June, some referrals to the crisis line had escalated.

·         Evidence of poverty was stark, tackling the educational deficit would be critical and should be considered by the board in their work going forward.

·          Some children supported in home learning by schools and others have not been able to take up this opportunity and the impact of this will be seen in the coming years.

·          Need concerted effort on raising aspirations for young people in the borough to give them hope for the future, to have jobs, identify and feel safe in the community and have the security of housing.

·         The longer term impacts on children and young people were not yet known as they were just returning to school.

 

 

Due to the lack of time remaining in the meeting, discussion would include organisational perspectives as part of this item.  The PowerPoint slides provided by partners would also be shared with participants after the meeting.

 

Board members were asked on the information received above, and think about what the key issues were and what the board should be focusing on:

 

The following observations/ comments were put forward:

 

·         There was some anxiety in Primary Care community contracting Covid, and the recovery process. Patients were concerned about going to hospital and there was late presentation of symptoms.

 

·         Board need to consider the evidence link between ethnicity, poverty, deprivation and, the concern about contracting Covid in the community and the health outcomes this could have.  Noted that, locally, there had been 12 cases of Kawasaki syndrome and important to explore why more experienced in NE London.

 

·         Recovery of severe Covid – locally taking forward a follow up service to understand impact on respiratory needs.

 

·         Late stage presentation of severe illnesses seen and need to look at how to address this.

 

·         Some clinics had moved offsite from hospitals and, now look at moving back these services safely and reassuring people.

 

·         Consider, as a Board, the continuing effects of bereavements and long term effects this will have on communities and mental health.

 

·         There was zoning of hospital to make them feel as safe as possible, and encourage public to use services. AE had seen a reduced demand.

 

·         Paused community services but will look at how work in the community settings so as comfortable coming back.

 

·         BAME staff and public cautious with risk assessments needed to provide assurance.

 

·         Impact of Covid on Prevention agenda highlighted, and the challenges for immunisations and vaccinations, screenings, supporting people with long term conditions such as diabetes that need consideration.

 

·         General Practice impact has been significant. This will be an ongoing challenge with older and BAME staff often working at these settings who will need confidence that safe to work. It will be difficult to open, some services even with social distancing.

 

·         Access to services impacted, at the moment cannot get access to usual triage services and means patients sent to hospital. Need to reassure staff operating local services.

 

·         Access and link to local authority services difficult with reduced staffing working in local settings and doctors having to facilitate access. Example of dementia service access highlighted and working with families to try and access local support.

 

·         Introducing single point of access, available 24 hours, brought forward a year early.

 

·         Expecting to see a surge of demand for mental health services by 30% because of increased conditions such as anxiety, PTSD.

 

·         Health watch phone line identified confusion of access to services, hard to reach groups getting harder to reach. Digital exclusion with patients deprived of services and impact on health inequalities getting wider. This is affecting residents from BAME backgrounds who do not have English as their first language, people who are deaf and also unpaid family carers.

 

·         A lot of issues around interruptions to mental health services and cannot access new methods of delivery.

 

·         Health representatives were aware of digital exclusion and working on this. Noted that there most consultations were taken forward by phone instead of through digital access. There were bids for funding of digital booths at community access sites for hospital appointments.

 

·         With regards to Primary Care e -consultations, the thinking was to help improve access for those who can use digital means, then allowing other patients more access who cannot.

 

 

·         Digital exclusion was a key area of focus for local authority and there was recognition of this as an issue going forward.

 

Organisational impact of Covid 19

 

In the local authority, there had been new spend on additional services and funding provision for new services as a result of Covid 19. There had been response to the homelessness situation in boroughs with some funding from the government but not enough to cover the whole cost.

 

Loss of income for the local authority and voluntary sector and need to be mindful of the narrow financial impact for individual partner organisations and even more critical to consider the wider economic impact on the borough.  The partnership also could not take for granted the 500% increase in Universal Credit applications, unemployment increase rates, loss of hours.

 

Conclusion

 

Summary of discussion was provided by Dr Will Maimaris. This focused on impact of Covid on the borough with some of the populations affected and the real issues around BAME groups and more broadly health inequalities and access to services. The services were not felt to be running as smoothly as they could be, with some positive transformation of services taking place by providers in the room.

 

Emphasis on mental health, bereavement and preventative services was needed.

 

Cllr Blake spoke about BAME equalities and young people demonstrating in the Black Lives Matter movement. As a local authority, there was a need to question how the organisation responds to these issues.  He spoke about acknowledging that there was a problem, as partner,s and highlighted the importance of considering community perceptions and responding to the long term challenges. He felt that there were practical actions to commit to and work towards as a partnership to improve perceptions and working relationships with communities.

 

The Director of Adults and Health, highlighted the significant outputs related to the 9 point recommendations, included in the presentation slides, that had been compiled by Bridge Renewal Trust working with the Council and voluntary sector community groups. The Director recommended that the Board adopt these recommendations. Partners could then work out how to take these forward and with support of the subgroups.

 

It was further important to review the Health and Wellbeing strategy in the light of Covid. The governance for the Borough Partnership arrangements would be updated and reflect on the feedback from the sessions today

 

Support agreed for the 9 point recommendations

 

The Chair reflected on the discussion and expected the economic situation in the borough to worsen in the coming months with more homelessness, redundancies, high rents and loss of working hours. There was a need to focus on resources and help people through this period. The work on making sure people had food was an indication of how significant the health inequalities were in the borough.

 

The Chair thanked contributors to the discussion.