To receive a verbal update on the Covid-19 pandemic and the vaccination programme.
Minutes:
Dr Will Maimaris, Interim Director of Public Health, provided a Covid-19 update at the meeting. It was noted that the majority of new cases in Haringey were currently amongst teenagers and younger adults. The case rates amongst older people were lower and this appeared to show that Covid-19 vaccinations provided good protection against illness, hospitalisation, and death. It was added that the number of people in hospital had greatly reduced since the winter peak but it was noted that some people were still being admitted to the Intensive Care Unit (ICU).
It was explained that cases were expected to peak over the next four to six weeks, following the recent relaxation in restrictions. It was anticipated that cases would reduce in the autumn but there were concerns that there may be additional pressures over the winter in conjunction with seasonal issues such as flu.
It was highlighted that the Covid-19 vaccination was considered to be the best intervention and it was aimed to provide all eligible people with two doses of the vaccination. Booster vaccinations were also being planned from September for those in higher risk groups and the preparation for this was underway, in conjunction with flu vaccination planning.
The Interim Director of Public Health reported that the overwhelming majority of people were taking up their offer to receive a second dose of the Covid-19 vaccination. It was noted that there was over 80% coverage in older age groups and that the ethnic disparities for take up in older groups had been significantly reduced. It was commented that there were ethnic disparities in the take up of the Covid-19 vaccination in all age groups, particularly amongst Eastern European and Latin American groups. It was acknowledged that there was further engagement work to be undertaken but that there were reassuring levels of protection in the community.
Cllr Mike Hakata enquired whether there was a comparison with similar London Boroughs on the ethnic groups where there were the lowest levels of vaccination take up. The Interim Director of Public Health noted that this data was measured slightly differently in all boroughs but that it could be requested; it was understood that the levels of vaccination take up in different groups was similar across London.
Cllr Zena Brabazon enquired about hospital admissions and the impact on Accident and Emergency departments (A&E). Jonathan Gardner, Whittington Trust Director of Strategy, noted that there were currently about 24 cases at the Whittington Hospital and that this was increasing slightly. It was explained that A&E was very busy. Richard Gourlay, North Middlesex University Hospital Trust, commented that there were approximately 37 cases at North Middlesex Hospital, with five in critical care. It was added that the hospital currently had a critical incident due to capacity issues and that attendance at A&E had been close to a record high.
The representatives from hospitals noted that the current levels of pressure were similar to those expected in winter and that hospitals were also trying to recover their elective backlogs. It was explained that it had been difficult for staff who were having adapt to demand, which involved moving around and providing additional capacity. It was noted that the hospitals were trying to support staff as much as possible, including health and wellbeing support and encouraging staff to use their annual leave. It was added that staff had experienced an incredibly busy year and that there was still significant demand on the system as well as potential staffing shortages.
Sharon Grant, Healthwatch Haringey Chair, noted that some patients were experiencing difficulties in accessing primary care and that this could account for some of the additional presentations at A&E. She stated that it was important to consider the impediments to access. The Chair acknowledged this and noted that this might form part of the Health and Wellbeing Board’s work plan.
Ann Graham, Director of Children’s Services, noted that there seemed to have been an increase in the number of children with respiratory problems due to the impact of Covid-19 and it was enquired whether there was further information about the pressures on paediatrics. Rachel Lissauer, CCG Director of Integration, explained that there were a number of pressures across the system and that an Emergency Care summit in early July had identified some key areas for action. It was noted that A&E departments were maximising their ability to triage patients using senior decision makers at an early stage. There were also communications to inform people that primary care was available where relevant to avoid unnecessary pressure on hospitals. Richard Gourlay noted that there had been some increases in the numbers of children with bronchiolitis. It was explained that this had been anticipated and that some modelling had been undertaken. It was anticipated that there would be significant pressure on the system in the autumn and that solution planning was underway.
Sharon Grant, Healthwatch Haringey Chair, enquired whether there was still a GP service at North Middlesex Hospital A&E. It was noted that there were some new barriers to accessing GP services and these were likely to disproportionately affect vulnerable people and those with special needs. John Rohan, CCG Board Member, explained that GPs were fully open but that phone triage was being used due to the significant levels of demand. It was noted that practices were trying to encourage staff to have holidays but that it was challenging to find staffing cover until September. Richard Gourlay stated that North Middlesex had Urgent Care from 12am (midnight) to 7am which included GPs and emergency nurse practitioners.
The Director of Children’s Services noted that there were a number of pressures on the system, including on the availability of GP access. It was enquired whether there was a link between the ability to access GPs and any resulting significant issues, particularly in relation to mental health. It was also enquired whether the upwards impacts of the pressures on the system were being monitored. The Director of Adults and Health noted that there was a trend of increased A&E presentations relating to self-neglect and there appeared to be a possible link. It was commented that this issue and possible actions could be investigated.
The Interim Director of Public Health explained that there had been work to increase uptake of the Covid-19 vaccination. It was noted that data had been used to understand the overall picture and that there had been lots of engagement work with the Multi-Faith Forum and various community groups, including through the Community Protect project.
It was explained that there had been a pilot project for vaccinations in Northumberland Park. The project had incorporated a diverse group of staff from Covid-19 testing centres who were able to book people for immediate vaccinations at a local centre. It was reported that there had been over 8,000 interactions as part of this project but that most of the residents had already been contacted to take up their vaccinations and only about 10% of interactions resulted in a vaccination booking. However, it was noted that there had been some positive interaction with Eastern European and Latin American groups who had been generally harder to reach in the past.
The Interim Director of Public Health thanked all who had been involved in the project. It was explained that the pilot project had experienced some successes in responding to health inequalities, targeting resources in areas of greatest need, and working jointly with a range of partners. It was noted that there had also been some challenges, namely that there were still some gaps in the uptake of the vaccine and that the project was resource intensive.
Cllr Zena Brabazon stated that this was a very positive project and that it would be beneficial to replicate this model of working. She also enquired whether the diverse group of staff had been able to use different languages to connect with the community. The Interim Director of Public Health noted that the written materials had been provided in a number of languages and that many of the staff were local people and were able to speak a variety of languages which had been beneficial. It was added that this approach had been resource intensive but that a number of the methods were being considered in other areas, such as mental health.
Geoffrey Ocen, Bridge Renewal Trust, noted that this project had been a good opportunity as it was well resourced. He added that Community Protect included over 20 grassroots organisations and that it would be difficult to replicate this project but that it would generate a lot of learning. Cllr Zena Brabazon noted that it would be useful to use this model for the Early Years Review.
Zina Etheridge, Haringey Council Chief Executive, explained that there were insufficient resources to use this model for all engagements but that this project had generated a lot of learning. It was noted that a number of local people did not feel that various systems and services had been designed for them and, therefore, they did not have high levels of trust. It would be important to use opportunities and resources to build models and relationships that would sustain the long term effort to reduce health inequalities. It was added that one positive aspect of the Northumberland Park project was the vaccination take up from those who were undocumented and had previous feared that they would be reported to the authorities.
Rachel Lissauer, CCG Director of Integration, noted that this sort of project did not require additional resources for the delivery of the vaccinations but that providing vaccination booking options through Eventbrite and drop in sessions had been very popular. It was commented that, where there had been large scale vaccination availability and publicity, there had been good numbers of people attending. It was noted that, for any big public health campaign, people often wanted to access services in a variety of ways and it was important for organisations to work in a joined up way.
The Chair also thanked everyone for their efforts in this programme.
RESOLVED
To note the update.