The Director of Public Health will provide a general update.
Minutes:
Rob Howard, Consultant in Public Health (Medicine), was present in the meeting to provide an overview of the latest picture of ward trends, including Covid-19 infection rates and vaccinations. During the update, the following points were noted:
· The current situation in terms of overall rates had saw the rate increase slightly over a few weeks rates to 400 per 100k people. Previously the figure had been 365 per 100k people.
· The rates for over 60s had come down slightly.
· The rates for school age children though high had also reduced somewhat.
· The rates for 17-21 and 21-24 year olds had almost doubled in the past two weeks.
· Although the overall picture on a superficial level was giving a falsely reassuring picture, the city was on the precipice of an unprecedented increase in cases expected in the next few weeks along with the rest of the country who were somewhat behind London.
· One clue when looking at the rise of the new variant, was two weeks prior it was around 1% of cases, but now presented at 54%, so very soon the Omicron variant would be the vast majority of cases.
· It was known Omicron was more transmissible, but there was lots of uncertainly about the severity.
· Current efforts were focussing on the vaccination programme, with significant progress made as part of a huge campaign to boost vaccinations around the city.
· It appeared the new variant was doubling every two to three days but was expected to slow down. Nonetheless, the country was approaching a holiday period, with families expected to get together, and there was concern rates amongst the younger population would translate into the older population, particularly amongst the unvaccinated and the clinically vulnerable.
· An issue to be addressed as a system and as a city council was business continuity, a challenge that would likely see significant numbers of staff, particularly front line, absent through sickness and self-isolating.
· Everyone was working full out again to look at what could be done to prepare, to push the vaccination and booster programme, and was one of the most serious points of the pandemic to date.
· It was thought that because it was expanding so rapidly, the surge could also end rapidly. It was reported that in possibly one to two months, the city could be out the other side of the surge, though the damage that could be done in that period was unknown.
· Hospitals were preparing for surge capacity, though it was unknown whether it would be at a level at which they could cope, and further measures might need to be taken nationally, though it was clear there were disagreements with different interpretations on what needed to be done.
· It was generally recognised that it was a very serious time and situation and the Council continued to do all it could, including continuing contact tracing. So far in the city there remained a reasonable supply of tests.
The City Mayor provided an update on where the city was in terms of vaccinations. It was noted that the delivery of vaccinations was a matter for the NHS, and in general across the country they had done incredibly well. However, several months previously it had become obvious that the delivery performance in Leicester was lagging significantly.
The City Mayor continued that the Council had responsibility for the health and wellbeing of the city in general, and the scrutiny of health. Public Health was charged with the oversight of promoting the health of the public and encouraging and supporting measures to keep people healthy. The City Mayor had held over recent months a series of conversations with the NHS locally and had offered to provide them with information on the take up of vaccinations in the city, as it had become clear the NHS had struggled with the situation in Leicester.
The City Mayor referenced the latest figures which showed there were issues across the whole board in Leicester with delivering vaccinations one and two, as well as the booster vaccination. He reported that in ages 16-years plus of the population, only 66.7% had received vaccinations, which was 8.7% below the England average, and was reported to be more pronounced in some age groups than others, and in some parts of the city than in others and that overall figures were worryingly very low.
It was further noted that the latest figures for age 12-15 years showed the administration of dose one was a mere 28%, some 14.8% below the national average, and graphs drawn by Public Health of the delivery had been virtually flat over recent weeks after the initial surge. It had been said by the NHS that delivery was down to problems of consent from but did not explain why some schools had managed to deliver high levels of vaccination while others had very low levels.
The City Mayor noted the question of consent was a real issue given the complexity of the forms the NHS were using. It had been suggested that alternative forms be used but these had not been put into practice. He noted that it was even more concerning that, even with consent form, some children had not been vaccinated, and that coming towards the end of term, the levels of vaccination in children were many, many weeks behind comparable authorities and acceptable levels.
Looking more generally it was reported that dose one and two figures had barely changed over that past two months despite all the data shown and offers of help given to the NHS. As a result, the delivery of boosters in the city was, even before the massive extension had been announced, lagging way behind the UK average.
The City Mayor offered to produce a number of graphs and data on the issue. He noted that he had sought so far to enter into constructive dialogue with the NHS but believed that Leicester had not been well served when it came to vaccinations.
Members were given the opportunity to ask questions, and the following information was provided:
· Members said it was hard for elderly people with no access to IT in homes to book online for a booster, which was not the fault of the NHS or Council. Also noted that with the rollout of the booster it was not clear where people should go, with the NHS not working for those that had it, and for pensioners not being able to travel far as they could not afford transport. Members were frustrated with Government and believed that there should be easy access in each ward to gain dose one and two, and booster vaccinations.
· It had been reported in Eastern Eye there was a low take up of vaccinations by people of Indian and Asian backgrounds nationally. It was also noted that some walk-in centres in the city had run out of vaccines following long queues. Also, it was believed the qualifying time between vaccinations and booster had been confusing, resulting in people being turned away who were just a few days short of the qualifying time who might be discouraged from returning. The City Mayor responded that the excellent Public Health Team had developed a very good understanding of the presence of the virus in the community and were using that expertise to deliver the vaccine where it was needed, not identified in so far as Asian communities, but more in geographic areas in the city. He added the Team had sought to work with the NHS on how to work with communities, to help understand reluctance in areas, and to promote and make vaccines convenient in those areas, but still take up was extremely low, and there had been no significant impact.
· The City Mayor noted there were some good examples in the city of using centres across the city to deliver vaccinations, but were being done on a piecemeal basis, and not being applied as a result of the NHS promoting pharmacies, using Council facilities despite, or using St John’s ambulance to deliver vaccines, and was intensely frustrating.
· With the rollout of boosters, ignored was the fact that that a third of people in the city had not received their second dose and the past few weeks and months had been a missed opportunity to increase those figures before promoting the booster. There was also serious concern around older people who were completely unvaccinated and would be much more at risk. Teams around the Council would continue to promote the vaccinations and booster as far and wide as possible.
· It was noted by a member that the NHS assumed everyone was computer literate and the only way people could complete consent forms. It was noted that some schools were providing paper copies under their own initiative, rather than relying on the NHS to do it.
· Members were shocked at how low the level of boosters in care homes was. Recent figures showed that 40% of care home residents had not received the booster vaccination even though they were in Priority Group 1. Figures were better than reported, however, with a delay in care homes completing a capacity tracker, with the Social Care Team ringing around care homes for up-to-date data.
· Members were assured there were no problems with the supply of Pfizer and Moderna and the issues wasn’t the supply of vaccine but providing this to a sufficient number of people. Pharmaceutical companies were working rapidly on new types of vaccines as different strains of the variants appeared.
· People receiving the booster would not be effective for a couple of weeks, so thought was needed to be given with regards to business continuity over the next few weeks and the general message to give to the community to protect older and vulnerable people should continue.
· Members reported parents were finding it difficult to find out where they could take children under 12 years to be vaccinated. The City Mayor reported that the vaccination should have been offered in the first instance in schools and as it was the end of term, this would now be in the New Year. Outside of that setting the children would be able to receive the vaccination at the same centres as adults.
· Details in rates of vaccination uptake across the different neighbourhoods in the city would be provided to Members. Also noted was the Council and CCG websites had a list of walk-in centre, and people could contact their own GP surgeries for information.
· The vaccinations were currently approved for the over 12s. It was reported there was a lot of work going on around whether it would be approved for even younger age groups.
The Chair asked Councillor Kitterick (Chair, Health and Wellbeing Scrutiny Commission HWSC) to look in more depth at the issues with the NHS. He responded by stating that the HWSC had looked at the item at a recent meeting, and Councillors had identified as a matter of urgency the location of community organisations, booster jabs and lateral flow test information should be circulated to Councillors, and that they be asked to identify where there were gaps in provision, and to indicate where a particular location would work very well and where it would not work.
The Chair of HWSC continued by explaining that there were a few areas that consistently had low vaccination uptake; namely the city centre and West End areas, particularly around Newfoundpool. He noted there were two hypothesis put forward on the low uptake. Firstly, there were people GP on lists who could have left and had not de-registered from their GP. There was a problem in ascertaining if that was the case and this was not a quick and easy process. The other hypothesis was some of the patients were so disengaged with their GP they had not bothered to respond.
The Chair of HWSC acknowledged that there would be something of a lag in engagement in those areas due to the younger population, but the sheer gap was not plausible and believed that a problem of GP provision in the West End and city centre had been uncovered, and had been growing for many years prior to Covid. He added it was not an easy problem to fix, so had been difficult when the Government had requested vaccination rollout to be implemented.
The HWSC were aware of the issues and had raised them with the Clinical Commissioning Group (CCG), and two representatives of the CCG would develop an action plan. The decision on where to press the NHS needed to be made, but currently the absolute priority was the communication of where vaccinations, the booster and Lateral Flow Tests (LFTs) could be obtained, with information cascaded to local councillors who could provide the information to residents. The Chair of Health Scrutiny Commission asked that any pressure that the City Mayor could put on that information being distributed was most welcome.
The City Mayor thanked the Chair of the HWSC for the information and expressed frustration in the failure to get a joined up response. He added that the NHS priority was now the delivery of boosters, but expressed further frustration around the level of meaningful engagement with the Council on the fundamentals of delivering first and second dose vaccinations, and felt that this hindered progress with the local vaccination roll-out.
The Consultant in Public Health (Medicine) appreciated the frustration about some of the vaccines. He reported that officers had looked at campaigns for different groups, including the 12-15-year age group, the low delivery of which needed to be addressed before school commenced in the new year. It was noted there were a team of people working with communications to develop key messages that resonated with the younger groups.
In response to a member comment, the City Mayor stated he would seek to task the local NHS management with delivery of vaccinations and to monitor performance. He added it was appropriate for the Overview Select Committee (OSC) and HWSC to have much fuller data on vaccinations.
The Chair thanked the City Mayor and Officer. He praised frontline staff for all they were doing to protect the population. He asked that more detailed information as a written report be provided to the HWSC on 24th January 2022 and to the OSC on 10th February 2022. The Chair of HWSC would contact the CCG to request the information as a matter of priority.
AGREED:
1. That the update be noted.
2. Details of vaccination take-up rates across different neighbourhoods be provided to members
3. A written report be provided to HWSC on 24th January 2022, and to OSC on 10th February 2022.