The Director of Public Health and the City Mayor will provide a general update.
Minutes:
The City Mayor delivered a presentation which contained data on the delivery of Covid-19 vaccinations in Leicester (attached to the minutes for information).
The City Mayor, prior to his delivery of the presentation, acknowledged the effort, energy and expertise that had been used by the NHS both locally and nationally, in order to deliver vaccinations at a time when they were under enormous pressures as a result of Covid-19 and enormous backlogs as well. He added he wanted to make it clear that what he was going to present was not a reflection or any sort of criticism on the efforts that had been made. locally. Referring to the integrated care system, he added that he had enormous sympathy with the task that lay ahead to integrate the care system with the NHS into a single entity. He added that if there was any criticism to be had it was of the system within which they have been seeking to make vaccine delivery work.
During the presentation the following points were made:
· When comparing the delivery of vaccinations in Leicester with the delivery of vaccinations across the whole of England, there was a significant gap in those that were 12 years plus.
· There were significant geographic inequalities in uptake across the city, and the NHS had been asked to focus on the where the geographic inequalities were and seek to promote the take up in those areas in the city where it was known there were significant number of people who hadn’t had a vaccination.
· There had been considerable improvements over the last few weeks, but there was very slow delivery of the vaccine in care homes. There had also been a very significant lag in the delivery of vaccines in schools.
· Vaccine delivery in the run-up to Christmas showed mainly booster vaccinations were being given. The period after Christmas showed that vaccinations one, two and booster numbers had dropped significantly. A graph showed doses one, two and the booster vaccinations for 16years plus over time. The Office for National Statistic target was one for which the city should be aiming, and was significantly higher than Leicester figures.
· It was noted that by August 2021, the delivery of the vaccinations one and two had flattened off.
· It was noted on the booster delivery for 16years plus, figures plateaued in the middle of December 2021, and was a long way off delivering even 80% of the population.
· A graph outlining vaccination numbers in Leicester and England showed the percentage variances in different age bands and showed how far Leicester was behind nationally.
· The 12years plus chart was highlighted as an example for the whole of the eligible population in the city. The figures showed the city was 7.5% behind for first dose, 8.9% second dose, and 13.7% for the booster. When breaking the lower age range figures down further to 12-15years, the gap was even greater at 10.7% behind for first dose.
· A chart for doses one administered to 12-15 year olds in Leicester showed the target of delivery of dose one by November 2021 fell a long way short of what was being delivered and had plateaued by December 2021.
· It was believed that uncertainty nationally was affecting delivery. It was noticeable that some schools in the city had very few vaccines being delivered whilst others received very high numbers. It was believed that this was in part as a result of the effort put in and encouragement to get consent forms signed. It was very clear where the NHS had worked with schools, they had been able to deliver the vaccines.
· The slide on vaccination status by MSOA area was included to show the points made about the concern over geographical disparities in the delivery of vaccinations, with the grey part of the bar showing numbers of people in that particular part of the city with no vaccinations at all, with significant high numbers in Leicester city centre, West End, Westcotes and Stoneygate North.
· Discussions had been held with the NHS locally to ask them to focus on those particular areas with higher numbers of unvaccinated people, but there was criticism of the system and its ability to adapt itself in a flexible way to respond to what public health officials were identifying as areas where they could make the most impact.
· The chart with 50+ population showed Super Output Areas (SOAs) that should be targeted in Spinney Hill Road, Stoneygate, Westcotes and the West End. Again, the information had been supplied to the NHS but there had been difficulties getting the system to adapt.
· Delivery in care homes was a concern. Here numbers of eligible people for vaccination were known, but delivery had not met the Government’s stated target date when residents should have received a booster vaccination. It was acknowledged that considerable efforts had been made to ensure the booster was delivered, but the blue line showed actual delivery locally fell a long way short of the target in November and remained so.
· 44% of staff had received a booster and it was suggested that more could have been done earlier to get staff vaccinated, given that many other urban areas had better rates.
· There had been good examples of pharmacists going out into community venues and delivering vaccinations, which showed the vaccinations could be delivered in challenging circumstances.
The Chair stated he was shocked by the fact that data could be obtained that showed where problems were and there seemed to be a lack of acknowledging the data and was problematic that the council was not getting the responses from the health service that it should be.
The City Mayor responded that it seemed to be systemic that the NHS could not deliver as effectively as public health officials were. He believed that the establishment of integrated care system would seek to look at those problems to try to get the NHS aligned at local level and properly integrated.
Members were then given the opportunity to comment and ask questions:
· It was noted that only 6% of agency staff in care homes had had booster jabs which seemed incredibly low.
· In terms of working in schools and care homes, it was asked if there was any data on children, especially in schools, who had developed natural immunity. It was stated the Omicron variant spread easily which might explain the low take up in vaccinations because of natural herd immunity.
· It was noted in Leicester city south, it showed the highest level of people not having received vaccinations. It was asked how many students made up the number who may have received vaccinations at home? The Chair of Health and Wellbeing Scrutiny Commission stated that the city centre was composed of a transient population whereby people did not de-register from their GP when moving on, leaving a number of ‘ghost’ patients on the roll, and that he was engaging with the Clinical Commissioning Group about the issue to identify those non-patients
The City Mayor acknowledged that the city centre population was transient, but the fundamental point was there were a number of areas in the city where there was a disproportionate under delivery of the vaccination, with the possibility of engaging in targeted work being missed.
Members expressed disappointment about the issue around complexities in the completion of parental consent forms which appeared to be a recurring challenge going forward and asked what resources could be used to assist parents to help them better understand. The City Mayor responded that it had certainly been the case that of late the NHS had acknowledged the consent forms being used were not the only way to gain consent and a note from parents was enough. He added it was clearly possible for the NHS to work with schools to get consent and vaccinate through collaboration, but what was lacking was consistent support. He added as an example that it was interesting adjacent secondary schools had delivered dramatically different proportions of the children vaccinated.
Councillor Kitterick left the meeting at 6.15pm.
Members thanked the Director of Public Health and Team, and the City Mayor for the regular updates on the Covid-19 virus and vaccination programmes which had been important for Members. It was suggested that low uptake of the vaccination had partly been through not appropriately utilising social media and had this played a huge role in preventing people having the vaccinations.
Members noted the vaccination uptake in care home residents which, according to the latest figures, was at 83%. Concern was raised with just 44% take-up of the vaccination by staff. The deadline for staff to have had vaccinations had been November 2021, but had changed since. An issue had arisen with social care services having lost so many care workers because they had not been vaccinated before the deadline or had chosen to leave the service.
Members observed that vaccination take up in 12-15year old children was 14% and that this was lower than the national average. Members asked if the data showing ethnicity of non-take up could be provided so that those groups could be worked with. The City Mayor responded that when looking across ethnicity of vaccination that some variations could be seen, but was not the most significant variable, and by focussing on geographic areas had been the most effective way of getting more vaccines in more arms. He added that elected representatives were well placed to help the NHS to identify ‘influencers’, such as sports people or religious leaders, as trusted voices in those wards and communities to encourage take up of vaccinations.
Ivan Brown, Director of Public Health, noted the point that one of the challenges faced was flexibility in the NHS not only at local level but at national, and if a blanket approach was taken, it did not serve the entire population. A lot of discussion had been had around trying to increase levels of flexibility in the system, and in order to do that had been to provide them with data on areas, communities and taking the vaccination to the people, such as care homes, going back into schools and with a much more flexible approach, and using mobile units going into localities not taken to before. The data being brought around schools seemed to be moving in the right direction, but against a backdrop where it was becoming increasingly difficult compared to several weeks ago.
The Chair noted the Prime Minister’s move to weaken restrictions against Covid-19, and felt that this would make it more difficult to convince people there was still a problem and should therefore get vaccinated. The City Mayor responded by stating that there was also serious concern with the dropping of testing, which meant Public Health would lose the ability to track the virus.
The Director of Public Health also raised concerns around testing. Firstly, because there was still a high proportion of people who were clinically vulnerable, who would be concerned and would want to know if they had to continue to isolate, which was a major challenge. Secondly, if there was no capturing of data and testing, it would not be known if there were any new variants, and this could lead to a return of testing in hospitals and would limit what Public Health could do and what could be shared in the community.
He added that Public Health colleagues had always been as cautious as possible, and he did not believe there would be a rush to bring staff back to the office. There would remain precautionary messages to people to stay as safe as possible, reminding them of the basics to protect themselves and loved ones the importance of vaccinations, and if sick to encourage people not to go into work or schools and to continue to good work that had been undertaken in the city to place it in the lower third of the number of cases, through contact tracing and testing.
The Chair said he believed the City’s public health was in very safe hands, but felt that there was some uncertainty now the government had relaxed controls. The Chair supported the work of the Director of Public Health and his team for their continued work.
The Chair thanked the Director of Public Health, City Mayor and officers for the update.
AGREED:
That the update presentation and supporting information be noted.