Agenda item

Mark Adams, Director of Public Heath (South Tees) (CCG) will be in attendance to provide an update on Covid-19 and the local Public Health / NHS response.

 

Recommendation: Panel notes the information provided.

 

Presentation

Presentation - TVCCG

The Director of Public Health (South Tees) was in attendance to provide the Panel with an update in respect of COVID-19 and the local Public Health and NHS response. The Director advised that at the last Health Scrutiny Panel meeting, as held on 13 October 2020, the 7 day rolling average figure for the COVID-19 infection rate in Middlesbrough was 268.8 per 100,000 (11 October 2020). Today that rate had climbed to 430 per 100,000 (8 November 2020).

 

Reference was made to the fact that Middlesbrough and Hartlepool had been placed in Tier 2 'high' restrictions from 3 October 2020. It was noted that although around 29 October the rates had started to decrease infection rates had since started to increase. There remained a high prevalence of infection in the community and the current rate of infection was similar to the highest rates seen in the previous peak.

 

In terms of the regional picture Middlesbrough's testing rate of 2,825 (1 - 7 November) was the highest in the North East, which indicated that access to testing was not an issue. The rate of positive tests at 13.6 per cent was high and a figure of 5 per cent would be an expected ratio. However, the rate was consistent with other Local Authorities in the North East region. 

 

In terms of analysis by age the figures showed that the prevalence of COVID-19 was highest in Middlesbrough amongst people of working age (age ranges 35-49, age 15-34 and age 50-64) with rates of between 350 and 450 per 100,000. Currently the rates amongst those aged 65+ was around the 200 per 100,000 figure. 

 

In relation to the approach that was being adopted to disrupt the spread and protect local communities it was advised that there were four main areas of activity:-

 

- Community Capacity Building

- Test and Trace

- Protecting Vulnerable People

- Covid-Safe Settings

 

Within each area specific work was being undertaken, for example, some of the work would be co-ordinated at a regional level including:-

 

- Mass Testing - Lateral Flow Tests(LFTs)

- NE Test, Trace & Isolate (TTI) Programme

- Building behavioural insights

 

In terms of the LFT's it was explained that Middlesbrough was anticipating receiving a large supply of LFT's (a weekly amount of 10 per cent of the population) and it was explained that these would be used to protect the most vulnerable people in our community. Across the North East the plan was that the LFT's would be used primarily for the following purposes: 

 

- Opening up testing to care home visitors

- Introducing testing amongst Domicilary Care staff

- Potentially testing Care Home staff more frequently than weekly

 

In addition the Local Authority was looking to develop a more locally enhanced contact tracing programme. The Panel was advised that currently the national system reached about 75 per cent of positive cases and less than that figure for contacts of cases. With the introduction of a locally enhanced programme after 8 hours the national contact tracing team would hand over the details to our local teams. Contacts made would then be from a local number and staff would be available to advise on the local offer / support packages avaialble to people to help them self isolate.

 

It was advised that in terms of the COVID vaccine programme it would be developed on a North East basis and as of yet the Director had no further information in respect of timescales. However, Members were advised that a wide scale vaccination programme would need to be carefully planned and he anticipated that it would be Easter time before large numbers of people in the local community would receive the vaccine. 

 

The Director of Commissioning and Medical Director at Tees Valley Clinical Commissioning Group (CCG) were in attendance to provide an update on COVID-19 from the NHS' perspective.

 

In terms of the NHS priorities for this third phase of the pandemic it was explained that these were as follows:-

 

Accelerating the return to near-normal levels of non-Covid health services, making full use of the capacity available in the 'window of opportunity' between now and winter for:

 

-      Cancer, Elective activity, Primary care and community services, MH & LD/autism

 

Preparation for winter demand pressures, alongside continuing vigilance in the light of further probable Covid spikes locally and possibly nationally:

 

-      Covid-related practice, Prepare for winter

 

Doing the above in a way that takes account of lessons learned during the first Covid peak; locks in beneficial changes; and explicitly tackles fundamental challenges including: support for our staff, and action on inequalities and prevention:

 

-      Workforce, Health inequalities and prevention

 

Further details in respect of the Tees Valley CCG and ICP's progress towards recovery were detailed in the presentation. In terms of elective surgery it was advised that all cases of patients waiting longer than 52 weeks would undergo a harm review and efforts were being made to maximise the use of Redcar PCH and the Friarage, as well as local independent sector providers.

 

In terms of primary care and community services 100 per cent of GP practices across the CCG had initiated and video consultation triage services in response to Covid and 100 per cent of GP practices were offering face to face appointments where appropriate. 

 

In relation to the uptake of the flu vaccine it was queried whether issues relating to shortages in supply had been resolved. The Medical Director at TVCCG advised that the uptake this year had been unprecedented and currently demand did exceed supply. However, GP Practices were receiving additional stocks and it was also the case that this year far more people had been eligible to receive the vaccine than previously. At a national level flu statistics showed that the UK had not entered the peak of the flu season and it was hoped that the low levels of flu prevalence would remain.

 

With regard to the NHS workforce the CCG had implemented a range of initiatives to support staff wellbeing. This included committing to the implementation of an agile working model in the medium and long term to offer greater flexibility during and after the pandemic. With regard to other developments new ways of working that had been implemented to support the Covid response had now been embedded and were having an impact on reducing overall demand (e.g. A&G, Virtual appointments, Covid Virtual Ward).

 

COVID OXIMETRY @ HOME - (Virtual Ward and Pulse Oximetry)

 

Reference was to the Covid Virtual Ward and the Medical Director advised that the Tees Valley COVID Virtual Ward formed part of a national pilot to evaluate both patient and system benefits. The ward used digital technology to support home monitoring. Patients were monitored remotely by a clinical team who could then intervene at the earliest opportunity should a patient show clinical indications of decline requiring a hospital admission.

The Panel was advised that the way in which the COVID Virtual Ward worked was that through the use of a pulse oximeter whereby patients could monitor and report their oxygen levels at home. Evidence from the first wave had suggested that patients conveyed to hospital by ambulance with O2 saturations of 95-100% had a 30 day mortality of 6%. If the patient's O2 saturation was 93-94% the 30 day mortality increased to 13% and if this fell below 93% the 30 day mortality increased to 28%.The aim of the Virtual Ward was to focus on those patient most at risk to detect 'silent hypoxia' at an early stage when intervention would reduce mortality, hospital length of stay and could reduce the risk of 'long COVID'.  

 

Those patients identified as suitable by clinicians would be admitted to the Virtual Ward in line with the following criteria. The criteria was based on groups at highest risk from the virus:-

 

- Over 65 years old, COVID diagnosis, symptomatic

- Under 65 years old, symptomatic, clinically vulnerable.

 

It was explained that examples of populations who were classed as & ‘clinically vulnerable' included:

 

- Comorbidities (active cancer treatment, significant immunosuppression, diabetes/chronic

lung disease, liver disease, cardiovascular disease), including those as identified as extremely clinically vulnerable (shielded population)

- People with a learning disability

- BMI over 35

- BAME population

 

In terms of the number of patients currently referred to the COVID Virtual Ward it was advised that to date the total number stood at 283. Of those referrals 248 had been accepted and 222 had been discharged. As of 10 November 2020 there were 34 active patients on the ward with 10 due to be admitted. Feedback from patients and clinical staff had been extremely positive and approval had been given for the project to be rolled out nationally.

AGREED that regular communications be provided to Members in respect of the localised COVID-19 data and a further update be given at the panel's next meeting.