Agenda and minutes

Health and Wellbeing Board - Thursday 2 July 2020 5.00 pm

Venue: Microsoft Teams

Contact: Adrian Bentley, Democratic Services Officer  Tel: 020 7926 7162 Email: abentley@lambeth.gov.uk

Items
No. Item

1.

Introductions

    Minutes:

    Councillor Dickson welcomed those attending the first Health and Wellbeing Board. This was the first meeting since the Covid-19 pandemic had affected the UK and was taking place virtually whilst being live streamed. A recording of the meeting would also be available online.

     

    The Chair expressed the thanks of the Board to key workers who by their dedicated efforts had ensured that the community was able to get through the first period of Covid-19.

     

2.

Public Notice Questions

    Minutes:

    Two Public notice questions had been received.  The first question was from Nicola Kinston, which read:

     

    “Local people, patient groups, the voluntary and community sector, faith communities, Mutual Aid groups and others have all contributed to support the statutory response to Covid-19. We welcome the statement by the Leader of the Council that local people will be involved in the Recovery Plan.

     

    People who went to the Clinical Commissioning Group (CCG) meetings in February and March, before the pandemic, about what engagement should look like going forward, were left feeling unsure what public involvement there would be in the future.

     

    Can we ask for:

    ·         A community meeting where the public can talk, to discuss this?

    ·         Local Primary Care Networks to engage with their patient groups to discuss their local response?”

     

    The Chair answered the first part of the question saying that the Board was still formulating how community involvement in the Recovery Plan would work, but there would be significant community involvement. The Chair suggested further discussion with Nicola and others as to how engagement could best take place such as through a community meeting.

     

    Andrew Eyres, Strategic Director, Integrated Health and Care, said he had spoken to the lead on the recovery plan for the Primary Care Networks (PCN) and they were keen to engage with Patient Participation Groups (PPGs). They were currently undertaking a survey with all patients across Lambeth and had over 5,500 responses, with consolidated feedback to be taken back through patient groups etc. How this would take place was still to be decided and the Clinical Cabinet would discuss it further. This information would be built into recovery planning.

     

    Nicola thanked the Board for the responses and noted that the Primary Care Network were having discussions, especially around the equalities impact.

     

    The Chair asked that the second question from Fraser Symes be displayed, which read:

    ·      “What confidence, in percentage terms, does the Lambeth Health & Wellbeing Board have in the Government’s/NHS’ Track & Trace system and what is this level of confidence based upon?

    ·      Does Lambeth fully understand the correlation between diabetes and obesity with Covid-19 other than the general association with inflammation and diminished lung capacity making the flow of oxygen more difficult to the lungs, which the Coronavirus also attacks?”

     

    The Chair noted that Mr Symes had sent in eight questions. Whilst written responses would be provided for all of these it was not possible, due to time constraints, to provide verbal answers to all of these. Many of the questions would also be dealt with in presentations.

     

    Ruth Hutt, Director of Public Health, answered the first question stating that Test and Trace had been live for over a month. Anyone who had given a positive coronavirus test would be contacted by the service and asked to provide information of who they had been in contact with so those people could be asked to self-isolate. The Director of Public Health received a daily report saying how many positive results there had been. Certain high-risk places  ...  view the full minutes text for item 2.

3.

Declarations of Interest

    • View the background to item 3.

    Under section 4 of the governance arrangements for the Health & Wellbeing Board, Board members are bound by the Members’ Code of Conduct as set out in the Council’s Constitution (Part 4 Section 1).  Where any Board member has a Disclosable Pecuniary Interest in any matter to be considered at a Board meeting they must withdraw from the meeting room during the whole of the consideration of that matter and must not participate in any vote on that matter unless a dispensation has been obtained from the Monitoring Officer.

     

    Minutes:

    There were none.

4.

Minutes of Previous Meeting pdf icon PDF 158 KB

    • View the background to item 4.

    To approve the minutes of the previous meeting.

     

    Minutes:

    RESOLVED:

     

    That the minutes of the previous meeting held on 13 February 2020 be approved and signed by the Chair as a correct record of the proceedings.

     

5.

COVID 19 - Epidemiology pdf icon PDF 1 MB

    Minutes:

    Ruth Hutt, Director of Public Health, introduced this item and Carla Hobart, Public Health Specialist Trainee, presented noting:

    • Epidemiology was the study of the distribution and determinants of health-related events, such as for disease;
    • Public Health was the science and art of preventing disease, prolonging life, and promoting health through the organised efforts of society;
    • Covid-19 had spread from a local outbreak and at the time of the meeting had led to 10m cases globally;
    • Covid-19 had a highly variable clinical course;
    • There was an unknown proportion of asymptomatic infections.  
    • People without symptoms were capable of infecting others although symptomatic people were the highest risk;
    • Lambeth had 1,222 cases to date – although this reflected only those that had been tested;
    • The number of daily cases had dropped significantly;
    • The majority of deaths from the disease happened in hospital;
    • The disease did not affect the community evenly; with high risk factors being, age, ethnicity, underlying health conditions and deprivation;
    • Evidence around ethnicity and Covid-19 was still being developed. Ethnicity had not been previously recorded on death certificates and so place of birth had had to be used;
    • Care home residents made up a significant proportion of Lambeth deaths with 2.3 times the number of deaths that would usually be expected;
    • Factors that may contribute to the unequal impact of Covid-19 on Black Asian and Minority Ethnic (BAME) groups included those highlighted in a recent PHE report such as: historic racism and poorer experiences of healthcare, or at work, occupation, housing conditions, use of public transport and long-term conditions/co-morbidities; and,
    • Control measures included, social distancing, hand washing, face covering, testing and self-isolation of those with symptoms.

     

    Following questions from the Board officers responded:

    • The true numbers of those with Covid-19 was difficult to know and the only way to measure the under-ascertainment was through prevalence survey. This was happening but the numbers were constantly changing making an accurate assessment difficult;
    • Local deaths assessments had been based on crude mortality. Age adjusted mortality would be looked at; and,
    • Death certificates did include underlying conditions and this data was being analysed. The office for National Statistics (ONS) had done this analysis nationally.

     

    RESOLVED:

    1.        The Board agreed to the ongoing collection and analysis of local data in relation to disparities in Covid-19 risk and outcomes, in order to inform actions to address inequalities locally.

    2.        The Board agreed to the development of a local surveillance dataset to provide up to date information on Covid-19 cases, admissions, deaths and local outbreaks to inform local outbreak control.

     

6.

COVID 19 -Perspectives from the community

    Minutes:

    The Chair said that the Board was keen to hear the perspectives of the impacts of Covid-19 from the community and ten individuals and organisations had been invited to speak.

     

    Maggie Owolade, Director of ARCS presented. ARCS had been one of the first small groups to do Covid-19 surveys for some of families. Issues raised were:

    • Difficulties in managing children’s behaviour;
    • Disrupted sleep routines;
    • Children refusing to go out;
    • Lack of structure at home causing anxiety; and,
    • Lack of safe spaces for exercise.

     

    Families with children with Special education needs, and particularly neurological conditions such as ADHD and autism, reported:

    • Fear of bringing germs into the house;
    • Impact of children’s challenging behaviour; and,
    • Reduction in school-based anxieties. This though would likely lead to problems when children return to school.

     

    bout 30% of respondents were on free school meals and 54% of respondents were lone parents. 

    The report on the survey recommended that Test and Trace be localised as families had problems getting out. Covid-19 information needed to be in different languages and include infographics and there needed to be a recognition of children’s general anxieties.

     

    Andrew Preston, Chief Executive of Rathbone, presented and noted that:

    • Rathbone had been based in Lambeth for 55 years and worked with those with learning disabilities and autism. Rathbone looked after 100 adults and provided statutory services to them, funded by Lambeth Council. A further 30-40 adults used the informal non-statutory groups. The Society also worked with 200 young people between the ages of 11-19 with special needs;
    • Covid-19 had hit the organisation hard and a third of the staff were originally lost through shielding or self-isolating but had to date reduced to 15% of colleagues;
    • There were health inequalities with the cohort and a high rate of co-morbidity issues;
    • There was anxiety with young people about school;
    • There had been incidents of young people, especially young men, not wanting to comply with lock down arrangements. Youth workers had been sent out to disperse these groups;
    • There had been greater coordination across voluntary sector on food poverty; and,
    • Technology would be important but there would be a need to bear in mind that people with learning difficulties often struggled with this.

     

    Andrew thanked colleagues at the Council for their support over the Covid-19 period.

     

    Candace James, manager of the Loughborough Community Centre, which was based at the Max Roach Centre, highlighted:

    • The Max Roach Centre was run as a local charity by local residents and parents;
    • Before lockdown preschool holiday engagement activities for children 0-18 years of age were run;
    • The response to Covid-19 was Happy Lunch and Play, providing 6,445 lunches to 140 children, reaching to 70 families in the previous four months;
    • Participants stated that food poverty was a big issue. 73% of parents said they had less money, 55% said they had less food due to lack of shop supply, 39% had no way to getting to shops or food banks, 41% couldn’t get food to meet dietary needs, an.  ...  view the full minutes text for item 6.

7.

King's Health Partners: Response to COVID-19 pdf icon PDF 356 KB

    Additional documents:

    Minutes:

    Jill Lockett, Managing Director, King’s Health Partners, presented. She was joined by Irem Patel,Joint Director of Clinical Strategy and respiratory physician, and Joseph Casey,Deputy Director, Programme Delivery.

    • The role of King’s Health Partners was to deliver better health for all through high impact innovation;
    • There had been a significant response across partners and each of them had taken a role in the response to Covid-19;
    • There had been great work in high level of specialism in respiratory, with a huge response from the Respiratory Network and Extracorporeal Membrane Oxygenation (ECMO) units;
    • The had been an immense response from King’s College Hospital (KCH) around testing and from King’s College London looking at mass testing and using university laboratories to scale up that offer;
    • There has been a large amount of work on research. CogStack had been deployed to provide rapid insights, such as impact of ethnicity on outcome and oxygen consumption;
    • 3,200 patients had been treated at King’s Health Partners as at 31 May, of which over 500 were admitted to intensive care. Post-Covid-19 clinics were in place to support patients in recovery. 3,300 Guy’s and St Thomas’ Trust (GSTT) and KCH patients had been recruited to “Chief Medical Officer Priority” clinical trials;
    • Ipad style devices had been distributed to 150 Intensive Care Units (ICUs) across England to ensure virtual visiting for the most unwell patients;
    • Lots of work had been done looking at the mechanisms of the disease. A Covid-19 symptom study had been recorded into an App. There had been a great response across the community and there was a desire to extend this across the six boroughs;
    • BAME communities were presenting at a much younger age than white communities; and,
    • The last months had been unprecedented. Colleagues had been redeployed. Post-Covid-19 clinics had been set up to give early follow up and see if patents had developed lung disease as a result of Covid-19 and carry out assessments of their breathlessness, mental health and recovery. Three out of every four patient showed good recovery.

     

    Clive Kay, CEO of KCH, noted that:

    • King’s first Covid-19 patient had been seen on 4March 2020. Command and control was put in place and the critical care service was extended across the entire trust;
    • The virus hit south east London hard and early, and there was an incredible response from all providers across south east London;
    • Non-Covid-19 wards were converted to treat only Covid-19 patents. An early decision was taken to stop all routine and elective activity. There had been good collaboration;
    • There was not a need to transfer any patents from south east London;
    • Staff had been redeployed across the organisation and 2,000 staff had been upskilled. At peak there were 550 inpatients. The Trust had seen 444 though critical care, 2,400 had been discharged and there had been just over 500 deaths; and,
    • Some of the changes that had been made over this time had been planned for years and there was a desire that these improvements  ...  view the full minutes text for item 7.

8.

Lambeth Outbreak Control Plan pdf icon PDF 520 KB

    Additional documents:

    Minutes:

    Ruth Hutt, Director of Public Health, presented the Outbreak Control Plan, noting that:

    • Every authority had been to develop an outbreak control plan;
    • The Plan provided a strategic framework to stop Covid-19 transmission in Lambeth, helping a return to safe communities and social life, and restarting the economy;
    • Measures would be established to prevent transmission and protect vulnerable residents by: risk assessment, easy access to testing, timely and effective identification, and notification of contacts. Support would be given to cases and contacts;
    • The outbreaks would be managed in the community while identifying and mitigating the negative impacts of control measures;
    • Local surveillance and intelligence would be established with timely and effective monitoring built on local intelligence;
    • There was a need to do all of this work in partnership with Lambeth residents;
    • Testing at scale would be required. Community confidence in testing would be vital for an effective response;
    • Adequate support for those that were most vulnerable was needed;
    • The Lambeth Gold Health Protection Board would feed into the Health and Wellbeing Board. The Health and Wellbeing Board would have the public facing role and would engage with residents; and,
    • Next steps would be the publication of the Outbreak Control Plan and ensuring engagement with the community to ensure that they knew to inform if they had symptoms.

     

    The Board expressed their thanks to the Public Health team for their exceptional work over the previous weeks.

     

    RESOLVED:

    The Board:

    1.         Agreed the approach to the outbreak control plan.

    Agreed the Health and Wellbeing Board acting as the Member led board in accordance with the guidance from DHSC.

9.

Lambeth Children's Partnership update pdf icon PDF 315 KB

    Minutes:

    RESOLVED:

    The Board noted the paper.