Agenda item

The Committee received a report of the Director of Public Health, Durham County Council that provided members with on update on the public health planning, response and current recovery position in relation to the COVID-19 pandemic.

The Director of Public Health updated the committee on the key challenges and the opportunities across public health during the COVID-19 pandemic following a

verbal update at the Adults, Wellbeing and Health Overview and Scrutiny Committee meeting on 5 March 2020.   She recognised that although there had been outbreaks of Ebola and flu there had never been anything as severe as the current Covid 19 pandemic.  She was happy to provide updates at future meetings to ensure members were kept up to date.  She outlined the timeline from when the virus was realised in China in December 2019 to the World Health Organisation proclaiming the virus to be a pandemic to the eventual lifting of restrictions in July along with the responses to each stage on a regional, national and local level.  She referred members to paragraph 25 of the report that outlined the statistics on a global level.

The Research and Public Health Intelligence Manager addressed the committee that there were weekly statistical updates on the members dashboard.  He highlighted the number of positive cases, additional cases and the number of deaths in the UK. He added that the numbers did not reflect a surge in cases but more accurate reporting.  He noted that statistics for Durham were higher than in England and in the North East with a peak in confirmed deaths in week 15 and a reduction by week 25 with Durham being the 9^th highest care home related deaths nationally.

The Director of Public Health stressed that there had been a strong input of data into the public health team from a North East level which had ensured advice was given across the Council and partners alike.  There had been a proactive response that focused on mental health and supporting the wellbeing of staff with people shielding or self-isolating.  Support had continued with drug and alcohol clients, no smoking projects and sexual health clinics with meetings being held virtually online and additional support linked into the suicide and prevention team.  She did note that the government had stopped testing in March but had reintroduced it as part of the recovery stage to live with Covid 19 to ensure that all key people were involved with the local outbreak management plan and the government test and trace scheme.

The Committee wished to thank and commend all staff within the council and health services who had done sterling work in responding to the Covid 19 pandemic to save lives and protect the community.  The Chair extended gratitude to all emergency service workers including fire, police and ambulance workers and praised all schools that had remained open to allow key workers to work.  He also applauded organisations like the post office delivery people who provided support to keep communities going.

Councillor Bell endorsed the report and wished to express his appreciation to all staff in particular those in the Public Health Team who had worked tirelessly in the current situation.  He wanted to know from a regional response if the test and trace pilot fed results into the local management outbreak plans.

The Director of Public Health responded that Newcastle and Middlesbrough had been picked as part of the government’s track and trace pilot.  She confirmed that information from the pilot was shared locally to inform management outbreak plans that were in place especially around vulnerable groups.  She noted that Leeds City Council Chief Executive Tom Riordan had been asked by the government to take a key role in its contact tracing programme across the country that would ensure arrangements were in place for linking contact tracing work at a local level.

Councillor Bell thought this sounded good but questioned where the data went and whether it did inform the outbreak management plans.

The Director of Public Health stressed that access to information was forthcoming on all positive cases in the NHS and through pillar two sources.  She also stated that data was being acquired on postcodes to allow those who had tested positive to be matched up with local areas. 

She explained that she was reliant on members of the Adults, Wellbeing and Health Overview and Scrutiny Committee, Businesses and Schools to raise any concerns with the Public Health Team who would in turn report findings to Public Health England for the protection of the wider community. She advised that data available to the Public Health Team about local communities was analysed daily and used to prevent local lockdowns like in the case of Leicester.

Councillor Temple thanked the Director of Public Health for her profound report and referred members to paragraph 44 and 82 in the report and asked how reliable the developed PPE sources were and if there was another emergency immerge would there be enough supplies.  He was aware that half the supply was sent to the local community and wondered if schools were included in the distribution of the other half.  He recognised that there was a need to test residents and staff in care homes but queried if testing would move into other service areas like schools as children could be a natural source of transmission of the virus due to the environment in doors.

The Director of Public Health firstly responded to Councillor Temple’s query regarding PPE that there had been a co-ordinated approach that linked to the Local Resilience Forum that had been created to consider the pandemic.  She advised that work had been carried out with the NHS to ensure care homes and NHS staff had sufficient PPE along with schools who had also been supplied with PPE.

The Corporate Director of Adult and Health Services advised that the supply of PPE would be maintained and care homes, schools and Council staff had all been supplied with PPE.  She added that excess stock would go forward if required should a potential second peak of the virus arise.

The Director of Public Health secondly responded to Councillor Temple regarding testing that pillar one were tested within the capacity of the NHS that included NHS staff and council staff on a local level.  The testing was extended to include residents and staff within care homes in May 2020 as part of the national testing programme on a systematic basis. She noted that as part of the national testing programme mobile testing sites had been established and located in places like IKEA, Gateshead and rolled out to establish a base in Teesside for pillar two testing.  She indicated that results were not as quick with pillar two testing as labs were located in places like Milton Keynes and this data needed to also look at asymptomatic testing.  She advised that there was a precaution with testing in schools as they were more widespread and contact tracing only tested if someone displayed symptoms.  The regional testing group looked at the overall strategy on testing.

The Chief Executive (CDDFT) emphasised the point that testing was very quickly put in place with facilities to test locally.  The testing programme had been proactive to support the wider system with care homes and council staff and there were drive through facilities in Durham and Darlington that were safe and convenient for people to get tested. She noted that with pillar two testing people had to travel along way which put people off going. She advised that the programme had tried to keep up local testing and put in place more to increase the capacity from hospital sites.

Councillor Tucker referred members to paragraph 98 in the report that identified seven themes to be addressed in the local outbreak plans and wondered how data integration and testing was incorporated.  She asked if a person’s medical record linked up with testing as she was aware of a multi-agency project working on a one patient one record scheme across the health service and wondered how effective this was with Covid 19 testing.

The Director of Public Health advised that Covid 19 infection was a notifiable disease and a GP would be required to report it to the local Public Health Team.  She explained that the Biosecurity Centre used a difference system to collect data on Covid 19 testing.  She felt that locally information needed to flow into the GP system and the 111 service that dealt with cases with Public Health England and the Public Health Team reporting individual or cluster of cases.  She added that information from the test and tracing service was complex and was not tied to an employer or setting. Improvements were required so there was a better idea of where cases of the outbreak were. 

The Research and Public Health Intelligence Manager believed that there needed to be a granular level of data produced that included postcodes to trace cases and identify local areas where there were high levels of infection.  He clarified that work was ongoing with the GIS mapping system to create a layer on the map to identify areas of outbreaks to inform businesses and care homes of any potential risks. He notified the committee that the first version had been trialled.

Councillor Tucker understood the Covid 19 element but probed to ascertain what was happening with the one person one record project.  She requested information on whether a person’s medical history on their records would be considered when offering a treatment plan if they tested positive for Covid 19.

The Director of Public Health was unable to answer but if a treatment pathway was offered then a patient would be looked at as a whole and supported positively.

The Chief Executive (CDDFT) advised that to a degree medical records for a patient were linked.  She was aware of the project that Councillor Tucker referred to, namely the ‘great north care record’ that aimed to link all health services together.  She informed the committee that with some Covid 19 patients they would have a long recovery back to health and within that period would be connected to different services like rehabilitation.  She added that this would be seamless due to effective communication across services that were involved with the patient.

The Head of Integrated Strategic emphasised that when a Covid 19 patient was discharged from hospital they would be dealt with by the team around the patient (TAP) that was a multi-disciplinary team that included community nurses, GP’s, social care, mental health services to ensure that all their health needs were met while they fully recovered.

Councillor Smith followed on from Councillor Temple’s comments regarding testing in schools and believed that it would be too widespread to carry out.  She felt that the testing process that included taking nose and throat swabs was too invasive for children and that they should not be exposed to this form of testing unless it was absolutely necessary or a less invasive test was produced.

The Chair agreed that the local outbreak management plan was the way forward for the future and understood that it would need monitoring.  He referred members to paragraph 99 in the report and queried why the Health and Wellbeing Board would be used as an engagement board as he felt that local members should be involved with communicating things to the public.  He was concerned regarding the lock down of Leicester and wondered if there would be moves towards localised lockdowns if the rate of infections did not decrease.

The Director of Public Health maintained that the Health and Wellbeing Board was only put forward as an engagement board as it already had well-established reporting networks.  She added that the Health Protection Assurance Group (HPAG) reported to the Health and Wellbeing Board so it had made sense for the board to oversee the engagement with the public as it fit into the existing arrangements for the statutory obligation. She informed the committee that the HPAG was a small group that had carried out work with care homes and workplaces throughout the pandemic to support communities and raise awareness of prevention measures.  She noted that if there were high risks of an outbreak in an area the HPAG would develop local arrangements.  She advised that at present there were no legal powers to carry out localised lockdowns and local members would always be kept up to date as a voice of the local community in prevention work.

The Chair understood the challenges of Covid 19 especially when things changed so quickly making it extremely difficult to manage.

Councillor Wilkes was concerned with the working practises of some factories in the Durham area that appeared not to have adhered to Covid 19 rules during lockdown forcing staff to work.  He felt whistle blowers were being relied upon to inform him of the situation and questioned how much control there was with Health and Safety Executives to check if these factories were high risk.

The Director of Public Health advised that work was ongoing with Business Durham, Local Education Authorities and other partners about prevention measures, promoting hand hygiene and raising awareness of local intelligence to highlight any concerns.  

Resolved

That the report be noted.