Agenda item

The Board considered the report of the Director of Public Health, that provided an updated COVID-19 Local Outbreak Control Plan.

 

The Director of Public Health was in attendance to present the report and deliver a detailed presentation that highlighted the following:

 

·       Local Data – County Durham Case Summary

·       Update on the work of the Health Protection Assurance Board

·       Outbreaks

·       County Durham Together Community Hub

·       Key Communication Activity

·       Mental Health Update

·       COVID-19 Champions Programme

 

The Director of Public Health advised Members that of the County Durham COVID rate position as of 9 November 2020.

 

Durham University had also now moved from managing outbreaks to planning for the students returning home at Christmas.

 

The mass rapid community testing that was announced yesterday by government across the North East was being looked at in relation to the vulnerable population but also potential of rapid community testing and the use of the lateral flow tests to support people and Durham University were utilising this with their students.

 

The key focus of work going forward from the Health Protection Assurance Board was the piece of work around taking communities with us, test and trace remained a priority, the implementation of the rapid community testing was important locally, the ongoing protection of the vulnerable and the implementation of the vaccine programme.

 

The Chair indicated that information did change quickly so some of the information was correct at the time of writing but may now be out of date.

 

A number of questions had been submitted by members of the public and answered as follow:

 

Question 1:

 

How had our local schools responded to any Covid-19 outbreaks and what additional support was being given to our vulnerable young people to give them the best possible chances for their future?

 

The Corporate Director of Children and Young People’s Services indicated that schools were one of the key groups in terms of targets for outbreak management.

 

The County’s schools have had a whole range of challenges since the COVID outbreak, through the initial lockdown period and since reopening in September.

 

He wanted to thank everyone who had been involved across schools, staff, leadership in schools who had done an amazing job over that period of time to ensure that children and young people have had some of those risks mitigated for them and they had really stepped up and had been well supported through Public Health and Local Authority Education Officers and the support services that the council had in place.

 

Schools had continued to do an excellent job and had showed a massive amount of resilience through some really challenging times to ensure they were able to provide schooling in a secure environment for children. They also had remained open during the spring and summer for the most vulnerable children and those of key workers.

 

There was a whole range of work done to provide secure environments that involved risk assessments and taking a lot of the national guidance often at extremely short notice and translating that into what it meant on a school by school basis. All of our schools were different in terms of physical infrastructure, their size, the pupils they support, so it was really important that they took that individualised approach to risk assessment whilst maintaining learning and utilising best practice.

 

Information based on the first half term of this academic year from the beginning of September through until the end of October showed that whilst they did have a number of positive cases in schools as a proportion of the population it was really low. For that 8 week period it was 0.3% of school age population who tested positive, 250 cases out of 77,500 pupils.

 

Every time a case was identified, schools had robust decision making and had worked with public health colleagues and school education service links to understand the risks associated with the case and to ensure that the appropriate scale and proportionate response to the case had been taken to minimise any disruption on education and that had continued to work extremely well.

 

Schools had also provided a range of support materials for pupils who had been self-isolating that included things like vouchers and food parcels for those families who were eligible for free school meals, ensuring that as much access to remote learning could be put in place to mitigate the impact. They had continued to update the risk assessments as new guidance had emerged.

 

In terms of the support specifically around vulnerable young people, a range of additional services had been put into place, specific education resources were developed for children with special educational needs and disabilities and children looked after. That provision had some targeted support and signposting to services who could provide emotional and health and wellbeing support.

 

Many services through this period had also adapted the way they delivered services so that they were able to target support to those children and families who needed it.

 

Home Learning facilities had provided access to equipment for those who required it, particularly vulnerable children. They had 1500 devices for children who had been identified across the County and in addition to that schools had also been able to access remote learning facilities and IT equipment, although there had been some challenges in more recent times about some of the access to the equipment they had been promised nationally and had been picking that up with the Department of Education to make sure some of the delays in providing that equipment could be expedited.

 

The Council had also put into place financial support for families including things like the back to school fund for targeted support for those families that required additional support.

 

They had also looked at key transition points in particularly transition from year 11 students into Post 16 provision and transition from primary through into secondary school. The educational psychology team had developed a range of resources to support that transition, targeting vulnerable groups of children to make sure that they had the support that was required.

 

There had been a whole range of activity that had been put into place, they recognised that they hadn’t been able to mitigate all the impact and completely understood that it would continue to be a challenge over the remainder of this academic year but schools and the support services that had worked around them had absolutely gone over and beyond what could have been expected in terms of how they supported children and young people to mitigate some of that risk.

 

Question 2:

 

Covid-19 is widening the health inequalities gap in County Durham between the least and most deprived areas. What are partners doing to support those areas in greatest need?

 

The Director of Public Health responded that the North East already had real gaps in terms of health inequalities and that was reflected in County Durham, that was one of the key priorities in the Joint Health and Wellbeing Strategy.

 

The pandemic had exacerbated some of those health inequalities and they had been very proactive as a partnership and carried out as part of the initial recovery programme a quite detailed health impact assessment which highlighted some key areas of focus including mental health.

 

The impact of poverty for example the poverty action steering group would be really focusing on those recommendations from the health impact assessment so that they could try and mitigate the increased risks of poverty and child poverty.

 

Services such as drug and alcohol had moved to online assessments and they increased levels of funding into domestic abuse services. We have also co-ordinated with children and young people services to ensure that vulnerable children and young people affected by domestic abuse could still access support.

 

Partners within the NHS would be looking at the impact of programmes of elective surgery and screening. A northeast conference had focused on health inequalities and how the underpinning inequalities were exacerbated in a pandemic situation and ensuring that they focused their attention on those who were most at risk from the virus but also the impact of the virus and was a key part of their work going forward and would take that work into the review of the Joint Health and Wellbeing Strategy next year.

 

They would really focus on those inequalities and wider social inequalities going forward.

 

Question 3:

 

There’s a lot of confusing information about test, track and trace and requirements when needing to isolate if in contact with someone who tests positive. What can be done to provide clarity for County Durham residents regarding when to specifically isolate and for how long?

 

The Director of Public Health responded that there was a lot of confusing information about test and trace and isolate and that it was important to be clear for individuals to follow.

 

They were still advising people if they had symptoms, a high temperature, new continuous cough or loss of sense of smell or taste then the immediate thing to do was to self-isolate and to book a test and all of the members of your household must also self-isolate. If that test came back negative, household and yourself could stop isolating, if it was positive you needed to self-isolate for 10 days from the onset of your symptoms and your household needed to self-isolate for 14 days.

 

If you have been contacted by NHS Test and Trace and identified as a close contact you must self-isolate on the dates provided by NHS Test and Trace.

 

Only get tested if you have Covid-19 symptoms.

 

This information was on social media, the council’s website and was available nationally. What they hoped was community champions would be able to relay that information to people locally and because again they recognised that sometimes it changed and gets updated, but that they could be conduits into local communities. The information was also held on County Durham Together in the community hub and they answered queries for local residents.

 

Question 4:

 

How is the local NHS system coping with the increase in Covid-19 cases and additional hospitalisations?

 

The Chief Executive of County Durham and Darlington NHS Foundations Trust indicated that she had already covered some aspects of this in her earlier paper.

 

The NHS and care systems were working really well together in an integrated way to support patients and residents and each other with the additional demands that the pandemic placed on the system.

 

People attending for emergency and urgent care had put greater pressure on the system as she referred to earlier, however all services were stood back up and generally they were able to undertake what they had committed to in terms of the elective programme.

 

Clearly the issues that COVID had brought affected all NHS systems in a similar way. The NHS were encouraging people to #doyourbit and use services appropriately and think of accessing pharmacy, GP or 111 first, as she described when presenting the winter planning paper.

 

Many measures were put into place to safeguard patients in their care at this point that ranged from adaptations they had made to the hospital environment which was largely segregated into COVID and NON-COVID specific areas, the protection of the elective surgery and using technology to help maintain the outpatient programme by having some of that delivered virtually.

 

They also reviewed anybody on any of the waiting lists for non-urgent operations to ensure that their condition wasn’t deteriorating and if that did happen, that their priority was reassessed.

 

The good community estates were fully utilised so they had additional capacity at Bishop Auckland, Chester-le-Street and Shotley Bridge, and all community hospitals were playing their part in dealing with the increased pressure that COVID brought in wave one.

 

Question 5:

 

How are those people who previously shielded and who were classed as Clinically Extremely Vulnerable, being supported?

 

F Jassat, County Durham Clinical Commissioning Group indicated that they were focusing on communities helping each other in the first instance and they saw this huge neighbourly effort in wave one and that was continuing in wave two.

 

They also knew the significant impact voluntary, community and faith sector provided within local communities helping with food, loneliness, and money worries. Today’s meeting had reflected on a lot of these issues.

 

The Area Action Partnership’s had injected significant amounts of money into local communities to enable communities to respond during the pandemic and meet the needs of the most vulnerable.

 

Those who were categorised as clinically extremely vulnerable would be patients within the NHS and they continued to strongly advise they remained in contact with their clinicians and maintain all appointments.

 

The Social Prescribing Link Workers, who were aligned to general practice currently had an active list which included those identified as clinically vulnerable. Practices also contact patients regarding their welfare and continued to undertake home visits where appropriate.

 

They had written out to all clinically extremely vulnerable locally and had advised how and where to seek help. The County Durham Together Community Hub was the local place to phone or email if people were unsure of what support was out there and they could work with people to find the right solution for them be it essential supplies, practical support, low level mental health worries, loneliness or money worries.

 

The County Durham Together hub was in contact with all the right agencies to signpost and guide people towards the most appropriate support.