Agenda item

To present to the Health and Wellbeing Board details of the second wave of the pandemic and its impacts, an update from the work of partners during the pandemic, a vaccination programme update and a Brent Health Matters update.

This paper is made up of several reports with Appendices as detailed:

·         i. Epidemiology of Covid-19 in Brent (including one appendix)

·         ii. Partners Update

·         iii. Brent Covid-19 Outbreak Plan (including five appendices)

·         iv. Vaccination programme (including two appendices)

·         v: Brent health matters

reports published on 31 March 2021

COVID-19 Epidemiology

Dr John Licorish (Public Health Consultant, Brent Council) introduce the report outlining the epidemiology of the COVID-19 outbreak in detail. He highlighted that at the time of writing the report 835 people had passed away in Brent due to COVID-19 and that during the second wave of the pandemic there was a wider demographic across the Borough in terms of cases and deaths, including various ethnicities. The Board were advised that during the second wave the public health department were able to get better data with regard to ethnicity so had a better handle on the data of cases. In addition during the second wave there was access to more testing. Subsequent to the timing of the report Dr John Licorish suggested that numbers were plateauing.

The Chair thanked Dr John Licorish for the introduction and invited comments and questions from those present, with the following issues raised:

·         In relation to the ethnicity data in section 3.7, it was confirmed that this referred to mixed ethnic groups using the census summary.

·         It was noted that statistically in the report Brent was at the bottom of NWL for vaccination figures, but was no longer the highest in terms of rate per 100k in comparison to Harrow, Hounslow and Hillingdon which all had higher vaccination rates. Dr John Licorish advised that the report looked at the entirety of the pandemic. There was significant disproportionality and Brent had initially been affected, but as the pandemic had gone on there was a broader set of people being affected and Brent was no longer the top for death rate. Dr Melanie Smith (Director of Public Health, Brent Council) added that currently the purpose of vaccination was to reduce hospital admission and death and vaccinations were not yet being given to cohorts that would have a big impact on transmission, therefore she would not expect the overall infection rate to be affected by vaccination levels at this stage, but would expect infection rate in older age groups to reflect vaccination rates which it did.

·         The Board highlighted that the statistics within the report showed that the Caribbean community was lowest on vaccination uptake in the majority of data, despite various webinars being undertaken and community and faith leaders encouraging vaccination uptake, and queried what further work would be done to address the vaccination hesitancy within the Caribbean community. Dr Melanie Smith advised that there had been movement and while it was still differential that differential had reduced. The vaccination programme was being looked at through a more flexible and tailored approach now addressing not just beliefs but also practical barriers to people getting vaccinated. In addition, through library staff phone calls, something emerging as a finding for vaccination refusal was the influence of family and friends, so a lot of work had been done with trusted messengers and community leaders. Dr Melanie Smith suggested a focus could be on younger family members who may influence someone’s decision to receive the vaccination.  Dr John Licorish advised that the work done by enforcement and the community taking the vaccination to people had been admirable, as another issue was that the Borough was geographically challenged and getting around was difficult, meaning some residents were unable to travel to a vaccination hub.

·         In relation to the geographical data of places which had been more affected by COVID-19 and the fact those locations were often highlighted for other indicators of health inequalities, the Board queried whether the Brent maps were comparable to other similar London Authorities. Dr John Licorish advised that there were similar maps in different places in London reflecting particular diversity and showed Brent had specific issues which brought into context the importance of the Brent Health Matters work addressing health inequalities.

·         Members of the Board felt the difference between the Brent response of the two waves was noticeable and the work during the second wave had shown a positive improvement, particularly the work done on outreach and vaccination, street enforcement and communications with residents. Dr John Licorish agreed that he had seen an improvement in how the pandemic had been managed.

RESOLVED: to note the information provided in the paper.

COVID-19 Vaccination Programme

Dr Melanie Smith (Director for Public Health, Brent Council) introduced the report. The Board heard that the current priority was not just to get people vaccinated but also to improve vaccination equity across the Borough, and the vaccination programme aimed to do both by addressing the need to get large numbers vaccinated, twice, at speed, and also reflecting the need for a flexible and tailored approach, working with communities to understand barriers to vaccination. She told the Board that there were practical, geographical and digital barriers associated with vaccination and understandable concerns about the vaccinations given the disproportionate impact of COVID-19 and historic disproportion of inequalities in care. Brent was not doing as well as would be hoped and she advised that this was viewed as a system issue requiring the NHS, Council, third sector and communities to work together to address. Brent had set itself a high ambition, going higher than the NHS target of 92% uptake, and aiming for 92% uptake within each JCVI cohort by ethnicity and by deprivation. Dr MC Patel (CCG) endorsed the way forward in aiming for a 92% uptake within each JCVI cohort.

Simon Crawford (LNWUHT) advised that they were seeing low uptake amongst staff at Northwick Park Hospital, and had done a lot of work on the myths of the vaccine and used clinical staff as vaccination champions with had individuals who had already received the vaccination encouraging others, and whilst they had a captive audience with easy access to the vaccine and reliable information they were still not getting near 100% uptake with staff. He felt what was being done in the community was excellent and needed to continue, pushing messages, but wanted to recognise the difficulties and the fact some had very long held beliefs impacting their hesitancy.

The Chair thanked colleagues for the introduction and invited comments and questions from those present, with the following issues raised:

·         The Board acknowledged the point made about locality of vaccination centres and difficulty travelling to them, and queried what more could be done to bring the vaccine to individuals. Dr Melanie Smith advised that they had experienced people being more willing to take up the vaccination if it was nearer to them, which was the reason behind the pop-up vaccination hubs, and work was being done for a vaccination bus which was hoped would make a difference. Dr MC Patel advised that many of the larger vaccination centres were open until 8pm and opened on weekends, and over Ramadan some clinics were starting late and running later into the night. There were also 2 satellite pop-up sites in the South of the Borough that could run every day and store the vaccinations, and the travelling pop-ups, but the limiting factor was resource and vaccination supply. There was also a need to factor in staffing, admin support, vaccinators, and IT. Dr John Licorish agreed that by bringing services and pop-ups into the community in a space communities were comfortable with this broke down some of the barriers such as the geographical barriers and gave an element of trust, and was a lesson not just for vaccinations but also how other services were delivered within the community.

RESOLVED: To note the vaccination programme.

Brent Health Matters Programme

Tom Shakespeare (Director of Health and Social Care Integration, Brent Council) introduced the work of the Brent Health Matters programme, which focused on health inequalities and was built on the pilot conducted in Alperton and Church End. The focus of the pilot was for community leaders and champions to lead on the development of hyperlocal action plans to address individual health inequalities in those 2 areas, and since the pilot work was being done to expand that work. He highlighted the following key points in relation to the report:

·         The establishment of a clinical service and team across mental health and wellbeing, which had been doing targeted work calling residents and had a dedicated phone line. That service was currently being reviewed and would focus on long term conditions, ensuring the service was having an impact Borough-wide as the programme expanded.

·         The grants programme had begun, with 12 bids received from community organisations thus far. He felt that there were some really innovative and interesting ideas coming out of it.

·         Organisations had been appointed to lead in the recruitment of health educators within the community and 20-30 of those would be community co-ordinators working to each of the 5 Brent Connects areas. A number of outreach days had taken place with community champions in Alperton and Church End and those outreach days would be taken forward as the programme went Borough wide. A large amount of communications material had been developed with the community champions including in different languages.

·         The team had been purposeful in making clear the message that the work of the Brent Health Matters programme was not just about vaccination, which there would be a big focus on, but also about long term conditions and wider determinants of health with a long term approach.

The Chair thanked Tom Shakespeare for the introduction and invited comments and questions from those present, with the following issues raised:

·         The Board queried whether it was possible to go door to door to encourage people to take up the vaccination and regular testing, similar to the work done during electoral registration and census drives. Dr MC Patel (CCG) advised that through regular meetings with PCN leads and GPs in practice forums he had been informed that many GPs and their practice staff had been to patients residences, knocking doors and asking if they would have the vaccination and their reasoning behind their decisions. The health inequalities team had also been phoning people. He agreed that it was something that should be done over and over again but the difficulty was visiting door to door unannounced from a health perspective could result in residents becoming resentful, and there had been some instances of GPs being threatened with being reported regarding the number of attempts made trying to get patients vaccinated. He advised that it was a difficult task and there were complexities with that approach. He assured the Board that a lot of practices, particularly in the South of the Borough where uptake was lower, had been calling on patients and even offering to vaccinate patients in their own homes.

·         Going forward, CLCH would host the Brent Health Matters Clinical Team. Due to the vaccination figures in Brent, it had also been agreed that some of the health inequalities clinical team would devote time over the weeks following the meeting solely on covid vaccinations and those who had declined to try to help practices improve figures.

RESOLVED: To note the refocus and the key work streams and endorse the whole system approach.

COVID-19 Outbreak Control Plan

Dr Melanie Smith (Director of Public Health, Brent Council) introduced the report, explaining that the initial covid outbreak control and management plan was agreed last June and as things had moved on considerably there was a requirement for all local authorities to revise and resubmit their plan which Brent had done. Presented to the Board was the draft plan. Feedback on the plan had now been received from Public Health England, who found the plan to be generally sound. One area she was asked to strengthen in the plan was around support for self-isolation. The plan had gone through a peer assessment process with Public Health England, DHSC, JBC and other Boroughs in NWL., Following that, she was able to assure the Board that the need for strengthening support for self-isolation was about better articulation of what Brent was already doing rather than a need for additional action.  Brent’s offer to those self-isolating was equivalent to that which had been made to those shielding and included payments for those who met nationally determined eligibility criteria. Brent was due to offer increased support for self-isolation in the form of an offer of accommodation for those who would find it difficult to self-isolate within HMOs or multi-generational households and that offer would go live soon. The experience from other Boroughs was that there was not a lot of uptake on the offer of alternative accommodation but it was a useful addition to the response to Covid.

The Chair thanked Dr Melanie Smith for her introduction and invited comments and questions from those present, with the following issues raised:

·         The Board queried whether there was any evidence that those who might have had or believed they had covid were declining the vaccination as they thought they had immunity already. Dr Melanie Smith agreed that this was something coming up in the calls the library staff were making. Those so reasoning were a small  number and this was not the main reason for vaccination refusal, with pressure from family and friends being more significant, but she suspected that as the vaccination cohort age range reduced that this reason would become more prevalent and agreed to work on messaging around that. She advised that the library staff worked to a structured recording of a conversation and people were prompted if they did not address various reasons.

·         The Board noted that the financial implications section of the report highlighted that Brent was underfunded, and queried whether that was impactful. Dr Melanie Smith advised that specifically with the outbreak control and management plan the basis of funding was initially quite arbitrary. However, she did not feel funding was inhibiting the response specifically within the outbreak control plan, but that was not to say that Brent should not have greater funding to address health inequalities.

RESOLVED: To note the plan.

The Chair thanked those who had contributed to the discussion and acknowledged the wealth of work ongoing across the whole system to tackle the pandemic and keep Brent residents safe, extending thanks to everyone.