Agenda item

To receive an update from the Director of Public Health in relation to UK immunisation and vaccination programmes.

Dr Melanie Smith (Director of Public Health, Brent Council) first updated the Board in relation to Covid-19, as at the time of the meeting. She advised that the rates of Covid-19 infection were increasing locally, across London, and nationally, although it was becoming more difficult to interpret the rates as measured by testing as it became less accepted and people prepared for testing to be unavailable from the following month. The Public Health Team had been paying attention to the ONS survey figures, which were reliable but only gave London figures rather than Brent figures. Both the testing figures and ONS figures showed approximately 4.4% of the population in London had Covid-19 at the time of the meeting which the Board were advised was very high, with increases across all age groups. Locally, the NHS was not being significantly impacted, because the vaccination had broken the link between infection and severe disease. Dr Melanie Smith advised that Public Health experts would have predicted this increase as society opened up and people began to mix. It was critical to monitor the impact on hospitalisation in terms of how sick people were from Covid-19 in hospital.

James Walters (Deputy Chief Operating Officer, London North West University Healthcare NHS Trust) explained that in LWNUHT the number of Covid-19 inpatients had increased, but the number of incidental findings was around 40%. These were patients whose primary presenting health complaint was not Covid-19, so would have otherwise been in hospital but happened to have Covid-19. A & E was exceptionally busy across the whole of NWL, putting pressure on each of those services, for example how patients’ urgent and emergency care needs were managed while maintaining infection control and prevention. Those in hospital who happened to have Covid-19 were not making their way to the High Dependency Unit or Critical Care in the way patients with Covid-19 were previously.

Regarding the vaccination programme, Dr Melanie Smith highlighted that achieving vaccine equity in Brent was a challenge, but the vaccination programme had shown how the system could work together, be innovative and develop solutions with communities. There was no desire to continue doing things the way they had been done in the past, and the paper asked the Board to take the lessons learnt from Covid-19 specifically in relation to inequalities. The new approach would involve working with communities to co-produce solutions, and take that learning and apply it to other programmes such as the childhood immunisation programme. There would be a need to develop new KPIs in order for the system to hold itself to account on performance for inequalities and the Board was asked to assist with that. The Board strongly supported Dr Melanie Smith’s suggestions and hoped those conversations would take place at an ICP and ICS level, with any proposals brought back to the Health and Wellbeing Board.

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

·         The Board noted the increase in Covid-19 infections in Brent, with the figures showing around a 40% increase in cases compared to the previous week, and some London boroughs showing nearly 100% increase. The Board queried at what point the government or NHS would consider another booster vaccination. Dr Melanie Smith advised that the JCVI were meeting on a regular basis to discuss this, and she predicted more boosters.

·         In relation to how comfortable Dr Melanie Smith was, as the Director of Public Health in Brent, with the full easing of restrictions and testing, she advised that she would always be cautious from a public health perspective, but that must be balanced against the fact the public had been living against unprecedented levels of restriction for two years. At this time, she was not uncomfortable with the lifting of restrictions, but thought it was critical that the ability to scale back up the restrictions was retained, should the UK be faced with a variant which evaded the vaccination. She highlighted that surveillance needed to be maintained so that any new variant was discovered.

·         The Board noted that free Lateral Flow Tests which had been available to the public for testing would cease to be available by the NHS in 2 weeks’ time, which would mean fewer tests were available and there may be a charge for them. They queried the implications for both infection management and control, and for local, regional and national data. Dr Melanie Smith advised that at the time of the meeting there was not complete clarity about the testing arrangements going forward. There were some helpful commitments from the UK Health Security Agency (UKHSA) about the principles in which testing would be made available, and while it would be important to see how those principles translated into practice, as principles they were sound. The ONS survey would continue, which gave reliable data, although it was not Brent specific. There had also been assurance from the UKHSA that, with the current levels of Covid-19, the intention was to maintain testing in residential and social care settings, although there was less clarity on other health and social care settings and SEND settings. Locally, the Public Health Team were looking at contingency arrangements should the national testing regime not continue to provide tests to those groups which were considered high risk.

·         Public Health predicted that, over the summer, infection levels would decline to such a level that routine testing could be switched off even in high-risk non-clinical settings, but there would be a need to be prepared to switch that back on during Autumn, and standard testing would remain for clinical purposes.

·         In relation to the 3 major cities in China currently in lockdown due to new variants, Dr Melanie Smith advised that it was not known whether those variants were likely to spread to the UK. She highlighted it was inevitable there would be variants as the virus mutates, but it was very difficult to extrapolate the experience of populations with differing levels of past infection, natural immunity, and different approaches to vaccination. To date, it had been seen that the UK vaccination programme protected against all variants that had spread in the UK, but the risk was that it could fail in the future. This was why surveillance systems were important in order to spot new variants, assess how transmissible they were, look at whether they caused more severe disease, and find out whether they evaded the vaccination.

RESOLVED:

i)              To commit to a continued and consistent “evergreen” offer of Covid-19 vaccinations which is delivered in community settings in partnership with community and faith groups.

ii)             To make childhood and maternal immunisation a priority for the ICP, and to invite NHSE&I (as commissioners of immunisations) to join the ICP in developing plans as outlined in section 2.2 of the report.