Ian Wake, Director of Public Health, started this item by presented a PowerPoint to Members on the latest update on COVID-19 in Thurrock. This provided Members with details in regards to epidemic curve of laboratory confirmed number of cases and when these were reported and ICU Bed occupancy; data on the number of deaths; the impact of lockdown on health and wellbeing; the economics of lockdown; the current situations on positive test results and the R Value; exiting lockdown and future policy implications, Test and Trace and the next steps. This PowerPoint can be found from the following link:
Councillor Ralph questioned whether there was a link between the number of excess deaths compared to the number of general practitioner and hospital appointments that had been cancelled. Ian Wake stated he was unable to answer that question in great detail but there had been an unexplained level of non COVID deaths but this would be known more once analysis of the data had been carried out.
Councillor Ralph questioned whether there was the capability to lockdown one particular area. Ian Wake stated he did not have the answer but potentially there could be powers attributed to local authorities to implement local lockdowns/settings but there was no clarity with Government working on decision frameworks at this time with clarity being available shortly. Ian Wake stated that local lockdowns would be difficult to manage for example identifying where a resident worked on the border and monitoring the transport and infrastructure going through that area.
Councillor Muldowney asked for more detail as to why the excess death rate was around +30-40% above what would be expected from the five year average. Ian Wake said he did not have the answer to that question but more readable data was being issued from the Office of National Statistics. The reasons were unclear but could be down to greater prevalence within the community, underlining health problems, transmission of settings, ethnicity or deprived areas. That a huge amount of work on the data was required to get those answers.
The Chair questioned what would the practicalities be if a school had an outbreak and staff and pupils were told to isolate for example due to the numbers of teachers sharing a staff room. Ian Wake stated that school’s protocol would play an important factor and advice would be set out with details of social distancing within settings such as staff rooms. Schools were currently operating in bubbles, with one bubble having 15 children and one teacher and would remain in their own social bubble. If there was to an outbreak that bubble would isolate on its own.
The Chair questioned how effective Test and Trace was when the news was reporting that a quarter of those identified from the 45,000 people told to self-isolate as a result of track and trace but could not be reached. Ian Wake stated this was one tool with a range of things to do to try and slow the spread.
Councillor Massey stated that Ordnance Survey geographical map of COVID-19 death showed a drop in Thurrock compared to the number of deaths in London and questioned whether this could be due to less density and more green space. Ian Wake stated that he would have expected a higher death rate in London due to the population and density but stated until this crisis was over this may change and was still an ongoing risk for Thurrock and caution must be adhered to at this point.
Councillor Ralph referred to the technical problems the Track and Trace App had experienced and questioned why an App that was already available was not used. Ian Wake stated that information had not been shared with Directors of Public Health.
Roger Harris stated the report covered how the local systems had work with the whole of the Mid and South Essex system responding well and how locally Thurrock should be proud with those responses. Under the Thurrock Integrated Care Partnership umbrella the work carried out was the partnership around organisations, the swift response, over £1 million had gone to the residential care home providers, the care homes protocol had been put in place quickly and the step-down facilities put in place. Roger Harris paid tribute to all Thurrock’s partners as the system response had been very strong and also the partnership with the Mid and South Essex had been very good and highlighted that the swift response had saved lives in Thurrock.
Members were referred to the Annexes of the Agenda that provided individual summaries of the key elements from partners and trusts across the Health and Social Care System. The Chair thanked all partners for their contribution and update.
Councillor Muldowney stated how proud she was of residents and volunteers of Thurrock who stepped up to help with providing Personal Protective Equipment to those that needed it. Councillor Muldowney referred to reports of lack of Personal Protective Equipment and asked for assurances that should there be a second wave there was confidence that this would not be an issue going forward.
The Chair referred to a Panorama Programme entitled “Has the Government failed the NHS” which had named Thurrock’s local trust and had reference to lists of items that had been delivered to a number of hospitals and questioned the reasons for there to be a lack of Personal Protective Equipment, what was being carried out to fix it and how sure staff could be assured that there was sufficient Personal Protective Equipment now. Tom Abell thanked all those that had contributed and stated that the Government took control of all supplies of Personal Protective Equipment and organised the distribution which was based on the calculation of need. That this was not an order system, the hospital received a certain amount of products but in some cases there was not sufficient of some items. Tom Abell stated the hospital had been supported by local communities, the hospital had looked at different alternatives such as a suitable substitute for a gown. The hospital also worked with local businesses who had stock available and donations. That there had not been any shortage of Personal Protective Equipment at Basildon but very tight on some days. There was confidence that stock levels were now way in excess and would be best placed if a second wave happened.
The Chair questioned whether this was the same process for care homes. Roger Harris stated they had different arrangements with each provider had their own source of suppliers, MHCLG deliveries and from system and mutual aid which had been organised locally. Roger Harris stated that although it had got very tight no supplies had ran out and supplies were now more regular and more reliable. Roger Harris also stated that the guidelines had changed and had got tighter over the last couple of months as more was known about the pandemic.
Councillor Muldowney asked for reassurance that following the COVID-19 crisis the Mayfield Ward would return from Brentwood hospital into its normal unit in Thurrock hospital and questioned whether the specialist equipment would also be placed. The Chair agreed with Councillor Muldowney’s question and if time had allowed this item would have been brought to the committee for scrutiny. Anthony McKeever stated that all the moves that took place during the COVID-19 crisis were essential and temporary and it would be the intention for services to be re-established back to local level. The Chair thanked Anthony McKeever for his comments and stated that it was important that Thurrock services stayed in Thurrock.
Tania Sitch stated that equipment that was old and no longer required had been disposed of, with other equipment being stored and new equipment purchased. That the move from Thurrock to Brentwood hospital had been a challenge undertaken within a quick timeframe and Brentwood had received compliments on how exceptional the service had been.
At 9.15pm the Chair called Standing Orders.
Councillor Ralph thanked Kristina Jackson and her team for the all hard work undertaken within the community undertaken during the COVID-19 crisis. Councillor Ralph also thanked those involved with the work undertaken within care homes in the borough they had done an amazing job. Councillor Ralph asked for clarification on the number of deaths in care homes during this time compared to other years. Les Billingham stated there had sadly been 35 deaths of people who had been in care homes of which six had died in the care home with the others unfortunately had passed away in hospital. The figure was being recorded this way to help identify whether a second outbreak would occur that could potentially run through care homes. Les Billingham stated that this was how the figures were being recorded across the country. Ian Wake stated there had been an increase of non-COVID-19 deaths in care homes over this period when compared over a five year average. Ian Wake agreed to take the action point away for clarify.
Councillor Ralph stated in regard to mental health what more could have been done in the community as there was now a backlog seeking help and questioned whether lack of early intervention had impacted more cases into hospitals. Andy Brogan stated that there had been a lack of demand but that further down the line this may have an impact on services and had concerns that people were not accessing these services. Mark Tebbs stated that monitoring had identified a drop in IAP services but services such as 1-2-1 or group therapy were up and running and capable but the demand had not been there. That demand had started to pick up again and it was noted that referrals for key workers were now being received and although temporary the aim would be for the services to be accessed as at previous levels.
Councillor Ralph raised his concern that once the restrictions of COVID-19 had lifted the services may not be able to cope with the demand of mental health referrals. The Chair stated that the mental health of residents and NHS staff would need massive support as did domestic violence and sexual abuse victims and questioned the Portfolio Holder for Health how he had intervened to ensure that these services would now have the resources to manage when we come out of lockdown. Councillor Mayes stated that mental health and the fewer number of referrals had been a concern, he reported that a Deep Dive Report on focusing on status of mental health would be undertaken with a recommendation to set up a working partner taskforce to focus on mental health in its own right. Working with partners and the workforce to look at how the service was working and what support could be provided. Councillor Mayes stated that this report would be presented at the Health and Wellbeing Board in July 2020 and to also look at the financial implications when the restrictions of lockdown had been lifted to monitor the referrals and need if there were to be another spike.
The Chair stated that funding was essential for domestic violence and sexual abuse and asked for reassurance from the Portfolio Holder for Heath that services would have financial support going forward. Councillor Mayes agreed and confirmed that resources and funding would be available. Andy Brogan stated the focus on mental health had raised the profile but the major challenge could be further down the line. That long term investment and a cost delivery plan with the Clinical Commissioning Group would be put in place. The Chair stated that it was vital that services locally received everything they needed. Mark Tebbs stated that a national bid was in process for domestic violence and sexual abuse and worked had been undertaken with SERICC to get that bid. That the outcome was not known at this time but would continue to chase. Mark Tebbs confirmed that transformation plans were up and running and back on track. The Chair stated that Members would be looking for that reassurance that those services were in place.
Councillor Ralph questioned whether there was funding available for male domestic abuse victims and was the closest shelter in East Ham. Councillor Holloway explained that services were offered to both men and woman as it was important that everyone received support. Councillor Holloway stated that domestic violence and sexual violence prominently impacted and affected women and quoted that it was in the high 90%. Councillor Ralph stated that figure was incorrect and had been aware of only one male shelter and added that a 2012 figure of 44% victims were male and saw a large percentage of males coming through with the work that he undertook. Councillor Holloway then continued to state she had contacted SERICC who provided support to adults and children, male or female, who confirmed that in April 2019 to March 2020 1216 Thurrock victims of which 1179 were female and 37 male had been helped, that was 97%. Councillor Holloway had also contacted Changing Pathways and from 2019 to 2020 all the people they had supported were female, that was 100% and so far had supported two males. Councillor Holloway then questioned where Councillor Ralph had got that 40% figure from eight years ago as she was unable to find it and stated it was important that Members were aware of facts before being presented with domestic violence and sexual violence disproportionately impacting women. Councillor Ralph stated that from the history of domestic violence and sexual violence men had trouble coming forward and speaking out about their abuse and how they had suffered, that figure was a lot lower than the 95% towards woman than it was to men. Councillor Holloway summed by saying that when studies of the different kinds of violence that were perpetrated on men and women, it would show that the violence perpetrated on woman was always more severe.
The Chair questioned how much money had been received from the Government and how much of that money had gone into the social care. Roger Harris stated there had been two tranches of funding from the Government which had not been ring-fenced with the Thurrock allocation being £9 million which had to support businesses, support social adult care and a whole range of services. That £1.5 million had been paid as resilience payments to care homes. That all hospital discharges since the 19 March had been paid for by Health as part of the accelerated discharge programme and would continue at least to the end of July but the long term plan was still unknown. The Council had received significant financial support with around £9 million in cash.
The Chair questioned why the General Practitioner service would cease from Orsett and although the Chair was mindful the hospital would close it had to be right time to move services out at the right time. Tom Abell stated that a change of operations would be undertaken and further details would be known over the next couple of weeks. Mark Tebbs stated that this was a temporary trial to provide a general practitioner service essentially for the winter pressures. Monitoring the Minor Injuries Unit had shown numbers had decreased and a decision had been made to increase the general practitioner presence into the hubs. The hubs would provide weekend and out of hour primary care services.
That the Health and Wellbeing Overview and Scrutiny Committee noted and commented on the contents of this report which sets out the response of the Health, VCS and Adult Social Care systems in relation to the challenges faced during the COVID-19 Pandemic.