Agenda item

·       Covid-19 response in West Berkshire and public health implications

·       Primary healthcare provision now and going forward

·       Adult Social Care, including care homes and domiciliary care

·       Wider healthcare system implications and response

·       Looked-after children and schools

·       Housing services and rough sleepers

Recovery plans

Matt Pearce provided an update to the board on the response from West Berkshire Council and the public health implications of COVID-19. He stated that as of 18^th May 2020 the data suggested that in West Berkshire 361 people had tested positive for COVID-19, which equated to 227.7 cases per 100,000. This was lower than the national rate. He further noted that deaths from COVID were 118 as of 8 May 2020, however it was likely that there may be more than this. Also as of 18 May 2020 there were 52 people in hospital with COVID, 60 in care homes and 5 at home. He noted that a third of care homes in West Berkshire experienced an outbreak as of 14 May, which equated to a 34% increase in deaths over a 5 year period. He further stated that in the period 1st March - 8 May, deaths by location saw Hungerford with the highest rate in the district region and Chieveley had no deaths. He further stated that COVID in care homes was still an ongoing issue in West Berkshire and that it was around the average for the south east in terms of number of deaths. He highlighted a number of risk factors, such as age, gender (women may have better immune response), dementia, diabetes, ethnicity (BAME groups four times more likely to die from COVID-19, with public health England undertaking a review into these figures). He stated that the data showed that these groups were more likely to have hypertension, diabetes and the fact that they tend to do more essential work. He stated that he would report back to the board when these findings were confirmed nationally. Furthermore, he noted that the data showed that deaths from COVID-19 were higher in poorer communities. However, the chances of dying from COVID-19 were still relatively low and that even if there was no vaccine, a high proportion of people may not get it, whereas 15%-30% will asymptomatic, and of those who do get it around 80% will have mild or moderate symptoms.

Matt Pearce then moved on to describe how West Berkshire had responded to COVID-19. He stated that the community support hub had been set up and through a collective effort. He further noted that West Berkshire Council had helped to interpret Government advice to residents and that PPE in West Berkshire had been coordinated through the local resilience forum which had, as of 21 May, no issues of supply. He also indicated that West Berkshire Council had coordinated testing for key workers and BHFT. He explained that the Council had been working with BFHT and the CCG around support for care homes in addition to supporting local businesses with grants. He noted that the community support hub had helped to meet the immediate demands from the community, with a big focus on vulnerable residents who needed to shield at home. He further noted that the Hub had a dynamic relationship with over 90 community groups across West Berkshire. He confirmed that over 4,000 shielded residents had been contacted by the Government across the district and that the Hub had contacted them regularly to offer support.

Matt Pearce then provided an update on the impacts of COVID-19 in West Berkshire. He highlighted impacts on mental health, and concerns about people drinking more, and those who are not seeking treatment at A&E. However, he noted that there were a number of opportunities that had arisen out of COVID and lockdown, such as air quality, more people taking up physical activity, community cohesion, public transport efficiency, opportunities for self-care, sustainable food use such as access to local shops, flexible working, less commuting and a sustained reduction in rough sleeping. He also stated that in the recovery and renewal from COVID, it was key to have a social, economic and environmental focus. He also stated that the people of West Berkshire may have to learn to live with the virus for a sustained period of time and that handwashing and social distancing were still the most effective ways to avoid catching the virus.

Dr Bal Bahia and Kamal Bahia provided an update on primary health care provision. They noted that between 80-90% of consultations were now being done remotely, with a limited number of home visits and face-to-face consultations. Kamal Bahia also noted that in GP surgeries, patients were separated into ‘hot and cold’, with hot signalling potential COVID symptoms and cold no obvious symptoms. She highlighted that a hot hub had been set up at Newbury Racecourse. She further noted that the direct booking of consultations through NHS 111 had been enabled.

Dr Bal Bahia and Kamal Bahia then stated that moving forward the focus for PCNs and the Primary Care Programme Board was to retain new models of working whilst creating a digitally enabled workforce and patients. They further noted that there would be a managed and phased opening of services, greater support for care homes and a remodelling of how routine and LTC care are managed.

Paul Coe provided an update on adult social care within West Berkshire and stated that during COVID, the first point of focus was supporting hospitals in discharging people, dealing with business continuity, working remotely as far as possible and the closing of care homes to unnecessary visitors early on.

He further noted that PPE was a major challenge but a panel was set up relatively promptly to coordinate supplies. As of 21^st May 2020, the panel was meeting daily and those in urgent need could make an approach. He noted that there were some concerns around care providers’ resilience and as such there were a number of actions taken to support them. He explained that funding had been made available from government to support care homes. He further stated that there had not been as much as demand as usual for locality / safeguarding / mental health teams, but this could be because the community response has been very effective and that he was trying to discover if there are any hidden risks around this.

Cathy Winfield provided an update on the implications of COVID on the wider healthcare system. She stated that in the early stages of the pandemic, the focus was making sure the NHS wasn’t overwhelmed and making sure it was possible to step up critical care capacity at Royal Berkshire Hospital. She noted that patients had been rapidly discharged where it was safe to do so, but routine screening was not in place at that point and there were lessons learned. She further noted that the community hospitals were able to free-up spaces at short notice. The health visiting regime had been reviewed to offer support for new parents. She further noted that the healthcare system in West Berkshire was in a position to step up primary care in care homes, with weekly check in calls from a clinician and a structured review of their medication and what they would like should their condition deteriorate. Furthermore, she noted that the system was now moving into a recovery planning phase, picking up routine issues such as screening, immunisation, vaccination and surgery, taking account of issues that may arise from a second peak of COVID.

Pete Campbell provided an update to the board on children and school services. He noted that as of 21 May 2020, there were 150 children looked after in West Berkshire aged between 0-18. With regard to care leavers that were over 18, he noted that the staff in this area had been great and there had been no significant reduction in capability and ability. He stated that, with regard to foster homes, the absence of school pressure has helped some children and their relationships and that some birth family contact has become virtual. He further stated that some schools had remained open throughout the Easter holidays to take care of some children and that schools have worked hard to support vulnerable children. He commented that the Council had accessed funds to provide IT equipment for children who needed it to maintain access to learning. He noted that schools were now trying to work out the logistics to ensure social distancing and that the children eligible for free school meals have received hampers.

Gary Lugg provided an update on housing and rough sleepers. With regard to housing, he noted that the service had to move quickly to work at home and to carry on being to work with individual families threatened with homelessness. He noted that work to stop eviction was now also being done remotely. On rough sleepers, he noted that there were 10 on the streets just before COVID kicked in and this was done by Homelessness Strategy Group forming a task group. He further stated that he his team had made contact with a number of hotels, and that all rough sleepers were now in hotel accommodation. He stated that the hotels were being supported by the voluntary sector providing food and support. He explained that Two Saints Hostel had reduced capacity so new referrals had to be accommodated in hotels. He also stated that work was now being done to ensure permanent housing for the residents whilst also continuing to work on personal housing plans and assist in finding employment. He concluded that the challenge was to build on the successes delivered during COVID.

Nick Carter provided an update to the group on the recovery of West Berkshire post-COVID. He stated that there was a widespread expectation that West Berkshire would enter a recession, which was a concern particularly for the younger generations. He highlighted work being done with the LEP. He noted that on an environmental front, there were opportunities to seize in recovery and the need to push on with a reduction in carbon emissions. He stressed the need to retain the voluntary work that has come out of COVID. With regard to recovery within the Council, he stated that virtual communication has developed extremely quickly and that a number of recovery elements need to be done as a joint effort.

Councillor Lynne Doherty stated that a resident survey would be sent around shortly to gauge the public mood on the social, health, economic and environmental impacts of COVID.

Councillor Howard Woollaston stated that the response to COVID has been commendable, especially the joint effort in the community.

Andrew Sharp expressed his thanks to the voluntary sector, key workers and others in response to COVID. However, he stated that there were some tough questions to ask in the review of COVID, including around care home deaths and whether the board could have done more. He commended the CCG on its transparency, but questioned whether there could have been more transparency around care homes. He stressed the need to learn lessons and put recovery boards in place and highlighted issues around disproportionate impacts in the BAME communities.

Councillor Steve Masters commended the leadership at West Berkshire Council during the crisis and asked about priorities for tackling homelessness in recovery. Gary Lugg confirmed that extra resources would be committed and that hotel accommodation would be secured in the medium term pending transition to permanent accommodation. Councillor Masters asked about funding. Gary Lugg replied that the council was adopting the Housing First approach.

Tessa Lindfield highlighted the importance of identifying COVID hotspots as they arise and the Test and Trace Service. This meant that the local role would increase. She commended the response from the CCG and Council. She highlighted complications as we head into winter with COVID appearing alongside other illnesses. She stressed that recovery would be long-term and would run alongside response and emphasised the importance of social recovery. She suggested that data should drive decision making in moving forward.

Councillor Lynne Doherty thanked Public Health for their contribution and highlighted the challenges of coordinating response and recovery at the same time. She agreed that data was important, particularly in analysing impacts on deprived communities and other disparities related to COVID. Matt Pearce indicated that data was coming through, but numbers were small which made showing a link more difficult. Tessa Lindfield added that data was better now that testing was ramping up, which would be key to coordinating local responses to outbreaks and to learning and adapting.

Andrew Sharp suggested that the Board review the processes about submitting questions in order to better engage the public and asked for any other business to be included as an item.

Councillor Martha Vickers asked if PPE was provided to all front-line staff and if the Council could help businesses to access PPE. She also expressed concerns that some families are not getting adequate food and that people with health needs are not seeking help. In addition, she stressed the need to take advantage of the good things that have arisen from lockdown. Nick Carter replied that there was enough PPE and front-line staff at the council had access, with businesses also OK. With regards to food, he indicated that the Hub and local community groups were working well and there was no evidence of problems. He suggested there was no evidence of hidden demand for services at the moment. Bal Bahia commented that domestic abuse was an issue nationally and messages were going out about support. He indicated that many people were managing their care needs themselves. Councillor Lynne Doherty explained that food parcels were being tailored to customers’ needs and that deliveries were discrete to avoid embarrassment. She shared Councillor Vickers’ concerns about mental health and suggested this should be a key focus for the Board. Kamal indicated that mental health services had been widely promoted.