To include:

- situation report from all partners

- immunisation roll out for Bromley

The Borough Based Director – SEL CCG (“Borough Based Director”) advised Board Members that a large amount of work had been undertaken over the last couple of months to deliver, increase, and try to manage any inequalities in the uptake of the COVID-19 vaccination. Bromley had been doing very well in terms of uptake – over 89% of the over 80’s age group, a similar percentage for the 75-79 year old cohort; and 88% of 70-75 year olds had received their vaccinations. Work was also taking place to vaccinate health and social care staff, and residents classed as clinically extremely vulnerable. It was noted that the denominator of who was considered to be clinically extremely vulnerable kept changing, however it was thought that over 70% of this cohort had been vaccinated, largely due to the PRUH’s ‘Hospital Hub’ contacting in-patients that they were aware fell into that category.

GPs had been vaccinating residents through their Primary Care Network (PCN) vaccination sites, which the GP Federation in Bromley had been instrumental in helping to deliver. It was highlighted that pharmacists were not delivering the vaccinations in Bromley. Satellite services had been established, so some GPs could deliver vaccinations where they needed to, and over 100 residents had received their vaccinations at the mosque in Keston the previous weekend. There were plans to have a mass vaccination centre and the Civic Centre, and they were extremely grateful to partners for making this available.

With regards to residents and staff in care homes, vaccinations had been administered through the GP Practice for Care Homes. So far, 91% of people had been vaccinated, and this figure continued to increase – there had been delays going into some care homes due to outbreaks of COVID-19, so vaccinations would continue to be offered. It was noted that in Bromley, as across the country, there was a lower uptake from care home and hospital staff than had been anticipated. Commitment had been made to vaccinating 75% of the top four cohorts by the 14^th February 2021 – this had already been achieved, however it was emphasised that the programme would not stop, and they would be continuing to offer the vaccine to the most vulnerable residents. There were a number of people within these groups that were housebound, or reluctant to go out, and as a result they were looking to adapt their services. Work was also being undertaken with partners to encourage social care and care home staff to receive their vaccine.

In response to questions, the Borough Based Director advised that in relation to care homes for older adults and those with Learning Disabilities, around 60% of care home staff had been vaccinated. It was noted that the vaccination programme for this cohort was still underway, and they would continue to offer them the opportunity to receive the vaccination on numerous occasions. The Director of Public Health and Director of Adult Social Care had also been working to set up webinars, however there was still more work to be undertaken to improve the uptake from this cohort. They were aware that some ethnic minorities and lower socio-economic groups were less likely to take up the offer of the vaccine. There was some data available, and it was hoped that within the next few weeks they would be able to obtain details of uptake by ethnic group within each PCN. These communities were considered to be very specific, and more granular information was needed – work needed to be undertaken to understand these specific groups in more detail through community engagement. It was highlighted that the AstraZeneca vaccine could be delivered at pop-up clinics, which allowed them to be administered in venues such as the mosque in Keston, and with community leaders present.

The Chairman queried if anything further could be done by Elected Members with regards to pop-up clinics. The Borough Based Director advised that she had been contacted by several Councillors, with whom she had had discussions regarding extending the reach of vaccination services into specific communities. Work was being undertaken with Directors of Public Health to look at the inequalities in the vaccination uptake across South East London, and it was noted that it would be good to have input from local Ward Councillors too. The Chairman suggested that an external meeting could be set up, as and when required, to look at this in further detail, and Members were asked to contact the clerk to the Health and Wellbeing Board if they wished to participate.

The Borough Based Director advised that they were starting to see a reduction in both the number of COVID-19 cases, and the number of people being hospitalised. However, there would be a significant lag before the pressures on hospitals would be reduced, due to the length of time patients were currently needing to spend in hospital.

Safeguarding remained a concern, as they were aware that adults, children, and young people were particularly vulnerable during this time, including some that would not usually fall into this category feeling isolated and separated. They were doing their best to ensure services were available for those that needed them. It was noted that they were also trying to keep other areas “running as normal”, with elements such as MASH service reviews continuing despite COVID-19 pressures.

The Borough Based Director highlighted the need to return to addressing the backlog of patients, and the new services that had been developed during this period. This included a Community Respiratory Service and Respiratory ‘virtual ward’, so that patients recovering from COVID-19 could be managed in the community. These services were jointly delivered through the One Bromley approach, and highlighted the partnership work that was being undertaken.

The GP Clinical Lead – SEL CCG highlighted the need to recognise the impact and demand that had been placed on the combined workforce of partner organisations, to put the vaccination hubs; centres; and Respiratory services in place. It had required a considerable amount of collaborative work and goodwill. The vaccination programme would be running for a long period of time, and the resilience of these centres would need to be maintained – how these centres were staffed would be a key consideration.

The Borough Based Director advised that some of those vaccinated in December 2020 would be approaching their second dose in March 2021. Modelling work had been undertaken to look at the delivery of the second dose, whilst also delivering the first dose to the other age groups. The Borough Based Director noted her personal experience of the hospital services and stated that they had been doing a fantastic job of looking after people during the pandemic. Alongside these services, they had also been running the ‘Hospital Hub’ to deliver vaccinations – the way in which partners had come together to work collaboratively and manage the pandemic had been extraordinary. It was highlighted that some staff were extremely tired, and in relation to adult safeguarding, going forward further thought would need to be given as to how support could be provided across the statutory organisations.

The Chairman suggested that these issues could be discussed at the April 2021 meeting of the Health and Wellbeing Board, along with the delivery of the second dose of the COVID-19 vaccine and the possibility of a further booster dose during the autumn.

A Member highlighted concerns regarding the spread of negativity relating to the contents of the COVID-19 vaccinations, and queried what could be done to address this. The Borough Based Director said that if staff members expressed a reluctance to receiving the vaccination, they tried to combat this by providing them with the correct information, which was provided on their public website and social media channels. In general, they did not allow people to vaccinate others if they had not already received the vaccination themselves, as they would be in contact with a substantial amount of people which increased their level of risk.

The Site Chief Executive – PRUH and South Sites, King’s College Hospital NHS Foundation Trust (“Site Chief Executive”) informed Members that they referenced the second wave of the pandemic from the 1^st December 2020 until the current point in time. Comparing this period to the first wave (March – June 2020), the PRUH had been 109% busier in terms of the volume of patients that had been admitted for COVID-19 related care. The peak across the PRUH and South Sites had been the 8^th January 2021, on which they had been caring for over 300 COVID-19 positive patients. As of that afternoon, this number had reduced to 127 – of these patients, 115 were in general and acute beds, and the remainder in Level 3 ITU care. The wider King’s organisation had been one of the hardest hit across the NHS, in terms of the total number of COVID-19 patients treated.

The Site Chief Executive highlighted that other services had been impacted by the pandemic, with face to face outpatients’ appointments paused and a reduction in operative elective care across all sites. These were queries that had been raised by the Chairman and Members of the Health Scrutiny Sub-Committee, and responses had been provided on specific case issues. It was noted that there was a sizeable backlog of elective patients across the Trust, and the PRUH and South Sites. In line with guidance for the London region, patients currently on waiting lists had been risk assessed, and prioritised for restarted elective care on a spectrum of 1 (most urgent) to 4 – across the Trust there were over 1,400 patients ranked as priority 2, and required an operation within 28 days. This figure changed on a daily basis, and as COVID-19 volumes decreased they were able use more theatres for routine use.

The Site Chief Executive advised that some of the Trust’s physical developments had also been delayed as a result of the pandemic. However, it was confirmed that the new Frailty Assessment Unit and Mental Health Assessment Unit (in partnership with Oxleas), both located on the PRUH site, would “go live” before the end of March 2021, as would the larger waiting area in the Emergency Department to meet social distancing requirements. With regards to the building of the Endoscopy development and single-deck car parking facility, plans were expected to be put forward for approval during February / March 2021. Plans for the theatre expansion at the Orpington Campus were currently being drawn up, and it was anticipated that these could be presented during March / April 2021.

A Member highlighted the current need for health care workers to take a break from their work, and queried how this was being tackled locally. The Site Chief Executive said that the Trust had a huge regard for the entire workforce, both those on the frontline and support staff that had been redeployed. At certain points during the pandemic, such as entering into wave 2 over the Christmas and New Year period, leave had been paused or cancelled. However, to rebalance this, they had actively encouraged any member of staff that had not taken any leave since November 2020 to do so. Routinely, medical staff were required to give a greater notice period prior to taking leave, but this had been reduced from 8 weeks, down to 5 days. Individuals had also been encouraged to take leave before the restart of large-scale outpatient and elective surgeries.

The Chief Executive – Oxleas NHS Foundation Trust (“Chief Executive”) highlighted that the Mental Health Assessment Unit, mentioned by the Site Chief Executive, would provide the opportunity to care for patients with severe mental illness in an appropriate area, away from the busy Emergency Department.

In relation to vaccination uptake, 2,700 staff members had received their vaccination. It was noted that they were still seeing a disparity between the number of white and BAME frontline staff being vaccinated, and work would need to continue to address hesitancy around the vaccine. They would also be looking at a further vaccination programme during the autumn, and therefore the programme would be kept rolling.

The Chief Executive advised that pressures were reducing, however the number of inpatients with a COVID-19 diagnosis within the last seven days was still higher than at the peak of the first wave. As previously mentioned, CAMHS had seen a significant increase in referrals. In relation to adult presentations, over recent months there had been a trend of people previously unknown to health services accessing help, and this was a sign of the new demand which they would need to accommodate in the months ahead. Calls to the crisis line, which had more than trebled during the first period of lockdown, had now settled at a volume 30% higher than pre-pandemic levels, which again highlighted the demand for mental health services.

The Chief Executive Officer – Bromley Healthcare (“Chief Executive Officer”) informed Board Members that all community services had remained open throughout the second wave of the pandemic, with around 700 face to face visits taking place per day, plus virtual consultations. Along with partners, they had been running the Bromley Community COVID Monitoring Service (BCMS), which provided community support to residents that were displaying COVID-19 symptoms. Patients received a daily phone call from the integrated team of GPs and Community Matrons. At the peak of the pandemic, the service had been making around 180 call per day – this had now reduced to around 43. Over the whole period of the pandemic, 4,700 patients had been cared for in the community through this service. The Chief Executive Officer advised that, despite the pandemic, partners had established a new Hospital@Home service for children, which had commenced on the 1^st February 2021. This was a Nurse led service, for which the PRUH had medical responsibility, and was a good example of partnership working.

In terms of staffing, it was noted that colleagues displaying symptoms had fallen to 1.8% across the organisation – however it was highlighted that during the second wave staff had been more unwell, and off work for longer periods of time. They were also experiencing challenges similar to other partners in relation to the uptake of the vaccination. Around 62% of staff had received their vaccinations, however the figures for BAME and lower graded staff were much lower. Staff had been receiving their jabs at the PRUH, which it was noted had been an extremely well organised process.

The Director of Adult Social Care emphasised that the strength of the response to the pandemic in Bromley had been testament to working so well as a system. As noted earlier in the meeting by the Independent Chair – BSAB, the Director of Adult Social Care confirmed that the Director of Public Health or herself attended the daily surveillance meetings. Thanks were extended to the Consultant in Public Health for organising these meetings, and co-ordinating a number of multi-agency partners to look at the care sector in particular, identify any problems arising, and provide support. This system was working very well, bringing partners together to see where incidents may lead to providers struggling – it enabled more testing to be undertaken, or additional staff provided to keep care homes running.

With regards to staffing, it was acknowledged that there were issues related to the uptake of vaccinations by staff in the care sector. This had partly been due to a large number of staff in this sector being unwell in recent weeks, and the vaccination would continue to be offered as they returned to work.

In addition to the ongoing support provided to the sector, the department had also continued to work with the voluntary sector to provide support to the clinically extremely vulnerable. The voluntary sector had done an excellent job of providing emotional and practical support to this group, as well as supporting the Public Health Test and Trace programme.

The Portfolio Holder for Adult Care and Health expressed her thanks to all staff at the London Borough of Bromley, across health services and highlighted the valuable contribution of the voluntary sector. Partners had been required to moved incredibly quickly to establish new models of care, and credit was due to all organisations across the Borough for tackling the pandemic as a whole system.

The Chairman thanked partners for the updates provided, which highlighted the scale of the work being undertaken.

RESOLVED that the partner updates regarding the pandemic be noted.