Agenda item

The LBB Assistant Director for Integrated Commissioning and Dr Agnes Marossy – Consultant in Public Health, Bromley Clinical Commissioning Group (CCG) (“Consultant in Public Health”) provided an update on the COVID-19 vaccination programme in Bromley.

Members had been provided with benchmarking data across South East London regarding the number of COVID-19 vaccinations delivered as of 11^th March 2021 and 8^th March 2021 for data relating to care homes. The LBB Assistant Director for Integrated Commissioning advised that since this time, the programme had moved forward and around 67% of care home staff had now been vaccinated. The data highlighted that the Bromley vaccination programme was performing strongly – it was noted that Bromley had a larger population that neighbouring boroughs and a substantial amount of people had been vaccinated.

The priorities for the vaccination programme had been set nationally and, starting in December 2020, had focussed on the most vulnerable and those living and working in care homes. Since December, the programme had continued through the first nine priority groups to be vaccinated, with the over 50’s being the most recent cohort called in for their vaccinations. The programme had been working extremely well and a number of vaccination centres and Primary Care Networks (PCNs) in Bromley had been able to move ahead of the timetable. The groups currently being vaccinated were anyone over the age of 50; care home residents and staff; all adults considered to be Clinically Extremely Vulnerable; those with underlying health conditions; and unpaid carers. There were several designated vaccination sites across the borough, including a Mass Vaccination Site at the Civic Centre.

The vaccination statistics by age group highlighted that more than 90% of people in the older age categories had received their vaccination and good progress was being made in relation to vaccinating those over 60 years old. However, there were issues, as seen across London, with some sections of the community being more hesitant to take up the vaccination offer. The data indicated that people of African and Caribbean heritage were showing greater vaccine hesitancy and plans were in place to help address this. It was noted that three areas of the borough had been identified (Penge, Anerley and the Crays) where more work would be carried out to increase the vaccination uptake.

With regards to health and care staff, the LBB Assistant Director for Integrated Commissioning advised that, although they wanted all those who worked with vulnerable people to be vaccinated, there was still some hesitancy with this cohort coming forward to receive their vaccinations. Around 67% of care home staff had taken up their vaccination offer, and therefore further work would be required to encourage more to do so. A three-tiered approach had been taken to the vaccination of health and care staff. At the beginning of the year, a large amount of information had been provided to employers and managers to enable service leaders to get their staff “on board” with vaccination programme. A range of briefing sessions had been delivered to staff working in health and care services during February. These sessions had been extremely well attended, providing advice and one to one support if required. Since then, further targeted work had been undertaken to reach out to any staff having doubts about receiving the vaccine, or questions still to be answered. The Bromleag Care Practice had been visiting care homes with low take up and offered to vaccinate staff on site. All non-regulated care providers had been written to with the offer of more information and support, and they would be looking to collect data from this group regarding the uptake of the vaccine by their staff. A COVID-19 vaccination helpline and email had been established at the beginning of March for health and care staff to use to seek advice regarding the vaccine. So far this had received a good response and the staff manning the helpline had been booking vaccination appointments for some of the health and care staff that contacted them (around 29 people the previous week). Recognition was also being given to health and care settings with a certificate of achievement awarded to those with 100% staff take up of the vaccine. The importance of advice from peers within the health and care sector was noted, and a video had been produced by the staff at Heathers Residential Care Home to provide an insight into why they had chosen to be vaccinated which could be viewed via the following link: https://www.youtube.com/watch?v=ul7Hgfid7bs

The Consultant in Public Health highlighted that although overall vaccination rates in the borough were high there was a marked difference in the uptake between White (over 90%) and BAME groups, particularly the Black African and Black Caribbean cohort (around 60%). There were also lower rates of uptake in more deprived areas. Funding had been allocated to the Local Authority and a Bromley Inequalities in Vaccination Taskforce, led by the senior leadership team in the Council and CCG, had been set up to develop and test innovative ways of addressing vaccine hesitancy in the borough. It aimed to improve vaccine uptake amongst the BAME population; in deprived areas; amongst health and care staff; and the homeless community. There were a number of planned interventions to be delivered with local leaders, community influencers and ambassadors. As the uptake for priority groups 1 to 4 was already well above 90%, these interventions would be targeted on an individual and small group level to achieve the best impact. Work undertaken so far included:

-  Regular briefing sessions with local faith leaders, the voluntary sector, those working with older people, those from BAME communities and lower income families;

-  Insight gathering from BAME community influencers;

-  Satellite and pop up clinics set up in areas of need (including Keston Mosque and Anerley Town Hall);

-  New vaccination clinic had opened in Mottingham; and

-  Health clinic at the Bromley Homeless Shelter and in Homeless Hostels.

The Consultant in Public Health informed Members that further joint working was being carried out with the Shielding and Test and Trace teams. When contacting residents, the Shielding team would be asking additional questions to check if they had received their vaccination, and if not, what could be done to assist them. The Test and Trace team would also be sending out a survey, developed with the LBB Communication team, asking the same questions and asking residents to provide contact details if they required further practical help, information, or advice. A vaccine hesitancy conference was also planned to promote the vaccination and identify ambassadors.

In response to questions, the Consultant in Public Health said that the majority of care home staff would not be included in the eligible age cohort’s data. In relation to the number of people within the BAME community that had not received their vaccination it was agreed that figures could be provided to Members following the meeting. It was noted that vaccine hesitancy within the BAME community was an issue nationally, and it was important for this group to receive their vaccinations as the impact of COVID-19 infections were often more severe. There were a number of reasons for this hesitancy and it was largely due to misinformation including lack of trust; stories of microchips and conspiracies; reluctance to receive the Pfizer vaccine; and those with strong faith beliefs who said their faith would protect them.

A Member enquired if hesitancy had increased due to reports of the alleged reactions to the vaccine. The Consultant in Public Health said that a number of vaccination appointments had been cancelled the previous week. A strong message had been sent via vaccination sites and practices to reassure people that there was no link indicating that these had been as a result of the vaccine. It was hoped that further reporting of the EMA approval would help to reduce these concerns.

In response to a question, the Consultant in Public Health advised that when moving down the age groups to be vaccinated, there would be a need to focus communications to reassure women of childbearing age. The Chairman asked if there were plans to offer pregnant women the vaccine post-birth. The Consultant in Public Health said that pregnant women were being encouraged to discuss the vaccination with their GPs or specialists. There were no reasons for the vaccination to be damaging during pregnancy, however everyone was being very cautious. Some pregnant women may be considered as high risk due to having a high number of contacts with other people. These discussions would allow them to make a choice, and there should be a plan in place to receive the vaccination post-pregnancy.

The LBB Assistant Director for Integrated Commissioning noted that Members would be aware of the interruption in supply of the AstraZeneca vaccine which would see the vaccination programme scaled down nationally. The CCG were aware of the supply available to them into the first week of April and the principles used to manage it would ensure that those booked in received their second vaccination. The focus would remain on priority groups 1 to 9, offering vaccinations to residents aged 50 and above and vulnerable groups, and the age groups to which it was offered would not be extended during this period. All residents who had appointments booked would receive their vaccinations, however they may need to be delivered at a different venue.

In response to questions from a Member, the Consultant in Public Health gave reassurance that the second dose vaccines had been reserved and therefore national supply would not be impacted. The second dose received would be from the same supplier as the first dose – residents should receive their vaccinations at the same site, except for those who had previously attended Community House, who they were in the process of contacting. The second dose would be delivered to sites between 11 and 12 weeks after the first dose, however exact delivery dates were not currently known. A national webinar had taken place the previous week during which Mass Vaccination Sites and pharmacy sites were advised that they could no longer offer any appointments between 1^st and 30^th April 2021 – although all appointments already booked should be honoured. There were a handful of residents booked in to receive their vaccinations at the Civic Centre, who would be contacted to see if their appointments could be brought forward or offered an appointment at a PCN site. Further instructions were awaited from King’s College Hospital NHS Foundation Trust; however, it was likely that the Civic Centre site would need to close as it would not be receiving vaccine supplies during this period. It was highlighted that the PCN sites would remain open to deliver second doses and as many first doses as they could.

In response to a question, the Consultant in Public Health informed Members that a separate working group had been established to focus on patients with learning disabilities (LD), and included the Nurse Consultant from Oxleas NHS Foundation Trust, Mencap and the GP Clinical Lead – LD Champion. Two webinars had been held for people with learning disabilities, which had been very well attended. A webinar had also been delivered to practices, providing information related to consent and best interest, to ensure they were prepared to undertake this properly. Several practices had organised pop up clinics within their own surgeries and were inviting patients with learning disabilities to receive their vaccinations in surroundings that were more comfortable and familiar. So far, 79.4% of the borough’s patient with learning disabilities had already received their vaccinations and the GP Clinical Lead – LD Champion was tirelessly checking that practices were contacting this cohort to offer help and support. A similar programme was also in place for patients with serious mental illness. The Executive Assistant for Adult Care and Health informed Members that she had co-chaired a recent meeting of the Learning Disability Partnership Board and the feedback received from LD carers regarding the vaccinations programme had been very positive. They had been extremely pleased with the offer for the person with learning disabilities to receive their vaccination at home, and their carer being vaccinated at the same time.

The Chairman thanked the LBB Assistant Director for Integrated Commissioning and Consultant in Public Health, Bromley Clinical Commissioning Group (CCG) for their presentation to the Sub-Committee.