Agenda item

To follow

The Place Based Director – SEL CCG (“Place Based Director”) provided an update on behalf on the South East London Clinical Commissioning Group (SEL CCG).

The Place Based Director advised Board Members that in terms of vaccine uptake, the over 80’s age group had been Bromley’s biggest success with nearly 95% of this vulnerable cohort having been vaccinated. It was stated that a high percentage of uptake had been recorded across nearly all other cohorts and they were keen to vaccinate any further residents within them as soon as they were ready to come forward. However, there were still a few cohorts for which they wanted to improve the uptake of the vaccination – health and social care workers (84.4%) and one group of carers (72.3%), and a drive focussed on these groups was underway. It was noted that the vaccination of the 40-49 year old cohort had only started very recently and was still in its early stages – 40.9% of this age group had already been vaccinated and they were aware that a large number of those remaining were keen to receive their vaccinations.

The Place Based Director informed Board Members that there was a wide COVID-19 vaccination programme in Bromley. In addition to the Primary Care Networks (PCNs) there were several other designated vaccination sites across the borough, including a Mass Vaccination Site at the Civic Centre and pop-up clinics. It was emphasised that further pop-up clinics could be held, particularly if they were in areas identified as having a population for which they would like to see an increased uptake of the vaccination. As covered in the media, there were issues with some ethnic minority groups and those belonging to certain faiths and, in collaboration with the Local Authority, they were looking at a programme to develop relationships with local community and faith leaders to help address this. A large number of GP practices were acting as satellite sites, as well as providing domiciliary vaccinations for those residents that were housebound.

In order to address inequalities in uptake of the COVID-19 vaccination a joint LBB and CCG Vaccine Uptake Inequalities Group had been implemented. A large piece of work was being undertaken across South East London to increase the uptake of the vaccination – a particular target was the Black Caribbean (64.1%) and Black African (67.6%) cohorts as they were the populations with the lowest uptake in the Bromley. It was also known that uptake was lower in the more deprived areas of the Borough (Penge and Anerley, the Crays and Mottingham) and uptake from people with serious mental illness currently stood at 72.2%. Vaccine uptake from care home residents was approaching 95%, however uptake from care home staff was only at 71.3% and the SEL CCG were working closely with the Local Authority to continue to further increase this number. It was noted that vaccinations were still being offered to this cohort, and the figures were slowly improving. In the coming weeks a website would be launched to share video clips from people who lived and worked in South East London encouraging others to get their vaccinations. A COVID-19 vaccination helpline and email had also been established for health and care staff to use to request further information, or seek advice and support, regarding the vaccine.

The Chairman noted that the figures for Bromley looked extremely positive but queried if anything further could be done by Elected Members with regards to vaccine hesitancy. The Place Based Director advised that any promotion of the vaccinations within Wards would be beneficial and if particular cohorts were identified as being vaccine hesitant consideration could be given as to whether a pop-up clinic should be held in that area. It was highlighted that colleagues at the Local Authority had been extremely helpful in identifying venues in which pop-up clinics could be run and had been working as volunteers at the Mass Vaccination Centre, helping to promote good practice.

In response to a question, the Place Based Director said that there was still some reluctance to receive the vaccine from within groups of health care staff in hospitals, general practice, mental health and community services – however reassurance was given that the vast majority of staff across all of these areas had been vaccinated. A national consultation had recently been launch regarding whether the COVID-19 vaccination should be made mandatory for care home staff, and centrally there was a drive to do this due to them looking after patients who were particularly vulnerable. It was noted that incentives to increase vaccine uptake by this cohort were being explored, such as allowing staff time off to receive their vaccination, and the Bromleag Care Practice had also been visiting care homes regularly to offer to vaccinate staff and residents on site. Some health care staff had concerns over the possibility of suffering side effects and being reimbursed for any time that they were required to take off work. It was emphasised that no decision had been made relating to this. In response the Member suggested that although they were uncomfortable with the notion of offering financial incentives, if this was taken forward it was considered that retrospective payments should also be offered to those that had already received their vaccinations. Another Member highlighted that any care home staff that were on 0-hour contracts would be extremely concerned about being unable to attend work following their vaccination – a large proportion of the population would be on low incomes and they should be encouraged to receive the vaccine by any means possible.

The Site Chief Executive – PRUH and South Sites, King’s College Hospital NHS Foundation Trust advised that, with regards to vaccine uptake by staff, of the Trust’s total workforce (around 13,700 staff) 75% had been vaccinated. It was noted that figures differed between individual staff groups and it was suggested that a more detailed breakdown could be provided to Board Members following the meeting.

In response to a question from the Chairman, the Place Based Director said that vaccine hesitancy in women of childbearing age was an issue for the general population as well as health care workers. Initially, misinformation had developed regarding the vaccine’s impact on fertility – this seemed to have now subsided however it was noted that this may resurface as the vaccination programme went down the age groups. It was noted that there had been a lot hesitancy and reduced take up of the vaccine due to reports in the media of thrombolytic issues following the AstraZeneca vaccine, but this had now settled down. The Place Based Director highlighted that as increased numbers of the population received their vaccinations more of the rare side effects would be seen and significantly revised communications would be required as the programme went through the younger age groups.

The Place Based Director advised that as part of the wider Bromley System Plan, One Bromley partners had developed the following schemes to support the system strategic priorities:

• Meet additional winter and COVID demands on front line services with a focus on supporting and preventing acute pressure;

• Focus on supporting vulnerable groups to prevent the need for hospital-based care; and

• Ensuring sufficient resources to manage wave 2 of COVID-19, learning from wave 1.

The Bromley Community COVID Management Service (BCCMS) had been established a year ago, in the first wave of the pandemic, and continued throughout the second wave. The service managed patients with COVID-19 in the community and its capacity had been expanded during the second wave, receiving referrals from GPs, 111 and the PRUH. The BCCMS was run in partnership by Bromley Healthcare and the GP Federation – it had seen over 5,200 patients, and at its peak it was seeing over 60 patients a day, reducing the burden on GP and Accident and Emergency services. The Oximetry at Home pathway had been run through the BCCMS and allowed the remote monitoring of patients using an oximeter. At its peak this service had been monitoring over 190 patients in the community.

The Bromley Community Respiratory Management Service had been established just prior to the second wave of the pandemic and was delivered jointly by the PRUH and community partners. This service included consultant oversight from the PRUH and supported the discharge of patients who then received additional monitoring and support once they were at home. A Bromley GP Access “Hot Hub” had also been established in Beckenham

with arrangements in place to see patients with COVID-19 symptoms. The service had offered face-to-face appointments in a dedicated hot hub, keeping these patients away from GP practices during the winter months, and had seen over 700 patients.

The Place Based Director informed Board Members that a Long COVID service had been established for patients who were still experiencing symptoms consistent with COVID-19 after three months that were not explained by an alternative diagnosis. This included a ‘Your COVID Recovery’ online platform which provided advice on COVID recovery, and the previous day a Post-COVID Syndrome Assessment Clinic had commenced at the PRUH. A One Bromley Integrated Post-COVID “Single Point of Access” and Multi-disciplinary Team had also been developed. The GP Clinical Lead – SEL CCG advised that the impact of Long COVID, on both those patients who had been admitted to hospital and those who managed their symptoms at home, was still being evaluated. It was considered that a good, co-operative pathway had been developed for patients and, as a number of the elements had only recently been implemented, evaluation could take place as they progressed. The service would require a large amount commitment from community, mental health, and primary care services, as well as respiratory care and hospitals, and the demand on it would need to be monitored. The Chairman highlighted that this was ground-breaking work and suggested that the SEL CCG may want to produce a report to capture it and share their learning more widely. The Place Based Director agreed that this was something that could be looked at in further detail. The Chairman requested that updates on the Long COVID service be included as a standing item for future meetings of the Health and Wellbeing Board.

The LBB Assistant Director for Integrated Commissioning provided an update on the Single Point of Access (SPA) and hospital discharge arrangements. Now that the second wave of the pandemic was subsiding, the additional measures put in place could be “stepped down”. This provided an opportunity to reflect what had happened over the last year, considering the response to the pandemic and how hospital discharges had been managed throughout. On the whole it was believed that the winter pressures and second wave had been very well managed from a discharge aspect with all patients having been discharged from the PRUH in a timely manner and agencies had provided support and help to those requiring it.

A key aspect of the arrangements for hospital discharges had been the introduction of the SPA which consisted of two main elements. The first of these was a multi-agency clinical triaging system, where different agencies and professionals came together to triage and assess patients to be discharged from the hospital, and then handed over any further care to be provided by services within the community. The second was a wider infrastructure of multi-agency arrangements that supported and managed a resident’s transition back into the community via different pathways such as domiciliary care, further rehabilitation or securing a place in, or returning to, a care home.

Data was provided showing details of the percentage of activity by pathway for all referrals processed through the SPA from April 2020 to April 2021 of which 6% related to onward referrals to the CCG, 27% to the Local Authority and 67% to Bromley Healthcare services. The LBB Assistant Director for Integrated Commissioning emphasised that hospitals, and the system as a whole, had been put under a great deal of pressure and it was pleasing to see the discharge arrangements had worked so well and that both patients and staff felt supported. Learning would be taken from the events of the last year and proposals would be put forward, taking on board any good practice developed to make them a more permanent feature in Bromley and prepare for any further surges of the pandemic.

The Chairman thanked the Place Based Director and her colleagues for the updates provided.

RESOLVED that the update from the CCG be noted.