Meeting documents

SCC Somerset Health and Wellbeing Board & Integrated Care Partnership
Thursday, 21st May, 2020 10.00 am

Meeting of Somerset Health and Wellbeing Board & Integrated Care Partnership, Thursday 21st May 2020 10.00 am (Item 433.)

To receive the report.

Decision:

The Board had a joint presentation on the Covid-19 response by Somerset County Council, the CCG and Avon and Somerset Police.

The Somerset Health and Wellbeing Board agreed to keep endorsing and reiterating the Public Health message of:

• Keep your distance

• Keep washing your hands

• Isolate for 7 days if you have symptoms (dry cough, fever or reduced taste sense of smell)

• Do not go to work if you have symptoms

Minutes:

The Board had a joint presentation on the Covid-19 response by Somerset County Council, the CCG and Avon and Somerset Police.

Background:

• Health protection is part of the HWBB remit sitting alongside health improvement when considering the health and wellbeing of the population. A key element is preparation and planning for a pandemic as historically we can expect a pandemic every 100 years last one was 1918 Flu pandemic (Spanish Flu). Planning prior to Covid19 was based on a flu pandemic with associated emergency plans and exercises in place.

• The World Health Organisation declared a Public Health Emergency of International Concern 30^th January 2020, and in Somerset the Public Health Incident room was stood up on 11^th February 2020. Once it was established that there was a high circulation of the disease a major incident was declared by the LRF and the system response was set up on 19 February. By March, the Somerset Pandemic Flu Plan was used as the basis for the response.

Response:

The first phase was containment. The concern was to protect capacity within the NHS to cope with expected Winter Pressure. This was achieved by ‘pushing down’ the curve of expected Covid-19 cases needing hospital admission. The second phase was the delay phase. This involved: shielding, lockdown, social distancing and assessing the success against the Government’s ‘5 tests’. The Board heard that the NHS response was to mirror the Public Health response. On 17 March, a major incident was announced, and this resulted in stepping down elective care and a doubling of intensive care facilities. Another step was to scale up digital solutions. Prior to the pandemic, digital consultations represented about 5% of activity while now it is nearer 90% in primary care. The risks at this stage mirrored the national ones: PPE and testing. On 29 April, the Board heard there was a concern that people were staying away from the NHS with serious conditions that needed help, such as strokes and coronary conditions. The message was "Talk before you Walk". Looking forward, the new model for delivering NHS services is to:

· Continue to support Fit for My Future.

· Maximise the experience gathered in relation to digital services with an aim to have ‘digital by default’ while still maintaining the personal relationships. Covid-19 is not a short-term issue, and all the cleaning and social distancing will reduce the capacity of Primary Care services by up to 30%.

· The proposed Integrated Care System (ICS) will operate ‘in shadow’, but the Board was assured that many of the positive steps of the ICS are already advanced. Somerset Adult Social Care has been working very closely with the NHS to help people to move out of Hospital when their clinical needs have been met. The Nightingale Unit in Yeovil (Henford Lodge) has greatly assisted in freeing up capacity. These positive steps will be preserved and enhanced by the ICS.

The Board then heard from the Police perspective. Initially, crime dropped by 30% but there was an increase in demand to enforce the lockdown regulations. This presented a challenge as there were 6,000 reported breaches which had to be explored. These resulted in 118 penalty notices being issued and 15 arrests. Although there had been a national concern about a large increase in domestic abuse as a result of lockdown, so far there has not been a significant change in Somerset. There are reported domestic abuse crimes but in a number not far off the average for this time of year. There is a concern that this might increase once lockdown measures are relaxed. Covid-19 has brought a new threat to police officers, and there is a delay in getting the appropriate guidance and regulation to cover arrangements for custody suits.

The Board was then updated on the co-ordinated and joint activity by district authorities to build community resilience and support vulnerable people. This has taken the form of delivering food to those on the shielded lists, setting up food distribution hubs, and establishing the Coronavirus Helpline. This helpline has taken 3,485 calls, and there have been 1,293 call outs to identified vulnerable people. This close and co-operative work amongst partners has relied on sharing local knowledge to help all those needing emergency support. Requests for food are growing as more people become vulnerable due to recent changes in their financial status. There has been a lot of work to support rough sleepers and to try to get them off the streets due to them being classed as vulnerable. In total, 140 people were taken off the street and given temporary accommodation. This has not been without controversy. The Board was shown a slide that set out the support being given to Somerset in relation to transport and economic recovery activities. These include business grants, business rates reduction and PPE distribution.

Finally, there were slides coving the current position in relation to Covid-19 and the confirmed cases in Somerset. These were broken down into number of cases in care homes, hospitals, and the community. The information was broken down into individual districts in Somerset. The Board was given the priorities for the next phase:

• To supress the spread of Covid-19 within Somerset

• To reduce the overall prevalence of Covid-19 being transmitted in Somerset

• To ensure health & social care capacity meets Covid-19 needs

• To monitor and actively co-ordinate services within and across organisational boundaries in Somerset, and to maximise and make best use of available capacity to meet the needs of the population

• To monitor and, where possible, mitigate longer term impact of Covid-19 on health, wellbeing and inequalities in defined population groups, e.g., children and young people as well as the elderly

• To preserve life

The Somerset Health and Wellbeing Board were then invited to comment on the proposed priorities:

• Communications - Reinforcement of shielding and containment messages, appropriate use of services, reassurance messages across all population groups

• Promotion of good health and wellbeing (physical and mental health) - Promotion of good physical and mental health during pandemic across all population groups

• Support to Shielding Vulnerable & Isolating People - Food, medicines, mental health support, etc

• Support to Residential Settings - Proactive infection control, care home flow, resilient markets, testing

• System-wide Infection Prevention and Control Measures - Advice for all aspects of the system, proactively and reactively

• Personal Protective Equipment - Ensure effective distribution of PPE and mutual aid

• Staff and Community testing & Contact Tracing - Tracing from confirmed cases Scaling up of staff testing and monitoring of available workforce

• System Flow - Monitoring of flow through the system, including arrangements for death management

• Vaccination Programmes - Flu vaccination and Covid-19 vaccination when ready

• Physical Distancing - Measures to ensure physical distancing: town centres, workplace arrangements, schools and nurseries

To support the discussion, there was a final slide containing a reflection on the successes of the response and a suggestion of good practice that could be carried forward into the Work Programme of the Board:

• Taking good, pragmatic decisions and risks that have delivered significant changes to services and processes in a timely way during the response. It has built momentum which we wouldn’t want to lose.

• Learning from fast paced transformation (looking forwards, not backwards)

• Increased partnership working through the multi-agency cells

• The workforce responding in an amazing way

• Virtual working and the use of technology

• Strong responsive communities – mobilisation and looking after each other

• Rough sleepers’ accommodation

• Increased focus on mental health

• Impact on climate change/active travel

• Lifestyle and associated outcomes for those who have Covid-19, e.g., obesity

The Board discussed the presentation. They praised the good work that has been done and were grateful for some early lessons learned. The first lesson is that things work better when they are joined up, and this has been the focus of the Board for a long time. Data sharing and data flow was recorded as a success. The Board wanted this to continue and to include Parish Councillors in some of the very granular local detail. It was suggested that rather than ‘Digital by Default’, perhaps the focus should be on ‘Digital by Design’. This approach would mean that there would need to be the appropriate thinking behind the decision rather than a simple dogmatic decision. This will ensure that those who would really struggle with digital solutions would be catered for. The Board concluded that they were very proud of the way Somerset as a whole has responded to the pandemic, and this puts the County in a strong position to tackle the next phase.