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Attendance by Reserve Members
To note the attendance at this meeting of any duly appointed Reserve Members.
Reserve Members may attend meetings:-
(i) to take the place of an ordinary Member for whom they are a reserve;
(ii) where the ordinary Member will be absent for the whole of the meeting; and
(iii) the meeting notes at the start of the meeting at the item ‘Reserves’ that the Reserve Member is or will be attending as a reserve;
(iv) if a Reserve Member whose intention to attend has been noted arrives after the commencement of the meeting, then that Reserve Member can only act as a Member from the start of the next item of business on the agenda after his/her arrival.
RESOLVED: To note that there were no Reserve Members in attendance.
Declarations of Interest
To receive declarations of disclosable pecuniary or non pecuniary interests, arising from business to be transacted at this meeting, from:
(a) all Members of the Board;
(b) all other Members present.
RESOLVED: To note that there were no declarations of interests made by Members.
That the minutes of the meeting held on 23 November 2021 be taken as read and signed as a correct record.
RESOLVED: That the minutes of the meeting held on 23 November 2021, be taken as read and signed as a correct record.
To receive any public questions received in accordance with Board Procedure Rule 14.
[The deadline for receipt of public questions is 3.00 pm, 13 January 2022. Questions should be sent to firstname.lastname@example.org
No person may submit more than one question].
The Board received four public questions, which were responded to.
Question 1: "Can you please advise what we need to do for Harrow Council’s support to sponsor or promote the work of Mind Angels Charity for the Health and Wellbeing of Harrow residents?"
Response: Mental Health and wellbeing are important areas of work for the council and especially so since the pandemic began. Our role, as a council, is to identify and address the local health and wellbeing needs of our population. As part of these needs’ assessments, we review the evidence of effectiveness and cost effectiveness of the various options and how they might meet our needs.
Local Authority procurement is a carefully balanced process given the requirements, the resources and the capacity we have. We work as a strong partnership with schools, the voluntary sector and all of our NHS partners to co-produce this evidence based and carefully evaluated programmes. We involve young people in designing or reviewing the programmes themselves.
Over the past few years, we have funded many programmes – probably too many to mention here - but working in such a close partnership has allowed us to gain additional funding to address the health needs. One of the innovative programmes which I’m sure you are aware of is the How are You (or HAY) Harrow programme. The evidence from this programme has allowed us to bid for funding from a variety of sources including private investors.
What we do not get involved in is the initial evaluation of the products of private companies. That is for them to do. Our role is to review the evidence of effectiveness of such products and how they might fit into the programme we are commissioning.
Question 2: “The Bridge has provided valuable support to mental health service users over the years. Since the pandemic services have been online, however I understood there were plans to bring face to face services back. I would like to know what is happening about this, and how Rethink will ensure that all service users are made aware of the current position.”
Response:Rethink have continued to support service users throughout the pandemic virtually. In person, or face-to-face services commenced from 1st December 2021. However, the government restrictions put in place on 28th December 2021 due to the increased number of infections of the Omicron variant meant that Rethink temporarily moved the face-to-face groups to online to keep clients and staff safe due to the increased rate of infection. This will continue until there is a change to the Government’s restrictions.
Rethink’s intention is to deliver the Peer led group with Covid Safe numbers and guidelines when they are able to return to face-to-face groups.
All service users who are receiving an intervention with a support worker have been informed of updates and what provision is available to support them by their support workers.
Rethink are working to establish the following service offer soon:
· a variety of groups hosted from ... view the full minutes text for item 175.
System Response to Covid-19 (Including Vaccination Programme)
The Board received the System Response to Covid-19 Including Vaccination Programme updates.
Rates of the coronavirus (Covid-19) illness were continuing at a high rate in Harrow and other London Boroughs. Harrow currently had the fourth highest rate in London. Although the number of people seriously ill in the latest phase was proportionately lower than previous waves, the numbers being admitted to hospital were increasing.
The current wave of Covid-19 was now affecting care homes in Harrow. A number had outbreaks and were closed to admissions which caused pressure on discharges from hospital. Temporary changes in testing had begun during the week. Anyone that tested positive asymptomatically using an LFD test (lateral flow device) no longer needed to take a confirmatory PCR test. The LFD was a good test for infectious disease. The person should then begin their isolation for up to 10 days. This change may cause a decrease in the rates and numbers as many people do not record the result of their LFD test.
Changes had also been announced for early release from self-isolation. Two consecutive negative LFT taken 24 hours apart after day five would allow early release. Negative tests on day five and day six would allow early release from isolation. If either of the tests were positive, isolation must continue until there are two consecutive negatives or day ten reached.
With high rates in the community and particularly in schools, it was important to follow guidance on wearing masks in enclosed public spaces and on public transport; washing hands and using sanitiser regularly; as well as keeping physical distance from people from external households.
On vaccinations, 73% of Harrow’s population (12+) had had their first doses, 92% of those who had had a first dose had a second dose as well. Seventy-three percent (73%) of those who had had a second dose had their booster dose as well. Harrow had delivered over 461,000 vaccinations to date, 177,000 first doses,163,000 second doses and 120,000 booster doses.
The schools-based vaccination has now recommenced from 10 January 2022 and would focus on those children aged 12-15 years old who were due a second dose. The programme would equally continue to promote and offer first doses. A number of universities would be visited by roving teams over the coming weeks to ensure access was made as easy as possible for students.
The Board inquired what impact vaccine hesitancy was having in care homes settings, and if the third dose had been taken up by both residents and workers.
It was advised that the majority of care home residents and workers had been fully vaccinated. Having a second dose met the definition of fully vaccinated. Booster doses were lower than this and was a struggle. However, there was not a large impact in Harrow of worker losses due to mandating of vaccination in care homes.
RESOLVED: That the updates be noted.
Hospital Response to Covid-19 and Plans for Recovery
The Board received the Hospital Response to Covid-19 and Plans for Recovery updates.
Around 22% of the London North West University Healthcare NHS Trust’s general beds were occupied with patients receiving care related to Covid-19 (around 200 patients). Eighty percent (80%) of the genotyped Covid-19 patients were Omicron patients. Critical Care had expanded to 36 beds across two sites. Around 35% of the beds were occupied by patients receiving care related to Covid-19. The majority of patients in hospital with Covid-19 were unvaccinated.
Absence rates in the workforce had increased to 7% from 4%. Safety huddles helped move staff between wards and service areas to maintain safety and support staff. In addition to parts of the Critical Care and other higher dependency areas, eight wards were converted areas to ‘Red’ areas, meaning they specifically catered for cases of Covid-19. This also reduced the risk of hospital acquired infections.
The elective recovery programme continued to progress despite the current wave of the coronavirus (Covid-19) pandemic. The Trust was working in partnership with the North West London system to align recovery across all in-sector providers.
The process was supporting:
§ increasing virtual/digital solutions to clinic appointments to maintain the national requirement for less than 25% of outpatient activity delivered virtually;
§ prioritisation of admitted waiting lists to support waiting list management;
§ tracking activity against pre Covid-19 baselines;
§ mutual aid for admitted and non-admitted pathways to transfer waiting lists across the sector where clinical suitable and agreed by the patient;
§ reducing long waiting patients monitoring patients waiting over 52 and 104 weeks;
§ operating Central Middlesex Hospital as a non-Covid-19 site to maintain elective flow;
§ maximising capacity using independent sector partnerships for outpatient, diagnostics, and theatre capacity;
§ aligning the Trust’s internal recovery plan to national benchmarking published via the Model Hospital (NHS Improvement); and
§ each year protecting around 100 beds for elective and non-elective surgical care.
The Trust had receipt of CQC re-inspection of Maternity Services (undertaken early November 2021) at NWP on 24 December 2021. The Report noted significant progress – “Inadequate” ratings had been replaced with “Requires Improvement”, with Caring and Effective rated as “Good”. Overall, the Report referred to significant improvement and progress, but noted changes needed to be embedded over time. A presentation of the Report could be done at a future meeting.
RESOLVED: That the updates be noted.
Demand Pressures on Primary and Community Services
The Board received the Demand Pressures on Primary and Community Services update.
All parts of the health and care system in Harrow had been responding to the Level 4 NHS emergency status as a result of the Omicron variant of coronavirus (Covid-19) illness. The system had had to respond to increased demand for urgent care services, the need to support effective discharge from hospital, outbreaks in bed units and offices, as well as much higher-than-normal staff sickness levels.
Business continuity plans were in place across all organisations in advance of moving into the current Level 4 status. Specifically for Primary Care, on 7 December 2021, NHS England and NHS Improvement wrote to all GP Practices regarding temporary changes to the GP contract to support the vaccination programme and defined two key priorities: delivering the accelerated vaccination programme until 31 December 2021; and ensuring to reduce the risk of admission to hospital with general practice looking to maximise on day care and essential proactive care.
On Primary Care Services, it was challenging to balance resources between the urgent needs of patients, the management of long-term conditions, and the vital task of vaccination and public health during the winter. Despite the challenges, primary care remained open and was continuing to serve the needs of the population. In response to accelerating the vaccination programme GP services had to pause some routine work, for example, routine health checks.
As the level of Covid-19 plateaued in London, there were plans to move towards recovery in the next few weeks. The focus across the system would be to bring back to 2019 level of achievement against targets.
Community based services had also been balancing the system of supporting booster vaccinations, managing urgent care, facility hospital discharge and managing core services with high staff sickness levels.
Central and North West London Mental Health and Children's Services were operating as normal, although with significant pressures. CLCH Adult Community Services had enacted their Business Continuity Plan.
It was noted that workforce sickness was showing some signs of improvement in the past week, and the Outer North West London division was now operating at the 6% mark, with 2% being Covid-19 related.
RESOLVED: That the update be noted.
Public Health Ward Profiles
The Board received the Public Health Ward Profiles across Harrow update.
The data depicted population statistics, life expectancy, employment, birth and death rates, dental issues, poverty indicators, as well as educational attainment (at GCSE level), and economic factors.
The Board was informed that the Ward Profiles were being undertaken now as there would be changes to the number of Wards after the Municipal Government Elections in May 2022.
The Board inquired if low birth weight was peculiar among certain ethnicities, and whether that had been factored into the update.
It was advised that low birth weight was the term used to describe babies who were born weighing less than 2,500 grams. This was not confined to ethnicities. However, it was common among some first-generation immigrant communities, where poor maternal health services could have been a contributary factor prior to coming to the UK.
Generally, Asian women had smaller babies. However, a lower-birth-weight baby may be healthy even though they were smaller. The public health team was working to improve the uptake of maternal and early start vitamins and food vouchers to improve maternal nutrition and that of pre-school children.
It was further noted that despite low birthweight, the national Child Measurement Programme data showed that Asian children had higher rates of obesity than average. The work on addressing childhood obesity continued especially as this had worsened during the Covid-19 pandemic.
The Board also asked if there were any language barriers that could be included in the profiles.
It was advised that it was known to be an issue but the data to measure this was more difficult to quantify as it was not gathered routinely.
RESOLVED: That the update be noted.