Agenda item

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6.1.        The Board considered a report seeking approval of the proposed East Sussex Outbreak Control Plan.

6.2.        The Board asked whether the Pillar 2 testing information had not been available in Leicester and whether it is made available for East Sussex Public Health Team within 24 hours.

6.3.        Darrell Gale, Director of Public Health, explained that Leicester’s Public Health Team had started to look at pillar 1 testing and had raised concerns with the centre that had not been heeded. Pillar 2 data was later made available to the local public health team and within a day Matt Hancock declared the local lockdown, as the centre had seen the data at an earlier date and was responding to it. East Sussex Public Health Team (PH) is now getting pillar 2 data usually within 24 hours, although the weekend can cause delays.

6.4.        The Board asked about the reasons for the difference in the number of cases between Hastings and the rest of the county.

6.5.        Darrell Gale explained that Hastings had the second lowest and now, following the addition of pillar 2 data, has the 13th lowest number of infections in England. The pillar 2 data added a number of positive results from the community, care homes and other settings. Hastings and Rother, however, still have a considerably lower infection rate than the rest of the county.

6.6.        Darrell Gale said that PH is working closely with the local universities on an investigation into why Hastings and Rother have a lower infection rate, especially given the higher health inequalities and Black and Minority Ethnic (BAME) population and tendency of these factors to lead to worse outcomes.  Some of the reasons being investigated include the fact the Hastings Borough Council and Rother District Council both cancelled public gatherings sooner than the national lockdown, and the area has poor transport links so was behind the curve in transmission rates when the local moves towards lockdown were made.  The investigation would include direct engagement with communities, including the BAME population.

6.7.        The Board asked whether there is any ethnicity data collected on pillar 2 and if not whether this meant there is no clear understanding of the impact of Covid-19 on BAME.

6.8.        Darrell Gale said he had not seen the most recent figures but it was case that previous tranches of pillar 2 data did not include ethnicity data for local populations or workforce, which are essential for helping to identify the impact of the virus on BAME community. He explained it is possible, however, for the PH to understand the impact on BAME communities via a proxy measure of comparing the postcodes of people with positive results included in pillar 2 data with the known location of BAME populations in the county. 

6.9.        Rob Tolfree, Public Health Consultant, confirmed that the issues with the dataset stem from both how it is collected and how it is distributed locally. Pillar 1 testing by the NHS and Public Health England records the ethnicity of a patient 50% of the time, meaning the information is there but is not cascading down to public health teams. Pillar 2 data is slightly better with some ethnicity data coming through to public health teams, but it is still less than 20%. It is, however, continuing to improve.

6.10.      Louise Ansari, Lay Member (Patient and Public Involvement), NHS East Sussex CCG, explained that the CCG had been undertaking individual risk assessments for BAME staff and has a locally commissioned service which is seeking to identify at risk BAME patients and individually contact them.

6.11.      Jessica Britton assured the Board there was a Sussex-wide plan with senior sign off from all partners containing a coordinated approach towards safeguarding BAME staff and population.

6.12.      The Board asked for confirmation whether there has been any deaths locally of health workers.

6.13.      Darrell Gale said there had been deaths in East Sussex including one employed by East Sussex Healthcare NHS Trust (ESHT). Joe Chadwick-Bell, Chief Operating Officer at ESHT, added that this member of staff had sadly passed early in the pandemic but was not working for the Trust in the weeks before becoming unwell. Other staff have since become very ill with Covid-19 whilst working. The Trust and CCG is offering BAME staff risks assessments and the Trust is complying with them; staff with symptoms are subject to track and trace; and all staff are offered antibody tests, with figures being passed on to PH.

6.14.      The Board asked what communications can be done locally around the local outbreak control plan and how they will be disseminated, including to BAME communities.

6.15.      Darrell Gale said the local outbreak plan is publicised through the HWB but is not meant to be read widely by the public, although it is accessible to those who do wish to read it. There is expected to be further central guidance on how to communicate actions during a local lockdown based on what has been learned during Leicester, including communicating in different languages. Communicating to local populations about new laws and restrictions such as wearing masks in shops is also necessary and the PH is working on how best to do so. He said it was important that organisations send out press releases as a joint effort with clear messages speaking as one voice to avoid confusion. PH releases a public bulletin on available Covid-19 data in East Sussex to stakeholders as a way of informing them and helping them to counteract rumours. The bulletin also contains general messaging on hand washing and face covering which, without a vaccine, remain the best ways to forestall the virus. 

6.16.      The Board asked whether the Public Health Team felt it was fully supported by the Government .

6.17.      Darrell Gale said that this is an unprecedented situation, and everyone was still learning on the job. This meant that whilst there may have been some errors made, everyone has been working on reducing the impact of the virus. Due to the unprecedented nature of the virus, there is regular changes to national guidance that local public health teams must keep on top of, for example, Personal Protective Equipment (PPE) guidance changed 20 times for health and care workers during April. PH is also able to raise quickly concerns when it is not happy about national advice or support via the professional director of public health association and via individual local authorities.

6.18.      The Board asked whether the Public Health Team had sufficient funding to respond adequately to the Covid-19.

6.19.      Darrell Gale explained that the Council had received £2.5m of funding to support outbreak planning with no certainty whether it is a one-off or will be repeated annually. In response to the uncertainty, PH has identified some areas to invest this money but is spending it slowly in case more is not forthcoming. The Team has capacity within its local contract tracing team and will be able to step up and provide contact tracing if asked to.

6.20.      The Board asked whether there is a trend in an increase in the non-Covid related deaths.

6.21.      Darrell Gale said looking at five-year data on normal patterns of death the unexpected numbers of deaths has tailed off in the last few weeks and may now enter a period of fewer deaths than the five year average. This is partly because some lives lost during the peak were people who were frail and in end of life settings that would have died in next few weeks or months.

6.22.      The Board asked about whether the quarterly meetings of HWB are sufficient to enable it to fulfil the role of the engagement board for the East Sussex Outbreak Control Plan.

6.23.      Darrell Gale said that it felt sensible to use existing governance structures to fulfil the requirement for a public-facing board led by council members. The frequency of meetings is driven by the current need and the Board could meet more frequently if needs be, including in response to an urgent need.

6.24.      The Board RESOLVED to:

1) approve the proposed East Sussex Outbreak Control Plan (appendix 1);

2) agree to receive a further report at its September 2020 meeting updating on the development of the Plan and an update on the pandemic response; and

3) request that the weekly Public Health Bulletin is circulated to the HWB.