Agenda and minutes

The Chair welcomed board members to the first meeting of the Outbreak Management Advisory Board.

No declarations of interest were made.

The Interim Head of Paid Service, Ian Floyd, presented the draft Terms of Reference contained within the agenda pack.

As the response to Covid-19 continued, the Government had announced the roll-out of the NHS Test and Trace Programme across England, with equivalent programmes being developed across the UK.

As part of this response each council with responsibility for statutory public health functions had been asked to lead the local approach, based around an Outbreak Management Plan.

The Government indicated that the setting up of a local Outbreak Management Advisory Board (OMAB) would be the key way of engaging with councillors and partner agencies.

The Terms of Reference set out the purpose of the OMAB and its function. The decisions of the Board were advisory and any recommendations the Board made would need to be considered through the governance arrangements of the individual organisations represented.

It was acknowledged that the OMAB did not exist in isolation and had links to many programmes of work that were happening at national, regional and local level; these were illustrated in Appendix 1 to the Terms of Reference. Cross-over in membership of the various groups and boards should aid connectivity across the system.

The Outbreak Management Advisory Board noted the Terms of Reference and acknowledged that these might need to change in response to new developments.

The Director of Public Health and the Assistant Director: Public Health gave a presentation which included an overview of the current situation regarding Covid-19 in York; the local epidemiology; the objectives of the NHS Test and Trace programme and the purpose of the Outbreak Control Plan. The slides used were included within the agenda pack.

The local information presented information relating to cases of Covid-19, including numbers of people in hospital with Covid-19, deaths in the city, care home outbreaks and the number of deaths in care homes. This had been plotted against a timeline which illustrated the course of events in the city.

To date there had been 156 Covid-19 related deaths in the city with over half of these being in residential care settings.

The presentation also included some detail on the limitations of data and what it would be helpful to monitor going forwards to understand how the situation is being managed in the city. However, it was important to note that the data did not tell us anything about the rate of infection in the wider community in York.

Looking at the impact in terms of age, gender and deprivation deaths impacted on our older population more in York.  The middle quintile of deprivation had seen the most deaths in York, rather than the lower quintile of deprivation which had been seen nationally.

Nationally there had been much reported on the impact of Covid-19 on the Black, Asian, Ethnic Minority (BAME) groups but we hadn’t been able to do this analysis in York in terms of death as this was not recorded in our mortality details.

There was a question about the fact that ethnicity was not recorded and that it didn’t seem right to dismiss this; was this something that we were going to be recording in the future as we were hearing nationally that ethnic minorities had been disproportionately affected.

It was confirmed that this issue had been raised and escalated to a national level; but at the moment this was how death data was recorded. We would like to be able to access better data at a national level but we could look at what could be done at a local level. We understand that this is important and want to be able to understand the picture more for BAME communities.

The Chair commented that he would like to be able to use this Board as a way of flagging up issues such as what we need in terms of support, information and guidance nationally, such as access to Pillar 2 data more quickly.

The Chair suggested that the Board make representation on this as there did seem to be a gap if you could compare by area, gender and age but not by ethnicity.

The Director of Public Health commented that the NHS Test and Trace Programme was just one strand of an overall approach to managing Covid-19 outbreaks. There was still a role for local authorities and partners to work jointly together to support the overall programme and ensure successful outbreak prevention and management in local areas.

One of the requirements for each local authority area with public health responsibilities was to produce an Outbreak Control Plan.

York had been allocated £733,896 to support this work as its share of £300m Government funding distributed in line with the Public Health Grant.

The overall aim of the Outbreak Control Plan was to provide a framework for the City of York approach to preventing and controlling outbreaks of Covid-19 and reducing the spread of the virus across the city.

There were a number of objectives to help deliver this:-

the first of these was to have a proactive approach to prevent outbreaks by identifying and supporting high risk settings and cohorts. Part of this work was to identify where we may have high risk settings and where there are groups in the population that might be at higher risk from Covid-19. Examples of high risk settings might be care homes; schools; high risk businesses where it is difficult to put in social distancing measures. Examples of groups that are high risk are the BAME population; older people and people with existing long term conditions.

The second was to identify outbreaks early by using local intelligence and responding to the various alerts of suspected cases through the testing system.

York had been successful in its application for a satellite testing site in the city and this will give us capacity for 500 tests a day. This opened up an opportunity to look at wider testing.

There was a third objective around outbreak management, which could include localised closures.

Fourthly, there was continuing the successful work done in York already through the community hubs to support people who needed to self-isolate.

Finally, there was a role for this Board to ensure that we had the right governance arrangements in place so that there was oversight and assurance in relation to the plan.

The Outbreak Control Plan had seven themes:

     i. Care homes and schools

   ii. High risk places, locations and communities

  iii.Local testing capacity

  iv.Contact tracing in complex settings

   v.Data integration

  vi.Vulnerable people

vii.Local Boards.

The Director of Public Health went on to give an overview of the national framework of the 5 pillars of testing and how far these had progressed and were available. The five pillars were:

Pillar 1: NHS swab testing

Pillar 2: Commercial swab testing

Pillar 3: Antibody testing

Pillar 4: Surveillance testing

Pillar 5: Diagnostics: national effort

Finally the presentation covered local testing capacity and capability as well as management and governance structure, the links into different groups across the health and care system and flexibility in terms of response and how long they might need to  ...  view the full minutes text for item 5.

The Assistant Director Public Health, Fiona Phillips, gave an update about the work that had been happening with care homes.  At one point there were 17 York care homes with outbreaks and this had now been reduced to 3.

In practical terms, colleagues in Adult Social Care had daily contact with every residential care home in the city. As part of this, care homes would report on a number of issues, including: whether any of their residents had symptoms; other concerns such as having low stocks of PPE; staff absences and cleaning regimes. This enabled Adult Social Care staff to gain an overall picture of what was happening in each care home and what support might be needed.

The conversations with the care homes had led on to a daily conversation with NHS Vale of York Clinical Commissioning Group (CCG) which then linked into a team that physically went to all care homes to provide support. The public health team were also included in these conversations and using the intelligence gathered they considered issues such as whether whole home testing needed to take place.

There was also a Care Home Gold meeting which took place every morning on the Local Resilience Forum (LRF) footprint which covered North Yorkshire and York. A wide range of partners were involved in this and this is where decisions were made about allocation of resources, such as whether the infection control team needs to visit a certain care setting to offer support.

This worked well and having a single point of access had been very useful. This is the approach we needed to build on for other settings such as schools and work places.

We needed to take a preventative and proactive approach in all settings and use the intelligence gathered to identify early where high risk settings were. Additionally we were building links with colleagues in other teams such as Environmental Health and Health Protection to ensure we were well resourced.

The Head of Communications at City of York Council gave an update on the draft communications plan.

The Communications team had been working on sharing safety messages on the outbreak since it started and there were a number of examples given in the slide pack contained within the agenda papers. These included videos on specific safety aspects such as using face covering and question and answer sessions with senior staff and councillors.

There had also been a ‘Let’s Be Safe’ campaign focused around opening the city in a safe manner which had been positively received.

A number of business packs had been provided free of charge to support businesses to re-open and a further pack would be launched imminently to support the hospitality sector’s re-opening.

The team were also involved in sharing national messages, messages from the Local Resilience Forum and providing updated information to all households in the city.

There were three strategic strands in the communications plan:

Ø    Build advocacy (sharing key public health messages and updates on the current situation in the city)

Ø    Build confidence in the steps taken

Ø    Build engagement through conversation

A comment was made that suggested this was a fundamental shift in communication strategy.  In the past 12 weeks communication had been focused on enforcement; this felt different and was akin to an education campaign around how individuals could take personal responsibility for keeping safe.

There was also a desire for consistent messaging and advice from all partners as we began to see a move away from enforcement to personal responsibility.

The communications plan was noted and agreed as a standing item for future agendas. It was suggested that partner organisations be invited to update the Board on their way of communicating shared messages.

The next meeting was set to be in 3 weeks’ time and would be monthly thereafter. This was subject to requirements, as the Board might convene sooner if necessary. 

There was no other business to discuss.