Agenda item

Councillor Janet Burgess, Executive Member Health and Social Care was present for discussion of this item, together with Julie Billett, Director Public Health, Mahnaz Shaukhat, Public Health, and Katherine Willmette, Adult Social Care. Presentations were made to the Committee, copies interleaved

During consideration of the presentation the following main points were made –

·         As of 1 July there had been a cumulative total of 542 laboratory tested confirmed cases in Islington. The number of cases has been declining since mid-April. Islington has had the lowest rate of cumulative COVID cases in London, and the availability of testing has increased, however many suspected cases would not have been tested early on. There were 2 new cases reported  between 20-26 June

·         COVID deaths in Islington – Between 14 March and 19 June there have been a total of 150 COVID related deaths in Islington and an estimated 179 excess deaths. There were 2 deaths reported in Islington between 13 and 19 June. There are no statistically significant differences between COVID mortality rates between men and women in Islington, and there are no clear trends across deprivation areas. In Islington, although the mortality rate is higher in men than women, 154 per 100000 compared to 113 it is not a statistically significant difference

·         As of 31 May 2020, Islington’s age standardised mortality rate due to COVID was higher than the England average, 131 deaths per 100000 population, compared to 82, but similar to the London average 138. Mortality rates in non-COVID and COVID deaths follow a similar pattern across the local deprivation quintiles

·         COVID related deaths peaked in Islington during the week 4 April to 10 April at 42 deaths but has been falling steadily since. 150 deaths in Islington were COVID related, and the majority of all COVID deaths took place in a hospital – 66%. Just over a third of all deaths took place in care homes, and 54% of all hospital deaths of Islington residents related to COVID

·         Disparity of risks and outcomes in COVID – Men are disproportionately affected and the risk of death increases with age. In the NCL region those born in Africa were more likely to die of COVID, 66%, than those born in UK and Europe 51%

·         In terms of Adult Social Care a silver command was established, critical work areas identified, services supported and close working arrangements with other LBI services and partners to ensure support for critical areas

·         4 critical service delivery areas – hospital discharge, in house provision, contracting and brokerage, safeguarding residents. Hospital discharges were managed, priority groups emerged as the crisis developed, partnerships and collaboration were critical, and extensive support to commissioned services required to support care homes and domiciliary care providers

·         Staff in non-critical areas were redeployed

·         PPE – 672K items purchased at a cost of £200k, support to access mutual aid, daily provided briefings and dedicated website, and co-ordination and testing of staff. A number of other measures such as support to recruit staff, parking permits, key worker letters, and a £178k hardship fund uplift on spot purchased beds. Discussion had taken place with providers who face ongoing financial pressures, and collaborative commissioning approach through 1:1 discussions with individual providers

·         Shielders had been identified and contacted, and since the beginning of COVID, all areas of adult social care have been making welfare calls to vulnerable residents known to Adult Social Care, some of whom were also on the shielding list. Vulnerable residents who appear not to be able to understand or manage their own affairs, even with support from a welfare check are referred to a new Adult Social Care Triage service

·         Domiciliary Care – As of w/c 22 June 1231 Islington service users receiving domiciliary care, 20651 hours of care provided per week. Capacity in the market is high and recruitment is not currently an issue. Across all providers there is 3000 hours of capacity in the local market. Testing of staff and service users remains low with only 5 providers indicating that they have conducted testing out of 62 who have completed the ADASSA Market insight tool

·         Providers are reporting that costs of PPE are rising additional financial support has been requested. It is expected the costs of delivery of homecare will rise and it is expected that there will be an additional cost of over £28800 -£37200 per week. This represents an increase of an hourly rate from £18 per hour to nearly £20 per hour

·         Older People – This week no new residents presented as newly COVID positive or symptomatic and no new resident or staff deaths were reported. Staffing levels remain generally stable, and care homes with vacant beds are working to fill these, and demand for placements for hospital discharges is currently limited. LBI continued to supply PPE this week, but only to two OP homes, and supplies provided were lower than recent weeks an similar to pre April 2020 levels

·         There has been a considerable reduction in the overall number of COVID cases reported in OP care homes. Different homes have been affected by COVID differently, with some large outbreaks at some homes at the beginning of the crisis. Since then there have been no comparable outbreaks in any home. After a sharp increase in the number of confirmed and suspected COVID related deaths early in the pandemic during wide scale outbreaks in some homes, over the last 8 weeks the number of new COVID related deaths has stabilised with relatively small numbers of new deaths reported

·         Next steps for care homes – work is going on to increase testing in care home settings, and homes will be able to receive support from commissioners, Public Health etc. and the situation in care homes will be monitored very closely

·         Adult Social Care response and learning – arrangements have been put in place for all teams and services to respond effectively. The Hospital Discharge Service has integrated 3 teams, and staff are working flexibly to ensure people have care on discharge. There is also more outreach into the community. There is an extended working pattern weekends 8-8, with an Emergency Duty Team, Resource Team, Urgent Response Team, and In House services

·         There has been flexible/remote working, fast decision making and reduced processes, focus on welfare of residents, and use of different technology, focus on staff well-being, giving staff professional autonomy, and joint working

·         Challenges – returning services to normal, ensure PPE capacity an adequate staffing, isolation of staff working from home, risk of losing innovative ways of working, maintaining quick turnaround of decisions and less bureaucracy, inability of staff and provider to maintain social distancing/safe working practices, heightened staff anxiety about returning to the new normal

·         Achievements and Learning – outcomes – excellent collaborative working, staff willingness to be flexible and take on new roles, residents appreciation, model of working combining face to face and remote working, processes and pathways streamlined. Learning can be carried forward into the recovery stage

·         In response to a question it was stated that information will be provided in future on the Council website in relation to the pandemic

·         The Chair stated that whilst Islington had recorded a lower number of deaths than many other London Boroughs, L.B.Camden, who Islington shares a Public Health function had fared even better. She enquired the reasons for this. The Director of Public Health stated that this was a complex issue, however it could be down to a number of factors, which would need further more detailed investigation in order to determine the specific reasons involved

·         A Member referred to the fact that some of the poorest countries had coped better with the pandemic than Britain, and had far lower death rates, and the Government should learn from this for any second wave of the virus

·         It was also noted that obesity was an increased factor in deaths from COVID 19, and that is an issue that needs to be addressed in the future

·         In response to a question as to whether there were any details of the deaths of residents per occupation, given that the retail sector had often remained working during the pandemic, and staff had not had protective equipment in many cases, it was stated that the Council did not have data to analyse this effectively at present

·         Reference was also made to the lack of information on deaths by ethnicity, and that discussions had taken place with the Council Registrars to endeavour to get residents relatives to supply this information, in order that data could be gathered in relation to BAME deaths

·         In response to a question, it was stated that work is continuing to take place with care home and domiciliary care providers, in order to ensure there are adequate supplies of PPE, and that there is staff isolation in place where there is a risk of infection. Lessons also need to be learnt from isolated spikes in the virus in Leicester, Kirklees, Blackburn etc. to ensure that this does not happen in Islington, and to look at high risk locations such as housing with multiple occupation, high risk establishments etc. to mitigate any outbreak

·         Katherine Willmette also stated that additional costs had been incurred with PPE in the Adult Social Care/Domiciliary Care sectors, and it is estimated that this would mean an additional cost of £1.5/£2m per annum. It was stated that it is felt that the Council now had a sufficient supply of PPE to cope with any second wave of the virus, however this situation would continue to be monitored

·         It was stated that the deaths in care homes were showing a downward trend, however there had been an impact of families who had not been able to visit care homes to see their relatives

The Chair thanked Councillor Burgess, Julie Billett, Mahnaz Shaukhat and Katherine Willmette for attending