To receive an update of the position in Trafford and to discuss the boroughs continued response to COVID 19.

The Director of Public Health Stated that Trafford had been steady around 3 cases per day and then from the 17^th July Trafford started to see an increase in the number of cases. The increase was among the younger population including people in their late teens and early twenties with only a couple of cases among people over forty. The teenager numbers had started to reduce but there were still higher levels overall with the highest infection group shifting to people in their thirties and children.

3% of people tested were positive in Trafford up from 1%, which was the national average. Trafford did have a good level of testing compared to other areas and additional testing sites were available. The Director for Public Health told the Committee that there was an app which tracked testing and a link to the app would be shared with the Committee. Despite the increase Trafford was still below the 50 cases per 100,000 people per week and 5% positive rate. While Trafford’s overall numbers were low they were still a concern and were higher than had been projected by national modelling.

The Chair noted that Trafford had been listed in the top 5 areas of concern and the Director of Public Health responded that while Trafford were in the top areas of concern this was due to having an increase from a low base rate. The actual numbers were still relatively low and were not near the levels of the other areas of concern.

Councillor Coggins asked about the exceedance report being in the red zone and what this meant. The director of Public Health responded that the monitoring was based on models on the number of new cases projected. Trafford had been doing well and had gone into red in the last two weeks as they were exceeding the number of cases projected. Leicester, for example, was now green on the exceedance indicator despite them having more cases than Trafford as their numbers were high but reducing. 8 out of 10 of the Greater Manchester Authorities were red on the exceedance indicator and the North West was showing the most areas for concern across the Country. The Director of Public Health added that the demographic spread of cases within Trafford was very different to the other areas of concern.

Councillor Coggins asked whether there was a breakdown of tests by age. ER responded that Trafford did not have that data at the moment but they were asking for that information to be provided. Trafford were testing around 131 people per hundred thousand population per day which was around 2000 people per week.

Councillor Western noted that the increase around younger people linked closely to the reopening of pubs in the area. The Councillor asked if it would be likely that there would be a spike when young people go to university and schools re-opened. The Director of Public Health responded that it was not likely that there would be an increase when schools reopened as most of the increases appeared to be from people socialising rather than school exposure. It was important that Trafford got messaging out to people that the pandemic was not over and to ensure people were following the government guidelines around precautions such as social distancing.

Councillor Barclay asked how the Council could maintain contact tracing among younger people. The Director of Public Health responded that the tracking and tracing was done through the national system and it seemed as though many young people had been contract tracing and asking for tests. At the moment Trafford had not seen many cases of people in the same household but the increase was expected to be seen in the next week or two.

Councillor Lamb agreed about the importance of ensuring that the message that was going out to the public was appropriate and suggested that this could be a recommendation by the Committee.

Councillor Barclay also asked about self-isolation and those returning from Spain. The Director of Public Health responded that the Council would be following the national guidance and supporting all those who were in Spain when the quarantine was put in place.

Councillor Blackburn asked about the residents who were hospitalised. The Director of Public Health responded that there had not been an increase in the hospitalisation yet. The Council had been working with Trafford CCG, MFT, and other partners to support those who had been affected badly by COVID 19.

Councillor Blackburn added that she had seen young people congregating in groups outside and not socially distancing. The Councillor asked whether there was anything that the Council could do about this. The Director of Public Health responded that it was important to have consistent messaging going out to the public regarding the guidelines and asking people to follow them. It was also important that people understood that if they had been socialising that they should then avoid visiting anyone who was at risk or to take necessary precautions when doing so.

Councillor Williams stated that while there had been an increase among the younger population that there had been an excellent level of buy in among young people and it was good that young people were presenting themselves for testing. While it was concerning that young people were being infected it would be more worrying if it was spread among those who were at a greater risk. The Councillor asked that data be added to the dashboard that was being circulated to councillors on the number of hospital admissions so that they could see the levels of more serious cases. The Director of Public Health responded that the data would be added to the dash board for councillors.

The Corporate Director of Children’s Services noted how well the young people had coped with the pandemic and the support that Trafford young people had provided for each other during the pandemic. The Executive Member for Adult Services added that it was important that messaging did not demonise young people and respected the impact the pandemic had on their lives.

The Director of Public Health added that it was important that people did get out of their houses as it was important for their mental health. But it was important that they did so safely.

The Chair asked which areas had seen an increase in positive cases and if extra measures were to be triggered what the process would be. The Director of Public Health responded that it depended on the demographics of the new cases. In last three weeks most cases had been seen in the WA 15, M41, and M33 postcode areas. Trafford had been working with industries to ensure that work places were prepared to prevent the spread of COVID 19. The Public Health team were continually analysing the data to try and work out where contact spreading was occurring and whether it was through workplaces, schools, or social gatherings so that action could be taken.

Councillor Blackburn asked if there was any difference in gestation periods among people of different ages. The Director of Public Health responded that the gestation was around five days on average but it was not known whether there was a difference in gestation period depending on age.

The Corporate Director for Adult Services provided a short verbal update to the Committee before inviting questions. The Committee were informed that Trafford services were starting to re-open although in limited capacity due to social distancing. Trafford were working with Manchester Foundation Trust (MFT) and Manchester Council around capacity modelling for the future. Currently the Council had adequate capacity within services to manage need and social work activity had seen referrals going back to normal levels.

Councillor Winstanley asked about rapid discharge from hospital arrangements and if they would be continued post COVID 19. The Corporate Director for Adult Services responded that the Council had used some of Trafford’s existing providers in addition to Commissioning a service for four months. The service was coming to an end but the Council were looking to remodel homecare and rapid discharge would be built into the Council’s long term model.

Before giving their update the Director of Performance and Quality Improvement, MHCC and Trafford CCG informed the Committee that MFT had 39 inpatients with COVID 19 with 6 in intensive care. At the height of the pandemic it was 474 patients with COVID 19 in MFT hospital beds. The Director of Performance and Quality Improvement, MHCC and Trafford CCG was in attendance to speak about outpatients but was happy to come back to the Committee to discuss the restart of the elective programme in MFT hospitals if the Committee wanted that information.

The Director of Performance and Quality Improvement, MHCC and Trafford CCG  gave a brief overview of the information that had been circulated as part of the agenda including the programme of work that was going on and what was still to be done. When the pandemic started there was guidance to cancel all elective surgery so MFT cancelled 130000 appointments. The Committee were informed of how MFT were working through the pandemic how this had started as an internally focused piece of work but had branched out to include wider partners throughout. During April and May MFT reduced outpatient appointments to just 40% of pre-COVID levels in June this was up to about 60% and they were looking to get to 90-100% by September. However, there was going to be a large backlog of appointments due to the months running at reduced capacity.

The programme was in phase one moving into phase two. Phase one was focused on improving the digital offer to support clinicians and patients. Phase two was about collaboration around referrals and making sure that they went to the right place and were triaged properly. Work was ongoing to check whether routine appointments which had been delayed were still needed.

Performance had deteriorated significantly both locally and nationally during the pandemic with many more patients having over 52 week waits, patients waiting over 18 weeks for routine services, and not delivering on cancer standards. The programme had two prongs the first was looking at different ways of managing activity the second was looking at the best way to handle to backlog of appointments that were cancelled at the start of the pandemic.

Councillor Barclay asked what plans were in place to protect the outpatient recovery plans if there was an increase in COVID 19 patients. The Director of Performance and Quality Improvement, MHCC and Trafford CCG responded that providers were looking to deliver a large amount of their services remotely to reduce the chance of infection and to enable services to be delivered in the event of another outbreak. In terms of their estate MFT had created zoned areas and outpatient areas were green zero COVID 19 case areas. A big concern was that if the number of cases did increase then staff would need to be re allocated to be COVID 19 facing staff. This was a dilemma and modelling had been done to help in such circumstances.

Councillor Winstanley welcomed that there was recognition of inequalities within the response and asked if there was a trade off between recognising a protected characteristic and clinical requirements. The Director of Performance and Quality Improvement, MHCC and Trafford CCG it was something that was an ongoing concern and a meeting was scheduled to address that balance.

Councillor Thompson asked for a brief breakdown of the procedures that had been postponed. The Director of Performance and Quality Improvement, MHCC and Trafford CCG explained that it was all specialties and it was all clinically prioritised routine patients. When they cancelled the procedures they put people into 4 prioritised areas priority 1 (life threatening), priority 2/3 (cancer and urgent), priority 4 (routine) during the pandemic all priority 1 had continued and there had been some priority 2 and 3 but no routine procedures had gone ahead. 

RESOLVED:

1)    That the updates on Health and Social Care be noted.

2)    That data on hospitalisations in Trafford be added to the dash board provided to Trafford Councillors.