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

The Chair introduced the item and explained that the Executive Members and Officers had been provided with a series of questions relating to this item. The Executive Members and Officers were to provide answers to those questions before giving Committee Members the opportunity for further questions and discussion. The Chair added that if any questions could not be answered at the meeting information could be sent to Members by email at a later date.

The Executive Member for Health, Wellbeing, and Equalities explained that the Director for Public Health had been working to provide answers to the Committee’s questions. Due to the wide scope of the questions received the Director of Public Health was going to provide written responses to be shared alongside the minutes of the meeting. The Executive Member for Health, Wellbeing, and Equalities then stated that they would be happy to answer any specific questions during the meeting.

The Chair noted that the main areas the Committee were keen to hear about in relation to health and social care were Track Trace and Isolate, the amendments to the Care Act, the impact on mental health services, and the CQC report regarding learning difficulties and autistic spectrum disorder.

The Director of Public Health gave responses to the Committees questions starting with the disproportionate effect of COVID 19 upon the BAME population. The Director of Public Health stated that it was difficult to know whether the position in Greater Manchester reflected the national position as death certificates did not record ethnicity. This meant that cross matching of information need to be conducted in order to build up a picture of the situation within in Greater Manchester and this work was being undertaken.

A paper had been released which looked into the impact of COVID 19 in relation to levels of deprivation which had been linked to higher rates of death from COVID 19.  That paper showed that the situation in Greater Manchester did reflect the national picture. The Director of Public Health had conducted some preliminary work looking at the impact of race by cross referencing deaths by ward against ward profiles and it did look as though the position in Trafford would reflect the National position.

Trafford had been making sure that the services that were being provided such as testing and treatment were being properly followed through to ensure that people were not dying from other treatable illnesses due to the impact of COVID 19 on services. Trafford were working closely with community groups to ensure that the message was reaching everyone within the community and that provisions were in place to facilitate people who needed testing to access it. The Community hubs had been very successful in reaching people and the Council were looking at how they could learn from that success going forward. The Director highlighted the co-design of the hubs which had been a key aspect of their success.

The Director of Public Health then moved on to the question relating to test track, trace, and isolation system. The national system went live on the 28^th May and it was expected to monitor around 80% of cases with the other 20% being more complex cases that would be handled at a regional level. Complex in this case meant those who would be difficult to trace through the national system due to lack of access to web or phone based systems or if it was in a high risk setting e.g. schools or nursing homes. The Greater Manchester System went live on the 8^th June 2020 and while there were some problems the system was continuing to be developed and improved. The Director of Public Health added that by the time a case of COVID 19 was confirmed by the national or regional systems Trafford were often already aware and in the process of dealing with the case.

The Chair asked how many cases had been tracked and traced within Trafford. The Director of Public Health stated that since the national system went live there had been over 100 cases within Trafford and 25 of those had been escalated to Greater Manchester. The majority of the escalated cases had been health care workers or people in care homes. There were a few other cases within the area where they were waiting to receive test results.

Councillor Barclay asked how long was it taking to get test results back, what percentage of the people identified by the tracing had been isolated, what support did Trafford Offer to those who were isolated, and how effective was the system. The Director for public health responded to each question in turn.

Local testing was pillar one and conducted by MFT labs and the Council received those tests back in 24 hours. These were mainly tests done for people in high risk groups, care homes, and Health care workers. The National system was not working as well and Trafford had only recently received pillar two data for the first time since the system was set up in March.

The Council only received figures on the number of people that been traced they did not receive information as to what actions had been taken with those people so did not know how many were self-isolating. It was hoped that this would improve as the Greater Manchester system was fully up and running.

The Director of Public Health stated that at the local level the engagement with cares homes, schools, and health care workers meant that there were good levels of self-isolation.

With regards to the support for those who were self-isolating there was not much support being provided as people were able to be supported by family and friends who were furloughed and working from home but this was likely to become an issue locally and nationally as people started to return to work, especially for low paid residents. The Council were looking to tackle this by supporting communities where this was most likely to be an issue, ensuring that they received testing if they were symptomatic, and that the right support was in place for those who needed to self-isolate.  The Director of Public Health emphasised that it was important that the Council got the right plans in place and that those plans were co-produced with the communities they served.

Councillor Lamb asked about the data gathered through track and trace and whether it was detailed enough to enable professionals to look for correlations between the rates of infection and the levels of lockdown that needed to be in place to keep the number for cases at manageable levels. The Director of Public Health responded that it was hoped that would become the case but the system was not providing the data quickly enough or in enough detail at that point.  As more comprehensive testing programmes were put in place the quality of the data collected would greatly improve as would the applications of that data.

Councillor Barclay asked whether GPs local knowledge and expertise was being drawn into and utilised by the system. The Director of Public Health responded that as people were being told not to visit their GP with COVID 19 symptoms the level of information they could provide was limited. The Council had recently been given access to data gathered from the 111 service which gave a good indication of what was going on within the area as that was the service people used to enquire about and book tests.  

Councillor Coggins asked whether conversations were being held at some level with other countries that had been running similar systems for longer and learning from their experiences. The Director of Public Health answered that this had been happening throughout and one of the main lessons had been that those countries that had outbreaks of similar diseases previously such as SARS were better prepared for the COVID 19 outbreak due to the experience of their populations and governments from those previous outbreaks.

The Executive Member stated that the point about learning from other countries was important. The countries that have done the best have had the most robust tracking and tracing programmes in place which have prevented or reduced the need for lockdown. This showed that tracking and tracing was the way forward and the importance of the work that the Director of Public Health was doing. The Director of Public Health added that tracking and tracing was only possible if the infection rate was kept low enough which was why it was so important for individuals, businesses, and organisations to follow the guidance around handwashing, social distancing etc.

Councillor Barclay asked what size was the team working on Trafford and tracing in Trafford and whether they were coping with the volume of cases they were dealing with. The Director of Public Health responded that in GM most of the tracking and tracing was being done by public health England and GM teams. Trafford was involved in the local hard cases and the team were setting up the programme management and looking at how Trafford link into the GM system. National funding was being made available and Trafford were putting together a plan of how many people they will need to run the system.

The Chair asked if there was anything to add regarding mental health. The Director for Public Health stated that the questions posed by the Committee about mental health were mainly focused upon the services. However, form a Public Health Point of view the Council needed to think about how COVID 19 and the actions taken to deal with it would impact upon the mental health of residents.

The Chair then moved onto the questions based upon Social Care. The Executive Member of Adult Services stated by addressing the question about the easements to the Care Act 2014. The Committee were informed that the government had introduced a number of easements introduced on the 31^st March to respond to the COVID 19 Pandemic and manage the pressures on local authorities to deliver services during that time. The Executive Member wanted to stress just how difficult this time had been upon staff working within health and social care and the impact that the pandemic had across all of the services. The response to the pandemic had seen a truly integrated approach taken by health and social care colleagues over the ten weeks since it began.

Some of the easements meant that Councils no longer had the duty to carry out assessments or reduced the detail of assessments and reduced their duty support carers. The Executive Member for Adults stated that Trafford had not moved from stage one of the easements which meant that in many ways it was business as usual. One of things that Trafford had put in place was an increase in discharge to assess capacity. This had enabled the Council to move people out of hospital much quicker to an alternative setting where detailed assessments can take place which has freed up hospital beds needed for those suffering from COVID 19.

The easements of the care act were time limited and there were a number of checks and balances in place to ensure the easements were only used when necessary. The Executive Member for Adult Services explained the different people and Boards that would be involved if Trafford were to move to the other stages of easements.

Councillor Lloyd asked whether the easements were to be in place for two years and whether the Council were going to have a backlog of assessments once the lockdown was lifted. The Corporate Director of Adult Services responded that it was up to two years with 6 month break clauses which could be used to rescind the amendments by the government. Trafford did not have any backlogs and were able to provide the majority of support digitally but were still having face to face visits where necessary. The main concern was around the levels of staff in care homes if the track and trace required large numbers to self-isolate and Trafford were working closely with providers to be prepared for that.

The Corporate Director of Adults added that the new guidance for hospitals, which came out at the same time as the easements, enabled people to move out of hospital to a home without having a choice of their preferred home.  The patient does still have the opportunity to choose where they go long term but that choice was made once they had been moved to a care setting rather than in a hospital setting. All of the placements were paid through the NHS so no one was being charged and that would stay in place until new guidance was issued.

The Executive Member for Adult Services responded to the groups question about the CQC Report Regarding Learning Difficulty and Autistic Spectrum Disorder. She informed the Committee that people who had learning disabilities were generally at a higher risk and likely to have underlying health conditions. Trafford had done a lot of work around shielding people at higher risk and people in supported living settings had restrictions on who could visit in place. The Executive Member for Adult Services noted the exemplary work of staff in these and other care settings across the borough where some staff had actually moved into the care setting to minimise the risk to residents. The day services the Council usually provided had to close due to lockdown but this put more strain upon family carers. While there was emergency respite facility in place none emergency respite services had also been closed. The Committee were informed that all of the staff members in those services were receiving the same support and equipment as staff in care homes.

The Corporate Director of Adult Services added that five deaths in learning disability services over March and April, which was not necessarily higher than normal. A review was conducted for each person who died as part of the LeDeR process. Nothing of concern had been raised at that stage but more would be known at the end of the review process. The Council were working with providers on a daily basis to reduce the risks for staff. The Corporate Director of Adult Services spoke of the great work that the providers were doing during the unprecedented times.

Councillor Holden asked about the discharge to assess beds and whether testing was in place to stop infection spreading into care homes. The Corporate Director for Adult Services responded that there was an agreement that had been in place since March with MFT that all patients would be tested prior to them being sent to the discharge to assess beds. While this was not perfect it provided reassurance for care homes. The care homes were still isolating those who came from hospital and wearing PPE when working with those residents until it was clear they did not have COVID 19. Testing was also in place for those who were moving from their own home into a care home.  

The Executive Member for Adult Services then addressed the Committee’s question regarding mental health services. The Committee were informed that the Council’s Adult Mental Health Services were operating as usual and they had a daily review of referrals, inpatients, and discharges into the community. The biggest area of concern was around the face to face contacts with people when supposed to be avoiding contact. This had been addressed through providing staff with PPE and training on infection control. There were helplines available across Greater Manchester for those who were known to mental health services and for those who were not engaged with services.

The Executive Member for Adult Services recognised that there was going to be a lot of work to be done after the pandemic as there would be issues around trauma, bereavement, and grief. The situations that had been seen in care homes were very traumatic and the Council had to be ready to provide support to those who had been through that.

The Mental Health transformation Board was being re-established and would be looking at moving away from crisis management to prevention and how to keep communities well and how do people live well at home.

Councillor Williams asked if the Committee hear about work that had already been started before think about the impact of COVID 19. The Councillor was concerned that the usual route into mental health services was through GPs but as GP attendance was down during the pandemic that a lot of people who needed help were not receiving it. Councillor Williams then asked that an update be provided on mental health services at one of the Committee’s upcoming meetings. The Executive Member for Adult Services agreed with the points made by Councillor Williams and agreed to provide an update on mental health services. The Executive Member for Health, Wellbeing, and equalities added that work had already started with GMMH and an update of the progress of that worked would be shared with the Committee in writing.

RESOLVED:

1)    That the responses be noted.

2)    That the Executive Members and Corporate Directors be thanked for attending the meeting.

3)    That written responses to the Public Health questions were to be sent to the Committee when ready.

4)    That an update on mental health services was to be given at one of the Committee’s upcoming meetings.

5)    That a written update on the progress of work by GMMH be share with the Committee.