Part 1: Covid-19 Verbal Epidemiology Update
Part 2: Covid-19 Pressures on Local Hospital Services
Minutes:
5.1 Councillor Kemahli prefaced the discussion by thanking all partners around the table for the excellent collaborative work in tackling Covid-19.
5.2 Russell Styles (Interim Director of Bi-Borough Public Health) gave a commentary on his slides Covid-19 Epidemiology Update that had been circulated at the meeting.
5.3 Mr Styles noted the new UK variant constituted more than 90% of cases in both boroughs and that cases had fallen steadily since early January. In the last two months case rates per 100,000 for both boroughs were consistently among the lowest rates for London boroughs. They were also below the national and regional average.
5.4 RBKC had third lowest, with WCC the sixth lowest. The 7-day case rate varied across London. The 7-day case rate those aged 60 and over, with WCC 320.9 per 100,000, and RBKC was 301.7 per 100,000. Geographical variation was a key feature and rate of decline was not even borough to borough. There was a slow and gradual decline in rates daily and there was a positive indication that rates would continue to fall.
5.5 In response to questions from Members of the Board, Mr Styles added the following points:
(i) Decline was to do with restrictions brought in from January;
(ii) Recommendations would be to slowly ease out of restrictions
(iii) There was excess testing availability in all sites, work was being done to put out communication with regards to utilising testing;
(iv) There was some correlation with testing rates and epidemiology but it was not a direct correlation;
(v) Rates of transmission were currently being explored with this strain.
5.6 Janet Cree (Managing Director of Hammersmith & Fulham CCG) gave an update on the Covid-19 Pressures on Local Hospital Services. There was a five-fold increase in Covid-19 positive patients admitted to hospitals since November across North West London. Just over half of all patients in North West London were positive, with 1500 patients overall and 330 in critical care. Of the positive patients, 60% were aged 65 or over. Covid-19 related 111 calls had increased as well as Covid-19 related staff absence, but there was a reduction, and it was being closely monitored.
5.7 Hospitals in London had all increased general acute beds and community beds and more than doubled critical care beds from 176 to over 350 beds. Acute mental health community trust, 111 and GPs were working together, to understand where the pressures were and act accordingly.
5.8 As a result of pressures around critical care, all non-time critical surgeries were paused to have sufficient staff and beds. Though time-critical surgical patients were still treated equally. To help support, additional beds were acquired from the independent sector and step-down beds in Nightingale for non-Covid-19 patients.
5.9 Both RBKC and WCC primary care hubs were running with extended hours of operating. GP extended access hubs had extended their hours and modified mechanisms for access. There was also a remote monitoring service, with hubs across H&F, WCC and RBKC for looking after patients who required their oxygen levels monitored. Patients who did not need admitting but required monitoring were supported in the community by the respiratory team at Imperial.
5.10 With additional beds and redeployment of staff, there was a concern over the right level of beds and there may have been some occasions where patients had been moved to other parts of the system for support. As a result, the CCG was also able to support other parts of London for receiving transfers.
5.11 It was expected that the pressure in North West London would continue for next few weeks. It was monitored daily and there was some reduction in admissions to hospitals, but this had not yet been reflected in demand required for intensive care beds.
5.12 The level of demand was being constantly monitored as well as continued work with GP surgeries. GPs, community mental health services and most community clinics remained open.
5.13 In response to questions raised, the following points were made:
(i) Time-critical referred to any urgent emergencies that required critical treatment and cancer treatments. Dr Neville Purssell added that this also included operations and diagnostic procedures. Other operations that may be seen as less time critical such as orthopaedic operations may be delayed;
(ii) GP practices were open and operating, with extended hours and access clinics;
(iii) Dr Andrew Steeden noted there was a waiting list on operations which was monitored, every patient was prioritised according to a strict range of guidelines depending on urgency;
(iv) Patients referred by GPs would need to be advised that there were extended waiting times.
5.14 Dominic Conlin provided a brief update on Chelsea and Westminster Hospital. He noted there was a 25% reduction in patients admitted in the last 12 days. Nearly half of patients were either in extended ITU facilities or purpose-built respiratory units. There was not any evidence that the virulence of the virus was reducing. There were high rates of staff sickness which was partly due to increased testing. The decrease in cases was largely due to the lockdown. There was support in the health and wellbeing of staff, as well as psychological support and staff morale remained high.