Minutes:
1. The Cabinet Member for Adult Social Care and Public Health, Mrs C Bell, gave a verbal update on the work of the Kent Resilience Forum (KRF). The KRF had set up a multi-agency Recovery Coordinating Group, to comply with Government guidance, to co-ordinate with partners across Kent and Medway to produce an overall Recovery Strategy. The KRF consisted of several ‘cells’, of which Health and Social Care Recovery was one. Each cell had first to undertake an impact assessment identifying both the negative and positive impacts of the pandemic. A KRF report on 22 June, which was not yet publicly available, had identified strengths, weaknesses, opportunities and threats resulting from COVID-19.
2. The main public health themes identified in the report were:
a) Latent and generated demand, where services had not been available or people had chosen to wait before contacting services, as well as new demand arising from COVID-19. Activity in key services had dropped as some had been stood down during lockdown, but if activity in preventative services were to reduce, the demand for acute services could rise. Some problem areas, for example, domestic abuse and antisocial behaviour, had shown a rise during lockdown, and it was expected that, once the current hold on evictions ended on 23 August, there would be a sudden increase in those at risk of eviction seeking support, all of which was likely to increase the demand for services.
b) Implications for mental health. Several groups appeared to be at risk of adverse mental health outcomes, including those with chronic physical and mental health conditions, those who had lost a family member, those with lower levels of education and those living in outbreak hotspots. Additional factors which appeared to influence mental health status were the duration of the quarantine period and associated financial losses incurred. Demand for mental health services had originally reduced but was already rising to pre-COVID-19 levels, and some cohorts, for example, young people, had already been identified as having extra risk factors.
c) There had been an increase in attempted and actual suicide by young people as well as an increase in mental health concerns in new mothers. People with dementia had experienced some disruption to services, including access to assessments and Deprivation of Liberty Safeguards (DOLs) assessments. Family carers were known to have poorer physical and mental health than the general population and it was expected that the strain of caring during the pandemic would have worsened the situation for many carers. Local housing associations were reporting a significant percentage of the client group exhibiting mental health difficulties and/or substance and alcohol misuse. A lack of coordinated strategic approach to addressing these needs had resulted in varying degrees of response across Kent.
d) Impact on communities - the full impact was not yet understood, and a further impact assessment needed to be undertaken. It was identified that COVID-19 would disproportionately affect different groups within society, including those already living in poverty, those most financially impacted by COVID-19, black and minority ethnic people, those experiencing domestic abuse, family and informal carers, children and adults with learning disabilities, families with children with special educational needs, people with dementia, those already mentally unwell, those experiencing digital poverty and neighbourhoods which had been at the centre of an outbreak.
e) Health inequalities already existed across Kent and Medway, with areas of deprivation most affected. Preventative services had been less accessible and there had been an impact on the physical wellbeing of those already experiencing health inequalities.
f) There was also the likelihood of poor outcomes for those who were obese or smokers. Older vulnerable groups had also experienced different impacts from the wider population, for example, some vulnerable groups like those with dementia or learning disabilities, had had difficulty accessing testing. There was no co-ordinated county-wide testing in place for those accommodated under the rough sleepers initiative. Some children with disabilities had been unable to return to school as they would be unable to follow social distancing guidance, young carers had taken all caring responsibilities as they've been concerned about letting home care workers into their homes, carers had not had access to short breaks or respite care, and some people would have found themselves taking on new caring duties during lockdown. Informal care would significantly reduce the demand on frontline services, and carers needed to be supported to be resilient in case of a second surge. People ineligible for services due to them having no recourse to public funds remained a challenge, and delay in the disabled facilities grant process would delay adaptations to people's homes to allow them to live independently for as long as possible.
3. Positive outcomes were:
a) The impact assessments clearly identified how the workforce had risen to the demands of the pandemic in unprecedented ways and there was significant positive learning for an improved multi-disciplinary team approach.
b) The use of digital technology had been accelerated across many services and people had received support which otherwise simply could not have been provided to them. There was emerging evidence that many people, for example, young people and those accessing mental health services, had found support through technology a very positive experience. Use of technology had created time and offered the opportunity of further efficiency. Partners had come together in far more imaginative ways due to the time created through holding virtual rather than physical meetings.
c) The report also identified positives in terms of partnership working and collaboration. Much of the feedback recognized the approach across partners to come together against COVID-19. Improvements in system communication, trust and an unprecedented swiftness of decision-making, the absence of big set-piece meetings replaced by frequent and purposeful decision-making forums were widely welcomed. There had been a multi-agency approach to communication and partners clearly recognized that technology had enabled much of the agility and decision-making, creating significantly increased availability. There was a plea for ‘digital by default’ for future partnership meetings.
d) The report also identified community resilience. This was a significant positive reason for changing demand due to an increase in individual family or community resilience. Extraordinary community spirit had been shown and had the potential to be sustained through the development of new community models.
e) Forecasting and modelling - the system should analyse, forecast and model demand intelligently across the health and social care system in the short-, medium- and long-term and take account of a possible second wave of infection and the potential for local lockdowns. This work should build on the integrated datasets available to identify people receiving both health and social care services and to take account of the public voice. The report recommended that health and social care services should work together to understand the public view of the impact of the pandemic and how their experience of changes to service delivery could shape new models of care. Consultation and engagement should be linked wherever appropriate to identify and act on priorities identified and a system needed to be prepared for a possible second and further waves of infection and the impact of winter pressure.
4. Quick wins identified were: Digital opportunities, mental health joint commissioning approach, building on volunteer workforce, communication with the public to support self-management and reduce demand, and encouragement of flu vaccinations. Process should be reduced and decision-making at the point closest to the issue enabled.
5. The next stage of work would be to identify critical success factors to achieving recovery.
6. The Chairman thanked Mrs Bell for her detailed update and it was RESOLVED that the update be noted, with thanks. There were no questions.