Coronavirus infection rates and the vaccination programme

Two weeks into the third lockdown, and we’re seeing a reduction in infection rates, as we would expect, some 20-25% inside a week. There’s a clear North-South split in rates, most probably caused by the spread of the more infectious variants from the Birmingham conurbation into South Staffordshire, Cannock Chase and East Staffordshire. Prison outbreaks continue to be a concern. Although there was discussion nationally about greater measures earlier in the week, we believe locally that the key is compliance with the current rules, rather than new, more severe measures.

The more encouraging news is the progress of the vaccination programme.  In addition to the national media covered Lichfield Cathedral centre opening up, the County Council is working with the NHS and Stoke-on-Trent City Council to accelerate the programme. We have submitted a plan to move even faster, and will be presenting it to the national programme director this week. It’s a robust, resilient and deliverable plan to increase the capacity of the programme locally. The quid pro quo from the national programme would be to ‘open up the taps’ as the vaccine supply improves in the coming weeks, and giving us the freedom to operate. 

Although detailed local statistics are hard to pin down in this rapidly moving operation, it’s clear that Staffordshire is already well ahead of the national and regional averages, and of course the UK is well ahead of other countries. Huge efforts are being made to ensure that the four vulnerable cohorts identified as priorities are vaccinated as quickly as possible. This is key when one considers that 88% of Covid deaths are in these four cohorts, and I was told this week by a senior NHS colleague that it’s estimated that one life is saved for every 20 care home residents vaccinated. Although there’s clearly no 100% certainty on the effectiveness of any vaccine, and the immunity takes up to three weeks to build up, one can understand the reasoning that lies behind the pace at which this operation is running, particularly when this week carried the sad news that, on some days, 1,500 deaths were being reported nationally.    

The coronavirus vaccines

Coronavirus continues to cause concern, with infection rates rising across Stoke and Staffordshire. We remain mainly below the England national average, but those areas bordering the Birmingham conurbation are seeing much higher rises than areas such as the Moorlands.  This would suggest that the new variants are spreading rapidly, and the combination of lockdown measures and Test and Trace are more important than ever.

The key focus this week is on accelerating the vaccination programme.  Stoke and Staffordshire are making good progress with the Pfizer vaccine. We have vaccinated 50,900 (of 128,700) of the first four cohorts identified by the Government – over 80’s, care home residents, health and care staff and clinically vulnerable. There’s another 17,000 planned for next week.  There are some areas of excellent practice such as the Stafford Primary Care Network (PCN) setting up its vaccination operation at the County Showground, where we previously ran a food distribution operation and training for iCount volunteers. They are using the large hall and the car parks to allow for a bigger service than would be expected using one of its practices. Consequently, they have vaccinated 4,180 people since the start of the programme, which is a great achievement.

We must, however, plan beyond the current challenges with the Pfizer vaccine, owing to its numbers and complex handling, and focus on full delivery of the Oxford AZ vaccine (and now we can add the Moderna vaccine to that list in the UK). We will need to see a rise from around 1,500 vaccinations per day to well over 10,000 if we are to meet the Government’s targets.  Three factors run in our favour: the Oxford AZ vaccine is more plentiful, The Medicines and Healthcare products Regulatory Agency (MHRA) have been able to reduce the Quality Assurance (QA) process from around 20 days to fpur; and its handling requirements are the same as existing vaccines, such as flu, which means we can expand existing supply chains before creating new ones.

The key to success is for the National level of the NHS to focus on getting the vaccine into the supply chain, and to leave local delivery to those who do it as a matter of course.  We have volunteered the services of Staffordshire County Council, so, all being well, we will be asking colleagues to take part in this vitally important national effort. I’ll keep you updated as we know more.

Happy New Year

Happy New Year to you, your family and your friends. I don’t think many people are sad to see 2020 end. The toll of the pandemic has been unrelenting, both in terms of physical illness and loss of loved ones, but also mental health. It’s not over, and with the more virulent variant now spreading across the country, we are once again in Tier 4. It will be some months before the vaccination programme allows the measures to be lifted.

In Staffordshire County Council, we have managed to maintain a balance in every area for our residents and our colleagues, whether in supporting the vulnerable, maintaining our care homes, supplying personal protective equipment (PPE), supporting our schools, and more. We will continue working closely with communities, partners and individuals.

As importantly, we will plan for the return to normality, and do everything we can to ensure that it happens as quickly as possible. There are some positive experiences and learnings to be taken from our pandemic response, and we will use this to build back better.

The first, and probably most important, task for 2021 is to accelerate the vaccination programme. Two pieces of recent news make a change to how we move forward: the certification of the Oxford AstraZeneca (AZ) vaccine, and the decision to focus on the first injection, leaving the second until 3-4 months after the first, rather than the initial plan of 3 weeks. The AZ vaccine is much more plentiful than the Pfizer version and much easier to handle, as it only needs refrigeration and it can be broken down into smaller batches. The Government has set a target of the end of February for all residents to have had their first injection. That is highly ambitious, and will require a step-change in delivery.  Our task, working with NHS partners, is to achieve it.

In the meantime, please continue to look after yourselves and keep doing an excellent job.

More coronavirus restrictions

The Prime Minister’s announcement of more restrictive measures in response to the new variant of the virus certainly upset the enjoyment of watching Bill Bailey win Strictly. In essence, the new variant, which has been found predominantly in the South-East, is around 70% more transmissible than the previous version, leading to an increase of 0.4 in the R rate. The bottom line is that Tier 3 restrictions in these areas were not resulting in reductions in the infection rate. Indeed, Dr Richard Harling observed last week that the previous assumption that Tier 1 countermeasures resulted in increases, Tier 2 held it steady, and Tier 3 reduced it, were no longer valid. 

Although there is no change to our Tier 3 level in Staffordshire, we are of course included in the reduction in the “Christmas Window”, which will now only be open for Christmas Day, rather than the five days previously planned. I know that this will be bitterly disappointing for those of you who may have made plans to spend the Christmas period with friends and family, but a smaller Christmas really is a safer Christmas this year.

There is no indication yet that the new variant has reached Staffordshire or the Midlands, but the medical evidence suggests that it is detected by the current testing regime, and that it is no more serious an illness than the original version.  I am sure that urgent work is being done to confirm that the various vaccines will continue to be effective against this variant of the virus. 

Meanwhile, the vaccination programme is underway in Staffordshire, and the welcome news is that we appear to be ahead of other regions in terms of vaccinating people.  The first Interim Operating Capability (IOC) – if you will forgive a military planning term – is focused on the difficult-to-handle Pfizer vaccine and targeted at the most at-risk people in our communities – the elderly, care homes residents and health and care workers.  This will, in the New Year, switch to a Full Operating Capability (FOC) when the vaccine can be rolled out to the wider population, making best use of the easier-to-manage AstraZeneca/Oxford vaccines which we expect to be certified for public use by the end of the year.   

I hope that you and your families enjoy a relaxing and healthy Christmas.    

The latest on coronavirus

The coronavirus infection rate continues to drop across Staffordshire, which is encouraging. But as Dr Richard Harling explained to me, isolated outbreaks have a disproportionate effect on statistics the lower the overall infection level. With 825 incidents currently open and being tracked, we are focusing our Lateral Flow Testing (LFT) on the 25 high risk hotspots, where we can have the maximum effect. You will hopefully have seen the successful deployment to Keele University to help their students return home safely.  

In the past few weeks, I’ve shared my thoughts on the continued improvement of our local Test and Trace programme, from how we use data to target local hotspots right through to support and enforcement where people test positive. We now have confirmation that Staffordshire has been selected for the Government’s Community Testing Programme which will see us prioritised within the supply chain for rapid tests and given assistance to develop our programme further. We have recruited, trained, and deployed 63 new rapid testers so far with another 27 in training; it’s a remarkable achievement and we will use the opportunity to the fullest extent that we can.  

The other major activity in the Covid response this week is the start of the Vaccination Programme, and I can certainly understand Matt Hancock’s emotion on camera when he was being interviewed. This is, almost certainly, our ticket out of this emergency, and will be the most important thing that we do in the next six months. We are working with the NHS to support the programme. At the moment, the focus is on the limited supply of the Pfizer vaccine, which requires a carefully managed “pull” supply chain. We are preparing for the greater supply of the easier to handle Oxford vaccine, among others, which will allow a “push” supply chain focused on maximising delivery through trusted places like Staffordshire GP surgeries and pharmacies. 

I will finish this week with something I found uplifting when I was walking in the dark on Friday morning to collect my newspaper.  A minibus taxi was collecting a boy in a wheelchair to take him to school.  Nothing exceptional at all in that observation, but the joy on the boy’s face at going to school, laughing and clapping, along with the happiness on his mother’s and the taxi driver’s faces, made my morning.  We arrange all of those services in Staffordshire County Council, and, while we focus on outcomes and budgets, it’s sometimes worth reminding ourselves why we’re doing this.  I hope you have a good week.    

COVID-19 vaccination and WeTalk

The main headline this week, after the disappointment of being placed in Tier 3 at the end of the national lockdown, is that the COVID-19 vaccination programme will start to roll out across the country from tomorrow (8 December). This is good news, especially for the most vulnerable in our communities, but it presents a significant logistical challenge for the NHS. To begin with, the hub in Staffordshire is at the Royal Stoke hospital and we expect limited supplies of the Pfizer vaccine, which requires special temperature-controlled handing. As more and more vaccination centres come online in the coming weeks and months, I’m keen that we do everything that we can to help with the programme. Nevertheless, it will be some time before the vaccine becomes available to the public at large, so we will not take the foot off the pedal on our outbreak control work and we will continue to encourage residents and businesses to follow the COVID-19 guidelines.

We are continuing to see a drop in Staffordshire’s infection rate, now below 200 per 100,000 across the county. This is an excellent result, given the rate was well above 400 only just over two weeks ago.  Stoke’s rate remains the highest in the West Midlands despite all of the efforts of the City Council, and we remain in close cooperation with them on all major aspects of the response, such as Lateral Flow Testing (LFT) and support to children in receipt of free school meals. 

Another area of development this week is the County Council leading the effort to get Keele University students home safely for Christmas through the use of Lateral Flow Testing (LFT).  Our programme rolling out LFT is developing as we learn by doing, as well as from others’ experience.  

As we approach the end of a very unusual year, can I also give a slight push for WeTalk, our programme to have better conversations between colleagues, about performance, but also more widely about wellbeing, expectations, aspirations and just generally having a conversation. What better time than the run-up to Christmas and the reflections that accompany the end of the year to have a catch-up with members of your team?  If you need a brush-up on the techniques and tools, the video which we made is a good start, as is the WeTalk intranet page which contains all the details.  After a year like this, we’ve all got lots to catch up on, and this year we won’t have the informality of the Christmas party to tell the boss what you really wanted to say!

Staffordshire in Tier 3 and the Spending Review

The main news this week that Staffordshire and Stoke will be placed in Tier 3 when England exits the national lockdown on Wednesday has somewhat eclipsed the progress we’ve made in reducing infection levels across the city and county, a 25% reduction from the peak 10 days ago. The task in the next two weeks is to maintain this progress and make the reduction to Tier 2 at the next decision point a certainty. 

As well as maintaining residents’ compliance, which is a challenge the longer this emergency lasts, we are working to develop our local Test and Trace programme, using Lateral Flow Testing (LFT). This is the technology which gives results in 30 or so minutes, which allows us to move more quickly in pursuit of outbreaks. We have the freedom to create an end-to-end process from intelligence-led targeting of businesses, schools and communities, through testing, contact tracing and testing of contacts, to support and compulsion for those who have a positive diagnosis. We already have around 150 volunteers applying to be testers in our programme, and we will develop the tactics, techniques and procedures as we learn by doing. 

The other big news this week was the Chancellor’s Spending Review on Wednesday.  Obviously, we will have to wait for the full detail, but I’m cautiously optimistic, and happy with the result. For local government, it was a rollover from this financial year and a little bit more in some important areas; there’s a bit more for social care, the potholes fund continues, and there is a mechanism for recouping a proportion of lost council tax. This last piece is very important, given the economic impact on our residents of the pandemic.

Having been careful in our shepherding of resources over many years, and particularly throughout the pandemic, Staffordshire County Council is well-placed to lead the response and recovery for our residents, businesses and communities, and we can do so without having to make difficult and damaging cuts in our activities.  The advantage of this is that we can remain focused on our residents, complete the transformation programmes as planned and stick to our MTFS, safe in the knowledge that it’s working well.  As an old friend used to put it to me, we’ve made our own luck, and now is the time to make the most of it. 

iManage and leadership energies

I thought I might cover something other than Covid this week.  I was fortunate to meet virtually with a group of colleagues on the first workshop of the iManage programme.  You might recall that we agreed at an SLT and WLT session that each member would sponsor a group, and more importantly, take an active role in each of the activities.  I have to say that it was a welcome opportunity to listen to colleagues, discover a new approach to management, and do a little introspection.

Dave Tomkinson of AndPartnership introduced us to the concept of the four energies of leadership: physical, intellectual, emotional and spiritual.  In essence, these are qualities that we all possess in some quantity, and the proportions that we use dictate how we lead and interact with our peers.  The core of his teaching is that, although we have a natural level of these in each of us, we can dial them up and down to suit the situation, within the limits of our approach being credible and genuine.  It got me thinking about how my own approach had evolved over the years, in response to changing environments, the amassing of experience and the evolution of attitudes in society.  For example, a General pointed out to me about 15 years ago that my almost forensic, intellectual approach at that time could be intimidating to those working with me, so I consciously dialled it down. I also dialled down the physical energy and dialled up the emotional energy when I arrived in Staffordshire County Council, as I realised that I was working in a different environment, which needed a different approach. I find it interesting that the Armed Forces have, in the interim, done the same thing in response to the changes in society, with the Sergeant Major of the Armed Forces, Glenn Houghton, speaking openly about mental health; that simply would not have happened a decade ago, but it is very welcome.

The iManage sessions are a real opportunity for all of our managers, and I would really recommend that you make best use of them.  I’d welcome any reflections that you have had as a result of Dave’s sessions and the conversations that follow.

Covid vaccine, virtual events and the US election

I write this entry in the second weekend of the second lockdown, and in the week that we learned that a vaccine for Covid has achieved 90% effectiveness.  The Prime Minister was absolutely right to be cautious in his optimism at the news, as we remain a long way from putting coronavirus behind us.  All that said, we are a step closer to the finish, and Staffordshire County Council is closely engaged in making any vaccination programme a reality for our residents. 

Meanwhile, we are continuing to operate as we have always done, but with so many more events now virtual than before.  This week saw the excellent Dignity in Care Awards take place virtually, with attendees contributing in the chat box, rather than face to face.  I’ve mentioned this event before, in that it is unusual – possibly unique – in celebrating professional as well as voluntary carers.  It has added another string to its bow by going online.  We also had an Informal Cabinet away-day to discuss the Medium Term Financial Strategy (MTFS), which was a hugely useful session in laying out and discussing our options for the years ahead.

Both of these events, and many others, such as the recent Practice Week for our Children’s Services, held entirely virtually, have demonstrated our ability to adapt and overcome these difficulties.  Regular readers will remember my analogy of the pendulum having swung from face to face to virtual, and that it will swing back to some degree; our task is to choose where it stops, making the best of all options.  I’ve asked the Digital Leadership Group to start to consider our preferred choices in the future. Some will return to face to face; some will offer hybrid choices; and some will remain online. Your views count – please let me, or a member of the Group, know what your thoughts are.

I couldn’t finish this entry without a mention of the elections in the United States.  I spent three years living there, and another three working in an American military environment, which taught me that the biggest mistake that Brits make with Americans is thinking that they’re Brits with funny accents.  It really is a different country, and this past fortnight has demonstrated that admirably.  I’m sure they will find a way through it, but the level of Covid infections, hospital admissions and deaths across the US must be a great concern to American public health professionals.   

Tackling coronavirus

I’m writing this on a very unusual Remembrance Sunday, on the 4th day of the second lockdown.  Although this is a very unwelcome turn of events, it’s probably the only viable option given the rise in infection rates through October.  In Staffordshire, we have risen from below the national average to well above it, with outbreaks in a range of settings. The highest source of transmission though is in and between households – between families and friends. We continue to manage outbreaks down with our local version of Track and Trace, but there is really only one way to make a difference, and that is by changing our individual behaviour. Each and everyone one of us has the power to stop the spread of this virus by staying at home where we can, following the guidance around ‘hands, face and space’, isolating and getting tested if we have symptoms. We’ve got just under four weeks to get Staffordshire back on track.

Hopefully, the four-week lockdown will have the desired effect, but there is a real need to think beyond the New Year and work out what our long-term strategy is. One of the many differences with this lockdown is that the public are tired and stressed after eight months of Covid countermeasures, which have affected our lives and livelihoods.  Thankfully, in Staffordshire, we have always treated our residents with respect and trusted in their common sense.  This puts us in a better place in terms of maintaining the consensus that is required to get through what is already shaping up to be a difficult winter.   

What this means for us as colleagues in Staffordshire County Council is that we remain focussed on doing the best for our residents, while looking out for each other and ensuring that we remain well.  We will continue to work hard when we have to, but also take time to relax and decompress when we can.