Wednesday 16 September 2020

Action promised on BAME access to GPs as Brent's Covid19 response comes under scrutiny

Melanie Smith, Brent Director of Public Health, told last night's Community and Wellbeing Scrutiny Committee that during the early months of the Covid19 pandemic many in Brent's BAME community felt disempowered and lacking in agency. Lessons had been learnt and Brent had realised the importance of engaging with the many different BAME communities in Brent and their community leaders. They had concentrated on Alperton and Church End which had the highest number of cases.  Messages had to be consistent and make sense to the communities concerned, for example over shielding in multi-generational households.

Confirming that access to primary healthcare was a major issue, Cllr Abdi Aden, who is of Somali background, said that many in the community who had been feeling sick had problems making appointments with their GP.  They had waited for hours in a queue at the medical centre only to give up and go home without receiving any help.

Cllr Mary Daly backed up the claim. Chair of the Committee, Cllr Ketan Sheth, interjected to say that many in the BAME community still suffered from a poor GP offer.

Dr MC Patel, chair of Brent CCG and NW London NHS lead on inequalities, offered to go with Cllr Aden to the surgery to address the issue of practices not affording access. He said unnecessary denial of access should not be tolerated.  He offered to talk to groups of 5 or so from the community to listen to their experiences and take action. 

Government guidelines recently issued should mean more face to face appointments with GPs rather than on-line arrangements which discriminated against those without internet access or lacking in English language,

Earlier in the discussion the high rate of BAME Covid deaths initially had been attributed to people not going to their GPs early enough. A speaker from Brent Healthwatch said that many residents had been hesitant about going to Northwick Park Hospital and were wary about getting infected there. Cllr Janice Long asked if late admissions to hospital was the cause of the higher death rate in Brent. She pointed out that there was only one medical centre in hard-hit Church End and asked what was being done to encourage people to go to their GP.

Cllr Ahmad Shahzad pointed out the structural issues affecting the BAME community including lack of opportunity and poor housing and said the death toll must not happen again - the Council had to safeguard the population. He said Public Health England and the BMA had been side-lined by the government.

Dr MC Patel said Brent CCG and NW London NHS were looking at devising an additional shielding list for Brent, that would include more people than the government list, and give them appropriate advice. The initial list did not include ethnicity as a factor and experience of the first wave means more needs to be done to include the BAME community, especially those with underlying conditions. Once offered it would be up to the individuals concerned to decide whether to be included in the vulnerable list.

Recently elected councillor, Gaynor Lloyd, said the elephant in the room was whether people would isolate as a consequence of being included in the list. She expressed doubt about a proposal to educate landlords about Covid19 and the risks stating, 'we all know about some landlords.'

 Dr MC Patel said that this was an opportunity for the local authority and health to work together. Joint work and shared commitment were necessary to make things happen and for 'Brent to do it differently.' He cited the response on care homes as being one example of success and said local hospitals had done well.  There was now a clear message to GPs to see patients face to face if that is what they wanted and the CCG were also looking at hot hubs for Covid patients.  It was a matter of 'making the best of what we've got.'

Simon Crawford of NW London Hospital Trust said that the emergency pathway at Northwick Park Hospital was now 85% of the pre-Covid level. Segregated pathways at A&E meant there were clear pathways for non-Covid patients. Presently there were 12 Covid patients in the hospital, a slight increase compared with 8 or so recently.  Patients' temperatures were taken when they first entered the hospital. Patients due for an operation were tested 3 days before the operation was due.  He emphasised, 'We are open for business. If you have an appointment, keep to it!'

He said that Northwick Park had been the busiest hospital in London at the peak and had been supported by other hospitals There had been positive coverage recently and they had been innovative in going with oxygen treatment rather than ventilating machines.  He said that Northwick Park had never run out of oxygen, contrary to reports.

The Trust has signed private sector contracts with Clementine Hospital and the London Clinic. Cancer referrals that had dropped by 50% were now coming back.

Cllr Neal Nerva, recently appointed to the Cabinet as lead member for Public Health, Culture and Leisure, said he was going to introduce a political dimension into the discussion.  Testing had become a matter of private competition and local government had been side-lined. Cllr Shahzad had been right about Public Health England being side-lined and there was also the failings of Test, Track and Trace.

Despite this, he said, the Council could not stand back, too many people were at risk in Brent.  He expressed confidence in the NHS and said people need to be seeking help for non-Covid conditions. The Alperton and Church End meetings showed the need for a wider Brent policy on social distancing and engaging with BAME communities.  Structural issues such as Housing, jobs, co-morbidities, learning for the Covid19 experience, would feed into the Council's new Health and Wellbeing Strategy.

All in all it was a useful discussion, although much more needs to be investigated and acted upon. The trio of councillors, Daly, Long and Lloyd, looked particularly effective as scrutineers.

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