COVID-19 and vaccine announcements 15 December 2021

Transcript

Mark Lloyd: Good evening everybody. I'm Mark Lloyd, the Chief Executive of the Local Government Association. Big thanks to you all for joining us at very short notice for this important webinar. My apologies that we're running a few minutes late in starting, I was just waiting for our final panellist to transition over from a session with NHS system leaders into this session. She's not just yet made that transition but we're going to make a start and are juggling our running order around to make sure we don't keep you waiting. Let me say a few words by way of introduction, we're joined this afternoon by chief executives, directors of public health and LRF chairs and I'm grateful to you all for carving time out to be with us. Since news of the new variant, step-, news of the new variant, stepping up alert levels, we've been stepping up our alert levels in preparedness for action in local government. Following the Prime Minister's announcement last week we immediately planned to support our communities with the new restrictions but we all recognise that last night's Prime Minister announcement puts us on an entirely different footing. Everyone on this call recognises the new national mission and its importance. We're all stepping up again to work with our NHS partners locally and nationally, news has been pinging all day through my phones, WhatsApp groups, etc., about local resilience fora being stood back up, bringing local partners together to hit the end of December ambition despite the massive operational issues that we face.

We thought it would be helpful to bring together at this point Emily Lawson, who's now appeared on my screen. Great to see you, Emily. The National Director Lead for the Vaccine Deployment Programme who some of us have heard during the last hour talking to NHS colleagues and emphasising the really important role of local government. We also have Tony McArdle here from the UK Health Security Agency but familiar to many of us from his time in local government, so knows life with us very, very well. The President of Solace, Joanne Roney, great to have you here Joanne and, of course, the President of the Association of Directors of Public Health, Jim McManus. Jim, thank you for joining us. Colleagues, we're using Zoom so please spot the Q&A function at the bottom of your screen, use it to raise questions and to upvote questions that you think we most need answering this evening so that we can all crack on with addressing those issues and if we don't know the answers, and frankly we don't know them all yet, we will know what matters most to you so we can work on solving those particular issues as quickly as possible. Unsurprisingly Emily is under very tight time pressures today so let's hear from her first. Emily needs to leave us by 5:30pm so also try and make sure that any questions that need to come Emily's way are dealt with by then. Emily, may I hand over to you, please?

F: Yes, of course, Mark, and thank you very much for having me. I think-, I'm glad you were able to join the other call, because, as you know, local government has been at the heart of the vaccine programme since the very beginning. In fact, I think the first day I joined the programme I did a call with local government, so-, and having Eleanor Kelly as part of the leadership team of the vaccine programme, I think has helped us make sure we're doing the right thing and making the most of your energy and resources and connections with local communities. So, I want to start by thanking everybody on the call for all of the work that your teams have done during the past couple of years of the pandemic, as well as part of the vaccine programme. And, even while we face the new challenge that you just outlined, we should make sure we are relishing the two huge milestones that we had last week. One year since we became the first country to vaccinate people against COVID-19 outside of a clinical trial, and, on the same day, in England alone having delivered 100 million vaccine events. Our booster programme has also led the way globally, we've now vaccinated more than two-thirds of eligible people aged over 40, and have just opened up bookings to those aged 30 and over on the National Booking Service this morning. By tomorrow-, by Wednesday morning, everybody over 18 and over who's eligible will be able to book a booster vaccine through the National Booking Service. We've committed to offer a vaccination to everyone who is eligible by the end of this month. We wouldn't have been able to do any of this without that incredible partnership with local government in every part of the country.

You've provided critical local insight about the different communities that you serve, you've helped us identify and reach the most vulnerable, and your front-line teams have worked closely with NHS staff to ensure that vaccination services were located in the most appropriate places and well-signposted locally. The work your teams has done has helped save, by latest calculation from UKHSA, over 120,000 lives, to narrow long-standing health inequalities in our approach to vaccination, and to take critical pressure off local NHS services, the social care system, and other public services. I've visited vaccination sites and seen with my own eyes the impact of the work that your teams are doing. I'm sure everybody saw the Prime Minister's address to the nation last night with regard to Omicron and other variants, and that, yesterday, the chief medical officers across the UK recommended that the alert level be raised from three to four. You will have heard how scientists are deeply concerned about the new Omicron variant. It spreads far more quickly, meaning that 1,000 cases a day becomes 8,000 cases a day just a week later, and 64,000 cases after a fortnight. The UK Health Security Agency has also warned that two primary doses of vaccine do little to protect against Omicron. Thankfully, we also know that a booster jab dramatically improves protection, preventing more than seven in ten people from contracting and transmitting the virus.

While symptoms of Omicron currently might look to be milder than other variants, CMO has warned that this is really preliminary data from a very small number of cases and we need to know much more from scientists and clinicians before we count on that. But even so, a mild variant that spreads incredibly fast means the next wave of infection could be much bigger than those we've seen before, which could mean, as the Prime Minister said last night, sadly many more deaths. As you know, in the NHS we are redoubling and in every sense of the word our efforts to get jabs in arms and will need your help to support that immediate all out drive to protect the health of the nation. Firstly, we need your advice and intelligence which has been so invaluable in the past. You're the eyes and ears in local communities and we're looking to you to tell us what will maximise uptake in each area. We recognise that every local area has very different challenges in driving booster uptake, in some areas it is an uptake challenge where we just haven't found the right way to engage with the local community to make sure they understand how important this is, in other areas it's capacity. There just aren't enough slots or GPs working at the moment to vaccinate everybody who wants it. But we know-, so, we know that we have to increase the capacity across the country and make sure communities understand how important this is for them and, as we've done throughout this, take the vaccine to the people.

Make sure that those sites are where communities do go and want to go, and that material is available in the languages that they speak and delivered by people that they trust. We expect that walk-in vaccination sites and mobile clinics with dedicated workforce and supplies will be an important part of the mix, alongside additional vaccination centres and thanks to local authorities who have already come forward today suggesting that a particular leisure centre or church hall would be a good place for us to expand the offer. That needs to go alongside GP practices and community pharmacies who are coming on-board or still vaccinating as they have done throughout the pandemic and the extension of opening hours needs to happen at all centres. As before, your expertise in the best way to reach people will be critical. We also need your help delivering vaccinations, where your councils are able to move to an emergency footing you could help by freeing up non-essential work from home staff to support administration and delivery of the programme, recognising workforce in some areas is a rate limiting factor for engagement and that the skills in your teams could have-, could be hugely valuable to the mission.

Similarly, we hope that as it makes sense locally you'll be able to free up civic spaces that could be offered as vaccination sites building on the widespread recognition, the public esteem and the convenience that they bring. We've made similar requests of other public and emergency services such as Fire and Rescue forces and we're also working with national government to identify and repurpose other flagship sites to raise profile and encourage uptake, and that will include, as I mentioned, the sport and leisure centres but also transport hubs, particularly where one area doesn't have much capacity and another does let's make sure we bring people to the vaccine and put the slots at vaccinate-, at transport hubs and also at larger workplaces working with core employers. We need to make sure that we balance all of this focus on volume with equity of access, that's been as you know one of the most important aspects and one of the most valuable aspects of the Vaccine Deployment Programme to date. We need to balance precision with volume. Recognising that different people have different exposures and experiences of healthcare in this country, we must make sure that no individual community or group of people is left behind as we make this universal offer at speed. To ensure equal access we need not just large scale vaccination but also to maintain a focus on outreach into and impact within local communities, particularly in major metropolitan areas where as I speak there are still open slots for tomorrow on the National Booking Service.

Those major metropolitan areas often contain a much wider range of experience and background among their citizens and demand for vaccination has often been lower throughout the last year, so today we've written to every integrated care system asking NHS partners to work with and through their directors of public health and local authority leads to offer mobile and pop-up clinics to ensure a walk-in vaccination centre in every city, town and market town in England. My supply team has, for example, put together today 200 pop-up kits, so that's everything you need to run a pop-up centre, those are ready to go. We need to know where people want them and they can be available at 24 hour's notice. We're asking our ICSs to work with you to support active and locally appropriate community engagement and improvements to accessibility of vaccination services, for example by providing community transport facilities which is already being done in several areas. We know that councils in different tiers have a wealth of experience in brokering or directly providing these services and I think one of the things, Mark, that perhaps it's worth discussing here is the fact that across the country almost all of those things are already happening. So, this is a case of figuring out how do we make sure every system feels able to do this, every system has the local relationships and local connections to make it happen.

I was reflecting on a Twitter account that I follow, which was an extremely positive experience for me this weekend as I was dealing with quite a lot of other stuff but this site-, this account on Twitter was just regularly retweeting all of the brilliant local things that were going on and I was particularly impressed by the Bolton account which was-, which basically was a kind of lesson in how to make sure your community cannot possibly avoid getting a vaccination this weekend. So, buses, GPs, walk-in clinics, community pharmacy, school halls, sites in the marketplace. It was just a huge amount of very locally tailored information and I'm sure there were lots-, were equally much everywhere else that I didn't see. So, thank you for everything you've already done, thank you for what we're going to do together over the next three weeks and I think critically, you know, let me know whatever we can be doing nationally to support those local conversations. Know that what you want in terms of resources locally is absolutely available, if it's funding we can do that through the CCG ICS route that exists. My finance team stands ready to sign off requests for local support and everything that your directors of public health need to ensure their teams have got what it takes to take the community into-, take the vaccine into communities. That's what we're here to do. Over.

Moderator: Emily, thank you ever so much. So, I think you said, if I may Emily, four, four key things. Let me just play back, see if I've got this correct. So, (1) is recognising local government's unique insight into communities and helping to reach harder to reach groups within them. (2) Something about are there locations, facilities, premises that can be better used, whether school halls or leisure centres or whatever it may be. (3) Can we remove barriers to getting to those locations, i.e. transport was the illustration you used and (4) which might be more difficult for people on this call was the issue around staffing resource that can be redeployed away from other activities. So, I deliberately changed your order, Emily, to reflect probably the difficulty in local government. Is that a fair summary?

F: Very, very impressive summary, Mark. Thank you.

Moderator: Okay, Emily. Thank you. So, what I'm going to do, I'm going to just go to Joanne and Jim as chief exec and director of public health, leaders in our fields, just to get a reaction from them and then Tony I'll come to you in a little while on the money issues and the like, okay? So, Joanne first, perhaps.

F: Okay, thanks very much Mark, and thank you Emily, and that was a very succinct run-through. A couple of points from me and I know there's quite a lot of questions in the chat already. I think the first point is to say that we have been here before and we are the people who know our places, and we know our communities and therefore we are the right people to help lead the efforts that need to take place in our localities and so it's good that you've took the time out to talk to us tonight so that we can all start leading the plan of-, to respond to the call to action. A couple of points from me. I think you're going to hear the point about resources raised quite a lot. I think the key priority on the resources are vaccinators. It's the people who are available to actually do the vaccinations that's a real challenge for our primary care networks and for ourselves. So, when we say resources can we separate out a conversation around access to vaccinators versus access to other resources? I would say that the volunteers that we've used extensively through the last two years have come from the voluntary and community sector and anything we could do to give certainty to enable us to continue existing contracts or to commission and contract from the voluntary and community sector would be helpful, particularly important when you talk about reaching into certain communities. We know there are organisations better than us that can reach certain people, so anything that we can do around certainty of commissioning to engage them would be helpful.

I think the third point from me is the speed of decisions that are required, so absolute clarity that in our localities we'll probably all be working through our LRFs but where we identify mass vaccination sites and we want to galvanise and we want to move, I think there is a need to make sure that we've got clarity of decision making and speed of decision making back to government for approvals to proceed, particularly in that three week window. The, the challenge to formally stand up a mass vaccination site and to deploy resources to that is not an easy one for us, working through our LRFs is crucial but it does mean pulling people off other duties for this national emergency and that's why the LRFs are important and it gives us cover, I think, around, around what, what we are stopping doing in order to put the effort in to support our NHS colleagues on this call. So, clarity of decision making, speed of decision making and a recognition that we'll work you through our, our local resilience forums. A couple final points from me, one is that costs, I know that we need to get on and do this work but everybody will be asking questions around continuation of COVID funding or new COVID funding that's around. I'll just be parochial for a moment, when we did Operation Eagle which was a bigger scale activity around the Delta variant last year, I think we spent £250,000 in Manchester setting up mass sites, deploying resources and targeting communities.

So, you know, this isn't about a few bits of money, it's, it's, it's a scale for a number of places. Final points, students, particularly our overseas students and an urgent call for clarity around which vaccinations from overseas we are considering or counting because there's quite a lot of confusion. If I say I've got 40,000 Chinese students in Manchester, they don't know whether they're eligible or not so clarity as soon as we can please for overseas vaccinations. And finally that clarity around walk-in as opposed to appointments. We have variable messages I think around that from some ICSs so-, and I think that's partly from today's NHS website, difficulty. I think we do-, our primary job in supporting you as leaders is to help with the comms message and to ensure that the clarity of the information reaches all parts of our communities, so anything we can do to make it simple around walk-ins versus appointments, or anything else that we can do on a local level I think would be incredibly helpful and that's particularly true around the anxiety for schools. If I was to say there's anything it's probably the schools and the position of schools. But alongside all of that, as I've said, lots of good practice in local government. Our ability to galvanise at pace is well-known but we do need to get that clarity of energy with government around the speed of response so-, but thank you, hope that was useful, Emily.

Moderator: Joanne, that's brilliant. Thank you. I'm going to go to Jim. Jim, if you could make key points I think it's important to make while Emily is here because we're going to lose her in about seven or eight minute's time and I want to give Emily a chance to come back and to address the questions that are coming in from colleagues that she thinks are the, the most-, the ones that she needs to address the most. So, Emily, if you could take a peep at the Zoom Q&A section as well as Jim is talking, that would really help. Jim, over to you.

M: So, I'll be very brief and won't repeat anything Joanne said. Hi Emily, it's nice to see you again. Three points I guess, firstly please use the local SCG because actually when we did that in Wave One what we saw from the success for the area was that the, the tremendous NHS capabilities matched with the capabilities of other agencies actually really shone through at the best when we had a team of teams, so we're keen. I think secondly there's about eleven things that local authorities could do from the offer that directors of public health have collated. I've put them in chat, they're also on slides which we're happy to send (ph 19.36), although Joanne's list is even more extensive. And I think the third thing is there are things that directors of public health can do nested in local government around inequalities in access and uptake that we're really keen to help you with. So, I, I think you've got a massive system that is really keen to stand absolutely shoulder-to-shoulder with you and I think the best thing to do is go through local SCGs because they are the core-, the multi-agency local coordinators par excellence and local government knows how to-, how to use them because we have largely set them up. I'll stop there for the sake of time, Mark, if I may.

Moderator: Jim, that's excellent. Thank you. Emily, keen to come back to you. Any reaction to what you've heard from Joanne, Jim and the top questions that are popping up where they're in your, your responsibilities?

F: Yes, thank you for saying that because some of them aren't and apologies, I can only join from an iPad because the NHS computer doesn't like Zoom and if I have the questions up I can't see any of you so forgive me if I look like I'm looking in weird places right now. So, I mean, a couple of really specific things Joanne with reference to your Chinese students, there are two options for them. The first is if the vaccine has already been uploaded, i.e. it's registered by the UK government they should now be able to book on the NBS. I don't think Sinovac is on that list at the moment but what we've launched and there should be communications on the NHS website but I'll make-, go and make it's really clear and signposted, we have a specific set of vaccination centres, and I'm pretty sure one is in Manchester, where they can attend with evidence of their vaccination and it will just be manually checked, whatever their card is or, or their medical record and then they can receive a booster and the NHS Digital team is obviously working to approve all WHO vaccines but it will just take time to get them all on the system, so in the short-term if it's not already on the list they can go to a specific centre and I'll make sure that's signposted. It's a good question. The-, there's quite a lot on the costs. I did have a discussion with my team about this over the weekend because obviously we don't have time to mess around, as you discussed. We're doing several different things, one is working with Treasury to get additional cover for this part of the vaccination programme. They've been incredibly helpful.

That will include some additional funding for staff and that kind of thing, which as soon as we have clarity we will-, we will talk about. The second is the existing funding route via CCGs and ICSs to the national programme. We've made a commitment that those requests will be cleared in 24 hours so long as there is clear evidence of, you know, being directed towards the vaccination programme and I've asked to make sure that assurance is obviously clear given it's tax payer money but, but, you know, at the appropriate level given the speed of the challenge and they've assured me that they're, they're confident they've got that in place and I said to ICS leaders yesterday, you know, if you're-, if you're not making us sweat you're not trying hard enough, so this is-, this is not the time to hold back. If you know what's going to work for your community, tell us the resources that you need to make that happen and if it's within the vaccination programme's budget I will clear it. If it is something that where there is DLUHC existing funding for that we'll work with, with DLUHC to make sure it's cleared through that route and, and, you know, the team there, Catherine Francis has been incredibly helpful today on that. So, I, I think push us to get it done rather than, than, than hold back on the request and that relates to the speed of decision making as well.

So, you've heard me say that about finance and I can see several questions and I'll open the Q&A up in a second again on sign-off for sites, so we did simplify the process for pharmacies twice in the last six weeks since I re-joined the programme and I know Caroline Temmink who leads the planning team has done that again over the weekend. There do need to be some safety considerations in community pharmacy but I will make sure that process has been updated and is clear. Mass vac sites are harder, so if you're thinking about this in your system I think we've got three options to get it done fast, (1) is to set it up as a mass vac site now and that will take I think realistically probably until next week to get cleared. The second is to basically set it up as a satellite of an existing site, so that means we can use the OGGD (ph 23.54) code from the existing site to parent it and therefore the tech and everything and the recording of events is easier. The third is if the site was previously vaccinating and you've stood it down, we can reactivate it in 48 hours. So, let's get creative and what I want to do is to put the site where your communities need them, so again get the request in via the ICS, via the regional team and, and my, my brilliant NHS Digital team will work really hard. They're going to run daily uploads onto the national booking system to get sites approved, so.

Shall I-, let me just look at the Q&A, Mark, to make sure. So, workforce, we have since we reignited the campaign with the Royal Voluntary Service last week had 13,000 new volunteers register and 4,500 people registered to learn how to vaccinate via the St John Ambulance piece. The challenge I think everybody's got with workforce is you can have a lot of people in one place and nobody anywhere else. We have today spoken to all government departments and already had I think nearly 10,000 civil servants volunteer to either train as vaccinators or stewards and we made it very clear in that offer that we're going to ask people to travel and, again, working with Treasury to, to think about their travel and expenses while they're moving. And we are going to push workforce to community pharmacy and primary care who have previously not really drawn down on the offer, so I can imagine it is, you know, given how tired everybody is at this point quite challenging. I'm hoping that situation will ease during the week but please work with your local lead employer to flag any particular constraints on your workforce and therefore your capacity and I'll work really hard to, to, to push the right workforce to your direction before the end of the week. I mean, really my goal is to make sure by the end of this week we are operating at our max capacity and that's going to take, as I said, effort from all of us to get that done. Mark, is there-, are there any other particular questions that you would like me to answer?

Moderator: Emily, Emily, your, your, your time is about to run up-, run out. So, on the last call I heard you talking about working through the bank holidays to your NHS systems.

F: Yes.

Moderator: Just say that please out loud to the local government community here. What's the plan?

F: So, in order to meet this goal we will need to operate on the Monday 27th and Tuesday 28th as if those are normal working days, so we will make sure that there is a clear bank holiday pay offer and make sure that there is local and, and national communications to make sure that those, you know, if we put the capacity on people are actually going to come and use it. I do notice that some communities have loaded up slots for Christmas Day and Boxing Day and I'm assuming that they've looked at local communities and said, you know, 'These are actually really good slots for us.' The, the PM I have to say is very keen on Boxing Day to make particularly I guess around, sort of, people making shopping trips, etc, so I think that's probably a strong argument. Last year we worked very hard to get people vaccinated on Christmas Day and there, there really wasn't a lot of take up but it may be different this year given the booster campaign but what we can't afford is for the 27th and 28th to be treated as bank holidays. So, we'll put the right support in around that and please let me know if there are any problems. There was one more point actually I saw that I thought I wanted to pick up. Yes, there's, there's a couple of points around, 'Our CCGs told us walk-ins aren't allowed.' I cannot tell you how many times I have said both previously and over this weekend to CCGs that that's not the story, so they're going to get a system letter from me that also says that tonight.

So, can anybody, I mean, Mark and Jim know where I live, if anybody is still getting that message from a CCG can you please send me a personal message and I will pick up the phone and make sure they are clear. I mean, look, walk-ins are not always the right answer but it, it is a really important part of the offer. What we've said to-, and, and the same for, for pop-ups. What, what is really important is that sites feel able to be clear with people and I did put it in the Number Ten communications yesterday that walk-ins are not guaranteed. Just because you have queued for four hours does not mean you are entitled to a vaccination. There has been some really difficult behaviour at front-line sites, so again if you have systems which are struggling with walk-ins I think there is something about training and queue management, you know-, you know, take the Disneyland approach of putting signs up that says, 'If you are here it is a two hour wait,' or alternatively putting somebody at the end of the queue and saying, 'We are not going to have capacity to serve you today,' so there's some better operational management we can support sites with. I do not think every site should offer walk-ins, if you know that a community pharmacy site is flat out I think they should have absolutely the right to say, 'We cannot do walk-ins today.'

Equally there are some communities that we know just won't book, so I think this is a, a question of looking at what your sites can handle, who are your strongest operational managers and making sure on the Grab a Jab site it's clear this site can handle walk-ins and this site is not offering walk-ins and then making sure your site leaders have confidence to be managing that process. Does that pick up that question?

Moderator: Emily, thank you. I know you're gonna have to dial off because you've got other things to do. Can I just say to colleague while Emily is still with us, Emily really is driving this programme nationally so her taking time out today to join us on this day of all days really signals the importance of local government's role in this national mission. So, Emily, we're grateful. There are a ton of questions we've not got to but it means that we can work with your team afterwards to make sure local government has got the answer to things that are troubling them. Emily, good, good luck with the days ahead. We're there with you, thank you.

F: Thank you very much, thank you for having me.

Moderator: Thanks. So, colleagues, now in slightly, slightly slower time now we've tried to cover as much ground as we could with Emily during her brief time with us. Tony, I said I'd come to you on the money issues and you can see they're top of the list, do you want to just expand a little bit on where we're at?

M: Yes, thanks for that, Mark, really appreciated that you'd given me this one. I mean, it was noticeable in, in Emily-, in, in what she said, you know, they have got funds to support this activity in-, through the NHS vaccine programme, and, of course, that is the route that the government decided to, to fund this activity through. It is through the NHS and it is through the vaccine programme which she's leading and, and she was very clear about all of the, the measures she's taking there and she did mention money. So, anything which is a direct-, a direct bill, as it were, to the vaccine rollout programme, really should be directed through a CCG, through your emergent ICSs and should be met in that direction, because that is the right way of doing it. Now, that, that I know is, is easier said than done, and I know colleagues will be slightly sceptical about it. I think that is what you do first of all. If you are finding you've got difficulties with that, you do need to let us know, you need to let Emily know in the first instance, and I think she'll probably clear that one through, but, if not, let us know, let your colleagues in, in DLUHC know as well, because, clearly, that is what's supposed to happen. Let's, let's make sure it does happen.

Now, I know, of course, that the consequential effects on local government of course are greater than simply the stand-up costs of providing facilities or, or staff. I know we're all particularly worried about that and I know DLUHC colleagues are as well. Specifically to the UKHSA responsibilities to make sure you are funded, that is around the COMF. You will know, Mark, and colleagues on the call will know, that we have been in, in discussions with the Treasury on an endless basis on the subject of COMF and all of the aspects of it in recent months. Thing-, the pace is quickening now. We have produced more data to give to Treasury, and Treasury, not unreasonably, want to know what you're going to spend it on, how much it's going to cost. We have been pulling that data together today as best we can, we've been in contact with the LGA, we've been in contact with a number of individual local authorities, we've done some modelling work to try to get clarity about what the ask is. So, we're, we're putting an ask to Treasury for money, not just for the immediate next few days and weeks, but money that will last into next year so that you've got certainty to employ the staff that we know you need to employ, either by recruiting new ones or by retaining people you've got now who are worried about the 31st March deadline. I can't give you an answer yet, because I don't have an answer from the Treasury. All I can do is assure you that all of the arguments that you're making, the points that are being raised in the chat by, by colleagues, are all on our list and we are making that case to Treasury.

I wish I could just tell you that Treasury have just answered the, the email and have responded. I'm not in that position to do that yet. I sincerely hope I will be in that position before the end of the week, certainly it is not for the want of trying and I would make the point, as well, that colleagues in DLUHC, I know Catherine was in, in, in discussions with colleagues in, in Treasury yesterday as well. So, we are pushing from all directions to get an answer to this. I firmly believe you will get an answer. I don't think anybody believes that, that local government should be hung out to dry on this. The government has supported throughout this, this activity whenever it's put it in hand. I think the difficulty here is not the principle of doing it, it's just getting it some sort of quantification out of it. If there's any issue of how it should be routed, it should be routed through COMF on a formulaic basis, as it has been in the past or, or some other way. We know that some authorities ran out of COMF some time ago, we know that some authorities still have a considerable amount of COMF available to them. So, that's, that's an issue that's going to be addressed as well, if not at this particular point but at least in terms of what then would happen should there be, as I sincerely hope there will be, a COMF for next year. So, no answers yet but believe me that the points are well-understood and, and nobody is more frustrated that I can't give you an answer than I am.

Moderator: Tony and I know you-, the Treasury are searching for the evidence base, aren't they? To justify any funding and I know you've got your sleeves rolled up trying to establish that evidence based with DLUHC, with the LGA, with councils directly, so thanks for what you're doing. And in the pre-meet Joanne was talking about some Manchester examples were drawn and we'll keep looking across the country to support that argument. Thanks, Tony. Tony, the other thing that's popping up just to ask you is about testing capacity. How are we looking for LFTs across the country?

M: We, we are fine. There is no shortage of, of lateral flow devices. That is, you know, there are none being sent out today through the home channel, through the, the direct channel simply because there wasn't the time to stand up the necessary capacity there following the very speed announcement the Prime Minister made but there is no shortage overall. You can still get your lateral flow devices from other sources, people can get them from pharmacies, they can get them from various other community sites at schools and so forth, so they, they are plentiful and they will continue to be plentiful and as soon as it's possible to stand back up the home delivery mechanism that will be done, and that will be within I think a matter of days. So, there are no shortages around LFTs. And as far as testing generally is concerned, Mark, I mean, colleagues on the call, chief exec colleagues, if they haven't already had it in the last half-hour, will be getting a letter about targeted (ph 34.22) community testing and the extension of the programme through to the end of March and the-, in fact the expansion of the programme over the next fortnight to do the direct-, sorry. The direct testing of close contacts. So, again, to, to echo Emily's words, you know, we do need local government and we do expect them rightly to stand up and, and, and fill this space. I am confident that you will get recompense for it if you're out of pocket but the priority now has to be to stand up our testing programme over the next fortnight to do all of the necessary testing with the equipment which is available to you and the, the ability to order it has been extended through to Wednesday at five o'clock so you can get your orders in for bulk deliveries of LFTs. So, please keep doing that work in parallel with what's being done on the vaccine programme and we will meet this deadline at the end of the year.

Moderator: Tony, thank you. So, Joanne and Jim, I cut you a little bit short so we could make progress with Emily. You've had a chance to look through the Q&A as well, are there any other further comments you want to come back with? And then Jim I'll come-, then Tony I'll come to you as well. Joanne?

F: I suppose the only thing I'd pick up is there seems to be understandably a, a difference of whether some people are working through their ICSs or their LRFs just to say I guess at one level it doesn't really matter so long as somebody is taking system leadership in your local places to galvanise all parts of the public sector and community response. On a, a personally I would say you really are better off co-joining your ICS and your LRF because this does need a whole place approach, not just a health lens on it. You know, we need to be alongside NHS colleagues doing all of that wraparound support and all of that community engagement. So, I wouldn't wait for your-, to stand up your resilience forums, local government can stand up a resilience forum and can call partners to it and this feels to me that we need to be in that space of treating it as an emergency as we have done previously.

Moderator: Joanne, thanks. Jim?

M: I agree completely. I think we need to run this as a major incident, don't we? Because actually (audio distorts 36.32) everybody together and, again, our NHS has great capabilities but local authorities have great capabilities and we need to see them as complementary. I just wanted to thank Tony for all his efforts on the finance on top of all the other stuff because I think that has moved further in the past couple of weeks again, which I think is really promising, and, and the kind of call for us to move. ADPH has a number of asks and we've prepared some slides which I think-, we're not going to use, Alex is going to kindly send them round but I think their asks are, look, we need to be in this truly together is the first ask. That means that vaccine uptake and equity should be a matter for joint agreement, whether it's ICS and local authority or, or SCG and ICS. I think the second thing is the, the ability of the local system to make joined up decisions was absolutely crucial in the first phase of ruling out the vaccine. That was critical to our success. Director of Public Health advice on equity and access, whether it was acted on best actually reduced the inequity gap because these things always happen with large scale health programmes. You get inequities, that's not a criticism, it just happens by the nature of large scale programmes.

So, I think we need joint decision making on channels and coverage. Investment is a key thing, we do need data granularity to continue so it's great that we're getting the booster data. I would say of course we do need to shift from the short to the long-term but that's beyond today. So, those I think would be my key points going forward from today for us.

Moderator: Jim, thanks. Let's go to Tony. Any final words from you, Tony?

M: I just want to echo I think what everybody is saying. Let's get-, let's get this done. You know, I can't shake off the concern that you all rightly and reasonably have about money, all I can do is say I am confident we will not-, you will not be let down on this. So, let's just get this job done, as Emily said and as Jim and Joanne have, have rightly emphasised, you know, we've got a-, we've got a deadline, let's get on, let's get it done and I, you know, I'll, I'll, I'll be held to account for this, I'm sure, but I am sure that you will be in the right place in terms of the financial support you will get for doing that. Don't let that be a barrier to doing the right thing now.

Moderator: Tony, thank you. So, colleagues, on the call with the NHS system leaders the chief exec of the NHS said, 'Nobody needs persuading about the importance of this new national mission,' and I'm sure that's the case across local government too and as Joanne, Jim and Tony have said, we know that local government will look to play its full role. We are mindful of the constraints that we have on the way that we're operating and the multiple pressures that we face but I think we recognise the importance of protecting our communities as we look at the impact of this new variant. So, thank you for taking time out, 400 of you taking time out at very short notice to join this call with Emily, Joanne, Jim and Tony. Thank you to them but most importantly thanks to you for joining the call and thanks for all that you're going to do in the weeks ahead to hit this new mission. See you all again soon, bye bye.