Public health leaders recommend Lancashire stays in Tier 3
The Government are expected to review the tier system later today
Last updated 16th Dec 2020
Lancashire’s public health boss has told the county’s council leaders that the region should remain in Tier 3 when the government reviews its Covid controls this week, we can reveal.
It is understood that Dr. Sakthi Karunanithi issued the advice at a meeting of local authority chiefs last Thursday – with the potential effect of the forthcoming relaxation of restrictions over Christmas being among his key concerns.
New figures have also emerged showing high Covid case rates within the over-60s population in Central Lancashire. Chorley, Preston and South Ribble currently have a greater proportion of residents testing positive in this age range than any other part of the county – while Lancashire as a whole is significantly above the national average.
The over-60s measure is one of the criteria on which the government will make its decision over which tiers are to be imposed on an area through until the new year.
Covid-related pressure on hospitals is another major ministerial consideration – with the number of coronavirus inpatients across the county remaining at about the same level as when the government decided to place Lancashire into Tier 3 late last month.
We understand that 13 out of Lancashire’s 15 council leaders nevertheless resolved to ask the government to consider moving some parts of the county down into Tier 2 if the epidemiological evidence should permit it at the time of the review. However, since last week’s meeting, the average case rate for the county has deteriorated slightly.
It is understood that two district leaders wanted Lancashire to be treated uniformly across the board – with one calling for the entire region to move into Tier 2 and another for it to remain collectively in Tier 3.
The standalone council areas of Blackpool and Blackburn have their own separate directors of public health. Blackpool’s Dr. Arif Rajpura has called for the resort to be moved into Tier 2. Blackburn with Darwen Council was approached for comment on its position.
Three weeks ago, Lancashire issued a similar plea to that agreed by most leaders in recent days – once again approved by a majority – for the government to introduce different regulations in districts with differing infection rates at the end of the national lockdown.
It appears that there may now be more flexibility on that front when the tiering system undergoes its first reassessment.
On Monday, emergency changes to the rules in the south of England saw some county areas split into different tiers – and health secretary Matt Hancock told the Commons that the government would consider the “human geographies” of individual areas when making its decisions this week.
The outcome of the review is expected to be announced on Thursday – and only then will it be known whether the latest Lancashire data has persuaded the government that the county is deemed fit for the more nuanced approach to which ministers now appear open.
Dr. Karunanithi – Lancashire County Council’s director of public health – would not be drawn on the discussions at last week’s private leaders’ meeting, nor the advice he provided.
However, he did tell the LDRS of his fears over the potential impact of carefree Christmas festivities on the county’s infection rate. As things stand, up to three households will be permitted to mix during a five-day window beginning on 23rd December.
Dr. Karunanithi said it was important for people to realise that “the virus will not be taking a break over Christmas”.
He warned:
“Christmas relaxations are risky for Lancashire.
“I don’t want to be a killjoy, but I’m not here to be popular – I’m here to protect public health and to provide evidence-based advice.
“My message would be that we need to restrict our mixing as much as possible – we need to shop safely and share Christmas safely with our family members. You certainly don’t want to be sharing the virus with loved ones.
“Christmas is to be celebrated every year for life – not just for 2020."
The LDRS understands that his advice to leaders on the tiering system was based on an assessment of five key questions. In addition to the possible effects of Christmas, these included whether rates had reduced sufficiently – both relative to previous weeks and in absolute terms – and the likely effect on the direction of travel if the county moved into a lower tier.
It is believed to have been concluded that Tier 2 – from the current starting point in the county council area – would, at best, lead to rates remaining stable rather than reducing. However, it is understood that the public health boss is open to Lancashire being split into different tiers as soon as the figures support such a move.
Other factors weighing on his recommendation are understood to have included consideration of the current effectiveness of test and trace and the degree of pressure on the NHS.
The latter is one of the key criteria of the government’s own tier review mechanism – along with case rates in all age groups, case rates in the over-60s, the rate at which cases are rising or falling and the number of positive cases detected as a percentage of tests taken.
The case rate amongst the over-60s is currently exceeding 200 per 100,000 of the population across Central Lancashire, a level thought to be a threshold of concern for the government – standing at 254.4 in Chorley, 213 in Preston and 209.2 in South Ribble in the week to 9th December. It is also just over 200 in Blackburn with Darwen.
The Lancashire average over the same period was 164.6 compared to the figure across England, which was 121.8.
The Lancashire case rate average in the seven days to 11th December is 189.1 per 100,000 people – down from 207 on 26th November, when the last tiering decision was made, but up from the date of last week’s leaders’ meeting, when it was 176.6. The latest England average is 173.3.
The all-age Lancashire case rate average in the seven days to 11th December is 189.1 per 100,000 people – down from 207 on 26th November, when the last tiering decision was made, but up from the date of last week’s leaders’ meeting, when it was 176.6. The latest England average is 173.3.
However, Lancashire’s average case rate has more than halved from late October, when it was nearing 400.
Six districts – Burnley, Chorley, Lancaster, Preston, Ribble Valley and West Lancashire have slightly higher rates in the week to 11th December than they did on the first tier assessment date on 26th November – and every area of the county bar Blackburn has hit a lower figure during that interim period than it has today.
Meanwhile, we understand Covid-related hospitalisations across the whole of Lancashire and South Cumbria are almost unchanged from the position in the penultimate week of November – when one in four people in a hospital bed was a Covid patient, with the total number of coronavirus inpatients hovering around the 700 mark.
It is thought that an agreement for the county’s hospitals to share capacity if necessary might mean areas with lower case numbers may nevertheless need to take a cautious approach to assessing the ability of local NHS services to cope, in case they are called upon for help by a Lancashire neighbour.
Lancashire County Council leader Geoff Driver said he was one of the majority of leaders who backed the call for the government to consider Tier 2 status for any areas of the county where the scientific data supported it.
He said:
“We are saying that we would like the government to consider not treating Lancashire as a whole, but treating separately those parts where infection rates are low. But we recognise that the epidemiology has to permit that."
He also appealed to anybody invited to take an asymptomatic test as part of a targeted testing programme being rolled out in the county to do so – along with those invited to receive a vaccine to take up the offer.
“That is how we’re going to get on top of the virus."
Blackburn with Darwen Council leader Mohammed Khan said that local authority leaders were working “collaboratively” over the ongoing challenge posed by the pandemic.
He said:
“There is a broad level of consensus, albeit with some leaders advocating a different approach to get to what is ultimately the same goal.
“We are seeing significant reduction in infection, which is a testament tot he hard work of people. Any decision on tiering will be made by the government based on the most up-to-date data and public health advice at the time of the decision."
South Ribble Borough Council leader Paul Foster is once again pushing for Lancashire to be moved into Tier 2, having branded the tougher top-tier restrictions “an absolute disaster” when they were announced last month.
He says that the general public will continue to try to reduce the spread of the virus whichever tier they may be in.
Cllr Foster said:
“All that Tier 3 does is single out the hospitality sector, when there is no proof that it is adding to the infection rate – whereas there is a huge amount of evidence that schools are adding to it.
He also said that it was important to “contextualise” data showing that Central Lancashire had the highest Covid infection rates in the over-60s of any part of the county.
“If you were to look at influenza rates in December, I’m sure you’d find that they were high in the older age groups as well.”
However, Preston City Council leader Matthew Brown – himself a staunch critic of the appropriateness and effectiveness of Tier 3 for the city – appeared to accept that a drop down to Tier 2 appeared unlikely before Christmas, as a result of infection rates across the population and in the over-60s in particular.
He said:
“I understand that if this is the case after the government’s review this week, it will come as frustrating news for everyone who has sacrificed so much by living under these restrictions in our fight against the virus.
“I also feel more need to be done to tackle infection rates in settings where they are highest, such as the educational sector, and continue to make appropriate representations which if enacted open the possibility to explore less stringent restrictions in areas comparatively low such as hospitality.
“Now more than ever, it is vital that we take extra precautions to protect ourselves and loved ones and exercise caution over the festive period. Winter is already a tough time for our NHS and any steps we can take to reduce the rate of infection will prevent our hospitals from becoming overwhelmed.
“If we continue to follow the rules and do the basic things like washing our hands, wearing face coverings and giving each other space we will be in a stronger position to be placed into Tier 2 in the New Year."