Personal Thoughts on PPE during the Coronavirus Pandemic

Personal thoughts on PPE during Coronavirus

I have received numerous requests and had many conversations with individuals and organisations about the use of PPE. It is hugely encouraging as a H&S professional to hear enthusiastic debate about such things as PPE being discussed in the wider media and community, however too often people will jump at the possibility of using or issuing PPE as the first option to control a risk, this is wrong. Let me explain why.

There is understandably some confusion about what PPE is and where and when it is to be used and a lack of clear understanding on what we should consider before issuing it. This is in no way a surprise or a criticism of those looking at the issue, there are not many community groups, parish councils or charity’s who have heard of, let alone considered, RPE FFP3 respirators. 

The starting point for identifying any suitable control measures is through a good assessment of the risk, being completed in a structured approach and usually being documented and regularly reviewed. Bearing in mind the minimal understanding we have of the virus and the rapidly changing information coming forwards it is imperative that any risk assessment must be reviewed and updated regularly to keep abreast of any such changes.

Risk Based approach; When thinking about your risk assessment, remember:

• the hazard is anything that may cause harm; these can be hazards to physical health such as chemicals, electricity, working from ladders, an open drawer or to mental health – if, for example the common causes of work-related mental ill health e.g. demands, control and support for individuals are not properly managed in the workplace.
• Clearly the Hazard under consideration here is C-19
• the risk is the chance, high or low, that somebody could be harmed by these and other hazards, together with an indication of how serious the harm could be
• Clearly the current Risk is High in relation to contracting C-19 from face to face contact with others who may be carrying the virus either knowingly or unknowingly and the potential consequence.

Having identified the hazard and ascertained the starting level of risk we would now need to consider how we manage that risk level down to its lowest practicable level in the environment we are considering. We can look at each end of the spectrum here, we could do nothing and leave the whole process down to chance and in the end hope to achieve herd immunity from C-19 or we could isolate every member of society in their homes for 6 months, or longer, to remove the chance of transmission completely. Neither of these are ‘reasonably practicable’ approaches so we must consider the controls we can put in place to reduce the risk to as low as reasonably possible. To do this we should be looking at the controls we might have to hand to protect us, our friends, family, staff, volunteers etc. Remember the hazard C-19, may only be one of the associated hazards to the activity your are assessing e.g. deliveries in your community during the pandemic may involve other hazards such as driving, traffic, slips trips and falls etc.

To control the risks, you should consider:

• Removing the process or activity altogether or change it for a less hazardous process such as removing or reducing social contact to as low as is possible or exchanging cash payments to phone or contactless payments as an example.
• Stop staff, visitors, customers etc accessing the hazardous activity, in this case contact with others. If it is not possible to remove all social contact e.g. in the case of supermarket employees, how can you reduce it to its absolute minimum, in the scenario here you could think about floor markings to enforce the 2m rule, changing processes to remove the need to break the 2m rule i.e. when one person holds a piece of equipment to allow another to access it, could you secure it mechanically removing the second person from the process. If you have situations where people usually come into close contact, such as small areas or rooms, can you limit the number of people entering at one time or place static protective screens in situ. Could you reduce contact by varying shift patterns, split in to two separate teams working at different times as an example.
• Provide employees, volunteers, customers etc with Personal Protective Equipment (PPE). But remember; PPE should only be used as a last resort when all other controls have been exhausted through the application of the hierarchy of controls.
• Ensure you have adequate first-aid and welfare facilities available including soap, water and individual/single use towels.
• Communicate with those at risk and consider their opinions and experience on control measures.

Personal Protective Equipment

When considering the correct PPE for the task and activity being undertaken there are a number of considerations we need to be thinking about. In some cases issuing PPE may actually create greater risks for the person we are trying to protect, so it is critically important that we understand what that piece of PPE is designed and capable of protecting us/them from and to consider what unintended consequences we might be bringing into the equation.

If we think about the known transmission routes of C-19 such as airborne particles or aerosols, being inhaled directly or hand to mouth/face transmission from contact with contaminated surfaces to mouth, nose and eyes we can see how putting things such as face masks or respiratory protective equipment (RPE) on and off our faces when the risk of aerosol transmission is very low, may well increase the risk to the face mask user simply by increasing the likelihood of hand to face contact. Front line staff, in most cases, are being issued with RPE with a face fit protection level 3 (FFP3), this is one the highest standards with FFP1/2 being lower protection. Again if we were to issue the FFP1 RPE the level of protection would be far below the standard required and may increase contamination risks rather than lower them. The risk maybe made greater through a misplaced belief that they are safer and therefore reduce personal social distancing because they have a face mask, albeit an ineffective one.

Face visors are a similar consideration, the updated UK Gov advice on the use of face visors suggest they should be used where aerosol generating procedures (AGP’s) are being conducted such as CPR where forced exhaled air from a patients lungs may produce large aerosols or bodily fluid that could make contact with the face of frontline staff. However if we consider someone working in a busy food takeaway scenario, where by definition most people are not likely to be symptomatic because the majority are following UK Gov advice and placing themselves and their families in isolation when they become symptomatic, they are unlikely to be exposed to AGP’s. Therefore we should consider the potential ‘increased risk’ in issuing face visors in this scenario if we were to issue it without making the decision on a clear risk based assessment. As an example, the risk maybe made greater in this scenario through staff sharing the visors or placing them on contaminated surfaces before use.

Other considerations to bear in mind when thinking about PPE are quality, are they CE Marked, could they cause a greater risk if the PPE is substandard or defective i.e. poorly made goggles that shatter on impact. The maintenance, storage and cleaning of PPE are also important considerations, what processes should be in place to ensure that facially worn PPE is not passed from one user to another either inadvertently or without a suitable and effective decontamination process in place.

Personal Protective Equipment is essential in protecting the health of those at risk but the process in deciding what to use or not to use is not as straight forward as some people I have been speaking with during this awful pandemic believe it is. I hope that this gives an insight into some of the considerations you could be thinking about and discussing with those at risk.

This is not specific guidance on the use of PPE and you should ensure that your risk assessment takes into account all reasonably foreseeable risks and hazards inherent in the activity you are assessing. The information here is only my personal opinion as a H&S professional and is not intended to be specific guidance in preventing any risk from contacting the C-19 virus or any other type of harm. The comment here is solely intended to provide some context around the decision making you might want to consider in preventing the spread of C-19 if you are being asked about providing or using PPE as a control  measure.

The best advice is to stay home, wash your hands for at least 20 seconds with soap and water regularly and maintain social distancing where ever possible.

Stay safe.

Hugo

Sources;

Health & Safety Executive

UK Gov Updated Advice on PPE

BBC PPE Background Info

NOTE; References or information may change and the reader should check for any updates during this rapidly changing pandemic before making any safety critical decisions. 13/04/2020.

Decision Making for Civic Car in Chester

Much is being attempted to be made by the Cheshire West Labour group of the decision and the decision making process that was employed recently when the replacement second car for Chester's Civic team, including the Lord Mayor of Chester, was agreed on.

It might be helpful to put some context in place around the decision and the vehicle finally decided upon.

The decision was made by the executive body who manage the historic roles of Lord Mayor, Deputy Lord Mayor and Sheriff of Chester, the Charter Trustees. This is a group of elected councillors who sit in wards which used to constitute the old Chester City Council.

The lease on the old Vauxhall Insignia expired in 2013 and the Trustees previously agreed that that lease should be renewed on a 6 monthly basis. This was done from 2013 to 2016 and since then it has been leased on a monthly basis. It is without doubt that this current second car requires replacing.

So what considerations were taken in to account by the Trustees? We needed a car that had proven reliability, no undue limitations on distance or range, as minimal an environmental impact as possible, suitable rear seat and cabin room for the Civics', often dressed in full regalia including robes and hats, and a local employment/manufacturer link to the North West.

Clearly the smallest and most economical of the cars on offer are unlikely to be a suitable car for the purpose it is intended for whilst the largest is not going to reduce our impact on the environment as much as we should.

The information below was taken from the report papers presented to the Trustees to aid their decision making. The financial information has been removed for contractual reasons.

The Cost Ranking orders the cars in relation to their total cost, with 10 being the most expensive and 90 the least. The second civic car does limited mileage, rarely over 3000 miles per year.

Taking in to account the user requirements, the environmental impacts and the cost implications the Trustees passed a majority vote in favour of the Jaguar XE. While there is a difference (and one all trustee's were concerned with) of the MPG between the models on offer, over 3000 miles x 3 years the average increased consumption of the XE is = 9 gallons of petrol compared to the hybrids. The difference in the average CO2 emissions of the Toyota's and the Hyundai when compared with the Jaguar XE over the same period and mileage indicate that the XE would emit an additional 2,860 Kg of CO2. To add some context to this, the average human being exhales about 1 Kg of CO2 in 24 hours as part of our normal breathing process.

Taking the costs, the practical requirements, the reliability and local employment links in to consideration the Jaguar XE was voted for, by a clear majority, when the Trustees met on the 2nd of Nov 2017.

One of the key things that I have noted in persuading us all as individuals to reduce our CO2 footprint is the success of encouraging us to consider our impact on the environment when making major purchase or travel decisions. To 'dictate' to others rarely encourages any positive actions. What we must always strive do as an elected body is to balance the impact of our corporate actions with the practicalities of delivering our obligations.

As a keen supporter of environmental improvement programs I am more than happy to be held accountable for my part in this decision making process as I have done exactly that, balanced environmental and cost impacts against the requirements of the asset being procured.

 

Review of Ashton Hayes Theatre Club’s production of Great Expectations by Charles Dickens adapted & directed by Yvette Owen

Review of Ashton Hayes Theatre Club’s production of Great Expectations by Charles Dickens adapted & directed by Yvette Owen

I attended this production of the Dickens’ classic at Tarvin Community Centre on the final Friday of the run. The cast played to a full house in a well laid out seating and staging arrangement.

Yvette Owen’s adaptation is set in the 1920’s with sharp but very effective emphasis on the styles and clothing fashions of the time. We are taken seamlessly through the 80 years that make up Pip’s life reflecting the form of each period throughout the play, of particular interest was the addition of, often vibrant, colour to both men’s and women’s wardrobes of the time.

Though some of the larger than life characters provided opportunities for humour, however 'Great Expectations' is not a bundle of historic fun. It is often poignant, sad and not a little depressing at times. But that is what makes this a compelling story, and the audience on Friday seemed hypnotically engaged by both the story, the music (yes music in a Dickens play) and this meticulously-directed and worthy adaptation of a much loved classic novel. I admit I had reservations about the period setting for the first few scenes of the play, but those quickly passed and I found the story and its setting totally absorbing too.

The play is set in the same Kent countryside and London that that Dickens originally set this, his the thirteenth novel, first published as a serial in Dickens' weekly periodical ‘All the Year Round’, from 1 December 1860 to August 1861. The coming-of-age novel by Charles Dickens was originally set almost one hundred years before our adaption here in the Tarvin Community Centre. The main location, most of us will recall, is Miss Havisham's house where the set is both evocative and impressively detailed with everything encapsulated in time, here we find the remnants of a wedding which never happened and a bitter jilted bride. This set forms the centre piece on stage both literally and from the set design and layout perspective. To the left of stage is the set that Pip’s sister and her husband Joe inhabit as part of Joes’ blacksmiths shop. To the right of the stage is a set more adaptable to hosting the numerous other facets of this stage play. These three distinct areas of set have one thing in common, they are designed and laid out with simplicity but with great attention to detail and reflect the period very effectively, in turn introducing this atypical period setting easily to the audience and embedding it as intrinsic part of this adaptation from the very opening scene.

Phillip Pirrup, nicknamed Pip, played by Charlie Auckland-Lewis (young Pip), Dan Aynsley and Mike Melville (old Pip) is an orphan living with his ‘at best unwelcoming’ sister and her blacksmith husband Joe. Each of the actors brought their own personal touch to Pip’s character, Auckland- Lewis plays an engrossing scene early on in the play alongside Stuart McNeil as Magwitch, Aynsley’s excellence was in bringing the emotional and romantic element of Pip alive and Melville was simply outstanding with his silvery delivery of the narrative as we passed from scene to scene throughout Pip’s 80 years. Melville opens with “The human heart is a wonderful organ. If nurtured the heart has the capacity to bring great happiness to anyone brought under its wing. But mistreat or starve it of love and it may shatter into a thousand pieces and leave a swathe of destruction in its wake.” These opening are scenes set on the Kent marshes and were given authenticity through the cleverly supporting sound effects of curlew calling along with other marsh birds transporting the audience to the very edges of those imaginary reed beds.

Pip’s unplanned and violent meeting with Magwitch is in these opening stages of the play at the graveyard and is significant in as much as the small unsolicited act of kindness in bringing Magwitch some cake is an abiding memory for its recipient.

Pip first encounters Miss Havisham and her adopted daughter Estella, whose beauty and haughtiness is brought alluringly to the audiences attention by Grace Owen’s skillful acting, in the time capsule that is Miss Havisham’s house. She makes no bones about clearly telling Pip that he is coarse and common. However Pip is already in love with her and keen to point out (in a move away from the original) that he has his own expectations of becoming a recognised writer. When a mysterious benefactor allows Pip to move to London and become a gentleman, he hopes to win over Estella and achieve a wealthy, enviable life through his writing. This ambition is a golden thread that weaves though this adaptation very neatly and provides Pip with a little more purpose than in the original novel.

For me the play brought the topics of rural poverty, love and in particular the human approach to our emotions of guilt and forgiveness to the fore, particularly the need to forgive one’s self.

The cast and storytelling were further enhanced by the four well chosen, modern and professionally sung songs at key points of the play. The choristers came from three local choirs and collectively sung beautifully with a well balanced cast of sotto voce and orotund voices. The scene at the society ball supported by the lyrics of Moby’s “Be the One” was very emotive and worked tremendously well for me.

The story progresses through as we would expect with many short scenes delivering as much to the audience of the original novel as you can reasonably expect to get in to an 80 minute play. None were too short I would suggest to those who were familiar to the novel, but may have been for those who were not able to relate it to past exposure to Great Expectations. The second half of the play was trumped by the excellent scene of the revelation of Pip’s benefactor played brilliantly by McNeil, Magwitch loves Pip with a simple heart, and, having had a chance to return to the basic tenderness that was always within him, is able to die with dignity and peace knowing he had done his upmost to repay Pip for his kindness all those years ago in the graveyard.

Meanwhile Pip’s originally unrequited love is beginning to bear fruit as Estella slowly reveals a softer, more affectionate side after all the years of callousness ingrained in to her by Miss Havisham. As Estella realises her true feelings towards Pip, an emotional heart gripping line is delivered by Owen ‘My heart maybe broken in to many pieces but I love him with every single one of those tiny pieces.’ We know now that Pip’s unfaltering love for Estella is finally going to bring the two of them together.

The closing scene of the play is very simple in its design and execution but quite brilliantly pulls each of the raw threads of emotion we have been experiencing as an audience together in a coming to consciousness about the numerous mistakes we are all apt to make within our own lives. Old Pip and old Estella along with young Pip and young Estella both appear as couples centre stage in a warm embrace with each other, succinctly summarising their long and tortuous path of love and despair with just about every other human emotion in between.

The cast of 18 (not including the singers) all delivered their own excellent personal performances to bring each of the characters acutely in to focus and collectively delivered what was an outstanding evening’s entertainment and a very professional performance of an adaptation of a classic novel which should never have worked on paper, let alone the stage. But it did, and did so brilliantly. Maybe this production should make its way to our new theatre ‘The Story House’ in Chester as its next stop!

Reviewed by

Hugo Deynem

17^th March 2017

Household Waste Recycling Centres face reduced opening hours

Regrettably CWaC are reducing the numbers of days that our Household Waste Recycling Centres are opening, I say regrettable set against the context set out below.

Cheshire West Council run by Labour have increased your council tax this week by 4% (despite a highly credible and peer reviewed lower alternative budget put forward by the Tories), over each of their last budgets they have gone for the maximum tax increase they can realistically get away with.
In contrast, the previous Conservative administration implemented over £50m worth of reductions during their administration whilst protecting front line services in every area. It is more than disappointing that the same old Lab mantra of 'tax & spend' persists, even in light of the outstanding example set by the Tories here in CWaC and across many other Conservative run councils of delivering more for less.

Labour here in Cheshire West will have you believe that they are not cutting font line services and continue to deliver an acceptable level of customer service handed over to them by the Tories.

You will see terms in their literature such as:

"We're modernising the Household Waste Centres" or this is
"Your refreshed Household Waste Recycling" service. Centres
They are clearly not maintaining service levels, they are now clearly cutting services by reducing the numbers of days these important sites are open and accessible to residents. The details of the reduced opening hours can be found via the link here:
CWaC Reduces Household Waste Service

Please feel free to share these changes with those you think might be interested or you know use these facilities.

If you would like to be kept up to speed with political and council events that may affect you feel free to drop me an email and I will keep you posted of any interesting or related stories.

hugo.deynem@cheshirewestandchester.gov.uk

Cllr Reggie Jones resigns his Labour Council seat

Cheshire Conservatives will miss the antics of Cllr Reggie Jones from Blacon, who resigned this morning (Fri 3rd of March), hours after supporting Labour to raise Council tax by almost 4%. Had he quit last Friday as planned or even yesterday, residents would be paying a lower council tax

At the budget council meeting last night (Thurs), Cheshire West Conservative Councillors put forward alternative budget plans for 0% change to council tax but were voted down by the Labour Administration to increase council tax by 1.99%, the maximum rise without triggering a borough referendum.

With growing pressures in social care, the Conservatives wanted to see more progress made on established plans to integrate health and care for older and vulnerable residents. Tory proposals for a 3%  rise to the adult social care precept were voted down and set at 2% by Labour. With delayed discharge from hospital running at 13,256 days this year in Cheshire West, Conservatives believe that more can be done locally to help residents and relieve pressures on the NHS.

Proposals to spend less on ICT, buildings and council staff were put forward in a package of measures to keep tax rises down for households, many of whom are just-about-managing on low and fixed incomes.

"We asked Labour to rethink the timing of introducing the local living wage which is set higher than the national living wage that comes in next month" said Neil Sullivan, Handbridge Ward Councillor. " It's really important to think through the implications and who will be paying this higher rate of pay for Council staff. The majority of older residents pay for some or all of their care and this policy will mean higher costs for them, many of whom live on fixed incomes. Low paid workers will be paying higher tax rates to fund higher wages for those in the public sector.

We also wanted to stop the taxpayer picking up the tab for Trade Union representatives as this is unfair when difficult decisions are being made about public services."

“Too many Labour plans had big budgets but no detailed plans “ commented Lynn Riley, leader of the Conservative Group at CWAC. “ the taxpayer shouldn’t be asked to pay higher tax rates to front load huge projects for ICT and new buildings that will take years to deliver, especially when the council budget is £1.5m underspent this year and mot council buildings have empty space“

 

Cllr Jones' resignation leaves a vacancy and a by election on CWaC for his Blacon ward seat. Cllr Jones will also no longer be sitting on the Board of Avenue Services in Blacon, a charity which I also hold a Board position. In light of his resignation the council now has no overall majority as both Lab and the Conservatives have equal numbers of seats. It will be interesting to see how Lab run the program of meetings that deliver our democracy over the next few weeks.

 

If you wish to be kept up to speed with local politics and council events that affect you please send me an email and I will keep you updated.

 

hugo.deynem@cheshirewestandchester.gov.uk

CWaC Parking proposals for Tarvin & Kelsall 2017

I have had a number of enquiries as to what the CWaC Parking Review is recommending for Tarvin and Kelsall. Many will have seen the supporting document that was circulated with the councils consultation document recently, this was an abridged version of the full consultants report.
However there is a more detailed document entitled Cheshire West & Chester Parking Study that is still available in full on the CwaC website, you can read it in full here.
Parking Strategy Review

The two screen shots below are taken from the full document and are the recommendations for both Tarvin & Kelsall.

West Cheshire NHS proposals to stop providing certain treatments

West Cheshire NHS Consultation

 

– On proposals to stop providing certain treatments

The West Cheshire NHS Clinical Commissioning Group has launched a new consultation today which runs until the 17^th of January 2017. They are consulting on which services, if any, it should cease to fund. West Cheshire CCG is consulting whether to cease funding or make available on a more restricted basis the following list of procedures:

• Surgery for the correction of asymmetrical breasts
• Surgery for breast reduction
• Surgery for Gynaecomastia
• Hair removal treatments
• Surgery to remove benign skin lesions
• Desensitising light therapy using UVB or PUVA for PMLE 
• Ear wax removal including microsuction
• In Vitro Fertilisation (IVF) with or without Intracytoplasmic Sperm Injection (ICSI) 
• Surgical Sperm Recovery (Testicular Epididymal Sperm Aspiration (TESA)/Percutaneous  Sperm Aspiration (PESA) including storage where required
• Donor Oocyte Cycle – depending on outcome of consultation relating to IVF
• Donor Sperm Insemination
• Intrauterine Insemination (IUI) unstimulated 
• Sterilisation (male & female)
• Arthroscopy – Shoulder, (document explains includes knees and hips) 
• Dupuytren’s Contracture – surgical and nonsurgical interventions
• Knee replacement 
• Hip Injections (excluding bursitis)
• Erectile Dysfunction 
• Percutaneous posterior tibial nerve stimulation (PTNS) for urinary and faecal incontinence.

The text below is taken from the NHS press release:

In September we launched “Our Savings Plan” to start a frank conversation about the challenging financial position facing the local NHS and the savings we must make in 2016/17 to help ensure a sustainable, high-quality health and care system in West Cheshire – both now and in the future.

There are many reasons for the financial challenges we face, not least that we have a fast-growing, ageing population and more people than ever are being diagnosed with long-term conditions.

This means that demand for local health and care services is rising faster than our budget. We simply do not have enough money to continue to buy all the services we currently do in the same way as before. If we did, in 2016/17 alone we would spend £13m more than our budget.

As this challenge is similar in many areas, the Clinical Commissioning Groups (CCGs) for West Cheshire, Eastern Cheshire, South Cheshire, Vale Royal and Wirral, have come together in partnership to ask the public for their views on proposed changes to some services that we currently commission.

A consultation has been launched which is asking the public and other stakeholders for their views on the proposals, building on work already undertaken to engage with local people about the challenging financial position facing the local NHS and proposed changes to services.

Dr Andy McAlavey, Medical Director, NHS West Cheshire Clinical Commissioning Group comments: "This is the first time that CCGs in this area have come together to seek the views of the public and stakeholders as we continue with our programme of changes. Our aim is to ensure that the services we provide are effective and sustainable whilst we continue to encourage people to lead healthier lives. It is important for us to make the best use of our resources and we are encouraging people to have their say."

Consultation Cheshire and Wirral Clinical Commissioning Groups are undertaking a formal consultation on the proposals detailed in the consultation documents below to explore them in more detail and obtain feedback from patients and the public. The consultation will run from Tuesday, October 25, 2016 to midnight on Tuesday, January 17, 2017.

How to share your views
As part of the consultation we need your views on the proposals and to understand the impact they may have on you. To hear what you think about the proposals you have a variety of opportunities to give your feedback. You can fill in the questionnaire included in the consultation document below and submit by post to, SRP consultation, NHS West Cheshire Clinical Commissioning Group, 1829 Building, Countess of Chester Health Park, Liverpool Road, Chester CH2 1HJ

By email – send your completed surveys to: enquiries.wcheshireccg@nhs.netIf people are hard of hearing, have sight impairment, English is not their first language or they require the information in an alternative format, please contact 0800 132996 or email: enquiries.wcheshireccg@nhs.net'

Copies of the consultation documentation and surveys can be obtained from West Cheshire CCG.