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Staffordshire Pays Respects To HRH Prince Philip (1921 - 2021)

Staffordshire COVID Local Outbreak Management Plan

 

Foreword

The COVID pandemic is the biggest peacetime crisis that the UK has faced in living memory. All of our lives have been affected in some way and some people will feel the effects for years to come. At 01 March 2021 there have been more than 3.67 million confirmed cases across England and many more cases that have not been diagnosed. Nearly 400,000 people have been hospitalised, and there have been over 110,000 deaths from COVID with additional deaths arising as a consequence of the pandemic. Mental and physical well-being will be affected by the long period of isolation and inactivity. Children have lost a chunk of their education. Many have lost their jobs and livelihoods.

There is now cause for optimism that things will start to improve. The COVID vaccination programme is making incredible progress. The vaccine is safe and effective and in Staffordshire more than 300,000 people have now received their first dose, with the NHS on track to offer vaccination to all adults over 50 by 15 April 2021. We need to make sure that we have the best possible uptake of vaccination right across the population.

On 22 February 2021 the Government published a Roadmap for releasing lockdown. This is very welcome and gives people hope that there is a path to getting their freedoms back. Unfortunately, COVID is not going away completely. There will inevitably be some people who are not vaccinated, and the vaccine does not offer 100% protection. In addition, the virus has shown that it can evolve in ways that might make the vaccine less effective. This means that we will need a series of COVID defences for the long term. These will be essential to limit the spread of infection so that our lives can return and remain as close to ‘normal’ as possible, and our economy can be restarted and remain open. We must avoid another lockdown.

Everyone has a part to play in COVID defences. Residents need to continue to observe a minimum of good hygiene and social distancing, follow the prevailing national rules, and get tested regularly to check they are not carrying the virus. People who develop symptoms should isolate immediately and get tested, and close contacts should isolate in line with legal requirements. Care providers, businesses and schools and businesses should be testing employees and pupils regularly and reporting cases and outbreaks so that they can be managed effectively. If we all do our bit we can avoid the imposition of more intrusive restrictions.

Cllr Alan White
Leader of the Council

Cllr Johnny McMahon
Cabinet Member for Health, Care and Wellbeing

Dr Richard Harling
Director of Health and Care

 


 

Introduction Back to top

Contain Framework

HM Government in May 2020 published the Contain Framework, setting out how national and local partners will work with the public to prevent, contain and manage COVID outbreaks. Each local authority was asked to produce a Local Outbreak Control Plan setting out the arrangements in place locally. The Staffordshire Local Outbreak Control Plan was first published in June 2020 and has been updated subsequently as national policy has evolved.

HM Government in March 2021 updated the Contain Framework and requested a substantive revision to what are now called Local Outbreak Management Plans to take into account the COVID vaccination programme, the Roadmap from lockdown, and evolving arrangements for test, trace and isolate, and asked that local authorities update their own Plans accordingly. The Staffordshire Plan has been updated to take this revised national framework into account.

HM Government’s request is that Local Outbreak Management Plans cover the arrangements required to ensure an effective COVID response, including the core components of COVID defences:

  1. Surveillance
  2. Testing, tracing, isolation and outbreak management
  3. COVID security
  4. Vaccination
  5. Support for the most vulnerable
  6. Communications and engagement

And a number of cross cutting themes:

  1. High-risk settings
  2. Vulnerable and underserved communities
  3. Compliance and enforcement
  4. Data management and information sharing
  5. Resourcing
  6. Governance

Roadmap from lockdown

On 22 February 2021 the Government published a Roadmap from lockdown describing when restrictions might be released. The four main steps are summarised in Figure 1 and described in more detail on the gov.uk website. The dates are the earliest that restrictions will be lifted and progress is conditional on:

  1. The COVID vaccination programme continuing successfully.
  2. Evidence showing vaccines are sufficiently reducing the number of people hospitalised people or dying with the virus.
  3. Infection rates not risking a surge in hospitalisations which would put unsustainable pressure on the NHS.
  4. The assessment of the risks not being fundamentally changed by the emergence of new variants of concern.

The Government also intends four reviews to determine:

  1. Whether having a vaccine or a negative test result can reduce restrictions on social contact.
  2. The impact of testing and reduced social distancing on events.
  3. How to facilitate more inbound and outbound travel.
  4. The extent of social distancing measures required.

Under a best case scenario, the COVID vaccination programme will continue to make good progress and the effectiveness of vaccines will not be significantly compromised by the emergence of new variants of the virus. Between vaccination and other COVID defences we would be able to control the infections to a background level, with occasional outbreaks. This would allow early progress on the Roadmap without unsustainable pressure on the NHS, and for restrictions to remain lifted.

Under less optimistic scenarios, uptake of COVID vaccination will be suboptimal and/or the effectiveness of vaccines will be partially compromised by the emergence of new variants. We would be dealing with higher levels of infections and larger and more frequent outbreaks. This would delay progress on the Roadmap and carry a risk that COVID defences are overwhelmed, leading to the Government reimposing restrictions in the winter.

This Plan has been prepared on the basis of ‘hope for the best; plan for the worst’, with systems, processes and capacity to undertake testing and contact tracing at scale, deal with the emergence of variants of concern, manage multiple concurrent outbreaks across different settings, and tackle enduring transmission in vulnerable and underserved communities.

Figure 1: Roadmap

Lockdown

  • One person from two households outside for exercise
  • Stay at home
  • Work from home unless essential – COVID security required

1A: 08 March

  • One person from two households outside for recreation
  • Stay at home
  • Work from home unless essential – COVID security required
  • Schools and colleges open

1B: 29 March

  • Up to six people, or two households if larger group, outside
  • Stay local
  • Work from home if you can – COVID security required
  • Outdoor sports can resume

2: After 12 April

  • Up to six people, or two households if larger group, outside
  • Travel nationally
  • Work from home if you can – COVID security required
  • Open gyms and swimming pools 
  • Non-essential retail open
  • Personal care and close contact services resume
  • Hospitality open outdoors; table service only
  • Some outdoors entertainment and attractions can open

3: After 17 May

  • Up to 30 outside; two households indoors
  • Potential international travel allowed
  • Work from home if you can – COVID security required
  • Open indoor group sports and exercises; careful return of spectators
  • Open indoors; table service only
  • Remainder outdoors entertainment and attractions can open; indoors can open

4: After 21 June

  • Social contact limits lifted
  • Large events may be possible to resume with testing

 


 

Staffordshire and COVID Back to top

There are approximately 880,000 people in the county, living in an area of more than 1,000 square miles. There are some features of the population that increase, and some that decrease the risk from COVID compared to England as a whole:

  1. We are relatively rural (80% of our area), with a population density of 332 people per square kilometre (2017) compared to 432 for England overall (2019), which probably decreases the risk of infection.
  2. We are relatively elderly with 16.1% of the population over 70 and 2.7% over 85 compared to 13.4% and 2.5% for England overall (2019). The risk of complications and death from COVID increases dramatically with age, is higher in men than women, probably due to the higher rate of underlying health conditions in older people – see Figure 2.

Figure 2: deaths rates due to confirmed COVID death rates by age and sex (April 2020)

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Source ONS

  1. We have a relatively high rate of underlying health conditions, with the recorded prevalence of heart disease, stroke and diabetes higher than the England average. The risk of complications from COVID is higher in people with chronic lung and heart conditions, diabetes, kidney and liver disease and impaired immune systems.

Black, Asian and Minority Ethnic (BAME) people have an increased risk of complications from COVID. The cause of this is not yet clear and may be a combination of genetic factors, higher rates of underlying health conditions, and higher rates of deprivation. This will be important to consider in those areas of the county with BAME communities. 

Staffordshire overall, has a low percentage of the population from BAME backgrounds (4.3% compared to 14.6% in England, 2011). However, parts of our county are more diverse – such as East Staffordshire, where approximately 9.5% of the population are from BAME backgrounds.

COVID also appears to be further exacerbating health inequalities. General mortality rates are normally higher in more deprived areas, however COVID seems to be increasing this effect. The COVID mortality rate nationally in the most deprived areas is more than double that in the least deprived areas. Staffordshire has pockets of deprivation, with approximately 76,922 (8.8%) of residents living in areas that rank in the top 20% most deprived nationally.

Staffordshire’s first case of COVID was confirmed in mid-March 2020. At 01 March 2021 there have been over 56,000 confirmed cases. Over the pandemic to date there have been an excess of 2,000 deaths compared to the average for the same period in the previous five years.

COVID continues to have a profound impact on health, quality of life, and the economy, which goes beyond the direct impact of the disease:

  1. COVID related restrictions have compounded the obesity epidemic with poor diet and inactivity as well as alcohol intake increasing amongst some sections of the population. Data from the COVID Symptom Study App suggests an average weight gain over lockdown 1, as twice the amount gained over the normal Christmas period. Locally, 27% of Staffordshire residents, responding to our COVID-19 Survey, reported drinking more alcohol, and 29% exercising less during the pandemic.
  2. There is growing evidence about increased levels of mental distress and anxiety as a consequence of COVID related restrictions as well as the economic shock. 41% of Staffordshire residents who responded to our COVID-19 Survey reported being worried about their mental wellbeing.
  3. The UK economy shrank by a record 9.9% in 2020, unemployment rose to 5.1% by December 2020, with approximately 3.8 million jobs furloughed across England at the end of January 2021.In Staffordshire, the unemployment claimant count stands at 4.6% in January 2021. A rise of over 12,000 claimants from pre-pandemic figures. 55,400 Staffordshire jobs have been furloughed during the third lockdown, equivalent to 14% of eligible workers.
  4. All children and young people have had their education significantly disrupted over the past 12 months. This disruption is likely to effect disadvantaged pupils to a greater extent, with educational attainment gaps likely to widen.
  5. These effects are being most keenly felt by certain sections of society, in particular younger people, those living in deprived areas and black and ethnic minorities. This risks compounding health and societal inequalities. 

Local Resilience Forum partners have been working tirelessly to manage the pandemic. Our efforts have included:

  1. Maintaining essential public services in the face of reduced staffing.
  2. Information, advice and guidance for care providers, businesses, schools, and the public.
  3. Engaging with high risk communities to promote testing and vaccination.
  4. Practical support for care providers including additional staffing, financial assistance and specialist advice to help with infection prevention and control.
  5. Emergency supplies of Personal Protective Equipment to a whole range of settings, with more than 6 million items provided so far.
  6. Support for vulnerable people with reassurance and supplies of food and medicine.
  7. Providing education online and supporting vulnerable children and children of essential workers in schools.
  8. Supporting residents and businesses to understand and comply with COVID regulations.
  9. Establishing a network of symptomatic and asymptomatic testing sites as well as a contact tracing service.
  10. Rolling out the COVID vaccination programme.

We are hugely grateful to the staff across who have risen to an unprecedented challenge, to residents and businesses who have been diligent in observing the rules, and to the members of the public who have stepped forward to play a role in the COVID response.

With the Roadmap for releasing lockdown we can start to think about how we recover from the pandemic. Unfortunately, COVID is not going away completely. There will inevitably be some people who are not vaccinated, and the vaccine does not offer 100% protection. In addition, the virus has shown that it can evolve in ways that might make the vaccine less effective. This means that we will need to maintain COVID defences for the long term. These will be essential to limit the spread of infection so that our lives can return and remain as close to ‘normal’ as possible, and our economy can be restarted and remain open. We must avoid another lockdown.

Everyone has a part to play in COVID defences. Residents need to continue to observe a minimum of good hygiene and social distancing, follow the prevailing national rules, and get tested regularly to check they are not carrying the virus. People who develop symptoms should isolate immediately and get tested. Close contacts of confirmed cases should isolate in line with legal requirements. Care providers, businesses and schools and businesses should be testing employees and pupils regularly and reporting cases and outbreaks so that they can be managed effectively. If we all do our bit we can avoid the imposition of more intrusive restrictions.

 


 

Purpose, aims and principles Back to top

The purpose of this Plan is to keep COVID cases and complications low and protect our freedoms and livelihoods.

The specific aims are to:

  1. Identify and isolate a high proportion of cases and contacts – and do so quickly.
  2. Prevent and detect clusters and outbreaks and intervene to stop further spread of infection.
  3. Increase population immunity through roll-out of vaccination.
  4. Protect the most vulnerable.
  5. Enable social and economic activity.
  6. Build and maintain public trust and confidence.

Our principles remain that we:

  1. Work as a system to co-ordinate activities across local and national partners.
  2. Intervene early in order to prevent and control outbreaks and minimise the spread of infection.
  3. Target preventative interventions on the highest risk settings and communities.
  4. Draw on the skills, experience, systems and processes of existing teams.
  5. Ensure that these teams are appropriately resourced, with information, training and additional capacity where necessary.
  6. Aim for consistency of approach across Staffordshire (and Stoke-on-Trent) in terms of what functions are delivered, whilst allowing for variation between areas in terms of how these functions are delivered.
  7. Provide clarity about the roles and responsibilities of individual organisations and teams.
  8. Communicate well and share data and information.
  9. Work collaboratively with those settings affected by outbreaks to ensure effective management.
  10. Be flexible, prepared to take on new roles and responsibilities and do whatever it takes to ensure that outbreaks are managed effectively.
  11. Draw on the assets available in our communities.
  12. Provide mutual aid between organisations and teams to ensure that no-one is overwhelmed (The Strategic Co-ordinating Group has a Resources and Mutual Aid tactical group that receives and fulfils requests for mutual aid).
  13. Continually reflect, learn and improve.

 


 

COVID Defences Back to top

The components of COVID defences are summarised in Figure 3, with a more detailed operating model in Figure 4.

Figure 3: COVID defences

Surveillance, communications and engagement:

  • Testing, contact tracing, isolation and outbreak management
  • COVID security
  • COVID vaccinationSupport for the most vulnerable (CEV and other high risk)

Surveillance

We have comprehensive local real-time surveillance in place including:

  1. Cases – overall rates, for each district and borough, and down to ward level to help identify clusters, outbreaks and geographical and temporal ‘hotspots’ that might indicate community spread.
  2. Complications – including hospitalisations and deaths.
  3. Testing – both symptomatic and asymptomatic.
  4. Contact tracing
  5. Incidents – across a range of settings.
  6. Vaccination uptake.

Wastewater Based Epidemiological data is not currently available in Staffordshire.Once this becomes available this can be usedto monitor the total viral load in the ROI to inform our response to community transmission.

Surveillance data is available on a COVID Local Outbreak Control Dashboard and is reviewed regularly and linked directly to action through the Health Protection Board, COVID Member Led Local Outbreak Control Board and Local Outbreak Control Groups. The Strategic Co-ordinating Group has an Intelligence and Modelling tactical group, which ensures a common understanding of the COVID situation across Local Resilience Forum partners in Staffordshire and Stoke on Trent.

We work closely with Public Health England and the Department of Health and Social Care Regional Convener team to understand regional and national epidemiology as well as emerging national COVID policy and operations.

Figure 4: COVID defences operating model

People and partnerships

LRF partners:

  • Staffordshire County Council
  • District and Borough Councils
  • NHS
  • Police
  • Fire and Rescue Service
  • Utilities

National partners:

  • PHE
  • DHSC Regional Convener
  • MHCLG
  • NHS Test and Trace

Processes

  • Asymptomatic testing programme SOP
  • Contact tracing scripts
  • Surge testing protocol
  • Enforcement of isolation
  • Test & Trace Support Payments
  • Incident management SOPs
  • Support for vulnerable people
  • Assistance for compliance; and enforcement of COVID security
  • Communications and engagement
  • Data management and information sharing

Technology

  • COVID Local Outbreak Control Dashboard
  • PCR testing
  • LFD tests
  • Vaccination

Focus

  • Vulnerable and underserved communities
  • High risk settings

Performance 

  • Cases
  • Complications
  • Testing
  • Contact tracing
  • Incident management
  • Vaccination

Governance

  • SCG
  • Health Protection Board
  • Member Led Local Outbreak Control Board
  • Local Outbreak Control Groups

Testing

Testing for the Sars-Cov-2 virus is with either Polymerase Chain Reaction (PCR) or Lateral Flow Device (LFD) tests.

  1. PCR is regarded as the ‘Gold standard’ test. PCR tests must be taken by a trained operator and require laboratory processing with a result usually available in 2-3 days. The test has a sensitivity of around 90% overall for detecting people who have been infected with the Sars-Cov-2 virus, although it may miss some cases early in the course of infection. It will continue to test positive after people are no longer infectious, sometimes for a long period, however this indicates the presence of inactive viral rna and not active virus. Confirmed cases are therefore advised not to take a repeat test within 90 days of a positive result.
  2. LFD is a ‘near patient’ test that gives a result within 30 minutes. It is best supervised by a trained operator in order to maximise accuracy, although it can be done at home. The test has a sensitivity of around 75% for all PCR positive individuals but detects over 95% of people with a high viral load who are more likely to be infectious, whether symptomatic or asymptomatic. This is when supervised by a trained operator and it is likely that tests at home are less accurate. We mitigate this risk with initial supervised on-site testing and training offered to maximise accuracy, and we request assurance from HM Government that home testing is supported by good evidence.

Testing in Staffordshire includes the following:

  1. Symptomatic testing. This is for people with symptoms of COVID and uses PCR. The function is currently provided by NHS Test and Trace Regional Testing Sites, Local Testing Sites and Mobile Testing Units. We require confirmation from HM Government that these will continue to be available throughout 2021/22 or whether alternative local facilities will be required.
  2. Outbreak testing. This is in the event of outbreaks in individual settings or community spread. Those potentially exposed to the virus are offered PCR or LFD tests to identify and isolate additional cases and prevent any further spread of infection. We have the ability to deploy testing assets anywhere in Staffordshire within 24 hours, through a combination of the MPFT swabbing team, and Nexxus Community Testing Service.
  3. Asymptomatic testing. With one third of cases asymptomatic, regular testing with LFD is important to identify infections and intervene to limit the spread of infection. This is particularly important in high-risk settings and vulnerable and underserved communities.
  4. Surge testing. This isin response to new variants of concern. Those potentially exposed to the virus are offered either PCR or LFD tests to identify and isolate additional cases and prevent spread of infection.
  5. Daily contact testing. This is daily testing of close contacts with LFD for seven days as an alternative to isolation. It is in operation in care homes as part of a national programme, and is being piloted in some businesses and schools, also as part of national programmes. We are ready to roll this out as part of our local asymptomatic testing programme if and when it is proved effective and approved.

Table 1: National asymptomatic testing programmes

NHS staff

Test: LFD
Frequency: Twice weekly
Supervised on-site/home: Home

Care home staff

Test: PCR
Frequency: Weekly
Supervised on-site/home: Supervised on-site

Care home staff

Test: LFD
Frequency: Twice weekly and in the event of an outbreak on each working day until 5 days after the last positive case
Supervised on-site/home: Supervised on-site

Care home residents

Test: PCR
Frequency: Monthly and in addition to the event of an outbreak
Supervised on-site/home: Supervised on-site

Care home residents

Test: LFD
Frequency: At the same time as PCR test in the event of an outbreak
Supervised on-site/home: Supervised on-site

Care home visitors

Test: LFD
Frequency: On arrival
Supervised on-site/home: Supervised on-site

Home care staff 

Test: PCR 
Frequency: Weekly 
Supervised on-site/home: Home 

Extra care / supported living and day care staff 

Test: PCR
Frequency: Weekly 
Supervised on-site/home: Supervised on-site 

Extra care / supported living residents

Test: PCR
Frequency: Monthly
Supervised on-site/home: Supervised on-site

Secondary school teachers

Test: LFD
Frequency: Twice weekly
Supervised on-site/home: Supervised on-site

Primary school teachers

Test: LFD
Frequency: Twice weekly
Supervised on-site/home: Home

Secondary school pupils

Test: LFD
Frequency: Twice weekly
Supervised on-site/home: Initially supervised on-site then home

Parents of school children

Test: LFD
Frequency: Twice weekly
Supervised on-site/home: Home

Early years provider staff

Test: 
Frequency: Twice weekly
Supervised on-site/home: Home

Some businesses 

Test: LFD
Frequency: Twice weekly
Supervised on-site/home: Supervised on-site 

Some public sector employees

Test: LFD
Frequency: Twice weekly
Supervised on-site/home: Supervised on-site or home

University students

Test: LFD
Frequency: On return to university and then weekly
Supervised on-site/home: Supervised on-site 

Local asymptomatic testing programme

Our asymptomatic testing programme supports Local Resilience Forum partners, businesses, health and care providers, early years providers, and registered social landlords to establish regular testing for employees (and tenants). Asymptomatic testing uses LFD tests according to a Standard Operating Procedure based on the national template. Our programme is dependent on free LFD and we require confirmation from HM Government that these will continue to be available throughout 2021/22.  

We also offer testing in the community through a network of Community Testing Centres. There is at least one semi-permanent Community Testing Centre in each district or borough, complemented by ‘pop-up’ Community Testing Centres that rotate between smaller venues.

This means that over the course of a week, 98% of residents have a Centre available within 5 miles and 100% of residents have a Community Testing Centre available within 10 miles. We have particularly focused on ensuring access in vulnerable and underserved communities. We have a full clinical standard operating procedure in place for supervised on-site testing in settings and in the community, based on the national template.

Our preference is for supervised on-site testing to ensure accuracy. We recognise that this is not possible for everyone and we also offer home testing where this is more convenient. This includes settings offering home testing for employees, with appropriate checks and balances in placeto maximise accuracy.We also support the Community Collect model at the Community Testing Centres, with initial supervised on-site testing and training offered to maximise accuracy and supplies of tests that people can take at home.

Variants of concern

Like all viruses, Sars-Cov-2 regularly mutates creating new variants. Most have no effect however some pose an increased risk to public health due to changes in transmissibility, infection severity, ability to evade immune responses or susceptibility to therapeutic treatments – these are variants of concern.

In late January 2021 we were notified about a case of the South African Variant of Concern in Stafford.

The Incident Management Team met the following day and determined that the best testing strategy would be to enhance asymptomatic LFD testing in the Borough and send all positives for PCR and genetic sequencing, as well as to request genetic sequencing from all symptomatic people testing PCR positive.

Testing assets were deployed within a further 24 hours and remained in place for four weeks. During this period an additional 7,500 LFD were completed and nearly 100 positive tests sent for genetic sequencing.

We have a multi-agency protocol in place for surge testing in response to new variants of concern to collect specimens for genetic sequencing. This has 5 steps:

  1. Incident management team involving Local Resilience Forum (LRF) partners and Public Health England (PHE) to establish the facts of the case.
  2. Risk assessment to determinepotential sources of infection as well as contacts of the case – this defines the settings and people potentially exposed to infection, and therefore the target groups for surge testing.
  3. Development of testing strategy to confirmwho will be tested, how, when and where, based on the assets available. This may include testing through a PCR and/or LFD tests, and use NHS Test and Trace sites or local Community Testing Centres, semi-permanent or mobile / ‘pop-up’ facilities, as well as ‘collect and drop’ / ‘drop and collect’.
  4. Contact tracing with those potentially exposed to infection to offer them a test and provide details of the options available.
  5. Deployment of testing assets, co-ordinated by the Fire and Rescue Service and involving a combination of NHS Test and Trace, MPFT swabbing team, Nexxus Community Testing Service, and support from LRF partners.

In February 2021 we were notified about a case of the South African Variant of Concern working in Tamworth.

The Incident Management Team met the following day and determined that the best testing strategy would be to offer PCR testing to all staff and clients of the business.

A ‘drop and collect’ model was led by the Fire and Rescue service supported by Tamworth Borough Council and the NHS. All staff and clients returned tests.

The protocol is supported by stakeholder and public communications to ‘warn and inform’ residents and remind them about the precautions they can take to limit the spread of infection. The protocol has been tried and refined and we are confident we can deploy testing assets within 48 hours of report of a new variant of concern, subject to the necessary input and agreements from PHE.

Enduring Transmission

Areas of enduring transmission are identified as areas with high rates of positive Sars-Cov-2 cases that remain above the national average for long periods of time. Acting on enduring transmission is critical to help reduce the disproportionate impact of COVID-19 on our most under-served communities, that are already at greatest risk of the burden of ill health due to COVID-19.

 Staffordshire will use an approach of drawing on local knowledge, alongside national reports and statistics to identify these areas and to formulate a response that is tailored to the community. Steps we will take:

Analysis of local data including information about localised deprivation, ethnicity, cultural impacts and cumulative case rates.

Local testing outputs and vaccination uptake.

Data collected by the Local Outbreak Control Groups (LOCG) on enforcement activities and local colloquialisms to transform arbitrary ward data into real-life recognisable areas.

Engagement with community leaders is essential in addressing areas of enduring transmission. Identification of key stakeholders that represent the community make-up enabled Staffordshire to successfully increase localised testing and vaccinations in areas of low take-up.

In April 2020 East Staffordshire’s case rates were higher when compared to other areas and did not show signs of reducing. To address transmissions community leaders forum was established which ultimately evolved into a weekly Incident Management Team (IMT).

Local Contact Tracing was initiated to understand how transmissions were occurring and to provide insight to the IMT. Localised community testing was arranged in a range of locations to identify cases and isolate contacts.

January 2021 a semi-permeant testing centre was agreed, offering testing 7 days per week in a ward with the most enduring case rate; supplementary testing is offered across other East Staffordshire wards.

The IMT also agreed and delivered two pop-up vaccination days on 05 March 2021 and 26 March 2021. A further 150 people in the East Staffordshire area have been vaccinated as a result of this initiative

Contact tracing

We have well established local contact tracing arrangements in place as part of a Local Tracing Partnership. Our local contact tracing currently involves four cohorts as below. We are participating in a range of national contact tracing pilots to expand the scope of our activities and improve the timeliness of contact tracing – these include ‘Local 0’ and "Follow-Up Failed – Contacts". The County Council’s local contact tracing team has sufficient capacity to be able to call more than 300 contacts and their associated close contacts daily, supported by District and Borough Council Environmental health teams. They use a standard script for contact tracing, based on the NHS Test and Trace script, and supplemented by ‘free conversations’ based on local knowledge, which is particularly helpful at exploring potential sources of infection.

  1. ‘Follow up fails’. These are confirmed cases that NHS Test and Trace has been unable to complete after 24 hours – typically 16% of all cases managed by NHS Test and Trace. We typically reach around 60% of these to advise isolation, collect information about contacts, and explore potential sources of infection. This takes the total proportion of cases completed to 94% between NHS Test and Trace and local contact tracing. 
  2. All cases – determination of likely source of infection (also referred to as ‘enhanced contact tracing’ or ‘backward contact tracing’). For all confirmed cases we check the information available on CTAS about potential sources of infection. Where this is unclear, we contact the individual to explore potential sources of infection. This is typically 70% of all cases managed by NHS Test and Trace and provides crucial information about links between cases to identify clusters and outbreaks and the settings which may have been implicated in exposure. Typical findings are shown in Figure 5. This is cross referenced with data from NHS Test and Trace and Public Health England and used to inform outbreak management. We also use these calls as an opportunity to verify that cases are isolating. 

Figure 5: likely source of infection

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  1. Intra-household transmission
  2. Workplace
  3. Unknown transmission
  4. Social care setting
  5. Health care setting
  6. Leisure setting
  7. Prison setting
  8. Education setting
  9. Inter-household transmission
  10. Holiday
  11. Private/social gathering
  1. Close contacts. These are close contacts identified through contact tracing, both by NHS Test and Trace and as part of the local contact tracing. Typically, each confirmed case has 1.8 close contacts who need to be isolated to reduce the chance of onward transmission. We confirm the isolation of close contacts already identified in CTAS and any new close contacts that we identify – and in addition explore whether they have any support needs. We successfully confirm the isolation of 98% of all close contacts.
  2. Outbreak contact tracing. When an Incident is identified we proactively call all contacts to provide isolation and testing advice. This provides an opportunity to prevent further spread of infection. We have used this approach to successfully manage a range of outbreaks including in the hospitality sector, taxi firms and personal care services.

Isolation

The legal requirements for isolation are:

  1. For people with one or more of the three main symptoms of COVID: until they can get tested and have a result.
  2. For confirmed cases: for 10 days starting the day after the onset of symptoms; or if asymptomatic then for 10 days starting the day after the date the positive test was taken (14 days for care home residents).
  3. For close contacts: for 10 days
    i. For household contacts commencing the day after the onset of symptoms in the case; or if the case is asymptomatic then commencing the day after the date the positive test was taken.
    ii. For other direct and proximity contacts commencing the day after the last contact with the case.

Communications. The County Council as well as District and Borough Councils communicate regular information about isolation to remind the public about the legal requirements and rationale for isolation.

Practical, social, and emotional support. Assistance for vulnerable people who may be struggling during isolation is available through our Staffordshire Cares helpline. This can signpost them to help from the local community including delivery of food and other essential supplies, medication collection, and support groups.

Financial support. The Test and Trace Support Payment and discretionary schemes are managed by the District and Borough Councils. By the end of February 2021, they had collectively received a total of nearly 5,000 applications to the Test and Trace Support Payment scheme of which one third had been approved; and around 2,500 applications to the discretionary scheme of which 12% had been approved. Funding from HM Government has been extended until the end of June 2021 and we require confirmation that this will be extended for the remainder of 2021/22 to avoid a risk that people cannot afford.

Targeted enforcement. Every effort will be made to persuade people to voluntarily comply with legal requirements for isolation, with checks to ensure they have the capacity to understand what is required. Our local contact tracing team calls the majority of cases and contacts to verify that they are isolating. Where there are reasonable grounds to doubt that cases or contacts are isolating the local contact tracing team makes a referral to the Police who visit them at home to check compliance – typically 50 per week. The Police also receive intelligence that cases or contacts are not isolating. The Police may issue fixed penalty notices where people are found to be in breach of legal requirements.

There may be some people who are unwilling and/or unable (e.g. because of lack of mental capacity) to comply with legal requirements for isolation, or unable to isolate because they do not have suitable accommodation. The County Council, District and Borough Councils and Police have a joint protocol in place to manage these individuals and each district and borough has identified accommodation that could be used. This includes arrangements for security if required.

Where people refuse to isolate then it may be necessary to impose proportionate restrictions to ensure isolation as set out in the Potentially Infectious Persons Schedule 21 (Coronavirus Act 2020). There must be reasonable grounds to suspect that an individual is, or may be, infected or contaminated with COVID and that there is a risk that they will infect or contaminate others – these would include:

  1. Tested positive for COVID;
  2. Presenting with symptoms of COVID;
  3. Is, or has been, in contact with another person with symptoms of COVID, regardless of whether that other person has been tested for COVID; or
  4. Has arrived within the last 14 days from an infected area.

In this event an Incident Management Team will be convened to consider and determine an appropriate course of action. This will include the Public Health England Consultants designated by the Secretary of State to cover the West Midlands for the purposes of Schedule 21.

Outbreak identification and rapid response

We have robust arrangements in place for identifying and responding to cases, clusters and outbreaks of COVID in a range of settings, as well as community spread of infection. Collectively these are referred to as Incidents. Since the start of the pandemic we have managed over 3,700 Incidents.

The Public Health England (PHE) Health Protection Team provides invaluable expert advice and support and we require assurance from HM Government that they will be sustained during the transition to the National Institute for Health Protection with sufficient capacity to maintain the response to COVID as well as to other communicable diseases and non-communicable environmental hazards.

Incidents are usually identified by our local contact tracing team and may also be identified through local intelligence, the PHE Health Protection Team, or through national algorithms that identify postcode co-incidences or common exposures as part of the Outbreak Identification & Rapid Response. Any organisation that suspects an Incident is asked to notify this immediately to the County Council and / or the PHE Health Protection Team.

The County Council, along with District and Borough Councils, the NHS and the PHE Health Protection Team, has a range of Standard Operating Procedures (SOPs) in place to guide the management of Incidents. The SOPs set out the actions required and the organisations responsible to ensure that the approach is comprehensive and consistent across Staffordshire. The SOPs are not intended to fetter discretion and following them should never be an alternative to good judgement. Where circumstances dictate, ‘doing the right thing’ must take precedence. An outline of the SOPs for management of cases, clusters and outbreaks in specific settings is shown in Figure 6.

Figure 6: Outline Standard Operating Procedure for Incident Management

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Detailed SOPs are in place for individual settings:

  1. Care settings: Appendix 1.
  2. Education, Early Years and Children’s social care settings: Appendix 2.
  3. Prisons and other prescribed places of detention: Appendix 3.
  4. High risk places, businesses and communities: Appendix 4.
  5. Community healthcare settings: Appendix 5.

The Strategic Co-ordinating Group has a Local Outbreak Control tactical group, which ensures a consistent approach to managing outbreaks across Local Resilience Forum (LRF) partners in Staffordshire and Stoke on Trent, and co-ordinates management of Incidents affecting both local authority areas. Where community spread is identified then this is discussed with LRF partners, the COVID Member Led Local Outbreak Control Board, and the affected community to determine an appropriate response.

The County Council maintains a COVID Local Outbreak Co-ordinating Team which:

  1. Provides a single point of contact for reports of Incidents from all sources.
  2. Ensures that all Incidents are logged in a COVID Local Outbreak Control database with a minimum data set.
  3. Maintains a COVID Local Outbreak Control dashboard with details about epidemiology and Incidents, and provide updates to the Health Protection Board, COVID Member Led Local Outbreak Control Board, Local Outbreak Control Groups and other partners as required.
  4. Ensures that a Risk Assessment is completed for all new Incidents to determine immediate control measures required and a Risk Rating.
  5. Ensures that an Incident Management Team with an appropriate lead and involving local partners is convened where necessary and ensure that Incidents are followed up according to the relevant Standard Operating Procedure.
  6. Closes Incidents on the advice of the lead organisation and team, and conducts a brief reflection following closure to identify learning and improvements for future management.
  7. Ensures effective data management and timely communication of key information to relevant settings, partners and PHE.

Responsible organisations and teams have been identified who lead management of Incidents depending on the setting. This allows us to draw on local knowledge, skills, and experience. Where Incidents are very large and complex and/or have wider regional or national significance – for example they affect critical infrastructure or major supply chains then PHE may take the lead.

  1. Care settings: County Council Care Commissioning Team.
  2. Education, Early Years and Children’s social care settings: County Council Education and Early Years COVID Outbreak Management Team–includingHealth, Safety and Well-being and Education Strategy and Improvement Teams.
  3. Prisons and other prescribed places of detention: PHE Health Protection Team supported by County Council Public Health and Prevention Team.
  4. High risk places, businesses, and communities: District and Borough Council Environmental Health Teams.
  5. Community healthcare settings: County Council Public Health and Prevention Team, Clinical Commissioning Groups and NHSE/I.

The responsible organisation and team:

  1. Conducts an initial Risk Assessment.
  2. Determines, co-ordinates and ensures implementation of control measures, drawing on specialist advice from PHE and locally as required.
  3. Follows up Incidents according to the relevant Standard Operating Procedure.
  4. Ensures that clear records are maintained about control measures and progress of implementation.
  5. Closes Incidents when appropriate; and
  6. Ensures that the COVID Local Outbreak Co-ordinating Team have accurate and up to date information to maintain the COVID Local Outbreak Control database.

Where necessary an Incident Management Team (IMT) is convened. The IMT ensures a comprehensive and accurate understanding of the Incident by all relevant partners, and agrees, documents, allocates and ensures implementation of the multi-agency control measures required to minimise the spread of infection and mitigate the wider consequences of the Incident. The IMT includes a further Risk Assessment and produces a revised Risk Rating to guide ongoing management and follow up.

Management of Incidents may include a range of control measures, which are determined following the Risk Assessment and/or by the IMT – including potentially:

  1. Enhanced infection prevention and control measures for example additional handwashing, decontamination / ‘deep cleaning’ of the environment, increased social distancing, and enhanced Personal Protective Equipment.
  2. Outbreak testing to identify and isolate additional cases and prevent any further spread of infection.
  3. Closure of settings – either full or partial.

Where it is necessary to close settings to prevent the spread of infection then consideration is given to the impact on business continuity, especially where services are essential. Alternative ways of providing services are considered and established where possible. The balance of risks between minimising the spread of infection and the impact on business continuity is considered and documented carefully. The County Council and NHS provides support for business continuity in care providers where this is necessary and practical. Any Quality or Safeguarding issues must be addressed.

All Incidents are followed up, with a frequency determined by the Risk Rating. Follow up considers any significant information, such as new cases or deaths, as well as progress of implementing control measures. Follow up includes further Risk Assessments on a regular basis to ensure that the Risk Rating is up to date. Where necessary an IMT is convened.

High Risk Incidents are escalated to the COVID Health Protection Board for assurance that appropriate control measures are being implemented – for example Incidents with large numbers cases or deaths, substantial delays or difficulties in implementing control measures, substantial public anxiety and/or media interest.

Incidents are closed when there are no new cases for a period, when control measures have been implemented and when the level of risk has reduced to the background for the type of setting. Following closure, a brief review is undertaken to identify learning and improvements for future management.

COVID security

COVID security means having optimal standards of infection prevention and control in place in all settings, relevant to that setting. These standards are well described in HM Government guidance. We offer proactive advice and support to all settings to help them ensure COVID security:

  1. Care settings: County Council Care Commissioning Team and Midlands Partnership Foundation Trust Infection Control Team.
  2. Education, Early Years and Children’s social care settings: County Council Health, Safety and Well-being and Education Strategy and Improvement Teams.
  3. Prisons and other prescribed places of detention: County Council Public Health and Prevention Team.
  4. High risk places, businesses, and communities: District and Borough Council Environmental Health Teams.
  5. Community healthcare settings: County Council Public Health and Prevention Team, and Midlands Partnership Foundation Trust Infection Control Team, Clinical Commissioning Groups, and where required, District and Borough Council Environmental Health Teams.

Advice and support includes:

  1. Advice on infection prevention and control measures such as personal and environmental hygiene, face coverings, social distancing, cohorting of clients, pupils and employees.
  2. Emergency supplies of Personal Protective Equipment where necessary.
  3. Promotion and facilitation of asymptomatic testing.

Where enforcement is necessary then this may be pursued:

  1. Care settings: through the Care Quality Commission.
  2. Schools: via the Secretary of State and/or Ofsted.
  3. Businesses: as set out in the Compliance and Enforcement section.

South Staffordshire District Council environmental health team conducted a rapid review of workplace outbreaks, identifying common themes and learning. This will be embedded into proactive support to businesses across Staffordshire and has been shared with Public Health England.

  • Offices were identified as high risk for workplace transmission, particularly those with low ventilation. Perspex screens appeared to have minimal impact unless extending significantly beyond and above desks, and use of face coverings were often considered a panacea and therefore less vigilance observed with other measures. Transmission often occurred when 2m distance was maintained, suggesting it is potentially not sufficient for new, more transmissible variants.
  • Manufacturing and warehouses are often noisy and maintaining 2m distance is difficult. However, very often it was behaviours off-shift that led to transmission, such as making drinks and standing too close when taking breaks. COVID-secure guidance needs to further highlight these risk points.
  • In many settings regular cleaning of touch-points was left to employees, which was poorly implemented by staff without infection prevention and control knowledge or accountability. Guidance needs to place more emphasis on businesses ensuring audit of touch points and robust cleaning regimes, with spot checks where necessary. Communications need to emphasise collective responsibility by all.

COVID vaccination

The COVID vaccination programme in Staffordshire is making excellent progress, delivered by the NHS and supported by Local Resilience Forum (LRF) partners. We have good coverage of Joint Committee on Vaccination and Immunisation (JCVI) priority groups 1 to 6 and are on track to achieve the national target to offer COVID vaccination to all adult 50 and over by 15 April and all adults by 31 July, subject to adequate vaccine supplies.

The Strategic Co-ordinating Group has a Vaccine delivery tactical group, which co-ordinates activities to optimise vaccine uptake people across LRF partners in Staffordshire and Stoke on Trent.

The County Council and District and Borough Councils play an important role including:

  1. Providing leadership and advocacy from the Director of Public Health and elected members.
  2. Support for logistics – for example premises for vaccination centres.
  3. Identifying eligible people – among frontline health and social care workers, and in at-risk groups.
  4. Support for communications.
  5. Engagement of vulnerable and underserved communities, especially black and minority ethnic communities to promote and enhance access to COVID vaccination.

COVID vaccination data in early February 2021 indicated low uptake among the South Asian Muslim community in Burton on Trent.

We engaged with local community leaders, including Mosques, to explore how uptake could be increased.

Following their advice we ran the first of a series of ‘pop-up’ vaccination clinics at a community centre a associated with one of the Mosques.

The clinic was a great success with 180 vaccines given and a positive response from the community including many requests for details about where else vaccination is available.

Further clinics are planned.

Support for the most vulnerable

Staffordshire has 60,000 residents identified as Clinically Extremely Vulnerable. We have been providing practical, social and emotional support throughout the pandemic and these arrangements will continue. Just over 4,000 of these people have registered on the National Shielding Support System with the majority not needing any support other than allocated priority supermarket shopping slots. Approximately a quarter of the registered group also request further support. 

Assistance for these and other vulnerable people is available through our Staffordshire Cares helpline. – this includes support for vulnerable people who may be struggling during isolation. Staffordshire Cares can signpost individuals to help from the local community including delivery of food and other essential supplies, medication collection, and support groups.

Support is provided through a network of “anchor” organisations, which are available at any time to offer help to residents and follows up initial support with fortnightly calls to check on well-being and offer further assistance. Where speed is of the essence the County Council has the ability to deliver food and other essential supplies directly. The Strategic Co-ordinating Group has a Vulnerability & Voluntary Support tactical group, which co-ordinates activities to protect vulnerable people across Local Resilience Forum partners in Staffordshire and Stoke on Trent.

Communications and engagement

Timely, proportionate and accurate communications is essential to our COVID response. The County Council’s Communications Team leads on communications related to Local Outbreak Management, linking closely with District and Borough Council communications teams. The Strategic Co-ordinating Group has a Communications tactical group that co-ordinates communications across Local Resilience Forum partners in Staffordshire and Stoke on Trent.

Communications messages include:

  1. General update on the COVID situation and to remind the public of the precautions they can take as well to limit the spread of infection as well as the legal requirements they are required to observe.
  2. Highlighting geographical and temporal ‘hotspots’ that might indicate community spread and encouraging compliance in these areas.
  3. Promoting testing and raising awareness of the testing facilities available – including during surge testing for variants of concern.
  4. Raising awareness among residents and businesses about legal requirements for isolation and COVID security.
  5. Promoting vaccination.
  6. Raising awareness of support available to vulnerable people.
  7. Promoting health and wellbeing messages to the wider population, around mental health, exercise, and healthy lifestyles.

Communications media include:

  1. Digital channels including the SCC website and intranet, social media, digital advertising, and email/text.
  2. Media, including, press, radio, television, and online
  3. Out of home advertising, including billboards and mobile advertising vans.
  4. Engaging schools to help them get key messages to pupils and parents.
  5. Engaging businesses to help them get key messages to employees and customers, especially high risk businesses.
  6. Engaging community leaders and influencers, including elected members, to help them get key messages to local residents and businesses, especially in vulnerable and underserved communities.
  7. Briefings for Local Resilience Forum partners and elected members about high risk incidents to ensure that they are up to date with the current situation.

We provide regular communications for local MPs and councillors about the overall situation in their area as well as High Risk Incidents that may be of concern to local residents. We do a weekly Microsoft Teams briefing for MPs, and councillors from both County and District and Borough Councils are involved in our Local Outbreak Control Groups. We also ensure that we are responsive to enquiries from individual elected members. This helps them keep their constituents informed, amplify key messages and allay any anxieties.

 


 

High-risk settings Back to top

There are some settings that have an inherent high risk from COVID due to density of occupation (relatively large numbers of people sharing a relatively small space), difficulty in maintaining infection prevention and control, and or the vulnerability of occupants. We offer proactive advice and support to all settings to help them ensure COVID security and focused on those that are high risk.

Care homes

Advice and support includes:

  1. Advice and practical assistance to enhance infection prevention and control.
  2. Advice to support management of cases, clusters, and outbreaks - more than 1000 Incidents so far.
  3. Working with the NHS to develop hospital discharge pathways to ensure that care homes are protected from new infections introduced from hospitals.
  4. Additional staff to support business continuity.
  5. Personal protective equipment supplies.
  6. Additional funding - a total of £38m during 2020/21.
  7. Support to establish testing for residents and staff.
  8. Support to access COVID vaccination for residents and staff; and
  9. Links to NHS skills and resources, such as the local Infection Prevention; and Control team and the Midlands Partnership Foundation NHS Trust Intensive Support Team.

Schools

Advice and support includes:

  1. Advice and practical assistance to enhance infection prevention and control.
  2. Advice on COVID management controls and setting risk assessments:
  3. Advice to support management of cases, clusters, and outbreaks - more than 1000 Incidents so far.
  4. Personal protective equipment supplies.
  5. Support to establish testing for pupils and staff; and
  6. Support to access COVID vaccination for staff.

Prisons

Advice and support includes:

  1. Advice and practical assistance to enhance infection prevention and control.
  2. Advice to support management of cases, clusters, and outbreaks.
  3. Personal protective equipment.
  4. Support for testing of inmates and staff; and
  5. Support to access COVID vaccination for inmates and staff.

Businesses

We have a register of high-risk businesses including food processing facilities, businesses using high numbers of temporary immigrant staff, homeless hostels, warehousing and distribution premises, and taxi companies. We have been proactive in offering advice and support and visiting to assess COVID security.

The hospitality sector is also in high-risk and it is important that they maintain accurate and comprehensive records of customers in order that we can contact them I the event of an outbreak. Relying on the NHS app is insufficient as we cannot get access to this data for contact tracing purposes. We request that HM Government issue a reminder to the hospitality sector about the importance of customer records.

Advice and support includes:

  1. Advice and practical assistance to enhance infection prevention and control.
  2. Advice to support management of cases, clusters, and outbreaks - more than 1000 Incidents so far.
  3. Personal protective equipment supplies; and
  4. Support to establish testing for employees.

Community healthcare settings

Advice and support includes:

  1. Advice and practical assistance to enhance infection prevention and control.
  2. Advice to support management of cases, clusters, and outbreaks - more than 1000 Incidents so far.
  3. Personal protective equipment supplies.
  4. Support to establish testing for inmates and staff; and
  5. Support to access COVID vaccination for inmates and staff.

 


 

Vulnerable and underserved communities Back to top

There are some communities and groups that may be at elevated risk of infection and/or complications, and/or less likely to engage with testing and vaccination.

These include:

  1. Communities living in high-density, multi-generational or overcrowded accommodation.
  2. Communities with low literacy levels and/or digital exclusion.
  3. Communities with a high proportion on low or no income.
  4. Communities with a high proportion from black and minority ethnic groups.
  5. Communities with a high proportion working in high risk settings.
  6. Homeless.
  7. People with drug and alcohol problems.

The Strategic Co-ordinating Group has a Safeguarding, Vulnerability & Partnerships tactical group, which co-ordinates activities to protect these communities and groups across Local Resilience Forum partners in Staffordshire and Stoke on Trent.

There are a number of components of COVID defences where we target vulnerable and underserved communities:

  1. Surveillance. We have identified ‘hotspot’ communities based on deprivation, ethnicity and cumulative COVID case rates in order to allow targeting of activities.
  2. Testing. We ensure that asymptomatic testing is accessible to ‘hotspot’ communities, both through local businesses and registered social landlords, as well as the location of community testing centres.
  3. Vaccination. We monitor COVID vaccination uptake by geography and ethnicity to identify any shortfalls. Where uptake is low, GPs contact eligible individuals personally to encourage them to get vaccinated. We also put on dedicated vaccination clinics, for example in Burton.
  4. Communications and engagement. We have engaged with black and minority ethnic communities throughout the pandemic to encourage adherence to lockdown rules as well as promote and enhance access to testing and COVID vaccination, using trusted local leaders to convey key messages.

 


 

Compliance and enforcement Back to top

Our approach is to engage, explain and encourage compliance by residents and businesses, and use enforcement only as a last resort for serious or persistent breaches of COVID security. The Strategic Co-ordinating Group has a Compliance and Enforcement tactical group, which co-ordinates activities across Local Resilience Forum partners in Staffordshire and Stoke on Trent.

Residents

Communications regularly highlight the precautions the public can take to limit the spread of infection as well as the legal requirements they are required to observe, both on a day to day basis and in the event that they are required to isolate. All of the Districts and Boroughs have ‘COVID Marshals’ or equivalents operating in public places, whose role is to engage, explain and encourage the public to follow rules on personal hygiene, face coverings, and social distancing.

The Police receive and investigate reports about members of the public suspected of not following legal requirements to limit household gathering and movement, and issue fixed penalty notices where appropriate. Our local contact tracing team calls the majority of cases and contacts to verify isolation and makes a referral to the Police where there are reasonable grounds for suspicion that they are not following legal requirements. The Police visit these at home as well as any other cases or contacts where they have intelligence that they are not isolating and may issue fixed penalty notices where people are found to be in breach of legal requirements. So far around 500 fixed penalty notices have been issued for breaches of COVID regulations by residents of Staffordshire and Stoke on Trent.

Businesses

Issues of compliance may be identified during management of an outbreak, or through local intelligence with concerns reported to a range of agencies. The number of complaints and queries about COVID compliance in Staffordshire businesses are shown in Figure 7. Issues are typically be investigated by District and Borough Council Environmental Health Teams initially, who offer advice and support where possible.

Where concerns are serious or persistent then the most appropriate route for enforcement is determined through existing powers available to the District and Borough Councils and/or Health and Safety Executive, and/or through powers available under the Health Protection Regulations 2020 to the Police and County Council.

Under the Health Protection Regulations 2020 the County Council has powers to direct businesses to limit their activities or to close, limit access to public outdoor places and to prevent specific events, without having to make representations to a magistrate. The expectation is that these powers are used with discretion, and only to be used having had regard to any advice given by the Director of Public Health.

Figure 7: complaints and queries received by Staffordshire Trading Standards

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  • Closure
  • Distancing
  • Other
  • PPE
  • Advice
  • Profiteering
  • Scams

Directions for businesses may take the form of:

  1. Coronavirus Improvement Notice: usually the first step for local authority enforcement officers to encourage businesses to remedy unsafe practices. It is applied for a minimum of 48 hours with the actual duration at the discretion of the Local Authority.
  2. Coronavirus Restrictions Notice: issued when there has been a breach of the provisions of the relevant COVID regulations, and a premises has failed to comply with the terms of a Coronavirus Improvement Notice, where this non-compliance creates a risk of exposure to coronavirus.
  3. Coronavirus Immediate Restrictions Notice: where rapid action is needed to close a premises or restrict an activity to stop the spread of, without first issuing a Coronavirus Improvement Notice to stop the spread. Closure is for a 48-hour period initially. 

To date we have issued 3 Directions. In line with legal requirements these are event notified to the Secretary of State as soon as reasonably practicable and reviewed at least once every 7 days to ensure that the basis for the Direction remains.

Businesses that form part of essential national infrastructure are out of scope of these powers. A non-exhaustive list of infrastructure in this category is set out in HM Government guidance. It includes supermarkets about which there are steady stream of concerns and we request that HM Government include these in the category of businesses that can be subject to local Directions.

HM Government has powers to under the Public Health (Control of Disease) Act 1984 to implement more substantial restrictions which could include:

  1. Closing businesses and venues in whole sectors (such as food production or non-essential retail), or within defined geographical areas (such as towns or counties).
  2. Imposing general restrictions on movement of people (including requirements to ‘stay at home’, or to prevent people staying away from home overnight stays, or restrictions on entering or leaving a defined area).
  3. Imposing restrictions on gatherings – limiting how many people can meet and whether they can travel in and out of an area to do so.
  4. Restricting local or national transport systems – closing them entirely, or introducing capacity limits or geographical restrictions; and / or
  5. Mandating use of face coverings in a wider range of public places.

 


 

Data management and information sharing Back to top

Local Resilience Forum partners involved in management of Incidents ensure that information is shared appropriately and in a timely and secure way.

The COVID Local Outbreak Co-ordinating Team ensures effective data management including:

  1. Surveillance for infections, with details maintained on the COVID Local Outbreak Control dashboard.
  2. Data systems to enable receipt, logging, monitoring, and reporting of progress of Incidents, and assurance on effective management.
  3. Temporal and spatial analysis of Incidents to identify geographical ‘hotspots’ and trends.
  4. Use of national algorithms that identify postcode co-incidences or common exposures as part of the Outbreak Identification & Rapid Response.
  5. Information governance protocols to allow secure and timely sharing of data and information.
  6. Data retention and disposal of in a timely manner in line with local retention schedules, taking into account applicable legislation where appropriate.

 


 

Resourcing Back to top

HM Government has indicated that in 2021/22 it will provide £400 million nationally from the Contain Outbreak Management Fund to local authorities to support implementation of Local Outbreak Management Plans. Staffordshire’s share is estimated to be c£6 million. This will be used to fund a range of teams and services contributing to the COVID response as listed in Table 2.

The Staffordshire COVID response is a corporate and multi-agency endeavour, rather than limited to Public Health. This means that we are able to draw on the knowledge, skills, experience, systems and processes – with robust arrangements in place for mutual aid if necessary. This ensures that we have the capacity and capability that we need.

Table 2: teams and services requiring funding

Co-ordination

  • County Council - Business and Executive Support Team

Clinically Extremely Vulnerable

  • County Council - Voluntary Sector

Intelligence

  • County Council - Insight

Testing 

  • County Council - Business support
  • MPFT - Swabbing team
  • Nexxus - Community Testing Service

Contact tracing 

  • County Council - Contact tracing 
  • District and Borough Councils - Environmental health 

Compliance and Enforcement

  • County Council - Contact tracing 
  • County Council - Trading Standards
  • District and Borough Councils - Environmental health 
  • District and Borough Councils - ‘COVID Marshals'

Outbreak management

  • County Council - Public health and prevention
  • County Council - Care commissioning
  • County Council - Health & safety
  • District and Borough Councils - Environmental health 

Communications

  • County Council - Communications 

Staffordshire’s Business Continuity Plans have been reviewed to reflect the stand-down of BAU so that surges in transmission are prioritised and resourced is moved from activities that can be temporarily suspended. 

 


 

Governance

The Director of Public Health is responsible for producing and implementing the Local Outbreak Management Plans, working through the Health Protection Boards, and supported by the Local Resilience Forum Strategic Co-ordinating Group and the COVID Member led Local Outbreak Control Board.

Governance of Local Outbreak Management, as set out in Figure 8, ensures that:

  1. The Local Outbreak Management Plan is supported by all of the partners who may be required to contribute to implementation.
  2. There is robust day to day monitoring of prevention and management of outbreaks.
  3. There is multiagency oversight of prevention and management of outbreaks and the ability to escalate for mutual aid if necessary.
  4. There is democratic oversight of prevention and management of outbreaks, which contributes to effective public communication.
  5. We can continually reflect, learn, and improve.

Figure 8: governance

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COVID Strategic Co-ordinating Group

The Strategic Co-ordinating Group (SCG) includes members from all Local Resilience Forum (LRF) partners as well as liaison from Public Health England, the Department of Health and Social Care Regional Convener Team and Ministry for Housing, Communities and Local Government.

The SCG ensures a shared understanding of the local COVID situation, in a regional and national context, and provides strategic co-ordination of the activities and resources required for the COVID response across LRF partners in Staffordshire and Stoke on Trent, including mutual aid where necessary.

The SCG has a number of tactical groups that co-ordinate aspects of the COVID response:

  1. Intelligence and Modelling.
  2. Local Outbreak Control.
  3. Health & Social Care.
  4. Testing.
  5. Communications.
  6. Compliance and Enforcement.
  7. Mortality management.
  8. Resources and mutual aid.
  9. Safeguarding, Vulnerability & Partnerships.
  10. Vaccine delivery.
  11. Vulnerability & Voluntary Support.

COVID Health Protection Board

The Health Protection Board provides day to day co-ordination of the COVID response for Staffordshire. Membership includes relevant teams from the County Council as well as District and Borough Councils and the NHS, with the Public Health England Health Protection Team invited. Outline terms of reference are to:

  1. Develop and continually review the Local Outbreak Management Plan.
  2. Ensure that appropriate and up to date Standard Operating Procedures (SOPs) are in place for Incident management.
  3. Oversee surveillance and management of Incidents.
  4. Consider issues escalated from Incident Management Teams and identify additional support required to address these.
  5. Provide assurance about management of Incidents.
  6. Reflect on learning from Incidents to identify improvements for future management and amend SOPs accordingly and/or identify additional capacity requirements.

COVID Member Led Local Outbreak Control Board

The Board is chaired by the Leader of the County Council or Cabinet Member for Health, Care and Well-being. Membership includes Members from the Healthy Staffordshire Select Committee and District and Borough Councils. The Board provides democratic oversight and leads public communication about the overall COVID situation and response in Staffordshire. The Board maintains a dialogue with the Healthy Staffordshire Select Committee and the Staffordshire Leaders Group.

Each District and Borough also has a Local Outbreak Control Group which provides oversight of the COVID situation and response at District and Borough level.

Clinical Governance

Clinical Governance is the systems and processes for continuously improving the quality of services and promoting high standards by creating an environment in which excellence can flourish. Clinical Governance has a number of requirements as listed in Table 3 along with our arrangements.

Table 3: clinical governance

Requirement: Governance

  • Clear lines of accountability and responsibility for the COVID response.

Arrangements: As set out in Figure 7 and described in this section above.

Requirement: Quality Management

  • Evidence based practice
  • Standard operating Procedures (SOPs)
  • Staff education and training
  • Clear performance metrics
  • Good record keeping
  • Adverse event reporting

Arrangements: The Staffordshire COVID response is based on the national guidelines and evidence from the Scientific Advisory Group for Emergencies. SOPs are in place for asymptomatic testing and for Incident management. All staff involved in the COVID response are trained prior to deployment in their roles. Performance metrics are in place to monitor uptake of testing, completion of contact tracing and uptake of vaccination. The COVID Local Outbreak Co-ordinating Team maintains all records in a central repository. Adverse events can be raised with the Director of Public Health.

Requirement: Risk management

  • Risk assessment
  • Audit
  • Reflection, learning and continuous improvement

Arrangements: Arrangements are in place to assess and document risks related to Incident management, based on a template. We have completed an audit of Incident management and implemented the recommendations arising. We complete a brief reflection of all Incidents with learning highlight to the Health Protection Board.

 


 

Risks Back to top

There are a number of risks to implementation of the Local Outbreak Management Plan as listed in Table 4.

Table 4: risks and mitigation


Risk: COVID defences can influence the spread of infection within the county but cannot totally control it.

Impact: Residual risk that COVID defences are inadequate, leading to resurgence of the virus. 

Mitigation: Accurate real time surveillance and robust COVID defences. Escalation to HM Government as necessary.


Risk: We have limited influence on the spread of infection in neighbouring areas.

Impact: Resurgences of the virus in neighbouring areas spreads to Staffordshire.

Mitigation: Engagement with Regional Convener team to understand epidemiology across West Midlands and dialogue with neighbouring local authorities where necessary.


Risk: National restrictions imposed by HM Government may be disproportionate to the COVID situation in Staffordshire.

Impact: Either restrictions in adequate to control the spread of infection, or unnecessarily intrusive with damage to well-being and the economy.

Mitigation: Engagement with Regional Convener team and lobbying HM Government to influence national restrictions.


Risk: Home testing with LFD is less accurate than supervised on-site testing. 

Impact: Significant proportion of asymptomatic cases missed.

Mitigation: Initial supervised on-site testing and training offered to maximise accuracy, and request assurance from HM Government that home testing is supported by good evidence.


Risk: NHS Test and Trace Regional Testing Sites, Local Testing Sites and Mobile Testing Units are discontinued.

Impact: No symptomatic testing facilities available.

Mitigation: Seek confirmation from HM Government that these will continue to be available throughout 2021/22 or whether alternative local facilities will be required.


Risk: National asymptomatic testing programmes are discontinued.

Impact: Reduced coverage of asymptomatic testing.

Mitigation: Seek confirmation from HM Government that these will be ongoing throughout 2021/22 or whether alternative local programmes will be required.


Risk: Supplies of free LFD are discontinued after June 2021.

Impact: Reduced coverage of asymptomatic testing.

Mitigation: Seek confirmation from HM Government that these will continue to be available throughout 2021/22.  


Risk: Poor uptake of asymptomatic testing.

Impact: Cases missed allowing spread of infection.

Mitigation: Local communications and request clear national communications about the importance of asymptomatic testing throughout 2021/22.


Risk: People cannot afford to isolate after July 2021 when funding for the Test and Trace Support Payment and discretionary schemes ends.

Impact: Cases and close contacts do not isolate leading to increased spread of infection.

Mitigation: Seek confirmation from HM Government that funding will continue to be available throughout 2021/22.


Risk: Health Protection Team is lost during transition from Public Health England to National Institute for Health Protection.

Impact: Expert advice and support for outbreak management is lost.

Mitigation: 

Seek assurance from HM Government that these will be sustained with sufficient capacity to maintain the response to COVID as well as to other communicable diseases and non-communicable environmental hazards.


Risk: Hospitality sector has insufficiently comprehensive or accurate customer records, and local authorities are not given access to data collected via QR app.

Impact: We are unable to contact customers in the event of an outbreak.

Mitigation: Request that HM Government issue a reminder to the hospitality sector about the importance of customer records, and local authorities are given access to records collated via the QR app.


Risk: Powers of enforcement are limited and do not extend to supermarkets about which there are steady stream of concerns about non-compliance.

Impact: Supermarkets become a vector for spread of infection.

Mitigation: Request that HM government include supermarkets in the category of businesses that can be subject to local Directions.


Risk: COVID vaccine supplies are insufficient to achieve the national target to offer vaccination to all adult 50 and over by 15 April and all adults by 31 July.

Impact: Slow progress towards full vaccine coverage and significant numbers of people remaining unvaccinated.

Mitigation: Seek assurance from HM Government that vaccine supplies will be sufficient.


Risk: There are insufficient resources to maintain effective COVID defences.

Impact: Outbreaks and community spread no identified or managed leading to preventable spread of infection.

Mitigation: Ensure effective use of Contain Outbreak Management Fund 2021/22. Small reserve carried forward from 2020/21.

 


 

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