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Staffordshire Covid-19 local outbreak control plan

 


 

Foreword  Back to top

The Covid-19 pandemic is the biggest peacetime crisis that the UK has faced in living memory. At 1 July 2020 there have been over 300,000 confirmed cases and many more cases that have not been diagnosed. Over 125,000 people have been hospitalised, and there have been nearly 50,000 confirmed deaths from Covid-19 and many more deaths arising from the pandemic.

The country is starting to emerge from a prolonged 'lockdown', imposed at the end of March 2020 to try and control the spread of the virus. All our lives have been affected and some people will be affected for years to come. 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.

We all want to get our lives back. But Covid-19 is not going away. There may be a vaccine, but this is likely to be many months if not years away, and even then, it may not be completely effective. The virus will continue to circulate in our communities, and it is essential that we limit the spread of infection so that our lives can return to something resembling 'normal', and our economy can be restarted. We want to avoid a return to full lockdown.

This requires ongoing action from the whole of society. It is vital that everyone continue to observe social distancing guidelines and good hygiene. People who develop symptoms should self-isolate, call NHS 111 and be tested. Contacts of confirmed cases who are contacted by the NHS Test and Trace service should isolate for 14 days. Care providers, schools and businesses should report cases and outbreaks so that they can be managed effectively.

HM government needs to provide clear guidance, ensure that national services are working effectively, and ensure that resources are available to support the local response. Local authorities, along with other local partners, have been given a crucial role in developing and implementing Covid-19 local outbreak control plans to prevent and manage outbreaks.

This is Staffordshire's plan. It will be continuously updated as the pandemic evolves and in light of emerging HM government policy and guidance. We would also welcome your feedback. By working together, we can continually improve Staffordshire’s response and support our recovery.

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

The national test and trace service

From June 2020 HM government launched a national test and trace service, which will form a central part of the Covid-19 ongoing response and recovery. The objectives are to:

  • control the Covid-19 rate of reproduction (R)
  • reduce the spread of infection and save lives
  • help to return life to as normal as possible, for as many people as possible, in a way that is safe, protects our health and care systems and releases our economy

The test and trace service includes four tools to control the virus:

  • test - rapid testing, at scale, to control the virus and identify its spread
  • trace - integrated tracing to identify, alert and support those who need to self-isolate
  • contain - using data to target approaches to flare ups, at a local and national level
  • enable - improving knowledge of the virus to inform decisions on social and economic restrictions

‘Test’ will be provided by a combination of local swabbing and laboratories as well as regional testing centres and mobile testing units.

‘Trace’ will be provided by the NHS Test and Trace service.

‘Contain’ includes a national Joint Biosecurity Centre that will work with Public Health England (PHE) and local authorities, including Directors of Public Health, to identify and manage local outbreaks. Upper tier local authorities are required to develop and implement local outbreak control plans and will be allocated a share of £300m to fund these.

Local outbreak control plans

These plans will centre on seven themes:

  • care homes and schools - planning for local outbreaks in care homes and schools (e.g. defining monotoring arrangements, potential scenarios and planning the required response)
  • high risk places, locations and communities - identifying and planning how to manage high risk places, locations and communities of interest (e.g. defining preventative measures and outbreak strategy strategies)
  • local testing capacity - identifying methods for local testing to ensure a swift response tha is accessible to the entire population (e.g. defining how to prioritise and manage deployment, examples may include NHS, pop-up etc.)
  • contact tracing in complex settings - assessing local and regional contact tracing capability in complex settings (e.g. identifying specific local complex communities, developing assumptions to estimate demand and options to scale capacity)
  • data integration - integrating national and local data and scenario planning through the Joint Biosecurity Centre playbook (e.g. data management planning, including data security, NHS data linkages)
  • vulnerable people - supporting vulnerable local people to get help to self-isolate (e.g. facilitating NHS and local support, identifying relevant community groups etc.) and ensuring services meet the needs of diverse communities
  • local boards - establishing governance structures led by existing Covid-19 Health Protection Boards in conjunction with local NHS and supported by existing Gold command forums and a new member-led board to communicate with the general public

Local Directors of Public Health will be responsible for producing local outbreak control plans, working through Covid-19 Health Protection Boards. They will be supported by and work in collaboration with Local Resilience Forum (LRF) Strategic Co-ordinating Groups (SCGs) and a public-facing board led by council members to communicate openly with the public.

In two-tier areas, district and borough councils are expected to be fully involved. Plans had to be in place by the end of June 2020.

Contain framework

On 18 July 2020, HM government set out its new contain framework that describes the national response to local outbreaks and community spread.

The hope is that in most areas of the country transmission of the virus can be kept to low levels and the number of cases can be kept low with outbreaks limited to discrete settings such as care homes, schools, businesses and households. Where there is wider community spread then upper tier local authority (UTLA) areas will be categorised according to a graduated scale:

Areas of concern

In areas where there is some community spread and the number of cases is rising the expectation is that UTLA will work with partners, supported by regional PHE and NHS Test and Trace, to take additional actions. Actions may include:

  • enhanced communications around the importance of hygiene, social distancing, and other preventative measures
  • additional targeted testing
  • more detailed epidemiological work to understand the spread of infection

They may also include additional restrictions with the UTLA using new powers to close premises, places and events where necessary.

Areas of enhanced support

In areas where there is more extended community spread and the number of cases is higher and/or increasingly rapidly then UTLA will be provided extra national capacity and oversight to support additional actions. Actions may include:

  • detailed engagement with high risk communities and sectors to help increase the effectiveness of testing and tracing
  • more widespread testing
  • further restrictions on premises, places and events, determined locally

Areas of intervention

In these areas decision-making on the need for more substantial restrictions will be determined nationally. This will be on the basis that one or more of the following criteria are met:

  • local leaders request intervention
  • management requires resource prioritization by HM government
  • the situation raises issues of national importance - for example impact on critical infrastructure, major parts of the economy or wider sectors such as food or energy production
  • local capacity and capabilities are exceeded, the local response is ineffective, or the scale of the situation calls for the use of wider or more intrusive powers

 


 

Staffordshire and Covid-19  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-19 compared to England as a whole:

  • 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
  • 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-19 increases dramatically with age, is higher in men than women, probably due to the higher rate of underlying health conditions in older people
  • 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-19 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 appear to have an increased risk of complications from Covid-19. 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 black and minority ethnic 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-19 also appears to be further exacerbating health inequalities. General mortality rates are normally higher in more deprived areas. However, Covid-19 seems to be increasing this effect. The Covid-19 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-19 was confirmed in mid-March 2020. At 1 July 2020 there have been over 3,500 confirmed cases and many more cases that have not been diagnosed. Over the period week ended 13 March to 12 June 2020 there have been an excess of 911 deaths compared to the average for the same period in the previous five years.

On 25 March 2020, our LRF declared a major Incident, and before and since the council and local partners have been working tirelessly to manage the pandemic. Our efforts have included:

  • maintaining essential public services in the face of reduced staffing
  • information, advice and guidance for care providers, schools, businesses and the public
  • practical support for care providers including additional staffing, financial assistance and specialist advice to help with infection control
  • emergency supplies of personal protective equipment (PPE) to a whole range of settings, with more than 2 million items provided so far
  • supporting vulnerable people with reassurance and supplies of food and medicine
  • providing education online and supporting vulnerable children and children of essential workers in schools

We are hugely grateful to our staff who have risen to an unprecedented challenge, to the public who have been diligent in observing social distancing guidelines and good hygiene, and to the many people who have stepped forward to help vulnerable people.

With the number of new cases decreasing we are starting to think about how we recover from the pandemic. However, it is clear that Staffordshire will not return to how it was before Covid-19 for the foreseeable future. The virus will continue to circulate in our communities, and it is essential that we limit the spread of infection so that our lives can return to something resembling 'normal', and our economy can be restarted. We want to avoid a return to full 'lockdown'.

This requires ongoing action from the whole of society. It is vital that everyone continue to observe social distancing guidelines and good hygiene. People who develop symptoms should self-isolate, call NHS 111 and be tested. Contacts of confirmed cases who are contacted by the NHS Test and Trace service should isolate for 14 days. Care providers, schools and businesses should report cases and outbreaks so that they can be managed effectively.

 


 

Objectives and key principles  Back to top

Objectives

The purpose of this plan is to support the quick and effective prevention and control of Covid-19 in a range of settings. The specific objectives are to:

  • reduce the spread of infection in Staffordshire, minimise the number of cases, protect our health and care system, and save lives
  • support settings experiencing an outbreak to mitigate the consequences and keep as many services and businesses going as possible in a way that is safe and releases our economy
  • give the public confidence that we are able to respond appropriately to outbreaks of Covid-19

Principles

Across the county we routinely manage communicable disease outbreaks in a range of settings. Covid-19 is not a unique challenge. However, it means putting in place standard operating procedures and capacity to ensure that we can respond quickly and at scale, potentially managing multiple outbreaks concurrently.

We needed to move rapidly and have 'good enough' arrangements in place by the end of June. These can then be refined through our experience of managing outbreaks. Arrangements will need to be maintained for the long term - at least a year, probably two and possibly in perpetuity.

Our key principles are that we will:

  • work as a system to co-ordinate activities across local and national partners
  • intervene early in order to prevent and control outbreaks and minimise the spread of infection
  • target preventative interventions on the highest risk settings and communities
  • draw on the skills, experience and ways of working of existing teams
  • ensure that these teams are appropriately resourced, with information, training and additional capacity where necessary
  • 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
  • provide clarity about the roles and responsibilities of individual organisations and teams
  • communicate well and share data and information
  • work collaboratively with those settings affected by outbreaks to ensure effective management
  • be flexible, prepared to take on new roles and responsibilities and do whatever it takes to ensure that outbreaks are managed effectively
  • provide mutual aid between organisations and teams to ensure that no-one is overwhelmed
  • continually reflect, learn and improve

 


 

Surveillance for infections  Back to top

The council will maintain real time surveillance for infections in order to identify geographical 'hotspots' and trends. This will include surveillance of population cases of Covid-19 as well as temporal and spatial analysis of Incidents. This will be critically dependent on receiving comprehensive, timely and accurate data from the 'Test' and 'Trace' tools provided by national services.

Where community spread is identified, this will be discussed with PHE, through the LRF, with the Covid-19 member-led local outbreak control board and with the affected community to determine an appropriate response. The response may range from enhanced communications to promote increase hygiene and social distancing to additional restrictions to activities. A local escalation framework with a series of thresholds have been developed to guide when these might be introduced.

HM government will maintain lists of areas at the various levels of the contain framework. This will presumably be based on the prevalence of infection and other factors, although the thresholds for escalation are not defined.

 


 

Standard operating procedures for incidents  Back to top

A range of standard operating procedures (SOPs) have been developed to guide prevention and control of outbreaks in a range of settings. These will set out the functions required and the organisations responsible. The intention is to ensure that the approach is comprehensive and consistent across Staffordshire.

These 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.

Outline standard operating procedure

Outline standard operating procedure

This illustrates how an incident is notified to the Joint Biosecurity Centre, PHE and local partners. The Joint Biosecurity Centre also refers to PHE.

PHE liaises with the council's single point of contact and also their lead management.

Our single point of contact also looks after data and local asurance as well as informing local lead management.

Both PHE and local lead managements conduct a risk assessment and creates an incident management team, if necessary.

From this, control measures are put in place. Finally a follow up is carried out.

The council single point of contact is informed of the risk assessment, control measures and the follow up.

Definitions

The SOPs use the following terms:

Case

An individual suspected or confirmed of Covid-19 among users and/or staff.

Cluster

Two or more suspected and/or confirmed cases among users and/or staff in the same setting with onset during a 14-day period in the absence of a common exposure or link - i.e. they appear to have arisen independently rather than through spread of infection within the setting. Or an increase in the background rate of absence in a setting due to suspected or confirmed cases of Covid-19.

Outbreak

Two or more suspected and/or confirmed cases among users and/or staff in the same setting with onset during a 14-day period and with a common exposure or link - i.e. the cases have had contact with each other or with another common source of infection, indicating spread of infection within the setting.

Community spread

This refers to an increased number of sporadic or linked cases within the community.

Settings

These include:

  • care settings - including care homes, extra care, supported living, day services, home care, Shared Lives and personal assistants
  • education, early years and children’s social care settings
  • prisons and other prescribed places of detention
  • high risk places, locations and communities including the following - a register of these has been established:
    • homeless hostels and domestic violence shelters
    • religious, traveller and other ‘defined’ communities
    • high risk workplaces - those that tend to involve one or more of:
      • people working in close proximity and/or in settings where it is difficult to maintain good standards of environmental and/or personal hygiene
      • people who both work and reside together
      • a low skilled and/or transient workforce who may be difficult to contact trace and/or isolate
  • community healthcare settings including the following (note that NHS Trusts are out of scope of the local outbreak control plan):
    • hospices
    • GP and dental surgeries
    • pharmacies
    • drug and alcohol services

Incidents

The remainder of this information will refer to incidents. This includes single cases, clusters and outbreaks where intervention is required to prevent and control an outbreak.

Interface with national services

This plan is critically dependent on the interface with the 'test' and 'trace' tools provided by national services. Whilst the roles and responsibilities of these is becoming clearer there remains some uncertainty about exactly what these will do and how they will relate to local partners. SOPs will need to be continually reviewed as further clarity emerges.

Identification of incidents

Incidents may be identified by the Joint Biosecurity Centre and/or PHE nationally or may be identified through local intelligence. Any organisation that suspects an incident must notify this immediately to the PHE West Midlands Health Protection Team and/or to the council so that appropriate action can be taken.

Surveillance will include:

  • information about the number, geographical distribution and trends in confirmed cases, incidents, hospital utilisation and deaths
  • information about expected versus observed numbers of cases from PHE ‘exceedance reports’

Working with Public Health England

The council will agree a joint standard operating procedure with PHE West Midlands Health Protection Team that describes how we will work together. We will remain in continuous dialogue so that we are clear about which incidents are ongoing, the lead for management and follow up, and progress with implementation of control measures.

Co-ordination

Staffordshire County Council will maintain a Covid-19 local outbreak co-ordinating team. This 'virtual team' will:

  • provide a single point of contact (SPOC) for reports of Incidents from all sources
  • ensure that all outbreaks are logged in a Covid-19 local outbreak control database with a minimum data set including those fields defined below:
    • date and time of first report received by the council
    • setting
    • number of suspected and confirmed cases
    • date of first onset of symptoms of suspected and confirmed cases
    • number and date of any associated deaths
    • date and time of risk assessment(s)
    • current risk rating
    • date and time of incident management teams where held
    • summary of control measures
    • progress updates
    • other pertinent information
    • date and time of closure
  • maintain the Covid-19 local outbreak control dashboard with details about incidents as well as local epidemiology, and provide updates to the Covid-19 health protection board, Covid-19 member-led local outbreak cntrol board, and other partners as required.
  • ensure that a risk assessment is completed for all new incidents to determine immediate control measures required and a risk rating
  • ensure that an incident management team (IMT) with an appropriate lead and involving local partners is convened where necessary, and to ensure that incidents are followed up according to the relevant standard operating procedure.
  • close incidents on the advice of the lead organisation and team, and conduct a brief review following closure of all incidents to identify learning and improvements for future management
  • ensure effective data management and timely communication of key information to relevant settings, partners and PHE

Local responsible organisation and team

We have identified local responsible organisations and teams who will support and lead management of incidents depending on the setting. This will allow us to draw on local knowledge, skills and experience.

The local responsible organisation and team will usually be as follows:

Care settings

Staffordshire County Council Care Commissioning Team.

Education, early years and children's social care settings

Staffordshire County Council Health, Safety and Wellbeing Team.

Prisons and other prescribed places of detention

Staffordshire County Council Public Health and Prevention Team.

High risk places, locations and communities

District and borough council Environmental Health Teams.

Community healthcare settings

Staffordshire County Council Public Health and Prevention Team and Clinical Commissioning Groups.

Community spread

County Council Public Health and Prevention Team.

The local responsible organisation and team will:

  • conduct an initial risk assessment
  • for PHE led Incidents support implementation of control measures
  • for locally led incidents determine, co-ordinate and ensure implementation of control measures, drawing on specialist advice from PHE and locally as required
  • follow up incidents according to the relevant standard operating procedure
  • close incidents when appropriate
  • ensure that the Covid-19 local outbreak co-ordinating team have accurate and up to date information to maintain the Covid-19 local outbreak control database

Risk assessment

Where PHE are notified of an incident, or significant new information about an existing incident, they will:

  • contact the setting and any other partners to gather information and ensure an accurate understanding of the epidemiology and circumstances of the inciden
  • carry out a risk assessment as soon as practically possible

Where the council are notified of an incident, or significant new information about an existing incident, the Covid-19 Local Outbreak Co-ordinating Team will ensure that it is logged and pass it to the appropriate local responsible organisation and team for action.

The local responsible organisation and team will

  • contact the setting and any other partners to gather information and ensure an accurate understanding of the epidemiology and circumstances of the incident
  • carry out a risk assessment as soon as practically possible drawing on specialist advice from PHE or local sources if required

The risk assessment will determine a risk rating, the immediate control measures required and arrangements for follow up. PHE will usually lead management and follow up of high-risk incidents. The local responsible organisation and team will usually lead management and follow up of medium and low risk incidents.

Incident management team (IMT)

Where necessary an IMT will be convened - either by PHE or the council. The lead organisation and team will usually chair the IMT - either PHE or the local responsible organisation and team.

The IMT will ensure a comprehensive and accurate understanding of the epidemiology and circumstances of the incident and agree and document the control measures required to minimise the spread of infection and mitigate the wider consequences of the incident including:

  • infection prevention and control measures
  • support for business continuity
  • requirements for testing and arrangements to complete them
  • requirements for contact tracing and arrangements to complete them
  • effective communications

The IMT will include a further risk assessment and produce a revised risk rating to guide ongoing management and follow up.

 


 

Management of incidents  Back to top

Management of icidents may include a range of control measures, which will be determined following the risk assessment and/or by the IMT. Potential control measures include the following, which are expanded in the next section:

  • infection prevention and control measures - including isolation and cohorting, closure of settings - either full or partial, 'deep cleaning', additional PPE
  • support for business continuity including management and staffing
  • addressing quality and safeguarding concerns
  • contact tracing
  • testing
  • support for self-isolation
  • enforcement

Management of incidents will be supported by:

  • specialist advice
  • safeguarding
  • equipment and associated logistics to ensure supplies
  • communications
  • data management
  • capacity and training

Where PHE is the lead for incidents, the local responsible organisation and team will:

  • ensure a clear record of control measures and progress of implementation
  • support further risk assessments based on any significant new information as well as progress of implementing control measures
  • support further IMTs as required
  • provide regular updates to the Covid-19 local outbreak co-ordinating team
  • draw any serious concerns to the attention of the Covid-19 health protection board - for example substantial additional cases or deaths, substantial delays or difficulties in implementing control measures, substantial public anxiety and/or media interest

Where a local responsible organisation and team is the lead for incidents they will:

  • keep a clear record of control measures and progress of implementation
  • complete a further risk assessment and produce a revised risk rating based on any significant new information as well as progress of implementing control measures
  • convene further IMTs as required
  • escalate or de-escalate the incident according to the risk rating
  • provide regular updates to the Covid-19 local outbreak co-ordinating team
  • draw any serious concerns to the attention of the Covid-19 health protection board - for example substantial additional cases or deaths, substantial delays or difficulties in implementing control measures, substantial public anxiety and/or media interest
  • determine when the incident can be closed and advise the Covid-19 local outbreak co-ordinating team accordingly

Detailed standard operating procedures

Detailed SOPs describe management in each of the following settings:

Follow up

All incidents will be followed up, with a frequency determined by the risk rating. Follow up will consider any significant information, such as new cases or deaths, as well as progress of implementing control measures. Follow up will include further risk assessments on a regular basis to ensure that risk rating is up to date. Where necessary an IMT will be convened, either by PHE or the council.

Incidents will be 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 will be undertaken to identify learning and improvements for future management.

Infection prevention and control

Incident management will include a range of control measures including:

Isolation of cases

For 7 days from the onset of symptoms or if asymptomatic with a positive laboratory test then until 7 days after the date the positive test was taken.

Isolation of close contacts

For 14 days from the last contact with the case. Any risks or impediments to this identified and addressed with additional measures to support self-isolation where necessary.

Cohorts

Where isolation of individual cases is not possible cases may be cohorted with different groups of people separated in different areas - where possible four cohorts should be maintained:

  • confirmed cases
  • suspected cases
  • close contacts of cases
  • others

Decontamination or deep cleaning

In some circumstances this may be necessary and arrangements will be put in place through specialist contractors to access this.

Personal protective equipment (PPE)

Provision of and advice regarding use of PPE. 

Closure of settings

Either full or partial.

Business continuity

Where it is necessary to close settings to prevent the spread of infection then consideration must be given to the impact on business continuity, especially where services are essential. Alternative ways of providing services must be considered and established where possible. The balance of risks between minimising the spread of infection and the impact on business continuity must be considered and documented carefully.

The council and NHS will provide support for business continuity where this is necessary and practical. Any quality or safeguarding issues must be addressed.

Contact tracing

The lead organisation and team will usually carry out contact tracing, either by telephone or in person.

Our Staffordshire Cares Team is available to support telephone contact tracing where this involved large numbers of people.

Contacts will not normally be tested unless they are symptomatic. Any symptomatic cases will be regarded as suspected cases and managed accordingly.

Testing

Midlands Partnership NHS Foundation Trust (MPFT) will provide a Covid-19 testing team with the ability to respond within 24 hours anywhere in the county. This will be supplemented by 'surge' capacity if necessary, from infection control teams, school nursing and other community NHS teams.

Other options for testing include:

  • prison health for prison incidents
  • regional test centres
  • mobile testing units

Support for self-isolation

There may be some people for whom self-isolation poses a risk because it means that they are unable to get food and other essential supplies. The council has established arrangements for supporting vulnerable people through the Staffordshire Cares helpline.

The council also has arrangements in place to deliver food and other essential supplies. These include:

  • access to the Defra supermarket scheme which has secured a number of priority online delivery slots with Tesco and Iceland for vulnerable people who can afford food and can shop online, but are having difficulty accessing food because they are self-isolating, are following enhanced social distancing or because support services they normally rely on aren't available, and they don't have friends, family or neighbours available to help
  • arrangements to deliver food and other essential supplies through voluntary organisations, which will continue to play a crucial role in the response to the pandemic
  • where speed is of the essence the council will retain the ability to deliver food and other essential supplies directly

There may be some people who are unable to self-isolate because they do not have suitable accommodation. In these circumstances, Staffordshire County Council and the district and borough council housing teams will work together to identify appropriate accommodation. There are a number of venues available through a national accommodation help line that may be of assistance, although these are not necessarily local.

Specialist advice

Local specialist advice will be available as follows:

Public Health

Staffordshire County Council Public Health and Prevention Team and PHE.

Environmental health

District and borough council Environmental Health Teams.

Clinical

MPFT and local GPs.

Infection prevention and control

MPFT.

Schools

Staffordshire County Council Education team.

Equipment and associated logistics

Successful incident management will rely on supplies of:

Personal protective equipment (PPE)

This would be for both the staff of the responding organisations and the setting itself.

For responding organisations, PPE will usually be provided for staff by their employing organisation. Staffordshire County Council has established arrangements to provide emergency supplies of PPE where necessary.

For settings, Staffordshire County Council will provide emergency supplies of PPE using established arrangements where necessary.

Swabs for testing

These will be sourced and distributed by MPFT. There is an assumption of adequate local laboratory capacity to complete tests.

Communications

Timely, proportionate and accurate communications will be essential to engaging the public in measures to prevent and manage outbreaks, as well as maintaining public confidence.

Staffordshire County Council's Communications Team will lead on communications, linking with district and borough council and NHS communications teams where appropriate.

A communications protocol has been developed to support communications activities.

We will continue to promote social distancing, good hygiene and the NHS Test and Trace service.

Plans are also in place to provide both broader and targeted communications to manage incidents across the county. This includes messaging via media and social media and working with partners, residents, businesses, MPs, community leaders and influencers to ensure communications is relevant to settings or areas affected by outbreaks.

Targeted communications will be especially important in the event that it becomes apparent that there may be community spread associated with particular high risk places, locations and communities such as workplaces or areas with a high proportion of the population from BAME backgrounds. This will require materials to be appropriately translated, and engagement of community leaders and influencers to disseminate key messages.

Our communications team will work with the member-led Covid-19 Outbreak Control Board to ensure strategic and operational communications are aligned. The intention is to provide members with aggregate information about outbreaks in their area, and specific information about those outbreaks which may be particularly sensitive.

Data management

The council, NHS, district and borough councils and any other partners involved in management of incidents will ensure that information is shared in a timely way.

The Covid-19 Local Outbreak Co-ordinating Team will ensure effective data management including:

  • surveillance for infections
  • data systems to enable receipt, logging, monitoring and reporting of progress of Incidents, and assurance on effective management
  • temporal and spatial analysis of incidents to identify geographical ‘hotspots’ and trends
  • information governance protocols to allow secure and timely sharing of data and information

 


 

Enforcement  Back to top

The intention is to work with individual settings and people as well as wider communities to implement whatever control measures are required. The expectation is that the majority will be compliant with public health advice. Occasionally it may be necessary to enforce control measures in relation to an individual setting, self-isolation and testing of a person, or wider restrictions in a community.

Enforcement in relation to individual settings

Enforcement powers exist in relation to the following and these are described in more detail in the accompanying legal guidance.

Care settings

Through the Care Quality Commission.

Schools

Via the Secretary of State and/or Ofsted.

Businesses

Through the existing powers available to the district and borough councils and/or Health and Safety Executive, and/or new powers available to Staffordshire County Council.

In relation to businesses where temporary closure is required in order to prevent the spread of infection, then mitigation of the financial impact may be available.

Enforcement of self-isolation and testing

All reasonable measures should be taken to persuade people to voluntarily comply with requirements for isolation and testing, with checks to ensure they have the capacity to understand what is being asked of them. 

If a person is unwilling and/or unable (e.g. because of lack of mental capacity) to comply with requirements for isolation and testing, then arrangements to impose proportionate restrictions are 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-19 and that there is a risk that they will infect or contaminate others. Reasonable grounds would include:

  • tested positive for Covid-19
  • presenting with symptoms of Covid-19 (regardless of whether the person has been tested)
  • is, or has been, in contact with another person with symptoms of Covid-19, regardless of whether that other person has been tested for Covid-19
  • has arrived within the last 14 days from an infected area

The Secretary of State has designated two PHE public health consultants to cover the West Midlands for the purposes of Schedule 21. If the IMT consider use of Schedule 21 is necessary, they must liaise with the Director of Public Health who will liaise with PHE to consider appropriate steps.

Wider restrictions

Wherever possible, restrictions to control community spread of Covid-19 as part of a 'local lockdown' will be undertaken in partnership with the community, on the basis of informed engagement and consent. The local escalation framework sets out how these are expected to be determined and implemented.

Under the new national contain framework, from 18 July 2020 the council has new powers to close premises, public outdoor places and prevent specific events, without having to make representations to a magistrate in order to close a premises. 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.

Any restrictions will need to be negotiated carefully with the community affected. Although UTLA have new powers it is unlikely that these will be enforceable without the consent of the community. They will only work it they are perceived as proportionate and practical.

Premises which form part of essential national infrastructure are out of scope of these powers. A non-exhaustive list of the types of categories of infrastructure is be set out in HM government guidance.

If these new powers are exercised, the council must notify the Secretary of State as soon as reasonably practicable after the direction is given and review to ensure that the basis for the direction continues to be met, at least once every 7 days.

Ministers have similar powers to take action against specific premises, places and events, as well as a power to direct upper tier local authorities and to consider whether an upper tier local authority direction is unnecessary and should be revoked, including in response to representations from those affected by it.

In areas of intervention, ministers will be able to use their existing powers (under the Public Health (Control of Disease) Act 1984) to implement more substantial restrictions (regulations would be produced - and approved by Parliament - on a case-by-case basis) which could include:

  • closing businesses and venues in whole sectors (such as food production or non-essential retail), or within a defined geographical areas (such as towns or counties)
  • 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)
  • imposing restrictions on gatherings - limiting how many people can meet and whether they can travel in and out of an area to do so
  • restricting local or national transport systems - closing them entirely, or introducing capacity limits or geographical restrictions
  • mandating use of face coverings in a wider range of public places

 


 

Capacity, training and implementation  Back to top

Local outbreak control plans have a crucial role in the Covid-19 ongoing response and recovery. HM government has allocated £3.6m to Staffordshire to support development and implementation.

Capacity

The priority is to ensure adequate capacity from the outset to manage incidents effectively. The number of incidents, and therefore the capacity required, is difficult to predict. The priority is to ensure that sufficient capacity is in place to manage multiple incidents concurrently, with the risk of some redundant capacity if the actual number of incidents is low.

A range of local teams will have a role in implementing the local outbreak control plan, as shown below. An analysis has been completed to identify where additional capacity is likely to be required and this will be put in place as soon as possible.

Training

A training needs analysis will be completed for each of these teams against each role to identify any skills gaps.

Implementation

Implementation of this plan will require a range of actions including:

  • finalisation of standard operating procedures
  • development of action cards to support incident management
  • development of data management systems
  • recruitment to additional capacity
  • training
  • establishment of governance arrangements
  • continuous learning and review

Ownership and timescales for these are set out in the Covid-19 local outbreak control implementation action plan:

There are a number or risks. Chief among them is the ongoing uncertainty about the roles and responsibilities of the 'test' and 'trace' tools provided by national services. If these are not operating effectively then this plan cannot work. We will need to continue to press HM government for further clarity.

This and other risks are set out in the Covid-19 local outbreak control plan risk register.

Teams with a role in implementing the local outbreak control plan

Public health and prevention and BEST, Staffordshire County Council

Covid-19 local outbreak control co-ordinating team

Care commissioning, Staffordshire County Council

Local responsible organisation and team: care settings

Health, safety and well-being, Staffordshire County Council

Local responsible organisation and team: education, early years and children's social care settings

Public health and prevention, Staffordshire County Council

Local responsible organisation and team: prisons and other prescribed places of detention and community healthcare settings.

Environmental health - district and borough councils

Local responsible organisation and team: high risk places, locations and communities

Public health and prevention, Staffordshire County Council

Public health specialist advice 

Environmental health, district and borough councils 

Environmental health specialist advice

MPFT and GPs

Clinical specialist advice

MPFT

Infection prevention and control specialist advice

Education, Staffordshire County Council

Schools specialist advice

MPFT

Testing

Staffordshire Cares, Staffordshire County Council

Call handling to support contact tracing

Housing, district and borough councils

Support for self isolation

Communications, Staffordshire County Council

Communications

BEST, Insight or Information Governance, Staffordshire County Council

Data management

Human Resources, Staffordshire County Council

Training

 


 

Governance  Back to top

Governance of local outbreak control will seek to ensure that:

  • the local outbreak control plan is supported by all the partners who may be required to contribute to implementation
  • there is robust monitoring of progress of management of Incidents individually and collectively
  • there is multiagency oversight of management of Incidents and the ability to escalate for mutual aid if necessary
  • we can continually reflect, learn and improve
  • there is democratic oversight of management of incidents, which contributes to effective public communication

The components of governance includes two new groups:

  • a Covid-19 Health Protection Board
  • a Covid-19 member-led Local Outbreak Control Board

Covid-19 Local Outbreak Control Tactical Group

This is a tactical group of the LRF SCG. Its outline terms of reference are to:

  • set system wide framework for local outbreak control plans
  • provide multi-agency and multi-professional input into development of local outbreak control plans
  • ensure local outbreak control plans are consistent with resources available from all agencies
  • provide assurance to the SCG about management of incidents
  • provide a route for escalation for mutual aid if necessary

Membership will include:

  • Staffordshire County Council
  • Stoke-on-Trent City Council
  • District and borough council representative(s)
  • Clinical commissioning groups
  • Midlands Partnership NHS Foundation Trust
  • Police
  • PHE

Covid-19 Health Protection Board

This group is required as part of local outbreak control plans. Its outline terms of reference are to:

  • develop and continually review the local outbreak control plan
  • ensure that appropriate and up to date SOPs are in place for incident management
  • oversee surveillance and management of incidents
  • consider issues escalated from the IMTs and identify additional support required to address these
  • provide assurance about management of incidents
  • to reflect on learning from incidents to identify improvements for future management and amend SOPs accordingly and/or identify additional capacity requirements

Membership will include relevant teams from Staffordshire County Council as well as district and borough councils.

Covid-19 member-led Local Outbreak Control Board

This group is required as part of local outbreak control plans. Its outline terms of reference are to ensure:

  • democratic oversight of local outbreak control plan development and the management of incidents overall and individually
  • lead communication with the public about the overall management of incidents

The group will be chaired by the Staffordshire County Council Leader.

Membership will include members from the Healthy Staffordshire Select Committee and district and borough councils, and will be reviewed continually. Additional members may be invited depending on those parts of the county worst affected by Covid-19.

The group will maintain a dialogue with the Healthy Staffordshire Select Committee, Staffordshire Health and Wellbeing Board and the Staffordshire Leaders Group.


 

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