Version Control

 

Timeline for review:This plan will remain a live, iterative document. It will be revised as new national guidance and evidence is produced and where lessons are learned locally or elsewhere. It will also be reviewed at the following three-month intervals:

 

Version		Date
3.0	This version will include updates from our emergency planning outbreak exercise, to test the plan and will be published following the July Health and Wellbeing Board meeting.
2.9	This version includes updates in response to the review by Public Health England and Department of Health and Social Care. It also includes a peer review with neighbouring authorities and updates from all lead authors. This version was added to the agenda for The Health and Well-being Board on the 13 July 21.	29 June 21
2.8	Updates made to reflect quality assurance review marking criteria.  Additional section on vaccination. Published to the ESCC website 1st June 21.	12 March 21
2.7	Quarterly refresh for the Health and Wellbeing Board. All sections updated and all partners consulted for comments.	11 Feb 21
2.6	East Sussex Outbreak Control Plan – COVID-19 published as part of Health and Wellbeing Board papers (meeting scheduled for 8 December 2020).	8 Dec 20
2.5	Government published a set of new local COVID alert levels: Medium, High and Very High, also known as Tiers 1, 2 and 3 on 12/10/20. The three alert levels are accompanied with a graduated scale of measures related to social distancing rules for businesses and care home visiting. Some detail related to the three levels has already been published and is available at https://www.gov.uk/guidance/local-covid-alert-levels-what-you-need-to-know. The new government alert levels and tiers meant that the local escalation framework was no longer relevant and so was shown with strike out font.	27 Oct 20
2.4	East Sussex Outbreak Control Plan – COVID-19 whole plan refresh, including new escalation framework approved by the Health and Wellbeing Board and published to website.	17 Sep 20
2.3	East Sussex Outbreak Control Plan – COVID-19 and published as part of Health and Wellbeing Board papers.	9 Sep 20
2.0	East Sussex Outbreak Control Plan – COVID-19 approved by the Health and Wellbeing Board.	14 Jul 20
2.2	Appendix B removed and Appendix C moved to Appendix B on website publication.	2 Jul 20
2.1	Minor corrections and amendments to the website publication.	1 Jul 20
2.0	Final version prepared by Rob Tolfree, Tracey Houston and Emma King based on comments received by partners. Approved by Becky Shaw, Chief Executive ESCC, and Darrell Gale, Director of Public Health ESCC and published as part of Health and Wellbeing Board papers	30 Jun 20
1.3	Second draft prepared by Rob Tolfree based on comments received.   Version 1.3 sent for comments to: Chief Executives of Districts and Boroughs and Environmental Health leads; Sussex Resilience Forum; Police; Emergency Planning; Communities, Environment and Transport; Children’s; Adult Social Care; ESHT; CCG; SCFT; SPFT; Health Watch; Public Health England; RSI; Communications; HMP Lewes; HSE.	23 Jun 20
1.2	First draft by Rob Tolfree.   Relevant sections of Version 1.2 sent for comments to Environmental Health for each District and Borough, Sussex Resilience Forum, Police, Emergency Planning, Children’s, Adult Social Care, Communities Environment and Transport, Health Watch, CCG, ESHT, SCFT; SPFT, Public Health England, Rough Sleeper Initiative, Communications, HMP Lewes, Legal.	17 Jun 20
1.1	Structure and outline approved by Darrell Gale, Director of Public Health ESCC.	15 Jun 20

 

 

 

Contents

Version Control 2

List of figures. 6

Glossary. 7

1. Introduction.. 8

1.1. Background. 8

1.2. Features of COVID-19. 9

1.3. Aim.. 10

1.4. Objectives. 10

1.5. Existing plans and guidance. 11

1.6. East Sussex overview.. 11

1.7. East Sussex health and care landscape. 14

1.8. COVID-19 Epidemiology. 15

2. Escalation Framework and Governance. 18

2.2. Forward planning. 21

2.3. Governance overview.. 21

2.4. Other joint working across Sussex and beyond. 25

2.5. East Sussex Outbreak Control Plan Governance. 27

3. Legal context 28

3.1. Coronavirus Act 2020. 28

3.2. Health Protection Regulations 2010 as amended. 28

3.3. Health and Safety at work. 29

3.4. Local Authority policy framework. 29

3.5. Data Sharing. 29

3.6. Summary of measures to prevent or control COVID-19 and the enabling legislation.. 30

4. Outbreak investigation.. 38

4.1. Principles. 38

4.2. Test and trace. 38

4.3. Local tracing partnerships. 39

4.4. East and West Sussex – Local Tracing Partnership. 39

4.5. Work in development 40

4.5. Outbreak Control Teams. 43

4.6. Sussex Resilience Forum.. 43

5.Communications and Engagement 44

5.1. Priorities for Communications and Engagement 44

5.2. Communications and engagement plan.. 44

6.Data Integration.. 45

6.1. Data objectives. 45

6.2. Data arrangements currently in place. 46

6.4. Data arrangements that need to be further developed. 47

6.5. Data sharing and Data security. 47

7.Testing. 48

7.1. Testing provision.. 48

7.2. Types of Tests. 48

7.3. Testing pathways currently in place. 48

7.4. Current issues in testing. 49

7.5. COVID-19 variants of concern (VoC) 49

7.6. Surge testing. 50

7.7. Enduring transmission.. 50

7.8. Self-isolation.. 51

8. Vulnerable People. 52

8.1. Overview.. 52

8.2. Current support available. 52

8.3. Shielding Support 53

8.4. Community Hubs. 54

8.5. Additional Support 54

9. Prevention.. 56

10. Vaccination.. 57

10.1. National overview.. 57

10.2. Governance of the COVID-19 Mass Vaccination Project in Sussex. 57

10.3. Background – COVID-19 vaccines. 57

10.4. Possible side effects: 58

10.5. Vaccine programme. 58

10.6. Vaccine prioritisation.. 58

10.8. Sussex COVID-19 vaccination programme. 59

10.9.  Outcomes of the Sussex Vaccination Programme. 60

10.10.  Measures to improve vaccine uptake locally. 60

11.Outbreak investigation: High Risk Places, Locations and Communities. 62

11.1. Care homes. 63

11.2. Children’s Homes. 66

11.3. Schools. 68

11.4. Prisons and other prescribed places of detention.. 71

11.5. Workplaces. 73

11.6. Faith Settings. 76

11.7. Tourist attractions, Events, Travel and Accommodation.. 77

11.8. Ethnic Minorities Communities. 79

11.9. Gypsy, Roma and Travellers (GRT) and Van Dwellers. 81

11.10. Homeless community. 83

11.11. Acute. 86

11.12. Primary Care. 88

11.13. Mental Health and Community Trusts. 91

11.14. Transport locations. 93

12. Appendices. 95

 

 

 

List of figures

Figure 1: Confirmed cases of COVID-19 per 100,000 population by upper tier Local Authority in England

 

Figure 2: Confirmed cases of COVID-19 per 100,000 population by lower tier Local Authority in England

 

Figure 3: COVID-19 cumulative crude case rate 100,000 population by lower tier authority, South East Specimen Date: 2020-06-27

 

Figure 4: Escalation Framework

 

Figure 5: Links between C-19 Health Protection Board, Local Outbreak Control Board (Health and Wellbeing Board) Sussex Resilience Forum

 

Figure 6: East Sussex Outbreak Control Plan Governance

 

Figure 7 - Summary of measures to prevent or control COVID-19 and the enabling legislation

 

Figure 8: NHS Test and Trace – Three Tiers

 

Figure 9: What is contact tracing (PHE)

Glossary

 

CCA               Civil Contingencies Act

CCG               Clinical Commissioning Group

DHSC            Department of Health and Social Care

DPH               Director of Public Health

EHO               Environmental Health Officer

ESCC             East Sussex County Council

FS                   Field Services

HPT                Health Protection Team

ESHT             East Sussex Healthcare Trust

GRT                Gypsy and Roma Travellers

HMP               Her Majesty’s Prison

iCERT            Integrated Common Exposure Report Tool

ICS                 Integrated Care System

ICN                 Integrated Care Network

IMT                  Incident Management Team

IPC                 Infection, Prevention, Control

ITS                  Integrated Tracing System

LA                   Local Authority

LCS                Locally Commissioned Service

LHRP             Local Health Resilience Partnership

LTLA               Lower Tier Local Authority

OCT                Outbreak Control Team

OIRR              Outbreak Investigation and Rapid Response

ONS               Office for National Statistics

MoJ                 Ministry of Justice

MHCLG          Ministry of Housing, Communities and Local Government

MTU                Mobile Testing Unit

NHS BSA      NHS Business Services Authority

NHSE             NHS England

PHE                Public Health England

PPE                Personal Protective Equipment

RSI                 Rough Sleepier Initiative

SCFT              Sussex Community Foundation Trust

SECAmb       South East Coast Ambulance

SID                 Sussex Integrated Dataset

SOP                Standard Operating Procedure

SPFT              Sussex Partnership Foundation Trust

SCG               Strategic Coordinating Group

SRF                Sussex Resilience Forum

TCG                Tactical Coordinating Group

UTLA              Upper Tier Local Authority

VCSE             Voluntary, Community and Social Enterprise

WHO              World Health Organisation

 

1. Introduction

 

1.1. Background

 

On the 31^st December 2019 the World Health Organisation (WHO) were notified about a cluster of pneumonia of unknown cause. This was identified as a coronavirus on the 12^th January and later named COVID-19. The WHO subsequently declared an Emergency of International Concern on the 30^th January, and on the 11^th March the WHO declared that COVID-19 was a pandemic following sustained global transmission.

 

In the UK, the first two cases of COVID-19 were confirmed on 31^st January 2020, and there has been substantial transmission across the UK. This has resulted in various degrees of social distancing measures advised nationally in order to interrupt transmission and limit spread.

 

On the 28^th May the national NHS Test and Trace service was officially launched. This new service provides the framework for people who have COVID-19 symptoms to access a test, and follows up confirmed cases to identify, assess and give advice to them and any of their close contacts. Further details are provided in the Outbreak Investigation section.

 

Infectious diseases require a coordinated, multi-agency response to ensure that where possible cases are prevented, and in the event of a potential outbreak the cause is investigated, control measures are put in place, appropriate advice is communicated, and that ultimately health is protected. Following the launch of the NHS Test and Trace service, Upper Tier Local Authorities were asked to develop local Outbreak Control Plans by the end of June 2020. This was accompanied by Upper Tier Local Authorities being awarded a grant to support local outbreak prevention and response, including funding activity of partners in Districts and Boroughs in relation to COVID-19.

 

Thanks to all agencies across East Sussex who have contributed to the development of this plan, and for their support in further iterations that will need to be developed. This plan will be a ‘live’ document and will be refreshed as further guidance is produced nationally and as lessons are learned locally.

 

 

1.2. Features of COVID-19

 

Key features of COVID-19, summarised from the green book COVID-19 Greenbook chapter 14a (publishing.service.gov.uk)

Transmission	SARS-CoV-2 is primarily transmitted by person to person spread through respiratory aerosols, direct human contact and fomites.   High transmissibility indicates that stringent control measures, such as active surveillance, physical distancing, early quarantine and contact tracing, are needed in order to control viral spread.
Incubation period	After the initial exposure, patients typically develop symptoms within 5-6 days (incubation period) although about 20% of patients remain asymptomatic throughout infection.   Transmission is maximal in the first week of illness. Symptomatic and pre-symptomatic transmission (1-2 days before symptom onset), is thought to play a greater role in the spread of SARS-CoV-2 than asymptomatic transmission.
Symptoms	In adults, the clinical picture varies widely. A significant proportion of individuals are likely to have mild symptoms and may be asymptomatic at the time of diagnosis.   Symptoms are commonly reported as a new onset of cough and fever but may include headache, loss of smell, nasal obstruction, lethargy, myalgia (aching muscles), rhinorrhoea (runny nose), taste dysfunction, sore throat, diarrhoea, vomiting and confusion; fever may not be reported in all symptomatic individuals.   Patients may also be asymptomatic. Progression of disease, multiple organ failure and death will occur in some individuals.   NICE (December, 2020 Overview | COVID-19 rapid guideline: managing the long-term effects of COVID-19 | Guidance | NICE), uses the following clinical definitions for the initial illness and long COVID at different times: • Acute COVID-19: signs and symptoms of COVID-19 for up to 4 weeks. • Ongoing symptomatic COVID-19: signs and symptoms of COVID-19 from 4 to 12 weeks. • Post-COVID-19 syndrome: signs and symptoms that develop during or after an infection consistent with COVID-19, continue for more than 12 weeks and are not explained by an alternative diagnosis.
Risk factors and high-risk groups	Severe infection is associated with increasing age, being male, and having long-term conditions such as diabetes, cancer and severe asthma. Other reported risk factors identified by Public Health England (Disparities in the risk and outcomes of COVID-19 (publishing.service.gov.uk) are:   People from Black ethnic groups were most likely to be diagnosed, and death rates are highest amongst people of Black and Asian ethnic groups.   The diagnosis rate is highest in the most deprived areas, and mortality rates in the most deprived areas were more than double the least deprived areas.   People working in certain occupations have also been found to have higher mortality rates from Covid-19, including lower skilled workers in construction and processing plants, social care and health workers, security guards, those driving the public, chefs and sales/retail assistants.   There has been over twice the rate of mortality from Covid-19 for residents living in care homes, and among people who have learning disabilities.  There is also increased risk associated with rough sleeping and being born outside the UK and Ireland.   Lifestyle factors also increase the risk of more severe disease, such as smoking and being an unhealthy weight.
Case fatality rate	The overall infection mortality ratio is 0.9%. This increases to 3.1% for those aged 65-74, and 11.6% to those over 75.

 

1.3. Aim

 

The aim of this Outbreak Control Plan is to outline current local arrangements related to COVID-19 across East Sussex and to identify gaps for future development.

 

1.4. Objectives

 

The Department of Health and Social Care (DHSC) has given two core pieces of guidance related to the development of Local Outbreak Control Plans. Firstly – the required governance arrangements [as detailed in section 2], and secondly, that plans are centred around the following themes:

 

1.    Care homes and schools. Planning for local outbreaks in care homes and schools.

 

2.    High risk places, settings and communities. Identifying and planning how to manage other high-risk places, locations and communities of interest.

 

3.    Testing. Identifying methods for local testing to ensure a swift response that is accessible to the entire population.

 

4.    Contact Tracing. Assessing local and regional contact tracing and infection control capability in complex settings.

 

5.    Integrated data. Integrating national and local data and scenario planning through the Joint Biosecurity Centre Playbook.

 

6.    Supporting vulnerable people. Supporting vulnerable local people to get help to self-isolate and ensuring services meet the needs of diverse communities.

 

7.    Governance. Establishing governance structures led by existing Covid-19 Health Protection Boards and supported by existing Gold command forums and a new member-led Board to communicate with the general public.

 

1.5. Existing plans and guidance

 

There are a range of local, regional and national plans and documents that this plan will need to align with and be based on:

 

·         East Sussex County Council (ESCC) Emergency Response Plan (2017)

·         East Sussex County Council Pandemic Influenza Business Continuity Supplement (2020)

·         Kent, Surrey and Sussex Public Health England Outbreak/Incident Control Plan (2014, updated 2020)

·         Joint Health Protection Incident and Outbreak Control Plan, Kent Surrey and Sussex Local Health Resilience Partnerships (2020)

·         Local Agreement between the Local Environmental Health Services of Surrey, East Sussex, West Sussex and Brighton and Hove, and Public Health England South East Horsham Health Protection Team (2019)

·         Public Health England (PHE) Communicable Disease Outbreak Management: Operational Guidance (2013)

·         PHE Infectious Diseases Strategy 2020 – 2025 (2019)

·         SOP PHE-LA Joint Management of COVID-19 Outbreaks in the SE of England (2020)

·         Sussex Local Health Resilience Partnership (LHRP) Memorandum of Understanding: Responsibilities for the Mobilisation of Health Resources to Support the Response to Health Protection Outbreaks/Incidents in Sussex (2019)

·         Sussex Resilience Forum Pandemic Influenza Plan (2020)

·         Sussex Resilience Forum, Sussex Emergency Response and Recovery Plan (2019)

 

There are also numerous organisational plans that individual agencies will use, covering scenarios such as emergency planning, infectious diseases and outbreak management. Although these are not listed here they are important context.

 

Any local outbreak plan is reliant on central government support as there are many interdependencies between a local system that is able to prevent and respond to outbreaks, and guidance produced at a national level.

 

1.6. East Sussex overview

 

This section provides an overview of high-risk populations and where these populations are within the county. As well as an introduction to some of the high-risk settings. Further details and data underpinning this is available from East Sussex Joint Strategic Needs Assessment (JSNA) website  eastsussexjsna.org.uk

 

Over half a million people live in East Sussex. It is a mixture of urban and rural areas with a large elderly population, particularly in some of its coastal towns. There are stark inequalities within the county with some areas having significantly worse health, as well as significant differences across the determinants of health.

 

The East Sussex Community Survey identifies that nearly three quarters of people have a strong sense of secure identity and sense of belonging, and over three quarters are more than satisfied with their local area. People are also engaged and willing to support each other with half of those responding to our community survey reporting they have volunteered in the past year.

 

 

The over 65s now present a quarter of the county’s population and are projected to make up nearly a third of all people by 2035. The fastest rate of growth will be seen in the 85 and over group. Those aged 85 and over are the largest users of health and social services.

 

 

 

A girl born in East Sussex can expect to live to 84, and a boy to 80. Healthy life expectancy has increased for males from 62 to 65 between 2009/11 and 2014/16, but it has fallen for females from 65 to 63 years. Those living in our most deprived communities have the lowest life expectancy and can expect to live fewer years in good health.

 

 

 

1.7. East Sussex health and care landscape

 

1.8. COVID-19 Epidemiology

 

Where there is substantial community transmission of a respiratory infection such as COVID-19, it is important to understand the wider context that the infection exists within.

 

The rate of COVID-19, the number of confirmed cases of COVID-19 per 100,000, provides a comparable figure that allows different areas to be compared by taking account of the population size.

 

A regular surveillance report is produced and published each week online at COVID-19 weekly surveillance update – East Sussex County Council. This report details the latest trends of COVID-19 across East Sussex.

 

The report provides a snapshot of the epidemiological picture of the county. For the 7-day period to 5^th June 2021, East Sussex was ranked 144^th out of 149 upper tier local authorities (with 1 having the highest rate of COVID-19 infections, and 149 having the lowest). The map below shows all confirmed COVID-19 cases since the beginning of the pandemic, displayed by upper tier local authority with the blue colours reflecting a lower rate.

 

Figure 1: Total confirmed cases of COVID-19 per 100,000 population by upper tier Local Authority in England (Source: Data from National Dashboard published 10^th June 2021, map produced by West Sussex)

 

 

Figure 2: All confirmed cases of COVID-19 per 100,000 population by lower tier Local Authority in the South East (Source: Data from National Dashboard published 10^th June 2021, map produced by West Sussex)

 

 

Until November 2020 East Sussex had a consistently lower rate of COVID-19 than England. However, the second wave of infection from November 2020 to February 2021 had a much greater impact on East Sussex than previously.

 

This second wave of infection was associated with the spread of a new variant, first detected in Kent, which has been shown to be much more transmissible. This led to East Sussex being put into the top tier of restrictions, followed by national restrictions again being imposed.

 

The following table shows the rate of COVID-19 for each of the 5 Districts and Boroughs with Hastings having the highest rate and Lewes the lowest in the county.

 

Figure 3: COVID-19 cumulative crude case rate 100,000 population by lower tier local authority in East Sussex, data to 9^th June 2021.

 

	COVID-19 rate per 100,000	Local Authority rank (1 highest)
East Sussex	5,526	121/149
Eastbourne	6,421	159/315
Hastings	6,749	145/315
Lewes	4,817	249/315
Rother	5,124	231/315
Wealden	4,941	242/315

 

 

 

The Governments COVID-19 RESPONSE − SPRING 2021included a new four-step plan to ease England's lockdown which aimed to see all legal limits on social contact lifted by 21 June, if strict conditions were met. The easing of lockdown requires four tests on vaccines, infection rates and new coronavirus variants to be met at each stage. The announcement coincided with the first data on the UK's coronavirus vaccine rollout from data produced by Public Health England (PHE).

2. Escalation Framework and Governance

 

The following table describes the COVID alert levels published by the government in October 2020, and the different actions and interventions required at each level. However, these were subsequently replaced by new national restrictions as part of a national lockdown and will be updated in light of new guidance. For more information see the national guidance National lockdown: Stay at Home - GOV.UK (www.gov.uk)

 

Local COVID Alert Level	MEDIUM – Tier 1 (National restrictions apply)	HIGH – Tier 2 (Additional restrictions)	VERY HIGH – Tier 3 (Tighter restrictions apply)
Intelligence and triggers	Daily review of COVID-19 data by Public Health team, presented weekly at multi-agency Operational Cell. National restrictions apply to all areas of England	Daily review of COVID-19 data by Public Health team. Detailed surveillance in the specific area to inform health protection measures, including expertise from Field Epidemiology. Data show increasing trend with high infection in an area and/or high/increasing positivity rate. Any thresholds determined by the government will be added. National watchlist published weekly	Daily review of COVID-19 data by Public Health team. Enhanced surveillance in the specific area to inform health protection measures, supported by national resources. COVID-19 rates causing concern with very high rates (e.g. positivity, older / at risk, growth rate, hospital admissions). National watchlist published weekly.
Notifications (partners) –	East Sussex COVID-19 weekly surveillance report shared with partners (Thursdays)	·         Notification sent to partners, including cross border ·         ESCC Operational Cell and Health Protection Board ·         ESCC COVID-19 Tactical Group and Strategic Group ·         ESCC Health and Wellbeing Board ·         NHS Silver ·         Sussex ICS Monitoring Group ·         Formal briefing to members and MPs ·         SRF – Consideration for multi-agency response	As for Tier 2, with Frequent briefings to members and local MPs, and assurance to Government as required.   Daily briefings with the media.
Comms and Engagement (public)	Communications based on the COMS plan, including: Prevention, symptom recognition, and testing messages; action to take if symptomatic; reactive statements for outbreaks	General high communications geo-targeted via multiple channels focusing on: ·         new alert level and household and travel restrictions  ·         Prevention, symptom recognition, testing, and action to take if symptomatic ·         raising awareness of local population/affected communities of increasing infection rates ·         proactive statements as required for outbreaks	Extensive widespread engagement and communications with affected areas/communities and shared with relevant neighbours to explain the restrictions and the geographical area for the restrictions, including in relevant languages.
Outbreak Control	Ongoing implementation of the Local Outbreak Control Plan, with cases / outbreaks, managed as detailed in section 10, including through convening OCTs as required. SRF notified if any outbreaks require coordinated response.	Consideration to Incident Management Team (IMT) for affected area, with support from relevant agencies to investigate potential reasons for transmission and to identify/implement actions to reduce infection rates. SRF notified if any outbreaks require coordinated response.	Government and local authorities agree additional measures above the baseline set in Local COVID Alert Level VERY HIGH. Increased national support for: local test and trace; local enforcement funding; military assistance; job support scheme
Testing	DPH works with DHSC and LRF Testing Cell to support whole care home testing, arrangements for local testing centres and MTU deployment	Increasing testing capacity via MTU deployment to targeted specific areas/communities	Significant increased widespread testing including MTU deployment Expanded testing of symptomatic and asymptomatic persons for affected area including MTU deployment
Welfare Support	Welfare support continues to known vulnerable residents Welfare support is unlikely to be necessary for clinically extremely vulnerable group (Shielding)	Welfare support continues to known vulnerable residents Welfare support is unlikely to be necessary for clinically extremely vulnerable group (Shielding)	Welfare support continues to known vulnerable residents. Welfare provision may be needed for individuals in clinically extremely vulnerable group (Shielding). CMO may advise more restrictive formal shielding measures. Welfare provision may be needed a higher number of individuals.
Care Homes	Visiting supported as per guidance unless PHE give specific advice.	DPH notifies care homes that they must close to all external visitors other than in exceptional circumstances, such as end of life	DPH notifies care homes that they must close to all external visitors other than in exceptional circumstances, e.g. end of life
Education and Childcare	Education and childcare fully open to all. Children’s groups permitted	Education and childcare open. Children’s groups permitted. Childcare bubbles for U 14s permitted in private homes/gardens Decision on implementation of ‘tiers of restrictions for education and childcare’ (Contain Framework) agreed with national partners. https://www.gov.uk/government/publications/containing-and-managing-local-coronavirus-covid-19-outbreaks/covid-19-contain-framework-a-guide-for-local-decision-makers#annex-3-tiers-of-national-restriction	Education and childcare open. Children’s groups permitted. Childcare bubbles for U14s permitted in private homes/gardens Decision on implementation of ‘tiers of restrictions for education and childcare’ (Contain Framework) agreed by national partners. https://www.gov.uk/government/publications/containing-and-managing-local-coronavirus-covid-19-outbreaks/covid-19-contain-framework-a-guide-for-local-decision-makers#annex-3-tiers-of-national-restriction
Prevent and Enforce	Police adopt ‘engage, encourage, educate, enforce’ for individuals to follow COVID guidance. Environmental Health, Licensing Teams and Trading Standards advise and monitor businesses/ events to ensure COVID safe practices. Consider use of local powers to prevent and manage spread. Consideration to COVID-19 marshals to be deployed by Districts/Boroughs	Police approach of engage, encourage, educate, enforce – for individuals to follow COVID guidance. Environmental Health, Licensing Teams and Trading Standards advise and monitor businesses/ events to ensure COVID safe practices. Consider use of local powers to prevent and manage spread. Enhanced support/enforcement to ensure businesses implementing COVID secure measures	As for Tier 2, but in addition Government consults with Local Authorities to agree additional measures such as restrictions and/or closures within hospitality, indoor and outdoor entertainment and tourist attractions and venues, leisure centres and gyms, public buildings, close personal care/close contact services  Enhanced support/enforcement to ensure businesses implementing COVID secure measures and enforcement of national regulations

 

2.2. Forward planning

 

Given the roll out of the national vaccination programme and the expansion of asymptomatic testing at pace, it appears that the current aim over the mid-term is for COVID-19 to become a ‘managed’ disease in which the virus will continue to circulate in pockets with small numbers of cases and outbreaks prompting an immediate response. This will be accompanied by an increased return to Business as Usual across the system. However, there is still the possibility of further significant increases or ‘spikes’ in East Sussex. These could be the result of a number drivers including decreasing levels of vaccine coverage, reduced effectiveness of contact tracing, new Variants of Concern (VOCs), reduced levels of adherence to Non-Pharmaceutical Interventions and decreased testing capacity.  

 

Assuming that this is the case there is the requirement for:

• Maintenance of programmes and activities to control and manage COVID-19 even when the incidence rate has greatly reduced
• An assessment of the impact of reduced capacity once national COVID-19 response resource ceases and how system partners can work together to mitigate this 
• Continued systemic oversight of both epidemiological data and service activity by those governance bodies with a remit for COVID-19 response and by East Sussex Public Health Team and Surrey and Sussex Health Protection Team
• Business planning for all key organisations covering process and capacity that will support a rapid move back from Business as Usual to COVID-19 response if necessary.  

 

2.3. Governance overview

 

As detailed in one of the four principles of good practice, this Local Outbreak Control Plan needs to sit within the context of existing health protection and emergency planning structures.

 

There are three new structures to oversee COVID-19 across East Sussex:

·         East Sussex COVID-19 Operational Cell

·         Health Protection Board

·         The Engagement Board

 

Each of these groups will be discussed in turn, before describing the involvement of the Sussex Resilience Forum and the escalation framework.

 

East Sussex COVID-19 Operational Cell

 

The East Sussex COVID-19 Operational Cell is chaired by the Director of Public Health and sits under the direction of the Health Protection Board. This is a multi-agency group that brings together and interprets information from the Test and Trace service, the Joint Biosecurity Centre, and other sources of intelligence in order to understand the current transmission of COVID-19 across East Sussex, and any supplementary investigation or control measures needed in addition to those already being discharged by other parts of the system.

 

The group also gathers and disseminates lessons learned and oversees specific Task and Finish Groups to address specific issues. Membership will be flexible according to particular areas of focus, but includes District and Borough including Environmental Health and Community Hub leads, Trading Standards, Public Health England, Environmental Health, Local Authority Public Health, Police, Emergency Planning, the CCG, East Sussex Healthcare Trust, and Communications.

 

Representation from East Sussex Health Care Trust and the CCG ensures the Operational Cell can link into the relevant clinical governance process and structure of these organisations.

 

The Health Protection Board

 

The Health Protection Board is a new function of the East Sussex Health and Social Care COVID-19 Executive Group that meets weekly. The Health Protection Board reviews the weekly surveillance report and Operational Cell risk log, and reviews and agrees any additional actions required. Membership includes local Public Health, Adult Social Care, the Integrated Care System, the CCG, and ESHT.

 

Representation from East Sussex Health Care Trust and the CCG ensures the Health Protection Board can link into the relevant clinical governance process and structure of these organisations.

 

The Engagement Board

 

The Engagement Board was a new function introduced at the start of the pandemic to ensure appropriate political and democratic accountability for outbreak investigation and response. In East Sussex, the Engagement Board has drawn upon the established Health and Wellbeing Board (as suggested by the existing guidance) as a new core function. This Outbreak Control Plan is approved by the Engagement Board although there are interim updates in between these meetings.

 

Sussex Resilience Forum

 

Local Resilience Forums are multi-agency partnerships made up of representatives from local public services, including the emergency services, local authorities, the NHS, the Environment Agency and others. These agencies are known as Category 1 Responders, as defined by the Civil Contingencies Act.  

 

The Sussex Resilience Forum (SRF) has an important role across Sussex in coordinating agencies, supporting joint communications, and identifying lessons learned. There are a range of scenarios where the SRF will be needed, for example in the event of a substantial outbreak, where multiple outbreaks are occurring at the same time, or where there are issues spanning borders. The need for Sussex Resilience Forum involvement will be considered at all stages of emerging outbreak investigation and control.

 

The Sussex Resilience Forum (SRF) will support local health protection arrangements working with the Health Protection Board and Local Outbreak Engagement Board directly through the Strategic Co-ordinating Group (SCG) or if in place the Strategic Recovery Group (RCG), Tactical Co-ordinating Group (TCG), and the following Cells: 

§  Multi-agency Information Cell

§  Logistics and Supply Chain Cell

§  Test and Trace Support 

§  Testing logistics 

§  Vulnerability and Wellbeing Cell

 

The Logistics and Supply Chain Cell will include the support to operations for Test and Trace and testing. The SRF structure will be expected to manage the deployment of broader resources and local testing capacity to rapidly test people in the event of a local outbreak. 

 

Figure 5: Links between C-19 Health Protection Board, Local Outbreak Control Board (Health and Wellbeing Board) Sussex Resilience Forum

 

 

 

2.4. Other joint working across Sussex and beyond 

 

It is vital that work to tackle the pandemic is conducted as seamlessly as possible across different geographies and organisations. For this reason, sections within the Plan relating to data, testing and complex contact tracing have been jointly developed with Brighton & Hove and West Sussex County Councils’ Public Health Teams, PHE and NHS partners.   

 

In addition to close working as part of the Sussex Resilience Forum, our plan reflects robust partnerships across the Sussex Health and Care Partnership (the Integrated Care Partnership which brings together NHS commissioners and providers, public health, social care and other providers), Local Authority Public Health teams and with the PHE Surrey and Sussex Health Protection Team, and the close working with the District and Borough Councils.

 

There is a Pan-Sussex Enforcement Liaison Cell, consisting of representatives from Police, Environmental Health and Trading Standards to ensure consistency and co-ordination of Covid-19 related compliance.

 

There are strong operational and strategic links across the Public Health Teams including regular meetings between Directors of Public Health in relation to the Covid-19 response. 

In relation to data, strong local and regional links have been developed, including a weekly South East Health Public Health Intelligence meeting led by Public Health England, bi-lateral working between authorities on specific issues and cross-organisational working and data sharing agreements established at speed on specific datasets. In East Sussex, this also includes working with Kent who share a border. 

 

National public health reforms - Transforming the public health system, Health Security Agencyand Office of Health Promotion

 

The pandemic prompted a Government review of the health institutions in place. The functions of the Public Health England (PHE) for health security/protection and health improvement will be split.

 

The health protection capabilities of PHE and NHS Test and Trace will combine into a new UK Health Security Agency (UKHSA) and its primary task will be to ensure the UK is well prepared for pandemics.

 

A new Office for Health Promotion will be created in the Department of Health and Social Care (DHSC), under the professional leadership of the Chief Medical Officer. The Office for Health Promotion will help the whole health family focus on delivering greater action on prevention; and – working with a new cross-government ministerial board on prevention – it will drive and support the whole of government to go further in improving health.

 

Transitions of services are due to take place over the summer and by Autumn 2021 it is intended that the transfer of staff to new destinations will be complete, the UKHSA will be fully operational and the DHSC Office for Health Promotion will be established.

 

Health Protection Team - Surrey and Sussex Health Protection Team (South East)

 

The Health Protection Team (HPT) prevent and reduce the effect of diseases and chemical and radiation hazards. During the current COVID-19 Pandemic they have supported local outbreak control teams with their specialist skills in communicable disease control, in identification and management of outbreaks. They assist and make sure appropriate risk assessment measures are taken. The HPT conducts detailed follow up of everyone identified as having a variant of concern resulting in the possible contacts and potential sources of infection being identified. The  HPT advises whether community wide testing (otherwise known as Surge Testing) is required after transmission may have occurred locally from an unidentified source. The HPT are vital in the management of outbreaks and form a crucial part of our alert systems, making any outbreaks easier to manage.

 

2.5. East Sussex Outbreak Control Plan Governance

 

The follow diagram outlines the governance arrangements for this plan. Health organisations are represented throughout which ensures the relevant clinical governance processes and structure of these organisations are aligned.

 

Figure 6 - East Sussex Outbreak Control Plan Governance

3. Legal context

 

The legal framework for managing outbreaks of communicable or infectious disease which present a risk to the health of the public requiring urgent investigation and management sits with:

·         Public Health England under the Health and Social Care Act 2012

·         Directors of Public Health under the Health and Social Care Act 2012

·         Chief Environmental Health Officers under the Public Health (Control of Disease) Act 1984 and suite of Health Protection Regulations 2010 as amended

·         NHS Clinical Commissioning Groups to collaborate with Directors of Public Health and Public Health England to take local action (e.g. testing and treating) to assist in the management of outbreaks under the Health and Social Care Act 2012 other responders’ specific responsibilities to respond to major incidents as part of the Civil Contingencies Act 2004

 

A communicable disease can also be notifiable i.e. a disease with significant public health implications, typically a highly infectious disease, for which the diagnosing clinician has a statutory responsibility to notify the correct body or person.

 

Specific legislation to assist in the control of outbreaks is detailed below. An Outbreak Control Team could request the organisation vested with powers take specific actions, but the final decision lies with the relevant organisation.

 

3.1. Coronavirus Act 2020

 

Under the Coronavirus Act, The Health Protection (Coronavirus, Restrictions) (England) Regulations 2020 as amended, most recently on 5 January 2021, set out the restrictions as to what is and is not permitted, which when taken together with both statutory and non- statutory guidance create the situation of lockdown. Any easing of lockdown comes from amending or disapplying these regulations and/or updating guidance. The powers of the Police to enforce lockdown also flow from these national Regulations.

 

3.2. Health Protection Regulations 2010 as amended

 

The powers contained in the suite of Health Protection Regulations 2010 as amended, sit with District and Borough Environmental Health teams.

 

The Health Protection (Local Authority Powers) Regulations 2010 allow a local authority to serve notice on any person or group of persons with a request that they refrain from doing anything for the purpose of preventing, protect against, control or providing a public health response to the spread of infection which could present significant harm to human health. There is no offence attached to non-compliance with this request for co-operation.

 

The Health Protection (Part 2A Orders) Regulations 2010 allow a local authority to apply to a magistrates’ court for an order requiring a person to undertake specified health measures for a maximum period of 28 days. These Orders are a last resort mechanism, requiring specific criteria to be met and are resource intensive. These Orders were not designed for the purpose of enforcing ‘localised’ lockdowns, so it is possible that there may be a reluctance by the Courts to make these Orders for this purpose. Non statutory guidance from government indicates that they should be considered as a means to reduce the risk of Covid-19 infection in limited circumstances.

 

3.3. Health and Safety at work

 

Local authority public health teams and the Health and Safety Executive have responsibilities for the enforcement of employers’ health and safety obligations as contained in the Health and Safety at Work Act 1974 (as amended) and associated regulations. The following guidance addresses how the general obligations in law apply to Covid-19

 

Working safely during coronavirus (COVID-19): Guidance to help employers, employees and the self-employed understand how to work safely during the coronavirus pandemic

 

Social distancing, keeping businesses open and in-work activities during the coronavirus outbreak

 

3.4. Local Authority policy framework

 

The following policies and plans written prior to the outbreak of COVID-19 are also being utilised by the local authority (“LA”)’s Emergency Planning and Adult Social Care and Health departments in planning for the potential impact on the County:

·         Emergency Response Plan (including Business Continuity Arrangements) Part 1 (dated 29th August 2017

·         Emergency Response Plan (including Business Continuity Arrangements) Part 2 (dated 29th August 2017)

·         Business Continuity Policy (dated June 2018)

·         Pandemic Influenza Business Continuity Supplement (dated July 2019)

 

3.5. Data Sharing

 

In addition to the Data Protection Act 2018, the intention is to encourage a proactive approach to sharing information between local responders, in line with the following framework:

·         instructions and guidance issued by the Secretary of State;

·         the following four (as at 03/06/21) notices issued by the Secretary of State for Health and Social Care under the Health Service (Control of Patient Information) Regulations 2002, which are now to remain in force until at least 30^th September 2021, requiring confidential patient information to be shared between organisations providing health services, general practices, local authorities, combined authorities, arm’s-length bodies of the Department of Health and Social Care, NHS England and Improvement, all GP practices in England whose IT systems are supplied by TPP or EMIS, and NHS Digital for the purposes of research, protecting public health, providing healthcare services to the public and monitoring and managing the COVID-19 outbreak and incidents of exposure:

              i.        Coronavirus (COVID-19): notice under regulation 3(4) of the Health Service Control of Patient Information Regulations 2002 – general;

            ii.        Coronavirus (COVID-19): notice under regulation 3(4) of the Health Service Control of Patient Information Regulations 2002 – NHSE, NHSI;

           iii.        Coronavirus (COVID-19): notice under regulation 3(4) of the Health Service Control of Patient Information Regulations 2002 – Biobank; and

           iv.        Coronavirus (COVID-19): notice under regulation 3(4) of the Health Service Control of Patient Information Regulations 2002 – NHS Digital;

 

·         such further notices issued by the Secretary of State for Health and Social Care under the Health Service Control of Patient Information Regulations 2002 requiring data to be shared (between healthcare organisations and local authorities) for the purposes of the emergency response to Covid-19;

·         statements and guidance issued by the Information Commissioner in relation to data sharing and COVID-19; and

·         the data sharing permissions provided for by the Civil Contingencies Act 2004 and the Contingency Planning Regulations.

 

3.6. Summary of measures to prevent or control COVID-19 and the enabling legislation

 

The following table (figure 7), describes the various measures currently available to different agencies, who the designated lead would be, and the enabling legislation.

 

The Health Protection (Coronavirus, Restrictions) (Local Authority Enforcement Powers and Amendment) (England) Regulations 2020 enable local authorities to issue notices to people who are in contravention of the restrictions from time to time in force.   In particular, these Regulations give local authorities the powers to do the following when a premises is failing to fulfil a provision set out in the relevant coronavirus regulations:

 

(a)  issue a Coronavirus Improvement Notice (“CIN”) which gives premises a minimum of 48 hours to take measures to ensure compliance with the requirements contained within the relevant coronavirus regulations;

 

(b)  issue a Coronavirus Restriction Notice (“CRN”)  where a person has already been issued with a CIN and an officer is of the opinion that they have failed to comply with it and the non-compliance involves a risk of exposure to COVID.  The CRN must require either the closure of the premises (or part) and/or that the person must end or remedy the contravention specified in the CIN.  Any requirement must be necessary and proportionate for the purpose of minimising the risk of exposure to COVID.  The CRN has effect for 7 days after issue.

 

(c)   issue a Coronavirus Immediate Restriction Notice (“CIRN”) which can close premises that pose a public health risk for an initial 48 hours where rapid action is needed to close a premises or restrict an activity to stop the spread of the virus, without first issuing a CIN.

 

Premises can be fined £2000 if a CIN is not complied with and £4000 if a CIRN or CRN is breached.  There is a right of appeal against the imposition if a Notice to the Magistrates’ Court within 28 days.  Significantly, failure to comply with a CIN, CIRN or CRN is a criminal offence punishable by an unlimited fine.  There is also a Power of Arrest associated with this offence.

 

It seems likely that these powers are more likely to be used than the No. 3 powers because they give local authorities the power to issue CINs without having to prove the risk of COVID-19 exposure.  They also give the local authority power to close premises entirely for a short period, issue a penalty notice and prosecute for non-compliance. They came into force on the 2 December 2020 and virtue of the Health Protection (Coronavirus, Restrictions) (Steps and other provisions) (England) (Amendment) Regulations 2021 they have effect until 20 June 2021.  This is based on the current timescales for easing restrictions.  If restrictions remain in force beyond 21 June 2021 it is likely that these powers will also be extended.

 

2. New Guidance has also been issued on The Health Protection (Coronavirus Restrictions) No 3 Regulations which give Local Authorities powers to issue directions when responding to a serious and imminent threat to public health and the restrictions proposed are necessary for the purpose of preventing, protecting against, controlling or providing a public health response to the incidence or spread of infection by coronavirus in the local authority's area and a proportionate means of achieving that purpose.  The mandatory requirement for a local authority to have regard to advice given to it by its Director of Public Health (or interim or acting direction of Public Health) now explicitly enables a registered public health consultant approved by the Director of Public Health to provide that advice.  In addition, appeals to the Magistrates’ Court or representations to the Secretary of State regarding a direction must now be made within 28 days of the date the Direction was issued.

 

Figure 7 - Summary of measures to prevent or control COVID-19 and the enabling legislation

 

Type of measure	Prevent/ Control	Lead	Enabling legislation	Description of use
Declaring a gathering of more than 6 illegal when event is to be held via a Temporary Event Notice	Prevent- For use at any point in escalation framework (as decision depends on CV19 RA quality etc)	Environmental Health	The Licensing Act 2003 and The Health Protection (Coronavirus, Local COVID 19 Alert Level) (Medium) (England) Regulations 2020 [1] (SI 684)   In extremis: The Health Protection (Coronavirus Restrictions) No 3 Regulations                       Health Protection (Coronavirus, Restrictions) (Local Authority Enforcement Powers and Amendment)(England) Regulations 2020 Health Protection (Coronavirus, Restrictions) (Steps and other provisions) (England) (Amendment) Regulations 2021	Organisers[2] for events of up to 499 people and of less than 5 days duration can hold events via a standard Temporary Event Notice (TEN)[3], which provides District and Borough council’s ten working days’ notice of the planned event.   The Police/Environmental Health may object within three working days on one of four grounds public safety, crime and disorder, protection of nuisance, protection of children. There are no public health groups on which to refuse permission. However, the No 2 regulations require a CV-19 risk assessment and demonstration that all reasonable measures have been taken to limit the risk of transmission of COVID-19 for events held in public open space. If the risk assessment is not deemed ‘suitable and sufficient,’ permission can be refused (with no hearing necessary) and the organiser and Police Prevent Inspector would be notified that the event is illegal.     In a case where the CV-19 risk assessment is not satisfactory and the above procedure cannot be used (e.g. if the event was planned on private land) or in a case where the CV-19 risk assessment is satisfactory, but there are serious concerns regarding the incidence rate in that area or in the incidence rate in the area of the people attending the event, we may feel the event should not go ahead on public health grounds, and would aim to engage with the organiser on this. If the organiser refused to delay or cancel, the Local Authority may make a direction under the number 3 regulations to prohibit the event, where the three conditions can be met in relation to responding to a “serious and imminent” threat to public health, necessity and proportionality.  Once a Direction has been made delegated Local Authority Officers can issue “prohibition Notices” to close individual premises. In the case of late TENs, the Police or Environmental Health can object with no right for the organiser to appeal. Alternatively, if the Local Authority believes that a person is contravening a relevant COVID statutory provision and it is necessary and proportionate to issue a notice to ensure that contravention is ended or remedied, it may serve a Coronavirus Improvement Notice (CIN) to give the premises 48 hours to ensure compliance.  Crucially, there is no need for breach to involve a risk of exposure to COVID.  The CIN must state the Name or premises or contravention, the date, the officer’s opinion, the provision being contravened, the particulars of reasons for the officer’s opinion and the period of compliance (not less than 48 hours) .  The CIN must also state the date it ceases to have effect, the consequences of failure to comply and the right of appeal to the Magistrates’ Court within 28 days.  It must be reviewed by a local authority officer as soon as practicable after the end of the period notice has effect. The contravenor can request the LA to review the notice if he believes if he has met its’ requirements.  The LA must review it within 48 hours and withdraw if satisfied of compliance. Where a person has already been issued with a CIN and the officer is of the opinion that he has failed to comply with it and the non-compliance involves a risk of exposure to COVID, a Coronavirus Restriction Notice may be issued (CRN).  A CRN must require the closure of the premises and/or the person to end or remedy the contravention specified in the CIN.  Any requirement must be necessary and proportionate for the purpose of minimising the risk of exposure to COVID.  It has effect for seven days after issue and takes effect immediately or at the end of the period specified in notice. In more serious cases, the Local Authority can issue a Coronavirus Immediate Restriction Notice (CIRN) where they believe it is likely that the contravention will continue or be repeated and where there is a risk of exposure to COVID.  The CIRN must require the Closure of the Premises (or at least part of it) and that the person must end or remedy the contravention and not repeat or continue it.  Any requirement must be necessary and proportionate for purpose of minimising the risk of exposure to COVID.  The CIRN takes effect immediately or at the end of the period specified in the Notice.  It has effect for 48 hours after issue.  It must be reviewed before it ceases to have effect.  The contravenor can apply for a local authority review to be carried out as soon as practicable.  On review, the LA must decide if the requirements are necessary.  They can withdraw the notice, amend or issue a new one, or issue a new CRN.   Failure to comply with a CIN or CIRN or CRN is a criminal offence punishable by an unlimited fine.  There is a power of arrest for breaching a Notice.  The local authority has the power to prosecute and a company officer can be liable. The local authority has not issued any of these notices to date (26/5/21). The local authority can issue a Fixed Penalty Notice instead (FPN).  Only one FPN may be issued for failure to comply with a single notice.  It can be £2000 for failing to comply with a CIN or £4000 in relation to a CIRN or CRN.  If an FPN is issued, there can be no prosecution for 28 days or if its’ paid.
Declaring a gathering of more than 6 illegal when an event permission is to be requested via a Premises License	Prevent- For use at any point in escalation framework (as decision depends on CV19 RA quality etc)	Environmental Health or Public Health representative at a SAG	The Licensing Act 2003 and The Health Protection (Coronavirus, Local COVID 19 Alert Level) (Medium) (England) Regulations 2020           In extremis: The Health Protection (Coronavirus Restrictions) No 3 Regulations                   Health Protection (Coronavirus, Restrictions) (Local Authority Enforcement Powers and Amendment)(England) Regulations 2020 Health Protection (Coronavirus, Restrictions) (Steps and other provisions) (England) (Amendment) Regulations 2021	Organisers[4] for events of up to 499 people and of less than 5 days duration can hold events via a standard Temporary Event Notice (TEN)[5], which provides District and Borough council’s ten working days’ notice of the planned event.   The Police/Environmental Health may object within three working days on one of four grounds public safety, crime and disorder, protection of nuisance, protection of children. There are no public health groups on which to refuse permission. However, the No 2 regulations require a CV-19 risk assessment and demonstration that all reasonable measures have been taken to limit the risk of transmission of COVID-19 for events held in public open space. If the risk assessment is not deemed ‘suitable and sufficient,’ permission can be refused (with no hearing necessary) and the organiser and Police Prevent Inspector would be notified that the event is illegal.     In a case where the COVID-19 risk assessment is not satisfactory and the above procedure cannot be used (e.g. if the event was planned on private land) or in a case where the CV-19 risk assessment is satisfactory, but there are serious concerns regarding the incidence rate in that area or in the incidence rate in the area of the people attending the event, we may feel the event should not go ahead on public health grounds, and would aim to engage with the organiser on this. If the organiser refused to delay or cancel, the Local Authority may make a direction under the number 3 regulations to prohibit the event, where the three conditions can be met in relation to responding to a “serious and imminent” threat to public health, necessity and proportionality.  Once a Direction has been made delegated Local Authority Officers can issue “prohibition Notices” to close individual premises. In the case of late TENs, the Police or Environmental Health can object with no right for the organiser to appeal. Alternatively, if the Local Authority believes that a person is contravening a relevant COVID statutory provision and it is necessary and proportionate to issue a notice to ensure that contravention is ended or remedied, it may serve a Coronavirus Improvement Notice (CIN) to give the premises 48 hours to ensure compliance.  Crucially, there is no need for breach to involve a risk of exposure to COVID.  The CIN must state the Name or premises or contravention, the date, the officer’s opinion, the provision being contravened, the particulars of reasons for the officer’s opinion and the period of compliance (not less than 48 hours) .  The CIN must also state the date it ceases to have effect, the consequences of failure to comply and the right of appeal to the Magistrates’ Court within 28 days.  It must be reviewed by a local authority officer as soon as practicable after the end of the period notice has effect. The contravenor can request the LA to review the notice if he believes he has met its’ requirements.  The LA must review it within 48 hours and withdraw if satisfied of compliance. Where a person has already been issued with a CIN and the officer is of the opinion that he has failed to comply with it and the non-compliance involves a risk of expose to COVID, a Coronavirus Restriction Notice may be issued (CRN).  A CRN must require the closure of the premises and/or the person to end or remedy the contravention specified in the CIN.  Any requirement must be necessary and proportionate for the purpose of minimising the risk of exposure to COVID.  It has effect for seven days after issue and takes effect immediately or at the end of the period specified in notice. In more serious cases, the Local Authority can issue a Coronavirus Immediate Restriction Notice (CIRN) where they believe it is likely that the contravention will continue or be repeated and where there is a risk of exposure to COVID.  The CIRN must require the Closure of the Premises (or at least part of it) and that the person must end or remedy the contravention and not repeat or continue it.  Any requirement must be necessary and proportionate for purpose of minimising the risk of exposure to COVID.  The CIRN takes effect immediately or at the end of the period specified in the Notice.  It has effect for 48 hours after issue.  It must be reviewed before it ceases to have effect.  The contravenor can apply for a local authority review to be carried out as soon as practicable.  On review, the LA must decide if the requirements are necessary.  They can withdraw the notice, amend or issue a new one, or issue a new CRN.   Failure to comply with a CIN or CIRN or CRN is a criminal offence punishable by an unlimited fine.  There is a power of arrest for breaching a Notice.  The local authority has the power to prosecute and a company officer can be liable. The local authority can issue a Fixed Penalty Notice instead (FPN).  Only one FPN may be issued for failure to comply with a single notice.  It can be £2000 for failing to comply with a CIN or £4000 in relation to a CIRN or CRN.  If an FPN is issued, there can be no prosecution for 28 days or if its’ paid.  These powers have been granted until  20 June 2021.
Taking action against a business/premises permitted to be open but not complying with COVID-19 guidelines[6]	Prevent- For use at any point in escalation framework.	Environmental Health	Health and Safety at Work Act 1974, and with reference to sector specific COVID guidelines   The Health Protection (Coronavirus, Collection of Contact Details etc. and Related Requirements) Regulations 2020   The Health Protection (Coronavirus, Restrictions) (Obligations of Hospitality Undertakings) (England) Regulations 2020     In extremis: The Health Protection (Coronavirus Restrictions) No 3 Regulations   Health Protection (Coronavirus, Restrictions) (Local Authority Enforcement Powers and Amendment)(England) Regulations 2020	Organisers for events of 500 people or over 5 days must hold a premises licence which may include a condition requiring approval of an event management plan by a Safety Advisory Group. Under this, there are unlikely to be specific public health grounds on which to refuse permission. However, the Health Protection (Coronavirus)  regulations require a CV-19 risk assessment and demonstration that all reasonable measures have been taken to limit the risk of transmission of COVID-19 for events in a public outdoor space and permission can be refused if the risk assessment is unsatisfactory. This is completed by the District or Borough and there is no obligation upon them to share that risk assessment. The organiser and Police Prevent Inspector would be notified that the event is illegal.  However, the event would be unlikely to be illegal if it was taking place on premises that were part of the business of the premises licence holder or a visitor attraction.   In a case where the CV-19 risk assessment is not satisfactory but permission cannot be refused due to the planned location of the event or in a case where the CV-19 risk assessment is satisfactory, but there are serious concerns regarding the incidence rate in that area or in the incidence rate in the area of the people attending the event, public health may believe the event should not go ahead on public health grounds, and would aim to engage with the organiser on this. If the organiser refused to delay or cancel, the Local Authority may make a Direction under the No 3 regulations to prohibit the event, where the three conditions can be met in relation to responding to a “serious and imminent” threat to public health, necessity and proportionality.  Once a Direction has been made delegated Trading Standards officers can issue “prohibition Notices” to close individual premises.   Alternatively, if the Local Authority believes that a person is contravening relevant COVID statutory provision and it is necessary and proportionate to issue a notice to ensure that contravention is ended or remedied, it may serve a Coronavirus Improvement Notice to give the premises 48 hours to ensure compliance.  Crucially, there is no need for breach to involve a risk of exposure to COVID.  The Notice must state the Name or premises or contravention, the date, the officer’s opinion, the provision being contravened, the particulars of reasons for the officer’s opinion and the period of compliance (not less than 48 hours) .  The Notice must also state the date it ceases to have effect, the consequences of failure to comply and the right of appeal to the Magistrates’ Court within 28 days.  It must be reviewed by a local authority officer as soon as practicable after the end of the period notice has effect. In more serious cases, the Local Authority can issue a Coronavirus Immediate Restriction Notice where they believe it is likely that the contravention will continue or be repeated and where there is a risk of exposure to COVID.  The CIRN must require the Closure Of the Premises (or at least part of it) and that the person must end or remedy the contravention and not repeat or continue it.  Any requirement must be necessary and proportionate for purpose of minimising the risk of exposure to COVID.  The notice takes effect immediately or at the end of the period specified in the Notice.  It has effect for 48 hours after issue.  It must be reviewed before it ceases to have effect.  The contravenor can apply for a local authority review to be carried out as soon as practicable.  On review, the LA must decide if the requirements are necessary.  They can withdraw the notice, amend or issue a new one, or issue a new CRN. Failure to comply with a CIN or CIRN is a criminal offence punishable by an unlimited fine.  There is a power of arrest for breaching a Notice.  The local authority has the power to prosecute and a company office can be liable. The local authority can issue a Fixed Penalty Notice instead (FPN).  Only one FPN may be issued for failure to comply with a single notice.  It can be £2000 for failing to comply with a CIN or £4000 in relation to a CIRN or CRN.  If an FPN is issued, there can be no prosecution for 28 days or if its’ paid.
Shutting a business/premises following intelligence of an outbreak where action wasn’t taken voluntarily	Control- For use at any point in escalation framework.	Environmental Health	Health and Safety at Work Act 1974, and with reference to sector specific COVID guidelines     In extremis: The Health Protection (Coronavirus Restrictions) No 3 Regulations       Health Protection (Coronavirus, Restrictions) (Local Authority Enforcement Powers and Amendment)(England) Regulations 2020 Health Protection (Coronavirus, Restrictions) (Steps and other provisions) (England) (Amendment) Regulations 2021	Action taken depends on the severity of the concern and strength of the evidence (following the hierarchy of control). This may include engagement with the business via a visit/call/letter and serving an improvement notice to require risk assessment. The decision to serve deferred prohibition/prohibition notices will be up to each Lower Tier Local Authority H&S Inspector in accordance with their own enforcement policy, professional judgement and with regards to each specific situation.   Where a business refuses to comply, the number 3 Regulations could be used to issue a directive to close the business.     Where a business refuses to comply with any COVID Regulations, a CIN can be served requiring them to comply with the law or alternatively a CRN and CIRN leading to the closure of the Premises until the law is complied with.   Failure to comply with a Notice is a criminal offence and can be dealt with by a Fixed Penalty Notice or prosecution.
Closing an outdoor public space	Prevent- Only to be considered in areas with ‘raised local concern/national concern’.	Director of Public Health (in partnership with relevant LTLA)	The Health Protection (Coronavirus Restrictions) No 3 Regulations	The Local Authority may make a Direction to close an outdoor public space where three conditions can be met in relation to responding to a “serious and imminent” threat to public health, necessity and proportionality.  However, it may be difficult to justify taking this action as there appears to be little evidence in increased transmission from crowded, outdoor spaces (e.g. Brighton or Bournemouth beaches). The potential difficulty of enforcing the closure of an outdoor public space should be considered when taking this decision.
Taking action against a business/premises NOT permitted to be open	Prevent- For use at any point in escalation framework.	Environmental Health / Trading standards (depending on sector)	The Health Protection (Coronavirus, Restrictions) (All Tiers) (England) Regulations 2020 (legislation.gov.uk)   The Health Protection (Coronavirus, Restrictions) (No. 3) and (All Tiers) (England) (Amendment) Regulations 2021 (legislation.gov.uk)	For businesses required to be closed under current restrictions. Enforcement via Prohibition Notice, Fixed Penalty Notices or Prosecution
Directing an individual to undertake specified health measures	Prevent/ Control- For use at any point in escalation framework.	Any local authority authorised officer designated to carry out this role under delegated powers	The Health Protection (Part 2A Orders) Regulations 2010	Following service of a notice to co-operate, a Local Authority can apply to a magistrates’ court for an order requiring a person to undertake specified health measures for a maximum period of 28 days. Very strong evidence would be required to support the use of this. These Orders are a last resort mechanism, requiring specific criteria to be met and are resource intensive. They were not designed to enforce compliance with COVID-19 measures and this is a time intensive process and so may not be appropriate due to the length of the infectious period of CV-19.
Take action against an individual contravening a requirement within the Self-Isolation Regulations (without reasonable excuse)	Control- For use at any point in escalation framework.	Local Authority designated officer	The Health Protection (Coronavirus, Restrictions) (Self-Isolation) (England) Regulations 2020	Under the Self Isolation Regulations, an authorised person is able to direct individuals who should be self-isolating to return to the place where they are self-isolating or remove that person to the place they are self-isolating, where this is considered necessary and proportionate. Fixed penalty notices can also be issued to individuals reasonably believed to have committed an offence under these regulations.

 

4. Outbreak investigation

 

4.1. Principles

 

There are well established principles of outbreak investigation and management. The Communicable Disease Outbreak Management - Operational guidance (2014), produced by Public Health England, outlines the national approach to investigating, managing and controlling outbreaks.

 

Whilst the principles of outbreak management are common to all types of infectious disease, some of the specific steps are dependent on how an infection is transmitted. As COVID-19 is a respiratory infection, with the route of transmission being respiratory droplets, contact tracing plays a vital role in interrupting transmission. Contact tracing requires the identification of people who have had close contact with a confirmed case, and an assessment of how much contact and when that contact occurred. This is used to determine whether someone is classified as a close contact, and the appropriate corresponding advice (including isolation advice, testing and follow-up). The following page describes the principles of contact tracing related to COVID-19.

 

The definition of an outbreak of COVID-19 below, provides examples of when action is triggered in relation to cases (adapted from PHE definition):

 

·         an incident in which two or more people experiencing COVID-19 are linked in time or place

·         a greater than expected rate of infection compared with the usual background rate for the place and time where the outbreak has occurred

·         a single case of COVID-19 in a high-risk setting

 

4.2. Test and trace

 

The NHS Test and Trace service was launched on the 28^th May 2020. Although contact tracing is already an established part of the current system for investigating and managing outbreaks, COVID-19 has necessitated a substantial scaling up of the current contact tracing system which has resulted in the new NHS Test and Trace structure.

 

There are three tiers to NHS Test and Trace:

 

·         Tier 3 is a newly formed national structure for COVID-19 that contains approximately 18,000 call handlers. They will work alongside a website and digital service to give advice to confirmed cases in East Sussex and their close contacts. Any cases fulfilling certain national criteria will be escalated to Tier 2.

·         Tier 2 is a newly formed national structure for COVID-19 that contains approximately 3,000 dedicated professional contact tracing staff who have clinical and/or contact tracing experience. This tier will deal with East Sussex cases and situations that are not routine. Any cases/situations that are complex will be escalated to Tier 1.

·         Tier 1 is the Health Protection Team, the existing team within Public Health England (PHE), who have the statutory responsibility for leading outbreaks. Tier 1 will be responsible for leading on outbreaks in complex situations such as cases in care homes, schools etc. Where PHE determine that an Outbreak Control Team (OCT) is required (see OCT later in this section) this will involve relevant agencies to support the investigation and control measures.

 

4.3. Local tracing partnerships

 

As part of the NHS Test and Trace business plan local tracing partnerships have been established to support tracking activities. Every upper tier local authority has established local tracing partnerships which allow the use of community-based tracers. The aim is for these community-based teams is to:

·         draw on local intelligence,

·         focus particularly on vulnerable or harder-to-engage groups, and

·         work alongside the national team.

 

4.4. East and West Sussex – Local Tracing Partnership

 

The East and West Sussex Local Tracing Partnership provides additional capacity to the National NHS Test and Trace service by contacting people who have tested positive for COVID-19 that the national team have been unable to reach within 24 hours. It acts to ensure that these individuals are given advice and support as soon as possible and details of their contacts are collected in order to control the COVID-19 rate of reproduction (R), reduce the spread of infection, and save lives.

 

Local contact tracing involves:

 

• Contacting individuals across East Sussex who have received a positive COVID-19 test result, but were unable to be contacted by the national NHS Test and Trace team within 24 hours
• Providing advice regarding positive test result and requirement to self-isolate
• Collecting details of the individuals’ contacts during their infectious period and entering on the national test and trace system for the national team to get in contact with
• Offering additional support as required, including the wide range of help and advice available from the Community Hub service.

 

The service operates between 8am-8pm seven days a week, including public and bank holidays. Contact is made via text message, phone call, email, or letter:

 

• Text messages will come from COVID TRACE (you cannot reply to these text messages).
• Outbound calls will come from 01323 432466 and inbound calls can be made to this number.
• Children under 18 may be contacted by phone when necessary and may be asked for their parent or guardian's permission to continue the call.
• Emails will be sent from West Sussex County Council Local COVID Tracing Partnership (you cannot reply to these messages).

·         in exceptional circumstances a member of our partner services may be sent to a residence in person to make contact.

 

 

4.5. Work in development

 

Enhanced Contact Tracing

 

Local authorities are currently being given the option to take on increased responsibility for local contact tracing in the areas below. No decision has been made by East Sussex County Council at this point in time.

 

·         Outbreak Investigation and Rapid Response (OIRR) using Postcode Coincidence and Common Exposure Reports. This is a systematic process using information collected from cases during contact tracing interviews to identify clusters of cases and activities/settings where transmission may have occurred. This intelligence is combined with local sources of information known to local authority and health protection teams to assess whether further investigation may be needed to determine whether public health actions are required in these settings to prevent further transmission. The ‘backwards contact tracing period’ refers to information gathered from cases about their activities and events outside the home from 7 days to 3 days prior to symptom onset/test date.

·         ‘Local 0’ refers to an option for LTPs to receive cases from the national T&T team immediately (within 1 hour) once the positive test result is entered onto CTAS, instead of after 24 hours of  the national T&T team trying to contact the individual. This will result in LTPs dealing with significantly more cases.

·         Isolation Support: Currently the national T&T team complete three phone calls and send three emails to positive cases during their self-isolation period to check compliance and wellbeing. LTPs taking on these calls would enhance the customer experience offer due to one contact tracing team making all contact.

·         Tracing Contacts of positive cases: Currently the LTP model involves only contacting the positive COVID-19 case with their contacts being fed back into the national team for phone follow up. This option would involve tracing (contacting) all contacts identified by a positive COVID-19 case. Phone calls from a local (LTP) number could potentially increase tracing success rates, and local support can be offered where needed. This would lead to a to a significant increase in LTP call volumes.

·         iCERT (Integrated Common Exposure Report Tool): will combine the existing contact tracing (common exposure) reports and postcode coincidence reports and enable greater interrogation and analysis. The team will work with the local Health Protection Team (Surrey and Sussex) using local Environmental Health Teams and other public health team information as part of our OIRR approach.

·         Integrated Tracing System (ITS): process enables the LTP pull-down details of infected people to contact instead of waiting for them to be pushed to us. This will result in a more proactive identification and management and prevention of infection risks.

 

Across Sussex, the outbreak reporting process is available at  https://www.eastsussex.gov.uk/community/emergencyplanningandcommunitysafety/coronavirus/outbreak-control-plan/.

If a positive case is identified in a business, setting, or organisation, then the relevant guidance should be followed, as detailed in section 11.

 

Figure 8: NHS Test and Trace – Three Tiers

 

Figure 9: What is contact tracing (PHE)

 

 

4.5. Outbreak Control Teams

 

As described in the Communicable Disease Outbreak Management - Operational guidance (2014), an Outbreak Control Team should be potentially convened in response to an outbreak where a multi-agency response is required. This is usually declared by a Consultant in Communicable Disease Control (CCDC) or Consultant in Health Protection (CHP) from Public Health England and is normally chaired by the CCDC / CHP or a Consultant Epidemiologist. Meetings are normally held virtually, and minutes of the meeting and all associated public health actions are recorded on HPZone (Public Health England’s infectious diseases database).

 

OCTs are a well-established process that existed prior to COVID-19. Members of this time-limited group will include typically include the following core members:

 

·         CCDC / CHP from Public Health England

·         Director of Public Health, East Sussex County Council (or representative)

·         Environmental Health Officer from the relevant District / Borough Council

·         Field Services, Public Health England

·         Communications

 

Infection Control representative from the Clinical Commissioning Group

Other members will be dependent on the scale of the outbreak and the specific setting. Where relevant these potential members have been listed under the specific High-Risk Places, Locations and Communities section. This could include representatives from health, the police, the voluntary sector, the SRF business management team, other neighbouring local authorities and emergency planning etc

 

Appendix A sets out the standard documents to be used including (a) Terms of Reference, (b) Agenda and (c) Minutes.

 

The Public Health England – Local Authority Joint Management of COVID-19 Outbreaks in the SE of England provides further detail on how outbreaks will be managed.

 

4.6. Sussex Resilience Forum

 

The Sussex Resilience Forum (SRF) has an important role across Sussex in coordinating agencies, supporting joint communications, and identifying lessons learned. There are a range of scenarios where the SRF will be needed, for example in the event of a substantial outbreak or where multiple outbreaks are occurring at the same time. The involvement of the SRF will be considered as part of the initial outbreak investigation as well as during the OCT. Further detail about the SRF is detailed in the Escalation Framework and Governance section.

5.Communications and Engagement

 

5.1. Priorities for Communications and Engagement

 

·         To secure public trust in outbreak planning and response

·         To ensure communication networks and systems are in place to rapidly warn and inform all residents of necessary restrictions in the event of any local outbreaks

·         To increase public understanding of evolving national and local guidance on health protection. Emphasise our collective responsibility for restricting the virus.

·         Ensure all partners in East Sussex (and more widely when relevant) are kept informed of, and involved in, developments in engagement and communication. Work effectively with partners across Sussex while recognising different parts of the county will at times have differing approaches.

5.2. Communications and engagement plan

 

We have developed a communications and engagement plan for East Sussex which sets out the approach to communicating with residents, businesses, partners, members and staff on local protection planning and activity. This supports the approach set out in this Outbreak Control Plan and sits within the governance framework identified. In particular, the level and scope of our communications activity aligns with national, regional and local changes in the shape of the pandemic and the response to it. The communications plan specifies how ESCC’s communications team works with partner organisations could do so quickly if enhanced testing or other new measures were needed in East Sussex.

 

The communications approach includes both digital and non-digital engagement tactics to ensure messaging can be targeted at residents within a few hours of a significant change. It will draw on existing communication networks (including among schools, care homes, GPs and other community services) to help achieve this.

 

The communication and engagement plan also outlines, how specific groups can be reached using online platforms, including how residents can be targeted by their locality (home or work) and /or their profession. It includes particular thinking on how we can reach at-risk or potentially marginalised groups, including ethnic minorities communities, shielded groups, the homeless and people with impaired vision or hearing.

To deliver messaging effectively, the communications team will work with the Operational Cell as well as monitor Government advice to provide fast and timely updates on the vaccination programme and Test and Trace service and to signpost people to the correct Government sources to gain information.

The communications and engagement plan has been shared with all local partners when each new version is published and is also available on Resilience Direct.

 

The full communications plan is available as appendix D.

 

6.Data Integration

 

6.1. Data objectives

 

To combat the pandemic at a local level, it is vital that there is access to timely and robust data; including data relating to testing, the number of cases, local outbreaks in places such as schools, hospitals and care homes, hospital use and deaths.

 

There are an increasing range of data being produced relating to COVID-19 and datasets have expanded as the response to the pandemic has developed. Some datasets are in the public domain, others are, and will remain, confidential and restricted.

 

At a local level Public Health, local authority and NHS staff are seeking to maximise the use of available data to ensure a quick, targeted and transparent response. To do this we need to ensure that we have good access to data being produced including by the Joint Biosecurity Centre, Public Health England and the NHS; we need to be vigilant of change such as increasing number of cases or hospital admissions; we need to produce clear summaries to support staff tackling outbreaks; and we need to support the transparency and accountability of decisions taken.

 

Much of this work will be coordinated Sussex wide, through the Sussex Covid-19 Data and Modelling Group, whilst ensuring a local East Sussex focus.

 

Objective 1:   Staff in local authorities will secure access to the range of data available, for this we will:	§  Have a clear understanding of the data flows, such as Test and Trace data and information from the Joint Biosecurity Centre, and raise concerns where information is not forthcoming; §  Work with local and regional partners to gain access/develop further data feeds which will inform outbreak control measures (such as Public Health England, Environmental Health) §  Ensure the Sussex Integrated Dataset (SID), an anonymised linked record level dataset, is developed to support this workstream; in relation to COVID-19 this will help to understand infection rates in specific areas and groups and in the longer term understand the recovery and on-going support needs of people affected.
Objective 2:   Using the range of data, we will be highly vigilant (“proactive surveillance”) in monitoring change:	§  There will be proactive surveillance by reviewing a broad range of indicators which may provide an early warning of outbreaks or possible community transmission §  We will have, and further develop, our understanding of high-risk places, locations and communities
Objective 3:   Staff tackling outbreaks will have access to robust and concise information and be supported in their use of data; this will include:	§  Information relating to the local response to outbreaks (e.g. care homes or schools), including providing an understanding and quantifying the numbers involved and the areas/settings impacted §  Help to identify similar settings of concern §  Modelling possible scenarios. §  A daily ‘Common exposure report’ is received from PHE. This identifies locations where multiple cases have been where they potentially exposed. This report is reviewed and cascaded to Environmental Health Teams who triangulate this information with their local intelligence and follow up as required. §  A new bespoke database has been developed locally in order collate all information on recent cases. This database combines lab case data with NHS Test and Trace case data and enables a detailed daily review of cases and situations in order to identify settings on concern, clusters and outbreaks. Following daily review there are a range of associated actions to make relevant partners aware and ensure situations are followed up as required, This includes notifying Public Health England, local Environmental Health teams, NHS England, local healthcare providers, as well as reciprocal arrangements with neighbouring local authority public health teams for settings out of area involving our residents.
Objective 4:   We will seek to maximise the transparency of local decisions:	§  There will be consistent reporting to each local authority Outbreak Engagement Board and support where possible wider dissemination working with local Communication teams §  Provide data to the public in a clear and transparent way, and demonstrate how this information is used, to inform local decisions. §  Clearly note the sources of data and which datasets are, and are not, in the public domain.

 

6.2. Data arrangements currently in place

 

Data to support this plan is sourced from a range of data sources, including Public Health England national and regional teams, the local PHE Health Protection Team, NHS Digital, NHS England/Improvement, the Office of National Statistics (ONS), the Care Quality Commission (CQC) the Sussex local registry offices and many local health and care partners such as CCGs and NHS trusts.

 

Public Health England are providing to local authorities record level datasets including postcode in relation to testing, cases and contacts from the national Test and Trace system.

 

Of particular relevance for this plan is daily reporting by PHE on outbreaks in care homes, schools and prisons and the hospital onset COVID-19 reporting by trusts to NHS England.

 

These data are managed by the East Sussex Public Health Intelligence team at the council in collaboration with other local, Sussex-wide and regional partners.

 

A public facing weekly surveillance updatefor East Sussex is available from the Council's website. More detailed data are scrutinised on a daily basis by the local authority public health team, with further investigations and actions agreed at the end of each session.

Data are shared and discussed weekly at the Operational Cell with further investigations and actions agreed at the end of each session.

 

Across Sussex there is a COVID-19 Data and Modelling Group, which reports to the Sussex Monitoring Group. This was established in March 2020 as a response to the pandemic and is comprised of staff from Public Health Intelligence teams, CCGs, the Sussex ICS, Sussex Partnership NHS Foundation Trust, Adult Social Care and the University of Sussex. The group’s focus has been around modelling the pandemic, for example modelling hospital activity and deaths.

 

It has developed a Sussex-wide dashboard to support partners in maintaining a proactive view of indicators that will help provide early warning when indicators are increasing across Sussex that require further investigation and action. The group is also coordinating efforts to ensure that evidence of inequalities is collected and analysed.

 

6.4. Data arrangements that need to be further developed

 

It is anticipated that the following developments will continue:

 

·         Improve flow and integration datasets, particularly from test and trace which is subject to weekly and sometimes daily changes in how it is provided and what it contains.

·         Improved insight reports to support the various governance structures.

 

6.5. Data sharing and Data security

 

Given the challenge of tackling this pandemic, all agencies will assume they are required to adopt a proactive approach to sharing information by default, in line with the Instructions of the Secretary of State, the Statement of the Information Commissioner on COVID-19 and the Civil Contingencies Act.

 

The Secretary of State has issued four notices under the Health Service Control of Patient Information Regulations 2002 requiring the following organisations to process information: NHS Digital, NHS England and Improvement, health organisations, arm’s length bodies, local authorities, GPs. These notices require that data is shared for purposes of coronavirus (COVID-19) and give health organisations and local authorities the security and confidence to share the data they need to respond to coronavirus (COVID-19). 

 

The data sharing permissions under the Civil Contingencies Act 2004 and the statement of the Information Commissioner all apply. Under the Civil Contingencies Act 2004 (CCA) and the Contingency Planning Regulations, Category 1 and 2 responders have a duty to share information with other Category 1 and 2 responders. This is required for those responders to fulfil their duties under the CCA.

7.Testing

 

7.1. Testing provision

 

There are regional testing site (RTS) centres at Bexhill and Plumpton Racecourse and local testing sites at Bexhill, Eastbourne, Hastings and Hailsham.

 

Mobile Testing Units (MTUs) are being used across the county. These are customised vans which are available to stop in a location for 1-3 days to test local residents. These are accessed by car or on foot and require a booked appointment.  Sodexo have been commissioned by DHSC to lead operational delivery of MTUs. There are additional MTUs which can be deployed if outbreaks occur.

 

Local Testing Sites (LTS) are small, localised test sites that are set up in high density, urban areas under the direction of the DPH.  LTS are meant to serve potentially more vulnerable people who may only be able to access a test site by walking locally or require a more in-depth and guided approach in taking a test.  They are designed to be walk-through sites, active for ideally 3+ months.  DHSC give approval for the specific site location, finalise contracts for the leases and appoint a contractor to oversee the site build, setup and preparation. 

 

The Sussex Central Booking Team is an additional resource put in place to assist organisations with the administration of testing. The team are able to advise on testing criteria, assist with booking on the national website and book community assisted testing where appropriate.

 

7.2. Types of Tests

 

Polymerise Chain Reaction (PCR) tests

·         throat and/or nose swab to directly detect the presence of an antigen

 

Lateral Flow Tests (using Lateral Flow Devices – LFDs)

·         A swab of the nose or throat, to detect the presence of an antigen

·         A paper-based test device, results displayed within 15 to 30 minutes.

 

7.3. Testing pathways currently in place

 

There are several different ways that testing can be accessed for Sussex residents.

 

Full details are published on our website Getting a COVID-19 test in East Sussex – East Sussex County Council

 

PCR Tests

 

·         Anyone with symptoms should book for a PCR test.

·         In addition, regular PCR testing is offered to those without symptoms, in key settings

 

 

Asymptomatic testing

 

There are now multiple pathways available for different settings to have and access testing these include:

·         Care home residents or staff and visitors

·         Domiciliary carers

·         Hospice workers and visitors

·         Day care centre staff

·         Personal assistants

·         Schools and Universities

·         Workplace Settings

·         Prisons

·         NHS workers

·         Supported care or extra care living services11. Before going into hospital: Patients may need to get tested if they are due to have surgery or a procedure. The hospital will arrange this with patients.

 

Rapid lateral flow test

 

Rapid lateral flow tests are available to those that have no symptoms and are not covered by a previous testing pathway. People are encouraged to test themselves twice a week to detect those who unknowingly maybe spreading the virus. Lateral flow tests can be collected from local testing sites, pharmacies or ordered from home. People who need assistance or supervision with doing a lateral flow test have can book into one of the local pharmacies offering this service in East Sussex. 

 

7.4. Current issues in testing

 

At present we are awaiting the next department of health policies on the roadmap, events, and surge testing. The issues we have will depend on the governments next policies.

The potential need for surge testing may be a challenge potentially, for us to surmount in the future.  Plans have been developed and tested should that be the case (see below).

 

7.5. COVID-19 variants of concern (VoC)

 

There are many thousands of different versions, or variants, of Covid-19 circulating.

It's not unexpected that new variants have developed. All viruses mutate as they make copies of themselves to spread. Most of these differences are inconsequential.

 

Some new strains [variants] of Covid-19 may be more contagious and can cause more severe disease. They can evade our immunity following a previous infection or after immunisation to varying degrees. These are known as Variants Of Concern [VOC].

The World Health Organization (WHO) has announced a new naming system for these variants of Covid-19. From now on the WHO will use Greek letters to refer to variants first detected in countries like the UK, South Africa and India.

 

The UK variant is now labelled as Alpha. The Indian variant of increasing dominance in the UK is now known as Delta. The South African variant is Beta, the Japanese variation of the Brazilian variant as Gamma, and the Brazilian variant as Zeta. These new names should simplify discussions in future and helps remove some stigma from the country names.

 

When a new COVID-19 Variant of Concern infection is found in a person living in the UK detailed checking of their contacts occurs [by the NHS Test and Trace service]. The finding of a new variant of concern may also initiate a process of active community [surge] testing to see if there has been any spread within a particular community.

 

Current vaccines were designed around earlier versions of COVID-19, but there is steadily growing evidence they should prevent severe illness from the variants, although perhaps not quite as well compared to the original strain of COVID-19.

 

There is active ongoing research to produce booster vaccines which will offer additional protection against these variants and to evaluate their real-world effectiveness.

 

The government is currently developing an enhanced toolkit of measures to address VoC, including surge PCR testing, OIRR, communications, and targeted enforcement.

 

7.6. Surge testing

 

Surge testing involves increased testing of people without symptoms of COVID-19 (including door-to-door testing in some areas) and OIRR in specific locations where a VoC has been identified. The response to VoC through surge testing will be coordinated across the whole Sussex region through the Sussex Resilience Forum (SRF) working in collaboration with local authority partners to ensure that risk and resources are managed, and that response is delivered at pace. The SRF is working with Public Health England (PHE) and the Department of Health and Social Care (DHSC) to develop a plan for a localised ‘surge testing’ programme to detect and assess the spread of variants of COVID-19, where necessary. This will have a specific East Sussex component. The programme of testing required will be activated by PHE and this activation will be through the East Sussex Director of Public Health where surge testing is required. PCR testing and test kits will be used. The local authority intelligence team will support this process by helping to understand the appropriate geography and communities to target.

 

A local COVID-19 Variants of Concern Surge Testing Plan for East Sussex dated the 23rd February 2021 has been developed which will remain a live document as learning from wider areas. The plan describes how resources will be mobilised.

 

7.7. Enduring transmission

 

Where there is a general downward trend, there is still a potential risk of enduring transmission of COVID-19 in certain sectors or geographic areas. Measures to address these in East Sussex include reporting the following to the Operational Cell each week:

 

• Ongoing data surveillance by East Sussex Public Health considering the pressure on NHS, new variants and the prevalence and trajectory of rates locally.
• Being aware of our local area characteristics such as the mobility, deprivation, ethnicity, reported contacts, household composition
• Testing, including asymptomatic testing
• Tracing, via the Local Tracing Partnership with West Sussex County Council
• Community Hubs and engagement such as door knocking by our local Environmental Health Officers
• Supporting people who are self-isolating, the Vaccination programme, including promoting vaccine uptake
• Communicating key prevention messages i.e. hand washing, face coverings, self-isolation, and social distancing

 

Targeted work on inequalities, including ethnic minorities and those in high risk occupations such as taxi drivers and health and social care workers takes place.

Where enduring transmission occurs in a community or setting all elements of this plan would continue to apply with a tailored approach and the relevant action card within this document.

 

7.8. Self-isolation

 

Self-isolation is a key action for reducing COVID-19 transmission; ten-day self-isolation is a legal requirement for both positive cases and contacts of positive cases. In practical terms, self-isolation means:

• staying at home
• not going to work, school or public areas
• not using public transport like buses, trains, the tube, or taxis
• avoiding visitors to your home

 

Effective self-isolation involves staying as far away as possible from other household members, minimising the use of shared areas such as kitchens and living rooms and eating in personal spaces. A face covering or a surgical mask should be worn when spending time in shared areas inside the home.

 

Employers have an important role to play in supporting self-isolation. There should be clear workplace messaging that employees who become symptomatic or who have been close contacts of positive cases should self-isolate immediately. Employers should provide information and advice to those employees required to self-isolate.  East Sussex Environmental Health and Public Health Leads continue to work with employers around supporting self-isolation, both at the level of individual outbreak control and sector led development.

 

Individuals asked to self-isolate by NHS Test and Trace are eligible for financial support while self-isolating if they are on low income or claiming benefits, unable to work from home, or will lose income from self-isolating. East Sussex County Council and our local partners are also able to provide support to people who self-isolate.

 

8. Vulnerable People

 

8.1. Overview

 

Vulnerable people support arrangements developed in East Sussex are multi-agency and cross-sector in nature. East Sussex County Council has led on the support to Clinically Extremely Vulnerable People (the Shielded Group), with the District and Borough Councils in partnership with local the VCSE have provided the local Community Hub response. Support has been available through the Hubs for those who for any reason are without a local support network, are isolated, struggling to cope, anxious, unwell, require information, advice and guidance or cannot get medicine, food or other essential supplies. The whole effort has been a collaborative, resident focused response.

 

Largely, the East Sussex response can be described as meeting the requirements for three groups of individuals:

 

·         Circa 38,000 Clinically Extremely Vulnerable people (CEV’s) who are advised to shield during national lockdown and Tier 4 local restrictions, during which proactive and responsive support is provided. When other local restrictions apply, CEV’s are advised to take additional precautions, and ongoing responsive support is available.

·         Approximately 4,500 vulnerable people known to statutory services and those locally identified as requiring support e.g. the homeless, those in substance misuse treatment and those who need safeguarding such as children and vulnerable adults. This work has been led by different agencies. 

·         Other vulnerable people (not at increased risk due to medical reasons) who are at risk due to a change in circumstances, or the impact of the restrictions put in place through social isolation, worsening mental or physical health. This support has been led through the Community Hubs. To date over 7,000 people have contacted Community Hubs for support.

 

8.2. Current support available

 

Government has frozen its offer to the Clinically Extremely Vulnerable Group as shielding came to an end at the end of March 2021. As such the proactive element of the ESCC support to CEV’s has paused. However, much of the practical support and advice required by residents is still live. Community Hubs within the five Districts and Boroughs have been absorbed as business as usual, and Health and Social Care Connect can still advise residents how to get support.

 

Residents seeking support should still in the first instance seek assistance from trusted family, friends and neighbours with basic support such as help with shopping, getting medicines and other essentials.

 

If this isn’t available the Community Hubs can be contacted – details are available here: Community hubs | East Sussex County Council. Alternatively, contacting Health and Social Care Connect on 0345 60 80 191 or emailing hscc@eastsussex.gov.uk  (open 8am to 8pm 7 days a week including bank holidays).

 

Across East Sussex, local authorities, and health partners commission work closely with Community and Voluntary Organisations to provide services to vulnerable people. Working in partnership with the voluntary sector has proactively adapted, to continue to deliver services, utilising new approaches, addressing the specific needs resulting from COVID-19 which are ever more complex and varied as circumstances evolve.

 

Project arrangements supporting the Community Hubs and CEV work have been maintained to ensure a continuity of offer through the spring and summer. Contingency arrangements are in place should shielding need to be reintroduced.

 

8.3. Shielding Support

 

Whilst shielding was live ESCC provided centralised coordination of support to those in the clinically vulnerable groups. Those identified by a GP or clinician as being in the extremely clinically vulnerable group were written to by Government. They were advised not to attend work, school, college or university, and limit the time spent outside the home. Going out only for medical appointments, exercise or if it is essential.

 

The National Shielding Support Service (NSSS) offered online: registration for priority supermarket deliveries, self-referral for support from an NHS Volunteer Responder, and requests for contact from local councils. 

 

ESCC worked closely with local partners to deliver the support required through a coordinated response to requests for help. Support[7] offered to CEV people in East Sussex included:

 

·         Pro-active calls were undertaken to CEV individuals. Prioritisation was based on those who have previously received support to access food or basic support needs, those most recently added as CEV, age and other additional vulnerabilities.

·         Health and Social Care Connect was (and is) available for advice, signposting and support to access NSSS and other services. It also responds to requests for contact via the NSSS. Additional capacity was been recruited to enable this, and it has been retained.

·         A food delivery contract was procured and when appropriate food box delivery was available to residents. This was only available as a last resort and where all other avenues have been exhausted.

 

Advice for CEV individuals requiring support was based on:

 

·         In the first instance seeking assistance from trusted family, friends and neighbours with basic support such as help with shopping, getting medicines and other essentials.

·         Seeking assistance from NHS Volunteer Responders - 0808 196 3646 or by visiting the website: NHS Volunteer Responders.

·         Registering for priority supermarket slots or NHS Volunteer Responders via the NSSS on GOV.UK.  https://www.gov.uk/coronavirus-shielding-support.

·         If medicine collection can’t be arranged through friends, family and neighbours, or NHS Volunteers, CEV people can inform their local pharmacy which will arrange delivery free of charge. The NHS Find a Pharmacy Service lists all pharmacies nearby.

·         Accessing community support⁹.

·         If there is nobody is available to help, contacting Health and Social Care Connect on 0345 60 80 191 or emailing hscc@eastsussex.gov.uk  (open 8am to 8pm 7 days a week including bank holidays).

 

 

8.4. Community Hubs

 

For residents who needed support but weren’t CEV the Community Hubs in each District and Borough were developed. Community Hubs were designed to help people affected by the pandemic who have no one else to turn to. Community Hubs[8] were a partnership between the voluntary sector, health service, County Council and District and Borough Councils in East Sussex. Hubs helped residents with activities like:

 

·         Options to access food and essentials.

·         Organising volunteers to help with shopping for food or essentials or collecting prescriptions.

·         Putting residents in touch with a local organisations or groups who can help with the impact of coronavirus.

·         Referring to local befriending services to combat isolation.

 

 

8.5. Additional Support

 

Food Security Grant

 

Recognising that food security has been a key issue during the lockdown investment was agreed to:

 

·         Support to 15 food banks across the County through £270k of funding.

·         Develop food partnerships in each District and Borough.

·         Provide £100k of additional funding to groups help those accessing food banks.

·         Fund Citizens Advice to provide fuel vouchers.

 

COVID Winter Grant/Local Support Grant

 

The scheme was announced by the government in November 2020. Funding was provided to Councils to support those most in need with the cost of food, energy and water bills and other associated costs.

 

In East Sussex the funding is being used for schools, colleges and early years settings to provide food vouchers for children and young people eligible for free school meals.

 

Funding has also been given to a range of local community organisations and charities to provide immediate support to households in need that they are working with.

 

 

Sussex Crisis Fund

 

Sussex Community Foundation (SCF) at the beginning of the 1st Lockdown (March 2020) set up a Sussex wide fund for VCSE organisations designed to assist groups and organisations affected by Covid restrictions. 

 

ESCC made an initial £100,000 contribution to the Sussex Crisis Fund, with the first and second phase of the fund allocating just under £400,000 to East Sussex organisations.

Subsequently ESCC worked with WSCC to agree a further contribution to the third phase of the Sussex Crisis Fund, with each local authority contributing a further £330,000 each, to the third phase launched mid-April 2021.

 

 

Additional Measures Grant Fund

 

Circa £550k has been awarded to 11 VCSE organisations to put in place additional measures for providing financial and benefits advice to people on the SPL, and for people that have been affected by Government Guidance in relation to the COVID pandemic.

 

 

 

9. Prevention

 

The most effective way to minimise outbreaks of COVID-19 is to focus on prevention. This includes promoting and supporting all parts of East Sussex to follow social distancing guidelines, to be vigilant to symptoms of COVID-19 (a new continuous cough, fever, or loss of taste or smell) and test and self-isolate if they appear, through adherence to risk assessed safe working advice as detailed in the COVID-19 secure guidance, and to ensure the public regularly clean hands and surfaces. All organisations across East Sussex have an important role to play in promoting these messages and ensuring the guidance and advice is shared and followed.

 

East Sussex County Council is working closely with District and Borough Councils to ensure that businesses are aware of and operating within COVID-19 secure guidance. District Councils, through their Environmental Health function have a key role in supporting residents to limit their exposure to COVID-19 infections and thereby to prevent the spread of infection, along with Trading Standards and the Health and Safety Executive. This has included a particular focus on specific settings of higher risk, for example letters have been sent to pubs across East Sussex detailing appropriate advice, and other high-risk settings have been proactively identified and risk assessed.

 

There are systems in place to ensure that local intelligence on settings and businesses not operating in a COVID-19 secure way is fed back to the relevant agency to enable follow up and review of current practices.

 

Communication with the public is key to preventing outbreaks, more of which is detailed in the Communications section, and all agencies have an important role in communicating with and supporting the public to ensure this is followed, including Health and Social Care, the police, Education, Upper and Lower Tier Authorities, the Sussex Resilience Forum, and at a national level. This includes messaging and nudge strategies to support the public to maintain social distancing, guidance on face masks where they are required, vigilance of symptoms, supporting vaccine uptake and reminding the public about hand hygiene.

 

All local health and care organisations are working to ensure that patients and staff are protected from COVID-19 and that testing of patients prior to discharge is in place. There needs to be continued campaigns and support for essential workers and other residents to self-isolate alongside promptly access testing on experiencing COVID-19 symptoms.

 

10. Vaccination

 

10.1. National overview

 

The NHS begun a mass vaccination program from early December 2020 using the Pfizer-BioNTech vaccine, and the AstraZeneca Oxford vaccine, the first ones to be approved for use against Coronavirus in the UK. Fifty initial tranche 1 sites were identified, making this the start of the biggest vaccination programme in history. Sussex was selected as one of these first tranches, with the first hospital hub to deliver the vaccine being the Royal Sussex County Hospital (RSCH). Vaccinations began from this hub on the 9^th December 2020.

 

10.2. Governance of the COVID-19 Mass Vaccination Project in Sussex

 

The COVID-19 Mass Vaccination Project Board reports to the Quality and Safety Group for monitoring and assurance purposes and is accountable to the Sussex Health and Care Partnership (SHCP) Executive Board. The Project Board and members of the Project Team are working in collaboration with all Sussex Health and Care Partnership (SHCP) partners and wider stakeholders through the Sussex Resilience Forum. The Clinical Leadership Group provides senior clinical oversight, risk management and advice as required.

 

10.3. Background – COVID-19 vaccines

 

Any coronavirus vaccine that is approved for supply within the UK national vaccination program must go through all the clinical trials and safety checks all other licensed medicines go through. The MHRA (Medicines and Healthcare products Regulatory Agency) follows international standards of safety. The 2 approved vaccines by Pfizer-BioNTech and Oxford - AstraZeneca (AZ) have met strict standards of safety, quality and effectiveness set out by the independent MHRA. The vaccines work by triggering the body’s natural production of antibodies and stimulates immune cells to protect against COVID-19-19 disease. For both Pfizer-BioNTech and AstraZeneca vaccines, a 2-dose vaccine schedule is advised.

 

Pfizer-BioNTech vaccine

 

The first COVID-19 vaccine approved for use in the UK was developed by Pfizer-BioNTech, early December 2020. COVID-19 mRNA Vaccine BNT162b2 is a vaccine used for active immunisation to prevent COVID-19 disease caused by SARS-CoV-2 virus. COVID-19 mRNA Vaccine BNT162b2 will be given to people aged 16 and over in a phased approach, commencing with the most vulnerable and frontline health and social care staff.

 

There are complexities in the delivery of the vaccine due to vaccine needing to be kept at -70C before being thawed and it can only be moved 4 times within the cold chain before being used. It is also supplied in large amounts with each pack containing 975 doses.

 

 

Oxford – AstraZeneca (AZ) vaccine

 

The Oxford – AstraZeneca (AZ) vaccine was approved for use on the 30^th of December 2020. Unlike the Pfizer vaccine this can be stored in a standard fridge making it easier to deliver at GP practices and care homes.

 

Evidence shows that the vaccines can provide immunity within 2-3 weeks after the first dose. Therefore, to maximise the speed of roll out, as many people as possible will be given the first dose with the second being given after around three months.

 

Other vaccines:

 

Other vaccines have been developed and proved to be safe effective vaccines such as the Modena vaccine, which has recently been through the MHRA to gain approval for use.  Many more are still working through the trial process with results expected later in 2021. They will only be available on the NHS once they have been thoroughly tested to make sure they are safe and effective.

 

10.4. Possible side effects:

 

Like all vaccines, COVID-19 vaccines can cause side effects, although not everybody gets them. Most side effects are mild or moderate and go away within a few days of appearing. If side-effects such as pain and/or fever are troublesome, they can be treated by medicines for pain and fever such as paracetamol. Side effects can include pain at injection site, tiredness, headaches, fever and muscle and joint pain.

It has been shown that people who have severe allergies can have a bad reaction to the vaccines, therefore it is recommended until more is known about this, that people with severe allergies do not receive the vaccines.

 

10.5. Vaccine programme

 

The aim of the COVID-19 vaccination programme is to protect those who are at most risk from serious illness or death from COVID-19. The vaccination programme needs high uptake - at least 70% to be effective. The impact of vaccines on COVID-19 transmission is being examined, but it is known that vaccines stop people from suffering serious illness, therefore the vaccine is a game changer in terms of hospital admissions and mortality from COVID-19.

 

We also do not yet know how long the protection from the vaccinations will last, it could be like flu needing to be done regularly.

 

10.6. Vaccine prioritisation

 

The Joint Committee on Vaccination and Immunisation (JCVI) advises that the first priorities for the COVID-19 vaccination programme should be the prevention of mortality and the maintenance of the health and social care systems. As the risk of mortality from COVID-19 increases with age, prioritisation is primarily based on age. The order of priority for each group in the population corresponds with data on the number of individuals who would need to be vaccinated to prevent one death, estimated from UK data obtained from March to June 2020.

 

This priority list is as follows:

 

1. residents in a care home for older adults and their carers
2. all those 80 years of age and over and frontline health and social care workers
3. all those 75 years of age and over
4. all those 70 years of age and over and clinically extremely vulnerable individual
5. all those 65 years of age and over
6. all individuals aged 16 years to 64 years with underlying health conditions which put them at higher risk of serious disease and mortality
7. all those 60 years of age and over
8. all those 55 years of age and over
9. all those 50 years of age and over

 

It is estimated that taken together, these groups represent around 99% of preventable mortality from COVID-19. People aged 80 and over as well as care home workers will be first to receive the jab, along with NHS workers who are at higher risk.

 

10.8. Sussex COVID-19 vaccination programme

 

Sussex Integrated Care System received its first delivery of the Pfizer/BioNTech vaccineon 8 December, via the Royal Sussex County Hospital (RSCH) (a designated Tranche 1 Hospital Hub). The vaccination programme has expanded as more vaccines become available. This will include:

·         hospital hubs

·         GP-led vaccination services

·         larger vaccination centers

·         vaccine service in care homes and people’s own homes if they cannot attend a vaccination site.

 

Further details can be found at the Sussex Health and Care PartnershipCOVID-19 Vaccination programme website.

 

The NHS in Sussex commenced with their vaccination programme from the 9^th of December 2020, at the Royal Sussex County Hospital (RSCH) in Brighton, the first site ready to administer the vaccine. Other hospital sites and GP practices have come on board in a phased approach, with other vaccination centres being made available across the area to ensure equitable access for local people. The Brighton Centre has been delivering vaccinations since January 25th, 2021.

 

Core frontline health and social care staff and patients aged 80 and above who were already attending hospital as an outpatient, and those who are being discharged home after a hospital stay, were the first to receive the vaccine. Work with care home employers was undertaken to identify staff who could attend an appointment at a local hospital hub. And as slots for health and care staff became available, eligible people were contacted by their employer.

 

Sussex Community NHS Foundation Trust have been leading the work to recruit and train more staff - both clinical and non-clinical - so that the NHS in Sussex can deliver this unprecedented immunisation programme without impacting on other vital services. People are contacted by either the local NHS or their GP when it is their turn for the vaccine. It is essential that people take up the offer to ensure protection for our communities against COVID-19.

 

10.9.  Outcomes of the Sussex Vaccination Programme

 

To date the local vaccine programme has met the targets for the first priority cohorts 1-4 who were to be vaccinated by February the 15^th. Priority groups 5 & 6 have been the recent focus to ensure those 65-69 and those clinically vulnerable have been offered vaccines. All have received vaccine appointments for their second vaccine, three months after the receipt of the first dose. From week commencing the 1^st of March 2021 the those aged 60-65 were invited to receive a vaccine. It the national ambition to vaccinate all adults over the age of 18 by the end of July 2021.

 

10.10.  Measures to improve vaccine uptake locally

 

To ensure the removal of barriers to people who have not taken up the offer of a vaccine, work is being taken forward led by an Inequalities Cell that sits under the Vaccine Programme Board. Identified actions include - focused communications, mobile/roaming vaccination services and localised partnership working to identify insight into reasons why some have not taken up the offer of a vaccine and to have a coordinated approach to target these people in line with respective needs.An action plan has been developed (please see Appendix E).

 

Key areas of focus for boosting East Sussex vaccine uptake

 

·         Older people – those with reduced access to vaccine centres, housebound, missed their appointments, uncontactable, are in care homes (e.g. people who would like to be vaccinated but haven’t been able to) – individual and geographical reasons need investigating and addressing.

·         Younger people (65-69 and younger) – those who have refused or not taken up their vaccine for a multitude of reasons – individual reasons need investigating; there may be a need for more information, education and awareness, discussion with trusted people, communications and champions.

·         Ethnicity groups with reduced uptake – targeted community engagement with different ethnicity groups using BAME networks, webinars, faith leaders, vaccine champions, translated and tailored messaging, pop ups at faith centres and community centres.

·         Females – younger females, childbearing age, worries about fertility/pregnancy/breastfeeding – individual reasons need investigating - webinars, Q&A sessions, high profile NHS, O&G, female respected and trusted leaders to provide up to date, easy to understand medical information, personal experiences from other young females.

·         Males – healthy, white, older and younger males – individual reasons need investigating – targeted communications including direct messaging ‘not just for you, to protect your children, grandchildren’. as well as behavioural and psychological work.

·         Areas of deprivation – Hastings, Rother and specific areas of Wealden.

·         Clinically extremely vulnerable – including learning disabilities, physical disabilities, mental health, younger people who are less engaging – individual reasons need investigating, needs help of service providers, community networks and carers, GPs and PCNs.

·         Healthcare workers – individual reasons need investigating, care homes, ASC work, engage with ESHT, PCNs, CCGs. Webinars, Q&As, clear direct messaging.

·         Other groups – e.g. homeless, travelling community, refugees.

 

Vaccine Champions

 

Vaccine Champions are a scheme created by the CCG which uses members of the local community to provide guidance and dispel myths with vaccines. Therefore, allowing residents to make an informed choice on whether or not to have a vaccine. The plan is to double the number based in East Sussex and targeting the groups and areas with lower uptake.

 

Volunteering from their own home at a time that is most convenient for them, Vaccination Champions are part of an exciting new way of helping the NHS in Sussex communicate about the COVID-19 vaccine and dispel myths on the vaccine – in their volunteer role they might:

 

·         post update-to-date information on the vaccine on social media;

·         share information from the NHS on What’s App;

·         produce videos of local community leaders for circulation,

·         share information in local magazines or newsletters; and

·         erect information on community noticeboards.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

11.Outbreak investigation: High Risk Places, Locations and Communities

 

The following section details the specific issues and considerations for specific high-risk places, locations and communities across East Sussex, and is structured in the following way:

 

Care homes

Children’s homes

Schools

Prisons and other places of detention

Workplaces

Faith settings

Tourist attractions, Events, Travel and accommodation

Ethnic minorities communities

Gypsy, Roma and Travellers (GRT) and Van Dwellers

Homeless

Acute

Primary Care

Mental Health and Community Trusts

Transport Locations

 

 

 

11.1. Care homes

 

Objective The objective is to prevent COVID-19 cases occurring in the first place, and to reduce and eliminate new cases of COVID-19 and deaths from COVID-19 in Care Homes in Sussex.

Context: There are 305 CQC registered care homes in Sussex.  They are all independent sector run homes except an intermediate care centre with nursing and two Learning Disability respite services which are run by East Sussex County Council.

What’s already in place:   All partners within Sussex LRF Community Care Settings Cell, Testing Cell, Health and care, Logistics and Recovery groups have worked closely with Sussex Care Association to implement a package of measures to support care homes, including: ·         Provision of Personal Protective Equipment (PPE) supplies based on a prioritisation framework that prioritises health and social care overnight settings ·         Infection Prevention and Control (IPC) training offer to all care homes delivered by Sussex trainers/super trainers, from Sussex CCG ICNs and Consultant ICNs from an independent provider.  Training included of the use of PPE and practical test swabbing   Testing via Get coronavirus tests for a care home - GOV.UK (www.gov.uk) •      Weekly staff and monthly resident testing PCR regime •      Twice weekly LFD (Lateral Flow Device) testing •      Undertake an additional two LFD tests per week, ideally at the beginning of the shift: •One LFD test on the same day as the established weekly PCR testing programme •One LFD test midweek – on days 4-5 between PCR tests •      If any staff test positive, they will need to undertake a confirmatory PCR and then self-isolate at home immediately until they receive their result. •      Staff will need to undertake an LFD test if they’ve worked elsewhere since their last shift or are returning from leave. For staff if a positive case is detected •      If there are any positive cases, PCR or LFD, found staff should also: •Undertake daily LFD testing of all staff for 7 days •If any staff test positive, they will need to undertake a confirmatory PCR and then self-isolate at home immediately until they receive their result •      This additional 7-day testing should be in addition to any outbreak testing that may be necessary from local Health Protection Teams. •      Continue to follow any outbreak management processes as per normal.   ESCC Adult Social Care Market Support Team supports registered providers in terms of day to day management challenges; workforce; training and CQC related matters.   Public Health England risk assess and give advice to all care homes experiencing an outbreak. PHE notify the local authority of all outbreaks and exposures in care homes. Similarly, the local authority tracks all cases linked to a care home via the care home tracker and line listings provided to local authority public health teams to ensure that all possible data sources are used and linked. This ensures all situations are identified, and also any escalation of situation is picked up at the earliest opportunity.   If any issues are identified previously this was being flagged up to the CCG for follow up. However, this is now being flagged to ESCC initially, with follow up by an Infection Control Advisor, and if there are quality issues that are outstanding then this is referred to the CCG. A weekly IMT is held with stake holders where homes of concern are discussed, and actions agreed and outcomes are confirmed. Bespoke work by local authority staff and NHS clinical leads is already deployed to improve vaccine uptake in care homes and within our adult social care staff. This includes educational sessions and presentations in established forums, as well as a programme to contact all care homes with low uptake and offer support.

What else will need to be put in place: In December 2020 The CCG announced they were needing to reduce the support given to care homes that are experiencing an outbreak. In response to this East Sussex County Council rapidly employed an Infection Control Advisor to support Care Homes.

Local outbreak scenarios and triggers: PHE will consider the severity and spread of the outbreak, current control measures, the wider context and will jointly consider with the local authority the need for an Outbreak Control Team (OCT). In the event of an OCT being required, additional members for the OCT will include; ·         Representative of the specific setting ·         Assistant Director of Operations, ESCC ·         Assistant Director of Strategy, Commissioning and Supply Management All outbreaks in care homes irrespective of complexity are initially risk assessed by PHE where provisional support and advice is given. If there are any outstanding concerns this is flagged to the Local Authority for follow up, and any continued concerns are escalated to the CCG’s Quality Team. All outbreaks in care homes are then discussed at the weekly Incident Management Team meeting to ensure no additional support is required. Furthermore, any other East Sussex care homes where there are potential COVID-19 related concerns are also raised at this meeting.

Resource capabilities and capacity implications: Staffing ·         Additional IPC training and support for care homes with outbreaks ·         Ongoing provision of PPE until care homes can source PPE through normal supply routes or the PPE Portal for small care homes (less than 24 beds) PPERequest@eastsussex.gov.uk

Links to additional information: Adult Social Care guidance can be found at; How to work safely in care homes Management of exposed healthcare workers and patients in hospital settings Personal protective equipment (PPE) – resource for care workers Coronavirus (COVID-19): adult social care guidance https://www.gov.uk/apply-coronavirus-test-care-home

 

 

 

11.2. Children’s Homes

 

Objective The objective is to prevent COVID-19 cases occurring in the first place, to identify cases and reduce the risk of transmission of COVID-19 in local authority children’s homes and residential schools in East Sussex, as well as the wider independent/private and semi-independent sector.

Context: In East Sussex there are: ·         3 East Sussex County Council Children’s Community Homes ·         2 ESCC Learning Disabilities Children’s Homes ·         1 ESCC Secure Children’s Home ·         25+ Private Children’s Homes and Residential Schools within the County   The rest of the market is independent/private, and semi-independent providers for children aged 16+.

What’s already in place: Partners within the Sussex LRF Community Care Settings Cell and Testing Cell have worked to put in place measures to support Children’s Homes and Special Schools in East Sussex, including: ·         Provision of Personal Protective Equipment (PPE) supplies based on a prioritisation framework that prioritises health and social care overnight settings ·         Testing – Coronavirus (COVID-19) test kits for children's homes - GOV.UK (www.gov.uk)           -            Symptomatic staff (as essential workers) can access testing through Gov.uk or via the Sussex Central Booking Team. Asymptomatic staff can also be tested through this route on an individual basis.           -            Symptomatic children are identified for testing when PHE receive initial notification of an outbreak ·         Staffing continuity has been provided for Children’s Homes ·         Information on how to access the vaccine as per national prioritisation guidelines is shared through general and specific communications.

What else will need to be put in place: Local outbreak scenarios and triggers: PHE will consider the severity and spread of the outbreak, current control measures, the wider context and will jointly consider with the local authority the need for an Outbreak Control Team (OCT). This will usually be chaired by PHE but if there is limited capacity this may be chaired by the Local Authority Public Health team.

In addition to the core OCT members, additional members would potentially include the two residential Operations Managers, for either Lansdowne and the open homes or for the disability homes.

Resource capabilities and capacity implications: Staffing ·         Ongoing IPC training and support for Children’s Homes with outbreaks ·         Ongoing provision of PPE until Children’s Homes can source PPE through normal supply routes or the PPE Portal for small Children’s Homes (less than 24 beds)

Links to additional information: Coronavirus (COVID-19): guidance on isolation for residential educational settings Coronavirus (COVID-19): guidance for children's social care services

 

 

 

11.3. Schools

 

Including: Primary and secondary, early years settings, universities/colleges & special schools

Objective: The objective is to enable all educational settings in East Sussex to open fully, to prevent COVID-19 cases occurring in the first place, and to identify cases and reduce the risk of transmission of COVID-19.

Context: In East Sussex there are: ·         503 early years’ providers, made up of 194 nurseries/pre-schools, 227 childminders, 25 standalone holiday playschemes/out of school clubs, 41 schools with nurseries, (maintained/academies), 13 independent school nurseries ·         186 schools - 149 primary schools, 3 all-through schools, 23 secondary schools, 10 special schools and one alternative provision ·         One further education college, One higher education campus, one sixth form college and one land-based college ·         67,502 number of learners on roll across primary, secondary and special.

What’s already in place: A virtual task group ‘Keeping Schools Open’ was established to oversee the support for schools, colleges and early years settings during this period and to ensure that provision is offered in line with the government’s guidance. The group consists of staff from across Children’s Services and other key teams across East Sussex County Council – school transport, catering and cleaning contract managers. The group quickly put in place key measures: ·         a Daily Message Board to schools, colleges and settings providing updates to national and local guidance, and key information from the range of Council services that work with schools ·         information and guidance provided on the Czone website ·         clear mechanisms for schools, colleges and settings to communicate with the Council with any queries ·         risk assessment templates for schools and settings ·         contingency plan guidance for schools and settings ·         advice and information on dealing with suspected or confirmed cases.   A model document has been made available to schools to support them in achieving the objectives of contingency planning as outlined in Section 5 of the DfE’s ‘Guidance for full opening: schools’. This includes the following elements,   Section A – Ensuring school is prepared for a potential outbreak Section B – Responding once a local outbreak has been confirmed by PHE   Schools also have access to a comprehensive ‘Schools Resources Pack’ developed by PHE South East to help them respond to cases occurring in pupils and staff. This is updated when there are changes to new national guidance.   As part of the local authority duty for safeguarding children, and supporting schools to safeguard vulnerable children and young people (0-25) during the COVID-19 school closures a virtual group was set up to agree and implement a process to do this, to ensure: ·         the assessment and management of risk for vulnerable children during COVID-19 school closures ·         improved systems for sharing information and utilising resources to monitor at-risk children during school closures ·         identification of barriers to vulnerable children attending school and working together to resolve these so that schools are able to prioritise the right children to attend.   East Sussex County Council's Public Health Department organised a number of online training sessions specifically for education settings on COVID-19 infection prevention and control (IPC). This training was delivered by Infection Prevention Solutions (IPS).   A further series of four webinars jointly organised and delivered by Children’s Services, Public Health England and Public Health, ran at the start of the academic year for early years, primary, secondary and special school education settings. These focused on what schools must do in the event of a suspected or confirmed case/outbreak and general IPC measures. A further webinar will be delivered for  secondary schools in January 2021, focussing on managing outbreaks and learning from schools.   Public health and Children’s Services have jointly developed systems for monitoring cases occurring in education settings. These settings now reliably update the local authority on all cases in staff and pupils as they occur. Children’s Services make contact with schools to support them with decisions regarding isolation of bubbles/year groups and partial or full closure. For larger outbreaks, Public Health may lead a multi-agency outbreak control meeting if it is felt to be helpful in assessment of risk and planning the response. Schools and colleges testing: order coronavirus (COVID-19) rapid lateral flow home test kits - GOV.UK (www.gov.uk)   All students began the return to face-to-face education on 8th  March with the following testing measures in place: ·         all primary school children will return on Monday 8 March. Primary school staff will continue to take 2 rapid COVID-19 tests each week at home ·         all secondary school and college students will take three COVID-19 tests as they return to the classroom from the 8 March at existing school testing facilities. Schools and colleges will have discretion on how to test students over that week to enable their return to the classroom. After the initial programme of three tests in school or college, students will be provided with 2 rapid tests to use each week at home ·         secondary school and college staff will also be provided with 2 tests to use each week at home ·         university students on practical courses who need to access specialist facilities and equipment can return to in-person teaching and learning from Monday 8 March. Twice weekly testing will continue to be available for all on campus Information on how school staff can access the vaccine as per national prioritisation guidelines is shared through general and specific communications.

What else will need to be put in place: There may be a need to review local authority support to schools as the pandemic progresses, as the options and thresholds set by DfE and PHE for advice are likely to change in the new year.

Local outbreak scenarios and triggers: There are two key likely scenarios which may result in partial or full school closure. 1) Confirmed or Suspected Cases in a School The existing protocols remain the same, and begin with the school making contact with DfE or the local PHE Health Protection Team for risk assessment and advice. PHE will consider the severity and spread of the outbreak, current control measures, the wider context and will jointly consider with the local authority the need for a multi-agency Outbreak Control Team (OCT). This may be chaired by PHE or a Consultant in Public Health from the local authority. An OCT may be required for a complex outbreak such as: ·         there has been a death at the school/college ·         there are a large number of vulnerable children  ·         there are a high number of cases  ·         the outbreak has been ongoing despite usual control measures ·         there are concerns on the safe running of the school ·         there are other factors that require multi-agency coordination and decision making. An OCT related to an educational setting would include a representative from: the children’s department; public health; the specific setting(s), Environmental Health; and Communications. Testing is available for individuals through GOV.uk or through community testing routes if required. 2) National Oversight In this scenario, the Council will follow national restrictions in place at the time or adopt the Tired approach set out in the Contain Framework.

Resource capabilities and capacity implications: Staffing and workforce planning dependent on further government guidance.

Links to additional information: Education and Childcare COVID Guidance

 

 

11.4. Prisons and other prescribed places of detention

 

Objective:   The objective is to prevent COVID-19 cases occurring in the first place, and to identify new cases and prevent onward transmission and deaths from COVID-19 in prisons and places of detention in East Sussex.

Context:    There is one closed adult (18+) prison located in East Sussex: ·         HMP Lewes – male prison, current op cap 560, category B (including remand) prison located in Lewes in East Sussex   There is also one secure children’s home ·         Lansdowne House – capacity 7 young people of either gender aged 13 – 17 years old.  The client group comprises of young people who have displayed serious and extreme behaviours which have resulted in them needing to be placed in a secure children’s home for their own protection or protection of others in the community.   Note that Lansdowne SCH will be covered in the earlier children’s care home section.

What’s already in place:   Prisons are currently in regime level 4  until further national guidance  is issued, with prison visits currently suspended, except for exceptional compassionate reasons, Health services, where risk assessment allows, are still in operation Prison staffing is experiencing some difficulties, with staff COVID positive rates coupled with isolation requirements via Test & Trace. Prisons follow strict COVID secure measures, which are regularly monitored through Health Protection and Health & Justice teams.   Established PHE procedures are in place to manage outbreaks in prisons and other prescribed places of detention, linking with Health and Justice teams in PHE and NHSE, and HMPPS Health and Social Care. Currently there is a high incidence of COVID-19 in prisons across the SE. HMP Lewes is currently in outbreak mode with increasing cases.   Symptomatic testing is in place for symptomatic individuals, alongside this all prisons are delivery weekly staff testing and reception testing of all new entrants to the establishment, this final testing process supports a reduction in the reverse cohort period from 14 days to a minimum of 10 days. Information on how prison staff and residents of the prison can access the vaccine as per national prioritisation guidelines is shared through general and specific communications.

What else will need to be put in place: Where an outbreak becomes significant, mass testing could be accessed via Department of Health and Social care.

Local outbreak scenarios and triggers:   PHE will consider the severity and spread of the outbreak, current control measures, the wider context and will jointly consider with the local authority the need for an Outbreak Control Team (OCT). This will usually be chaired by PHE but if there is limited capacity this may be chaired by the Local Authority Public Health team.   There are a wide range of stakeholders that are involved in prison OCTs over and above the core membership and this would follow the current prison outbreak guidance and be determined by PHE.

Resource capabilities and capacity implications: Staffing – prison officers and healthcare staff.  Staff levels currently sufficient to deliver a safe service.

Links to additional information: Preventing and controlling outbreaks of COVID-19 in prisons and places of detention - GOV.UK (www.gov.uk)   Covid-19 specific: COVID-19: prisons and other prescribed places of detention guidance   Prison Outbreak Plan: Multi-agency contingency plan for the management of outbreaks of communicable diseases or other health protection incidents in prisons and other places of detention in England, 2016

 

 

11.5. Workplaces

 

Including: ·         council owned premises – offices/depots, libraries, leisure centres, day centres etc. ·         private commercial premises - retail, offices, leisure and hospitality services (clubs, gyms, hairdressers/barbers, beauticians, pubs, restaurants, hotels, campsites etc), indoor event venues (conference centres, theatres, cinemas etc), outdoor event venues (racecourses, sport venues etc), manufacturing and processing sites, construction sites, forestry, farming and fishing premises. ·         critical infrastructure sites

Objective:   The objectives are to protect employees, visitors and customers, while restarting the local economy as quickly as possible, to prevent COVID-19 cases occurring in the first place, and to identify and eliminate all cases of COVID-19 in workplaces.

Context:   East Sussex has approximately 22,895 businesses. A higher proportion of businesses in East Sussex are micro (0-9 employees) than nationally[i] at 90.4%. There are fewer businesses in East Sussex that fall within the small (10-49 employees), medium (50-249 employees) and large (250+ employees) categories than nationally. The largest sectors within the county are construction; wholesale, retail and motors; and professional, scientific and technical.   There are a number of critical infrastructure sites across the county, where staffing levels need to be maintained, including: ·         Wastewater treatment services – Peacehaven, Eastbourne, Hailsham. ·         Water supply - Arlington Reservoir outside of Berwick. Bewl Water is on the border with Kent and supplies Kent; similarly, Weir Wood is on border with West Sussex, supplying West Sussex. ·         Power generation - Rampion. ·         Waste Disposal - Newhaven Energy Recovery Facility / incinerator.  ·         Shipping and goods – Newhaven Port. ·         Telephone exchanges (63 across County but not all staffed)

What’s already in place:   The key principles for workplaces are ensuring they take a preventative approach to keep their environment COVID-secure and to support them to undertake risk assessments. A number of agencies are involved locally in supporting businesses both proactively and reactively including Environmental Health, Trading Standards, and the Health and Safety Executive. Sector specific guidance for working safely during coronavirus is available on the www.gov.uk website, along with the 5 steps for working safely that all employers should take.   All businesses in England were able to sign up to the government’s free COVID-19 workplace testing programme until April 2021. Registered businesses can continue to order free rapid lateral flow tests until 30 June 2021.   Register to order free rapid lateral flow coronavirus tests for your employees - GOV.UK (www.gov.uk)   The NHS Test and Trace service does not change the current existing guidance that individuals should be working from home wherever possible. Workplaces where social distancing can be properly followed are deemed to be low risk. Sector specific Government guidance gives details of reducing the risk when full social distancing is not possible.   The NHS Test and Trace service supplements the risk mitigation measures taken by employers by identifying people who have had close recent contact with someone who has tested positive for COVID-19 and advising them to self-isolate, where necessary. Employers should ensure employees with COVID 19 symptoms self-isolate and seek testing as soon as possible. Employers should support workers who need to self-isolate and must not ask them to attend the workplace. Workers will be told to isolate because they: ·         have COVID-19 symptoms and are awaiting a test result ·         have tested positive for COVID-19 ·         are a member of the same household as someone who has symptoms or has tested positive for COVID-19 ·         have been in close recent contact with someone who has tested positive and received a notification to self-isolate from NHS Test and Trace. It is a legal requirement for employers to not knowingly allow an employee who has been told to self-isolate to come into work or work anywhere other than their own home for the duration of their self-isolation period. Failure to do so could result in a fine starting from £1,000. Employers (and the self-employed) must continue to ensure the health, safety and welfare of their employees. They also have similar obligations in respect of other people, for example agency workers, contractors, volunteers, customers, suppliers and other visitors. Venues in hospitality, the tourism and leisure industry, close contact services, community centres and village halls must: ·         ask at least one member of every party of customers or visitors (up to 6 people) to provide their name and contact details ·         keep a record of all staff working on their premises and shift times on a given day and their contact details ·         keep these records of customers, visitors and staff for 21 days and provide data to NHS Test and Trace if requested ·         display an official NHS QR code poster so that customers and visitors can ‘check in’ using this option as an alternative to providing their contact details adhere to General Data Protection Regulations (GDPR) If there is more than one case of COVID-19 in the workplace, employers should contact the local health protection team to report the suspected outbreak. The heath protection team will: ·         undertake a risk assessment ·         provide public health advice ·         where necessary, establish a multi-agency incident management team to manage the outbreak   Early outbreak management action cards provide instructions to anyone responsible for a business or organisation on what to do in the event of one or more confirmed cases of coronavirus in their organisation.   Districts and Boroughs are working with HSE on the spot checks programme.   Information on how the public can access the vaccine as per national prioritisation guidelines is shared through general and specific communications to business and local residents.

What else will need to be put in place:   Consider further ongoing proactive communication with higher risk workplaces/industries   Any learning identified by partners including Environmental Health, Trading Standards PHE, the police is shared on a weekly basis at the multi-agency Operational Cell. A plan is then developed for how this learning will be acted upon.

Local outbreak scenarios and triggers:   Where there appear to be multiples cases linked to a workplace these are flagged up to Environmental Health teams who investigate.   If there is a substantial outbreak in a workplace, PHE will consider the severity and spread of the outbreak, current control measures, the wider context and will jointly consider with the local authority the need for an Outbreak Control Team (OCT). This will usually be chaired by PHE but if there is limited capacity this may be chaired by the Local Authority Public Health team. Current PHE guidelines as of 11/2/2021 are that PHE will follow up outbreaks with 10 or more cases, where 10% of a workforce are affected, if anyone has been hospitalised, if the setting is national infrastructure, there is media interest or if there are concerns about the management of an outbreak.   In addition to the core OCT membership, attendance would also potentially include a representative from the specific setting in question and their associated HR / occupational health.

Resource capabilities and capacity implications: Staffing ·         to develop communications plan and SOPs, ·         to visit/contact non-compliant workplaces as part of prevention work ·         to visit/contact workplaces with outbreaks to advise/enforce on control measures.

Links to additional information: More detail is at: NHS test and trace: workplace guidance and Working Safely during Coronavirus guidance Further work and financial support information can be found here COVID-19 early outbreak management: Action cards How to find your local health protection team: Health Protection Team Sussex COVID-19 Toolkit: considerations for restarting your business safely Eastbourne Hospitality Association: Covid Ready scheme

 

 

11.6. Faith Settings

 

Objective:   The objective is to prevent COVID-19 cases occurring in the first place, to closely monitor any cases of COVID-19 linked to faith settings and ensure that any outbreaks are managed quickly and efficiently.

Context:   There are approximately 250 places of worship in East Sussex

What’s already in place:   Environmental Health will ensure that faith settings follow the relevant national guidance on whether they should open, and their associated measures required to be Covid safe. This will include advice on social distancing measures, hand and respiratory hygiene, cleaning, and ensuring those with symptoms self-isolate for 10 days and get tested for COVID-19.

What else will need to be put in place:   Any learning identified by partners including Environmental Health, Trading Standards PHE, the police is shared on a weekly basis at the multi-agency Operational Cell. A plan is then developed for how this learning will be acted upon.

Local outbreak scenarios and triggers:   If multiple cases of COVID-19 (suspected or confirmed) occur in a faith setting, PHE will consider the severity and spread of the outbreak, current control measures, the wider context and will jointly consider with the local authority the need for an Outbreak Control Team (OCT). This will usually be chaired by PHE but if there is limited capacity this may be chaired by the Local Authority Public Health team. In addition to the core OCT membership, additional members will potentially include a representative from the overall organisation, as well as a representative from the specific setting(s)

Resource capabilities and capacity implications:   Staffing ·         to visit/contact non-compliant faith settings as part of prevention work ·         to visit/contact faith settings with outbreaks to advise/enforce on control measures

Links to additional information:   COVID-19: guidance for the safe use of places of worship during the pandemic

 

 

11.7. Tourist attractions, Events, Travel and Accommodation

 

Objective:   The objective is to closely monitor any cases of COVID-19 linked to tourism, local events and tourist attractions, ensuring that all are COVID-secure and that any outbreaks are managed quickly and efficiently.

Context:   East Sussex is a significant tourist destination and there are a substantial number of particularly small to medium sized tourist attractions. In additional there are a range of small and larger scale events, for example, pop up mini markets, festivals and marathons. There are also a range of different accommodation businesses, including traditional hotels and bed and breakfast establishments, and camping and caravan sites.

What’s already in place:   Specific guidance for tourist attractions include: ·         Visit Britain: https://www.visitbritain.org/covid-19-new-coronavirus-latest-information-and-advice-businesses-1 ·         Heritage Locations: https://www.gov.uk/guidance/working-safely-during-coronavirus-covid-19/heritage-locations ·         The visitor economy - Working safely during coronavirus (COVID-19) - Guidance - GOV.UK (www.gov.uk)   The Health Protection (Coronavirus, Restrictions) (England) (No. 3) Regulations 2020 (“the Regulations”) make provision for a local authority (County Councils and London Borough Councils) to give Directions relating to premises, events and public outdoor places in its area. The Regulations include powers for the County Council to make a Direction to: ·         restrict access to, or close, individual premises (which could include a pub, restaurant, shop, factory etc.)                       ·         prohibit a specified event or events of a specified description from taking place (events could include garden shows, festivals, marathons, hospitality attractions, fairgrounds etc.) ·         restrict access to, or close, a specific public outdoor place in its’ area or public outdoor places in its’ area of a specified description (which could include parks, public toilets, stadiums etc.)   The Sussex wide Local Authority Resilience Partnership and East Sussex sub-group works to share learning and guidance applicable to businesses, events and tourist attractions.   Communications have been put in place on shopping electronic billboards and Highway variable signs have been in place at key locations (e.g. beach fronts and shopping venues) to continue remind people of the importance of social distancing etc. Local data is used to determine where and when communications are located.

 

What else will need to be put in place:   Continue to develop learning and understanding of methods of transmission and likely compliance with COVID secure measures. This will help inform any potential restrictions that are imposed to ensure they are robust but not excessive to requirements.   Any learning identified by partners including Environmental Health, Trading Standards PHE, the police is shared on a weekly basis at the multi-agency Operational Cell. A plan is then developed for how this learning will be acted upon. Issues arising from the Local Authority Resilience Partnership (LARP)  are raised at the Operational Cell each week together with lessons learned and case studies presented by partners.   Weddings and funerals numbers are now governed by venue capacity rather than a specific maximum set by Government. Organisers are required to produce a risk assessment but it is not clear who is required to monitor this risk assessment or who would issue a fine following any breach of that risk assessment.

Local outbreak scenarios and triggers:   If multiple cases of COVID-19 (suspected or confirmed) occur, PHE will consider the severity and spread of the outbreak, current control measures, the wider context and will jointly consider with the local authority the need for an Outbreak Control Team (OCT). This will usually be chaired by PHE but if there is limited capacity this may be chaired by the Local Authority Public Health team.   Environmental Health have established relationships with event organisers, tourist attractions and travel accommodation businesses and will be able to bring additional detailed knowledge of the specific setting. The OCT in addition to the core membership would also include a representative from the specific setting.

Resource capabilities and capacity implications: Staffing ·         to ensure continued communications through existing groups ·         contact non-compliant tourist / accommodation settings as part of prevention work ·         to visit/contact tourist / accommodation settings and event organisers where an outbreak has been identified to advise/enforce on control measures

Links to additional information: https://www.gov.uk/guidance/covid-19-advice-for-accommodation-providers https://www.gov.uk/coronavirus/business-support https://www.hse.gov.uk/simple-health-safety/risk/index.htm https://www.gov.uk/guidance/working-safely-during-coronavirus-covid-19 https://www.gov.uk/guidance/working-safely-during-coronavirus-covid-19/the-visitor-economy

 

11.8. Ethnic Minorities Communities

 

Objective:   The objective is to ensure approaches to reduce and eliminate new cases of COVID-19 across the county reach all ethnic minorities workforce, population groups and communities, and to ensure that inequalities in COVID outcomes are reduced.

Context:   The ONS national population survey 2019 showed that approximately 2% of the overall East Sussex population over 18 described themselves as Asian, 1% as Black, and 1% as Mixed. Within East Sussex, around 6% of the population of Hastings and Eastbourne are ethnic minorities, compared to 3% elsewhere in East Sussex.   A third of the NHS community and secondary care workforce are from ethnic minority communities, with almost 50% of the medical and dental staff from ethnic minorities groups. Most recent staff survey 4.7% of ESCC staff recorded themselves as ethnic minority background (with 7.5% not answering).

What’s already in place:   As part of the regional NHS-E/I response to the high number of deaths amongst ethnic minorities groups, local partners are participating in two workstreams: ·         reducing COVID-19 illness and mortality amongst ethnic minorities health and care workers, building on the Workforce Race Equality programme already under way ·          reducing illness and mortality in the general population, led by the Sussex ICS Equality and Diversity Clinical Lead   The Sussex Health and Care Partnership COVID-19 disparity programme is addressing the disproportionate impact of COVID-19 on people from ethnic minorities backgrounds.  The programme has two work streams:   Workforce programme – focused on ethnic minority health and care staff across Sussex and working with the Director of Workforce and OD  NHS England and NHS Improvement South East, to ensure risk assessment templates are updated in the light of emerging evidence e.g. about pregnancy risks in ethnic minority women.   Population programme -  Covid at risk groups Locally Commissioned Service (LCS) – a two part voluntary LCS delivered through GP surgeries which has had 98% uptake from GP practices across Sussex, and ethnic minorities residents who are registered with a non-participating practice, are covered by neighbouring practices.  The Sussex LCS was recognised by NHSE in their WRES programme board papers as an exemplar case study.       Part A – Proactive and protective ethnic minorities specific activities   ·         Identify ethnic minorities patients from practice list who might benefit from specific interventions to reduce their risk of COVID-19 related mortality and offer check with health professional. ·         Improve communication and engagement with local ethnic minorities communities, working with  ethnic minorities communities and voluntary sector and improving diversity of PPGs in recognition of the diverse range of people covered by the term ethnic minorities. ·         Improve communication directly to patients via text messaging cascade   Part B – Reactive care to vulnerable individuals  ·         Offer a supportive monitoring protocol for patients in vulnerable groups who develop COVID-19.   The programme includes community research and engagement and looking for alternative appropriate methods to ensure information reaches these communities. ESCC have developed a ‘COVID-19 model risk assessment’ which can be used to support employees in the workplace and includes all ethnic minorities backgrounds as well as age and gender.   Testing data The national testing website records ethnic group as part of the process for registering for a test, and this data is now shared with public health intelligence teams. Overall since March 23% of tests for East Sussex residents do not include ethnicity data. Completeness of recording has fluctuated over time.  8% of tests in East Sussex were for people of ethnic minorities backgrounds which is higher than the 4% of the population recorded as from ethnic minorities backgrounds.   Information on how to access the vaccine as per national prioritisation guidelines is shared through general and specific communications.

What else will need to be put in place:   PH are working with colleagues across the East Sussex system to better understand the impact of COVID on our ethnic minorities populations which will further inform action plans.  It will be important as a vaccine for COVID is developed to understand factors which influence vaccine uptake in different groups.   Any learning identified by partners including Environmental Health, Trading Standards PHE, CCG, the police is shared on a weekly basis at the multi-agency Operational Cell. A plan is then developed for how this learning will be acted upon.

Resource capabilities and capacity implications: Staffing Develop communications and work with the local ethnic minorities populations and communities through ESCC COVID disparities plan and the Covid at risk groups LCS Steering group. Work with CCG and GP Practices to establish text message targeted alert system.

Links to additional information: PHE report https://www.gov.uk/government/publications/covid-19-review-of-disparities-in-risks-and-outcomes

11.9. Gypsy, Roma and Travellers (GRT) and Van Dwellers

 

Objective:   The objective is to prevent COVID-19 cases occurring in the first place, and to identify new cases and prevent onward transmission and deaths from COVID-19 in the GRT community in East Sussex.

Context:  East Sussex County Council work in partnership with District & Borough housing teams to provide GRT sites in East Sussex.  Any issues with van dwellers are not a GRT issue and are therefore dealt with by District & Borough Councils.

What’s already in place:   The East Sussex County Council Traveller Liaison Teamwork in partnership with local District & Borough Councils and have been in regular contact with GRT and Van Dwellers across East Sussex. Any emerging needs are signposted to the appropriate District or Borough Council, health provider or Social Services.  Where GRT encampments are on East Sussex land, these are dealt with on a case by case basis taking into account community impact, anti-behaviour and Traveller needs.    During Covid-19 a risk assessment process for new admissions to our sites has been developed by the Traveller Liaison Team.   Information on how to access the vaccine as per national prioritisation guidelines is shared through general and specific communications.

What else will need to be put in place: All staff from the Gypsy and Traveller Team have access to face coverings, Disposable gloves, alcohol gel sanitiser and wipes. There is also a supply kept in the Transit Site office should they be required.   Any learning identified by partners including Environmental Health, Trading Standards PHE, the police is shared on a bi-weekly basis at the multi-agency Operational Cell. A plan is then developed for how this learning will be acted upon.

Local outbreak scenarios and triggers:   If there is one or more suspected or confirmed COVID-19 case within a GRT or Van dweller community the PHE Health Protection Team are contacted.   If multiple cases of COVID-19 (suspected or confirmed) occur in a GRT or Van dweller community, PHE will consider the severity and spread of the outbreak, current control measures, the wider context and will jointly consider with the local authority the need for an IMT (Incident Management Team). This will usually be chaired by PHE but if there is limited capacity this may be chaired by the Local Authority Public Health team. Additional membership over and above the core group would potentially include the relevant housing team within the District or Borough, the ESCC GRT lead.   If a local outbreak were to occur any encampment would continue to be assessed with recognition of the community impact and current welfare needs within the group. ESCC will continue to work with the relevant District and Borough’s alongside Sussex Police to manage encampments in East Sussex.   Additional issues to be considered include costs arising from risk assessment process and from purchasing additional PPE

Resource capabilities and capacity implications:   The ESCC transit site is able to operate at full capacity with social distancing measures in place to keep residents safe.  This is possible due to each resident having access to their own shower and toilet. ESCC will coordinate with Brighton and Hove County Council and West Sussex County Council in order to provide available transit availability across Sussex. Transit availability across Sussex stands at 41 pitches, but all of these pitches will not be able to be utilised. In Brighton and Hove residents use a shared facility, so this limits the capacity of the site. This could in turn put an additional strain on our transit site for families that are unable to access Brighton.

 

 

 

 

 

 

11.10. Homeless community

 

Objective:   The objective is to prevent COVID-19 cases within the homeless community, to closely monitor any new cases of COVID-19 and ensure that any outbreaks are managed quickly and efficiently.

Context: Due to the COVID-19 Pandemic, MHCLG asked local authorities to provide self-isolating accommodation for the homeless population. In East Sussex since the 23rd March 2020 there have been around 800 placements made by East Sussex for homeless people who have been housed in emergency accommodation, with most sites hosting several people. Of these, around130 had been rough sleepers.   There is a high burden of disease amongst the homeless population, which predisposes them to a higher risk of severe illness from COVID-19, and there exists a risk of outbreaks amongst those who share a living space such as hotels and Bed and Breakfasts. Other specific issues faced by this population include high levels of substance misuse, mental health issues and higher levels of resistance to engage with services.   Winter night shelters were not able to operate in the way that they usually would do and so an alternative provision was been put in place.  These are additional accommodation sites housing between 6-8 people who are able to access their rooms on a 24/7 basis.  There is Multi-Disciplinary Team input during the day, volunteer support during the evening and there is also night time security in place.

What’s already in place:   PHE locally have an outbreak management plan for use in sites of multiple occupancy such as hotels and Bed and Breakfasts, which includes a screening and monitoring proforma used by housing managers across East Sussex to support in identifying and escalating any new suspected cases of COVID-19. All former rough sleepers placed in temporary accommodation across East Sussex have been triaged by the Rough Sleeper Initiative. Details have been shared with commissioned GP federations. PHE will arrange testing of symptomatic individuals in hostels when first notified of a case and will risk assess and consider testing additional cases on a case-by-case basis.   All temporary accommodation units have been given training materials on COVID-19 and daily verbal checks that they undertake. In addition, the local authorities have dedicated teams of support workers (RSI Housing First, Rapid Rehousing Officers, Home Works) who undertake regular wellbeing checks. Informal contact and support is also happening through organisations such as Warming up the Homeless.   There is an East Sussex Homelessness cell with an associated action plan, and East Sussex CCG has commissioned a Care and Protect service for all rough sleepers being accommodated in response to COVID-19 which commenced on the 9th June.   Latest PHE guidance states that where possible people living in hostels/ hotels who have symptoms or test positive should have access to self-contained accommodation.  Where this is not possible they can be cohorted though avoiding any individuals who met the criteria for shielding.   The winter night shelter alternative provision has been put in place. This consists of a unit of accommodation in Eastbourne and one in Hastings. This is available to provide placements for those people who are still sleeping rough (i.e. they did not take up the offer of accommodation under ‘everybody in’/ or their accommodation placement was not successful. Night security is provided as well as MDT support during the day and evening. Those placed are able to access the accommodation through the day as well as over-night.  It is intended that these services will completely replace ‘winter night shelter provision’ enabling entrenched rough sleepers to be safely accommodated over the cold winter months, in a Covid-secure way, with MDT input provided to them.  Currently the accommodation and support will be in place until April 2021.   A pan Sussex plan to increase vaccine uptake by this population is underway in line with the announcement on the 11th March which enabled access alongside those with LTCs.

What else will need to be put in place:   As we start to prepare for recovery and transition those in emergency accommodation into longer term housing, there is a need for testing to be extended to those who are asymptomatic and those who are ineligible for home testing due to required ID checks.   We are currently working to ensure access to test kits for the Rough Sleeper Initiative nurses to use with clients.  The district and borough councils working with ESCC and the CCG successfully received a further budget via a bid for national funding to support ‘move on’ accommodation.  This consists both of revenue funding and also capital funding.  In relation to capital funding some of this is being used to acquire new properties for the councils to use as ‘supported move on accommodation’.  This will help to free up temporary and emergency accommodation for use with new clients coming forward as homeless.  East Sussex have also been successful in securing 30 new Housing First accommodation units across the county.  This is where wrap around support is provided to tenants, who are able to stay long term in their housing (or until they no longer need the support and are ready for ‘move on’).

Local outbreak scenarios and triggers:   In the event of an outbreak, PHE will consider the severity and spread of the outbreak, current control measures, the wider context and will jointly consider with the local authority the need for an Outbreak Control Team (OCT). This will usually be chaired by PHE but if there is limited capacity this may be chaired by the Local Authority Public Health team. If an OCT is required, additional members required to support this OCT over and above the core group would potentially include the Rough Sleeping Initiative Coordinator, the CCG homeless lead, the Consultant in Public Health with lead for homelessness, and any organisation that has a relationship with the community affected.   An OCT may be required for current emergency accommodation sites due to: ·         The clinical vulnerability of the homeless population ·         Borough and district housing managers recognised the need for ‘former rough sleepers’ to be provided with mobiles during Covid-19 lockdown. There may be the need to look at mobile provision amongst wider homeless placements in order to ensure the Test and Trace App alert service can be fully delivered. ·         Resistance to engage with services by some of the homeless population

Resource capabilities and capacity implications: To ensure that there is a thorough system of contact tracing for positive patients, there needs to be a strong system of identifying those who are symptomatic in the first place – this is not possible with the current staff capacity.

Links to additional information: Letter from Minister Luke Hall to local authorities asking to ‘bring everyone in’   MHCLG/ PHE Guidance for homeless people in shared accommodation and hotels/ hostels 7 August 2020 – https://www.gov.uk/government/publications/covid-19-guidance-on-services-for-people-experiencing-rough-sleeping?utm_source=5a049bbf-de8b-4995-929c-63b6826a838e&utm_medium=email&utm_campaign=govuk-notifications&utm_content=daily

 

 

 

11.11. Acute

 

Objective:   The objective is to prevent COVID-19 cases, to closely monitor any new cases of COVID-19 linked to exposure within acute hospitals, and to ensure that any outbreaks are managed quickly and efficiently to minimise spread of infection.

Context:   There is one combined acute and community hospital trust in East Sussex with two main acute hospital sites ·         East Sussex Healthcare NHS Trust (ESHT) Eastbourne District General Hospital, Eastbourne The Conquest Hospital Hastings   ESHT also runs Hospital sites at Bexhill & Rye and runs a number of other smaller community sites as well as the provision of community health services in clinics and people’s homes across East Sussex.   ESHT provides healthcare for the majority of the East Sussex population, however, a proportion of the population living in the west and the north of the county attend hospitals out of county, in Brighton or Kent.  In addition, there are five community hospitals run by Sussex Community Foundation Trust, who provide community health care in the west of the county, Brighton and West Sussex.

What’s already in place:   ESHT has a COVID-19 Response plan and processes in place to undertake outbreak management, including Outbreak control teams which are led by the Trust, with support from PHE. The COVID pandemic response is managed following incident management procedures as per Emergency Preparedness, Resilience and Response. ·         ESHT continues to use its Trust policies, procedures and guidelines for all infection control outbreaks. ·         ESHT tests patients for COVID on admission and at regular intervals during their stay. Most COVID testing is undertaken in a new resource in the pathology department at EDGH. Rapid testing is also available to aid patient pathways. ·         Patient management is approved via the Incident management Team following consultation with Clinical Advisory Group. Clinical decisions regarding COVID pathways are undertaken in consultation with  the Infection Prevention and Control Team (IPCT). ·         Contact tracing of ESHT patients is undertaken by the IPCT ·         Contact tracing and support of staff with COVID is undertaken by the Occupational Health team. ·         ESHT aims to comply with all national guidance for the management of COVID-19 and undertakes self-assessment of compliance via the NHSEI recommended Board Assurance Framework. ·         The Trust has its own internal processes in response to all PHE Guidelines and its COVID-19 response methodology is cascaded via Trust wide communications ·         The Trust is undertaking antigen and antibody testing. Staff undertake twice weekly COVID screening at home using “lateralflow” and if positive have a confirmatory PCR test. – ·         ESHT currently has a good PPE supply chain and has purchased additional powered respiratory hoods for staff required to spend long periods of time in FFP3 protection. ·         Staff absence, COVID infection and exposure is reported daily via the IMTMass vaccination service has been established since 22nd December following receipt of the Pfizer vaccine. ESHT is vaccinating health and social care staff working in the NHS and private care facilities at venues on the Conquest and EDGH sites.

What else will need to be put in place:   To support the effective management of COVID-19 outbreaks there will be some changes to existing reporting processes and development of standard ways of responding to these outbreaks, using high level flowcharts which can be adapted for local use.   Ability to escalate vaccination service is constantly under review.   Further collaboration with private care providers is required to ensure that COVID recovered patients can be discharged when medically ready as per PHE stepdown and discharge guidance.   These procedures will be developed further as needed between Local Authority, PHE and ESHT infection prevention team.  ESCC PH, PHE and CCG representatives are invited to the monthly Trust Infection Prevention and Control Group meeting which reviews the Trusts’ annual programme of infection prevention work,  Regulation 12, and Health Care Associated Infections (HCAI).  HCAI reports now include COVID-19 outbreaks and Infection Control self-assessment assurance. They also receive the minutes of these meetings.

Local outbreak scenarios and triggers: If multiple cases of COVID-19 (suspected or confirmed) are linked to exposure within the hospital, the Trust will consider the severity and spread of the outbreak, current control measures, the wider context and will routinely convene an ICT if they suspect an outbreak within their hospital. PHE, the CCG and the Local Authority Public Health team are included as required. Outbreaks are reported on a daily basis via the Southeast Provider outbreak reporting tool and the PHE electronic outbreak portal.

Resource capabilities and capacity implications: TBC – none raised to date.

Links to additional information: The ESHT website provides information for patients and visitors on the main measures implemented to reduce the spread of COVID-19.  ESHT staff can access full policies on intranet.   Kent Surrey Sussex outbreak incident control plan: https://www.eastsussex.gov.uk/community/emergencyplanningandcommunitysafety/coronavirus/outbreak-control-plan/

11.12. Primary Care

 

Including: ·         General Practices and Walk–in Centres ·         Community Pharmacy ·         Dentists ·         Optometry

Objective: The objective is to prevent COVID-19 cases, to closely monitor any cases of COVID-19 linked to exposure within Primary Care settings, ensuring that any outbreaks are managed quickly and efficiently.

Context:   In East Sussex there are: ·         63 General Practices ·         104 Community Pharmacies ·         150 Dentists ·         54 Opticians

What’s already in place:   In the event of a COVID-19 outbreak, NHS organisations should continue to follow existing Public Health England guidance on defining and managing communicable disease outbreaks.   General Practices and Walk-in Centres - As part of the COVID-19 response, Primary Care have put in place measures to manage any outbreaks of COVID-19.  In line with the 31 July 2020 letter from NHS England about the third phase of NHS response to COVID-19 Practices are changing how they deliver their services by ensuring face to face appointments for patients who need them, whilst continuing to utilise other methods of supporting the population such as online and video consultations.  This is part of a CCG programme to restore services and activity to usual levels where clinically appropriate.    All practices have access to national PPE portal from which they can access the necessary equipment. Appropriate level cleaning services are in place and deep cleaning takes place at these sites if any site appears to have an issue with an outbreak. If there are outbreaks, then staff and patients who have been in contact in the surgery can be traced and tested and staff self-isolate if appropriate.   At the beginning of the pandemic practices were provided with additional IMT equipment to undertake remote working and given the functionality to log into clinical systems from home. They have instigated a website across all practices (and undertaking training on the website). Footfall which allows patients to remote access into the practice by use of the website and ask questions and apply for prescriptions etc via the website. [is this just prescribing?  Not sure to what we’re referring here]   Practices have been supported in applying through the COVID-19 fund for cleaning, equipment, and alterations to their buildings to support and mitigate against any potential outbreaks.   Each practice has been encouraged to undertake a risk assessment for their at risk and ethnic minorities staff. Additional Locally Commissioned Services enable practices to offer additional support to Care Homes, shielded, and ethnic minorities patients during the first wave of the pandemic.   Community Pharmacy - commissioned service for delivery of medicines in place and funded until end of July to support shielded patients, and access to volunteer hubs to support delivery of medicines.   Information on how primary care staff can access the vaccine as per national prioritisation guidelines is shared through general and specific communications.

What else will need to be put in place:   General Practice and Walk in Centres - To develop clear local pathways for local outbreak management   Practices to notify PCN delivery manager, IPC Team and Primary care inbox when aware of COVID positive cases in their practice (to support the effective management of COVID-19 outbreaks there will be some changes to existing reporting processes and development of standard ways of responding to these outbreaks, using high level flowcharts which can be adapted for local use). There will also be reporting on staff absence due to NHS Test and Trace and the impact on the service.   General Practices and Walk-in Centres ·         Antibody testing for staff and patients [see above – national PPE portal is in place] ·         Further work being undertaken on supporting ethnic minorities communities   Community Pharmacy ·         Access to medicines & pharmacy services - all pharmacies to remain open during any local restrictions to provide access to medicines ·         Access to local volunteer hubs for pharmacies in the event of a local restrictions for support to in collection / pick-up of medicines for those that are shielded and others ·         Funding to support a locally commissioned service for delivery of medicines (in the event of the national pandemic pharmacy delivery service having ended) ·         Consider prioritisation of pharmacy staff within key services e.g. school places, access to other essential services

Local outbreak scenarios and triggers:   If multiple cases of COVID-19 (suspected or confirmed) are linked to exposure within a Primary Care setting, PHE will consider the severity and spread of the outbreak, current control measures, the wider context and will jointly consider with the NHS and Local Authority the need for an Outbreak Control Team (OCT).

Resource capabilities and capacity implications:   General Practices and Walk-in Centres – General Practices and Walk-in Centres Practice are in receipt of resource funding from the CCG who are liaising with NHSE for reimbursement Community Pharmacy ·         To co-ordinate with commissioner (NHSE&I) through national contractual arrangements to understand local impact and scope and ability to stand up previous flexibilities ·         Impact of local measures of other providers on pharmacies to be assessed, mitigated or funded e.g. displaced patients from local hospitals, GP surgeries and others

Links to additional information:

 

 

11.13. Mental Health and Community Trusts

 

Objective:   The objective is to prevent COVID-19, to closely monitor any cases of COVID-19 linked to exposure within Mental Health and Community Trusts, ensuring that any outbreaks are managed quickly and efficiently

Context: There is one Mental Health Trust operating in East Sussex ·         Sussex Partnership Foundation Trust (SPFT) with sites, including clinics, day centres and supported accommodation for people with mental illness and /or learning disabilities at a number of  locations across East Sussex https://www.sussexpartnership.nhs.uk/east-sussex including : o   Supported accommodation: Acorn House, Eastbourne, BN21 2NW; Mayfield Court, Eastbourne, BN21 2BZ o   In Health Centres: Battle, TN33 0DF; Bexhill, TN40 2DZ; Peacehaven, BN10 8NF o   Wellbeing Centres: Lewes, BN7 1RL; Bexhill, TN39 3LB; Eastbourne,BN21 1DG o   Assessment and Treatment Centres: Avenida Lodge, Eastbourne, BN21 3UY; Horder Healthcare, Seaford, BN25 1SS; Hillrise, Newhaven BN9 9HH. o   On Hospital sites: Crowborough Hospital, TN6 1NY; Orchard House, Victoria Hospital Site, Lewes, BN7 1PF; Uckfield Community Hospital, Uckfield, TN22 5AW (Millwood Unit, Beechwood Unit); Conquest Hospital, TN37 7PT (Woodlands) o   Amberstone, Hailsham, BN27 4HU o   Bellbrook Centre, Uckfield, TN22 1QL o   Braybrooke House, Hastings, TN24 1LY o   Highmore, Hailsham, BN27 3DY o   Cavendish House, Hastings, TN34 3AA o   St Anne’s Centre, St Leonards-on-Sea, TN37 7PT o   St Mary’s House, Eastbourne, BN21 3UU o   Hellingly, BN27 4ER (The Firs, Southview Low Secure Unit, Woodside),   There is one Community Trust operating in the west of East Sussex (In the old HWLH CCG area) in addition to the combined acute and community trust. ·         Sussex Community Foundation Trust (SCFT)

What’s already in place: In the event of a COVID-19 outbreak, NHS organisations should continue to follow existing Public Health England guidance on defining and managing communicable disease outbreaks.   Sussex Partnership NHS Foundation Trust - has a COVID-19 control command structure which includes operational, tactical and strategic command and control. The structures include internal and external escalation/reporting requirements to ensure early notification of outbreak/concerns. IPC governance is central to this which is underpinned by Public Health England guidance and the NHS IPC Assurance Framework supported by a specialist IPC team.

 

What else will need to be put in place:   To support the effective management of COVID-19 outbreaks existing reporting processes and standard ways of responding to these outbreaks will be utilised using agreed mechanisms including out of hours. Reporting on staff absence due to NHS Test and Trace and the impact on the service is also in place.

Local outbreak scenarios and triggers: If multiple cases of COVID-19 (suspected or confirmed) are linked to exposure within a Mental Health or Community Trust, PHE will consider the severity and spread of the outbreak, current control measures, the wider context and will jointly consider with the NHS and local authority the need for an Outbreak Control Team (OCT).

Resource capabilities and capacity implications: None identified

Links to additional information: Sussex Partnership Foundation Trust - website for COVID-19 advice for patients, family and staff.  Detailed advice for staff including procedures is on intranet - Coronavirus - what you need to know

 

11.14. Transport locations

 

Objective:   The objective is to prevent COVID-19 in the transport network, to closely monitor any cases of COVID-19 amongst those arriving in, or travelling through, East Sussex, and to ensure that any outbreaks linked to transport settings are managed quickly and efficiently.

Context:   Newhaven is the main port of entry for East Sussex, but the ports at Dover, and Gatwick Airport are key nearby ports of entry with many travellers likely to pass through or reside within East Sussex.   Within East Sussex there are 45 train stations providing key transport links for travelling in and around East Sussex as well as direct rail links to Brighton, London and the surrounding area.   The highest public transport use in East Sussex is on local bus routes, with a network of over a 100 bus services serving nearly all communities. Bus services also link to destinations outside the county including Brighton, Burgess Hill, Haywards Heath, East Grinstead, Tunbridge Wells, Ashford, Folkestone and Dover.   In addition, there are also over 100 bus services for the specific use of school/college students to enable attendance at their educational establishment. This number excludes home to school taxis and minibuses.

What’s already in place:   PHE Health Protection Teams have local arrangements with Port Health Authorities for both Heathrow and Gatwick Airports to manage symptomatic cases of infectious diseases arriving at these Ports of Entry. From 8 June, new rules are in place for those travelling to the UK (residents and visitors) which requires them to complete a Contact Locator Form (they will receive a receipt to prove completion of the form to UK Border Force) and where a Covid-19 travel corridor is not in place to self-isolate for the first 14 days. PHE will have access to these forms (held by the Home Office) for rapid contact tracing purposes. PHE will contact a random 20% of airline passengers to monitor compliance with self-isolation rules ­and will inform the Police of those that fail to comply.   From 3 July, travel corridors with various countries were established whereby anyone arriving from these countries did not need to self-isolate for 14 days on entering the UK.  The list of countries where these travel corridors are in place is updated periodically by Government to take account of the local Covid-19 circumstances.   To help control the virus where travel is still necessary, passengers are now required to wear a face covering (with some age, health and equality exemptions) when:   ·         on board a vessel (ferry) which has departed from, or is to dock in England; in the airport building and throughout their flight to and from their destination.   Environmental Health have arrangements in place with Newhaven for managing infectious diseases, including COVID-19.   Public transport networks including bus and rail are following guidance on social distancing, cleaning and wider infection prevention control.  Similar guidance, specific to students attending educational establishments who use public transport and dedicated school transport, is also being followed.    Rail passengers are now required to wear a face covering whilst within rail stations, including on platforms, in food and retail units within larger stations except when sitting down to consume food/drink (as of 24 September) and on trains.  Likewise, bus passengers are now required to wear face coverings on buses and contained transport hubs.   Information on how to access the vaccine as per national prioritisation guidelines is shared through general and specific communications.

What else will need to be put in place: Any learning related to transport will be raised and acted upon from the multi-agency Operational Cell.

Local outbreak scenarios and triggers:   For UK residents, self-isolating in normal place of residence is unlikely to result in outbreaks. For visitors, self-isolation in commercial accommodation such as hotels etc has the potential to result in outbreaks in commercial premises.   If there is evidence of a potential outbreak linked to a transport location, PHE will consider the severity and spread of the outbreak, current control measures, the wider context and will jointly consider with the local authority the need for an Outbreak Control Team (OCT). This will usually be chaired by PHE but if there is limited capacity this may be chaired by the Local Authority Public Health team. If an OCT is required then attendance in addition to the core membership would also potentially include representatives from the transport company including any managers of specific sites.

Resource capabilities and capacity implications: Provision of support for visitors needing access to food and medical supplies.

Links to additional information: Guidance: entering the UK and using transport or working in the transport industry, passengers on public transport in the UK, Covid-19 travel corridors, Guidance for transport operators: https://www.gov.uk/government/publications/coronavirus-covid-19-safer-transport-guidance-for-operators Guidance for transport to school Autumn Term 2020: https://www.gov.uk/government/publications/transport-to-school-and-other-places-of-education-autumn-term-2020/transport-to-school-and-other-places-of-education-autumn-term-2020

 

 

 

 

 

12. Appendices

 

12.1. Appendix A: Outbreak Control Team standard documents

 

12.2. Appendix B: Data integration tasks

 

12.3.Appendix C: Standards for managing an outbreak

 

12.4. Appendix D

 

12.5. Appendix E: East Sussex Vaccination Plan

 

 

 

 

Appendix A

Outbreak Control Team standard documents

 

 

South East OCT/IMT Terms of Reference

 

 

The terms of reference should be agreed upon at the first meeting and recorded accordingly.

 

Suggested terms of reference:

 

1.    Verify an outbreak/incident is occurring

2.    To review the data/evidence for contact tracing and COVID secure measures (setting/community)

3.    To regularly conduct a full risk assessment whilst the outbreak is ongoing, including determining PHE outbreak/incident level (i.e. local, regional,  national)

4.    To develop a strategy to deal with the outbreak/incident and allocate responsibilities to members of the OCT/IMT based on the risk assessment

5.    To agree appropriate further investigations for contact tracing, and COVID secure measures (setting/community)

6.    To agree and initiate further testing (e.g. MTU deployment)

7.    To ensure that appropriate control measures are implemented to prevent further primary and secondary cases

8.    To review and understand the impacts across the city’s different populations and use this to inform response

9.    To communicate as required with other health professionals, partner organisations, setting and staff (if applicable), media, public, and local politicians; providing an accurate, timely and informative source of information in appropriate accessible formats / languages 

10. Consideration of the need to refer aspects of incident control for legal or expert opinion.

11. Agreeing standardisation of email subject headings

12. To make recommendations regarding the development of systems and procedures to prevent a future occurrence of similar incidents and where feasible enact these

13. To determine when the outbreak/incident can be considered over, based on ongoing risk assessment

14. To produce a report or reports at least one of which will be the final report containing lessons learnt and recommendations.

 

 

 

South East OCT/IMT COVID-19 AGENDA

 

Outbreak/Incident location:

HP Zone No:

Date & Time:

Conference details: Usually virtual by skype/teams

 

Item:	Item:
1	Introductions and apologies
2	First meeting – agree chair and TOR Minutes of previous meeting
3	Review of information currently available ·      Contact tracing (case and close contact numbers) ·      COVID secure measures (setting/community)
4	Current risk assessment
5	Further investigations/controls needed ·      Contact tracing ·      COVID secure measures (setting/community) ·      Testing including MTU deployment
6	Communications ·      Agree lead communications teams for: -     Public / media and wider communications -     COVID secure measures at setting (if applicable) -     Contact Tracing at setting (if applicable) -     Health partners -     LRF partners and local politicians ·      Identify communications needed for: -     public / media / high risk settings (if applicable) -     setting / staff / affected persons etc -     health partners e.g. GPs, hospitals etc -     LRF partners and local politicians ·      Identify translation needs
7	Capacity Issues – including out of hours challenges
8	Review and record key decisions (including closure of outbreak/incident when appropriate)
9	Review, record and set timeframes for key actions
10	AOB
11	Date and time of next meeting

 

OCT/IMT Membership – Attendees and apologies

 

Organisation	Role	Name (Initials) and job title	Present / Apologies
PHE SE HPT	Consultant in Communicable Disease Control / Consultant in Health Protection*
	Health Protection Practitioner
	Regional Communications Lead
	Field Epidemiology Service
County / Unitary Local Authority	Director of Public Health / Public Health Consultant*
	Public Health Lead
	Infection Control Lead (as appropriate)
	Communications Lead
	Emergency Planning Lead (as appropriate)
	Directorate / Service Lead (as appropriate)
District / Borough Local Authority	Environmental Health Practitioner / Lead
	Communications Lead
	Emergency Planning Lead (as appropriate)
	Directorate / Service Lead (as appropriate)
Clinical Commissioning Group	Director / senior manager
	Communications Lead
Other	As appropriate to setting

 

*Chair to be agreed in advance of meeting, together with administration support

 

South East OCT/IMT COVID-19 MINUTES

 

Outbreak/Incident location:

HPZone No:

Date & Time:

Chair:

Minute Taker:

 

Item No:	Item:	Actions/Owner/Timescale
1	Introductions and apologies   See Attendance / Apologies list
2	First meeting – agree chair and TOR   Minutes of previous minutes
3	Review of information currently available   Contact tracing    COVID secure measures (setting/community)
4	Current risk assessment
5	Further investigations/controls needed   Contact tracing   Setting COVID secure measures (setting/community)   Testing including MTU deployment
6	Communications   Agreed lead communications teams:   Public / media and wider communications –   COVID secure measures at setting –   Contact Tracing at setting –   Health partners-   LRF partners and local politicians –   Details of agreed communications: public / media/ high risk settings –   setting / staff / affected persons etc –   health partners e.g. GPs, hospitals etc –   LRF partners and local politicians –   Agreed translation needs:
7	Capacity Issues
8	Key decisions (see decision log) Agreed email subject heading   Closure of outbreak/incident (when appropriate)
9	Key actions (see action log)
10	AOB
11	Date and time of next meeting

 

Decision Log

 

Log No:	Key Decisions made
1	Agreed email subject heading:
2
3
4
5
6
7

 

Action Log

 

Action No:	Action	Owner	Date completed
1
2
3
4
5
6
7

 

 

 

Appendix B

 

Data integration tasks

 

Action (Sussex Wide)	Date	Lead Officer	Internal /External partners involved
·      Expand role of the Sussex Covid Data and Modelling Group to include data integration to support Local Outbreak Control Plans at a Sussex and UTLA level.   ·      Readjusting plans to reflect what the JBC will provide to local areas.			Sussex wide Data and Modelling Group (membership above)
·      Complete work on early warning indicators for subsequent waves of the pandemic, and modelling of these waves based upon the assumptions published by SAGE and working.			Data and Modelling Group, University of Sussex (modelling)
·      Map and secure regular automated dataflows from a variety of organisations to provide the intelligence to support our system. This includes but is not limited to data from the national testing programme, the community testing programme (SECAMB/Mobile Testing Units (MTU), and the national contact tracing programme PHE, HPT, NHS.   Note: It is currently unclear whether the national JBC will provide a single source of data. This includes data to provide evidence of inequalities and high-risk groups.			Sussex wide Data and Modelling Group (membership above)         Local data group for vulnerable groups cell
·      Provide updates as requested to senior managers and local Members, and report to the PH Functional Cell and respond to external requests for information.		GE	East Sussex CC
·      Work closely with the local HPT, lead PH Consultant to establish systems to identify and examine outbreaks.		GE	East Sussex CC
·      Liaise with District and Borough councils to ensure accessing and sharing of data relating to local outbreaks, settings and events.   ·      Establish named contacts for data in each of the local authorities, specifically in relation to: o  Communities at higher risk of infection and the impact of COVID o  Specific settings and events at a local level   Note: it is anticipated that named contacts should, at least, include Environmental Health staff, and community development / engagement.		GE/RT	East Sussex CC

 

 

Appendix C

 

Standards for managing an outbreak

 

The standards for managing outbreaks are contained in the Communicable Disease Outbreak Management – Operational guidance (2014) and include the following steps:

 

Outbreak recognition	Initial investigation to clarify the nature of the outbreak begun within 24 hours
	Immediate risk assessment undertaken and recorded following receipt of initial information
Outbreak declaration	Decision made and recorded at the end of the initial investigation regarding outbreak declaration and convening of outbreak control team
Outbreak Control Team (OCT)	OCT held as soon as possible and within three working days of decision to convene
	All agencies/disciplines involved in investigation and control represented at OCT meeting
	Roles and responsibilities of OCT members agreed and recorded
	Lead organisation with accountability for outbreak management agree and recorded
Outbreak investigation and control	Control measures documented with clear timescales for implementation and responsibility
	Case definition agreed and recorded
	Descriptive epidemiology undertaken and reviewed at OCT. To include: number of cases in line with case definition; epidemic curve; description of key characteristics including gender, geographic spread, pertinent risk factors; severity; hypothesis generated
	Review risk assessment in light of evidence gathered
	Analytical study considered and rationale for decision recorded
	Investigation protocol prepared if an analytical study is undertaken
Communications	Communications strategy agreed at first OCT meeting and reviewed throughout the investigation
	Absolute clarity about the outbreak lead at all times with appropriate handover consistent with handover standards
End of outbreak	Final outbreak report completed within 12 weeks of the formal closure of the outbreak
	Report recommendations and lessons learnt reviewed within 12 months after formal closure of the outbreak