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
6.0	Quarterly refresh for the Health and Wellbeing Board sign-off. Approved by the Department Management Team. All sections updated and all partners consulted for comments.	08 Jul 22
5.0	Quarterly refresh for the Department Management Team sign-off. All sections updated and all partners consulted for comments.	30 Jun 22
4.0	Quarterly refresh for the Health and Wellbeing Board. All sections updated and all partners consulted for comments.	10 Feb 22
3.0	This version will include updates from our emergency planning outbreak exercise. The Escalation Framework was removed and replaced by the Contain Framework, Autumn and Winter Plan, and Plan B. All sections reviewed and all partners consulted for comments.	26 Nov 21
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 1^st 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. 7

Glossary. 8

1. Introduction.. 9

1.1. Background. 9

1.2. Features of COVID-19. 11

1.3. Aim.. 12

1.4. Objectives. 12

1.5. Existing plans and guidance. 13

1.6. East Sussex overview.. 13

1.7. East Sussex health and care landscape. 16

1.8. COVID-19 Epidemiology. 17

2. Contain Framework and Governance. 19

2.1. Autumn and Winter Plan.. 19

2.2. Autumn and Winter Plan B.. 20

2.3. Forward planning. 21

2.4. Governance overview.. 21

2.5. Other joint working across Sussex and beyond. 25

2.6. 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.. 33

4.1. Principles. 33

4.2. Outbreak Control Teams. 33

4.3. Sussex Resilience Forum.. 34

5.Communications and Engagement 35

5.1. Priorities for Communications and Engagement 35

5.2. Communications and engagement plan.. 35

6.Data Integration.. 36

6.1. Data objectives. 36

6.2. Data arrangements currently in place. 37

6.4. Data arrangements that need to be further developed. 38

6.5. Data sharing and Data security. 38

7.Testing. 39

7.1. Types of Tests. 39

7.2. Testing pathways currently in place. 39

7.3. Testing in care. 40

7.4. Surge testing. 40

7.5. Enduring transmission.. 40

7.6. Self-isolation.. 41

8. Vulnerable People. 42

8.1. Overview.. 42

8.2. Current support available. 42

8.3. Shielding Support 43

8.4. Community Hubs. 44

8.5. Additional Support 44

9. Prevention.. 46

10. Vaccination.. 47

10.1. National overview.. 47

10.2. Governance of the COVID-19 Mass Vaccination Project in Sussex. 47

10.3. Background – COVID-19 vaccines. 47

10.4. Vaccine prioritisation.. 48

10.5. Sussex COVID-19 and Flu vaccination programme. 49

10.6.  Measures to improve vaccine uptake locally. 50

11.Outbreak investigation: High Risk Places, Locations and Communities. 53

11.1. Care homes. 54

11.2. Children’s Homes. 57

11.3. Schools. 59

11.4. Prisons and other prescribed places of detention.. 61

11.5. Workplaces. 63

11.6. Faith Settings. 65

11.7. Tourist attractions, Events, Travel and Accommodation.. 66

11.8. Ethnic Minorities Communities. 67

11.9. Gypsy, Roma, and Travellers (GRT) and Van Dwellers. 69

11.10. Homeless community. 71

11.11. Acute. 74

11.12. Primary Care. 76

11.13. Mental Health and Community Trusts. 78

11.14. Transport locations. 80

12. Appendices. 83

12.1. Appendix A: Outbreak Control Team standard documents. 83

12.2. Appendix B: Data integration tasks. 88

12.3. Appendix C: Standards for managing an outbreak. 90

12.4. Appendix D: Communication Plan.. 91

12.5. Appendix E: East Sussex Vaccination Plan.. 91

List of figures

Figure 1: Escalation Framework

Figure 2: Links between C-19 Health Protection Board, Local Outbreak Control Board (Health and Wellbeing Board) Sussex Resilience Forum

Figure 3: East Sussex Outbreak Control Plan Governance

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

UKHSA          United Kingdom Health Security Agency

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 to interrupt transmission and limit spread.

On the 28^th May 2020 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.

On the 23^rd June 2020 it was announced that the 4^th July 2020 would lead to easing of restrictions meaning that many businesses can reopen including pubs, restaurants, hairdressers, and cinemas whilst ensuring Covid secure practices. From September 2020 some new measures were implemented and by October 2020 the three-tier approach was implement. On 5^th November 2020 to 2 December 2020 a second lockdown was announced, and a further lockdown was announced on the 6^th January 2021.

A plan was laid out to exit lockdown

Step 1a (8 March 2021): Children returned to returned to primary and secondary schools.  Meet with one other person outside.

Step 1b (29 March 2021): Staying at home was no longer a legal requirement. The rule of 6 was re-introduced outdoors or two families from different households could meet outdoors and in gardens.

Step 2 (12 April 2021): Business started to reopen: non-essential retail re-opened, hairdressers and gyms, pubs and restaurants re-opened outdoors, public libraries, community centres, zoos, and theme parks re-opened. Self-contained accommodation in England such as campsites and holiday let’s, with no indoor facilities which are not shared with other households.

Step 3 (17 May 2021): The rule of six was lifted outdoors and replaced by a maximum gathering of 30. Two households, or the rule of 6 people, could meet indoors. Business such as indoor hospitality, cinemas, hotels could reopen. Performances and sporting events also restarted with limitations on capacity

Step 4 (19 July 2021): Remaining businesses, including nightclubs re-opened, large events and performances could occur.

16 August 2021: people who are double vaccinated or aged under 18 will no longer be legally required to self-isolate if they are identified as a close contact of a positive COVID-19 case.

8 December 2021: Autumn and Winter Plan B restrictions announced in response to Omicron. For more information refer to section.

26 January 2022: Autumn and Winter Plan B restrictions ended.

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 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 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 (UKHSA) Communicable Disease Outbreak Management: Operational Guidance (2013)

· UKHSA Infectious Diseases Strategy 2020 – 2025 (2019)

· SOP UKHSA-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 can 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

Figure 1: 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 (UKHSA).

2. Contain Framework and Governance

The COVID-19 Contain Framework was first published in July 2020 and was most recently updated on the 7^th October. The framework sets out how all partners should continue work with each other to protect, the public, businesses, settings, and communities to prevent, manage and contain outbreaks of COVID-19. This includes the:

· Roles and responsibilities of LAs and our continued support and should be included in our Local Outbreak Management Plans

· Roles and responsibilities of the local system, regional and national teams including the support the LA will be given

· The decision-making and incident response structures

· Core components of the COVID-19 response, including Variants of Concern (VOCs) and enduring transmission, and considering the inequalities in every aspect of the response

To limit the spread of covid it is recommended that we all continue to ensure:

· Symptomatic and asymptomatic testing (please refer to: Types of Tests)

· Self-isolation for those testing positive, when contacted by NHS Test and Trace or the NHS App (please refer to: Self-isolation)

· Border quarantine for all arriving from red list countries

· Following guidance for individuals, businesses and the vulnerable while prevalence is high (please refer to: Outbreak investigation: High Risk Places, Locations and Communities):

o Supporting a safe return to workplaces

o Wearing face coverings in crowded areas such as public transport o

o Ventilation within settings such as schools and offices

o Minimising the number, proximity, and duration of social contacts

o Working with businesses and large events to use the NHS COVID Pass and measures in high-risk settings to help to limit the risk of infection

The UK Health Security Agency (UKHSA) actively monitors domestic and international epidemiology and considers a range of indicators to inform national and local response. These include:

• Case detection and testing rates

• Prevalence at a national, regional, and local level

• Trajectory the rates at which cases are rising or falling

• Pressure on the NHS considering occupancy and admissions

• Variants considering the epidemiology of variants of concern

• Vaccine uptake

• Effectiveness of operational response

• Local characteristics these include mobility, deprivation, ethnicity, data on reported contacts

2.1. Autumn and Winter Plan

The government plans to reduce the pressure on the National Health Service (NHS) and prepare for the challenges of autumn and winter. This is achieved through:

1. Building our defences through pharmaceutical interventions: vaccines, antivirals and disease modifying therapeutics.

2. Identifying and isolating positive cases to limit transmission: Test, Trace and Self-Isolation.

3. Supporting the NHS and social care: managing pressures and recovering services.

4. Advising people on how to protect themselves and others: clear guidance and communication.

5. Pursuing an international approach: helping to vaccinate the world and managing risks at the border.

Please refer the following link COVID-19 Response: Autumn and Winter Plan, for more details (please note the above was taken from this link).

2.2. Autumn and Winter Plan B

The Autumn and Winter Plan 2021 included a contingency plan (Plan B) which would be used if the NHS was likely to come under unsustainable pressure.

These contingency measures include:

· communicating to the public that the risk level had changed

· requiring mandatory vaccine-only COVID-19-status certification in certain settings

· requiring face-coverings in certain settings

Local authorities would be responsible for the enforcement of face coverings and mandatory vaccine-only COVID-19-status certification, including the compliance and enforcement responsibility for businesses and events’ organisers and the implementation of face coverings and the mandatory certification. Local authorities can engage and shape this with other local authorities and the regions / nationally.

2.3. Forward planning

Given the roll out of the national vaccination programme and the expansion of asymptomatic testing at pace, 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.  

2.4. 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 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 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 2: Links between C-19 Health Protection Board, Local Outbreak Control Board (Health and Wellbeing Board) Sussex Resilience Forum

2.5. 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, UKHSA 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 UKHSA 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 Improvement and Dipartites

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 of Health Improvement and Dipartites 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 staff have now transferred of staff to new destinations (completed Autumn 2021). The UKHSA and DHSC Office of Health Improvement and Dipartites are now 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.

2.6. 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 3 - 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 (CCGs) 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.  (The Health and Social Care Bill currently going through Parliament aims to replace CCGs with Integrated Care Boards (ICBs).  The current proposed date for this change coming into force is 1 July2022.

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) (No.3) Regulations 2020 as amended (“the No.3 regulations), most recently on 27 September 2021, set out the specific powers local authorities were given. These expired on the 24 March 2022 and statutory guidance was withdrawn.

Nearly all legal restrictions relating to COVID-19 under the Coronavirus Act in England have been abolished (as of 27 January 2022).  There is now no legal requirement in England to wear a face covering in any circumstances or to have a COVID passport to enter large events.  Restrictions on visits in care homes ended on 31January 2022.

The legal requirement to self-isolate if you test positive for COVID-19 ended on 24 March 2022. 

Very few provisions of the Coronavirus Act 2020 remain in force.  The specific powers granted to local authorities have expired and have not been renewed.

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 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 7/6/2022 28/10/21), Coronavirus (COVID-19) notices (last updated 14/2/2022) issued by the Secretary of State for Health and Social Care under the Health Service (Control of Patient Information) Regulations 2002,  , requiring confidential patient information to be shared between organisations providing health services, 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, in specific circumstances, (as detailed in the notice applicable to that organisation), for the purposes of supporting efforts against coronavirus (COVID-19):

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; which were made under sections 60 (now section 251 of the NHS Act 2006) and 64 of the Health and Social Care Act 2001 – Biobank; and

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

 If no further notices are received from the Secretary of State for Health and Social Care, these four notices will expire on 30 June 2022.

· 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 3) describes the various measures currently available to different agencies, who the designated lead would be, and the enabling legislation.

The specific powers given to local authorities to enforce COVID-19 regulations expired on 24 March 2022.

Figure 4 - 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	Organisers[1] for events of up to 499 people and of less than 5 days duration can hold events via a standard Temporary Event Notice (TEN)[2], 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.  All parties organising an outdoor event in a managed public space must carry out a COVID risk assessment demonstrating that risks to all staff, performers and people attending the event have been considered and that everything reasonably practicable has been done to minimise that risk. 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 In the case of late TENs, the Police or Environmental Health can object with no right for the organiser to appeal.
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		Organisers for events of up to 499 people and of less than 5 days duration can hold events via a standard Temporary Event Notice (TEN), 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.All parties organising an outdoor event in a managed public space must carry out a COVID risk assessment demonstrating that risks to all staff, performers and people attending the event have been considered and that everything reasonably practicable has been done to minimise that risk. 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. In the case of late TENs, the Police or Environmental Health can object with no right for the organiser to appeal.
Acting against a business/premises permitted to be open but not complying with COVID-19 guidelines[3]	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	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. All parties organising an outdoor event in a managed public space must carry out a COVID risk assessment demonstrating that risks to all staff, performers and people attending the event have been considered and that everything reasonably practicable has been done to minimise that risk 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 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.
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	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.
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.

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 UKHSA 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. 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.

4.3. 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 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 a range of data being produced relating to COVID-19 and datasets expanded as the response to the pandemic developed. Some datasets are in the public domain, others are, and will remain, confidential and restricted. Some have scaled back e.g. Test and Trace, as the pandemic has evolved into a new phase.

At a local level Public Health, local authority and NHS staff seek 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 UK Health Security Agency 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 UK Health Security Agency, 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 UK Health Security Agency and local environmental health teams) § 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 UKHSA. 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 bespoke database developed locally is being used to 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 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 UK-HSA, 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 UKHSA national and regional teams, the new Office for Health Improvement and Disparities within the Department of Health and Social Care, the local UKHSA 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.

UKHSA are providing to local authorities record level datasets including postcode in relation to testing and cases.

Of relevance for this plan is daily reporting by UKHSA 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 was available from the Council's website during the pandemic and this can be resurrected if we need to communicate data and messaging to our partners and the public should cases increase significantly again. More detailed data are scrutinised routinely by the local authority public health team, with further investigations and actions agreed.

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.

6.3. 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.

6.4. 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

The testing infrastructure has been dismantled through the living with covid plan and therefore removal of regional and local testing sites and mobile testing units has occurred. Online ordering of lateral flow tests is available for a limited number of the population and the Sussex central booking team is still functioning to assist testing in those who qualify but are unable to carry this out themselves.

7.1. 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 throat and/or nose to detect the presence of an antigen

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

7.2. Testing pathways currently in place

From 1 April 2022, free PCR and lateral flow testing will end for most people. Free COVID-19 tests will still be available to certain groups of people, such as those at serious risk of illness from COVID and NHS staff caring directly for patients.

Who is eligible for free COVID-19 tests?

Government guidance currently includes the following groups as eligible for free tests:

• Hospital patients where a test is required for their care
• NHS staff and staff working in NHS equivalent healthcare services
• Adult social care staff in care homes, homecare organisations, extra care and supported living settings, adult day care centres, shared lives carers and social workers.
• Care home residents and those in extra care and supported living settings
• Hospice staff and patients
• Prison and detention centre staff and detainees
• Immigration removal centre staff and detainees

Where to buy COVID-19 tests

If you are not eligible for free COVID-19 tests, lateral flow and PCR tests will be widely available to buy from supermarkets and pharmacies.

COVID-19 symptoms or positive tests

If you have COVID-19 symptoms or have tested positive, current advice is to self isolate for 5 days, or until your symptoms subside.

7.3. Testing in care

Symptom-free testing for care homes

See the GOV.UK website for details of testing in care homes.

Testing for personal assistants

Find out more about testing and order testing kits at GOV.UK.

7.4. Surge testing

Surge testing involves increased testing of people in a local community 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.

A local COVID-19 Variants of Concern Surge Testing Plan for East Sussex dated the 26^th June 2021 has been developed which will remain a live document as learning from wider areas. The plan describes how resources will be mobilised. Further updates of the plan will occur when the central continguency plan from UKHSA is produced.

7.5. 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 month:

• 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
• Communicating key prevention messages i.e., hand washing, face coverings, self-isolation, and social distancing

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.

7.6. Self-isolation

Self-isolation is a key action for reducing COVID-19 transmission; it is still recommended that you self-isolate for 5 days.

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 those 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 too 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.

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, providing 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, where required practical support and advice required by residents is still available. 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[4] 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[5] 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

ESCC contributed over £150,000 to Sussex Community Foundation to establish this fund to date the fund has allocated £135,807 worth of grants to 26 organisations across East Sussex. Grants have been used to fund such programmes as community fridges, surplus food sharing programmes, and cookery skills and healthy eating workshops. Monitoring information is still coming in but to date these grant funded activities have benefitted almost 2000 people.

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 was used for schools, colleges, and early years settings to provide food vouchers for children and young people eligible for free school meals. Funding was 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

Over the last two years ESCC contributed over £400,000 to the Sussex Crisis Fund run by Sussex Community Foundation (SCF) designed to assist groups and organisations affected by Covid restrictions.  The ESCC contribution was part of a much larger pot of funds topped up from private and public contributions with a total of £1.2million being allocated to East Sussex organisations. The majority of the 261 grants went to the small and medium sized organisations with annual incomes of less than £100,000. Organisations helping people living in poverty, children, young people, older people, families, local people in diverse communities, and mental health support.

Additional Measures Grant Fund

ESCC allocated eleven VCSE organisations with grants to support people with financial and benefits concerns because of the Government Guidance in relation to the COVID pandemic. During the first three months these relevant organisations have supported over 700 people with financial and debt issues attributed to energy bills, consumer debt, rent arrears, and a deterioration in health post Covid.

Household Support Fund

The Government announced support for vulnerable households in financial difficulties in October 2021. Funding for £3.9 million has been provided to East Sussex. This will be used to provide Free School Meal vouchers, support to foodbanks, warmer home initiatives, a range of VCSE organisations and a discretionary resident’s support scheme.

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.

Following on from this the programme has been delivered in these phases:

· Phase 1 prioritised the most at risk from covid. This was cohorts 1-9 which has been completed.

· Phase 2 protected those next most at risk from serious illness, death or hospitalisation descending by age group.

· Phase 3 has started in Autumn 2021 and offered the COVID-19 booster and Flu vaccines, the continued Evergreen offer and school’s immunisation of the 12 – 15-year-olds.

· COVID-19 boosters: due to the arrival of the fast-spreading Omicron variant in Winter 2021, third COVID-19 booster vaccines were offered to all aged 18 and over. This later also included 16- and 17-year-olds, and at-risk 12–15-year-olds.

· Spring Booster Programme: started in March 2022 and offered a fourth COVID-19 booster to people aged 75 and over, people who live in a care home for older people, or people aged 12 and over who have a weakened immune system.

· Healthy 5–11-year-olds: commenced in April 2022 following JCVI guidance.

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.

Place based operational cells have been set up in East Sussex, West Sussex, Brighton, and Hove City, that all report to the Sussex Vaccine Programme Board this would include oversight of the Flu programme.

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.

Moderna

The Moderna vaccine was approved for use in the UK in January 2021. Following a study in over 3000 children aged 12-17 years, which generated additional safety and efficacy data, the approval was extended to those in this age group in August 2021.

Other vaccines:

Other vaccines have been developed and proved to be safe effective vaccines. 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. 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 (which became known as Phase 1 this was aimed to prevent mortality and supporting the NHS and social care system) 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.

The next phase focused on further reduction in hospitalisation and targeted vaccination of those at high risk of exposure and/or those delivering key public services. This continued to develop resulting, in everybody aged 12 and above, having the opportunity to have a vaccine. This has been extended to include children aged between 5-11.

For further details on the COVID-19 vaccination programme and priority groups, please click this link: JCVI statement on the adult COVID-19 booster vaccination programme and the Omicron variant: 7 January 2022 - GOV.UK (www.gov.uk)

10.5. Sussex COVID-19 and Flu vaccination programme

Sussex Integrated Care System received its first delivery of the Pfizer/BioNTech vaccineon 8 December 2020, via the Royal Sussex County Hospital (RSCH) (a designated Tranche 1 Hospital Hub). The vaccination programme has expanded as more vaccines became available. This includes:

· 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.

Focusing areas of low uptake, deprivation to address areas of health inequalities.

Vaccine uptake in East Sussex as of 20^th June 2022

Source: Vaccinations in the UK | Coronavirus in the UK (data.gov.uk)

10.6.  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) alongside a Communication Plan are being followed.

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– 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 ethnic minorities 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, Eastbourne, and specific areas of Wealden.

· Clinically extremely vulnerable including housebound – individual reasons need investigating, needs help of service providers, community networks and carers, GPs and PCNs.

· People with learning disabilities, physical disabilities, mental health - 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 – homeless, travelling community, transient workers, refugees, and asylum seekers.

Vaccine Champions and Advocates

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 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 a 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.

Vaccine Advocates is a new programme that aims to build on the successful Vaccine Champions programme. The Advocates Programme works withvoluntary sector partners, and individuals to actively promote vaccine uptake within their communities, at a very local level for example, working with a local football club to promote the vaccines during men’s mental health month of November 2021.

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 sectors 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. UKHSA 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 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:

UKHSA 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 UKHSA 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 UKHSA 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:

UKHSA 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 UKHSA 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 holidays 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:

Children’s Services work closely with public health colleagues to support schools with their COVID arrangements. This includes,

· 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.

Public health and Children’s Services have jointly developed systems for monitoring cases occurring in education settings. Where an outbreak is suspected or confirmed Children’s Services contact schools to offer help and advice.

Key National Guidance:

Contingency framework: education and childcare settings. Updated 16 November 2021

What else will need to be put in place:

Advice to schools and the introduction of measures under the authority of the Director of Public are reviewed periodically in consultation with Children’s Services and Area Group Chairs (head teachers representing schools across the county).

Local outbreak scenarios and triggers:

The key source of information for schools in relation to testing and outbreaks is the

UKHSA South East Educational Settings Outbreak Pack which is updated regularly. It contains information regarding thresholds for seeking advice from DfE and the UK Health Security Agency health protection teams. This remains the first point of call for advice relating to outbreak situations.

In addition to the advice available from DfE and health protection teams, the Council’s Children’s Services and Public Health teams are available to discuss any aspect of outbreak management.

Resource capabilities and capacity implications:

Staffing and workforce planning dependent on further government guidance.

Links to additional information:

Guidance for schools: coronavirus (COVID-19). Updated 4.10.21

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:

In September 2021, guidance was issued to prisons regarding regime delivery levels, Stage 1 is the final stage of the National Framework. Though the Framework sets regime expectations for each level, its primary function is to set the level of COVID controls based on the live COVID risk and prevalence rates at each individual prison.

Prisons have experienced a very different third wave of outbreaks and infection largely due to vaccinations and testing. Though the ingress and transmission risks remain; the number of cases requiring hospital treatment has significantly reduced. The current risk profile (e.g., the risk of fatalities) and this has also led to the easing of restrictions in the community. Though prisons remain high risk, the severity of cases has reduced, and the level of restriction is disproportionate to the restrictions in the community.

Prisons need to ease some controls and increase access to the regime, where safe to do so (informed by public health professionals). This does not undermine the measured approach but does mean controls should be eased to enable progress at an appropriate pace.

HMP Lewes is currently delivering to a level 2 restricted regime and is working towards level 1, which will see greater access to activities. 

Established UKHSA procedures are in place to manage outbreaks in prisons and other prescribed places of detention, linking with Public Health, Health and Justice teams in NHSEI and NHSE, and HMPPS Health and Social Care. Currently there is a medium incidence of COVID-19 in prisons across the SE. HMP Lewes is currently not in outbreak mode but is regularly monitored.

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:

UKHSA and Public Health, Health & Justice leads 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 UKHSA 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 UKHSA.

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 several 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. Several 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.

Please refer to most up to date guidance: https://www.gov.uk/guidance/working-safely-during-covid-19

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.

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.

Information on how the public can access the vaccine as per national prioritisation guidelines is shared through general and specific communications to business and residents.

Local outbreak scenarios and triggers:

If there is a substantial outbreak in a workplace, UKHSA 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 UKHSA but if there is limited capacity this may be chaired by the Local Authority Public Health team. Current UKHSA guidelines as of 11/2/2021 are that UKHSA 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: Working Safely during Coronavirus guidance

How to find your local health protection team: Health Protection Team

Eastbourne Hospitality Association: Covid Ready scheme

Advice on business testing: https://www.gov.uk/get-workplace-coronavirus-tests

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 UKHSA, 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, UKHSA 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 UKHSA 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 gather insights on outbreaks and multiple case of COVID-19 linked to tourism, local events, and tourist attractions.

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:

Guidance is in place for control of Covid 19 at Reducing the spread of respiratory infections, including COVID-19, in the workplace - GOV.UK (www.gov.uk)

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 and to ensure a consistent approach across pan-Sussex SAGs.

Local outbreak scenarios and triggers:

If multiple cases of COVID-19 (suspected or confirmed) occur, UKHSA 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 UKHSA 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:

ESCC to ensure continued communication with partner agencies on Covid 19 status within East Sussex, using available data.  

Links to additional information:

Reducing the spread of respiratory infections, including COVID-19, in the workplace - GOV.UK (www.gov.uk)

Coronavirus (COVID-19): guidance and support - GOV.UK (www.gov.uk)

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 UKHSA, 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 minority’s 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:

UKHSA 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 considering 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 UKHSA, 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 UKHSA Health Protection Team are contacted.

If multiple cases of COVID-19 (suspected or confirmed) occur in a GRT or Van dweller community, UKHSA 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 UKHSA 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 can 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 to provide available transit availability across Sussex. Transit availability across Sussex stands at 41 pitches, but all 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, DLUHC asked local authorities to provide self-isolating accommodation for the homeless population. In East Sussex since the 23^rd March 2020 there have been around 1600 placements made by East Sussex for homeless people who have been housed in emergency accommodation, with most sites hosting several people. Of these, around 220 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 are not able to operate in the way that they usually would do pre-pandemic and in 2021 an alternative provision was put in place.  These are additional accommodation sites housing between 6-8 people who can 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:

The UK Health Security Agency UKHSA (UKHSA) 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. UKHSA 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, HomeWorks) who undertake regular wellbeing checks. Informal contact and support are also happening through organisations such as Warming up the Homeless.

There is a new Health, Housing and Homelessness Group, which is a subgroup of the newly formed East Sussex Strategic Housing Group. 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 9^th June 2020.

Latest UKHSA 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.

A pan Sussex plan to increase vaccine uptake by this population is underway in line with the announcement on the 11^th March 2021 which enabled access alongside those with LTCs.

What else will need to be put in place:

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 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 can 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, UKHSA 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 UKHSA 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 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:

Latest Guidance on provision of night shelters - September 2021 COVID-19: provision of night shelters - GOV.UK (www.gov.uk)

Letter from Minister Luke Hall to local authorities asking to ‘bring everyone in’

MHCLG/ UKHSA 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 several 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 most 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 UKHSA. 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 UKHSA 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 “lateral flow” 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 22^nd 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 UKHSA stepdown and discharge guidance.

These procedures will be developed further as needed between Local Authority, UKHSA and ESHT infection prevention team.  ESCC PH, UKHSA 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. UKHSA, the CCG and the Local Authority Public Health team are included as required. Outbreaks are reported daily via the Southeast Provider outbreak reporting tool and the UKHSA 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 Primary Care Hub

· 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:

· 52 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 Primary Care Hub – General practices are now returning to normal working practices and all practices should now have their doors open again. Primary Care has put in place measures to manage any outbreaks of COVID-19. 

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.

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. This remains in place to support practices if they have staff who need to work from home due to covid-19.

Practices were supported to apply 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 at risk and ethnic minorities staff. Additional Locally Commissioned Services enabled 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 July 21 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, inbox when aware of staffing issues due to covid-19 impact on ability to run the practice.

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

· 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, UKHSA 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).

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 several 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, UKHSA 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:

International travel and domestic aviation

To travel abroad from England, travellers need to check each point in the checklist:

1. Check foreign travel advice for all countries being visited or travelled through.

2. Arrange any COVID-19 tests to enter the countries being travelled to.

3. Find out how to use the NHS COVID Pass to prove your vaccination status abroad.

To help control the virus aviation passengers are required to wear a face covering (with some age, health, and equality exemptions) when in

· on board a vessel (ferry) in port and on board where social distancing is not possible, and 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

On public transport, passengers should wear face coverings in crowded and enclosed areas where you meet people you do not usually meet.  It is recommended that the following precautions are observed:

· plan your journey and check your route to identify the options for reaching your destination

· open windows where it is possible and safe to do so

· wash or sanitise your hands regularly

· avoid touching your face

· cover your mouth and nose with a tissue or the inside of your elbow when coughing or sneezing

· while waiting for a service to arrive stay outdoors, rather than indoors, where possible

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, UKHSA 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 UKHSA 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

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[1] Events of over 6 people organised by individuals are illegal, as per the No 2 regs and this is enforceable by the Police.

[2] In the case of late TENs, the Police or Environmental Health can object with no right for the organiser to appeal.

[3] In relation to sectors included under schedule 1 of the Health and Safety Authority Regulations 1989. HSE are responsible for health and safety in sectors outlined in schedule 2.

[4] Information on all support available can be found at https://www.eastsussex.gov.uk/community/emergencyplanningandcommunitysafety/coronavirus/

[5] More information is available at https://www.eastsussex.gov.uk/community/emergencyplanningandcommunitysafety/coronavirus/coronavirus-community-support/

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