South Tyneside COVID-19 Prevention and Outbreak Management Plan

Report compiled by the COVID-19 Health Protection Board:

Tom Hall

Chair, Director of Public Health

Paula Phillips

Public Health, STC

Anna Christie

Public Health, STC

Samantha Start

Public Health, STC

Tori Hunt

Public Health, STC

Stuart Wright

Development Services, STC

Joanne Chastney

Environmental Health, STC

James Maughan

Development Services, STC

Natalie Johnson

Communications, STC

Gemma Davison

Communications, STC

Jeanette Scott

South Tyneside CCG

Kirstie Hesketh

South Tyneside CCG

Phil Baker

Northumbria Police

Austin O’Malley

Cumbria, North of Tyne and Wear NHS Trust

David “Bart” Burton

Northumbria Police

Dave Stobbs

Northumbria Police

Dr. Gayle Dolan

PHE

This plan is subject to continuous review and may be updated accordingly.

9th March 2021

Published on

9th March 2021

Plan approved by COVID-19 Leadership Board on

What is the NHS Test and Trace service?

NHS Test and Trace service forms a central part of the government’s coronavirus (COVID-19) recovery strategy.

Specifically, the NHS test and trace service:

• Ensures that anyone who develops COVID-19 can quickly be tested to find out if they have the virus and includes targeted asymptomatic testing of NHS and social care staff and care home residents.
• Helps trace close recent contacts of anyone who tests positive for coronavirus and, if necessary, notifies them that they must self-isolate at home to help stop the spread of the virus.

The service aims to help return life more to normal, in a way that is safe and protects the NHS and social care. It will allow us to trace the spread of the virus, isolate new infections and give us early warning if the virus is increasing again, locally or nationally.

National testing strategy

The government’s testing strategy is framed around five pillars:

Pillar 1

NHS swab testing for those with a medical need and, where possible, the most critical key workers

Pillar 2

Mass-swab testing for critical key workers in the NHS, Social Care and other sectors (including symptomatic children of critical key workers)

Pillar 3

Mass antibody testing to help determine if people have immunity to coronavirus

Pillar 4

Surveillance testing to learn more about the disease and help develop new tests and treatments

Pillar 5

Spearheading a Diagnostic National Effort to build a mass testing capacity at a completely new scale

National contact tracing system

Anyone who tests positive for coronavirus will be contacted by NHS Test and Trace service and will need to share information about their recent interactions. This could include household members, people with whom they have been in direct contact, or within 2 metres for more than 15 minutes.

People identified as having been in close contact with someone who has a positive test will be contacted by NHS Test and Trace. They will be advised that they must self-isolate for 10 days, even if they do not have symptoms, to stop unknowingly spreading the virus.

The national contact tracing team is expected to operate at four broad levels:

• Automatic: an app-based platform that automatically alerts people to possible contact with a positive case and directs them to testing (the NHS coronavirus app is currently in development and when rolled out will complement rather than replace the other aspects of the Test and Trace service).
• Tier 1: Led by Public Health England (PHE) this tier will deal with complex cases and outbreaks in high-risk settings such as care homes, schools and workplaces. Local authorities will have a key role in supporting this tier of the Test and Trace service to support and manage complex cases and outbreaks at a local level.
• Tier 2: Centralised contact centre of health professionals who will contact and interview confirmed cases and collect details of anyone they have come into close contact within their infectious period (classed as 48 hours prior to symptom onset through to day 7 of symptoms). Tier 2 call handlers will escalate any complex cases (or contacts they are notified of via Tier 3) to Tier 1.
• Tier 3: Centralised contact centre of call handlers without a clinical background who will contact those individuals identified as a contact through Tier 2 providing advice on symptoms, testing and instructions to self-isolate at home.

Purpose of the South Tyneside Outbreak Management Plan

The purpose of the South Tyneside Outbreak Management Plan is to clearly outline how we intend to prevent and control outbreaks of COVID-19 in South Tyneside to support local recovery. It will cover the guiding principles of how we will operate and highlight the key activities we will undertake to prevent outbreaks. It will then outline how we intend to address the seven key national themes identified for outbreak planning, including managing outbreaks in high-risk settings (e.g. care homes and schools); ensuring we have sufficient local testing capacity, high-quality integrated data to support decision making and strong local governance to oversee plans.

It is important to highlight that this is a working plan that needs to remain responsive to the evolving nature of the COVID-19 pandemic. In response to the Government’s roadmap to remove restrictions in a planned way, local authorities and their partners have been asked to refresh their outbreak management plans. Therefore, this version of the plan will provide an update on the current response, highlight current practice, identify learning from the past 12 months and outline the arrangements for the next 12 months.

Guiding principles

Definitions

Public Health England has provided an overview of the definitions they would use as part of their submission to the Joint Biosecurity Centre and their ongoing monitoring of COVID-19 in different settings. It focuses on outbreak definitions in key settings, prioritising those that are critical for local and national infrastructure and areas with significant public and press interest. Applied to surveillance data shared with the Joint Biosecurity Centre, these definitions will inform local alerts and action and provide consistency with how areas manage outbreaks.

Table 2 provides a broader definition of an outbreak in residential settings. This definition differs from the definition for non-residential settings because SARS CoV2 is known to spread more readily in residential settings, such as care homes and places of detention, therefore a cluster definition is not required.

Governance Arrangements

To support the delivery of an effective response to outbreaks, strong coordination and local oversight will be key. The implementation of the Local Outbreak Control plan will be supported by the establishment of new governing arrangements as well as by aligning with existing oversight bodies such as the Local Resilience Forum (LRF) and Strategic (Gold) Command.

A COVID-19 Leadership Board will be established to provide strategic oversight and assurance on the delivery of the Outbreak plan, chaired by Cllr Tracey Dixon – Leader of the Council (Vice Chair Dr Mathew Walmsley – Chair of South Tyneside CCG and local GP).

A COVID-19 Health Protection Board will be established to provide oversight to the delivery of the Outbreak Control Plan (Chair – Tom Hall Director of Public Health). This group will bring together expertise from public health, environmental health, communications, clinical commissioning group, community health services, Police and PHE.

Setting-based Outbreak Control Management Teams (OCTs) will be called by either HPT or the DPH based on risk or scale of the outbreak and relevant officers will be invited accordingly and a standard agenda used. Lead members and heads of service will be briefed. The Director of Public Health will act as the liaison officer between the local Health Protection Board and the National Outbreak Control Advisory Board as well as the PHE North East Centre.

Key decisions taken by each of these groups will be logged to ensure transparency and shared with the Health Protection Board.

Terms of reference and membership for governing structures can be in Appendix 1.

Legal and policy context

The legal context for managing outbreaks of communicable 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
• With Directors of Public Health under the Health and Social Care Act 2012
• With Chief Environmental Health Officers under the Public Health (Control of Disease) Act 1984
• With NHS Clinical Commissioning Groups1 to collaborate with Directors of Public Health and Public Health England to take local action (eg testing and treating) to assist the management of outbreaks under the Health and Social Care Act 2012
• With other responders specific responsibilities to respond to major incidents as part of the Civil Contingencies Act 2004
• In the context of COVID-19 there is also the Coronavirus Act 2020
• In the context of potential outbreaks in workplace settings the Health and Safety at Work Act 1974 which place a statutory requirement on employers to control risks in the workplace through the process of risk assessment

This underpinning context gives Local Authorities (Public Health and Environmental Health) and Public Health England the primary responsibility for the delivery and management of public health actions to be taken in relation to outbreaks of communicable disease through the local Health Protection Partnerships (sometimes these are Local Health Resilience Partnerships) and local Memoranda of Understanding. These arrangements are clarified in the 2013 guidance Health Protection in Local Government2.

PHE is mandated to fulfil the Secretary of State’s duty to protect the public’s health from infectious diseases, working with the NHS, local government and other partners. This includes providing surveillance; specialist services, such as diagnostic and reference microbiology; investigation and management of outbreaks of infectious diseases; ensuring effective emergency preparedness, resilience and response for health emergencies. At a local level PHE’s health protection teams and field services work in partnership with DsPH, playing strategic and operational leadership roles both in the development and implementation of outbreak control plans and in the identification and management of outbreaks.

The Director of Public Health has and retains primary responsibility for the health of their communities. This includes being assured that the arrangements to protect the health of the communities that they serve are robust and are implemented. The primary foundation of developing and deploying local outbreak management plans is the public health expertise of the local Director of Public Health.

This legal context for Health Protection is designed to underpin the foundational leadership of the local Director of Public Health in a local area, working closely with other professionals and sectors.

Enforcement powers are seen as a last resort and we will first seek a strategy of engagement with the public, businesses and other key partners. It is important to explain the reasons behind the actions we are taking in managing outbreaks and we will seek to do this through a detailed communications plan.

While this document is titled an Outbreak Management Plan, our aim is to prevent an outbreak from happening in the first place to support recovery from COVID-19 and prevent future waves of disease. A key strand of this plan is therefore focussed on Prevention which will include:

South Tyneside

The population of South Tyneside is about 150,000. Compared to the rest of England, South Tyneside has:

• a slightly larger percentage of middle-aged to older demographic 50+
• a similar percentage of younger people
• a lower percentage of younger working aged adults.
• a projected ageing population, similar to England

The population overall is not dramatically increasing and is projected to remain under 160,000 over the next 20 years. The percentage of the population in South Tyneside from ethnic minorities is around 4.5 per cent.

The health of people in South Tyneside is generally worse than the England average. South Tyneside is one of the 20% most deprived districts/unitary authorities in England and about 26.4% (6,770) children live-in low-income families. Life expectancy for both men and women is lower than the England average.

Life expectancy is 9.3 years lower for men and 8.1 years lower for women in the most deprived areas of South Tyneside than in the least deprived areas.

Child health

In Year 6, 25.3% (406) of children are classified as obese, worse than the average for England. The rate for alcohol-specific hospital admissions among those under 18 is 107*, worse than the average for England. This represents 32 admissions per year. Levels of GCSE attainment (average attainment 8 score), breastfeeding and smoking in pregnancy are worse than the England average.

Adult health

The rate for alcohol-related harm hospital admissions is 983*, worse than the average for England. This represents 1,475 admissions per year. The rate for self-harm hospital admissions is 316*, worse than the average for England. This represents 460 admissions per year. Estimated levels of excess weight in adults (aged 18+), smoking prevalence in adults (aged 18+) and physically active adults (aged 19+) are worse than the England average. The rates of new sexually transmitted infections killed and seriously injured on roads and new cases of tuberculosis are better than the England average. The rates of violent crime (hospital admissions for violence), under 75 mortality rates from cardiovascular diseases, under 75 mortality rates from cancer and employment (aged 16-64) are worse than the England average.

Some of the challenges the borough has are around levels of deprivation as it’s in the worst to 25th percentile and is significantly worse when compared to England for the percentage of people aged 16-64 in employment. The proportion of children in low income families (under 16) living in the borough is also significantly worse than England.

A large majority of the workforce are classed as blue-collar workers and work in manufacturing and factories carrying out manual labour.

Areas of good practice

Schools

During the pandemic we have worked closely with our schools and take part in weekly meetings with school heads and governors. This allows a space for any queries on guidance or risk assessments to be raised, as well as challenges and areas of good practice to be shared and discussed. We have seen a cluster of schools need more support and have worked with them when dealing with a larger number of cases at a particular time or an area in the school where touch points have become an area of concern, or where parents have been congregating outside of some primary schools waiting to collect children.

Businesses

We have worked closely with Environmental Health and our Welfare Support teams to help businesses ensure they are doing all they can to remain COVID-19 secure but also keep their own employees safe. We have seen outbreaks particularly in the manufacturing industry where people have not been able to work from home and as a result have support businesses with issues such as car sharing, sharing communal areas at break times and supportive messages around keeping safe and playing your part to stop transmission.

Financial hardship is recognised, and we are supporting people who are eligible to access any payments should they need to isolate so that they don’t fall into financial hardship. We recognise that many of our residents work in the hospitality and manufacturing sector and some do not get paid should they be required to isolate. We have worked with employers and those we have spoken to us a result of contact tracing to raise awareness of the financial support available so that should people not get a wage they can still access funding if they can’t attend work due to being a close contact as a result of COVID-19.

South Tyneside does have high levels of deprivation, compounded with many people living on low incomes and not in secure employment and often working in jobs where they can’t work from home. These issues have played a major part in our rates as people have sometimes had to make very difficult choices, especially if they were asymptomatic and then been asked to isolate for a period of time which in turn has led to a major drop in their household income. The isolation payments have helped but more needs to be done to ensure that people are not forced to make these choices which could then see our rates rise.

Outbreak Management framework

A big focus of our efforts over the last 12 months have been on settings where reducing transmission risk is more difficult, such as care homes, schools and other high-risk settings, such as transport hubs. The HPT at PHE have lead the process for the detection and declaration of outbreaks in South Tyneside, with support of the local public health team.

There are some key principles of outbreak management that will apply across all of these settings and these will be outlined first for information, followed by specific issues for each setting in line with the Key Themes of the outbreak plan:

Identification of outbreak

Outbreaks may be recognised by PHE, Local Authorities or NHS Microbiologists. Each organisation has its own procedure for surveillance, detection and control and as soon as it becomes apparent that an outbreak may exist, immediate contact between these parties is essential.

All outbreaks should be notified to the local authority via an alert system from the Health Protection Team at Public Health England via a single point of contact (SPOC) email address: covid@southtyneside.gov.uk and notification to the Director of Public Health.

Outbreaks may also be notified via informal routes, for example direct contact from a setting (eg school). Notifications in these circumstances will be routed through the SPOC email address for consistency. Settings should also notify the HPT at PHE if they have not done so already to ensure a risk assessment can be carried out.

Initial response/investigation

Initial investigation to clarify the nature of the outbreak should begin within 24 hours of receiving the initial report. This will include, for example, reviewing local clinical and microbiological data and carrying out an initial risk assessment to guide the decision-making process.

Declaration of outbreak

It is usual that locally confined outbreaks will be recognised and declared by a PHE Consultant in Communicable Disease Control (CCDC) in the Health Protection Team at the PHE North East Centre. Where an incident occurs in a NHS Trust premises then the Medical Director or Director of Infection Prevention and Control (DIPC) may declare an outbreak.

Following the recognition and declaration of the outbreak, a decision regarding the need and urgency to convene an Outbreak Control Team (OCT) is required. This decision should be guided by the risk assessment.

Establishment of Outbreak Control Team (OCT)

The purpose of an OCT is to agree and coordinate the activities of the agencies involved in the investigation and control of the outbreak. The OCT will be a multi-agency group who will confirm and assess any outbreak, establish appropriate control measures to minimise the spread of disease (eg infection control) and mobilise the people and resources required to maximise outbreak control.

OCTs will be chaired by the CCDC or Director of Public Health and membership will be specific to the outbreak setting (e.g. care homes, schools, businesses) to provide a specialised response. The Terms of Reference for Setting-Specific OCTs, including roles and responsibilities can be found in Appendix 1. In the context of OCTs, it is possible that local authorities may have a role in chairing these where an incident is escalated, for example if the outbreak is not contained or if wider action is required at a sectoral/geographical level. A joint management document between PHE and Directors of Public Health is being finalised and will provide further confirmation on this issue.

It is acknowledged there will be a different approach for outbreaks detected within acute healthcare settings (STSFT) where the decision to declare an outbreak will be made by the Trust’s Director of Infection Prevention and Control (DIPC). OCTs in this setting will be led by the DIPC or a designated member of their team.

Key decisions and actions from the OCT will be captured within the notes ad shared with the Health Protection Board.

Escalation of outbreak

Escalation to an emergency situation or major incident

Outbreak planning and response is locally managed by each individual Local Authority Director of Public Health and Public Health Teams, in partnership with the PHE HPT. If the management of the outbreak causes a significant test to the council’s capacity and capability to respond and manage the issues, then consideration should be given to the declaration of an emergency situation or major incident, and activation of the existing Emergency Response Process.

Variants of Concern

If intelligence and information from PHE outlined a variant of concern detected in the local area the response would be mobilised to call upon all staff resource and agencies to initiate surge testing, clear communications and points of contact in line with incident management response. If the intelligence and information suggest any cross-border transmission regional response would be triggered by the LRF. An exercise to test this response is being planned and will be carried out with the HPT to ensure all partners are able to respond should it be required.

Northumbria Local Resilience Forum (LRF)

Some outbreaks may require a multi-agency response at the strategic level in order to provide a resolution. In such incidents, the LRF will convene a Strategic Co-ordinating Group (SCG) to determine policy between the lead organisation, the emergency services and other organisations involved directly in the incident and ensure there is that wider collaboration and coordination where required.

End of outbreak

The OCT will decide when the outbreak can be considered over and will make a statement to this effect. The decision to declare the outbreak over should be informed by ongoing risk assessment and considered when:

• there is no longer a risk to the health of the public that requires an OCT to conduct further investigation or to manage control measures;
• the number of cases has declined or;
• the OCT is satisfied that the chain of infection has been broken with the identification and isolation of cases

Accessing data in an outbreak

The OCT will review the latest laboratory and epidemiological data as part of the investigation. Other intelligence sources, for example, testing data will also be relevant.

Public communications in an outbreak

A communications lead will form part of the membership of an OCT. The OCT will discuss and agree an appropriate communications plan which may include proactive and reactive messaging.

Local authority outbreak management protocol

DPH and Public Health Team

As part of our COVID-19 outbreak management response plan, South Tyneside has integrated the Single Point of Contact (SPOC) COVID-19 inbox functions, case management and local Enhanced Contact Tracing (ECT) process into one pathway.

This allows us to draw on the intelligence from the SPOC and triangulate with other intelligence sources, e.g. residents, places of work, ICC and Environmental Health.

If intelligence or case management highlight any clusters, common exposures or venues of concern – particularly with 2 or more cases, then existing staff resources are allocated to carry out in depth investigation to gather information to both inform mitigating actions and to prevent further risk of transmission. This information also allows decisions to be made should spot check visits, enforcement action or a formal Outbreak Control Team (OCT) be deployed.

Investigation into specific settings has a focus on pre-determined questions to identify index case(s) and work with the setting and individuals to provide support, advice and guidance to help minimise the risk of transmission. A main contact is identified from the setting to facilitate case information to be shared and advise that they may be contacted by the local Public Health team.

The SPOC is managed and monitored over the working week and cover over a weekend to address urgent cases. Generally, there are two team members throughout the week and one person providing cover on a weekend for urgent queries and cases.

Queries are categorised and actioned as appropriate with any outstanding, e.g. areas of concern, common exposures, venues with more than 2 cases included in a daily handover to the team providing cover on the next day. This ensures that these can be addressed as necessary and any further cases or intelligence received to inform future actions.

With a robust framework in place, together with a joint management protocol for various settings, this system works well and quickly identifies the need for escalating any issues or immediate actions required.

Environmental Health

The Business and Hospitality sectors are significant risk areas for COVID-19 transmission. Tier 4 restrictions implemented in the North East at the end of December 2020 brought about the closure of non-essential retail, personal care and indoor gyms, alongside the hospitality sector, already closed for the previous two months. The Government’s Roadmap sets out plans for the gradual re-opening of these sectors, but critically with emphasis on the continuation of requirements that businesses operate in a COVID-19 - secure manner, with robust strategies in place for managing the risk of transmission and ensuring social-distancing rules are followed.

We are far better equipped at this point in the pandemic, than at any point prior, to manage business-related cases and outbreaks, to provide support and advice to newly reopened settings and to undertake enforcement activity as required:

• Very well-established links with Police colleagues for both pro-active and reactive joint working on COVID-19-secure measures in night-time economy businesses.
• Local Authority / Police joint working initiatives focused on ‘spot-checks’ of retail premises.
• Six newly appointed Business and Community Support Officers will provide business support and a front-line response to business enquiries /complaints, for a minimum six-month period, with the ability to escalate matters to enforcement officers when required. These officers will also help ensure social distancing in key public areas and will support COVID-19 testing and vaccination programmes.
• Closer links between enforcement officers, the Council’s Corporate Lead for Town Centre and Foreshore, the Business Investment team and the Public Health team.
• Two additional Environmental Health Officers have been employed on temporary contracts to help back-fill the roles of officers engaged in outbreak management and the management of COVID-19-cases linked to business premises. A third Environmental Health Officer has been employed for 12 months to support local businesses through re-opening and the recovery phase of the pandemic.
• The LA7 COVID-19 Compliance cell, the North-East Public Protection Partnership (NEPPP) COVID-19 Enforcement Sub-Group and the Legal Officer’s Sub-group have all helped to develop regional consistency on COVID-19 enforcement matters.

Additional resources will enable Environmental Health enforcement officers to focus on the resumption of more BAU activities, whilst continuing to provide outbreak management support as required. As part of the national approach to secure COVID-19 workplace compliance the Health and Safety Executive has offered its support to the Local Authority to carry out spot checks in Local Authority enforced businesses. These premises will include retail, wholesale distribution, warehousing, hotel and catering premises, offices and consumer / leisure services. This piece of work will commence March 2020 and will help to provide further assurance that everything possible is being done to ensure COVID-19 compliance and to minimise the risk of transmission in workplaces.

External Partner outbreak management responses

Police

Northumbria Police will work in partnership with other agencies particularly the Health Protection Agency to mitigate the effect of any current health outbreak. In doing so Northumbria Police will maintain shared situational awareness and understanding between South Tyneside Health Protection Board members and appropriate partners, maintain public-confidence; through active-engagement, providing public reassurance messaging and where appropriate supporting the sharing of warning advice and information provided/published by HPA or other appropriate agencies.

Northumbria Police will also maintain community cohesion; ensuring community tension information/intelligence is being actively gathered and effectively managed and finally when enacted will apply legislation approved by government in a positive and firm way in order to protect the wider population from the spread of any outbreak.

The role of prevention has been further strengthened with Northumbria Police working in partnership with the Environmental Health team. Sone of this work includes utilising key messages, providing guidance advice to businesses, as well as crowd control management.

Healthcare

South Tyneside CCG

The main clinical issues across our hospital environment mainly concerned nosocomial infections and the themes that emerged through root cause analysis processes were also attributable to other settings such as a care homes and primary care. These themes centred around nonadherence by staff groups to social distancing, use of car sharing, and occasional sharing food/beverages whilst at work. Across the health and social care sector infection prevention and control teams were identifying concerns with adherence to PPE guidelines and difficulties in effectively cohorting patient groups with complex needs.

Communication was key, with instances occurring where the Acute Trust were not necessarily aware that admissions were from care/ nursing homes who had previously had COVID-19 outbreaks, resulting in asymptomatic patients being admitted cleaning wards but found to be positive on the admission screen. Themes also emerged regarding poor patient compliance with wearing masks or claiming to be exempt from wearing a mask.

Learning has been shared with the CCG and Local Authority colleagues though established COVID-19 governance processes which informed our local response. Where necessary training was targeted, and clear communications disseminated throughout the south Tyneside health and social care system.

Heightened surveillance was undertaken at NHSE/I level and with the CQC due to the pandemic and this enabled the sharing of key learning and themes both regionally and nationally. From this national guidance was issued and supportive visits carried out to Trusts and other settings experiencing outbreaks.

Nosocomial infections are a leading cause of avoidable harm in hospital patients and a substantial, unnecessary drain on healthcare resources. They pose a serious risk to patients, staff and visitors and can cause significant morbidity to those infected.

Training, education, audit and surveillance are key areas used to mitigate the risk.

Clearer and more timely messages regarding IPC and learning across the region and nation. It is a must to ensure that regional systems are linked in with commissioners at place and working effectively together with openness and transparency.

With a shift of focus to vaccinations the CCG has supported the local vaccine programme with developing an overarching clinical quality framework aimed to help support safe, effective delivery of the programme across South Tyneside. This includes the process to support incident reporting and to learn from any patient safety incidents. There is also a clinical risk register to identify and mitigate clinical risks at an early stage.

North East Health Protection Team

There have been some instances following the use of pillar 1 (and hence local NHS labs) to undertake outbreak testing in care homes of results being delayed or incorrectly assigned to the wrong setting. This has resulted in a potential negative impact on public trust and the reputation of the HPT who co-ordinate outbreak testing. Delays in the receipt of results has the potential to impact on the timeliness of action within a setting e.g. vaccination (where COVID-19 status is awaited) resulting in potential compromise to patient safety. The use of a separate system for outbreak and routine asymptomatic testing also resulted in confusion amongst provider organisations, adversely impacting on their trust.

Where issues with outbreak testing have arisen, these have been investigated internally and with relevant regional stakeholders. Local challenges in using pillar 1 for outbreak testing were also raised with national colleagues.

A national policy decision has now been taken to co-ordinate outbreak testing via pillar 2. Providers have existing mechanisms for utilising pillar 2 testing as a result of the routine asymptomatic testing programme for this setting, mitigating many of the risks identified.

A less complex pathway of testing for care home providers with a single supporting operational system (including a shared information system) for responders.

Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust (CNTW)

As outlined from the start of the pandemic in 2020, COVID-19 outbreaks are structured in line with PHE/NHSEI Guidance for managing Infection Prevention and Control. The outbreak system is a national requirement both inside and outside of the NHS led by Public Health England (PHE). COVID-19 is a communicable disease and therefore fits this category.

• A COVID-19 outbreak is declared when confirmation of more cases of disease than would be expected within a specific place or group of people over a given period. The purpose of outbreak management is to protect public health by identifying the source and implementing control measures to prevent further spread or recurrence of the infection. Outbreak management is an established Infection Control process and was in place within CNTW to manage other infections i.e. D&V, Clostridium difficile and Flu for example prior to the pandemic.

As COVID-19 is a communicable disease, PHE defined COVID-19 related outbreaks as:

• 2 Or more cases defined in time and place within any setting.
• Due to the incubation period, this has been defined as within 14 days and links to all teams that are clinical or non-clinical.
• The outbreak has also been defined for closure as no new cases testing positive linked to the outbreak for 28 clear days.

Nosocomial infection is defined as an infection whose development is favoured by a hospital environment, such as one acquired by a patient during a hospital visit or one developing among hospital staff. On the 9th June, NHS England wrote to all organisations outlining the need to minimise nosocomial infections in the NHS and this outlined the process for the management of outbreaks. Reporting to PHE began in August and a national online outbreak portal managed by NHSE/I has been in place since December 2020.

Both patients and staff testing positive results are counted in the outbreak, and it should be further noted that although we are aiming to reduce nosocomial transmission to our patients, we are also working to ensure staff are protected.

In addition to established DIPC, Infection Prevention and Control Team and IPC policies to manage outbreaks, the Trust developed several structures to support the management of COVID-19 positive patients and staff. There has been an emphasis on learning through this process and this has been formally embedded into the processes from the very beginning. A PGN is in place as part of the IPC policy and this has been adapted to support the pandemic response. Further measures include:

• A central staff absence line to support staff with COVID-19 and non-COVID-19 related activity. This is the first opportunity to support and educate staff. The collection of data via electronic systems and links to ESR enable a real time/at a glance process, which identifies the work locations of staff who are positive. This information is used to flag an area of interest where two or more cases present in a close time frame.
• A patient recording system on RIO has been developed in order that symptomatic patients are recorded and when the PCR results are received. Staff access positive test results confirmed using ICE system. This is populated into a report which shows at a glance data and allows for real time reporting. The IPC team review this data and compare to information we receive regarding staff test results.
• The PCR testing of staff and patients has developed over the course of the pandemic. Staff also undertake Lateral Flow Tests (LFT) which are also recorded in an electronic system.
• The development of the Close Contact Risk Assessment (CCRA) process which is led by a team of senior nurses who have received specific training in order to undertake the role. The team are known as the Absence Nursing team. The team review the staff test results as they are sent from the laboratories to the Trust, undertake CCRA and identify themes of IPC practice that require intervention. This is a further opportunity to support and educate staff and to recognise where further work is a priority.
• Gold Command/IPC team under the leadership of the DIPC coordinate support to undertake 3 levels of outbreak activity. These are described below:
  • Fact Finds - with operational service representatives, IPC, absence Nurses, central reporting team and chaired by a member of Gold Command. This meeting reviews the likelihood of community versus nosocomial transmission. Actions required are coordinated in a plan led by the operational services. The plan will further include staff to isolate and further CCRA required. At this stage the core team are pulling information together and working collaboratively with operational services to understand the service and the environment.
  • Incident Management Group (IMG) - with the same core team, it reviews the information collected through the Fact Find process, CCRA and positive results to explore the connections between cases in more detail. This will enable the team to confirm an outbreak or define it as a cluster of cases linked to community transmission. Once nosocomial connections are confirmed an outbreak is declared. If it is a cluster, the action plan the meetings may continue or transfer to operational services in order that corrective interventions can be delivered and thus reframe IPC practice.
  • Outbreak Meetings - chaired initially by the DIPC, the group works to contain the outbreak by enhancing and adding additional controls, reduce the spread of further transmission and enables the team to learn and embed IPC guidance into everyday practice. Time is built into the process for learning and reflections culminating in a learning debrief held at the point of closure. The outbreak activity is formally shared at the COVID-19 Response Meeting (IMG) which is chaired by the Executive Nurse. The DIPC formally reports to the Trust Board monthly and quarterly through the COVID-19 Board Assurance Framework. The outbreak data is submitted to the national portal. An Executive Director notifies the CQC and CCG.

Prevalence of outbreaks

During August CNTW experienced the first outbreak, and there are currently 12 open outbreaks at the end of January. The outbreaks are reported to the national outbreak portal managed by NHSE/I. Weekly updates are also completed on the national portal to update the prevalence of the outbreak. The most outbreaks managed at any time during the pandemic is 14 as indicated in Appendix 1. In total 34 outbreaks have been declared and on average 8-10 meetings have been held to support each outbreak.

South Tyneside and Sunderland NHS Foundation Trust

There has been significant and ongoing scrutiny from the Health Protection Board and outbreak control boards about nosocomial infections and outbreaks occurring in South Tyneside and Sunderland NHS Foundation Trust (STSFT). The Trust has in place robust outbreak management plans with clear lines of governance that supports the understanding of individual roles, but which also encourages a collaborative approach across South Tyneside.

STSFT have reported varying numbers of outbreaks occurring within clinical and non-clinical areas. As community prevalence of COVID-19 progressively increased across the North East this impacted significantly on hospital admissions and staff cases. When the number of admissions and staff cases reached a point that patient flow is more challenging, then locally and regionally we started to see more outbreaks and more hospital onset cases.

All probable and definite hospital acquired COVID-19 cases at STSFT are reported as incidents and the commissioner notified, and a root cause analysis completed. Where there has been an outbreak the Trust have conducted outbreak, meetings chaired by the Director for Infection, Prevention and Control (DIPC) or lead Microbiologist. All deaths from COVID-19 have a stage 1 and stage 2 mortality review undertaken by a clinician independent from the care provided.

Learning from outbreaks and nosocomial infections have been shared with the health protection board and predominantly related to key themes around screening, social distancing and patient compliance. The Trust implemented several actions to address the key themes such as new infographics around swabbing and timings to reinforce the screening protocol and reduce false positive hospital acquired COVID-19 cases. COVID-19 adherence audit cycles of clinical areas were introduced and the standard protocols for testing were strengthened.

The Regional IPC lead for NHSE conducted a visit to the Trust in December to offer advice and support and reported positive findings.

The above paragraphs outline the current resource to deliver the outbreak management response. This resource needs to be protected or ring-fenced in the future so if we need to stand up arrangements particularly surge capacity to respond to outbreaks including variants of concern. This also applies to those staff supporting the testing, contact tracing and self-isolation support.

In terms of support in responding to surge testing and large-scale outbreaks some regional and national support would be beneficial.

Some initial scoping work has been carried out to identify staffing capacity to support surge testing, several local sites have been identified as potential testing sites and support from the Local Resilience Forum has been agreed to provide rapid response if required.

This revised outbreak plan is seeking assurance from the system that ongoing support is provided to the outbreak management of COVID-19 to ensure there is a resilient response over the next 12-18 months. All partners and agencies will be asked to agree to this.

The Public Health team will be employing on a temporary basis a COVID-19 resilience lead who will provide assurance to the system of the outbreak management response and will step up and step-down arrangements accordingly including surge response.

As BAU becomes the norm current resources will be limited therefore it is important to protect the current staffing and resources so they can be released from BAU to be able to rapidly respond when required. There is some risk in the staffing resource providing the community testing as they may move into more permanent jobs. This will have to be regularly reviewed.

Enduring transmission

We will use the intelligence as well as our local intelligence from the Public Health and Environmental Health teams and others to understand areas where there are possibly concentrated cases where usual interventions are not having a positive impact. We would then need to deploy targeted efforts such as surge testing, community engagement via COVID-19 champions ad targeted communications to assess whether cases could be reduced. We would also consider offering the support provided by the shielding hub to those communities to support self-isolation.

We would look to regional colleagues for support and then call upon national support to help. It is for the Board to consider any further restrictions that might be beneficial to reduce transmission e.g. similar to Tier 3 restrictions. This would be particularly important if a variant of concern was detected that is more transmissible than the current Kent variant.

Cross boundary arrangements

There is a range of regional forums of which regional approaches have been developed and best practice shared:

PHE HP group to raise issues and share learning across areas;

• Public health and health protection group to discuss regional situations and outbreaks
• Children and Young People’s Public Health leads meeting
• Regional Care Home Group
• Director of Public Health meetings
• ICS meeting
• DASS meeting
• Regional enforcement Group
• Local Resilience Forum
• Regional LTP
• Regional testing group
• Regional comms group

These groups will discuss latest guidance, regional position, opportunity to raise any questions or concerns and share local resources and challenges.

Care homes and schools

Care homes

Care homes remain a very high-risk setting for COVID-19 outbreaks as they accommodate and care for people who are particularly vulnerable to the virus by virtue of age and frailty.

At a regional level a joint management document has been developed to agree a consistent set of principles for preventing and managing outbreaks at a regional level between PHE and local authorities. This includes, for example, a consistent approach to testing asymptomatic staff and residents, eg agreeing frequency of asymptomatic testing.

In South Tyneside, there has been a strong network of support available for care homes to prevent and manage outbreaks and this network will continue as we move into the next phase of recovery. Care homes have been supported by a range of partners in the system through a Core Team, including representatives from the Joint Commissioning Unit, Public Health, Infection Prevention and Control and the Clinical Commissioning Group. The Core group have supported homes through the various changes in guidance for testing, visiting and IPC. The core group meet weekly but will instigate urgent meetings when a care home is in an outbreak situation. These meeting are an informal OCT to discuss the data, action to be taken to cohort, initiate whole home testing and outbreak response, and to monitor the management and leadership of the home, and healthcare support for residents and staff.

If an outbreak is declared within a care home with a high number of cases, a setting-specific OCT will be established to assess the outbreak, implement any control measures in conjunction with the care home and review lessons learned. Members of the Care Home Core Team will be involved in individual OCTs as required. Terms of Reference for OCTs can be found in Appendix 1. To date South Tyneside have only had 1 formal OCT for a care home, alternatively the core group has overseen all other outbreaks, with support from HPT direct to the home, and liaison with public health team.

National visiting guidance is in place across care home settings to enable lateral flow assisted close contact visits as well as arrange of other types of visiting e.g. screened rooms, visiting pods outdoor and window etc. All care homes are set up to provide lateral flow assisted visits, however this is an increased risk to introducing the virus into the care home and should be managed as part of their overall risk assessment.

Schools, early years and other educational settings

Schools represent another high-risk area for transmission of COVID-19. In England, education and childcare settings have been open to priority groups (vulnerable children and children of key workers) and are welcoming back a limited number of pupils from certain year groups. Plans to welcome back all primary school children following the latest lockdown is scheduled for the 8th March. Return to school guidance is in place as part of the 4 stage Roadmap outlined by the Government. The return to school has seen the expansion of testing among staff twice a week using Lateral Flow Devices, and the inclusion of secondary school pupils being initially tested onsite, for 3 tests 3-5 days apart. From then in pupils will be encouraged to test at home, with the introduction of a national Community collect model that will provide lateral flow testing for household with early years or school aged children, or those working in associated jobs such as school transport.

A joint management document between PHE and local authorities has been agreed to support the management of outbreaks in schools over the last 12 months, which has been amended to reflect changes in practice such as the introduction of LFT’s, changes to the isolation periods and whether confirmatory PCR’s are required. The joint management protocol is used to support schools with contact tracing and confirming isolation periods and will be referred to in the event of an outbreak.

Schools are currently operating in ‘bubbles’, defined groups of staff and pupils who can only interact with each other. If a positive case is confirmed in a school, as part of the risk assessment it will be assessed whether anyone in the school may have come within 2m of the case, identifying any close contacts that are required to isolate. Template letters have been developed for schools to use with both parents/carers and staff.

In complex situations where cases occur across bubbles a risk assessment will be done in conjunction with the Director of Public Health and if there appears to be sustained transmission across bubbles within a school then there may be a decision to close school however this will usually not be necessary. Decisions to close schools mainly occur due to high levels for staff needing to isolate, which leads to a school initiating their business continuity plans as they do not have enough safe staffing levels to operate the school.

As part of the outbreak management plan we have also engaged with early-years settings, special schools and further education (South Tyneside College). It is particularly important to engage with South Tyneside College as this is attended by a substantial proportion of students from BAME communities. This is important given it has been established that COVID-19 is having a disproportionate impact on BAME communities compared to people who are White British.

The joint management protocols have been implemented and the same guidance and template letters have been used and amended to suit the setting. All cases within school or education setting are routinely reported into the COVID-19 inbox to enable tracking and early intervention to prevent further spread.

High-risk places, locations and communities

Outbreaks may also occur in other settings where it will be more difficult to reduce transmission and where people may be more vulnerable if they are infected by COVID-19. Work is currently underway to identify those locations and communities in South Tyneside which will include, but not be restricted to:

1. Residential and supported living accommodation
2. Sheltered accommodation
3. Special schools
4. Local authority children’s homes
5. Healthcare settings
6. Transport hubs, eg Port of Tyne
7. Workplaces, eg large factories
8. BAME communities
9. Religious congregations – eg mosques
10. Hostels (which support people who are homeless)
11. Substance misuse treatment services

As part of the outbreak management plan we will proactively engage with identified high-risk settings and communities, providing advice and support to prevent outbreaks. If outbreaks are confirmed in any identified high-risk setting then an OCT will be established with appropriate membership.

Several OCTs have been held to support the high-risk settings. Learning from these OCTs have helped pinpoint specific areas or activities that can be addressed to halt cases. Car sharing, various touch points in communal areas in workplaces and schools and staff/employers letting their guard down when in the staff room or not teaching in the classroom have been the main issues to come out of the OCTs. This learning has then been shared with the various settings to help future cases.

Local testing capacity

In order to effectively respond to local outbreaks, it is important that testing capacity is available to provide vital intelligence. A timely and responsive testing system has been established in South Tyneside in response to the COVID-19 pandemic which we will continue to depend on moving forward as restrictions begin to be lifted as part of the Government’s roadmap out of lockdown.

Care home testing has expanded to offer routine testing of both staff and residents via LFT’s and PCR. Staff are tested twice weekly with LFT’s and one PCR, with residents tested every 28 days with PCR. LFT’s are only used for on residents when the home has an active outbreak. If a home reports one positive case in either a resident of staff member the staff carry out daily LFT’s until the home is 5 days clear from the last positive result.

Outbreak testing involves whole home being tested with LFTs and PCR on day 0, again on days 4-7 and day 28. All Testing for care homes is managed via the Government online portal (pillar 2). As part of the roadmap an easing restrictions Care home are also testing designated visitors using LFT’s to enable close contact visiting. All visitors will be required to have an LFT, negative result, and agreeing to wear and comply with PPR and IPC practices. In addition to routine and outbreak testing, all admissions into care homes will be tested prior to admission e.g. from the community or hospital. The only exception to the testing regime is if any resident or staff member tests positive they are advised not to test for 90 days from their positive result.

Regular asymptomatic testing at home via lateral flow devices or PCR is now in place for NHS staff, social care, carers (direct payment employer PAs) and education staff (and students over 11 years old) including colleges, secondary schools, primary schools and maintained nurseries, and will be rolling out via community collect to private nurseries, childminders early years staff plus parents and social/childcare bubbles from March 2021. Community asymptomatic testing at key sites was launched in January 2021, aimed at front line and high-risk workers unable to access testing by other means. This offer continues to be developed to target those unable to access home tests or where it is more convenient to be tested through their workplace/employer.

Where additional testing capacity is required, the deployment of mobile testing units (MTUs) in identified locations has been utilised. Work continues at a regional level to seek consensus on how testing resources could be safely and effectively deployed to support local outbreaks. This will continue to inform our plans at a local level in relation to outbreak management and surge testing if required.

The Department for Health and Social Care have established an Ops Line 24/7 in order to request MTUs: 07814 785 028 or 07821 801 611.

We would be keen to support and inform the national approach to testing though the development of local pilots such as Daily Contact Testing and sharing of learning and good practice around the communication and targeted delivery of asymptomatic testing to key groups and settings.

COVID-19 Safe

Testing and non-testing initiatives to enable the re-opening of social and economic life.

We are keen to explore and contribute to the evidence base around how regular asymptomatic testing can be utilised to support employers and staff around the reopening and ongoing operation of key settings such as the hospitality and retail industries, and how the utilisation of daily contact testing can support business continuity and mitigate against the impact of regular bouts of self-isolation for identified close contacts within workplaces, leading to service delivery and workforce capacity issues.

We are looking to expand the offer of asymptomatic testing to those in the hospitality sector as part of the roadmap so they’re ready to re- open in the spring.

In the initial stage of the pandemic NHS Test and Trace service was managed centrally with PHE conducting contact tracing in complex settings. However, as cases surged capacity within local health protection teams became increasingly stretched, and local authorities were asked to support with contact tracing.

The Public Health team developed a backward contact tracing function in September 2020. Backward contact tracing is a technique based on telephone interviews (standard scripts are used) to identify potential sources of COVID-19 exposure through linking cases based on the events and settings they attended during the period in which they would have contracted the virus. This was function was developed in response to local rising COVID-19 cases.

The team made contact over 500 residents offering them advice, support and detecting settings where outbreaks had and were occurring, mobilising support and helping to identify people who needed to isolate.

The national NHS test and trace programme is expanding and working with local councils to prevent further outbreaks of the COVID-19. This is through the development of Local Tracing Partnerships (LTPs).

A roadmap has been developed by the regional COVid-19 Resource Centre (CRC). On-going discussions are taking place at Director of Public Health level about the long-term direction of contact tracing at a local level. South Tyneside became an operational LTP on the 8th February 2021.

LTPs are an adaptation to the national programme, bringing local knowledge and effort to the NHS test and trace system. One of the challenges is to improve the ‘index case’ completion rate and in doing so enhance the effectiveness of contact tracing and self-isolation. NHS T&T will support each local authority to produce their own LTP model, tailored to suit their geography, resource capacity and caseload.

If the national test and trace team is unable to contact a local resident within 24 hours (failed cases) the local LTP team will follow this up with 2 calls in 24 hours, followed by a text message and email to the resident. The role of the local team is to speak to the individual and gather information about the people they may have infected. This is based on agreed criteria about when they were infectious and how close they were to them and for how long. The call will also provide information on available services and support, which is deemed crucial in helping residents to self-isolate.

Since becoming an LTP we have been able to contact ‘failed’ cases using out local knowledge of our residents, networks and the local area, for example workplaces, schools and community centres, in order to manage outbreaks.

The balance is working well between national/regional and local responsibilities. There is now close working between the integrated COVID-19 hub and South Tyneside’s Local Tracing Partnership. Our LTP is bringing local knowledge and added value to the NHS test and trace system. One of our challenges is to improve the ‘index case’ completion rate and in doing so enhance the effectiveness of contact tracing and self-isolation. We are doing this in close collaboration with the integrated COVID-19 hub. We are using several methods, including local texts, phone numbers and local data and intelligence to reach these cases. NHS T&T and the ICH are supporting the authority to produce our own LTP model, tailored to suit their geography, resource capacity and caseloads.

The main issue for the authority is sustaining our LTP/developments into the future and ensuring we have the capacity to stand up and exit from CT, as the national and local situation demands. The shorter-term issues of staffing and resources is being discussed and a plan developed with the support of NHS Integrated COVID-19 Hub North East. However, councils will need support into the future in order to develop their long-term resilience around contact tracing.

In terms of enhanced contact tracing, we would like to see an ability built into the ITS system to be able to search a neighbouring LAs cases in workplaces. This would give use the ability to identify cases, liaise with other authorities to prevent outbreaks. This would give us the opportunity to better respond and collaborate with our neighbouring LAs. This information is not always available.

Resources such as additional staff for testing and contact tracing is in place, regional insights work and communications at a LA7 to maximise impact and future sustainability of this is being discussed. Existing staff still dedicated to working on the COVID-19 response remains in place across all agencies. The support of the COVID-19 monies to ensure the plan can deployed.

Data integration

Public health intelligence is vital in helping to develop a local picture of new cases and outbreaks. Data on COVID-19 comes from many sources and these will be integrated to provide routine, timely reports for the COVID-19 Leadership Board, COVID-19 Health Protection Board and operational teams. Reports are now also routinely provided to each Health and Wellbeing Board for assurance.

This includes data and intelligence from Public Health England and NHS Digital on confirmed cases and exceedance reports for South Tyneside and across the North East. We will proactively gather local intelligence from the across the council, care homes, schools and elsewhere to identify potential cases and areas concerns.

Regular intelligence briefings are circulated to key partners in line with the COVID-19 Health Protection Board and to the COVID-19 Leadership Board to provide assurance and support direction of our response. This includes analysis of testing, cases, hospital activity and COVID-19 related mortality as well as vaccination roll out drawing on a range of data and intelligence sources. This is supplemented by intelligence provide by our partners and through our COVID-19 inbox. Additional in-depth analysis is provided on request or in response to questions generated by partners and members of the COVID-19 Health Protection Board

Data captured in the PowerBi is useful but often two days out of date so to do ay proactive follow-up is limited.

Sharing across local authority areas is inconsistent and is often determined or led by large scale outbreaks affecting residents from various localities. There is no thematic analysis to benchmark your local area in comparison to your neighbour for those high-risk settings as there is for the total population.

Vulnerable people

Support to self-isolate

Self-isolation for COVID-19 cases and their contacts is a big ask, and some people will need additional support to be able to do this in the event of further outbreaks. We will build on the arrangements developed in the South Tyneside COVID-19 Shielding Support Hub, which was established in the early stages of the pandemic, to support those who are clinically extremely vulnerable who have no other means of support, for example providing wellbeing checks and deliveries of food and essential medication. From 1st August 2020, a ‘stand-up’ COVID-19 Shielding Support Hub function and action plan will remain in place to respond to clinically extremely vulnerable clients and those self-isolating with no other forms of support, in the event of any future second wave or local outbreak.

It is recognised that some individuals may encounter financial hardship as a result of self-isolation which risks non-compliance with isolation measures. We will signpost individuals to relevant sources of support through our communications plan.

The Welfare Support team has been delivering self-Isolation support payments since October 2020. We have an online portal for applications which we have tailored as time has gone on to focus on what applicants are telling us. Areas where we have developed communication have been around evidence that will need to be uploaded, timescales for applications and further emphasis on the criteria – this has predominantly been on the Council’s website and the actual guidance tabs when making an application.

We don’t have evidence to suggest that local employers are not supporting those who are having to self-isolate – most are paying a level of sick pay to applicants who are having to self-isolate. What has been useful are publications for example for the retail sector where they list all the retailers and how they pay staff having to self-isolate.

Unfortunately, we do not offer emotional support to those applying for T&T self-isolation support. In terms of practical support, we will link those who are self-isolating in with the Shielding Hub, and other areas offering financial support such as the COVID-19 Hardship Fund.

Regionally we identified a potential gap in the self-isolation payment where a parent is required to isolate due to a child isolating and they are not eligible at this present time for the payment but have no other childcare options to allow them to go to work. In that circumstance it would be beneficial to extend the self-isolation payment criteria to those who find themselves in that situation.

Some of the biggest delays are individuals being able to upload the relevant information to process their payment which in turn can delay their process of the payment. On average people are paid within three days although where the end to end process has been swift. The current national scheme needs to be simplified and people asked to isolate need to get access to support payments more quickly. Currently, there are too many people struggling to isolate, due to not being eligible for either schemes. The government should consider how support can be expanded for those without workplace sick pay and ensuring the national and local schemes have expanded access and resources to match.

Supporting high-risk and diverse communities

A number of sessions were held with key members of the community to share the outbreak management plan and the response, highlighting the roles of the teams within the plan, and key points of contact such as the COVID-19 Mailbox supported by the Public Health team, the role of the Health Protection Team, Environmental Health and comms Bespoke comms materials were provided to ensure cultural and language barriers were addressed and information about COVID-19, including when to test and when to isolate were available. Support was provided to ensure any community events such as Ede, and other religious gatherings were reviewed, and public health advice given to ensure COVID-19 secure measure were in place and adhered to.

Planning to do further work with the BAME community via the COVID-19 champions. This would mean that if surge testing was needed the COVID-19 champions would be able to support our BAME communities.

South Tyneside was successful in securing additional funding to recruit COVID-19 community champions. Please see Appendix 2.

Vaccination Programme

The Roll out of the COVID-19 Vaccination programme has been a huge component of the response and reducing the transmission and the severity of the illness. A COVID-19 Vaccine working group was established to focus on the operational issues to the roll out of the programme. This subgroup reports in the Vaccination Board. The collective effort to roll out the programme has been critical to the number of people vaccinated. Staff and resources have been made available to ensure clinics are operational, as well as utilising local pharmacists to deliver housebound vaccinations, enabling a site clinic and outreach service to run in parallel. However, staff time and enthusiasm to get the programme delivered has been and remains impeccable.

In addition to the operational group, a health inclusion subgroup has also been established to ensure the programme is addressing health inequalities. The health inclusion group are focussing on monitoring uptake of the vaccine in those most at risk of the vaccine and those least likely to access it. A dashboard will be shared with the group to identify where targeted interventions need to occur, and to monitor effectiveness of those. In addition to this a comms and engagement element of the work programme will be supported by COVID-19 champions and our third sector organisations, to ensure the voice of the community is incorporated into any approach taken. The final element is how to support access to the vaccine, either via the local primary care networks or mass vaccination centres, or where accessibility is challenging an outreach service will be offered.

The work of the health inclusion group will also report in the regional vaccine and inequalities groups, to share good practice and to identify solution to improving uptake among certain groups.

The programme could have been helped further if local data could have been accessed from the beginning of the roll out, so active monitoring of uptake and any inequalities could have been captured earlier.

We currently have no evidence of any groups struggling to access the vaccine, however as part of the health inclusion group we are undertaking an engagement exercise to see if there are any access issues, so these can be addressed. Healthwatch South Tyneside are also carrying out a survey with people who have accessed the vaccine to understand their experiences to see if anything can be improved.

National and regional comms have been useful in targeting certain groups, and these will be utilised to ensure those not accessing the vaccine as well as their peers e.g. Black and Asian ethnic minorities, men and those living in the most deprived areas.

Governance and local boards

The development and delivery of local outbreak management plans is complex involving many partners across the system, including the public. Robust governance arrangements and timely and clear communications will be key.

The establishment of governance structures to oversee local outbreak management plans is outlined in Appendix 3. Guiding Principles.

Communicating effectively with internal and external stakeholders, including the public, will play a crucial role in the success of our outbreak management plan. A detailed communications plan has been developed, detailing what needs to be communicated at an operational and strategic level and where we will share proactive as well as reactive messaging to prevent outbreaks in high-risk settings. This is constantly reviewed as new campaigns, resources and assets are released.

Good Practice, risks, issues and opportunities

The Public Health team are utilising the COVID-19 Outbreak management fund to employ additional capacity within the Public Health team but to also support the whole system. This will be a 12-month post who will co-ordinate the COVID-19 outbreak management plan. This will be reviewed with options to extend or subsume into the Public Health team.

Regionally and nationally it was acknowledged that specialist infection prevention and control nurses were a limited workforce commodity with recruitment being made more difficult during the pandemic with CCGs, LAs and providers all fishing from the same pond.

The local acute and Community Trust and CCG were monitoring the IPC workforce situation with agencies, NHS professionals and brought back staff cohorts to see if further staff could be identified to support IPC delivery across South Tyneside but were unsuccessful beyond the appointment of the current team.

Across Cumbria and North East an exercise has been undertaken to understand current IPC resources, challenges faced by IPC teams, gaps in or risks to, IPC provision, and how those working in IPC feel these resources could be made more robust. This exercise led by Chris Piercy, Director of Nursing at Newcastle Gateshead CCG, aims to produce a list of recommendations for optimal resource use and reduction of risk to resources, in order to strengthen the IPC response across the region for the future.

What has worked well generally that you will look to maintain?

• Collaborative working between partners has been a key strength and sharing any learning such as how the various organisations prevent, respond to and manage outbreaks has helped ensure a real joined up approach across the borough. This approach is being used in our recovery plans going forwards. It will also help to inform future planning around Flu especially when working with healthcare partners.
• The daily stand up meetings between Public Health and Environmental Health to share any information and intelligence worked well and strengthened relationships between the services but also ensured that resources were targeted in the right places. This forum enabled earlier intervention rather than relying on the intelligence from the SPOC which sometimes was a few days out of date. As a result of this, actions were taken from the meeting and acted upon immediately and feedback was given the following day, as outbreaks and cases decreased the frequency of these meetings reduced to reflect demand.
• Targeted communications were developed to specifically support business to be COVID-19 safe. This resulted in action cards, latest guidance and points of contacts for Environmental Health and Public Health teams via their COVID-19 inbox arrangements.
• To support these self-isolating a text message is sent to everybody who tests positive thanking them for isolating in order to try to halt the onward transmission and to share with them a range of support available in the borough should they need to access it.
• In addition to the national shielding letters that went out the shielding hub provided additional information to everyone on the shielded patient list outlining local support available.
• As part of the asymptomatic testing and provision for early years practitioners and childminders an out of hours testing session has been provided to enable them to access LFTs. This has been received well by the sector and will be reviewed and could be extended to other workplaces or settings who would benefit from an out of hours session.
• Targeting of front-line workers via community (workplace-based) asymptomatic testing sites, plus out of hours support for key groups (prior to home testing kit roll out).

What areas most critical to the response have worked best and why?

• Working at a regional level has been crucial to the response especially in relation to communications as it’s allowed us to have consistent messages across the region. We have benefitted financially to work with the behavioural insights agency to target messaging in the right way and ensuring a collective community effort, for example the Drummond campaign.

What factors could impact the ability to deliver the LOMP and how are any risks being mitigated?

• The continued demand put upon teams and agencies to respond while also trying to deliver business as usual. The support from the COVID-19 Leadership Board so that all the strategic leaders are committing to provide that response in line with the plan, so we know what we need to stand up in line with the circumstances including the additional post being implemented.

Was the plan deployed as designed and if not why not?

• The governance arrangements of outbreak control meetings for high-risk settings was not deployed in the way the plan has intended for a variety of reasons e.g. health protection leadership, pressures on staffing resource and capacity to manage multiple outbreaks, high rates of transmission and alternative governance arrangements. Such as the Care Home Core Group and the stand-up arrangements between PH and EH based on information shared. Service leads and members were briefed as and when rather than through a formal OCT and outcomes of each OCT were shared with HP Board and the COVID-19 Leadership Board.
• The involvement of the outbreaks that occurred in the hospital could be improved along with the other OCT meetings held for the other high-risk settings to ensure PH measures are put in place, transmission is contained, and lessons are learned.

Were there gaps in the plan and are they resolved?

• We’ve addressed gaps constantly as we’ve gone along and reviewed membership at the Board and brought people in - more recently this has included COVID-19 champions and oversight of the self-isolation payment. Identifying a Trust representative to attend the HP Board would be useful. This could be beneficial if it was an ICP lead or emergency planning lead.

What national initiatives have not been helpful?

• The timing in advance notice of national initiatives could be improved so areas can prepare and able to respond in a timely way. Eat Out to Help Out scheme and Christmas mixing had an adverse affect on our case rates.
• Lack of upfront comms and enough notice regarding changes to asymptomatic testing guidelines and clinical SOPs, changes to guidelines for education settings and late changes to community collect eligibility etc has not been helpful.

What aspects of national, regional and local response if started/stopped/changed would have the most significant impact on local response effectiveness?

• A national focus on recruitment and training like retired NHS employees to repatriate to build capacity across the key services e.g. EH, PH and Police would strengthen the response and increase capacity to be able to respond and deliver business as usual. This would prevent burnout of staff and protect the workforce.
• Need clarification re: evidence and timescales for reintroduction of confirmatory PCR tests for community asymptomatic testing. How rapid LFTs can be utilised to enable the reopening and safe operation of large events/hospitality etc.

Are there links to asymptomatic testing and the road out of lockdown which need to be clearer/better supported?

• As above plus clarification on evidence base re: use of regular LFTs to reduce/end self-isolation (daily contact testing) to aid business continuity within critical services.

Management of the impacts of the resumption of BAU activities and or the end of temporary contracts

Do you have sufficient local capacity to deliver on all aspects of your local outbreak management plan

As lockdown eases and we begin to recover from the impact of COVID-19, capacity currently focussed on COVID-19 response will be drawn back into normal day to day work, which will impact on the availability of resources and therefore difficult to maintain the same level of support. Therefore, resources will need to be proportionate to the level of risk, which will be stepped up and down accordingly,

Is the local system response to the pandemic you have developed resilient for the future?

The local response works well, but agreement of stand-up arrangements needs to be agreed formally to ensure should the local response need to be mobilised that we have commitment from all partners and agencies to respond. Public Health will be establishing a COVID-19 resilience lead role on a temporary basis who will provide that overall management of the response, initiating stand up and down arrangements.

There are many challenges ahead as we try to return life more to normal while keeping our local community safe and well. It is important that as we move forward in this fast-paced environment that we remain pragmatic but reflective to ensure we take lessons on board and adapt our plans accordingly. This plan should be a “live” document that is adapted in line with the circumstances in which we find ourselves to ensure it is fit-for-purpose. As we now have the Government roadmap to take us out of lockdown and towards a future with limited or no legal restrictions, it is timely to update our outbreak response plan. The plan should ensure existing measures continue such as access to testing, contact tracing and comms to reinforce messages with residents.

Therefore, the plan has been updated to reflect current and future arrangements of the outbreak plan response for South Tyneside. The plan will be sign off by the Leadership Board and monitored regularly.