thock urr covid-19 loal c ou keatbr mant emenga plan
TRANSCRIPT
Thurrock COVID-19 Local Outbreak
Management Plan
March 2021
v 1.9
Authors: Dr Jo Broadbent, Director Public HealthRebecca Lawrence, Senior Programme Manager Public HealthElozona Umeh, Senior Programme Manager Public Health
The following members of Thurrock Council’s Public Health Team have contributed to the production of this COVID-19 Outbreak Control Refresh Plan
• Helen Forster - Strategic Lead Public Health – Health Improvement
• Kevin Malone – Public Health Programme Manager
• Lorraine Surrey – Senior Project Manager
• Maria Payne – Strategic Lead – Public Mental Health and Adult Mental Health Transformation
• Phil Gregory – Senior Public Health Intelligence Manager
• Scott Morrow – Senior Communications Officer
• Shirley Oram – Protocol Manager
• Tina Lincoln – Contact Tracing Service Manager
• Noor Shaikh – Senior Contact Tracer
• Catherine Mahoney – Senior Contact Tracer
Acknowledgements
2
Abbreviations
3
A&E – Accident and Emergency
ASC - Adult Social Care
BAME – Black, Asian, and Minority Ethnic
C19 – COVID-19
CCG – Clinical Commissioning Group
CIMT – Clinical Incident Management Team
COBR – Cabinet Office Briefing Rooms
CQC – Care Quality Commission
DHSC – Department of Health and Social Care
DPH – Director of Public Health
DsPH – Directors of Public Health
DASS – Director of Adult Social Services
EHO – Environmental Health Officer
EHT – Environmental Health Teams
EOE – East of England
EPUT - Essex Partnership University
Foundation Trust
GP - General Practitioners
HCP – Health & Care Partnership (Mid
& South Essex))
HPT – Health Protection Team
IMT – Integrated Management Team
JCVI - Joint Committee on Vaccination
and Immunisation
LA – Local Authority
LOCP - Local Outbreak Control Plan
MSE - Mid and South Essex
MTU – Mobile Testing Unit
NELFT –North East London NHS
Foundation Trust
NHS – National Health Service
PCN – Primary Care Network
PH – Public Health
PHE – Public Health England
PHEC – Public Health East of
England Centre
TCCA – Thurrock Covid
Community Action
TCG – Tactical Co-ordination
Group
TLOCC – Thurrock Local
Outbreak Control Centre
ToR – Terms of Reference
VAM – Variants and Mutations
VoC Variants of Concerns
1. Introduction and Background
1.1 Purpose of an Outbreak Control Plan
2. Aims, Objectives and Principles
2.1 Aims, Objectives and Purpose
2.2 Underlying Principles of the Thurrock Approach
3. Partnership Relationships
3.1 National, Regional and Local Architecture
3.2 Essex Strategic Control Group for COVID-19
3.3 Overview of Roles and Responsibilities of Key Partners
4. Thurrock COVID-19 Prevention and Management Architecture and Governance
4.1 Thurrock COVID-19 Prevention and Control System Architecture
4.2 Thurrock COVID-19 Governance
4.3 Thurrock COVID-19 Summary of Functions of System Architecture
5. Thurrock Operating Model
5.1 Thurrock Operating Model overview
5.2 Thurrock Operating Model Capacity and Function
5.3 Thurrock Operating Model Demand
5.4 Thurrock Operating Model Structure
5.5 Thurrock operating Model Outbreak management Process
5.6 Outbreak Prevention
5.7 Surveillance
Contents
5. Thurrock Operating Model (cont.)
5.8 Surveillance Lessons Learnt
5.9 Communication and Engagement
5.10 Thurrock Testing Strategy
5.11 Thurrock Testing Sites
5.12 Thurrock Testing Programme
5.13 Thurrock Test and Trace
5.14 Thurrock Test and Trace lesson Learnt
5.15 Thurrock Test and Trace Local 0
5.16 Thurrock Test and Trace Case Studies
5.17 Variant, Mutations and Enduring Transmission
5.18 Thurrock Test and Trace Supporting Vulnerable Communities
6. Prevention and Management
6.1 Overview
6.2 Vaccine Programme
6.3 Outbreak Management Hubs
6.4 Businesses and Workplaces
6.5 Care Settings
6.6 Vulnerable Communities and High Risk Communities
6.7 School and Early years
7. Finance4
Introduction
This Outbreak Control Plan sets out a local strategy prevent and control COVID-19 in Thurrockmoving forward and enable return to normal life and the economy as safe as possible.
The original Local Outbreak Plan (LOP) was published in June 2020. Following implementation, wehave learnt more about COVID-19 during the last nine months. It is becoming clearer that noteveryone within the population is equally susceptible, equally at risk or has an equal risk oftransmitting the virus if they do become infected. For example, there is now clear evidence thatchildren and young people are at significantly lower risk of complications from COVID-19 and maybe less likely than adults to transmit the virus if infected.
This is the second Local Outbreak Control Plan for Thurrock. It comes as the Government hasannounced a Roadmap out of Lockdown which has been published in February 2021)https://www.gov.uk/government/publications/covid-19-response-spring-2021/covid-19-response-spring-2021-summary , describing four key stages all impacting on sectors at varying degrees.
Step 1 - 8th and 29th March 2021
Step 2 – not before the 12th April
Step 3 – not before 17th May
Step 4 – not before 21st June
This plan sets out how we can collaboratively work together to live, work and operate within aCOVID-19 environment. Although variants of concerns still pose a risk to the this plan, vaccinedeployment programme continues to be a success. There is well established evidence that thelicenced vaccines in the UK are sufficiently effective in reducing hospitalisations and deaths inthose vaccinated and as such will contribute to managing infection rates so as not risk a surge inhospitalisation which would put pressure on the NHS.
The initial stage (8th March) signals the commencement of schools returning and care homesaccepting visitors in the home with a further gradual introduction of business and activities andtravel across 3 months. The government has made it clear that each stage, decision will be drivenby data and the evidence that hospital activity and mortality is continuously decreasing.
1. Introduction and Background
Background
On 22 May 2020, the UK Government announced its expectation that every top tier local authority would create aLocal Outbreak Control Plan by the end of June 2020.
Local Outbreak Control Plans are required set out measures across seven key themes:
1. Planning for local outbreaks in care homes
2. Identifying and managing outbreaks in high risk places, locations and communities
3. Identifying methods for local testing capacity
4. Contact tracing in complex settings
5. National and local data integration including local surveillance and monitoring of outbreaks
6. Supporting vulnerable local people to self-isolate
7. Establishing governance structures including a local DPH led Health Protection Board and elected memberled Engagement Board
Outbreak Control Refresh
Whilst the seven key themes remain in place for the Local Outbreak Control Plan, there are additional areas thathave been highlighted in the refresh plan. These include actions to relevant to address the following;
• Responding to Variants of Concern (VOC)
• Action on enduring transmission
• Enhanced Contact Tracing, in partnership with HPT
• Ongoing role of Non-Pharmaceutical Interventions (NPIs)
• Interface with vaccines roll out
• Activities to enable ‘living with COVID’ (COVID secure)
Thurrock Council was awarded a central government grant to develop and implement the current Local OutbreakControl Plan, including establishing and identifying local testing and contact tracing arrangements.
A prolonged period of lockdown risks long term economic damage and a resulting reduction in taxation base. Bothof these factors present a significant long term risk to health and wellbeing and of widening existing healthinequalities.
It is vital for the health of our population that we are able to relax the current lock down restrictions to allow asmany essential health, care and wider wellbeing 5
6
Figure 1: Map of Thurrock
Thurrock is located on the north bank of the River Thames immediately to the east of London. It has excellent transport links with London, the rest of the UK andEurope by road – via the M25 and A13 corridors – rail, river and air. It is part of the London commuter belt and an area of regeneration within the Thames Gatewayredevelopment zone. Thurrock covers 165 square kilometers and includes 18 miles of riverfront. The larger towns are Corringham, Grays, Purfleet, Stanford-le-Hopeand Tilbury, yet Thurrock is 70% greenbelt with rural villages such as Bulphan, Orsett and Horndon on the Hill.
PopulationThurrock has a growing and increasingly diverse population. The 2019 mid year population estimate for the Borough was approximately 174,000 individuals. This figure is projected to increase to 190,000 by 2029 and 205,000 by 2043. Whilst an estimated 77% of the Borough’s residents identify as White British. 9% of Thurrock’s residents identify as Black/African/Caribbean/Black British – a figure over twice the national average.
Local population estimates and projections are updated periodically by ONS. For the latest Thurrock population information go to: NOMIS: local authority profile for Thurrock or ONS: Population estimates for UK, England and Wales, Scotland and Northern Ireland.
Thurrock also has a relatively young population when compared to the national average. Approximately 15% of the population are aged under 10 years old, compared to a national average of 12%. Furthermore 28% of the population are aged under 20 years old, compared with the national figure of 24%. As would be expected Thurrock therefore has a smaller proportion of older residents, particularly those aged 70+. Only 10% of the resident population fall into this group, compared with a national average of 14%.
Diversity in socio-economic status is also evident in the Borough with a large degree of geographic variation evident. Deprivation in some areas of Thurrock places those communities in the worst 10% of areas nationally, whilst other areas within Thurrock are amongst some of the country’s more affluent. This disparity within the Borough plays a key role in health and wellbeing outcomes and informs local strategic decision making.
1. Introduction and Background
Test
Contain
TraceEnable
An integrated and world-class Covid-19 Test and Trace service, designed to control the virus and enable people to live a safer and more normal life
Underpinned by a huge public engagement exercise to build trust and participation
Rapid testing, at scale, to identify and treat those with the virus
Integrated tracing to identify, alert and support those who need to self isolate
Identify outbreaks using testing and other data and contain locally and minimize spread
Use knowledge of the virus to inform decisions on social and economic restrictions
Te
stT
race
Co
nta
inE
na
ble
Continuous data capture and information loop at each stage that flows through Joint Biosecurity Centre to recommend actions
The UK Government set out four key strands to the national approach in England to controlling COVID-19: Test, trace, contain, and enable. The intention is for this to form a continuous data capture and information loop at each stage, with intelligence following through a new arms length government body - the Joint Biosecurity Centre, that will recommend further actions. Local planning and response will be key to the success of the system, with local government having a key role to play in the identification and management of COVID-19 to contain its spread and infection. This plan outlines how Thurrock Council in collaboration with wider stakeholders and our residents will deliver this.
1.1 Purpose of an Outbreak Control Plan
7
Section 2:
Aims, Objectives and Principles
AIM:
• To prevent and control the spread of COVID-19 in Thurrock, minimising the number of deaths whilst reopening as much of the economy as possible to mitigate public health harms caused by lockdown
• To enable an exit from the Pandemic Phase of transmission and to enter and sustain a phase of endemic transmission which is as low as achievable until the disease is either eradicable or no longer of major public health significance
OBJECTIVES:1. Receive, review and analyse surveillance data to build an on-going picture of the
local epidemic and identify new outbreaks in settings or localities
2. Prevent outbreaks from occurring by providing setting specific advice and high quality communication to our residents to reduce risk of transmission
3. Where outbreaks do occur, provide a rapid and coordinated response to contain the outbreak, test suspected cases, isolate contacts and prevent wider transmission
4. To work in collaboration with health and social care partners to ensure all residents have access to vaccinations and information and guidance regarding the vaccination programme.
.1 Aim and Objectives of this COVID-19 Outbreak Control PlanPURPOSE OF THIS PLAN• Define the local governance structures for the identification and management of COVID-19 outbreaks in
Thurrock and how these interface with wider structures across Essex and the East of England.
• Define the roles and responsibilities of different stakeholder organisations in the prevention and management of COVID-19 in Thurrock
• Describe local surveillance functions in Thurrock to map local epidemiology and how we will identify new outbreaks
• Specify local arrangements to ensure timely testing of COVID-19 to support efforts to arrest the spread of COVID-19
• Specify outbreak management protocols for preventing and COVID-19 outbreaks in different settings and other high risk places
• Describe local contact tracing capability, procedures and how these link to NHS Test and Trace
• Describe arrangements for supporting vulnerable people who need to quarantine as contacts of a case
• Outline the communication and engagement work needed to ensure that this plan is successful
• Identify the resources needed to deliver our COVID-19 outbreak control response
• Summarise key risks, planning assumptions and considerations that underpin planning and response arrangements to COVID-19 in Thurrock
• Work in partnership with communities, businesses, the third sector and service providers to reduce the risk of transmission
• To protect populations and communities most vulnerable to the impact of COVID-19 including; prevention, ensuring access to and uptake of vaccinations, providing easy self-isolation support, early intervention to avoid enduring transmission
• Define the Thurrock Testing Strategy
• Evidence vaccination programme and how inequalities are being addressed
• To actively monitor for variants of the virus including a description of the plans in place to respond to contain or suppress variants.
2.1 Aims and Objectives of this Outbreak Control Plan
9
10
1
• We will provide regular communication on COVID-19 to our residents to help them minimise the risk of becoming infected
• We will deliver setting-specific communication and advice to different settings to allow them to reopen safely including support to develop risk assessments
• We will provide setting-specific advice and guidance on Infection Prevention and Control
• We will deliver pro-active testing to groups identified by surveillance
PREVENT OUTBREAKS
BEFORE THEY OCCUR
3
• We will develop and review dedicated outbreak control protocols for specific high risk settings
• We will provide multi-agency setting based outbreak support and management
• We will ensure enhanced and on-going testing in outbreak situations to identify and support management of outbreak and know when it is contained
• We will seek to rapidly identify all contacts of confirmed COVID-19 cases and provide advice and support to allow them to self-isolate to prevent further spread
• We will provide enhanced test and trace capacity when needed
MANAGE
OUTBREAKS
EFFECTIVELY
6
• We will implement a high quality surveillance function that triangulates a wide range of different metrics to describe and map the local epidemic, identify local outbreaks and describes, reviews and responds to risk
• Will regular cross reference and adapt our plan in line with the emerging COVID-19 evidence base
• We will ensure that all protocols and advice is based on the best published evidence and local intelligence
INTELLIGENCE AND
EVIDENCE DRIVEN
4
• We recognize that some communities and individuals are at higher risk of infection and at increased risk of serious health consequences if they become infected
• We will deliver a system of proportional universalism to ensure that all individuals get the right level of support required to help them stay well and where necessary to quarantine rather than a ‘one size fits all’ approach
• We will ensure that there is equality in accessing vaccines and that myths surrounding the vaccine are addressed with all groups
ADDRESS
INEQUALITY
2DETECT CASES
AND
OUTBREAKS
EARLY
• We will ensure a rapid response to suspected outbreaks
• We will deliver proactive PCR and LFD testing
• We will ensure rapid access to diagnostic testing and results in outbreak situations
• We will deliver Local 0 contact tracing and use proactive surveillance to identify clusters of cases and ensure swift follow up
• We will ensure clear and straight forward reporting mechanisms to allow every resident to report suspected cases easily
• We will work closely with PHE HPT to identify variants and issues surrounding these
5WHOLE SYSTEM &
PARTNERSHIP
WORKING
• Prevention and management of COVID-19 is the responsibility of everyone, not simply a “Public Health” function
• We will coordinate whole systems action across a wide range of stakeholders, led by a multi-disciplinary Health Protection Board
• We will work in collaboration with communities, businesses and the third sector to deliver this plan
7MITIGATE RISKS
OF LOCKDOWN
• We recognise that lock down itself presents a serious risk to public health due to social isolation, withdrawal or reduction of critical public services, damage to the economy, and from a reduced taxation base that can be used to fund future public services.
• We will seek to mitigate and balance this risk against the risk of COVID-19 by regularly reviewing restrictions and seeking to find ways to re-open as much of economy as possible where it is safe to do so.
• We will work within Government guidelines and best practice to ensure the return to business as usual is safe and controlled for all residents
2.2 Underlying Principles of the Thurrock Approach
11
Section 3:
Partnership Relationships and Responsibilities
123.1 National, Regional and Local Organisational Architecture
Figure 2 shows the organisational architecture of Outbreak Control and NHS Test and Trace at a national, regional and local level. Nationally, the Joint Biosecurity Centre, together with a PHE Incident Coordinating Centre is responsible for NHS Test and Trace. Regionally, a PHE regional Incident Coordinating Centre and Regional Hub/Oversight Group is responsible for the programme.
At Thurrock level Test and Trace responsibilities are shared jointly between PHE Health Protection Teams and Thurrock Council. Responsibility for the programme sits with a DPH led Thurrock COVID-19 Health Protection Board and member led Engagement Board.
Figure 2
13
LEVEL 3
ABILITY
REINFORCEMENT
3.2 Partnership Relationships: Essex Strategic Control Group
The Outbreak Control response needs to be a multi-agency response rather than something that is “public health” narrowly defined. Stakeholders from across all sectors are involved in the surveillance, prevention and management of outbreaks.
The involvement of stakeholders depends on the setting or geography of the outbreak and its extent and severity. Outbreaks in specific settings or localised outbreaks are managed at Thurrock level. However, should these spill out into wider spread community transmission over a wider geography or where increased transmission translates into demand that threatens to overwhelm the capacity of critical public sector infrastructure like hospitals, outbreak management may need to take place on a Mid and South Essex or Essex footprint, with coordination via the Essex COVID-19 Strategic Response.
The Surveillance Section of this plan and settings protocols sets out how we will manage these issues and defines different levels of outbreak and how we will communicate these to the Strategic Control Group (SCG) through the Health Protection Board and COP. Outbreaks that are wider than Thurrock will be escalated to the SCG who will be responsible for management.
Figure 3 shows how the Thurrock Health Protection and member-led Engagement Board and wider Thurrock Test, Track, Contain and Enable programme interfaces with the Essex Resilience Forum, tactical groups and recovery arrangements.
Figure 3
Strategic Coordination Group (SCG)
3.3 Overview of Roles and Responsibilities of Key Partners
14
Managing outbreaks is very dynamic. The overarching aim is to empower local decision-makers to act at the earliest stagefor local incidents, and ensure swift national support is readily accessible where needed.
Ministers are accountable nationally, and for oversight and intervention where necessary.
Locally, Directors of Public Health (DPH) are accountable for controlling local outbreaks, working with Public HealthEngland (PHE) and local health protection boards, supported with resource deployment by local ‘gold’ structures led bycouncil chief executives, and local boards to communicate and engage with communities led by council leaders.
Six principles support effective implementation of an integrated national and local system:
• The primary responsibility is to make the public safe• Build on public health expertise and use a systems approach• Be open with data and insight so everyone can protect themselves and others• Build consensus between decision-makers to secure trust, confidence and consent• Follow well-established emergency management principles• Consider equality, economic, social and health-related impacts of decisions
THURROCK COUNCIL (cont.)
• Through the Strategic Lead and DPH, provide a single point of access for communication with the Council on matters relating to the reactive and responsive outbreak management response, as well as out of hours contact.
• Through TLOCC Lead and the DPH, establish regular proactive meetingswith ‘link’ PHE colleagues to discuss complex outbreaks, local intelligence,alongside enquiries being managed by local authorities, alongside widerissues/opportunities. This may be at both local and sub-regionalfootprints.
• Underpinning this work will be a need to rapidly work jointly with PHE ona workforce plan to ensure capacity in the system for delivery of theabove.
• Under the Care Act 2014 have responsibilities to safeguard adults inThurrock including provision of support and personal care (as opposed totreatment) to meet needs arising from illness, disability or old age
3.3 Overview of Roles and Responsibilities of Thurrock Key Partners
THURROCK COUNCIL :
• Under the Health and Social Care Act 2012, Directors of Public Health in upper tierand unitary local authorities have a duty to prepare for and lead the local authority(LA) public health response to incidents that present a threat to the public’s health.
• To address outbreaks of COVID-19 - UTLAs will have powers (under Health Protection(Coronavirus, Restrictions) (England) (No. 3) Regulations 2020) to close individualpremises, public outdoor places and prevent specific events. (UTLAs will no longerhave to make representations to a magistrate in order to close a premises)
• Through the Director of Public Health, the Local Authority must notify the Secretaryof State if a premises is to be closed as soon as reasonably practicable after thedirection is given.
• A review of the direction should happen no more than every seven days.
• Under mutual aid arrangements, this collaborative arrangement creates a sharedresponsibility between the Thurrock Council through the Director of Public Health,and PHE East of England and Essex Health Protection Team to manage with COVID-19outbreaks.
• Through the DPH, continue with wider proactive and preventative work withparticular settings and communities in order to minimise the risk ofoutbreaks/clusters of cases including leading communication to residents and settingson COVID-19 including support in reviewing and advising on COVID-19 riskassessments.
• Through the DPH and the Strategic Lead for The Local Operating Control Centre, workwith PHE to support complex cases and outbreak management (in a range ofsettings/communities), looking to mobilise/re-purpose existing capacity within publichealth, environmental health, trading standards, infection control, education, as wellas wider professional workforces as appropriate (school nursing, health visiting, TBnursing and sexual health services, academia).
15
PUBLIC HEALTH ENGLAND:
• Has responsibility for protecting the health of the population and providing an integratedapproach to protecting public health through close working with the NHS, Thurrock Council,emergency services, and government agencies. This includes specialist advice and supportrelated to management of outbreaks and incidents of infectious diseases.
• Collect basic information on cases, incidents and outbreaks reported to the HPT
• Provide initial infection control advice to the setting
• Inform the LA of the case(s)/ incident/ outbreak/ issue reported to the HPT in an emailto the LA Single Point of Contact (SPOC), and a phone call for urgent issues
• Hand over the responsibility for managing the incident/issue to the LA, exceptincidents in GPs, dental practices and private healthcare (see separate section forthese settings)
• Provide health protection expert advice to the Incident Management Team (IMT),when requested IMT requests should be send to [email protected]
• Provide ongoing support to the LA for identification and management of clusters andoutbreaks, including attendance at regular LA meetings, e.g., Surveillance meetings
• Variants and Mutations (VAM)-
• Notify the LA of a case of VAM via an email to the SPOC email address, DPH will alsobe notified/copied in the email
• Inform LA of cases who have not engaged with the HPT after 24 hours of initial contact
• Discuss the need for surge testing and an IMT.
• Provide advice on the interpretation and implementation of national guidance byemail or telephone, as requested
• The SPOC for PHE is [email protected] or 0300 303 8537.
.
3.3 Overview of Roles and Responsibilities of Thurrock Key Partners
National Government:
• Ministers have powers to take action against specific premises, placesand events
• Ministers have a power to direct UTLAs to act and to consider whether alocal authority direction is unnecessary and should be revoked (includingin response to representations from those affected by it).
• These legal powers will take effect from 18 July 2021.
• Ministers will be able to use their existing powers (under the PublicHealth (Control of Disease) Act 1984) to implement more substantialrestrictions (regulations would be produced – and approved byParliament – on a case-by-case basis) which could include:
• closing businesses and venues in whole sectors (such as food production or non-essential retail), or within a defined geographical areas (such as towns or counties)
• impose general restrictions on movement of people (including requirements to ‘stay at home’, or to prevent people staying away from home overnight stays, or restrictions on entering or leaving a defined area)
• imposing restrictions on gatherings – limiting how many people can meet and whether they can travel in and out of an area to do so
• restricting local or national transport systems – closing them entirely, or introducing capacity limits or geographical restrictions
• mandating use of face coverings in a wider range of public places16
SHARED RESPONSIBILITIES (continued)
It is feasible that there will be outbreaks/incidents where the setting is located in one localauthority area, with cases or contacts in different one(s). In such situations the overallmanagement responsibilities will reside with the relevant HPT and lead local authority where thesetting or majority of cases are located. Other local authorities should:
• be informed of any associated cases or contacts
• invited and ensure participation of all key stakeholders to all IMTs
• Ensure preparation documentation for IMT completed
• take responsibility for local actions, when and if appropriate.
HEALTH AND CARE PROVIDERS:
• Medical practitioners have a statutory duty to notify suspected and confirmed cases of notifiablediseases to PHE under the Health Protection (Notification) Regulations 2010 and the Health Protection(Notification) Regulations 2020.
• Care Home providers have a duty to cooperate with Thurrock Council and PHE to fulfil theirresponsibilities under the Care Homes Settings Based protocol and in line with terms through whichadditional funding has been made available to them by Thurrock Council to manage COVID-19.
• Health and Care providers must follow National guidance and legislation
• Responsibility for decisions to move COVID-19+ residents to isolation units in other locations ultimatelyremains with care homes, with advice from General Practice and Public Health. The needs of theCOVID+ resident and consequences to their health and wellbeing must be considered before anytransfer takes place.
• MSE Hospital Group, NELFT and EPUT are responsible for preventing and managing COVID-19 outbreaksthat occur in their respective organisations including contact tracing in conjunction with Public HealthEngland
• Primary Care Providers are responsible for cooperating with support and advice provided by PHE,Thurrock CCG and Thurrock Council Public Health Team to preventing and managing outbreaks as setout in the Primary Care protocol
3.2 Overview of Roles and Responsibilities of Key Partners (continued)
NHS THURROCK CLINICAL COMMISSIONING GROUP:
• Under the Health and Social Care Act (2012), CCGs have responsibility to provide services toreasonably meet health needs and power to provide services for prevention, diagnosis andtreatment of illness.
• Provide infection control support to health and care settings as outlined in the protocols that situnder this OCP
• Support outbreak management arrangements where outbreaks occur in Primary Care and CareHomes settings in line with arrangements set out in the setting specific protocols that sit underthis OCP including participation in the Primary Care and Clinical hubs.
• Support prevention and communications activity where this relates to healthcare settings
• Lead vaccine role out across all cohorts
SHARED RESPONSIBILITIES:
• The NHS, PHE and Local Authority system has a shared responsibility for the management ofoutbreaks of COVID-19 in Thurrock.
• The Essex Strategic Control Group, its tactical cells and all partner agencies has over allresponsibility for responding to the COVID-19 epidemic including any ‘second wave’
• Infection Control support for each setting will be provided in line with current arrangements.
• The following Settings Based Protocols are in place and set out in detail the process of preventingand managing outbreaks and of contact tracing. It also specifies shared responsibilities betweenpartner organisations:
• Care Homes• Domiciliary Care• Primary Care and extra care• Workplaces and businesses• Schools and Education• Vulnerable populations • High risk and communities
3.3 Overview of Roles and Responsibilities of Thurrock Key Partners (cont.)
17
Section 4:
Thurrock COVID-19 Governance and
Architecture
4.1 Thurrock COVID-19 Outbreak Prevention and Control Architecture
Surveillance Data
Case/Contact Data from other elements of Test and Trace Programme
NHS T&T Tier 3 /
2
Tier 1 PHE
Essex HPT
De-escalation
PHE National
Surveillance
Specialist advice and guidance
SETTING
S IN W
HIC
H
OU
TBR
EAK
S OC
CU
RC
ASES /
CO
NTA
CTS
Locally Commissioned
Testing Capacity
Intelligence and advice
Direction / test results
Thurrock Health Protection Board• Strategic oversight of Tier 1 T&T• Strategic oversight of COVID-19 epidemic in Thurrock
Intelligence and Surveillance Cell
• Monitoring/analysis of surveillance and testing data to ascertain outbreak patterns/risk
Member Local Engagement Board
Thurrock Local Operations Control Centre (TLOCC)• Data processing• Case/contact/outbreak management system• Operational Management and coordination of all testing/contact tracing/outbreak management
Local Contact Tracing Capacity
SETTINGS BASED HUBS
Health and Social Care Settings Cell
Schools & Education
Settings Cell
Communities and high risk places and people cell
Businesses and Public Venues /Settings Cell
Other Local Authority / Thurrock Stakeholder Functions including Stronger
Together Partnership and TCCA
National Outbreak Control Plans Advisory board
Joint Bio-security centre
Essex Resilience Forum/SCG
Directors Board
Reporting
Thurrock Joint Health & Wellbeing BoardThurrock COVID-19 TCG
Communications
Cell
Residents, businesses and settings
Information
2
0
Operational and clinical oversight of, and operational focus on the implementation of COVID-19 epidemic in Thurrock and on implementation of
prevention and outbreak management and control
REINFORCEMENT
F unc t i ons o f P r og r amme B oa rds
Thurrock Health Protection Board
• Receives and reviews intelligence on:
• Overall epidemic in Thurrock including the epidemic curve
• COVID-19 outbreaks including nature, progress with control measures, input from local partners
• Performance on national Test and Trace relating to Thurrock
• Performance on local testing and vaccination in Thurrock
• Assess risk and determines the local ‘threat level’ (see section 5.3) and escalates to the Essex SCG where wider support of county wide coordination is necessary
• Oversees the operational implementation of Thurrock Outbreak Mgt Plan
• Identifies areas of risk, areas where there are blockages and over arching issues in order to either resolve or escalate these
• Approves alterations to strategies and settings based protocols in line with emerging evidence base
• Provides updates and make recommendations to the Member Oversight and Engagement Board
• Links and provides advice and recommendations to the Thurrock COVID-19 TCG and recovery architecture
• Sets communication strategy
• Ensures the programme is adequately resourced
The main function of the Board is to maintain strategic oversight and assurance that plans are in place and being delivered to:
- KNOW what is happening in our communities
- PREVENT COVID-19 from spreading within the community
- RESPOND to and manage outbreaks when they do occur including tracing and isolation of contacts
• Receives and reviews performance and surveillance information from the Health Protection Board
• Maintains strategic oversight of the COVID-19 epidemic in Thurrock and assurance of the implementation of the Outbreak Control Plan
• Acts as the mechanism through which recommendations to Cabinet on COVID-19 are made
• Ensures effective engagement with communities and groups on COVID-19, particularly in settings where outbreaks occur or are more likely
Member Oversight & Engagement Board (sub group of
H&WBB)
Chair• Leader of the Council
Frequency:• FortnightlyMembership:• Leader of Thurrock
Council• Chair of Health
Overview and Scrutiny Committee
• CPH Social Care• CPH Public Health & Air
Quality
In attendance:• CEX• Corporate Director
AHH• DPH• Deputy AO, NHS
Thurrock CCG• AD Law & Governance
& Monitoring Officer
Strategic and political oversight of the COVID-19 epidemic in Thurrock and Outbreak Management Plan
4.2 Thurrock Governance
Chair• DPHFrequency:• Every three weeks but
can be stepped up if needed
Membership:• Public Health COVID-19
response Leadership Team
• Corporate Directors AHH and Children’s Services
• Strat Lead Environmental Health
• Chairs of the Settings Based Outbreak Control/Prevention Cells
• Thurrock PHE CCDC• CCG Chief/Deputy Chief
Nurse• Essex Police Lead• Emergency Planning
Manager • Comms Lead
Prevention and Control of COVID-19 Outbreaks in specific high risk settings
• Dedicated specialist ‘hubs’ with relevant stakeholders that provide oversight of the settings based prevention and outbreak management protocols
• Health Care and Social Care
• Education and School based
• Communities and high risk places settings or with high risk individuals
• Businesses/workplaces/public buildings/spaces
• Supports development and oversees implementation of settings based T&T protocols
• Provides setting specific advice and guidance on prevention of outbreaks
• Assesses and mitigates risk of operational viability due to contact quarantine
LEADS / MEMBERSHIP: See section 8.2 on specific settings
Settings Based Outbreak Control /
Prevention Cells
Responsible for identifying contacts of cases and providing appropriate response
• Identifies/verifies the contacts of cases and provides appropriate advice in the following settings:
• Schools
• Care Homes
• Primary Care
• Workplaces
• High risk communities
• Assesses vulnerability of contacts and identifies additional support needs for follow up by Thurrock Covid Community Action (TCCA)
• Provides advice to contacts including infection/prevention/control in line with national guidance and local protocols
• Updates CTAS/Case-Contact database
• Communicates with contacts to provide advice to self-isolate to prevent onward transmission
Local Contact Tracing CellIntelligence and Surveillance Cell
Mapping and monitoring of COVID-19 epidemic in Thurrock
• Receives and analyses epidemiological and testing
data from PHE/JBC
• Receives data on cases from PHE Health Protection
Team and from within settings within the
community
• Surveillance of measures which could indicate early
signs of outbreak/increased community
transmissions and further investigate and alert
Operations Centre where appropriate
• Maps epidemic curve and outbreaks locally,
working with wider system to ensure demand
planning is timely and appropriate
LEAD:
• Head of Health Intelligence
MEMBERSHIP:
• Senior PH Programme Mgr: Health Intelligence
• PH Programme Mgr: Health Intelligence
• PH Informatics staff
Overall coordination and management of day to day Operations of Thurrock Test and
Trace Programme
• Coordinates and day to day oversight of all operational details of the OCP
• Data processing escalated cases from Tier 2 and 3 and de-escalation of cases back to tier 2/3
• Liaison between Thurrock service and PHE HPT team for joint management of cases/settings
• Acts on surveillance data to initiate new outbreak investigations
• Manages implementation of Settings Based Protocols including case/contact/management outbreaks and prevention in settings/high risk communities
• Maintains Case/Contact database / CTAS
• Liaison with Settings Based Hubs
• Management of Contact Tracing Cell
• Procure additional local testing and receives results
• Escalates issues / provides monitoring intelligence to Health Protection Board
• Ensures financial oversight
LEAD: Strategic Lead Public Health
MEMBERSHIP: See section 7.4
Thurrock Local Operations
Control Centre (TLOCC)
4.3 Summary of Functions of Thurrock System Architecture
21
22
Section 5 :
Thurrock’s Operating Model
Overview
The Thurrock Local Operation Control Centre (TLOCC) acts as the nucleus of the outbreakmanagement in Thurrock including test and trace. It provides a co-ordination function toensure the right information is shared with the right people at the right time. It serves toprocess data and facilitate the management of outbreaks and the investigation of caseswarranting further investigation. The service will operate Monday to Friday 9am – 5pm without of hour on-call arrangements provided by the Director of Public Health, Assistant Directorof Public Health and senior members of the Public Health Team.
Data is received from three key sources:
• Directly from other architecture in the Test and Trace structure, either via CTAS (if/whenoperational within the local authority) or directly from the Public Health England HealthProtection Team where a joint local authority/PHE tier 1 response is required and this hasbeen escalated from Tier 2/3 under the escalation criteria set out on section 6.3
• Directly from providers or settings, for example if a care home or school reports a case tothe Council.
• As an alert from the Surveillance Cell where clusters of cases have been identified locallyfrom local surveillance mapping activity.
The centre will be led by the Strategic Lead for Health Improvement Public Health andcomprise of EHOs, Public Health Protection Programme Managers, redeployed Public Healthstaff and contact tracers. The TLOCC has a central email [email protected] and [email protected] and are monitoredby administrators and Public Health staff 7 days a week.
The main objectives of the TLOCC are:
• To receive, understand and interpret national PHE guidance and other published evidencebase on best practice to prevent and manage COVID-19
• To receive and respond to local surveillance intelligence from the surveillance cell includinginvestigation of possible local outbreaks
7.1 Operating Model: Overview5.1 Capabilities: Prevention5.1 Thurrock Operating Model Overview
• To continue to work with settings protocols that set out prevention, risk assessment, outbreakmanagement procedures including enhanced testing where appropriate, contact tracing and self-isolation arrangements and determining when an outbreak is over in consultation with the foursettings hubs and PHE.
• To provide expert public health advice to the four settings based hubs including implementing andupdating settings based protocols in consultation with the hubs in light of local intelligence, nationalguidance and evidence of best practice and oversee their implementation including safe operating ofindividual settings.
• To implement Local Zero
• To provide central operational co-ordination of all outbreak prevention and management activityincluding maintenance of the CTAS database (if/when available)
• To support PHE in initial settings based risk assessments (where required), and formation andmanagement of outbreak control teams where necessary
• To investigate setting based outbreaks in conjunction with PHE and setting based hub members anddrawing on expert resources as required including but not limited to infection/prevention/controladvice and EHOs and to oversee the implementation of the settings based protocols. Wherenecessary forming an Outbreak Control team, collecting contact information, ensuring contacts arefollowed up (subject to access to CTAS), arranging enhanced testing arrangements, placing inadditional controls to manage outbreaks and determining when an outbreak is over.
• To develop and implement a communications plan including setting specific communications andgeneral advice to residents in conjunction with Thurrock Council Communications Team and settingsbased hubs.
• Provides governance, leadership and strategic coordination for the local (T1) Contact Tracingfunction including local zero
• The governance for the TLOCC sits with the Thurrock Health Protection Board. TLOCC will provideregular updates to the Health Protection Board on the COVID-19 epidemic in Thurrock and measuresto control it. 23
REINFORCEMENT
Contact Tracing Cell• Implement Local Zero – Receive notification of cases and contacts and
management of these.
• Assess initial contacts list and determine risk
• Follow up contacts and provide appropriate quarantine advice
• Provides results of tests to contacts were appropriate
• Manages case/contact CTAS database
• Assesses additional support needs and passes contacts’ details to TCCA for follow up
• All COVID-19+ cases are called to offer support and guidance.
• Informs GP where permission given by resident
7.2 Operating Model: Capacity and Functions
Contact tracing task delegation
Information flow to manage outbreaks
Surveillance/direct reportsOngoing management
Escalation from Tier 2/3Initial risk assessmentOngoing managementAdvice and guidance
5.1 Capabilities: Prevention5.2 Thurrock Operating Model: Capacity and Functions
Thurrock Outbreak Control Centre
• Receives intelligence data once a week from intelligence cell/ more frequently as required to investigate cases
• Single point of contact for reports from settings
• Informs PHE HPT of initial reports
• Receives escalation from Tier 3/2 to Tier 1 from PHE HPT Team
• Form OCT and agrees plan with PHE where appropriate
• Undertakes detailed settings based risk assessment conducted with setting
• Senior Test and trace operators commence risk assessment in workplace settings and liaise with cell lead to escalate to EHO team
• EHOs will risk assess workplaces only, provide an enforcement function and on the ground liaison.
• Liaison with settings based prevention/outbreak management hubs
• Initiates the establishment of contacts list
• Public Health Advice, IPC advice to setting to manage outbreak in line with Setting Based Protocol or Outbreak Control Plan
• Liaison with expert resource for further information to inform the risk assessment.
• Identifies services used by case & alerts
• Provides quarantine/isolation advice dependent on local protocol for setting
East of England Public Health England Health Protection Team• Receives escalation from Tier 2/3 and informs TLOCC
• Receives surveillance data and direct reports from TLOCC of new incidents
• Undertakes initial risk assessment
• Joint management of complex outbreaks as per settings based protocols or Outbreak Control Team/Plan
• Expert advice and guidance
• Management of outbreaks/situations not within the responsibility of the LA
• Data and information sharing
• Contact tracing
5.3 Thurrock Operating Model: Demand and Staff Capacity
Understanding potential demand on Tier 1 is important in both planning for both the short term andlonger term capacity that may be needed and in deciding at which geography to operate Tier 1, i.e.Thurrock only arrangements or collaboration over a wider geographical footprint. However it is alsoextremely difficult for a number of reasons:
We are unclear what the total number of daily cases handled by CTAS will be at Tier 3. This will be isa function of a number of variables that are subject to change as the epidemic progresses including:
• The total number of new daily infections of COVID-19 in the community (dailycommunity incidence).
• Daily numbers of new cases who become symptomatic• The proportion of symptomatic cases who decide to get tested• Asymptomatic cases who consent to be tested through screening• Overall testing capacity and responsiveness at national and local level• New variant discovery
We are unclear what further impact future government policy changes to lockdown lifting over thenext few months will have an the R value and how many additional cases this will generate. An Rvalue above 1 rapidly leads to growth in the number of daily cases and thus increased demand onthe system
We are unclear of the extent to which NHS Test and Trace will mitigate against a rise in R in theearly stages of lockdown measures being lifted and so keep cases over a longer time period at alevel which is manageable
We are unclear what proportion of cases initially at Tiers 3 and 2 will be escalated to Tier 1 in thefuture and this is likely to vary from week to week at Thurrock level
Detailed protocols specifying how tasks will be shared between PHE and Thurrock Council havebeen developed for all settings and these are reviewed and updated depending on guidance andlocal need
Initially, capacity was relatively low but capacity needs could increase significantly as the R valuemoved towards 1 and behavioral response to lock down restrictions cause a significant number oflocalised outbreaks. What is likely is that capacity required to meet demand is likely to need to flexif there is a third wave.
We have recruited to new specialist public health contact tracing or health protection roles and haveincreased their capacity depending on the demand locally.
We have designed our staffing operating model to provide capacity that is flexible by identifying roleswithin the existing Thurrock Public Health Team with health protection skills that can be redeployed ortake on additional COVID-19 responsibilities in the new structure, whilst commencing recruitment intointerim posts to support recovery of services.
We have used some of the central government grant provided for Local Authority Tier 1 response tofund back-fill for redeployed staff where necessary, as we believe that recruitment of interim non-health protection public health expertise may be easier in the current climate of very high demand forhealth protection staff.
We have also complimented the structure with interim EHO roles that have particular outbreakmanagement expertise in workplace settings. We have scaled this up and continue to monitor in orderto scale again
The proposed structure for both the Thurrock Local Operating Control Centre and Surveillance Cell areshown slide 5.4. The Strategic Lead for PH will oversee TLOCC and the DPH will oversee thesurveillance cell and the entire programme.
We have aligned outbreak control and health protection staff to the four hub settings as we believethat this will allow stronger level of focus, setting based expertise and relationship building. Howeverthe overall structure allows flexibility to move staff between settings where operational demandsrequire.
We have based overall capacity requirements on working assumptions used by other local authorities,aggregated to Thurrock overall population size.
25
5.3 Thurrock Operating Model: Demand and Staff Capacity (continued)
Staffing
A staffing structure is set out in section 5.4 which will be filled through a mixture ofredeploying existing Public Health staff and backfilling their current responsibilities, andthrough recruitment of new temporary staff. This structure can be scaled up or downdependant on need, in the event of requiring surge capacity due to VoC this can be donerapidly with staff prioritised to return to TLOCC. The Strategic Lead will manage TLOCC andContact Tracing. The DPH will oversee implementation of this plan and COVID-19 OutbreakControl.
Settings Based Public Health Lead
Each of the four setting areas is overseen by a Public Health Lead who will sit on theirrespective Settings Based Hub meeting and provide expert public health advice to the settingshub. Their role will include:• Continue to implement the respective settings based protocols that the hub is responsible
for overseeing in conjunction with Public Health England and other setting-basedstakeholders. Each protocol sets out roles and responsibilities of different stakeholders interms of preventing COVID-19 in specific settings including safe operating within the setting,managing positive cases and outbreaks, contact tracing and appropriate isolation advice forcases and contacts, enhanced testing (where appropriate) and criteria by which theoutbreak will be determined to be over.
• Providing advice to the hub based on the latest Public Health Guidance• Overseeing the development of a settings specific communications campaign with support
from the communications cell• Providing strategic oversight of public health activity to the setting• Line managing Protocol Managers and Case Investigators• Update HPB and HWB as appropriate ( bi-monthly HPB)• Escalate risk and issues to DPH, HPB and TCG
26
Protocol / Outbreak Manager
Each setting will also have a Protocol Manager. In the case of the Workplace setting, this willbe enhanced by a dedicated Environmental Health Officer. Protocol Managers/EHOs will beresponsible for ensuring that actions set out in the Settings Based Protocols for preventingand managing outbreaks are implemented including:
• Direct liaison with providers/communities within the setting to ensure thatadvice/activity/operating procedures reflect best practice in preventing COVID-19 forexample through excellent infection/prevention and control
• Providing settings based communications resources directly to providers/communitieswithin the setting
• Risk assessment in the case of outbreaks in conjunction with PHE as set out in the settingsprotocol
• Obtain contact details of all contacts where the setting receives a positive case based onthe risk assessment and ensuring that the setting manages positive cases and contacts inline with the protocol
• Arranging settings based enhanced testing where appropriate and coordinating the results• Direct liaison with the setting in an outbreak situation to advise of further controls to
contain the outbreak and prevent its spread in line with the protocol• Determining when the criteria set out in the protocol for when an outbreak is over have
been met• Liaise with health colleagues to ensure relevant cohorts are vaccinated• Escalate risk as appropriate to the Strategic Lead• Work in collaboration with the surveillance cell to escalate possible clusters or hotspot
areas
5.3 Thurrock Operating Model: Demand and Staff Capacity (continued)
27
Contact Tracing CellContact tracing is undertaken by the contact tracing cell who receive details ofcontacts from the Protocol/Outbreak Manager or case investigators in the caseof a workplace through the risk assessment.
Contact Tracers are responsible for determining if cases/contacts arevulnerable and where necessary brokering additional support via TCCA andother stakeholders to allow them to quarantine
The Contact Tracing Cell is led by a Programme Manager who is responsiblefor all data flows in and out of the Thurrock Local Operations Control Centre(TLOCC) and all administration to settings/cases and contacts. They areresponsible for ensuring the local data recording system is maintained.
Contact tracing has had to adapt to changes at pace throughout the phases ofCoid-19.
As the pandemic progressed contact tracing had to be scaled up regularly tocope with demand, during the epidemic numbers were scaled up at pace dueto the increasing numbers of residents affected.
As Thurrock adjusts to falling numbers as we progress to endemic status, thecontact tracing team have adjusted their delivery to ensure all cases selfisolating are identified and contacted on day 0. This is a bespoke outbreakaspiration for Thurrock and is only possible as the numbers reduce however ifthere was to be another wave resulting in a significant increase in numbersthis model may need to revert to an earlier system of contact tracing in orderto deal with the volume of traffic.
Major OutbreaksWhere the initial risk assessment, or as a result of subsequent testresults it is determined that the setting or community is experiencinga major or high risk outbreak, an Outbreak Control Team will beformed. The decision to form an Outbreak Control Team will be madeby the Settings Lead/TLOCC Lead in conjunction with PHE and inconsultation with the Settings Based Hub members. In suchcircumstances, a dedicated Outbreak Control Plan will be devised andthe Outbreak managed in line with this plan.
Surveillance and Intelligence CellThe Surveillance and Intelligence Cell will monitor the localepidemiology and alert TLOCC to any potential outbreak situationsincluding clusters of cases that warrant further investigation. Thefunctions of the Surveillance and Intelligence Cell are set out in section5.3
Communications CellThe Communications Cell will continue to develop overarching andsettings specific communications materials both proactively and inresponse to local intelligence. It will comprise of a dedicated COVID-19 post working closely with the DPH and Thurrock CouncilCommunications Team, as set out in section 5.2.
28
Strategic Lead – TLOCC Lead (BF)
H E A L T H A N D A D U L T
S O C IA L C A R E
EDUCATIO N &
EARLY YEARSWORKPLACES
COMMUNITIES AND V U L N E R A B L E
G R O U P S / S E T T IN G S
Manages implementation of protocol:• Prevention• Outbreak Risk
Assessment• Outbreak
controls• Testing• ID contact info
PR
OTO
CO
L
IMP
LE
ME
NTA
TIO
N
SU
RG
E
CA
PA
CIT
Y
EHO (interim/agency as required)
Contact Tracers (as required)
Information Analyst
0.5WTE (BF)
7.4 OPERATING MODEL: Staff Structure, TLOCC and Surveillance Cell5.1 Capabilities: Prevention5.4 Thurrock Operating Model: Staff Structure – TLOCC and Surveillance Cell
BF = Deploy from existing resource and back fillNTP = New temporary postWTE = Whole Time Equivalence
Senior Programme
Manager(also outbreak
lead)
Senior PH Programme
Manager (BF)
Programme Manager (BF)
PH Programme Manager (BF)
EHO 2.2 WTE
Senior contact
tracers 2.1 (NTPs and
BF)
Healthcare improvement
manager 0.2WTE
Healthcare improvement manager 0.8
WTE
STR
ATE
GIC
OV
ER
SIG
HT
AN
DS
ETTIN
GS
LE
AD
• Strategic Oversight of Setting
• PH Lead to Hub• Develop Setting
Protocols• Risk Assessment
to Setting
External testing via
pillar one (as required)
Senior Contact
Tracer (NTP)2.0WTE
Programme Manager
(BF)1.0WTE
Contact tracers
13.9 WTE
CONTACT TRACING & DATA
PROCESSING CELL
• Manages data flows / CTAS• Email/letters to settings• Follows up cases/contacts to assess
vulnerability• Provides advice to cases/contacts
on appropriate quarantine
Senior PH intelligence0.75 WTE
PH analyst1.7 WTE
SURVEILLANCE & INTELLIGENCE
CELL• Receives and analyses
epidemiological case and testing
data from PHE/JBC
• Local surveillance of epidemic
• Alerts TLOCC /wider system of
potential outbreak clusters
COMMUNICATIONS CELL• Develops and implements comms
plan• Setting specific comms on protocols• Proactive comms to residents• Reactive comms in outbreak
situations• Targeted comms to at risk groups
DPH – Outbreak Control Plan Lead
COVID-19 Comms
Lead
Thurrock Council Comms
Team Rep
Strategic Lead Communications
295.1 Capabilities: Prevention5.5 Thurrock Operating Model: High Level Process Diagram for Outbreak Management
The diagram below sets out the high level process through which cases, contacts and outbreaks will be managed. Detailed processes and responsibilities are set out in the Settings Based Protocols that sit below this plan.
Preventing Outbreaks from occurring in the first place is clearly more desirable than trying tomanage and control them once they do occur. Effective prevention is dependent on our residentscomplying with government guidelines and on individual settings such as workplaces, shops,restaurants, bars, schools and health and care settings undertaking effective risk assessments andimplementing safe working procedures that reduce the risk of transmission of COVID-19.
The more that our residents comply with behaviours that reduce the risk of COVID-19, and moresettings that we are able to open in a way that operates safely with minimal risk of COVID-19transmission, the better we can balance the two risks of direct threat of COVID-19 and the impactof lockdown itself on the health and wellbeing of our residents, and therefore meet the overallaim of this Outbreak Control Plan.
Evidence based interventions/behaviours that prevent the spread of COVID-19 that can beimplemented by all residents include:
• Limiting the number of people they have contact with
• Working from home whenever this is possible and conducting meetings virtually through useof technology.
• Avoiding public transport where possible and where not, avoiding rush hour
• Frequently washing hands for at least 20 seconds with warm water and soap
• Maintaining at least 2m distance from other people at all time
• Self-isolating at home for seven or 10 days if they or their household contacts show symptomsof COVID-19 including fever, a continuous cough or a loss of taste/smell
• Participating in NHS Test and Trace by getting tested for COVID-19 if they show symptoms andproviding contact information to the best of their ability
• Sneezing or coughing into a tissue, handkerchief or arm
• Wearing a face mask where maintaining a 2m distance is not possible (evidence on theeffectiveness of face masks is weaker than the above measures but there is some evidencethat they may help reduce the risk that those already infected with COVID-19 from spreadingthe disease to others.
Evidence based interventions/policies/procedures that employers can take to help prevent the spreadof COVID-19 include but are not limited to:
• Allowing all employees who can work at home to do so and conducting meetings virtually.
• Ensuring that those people who cannot work from home access regular testing
• Staggering start and leave times of employees who must access a workplace
• Conducting a thorough risk assessment of each workplace and its procedures to ensure that it is‘COVID-19 safe’
• Limiting the numbers of employees/customers/clients who can access a space at a given time
• Ensuring breaks are staggered
• Ensuring that employees/customers/clients maintain a minimum distance of 2m from each otherat all times
• We will run IPC webinars for health professionals
• We will provide enhanced IPC training for all care homes in Thurrock
• Following infection prevention/control advice recommended for the setting including regulardisinfection of surfaces, especially high volume surfaces
• Where employees/customers/clients cannot maintain a minimum distance of 2m from each other,ensuring that appropriate additional measures are in place including appropriate PPE, Perspexscreens, contactless payment methods
• Keeping a record of employee/customer/client contact details that can be used by NHS Test andTrace
Government Guidance
The reduction in cases, hospital admissions, extensive testing strategy, success of the vaccinationprogramme and preparedness measures in place for variants of concern has lead to the government’sfour-step roadmap from the March 8th 2021. This roadmap sets out steps and criteria for relaxingrestrictions at different stages. Full details of the Road map strategy and associated guidance can beaccessed at: https://www.gov.uk/government/collections/coronavirus-covid-19-list-of-guidance
5.1 Capabilities: Prevention5.6 Thurrock Outbreak Prevention
30
Relaxation of lockdown measures presents an opportunity for more sectors toopen and life to become more normalised and will begin to mitigate some of therisks to health and wellbeing and the wider economy of prolonged lockdown.However, COVID-19 presents an on-going public health threat to the residents ofThurrock and with lockdown relaxation, the guidance becomes more complex,nuanced and difficult to understand for our residents and risks a lower level ofcompliance that could result in new COVID-19 outbreaks.
In order to mitigate these risks we will undertake the following actions onprevention:
• We will develop an on-going communications campaign for our residents withup to date advice on what is and is not allowed under lockdown. This will bethe responsibility of the Thurrock Council Communications Team with adviceand support from the council’s Public Health Team
• Prevention strategy in specific settings will be the responsibility of the SettingsBased Hubs and prevention strategy is set out in the Settings Based Protocols
• We will continuously develop and update settings specific communicationmaterials/campaigns
• We will map all guidance available to specific settings and communicate this toproviders via the settings based hubs to allow safe opening
• We will ensure evidence based infection control and prevention advice isprovided to specific settings through the settings hub
• We will support individual settings providers with advice on risk assessments
5.1 Capabilities: Prevention (continued)5.1 Capabilities: Prevention5.6 Thurrock Outbreak Prevention (continued)
31
• We will highlight the risk of ignoring the 2m rule to providers in thecontext of increased risk of staff becoming identified as ‘contacts’ inthe event of a ‘case’ and the negative impact of operational viabilityon the setting should this occur
• We will highlight the need to remain vigilant to prevent complacencyand continue to adhere to hands face, space guidance
• We will monitor changes in positivity rate within Thurrock and ensurewe act effectively and efficiently to address changing patterns
• We will evidence how the Contain Framework is being strengthenedto focus on areas of enduring transmission and Variants andMutations, and to discuss how local plans are taking these risks intoaccount
• We will encourage all cohorts to get vaccinated and work withproviders and the community to ensure equality throughout thisprogramme
• We will work with local intelligence and authorities to ensure thesafety at all vaccination sites
• We will provide roving Covid Marshalls to advise workplaces andbusinesses on Covid-19 safe practices and work with schools wherecongregation at school gates remains an issue.
The Surveillance and Intelligence will be the fundamental capability of this Outbreak Control Plan.The Surveillance and Intelligence cell will bring together all available data, from national and localsources in order to provide intelligence to all other cells, local providers and other key stakeholdersto ensure key individuals and organisations are sighted on any local changes to the epidemic.
The surveillance and Intelligence cell provides regular overview of the local situations to the HealthProtection board. The cell is lead by the Head of Health Intelligence who is responsible for ensuringthat the messages provided from the cell are appropriate and that alerts are proportionate and goto the right people to action. Other key people in the cell are the Public Health Analysts and PublicHealth Graduate Trainee who all share responsibility for ensuring all data is analysed in a robust andtimely way.
The cell’s main functions are: mapping the epidemic; raising alerts; identifying clusters of cases andpotential outbreaks that have not been identified elsewhere; researching the impacts of COVID-19and lockdown on our population (particularly those with vulnerabilities) in order that these can bebalanced or mitigated against where possible, monitoring vaccine uptake to inform equity indelivery, monitor changes to the local alert system, maintain engagement with local and regionalsurveillance partners
An alert system has been put in place for the direct management of COVID-19. This relates to themonitoring of outbreaks and community spread of the virus, levels of testing and positivity andCOVID related hospital activity.
Alerts go through the DPH/PHLT COVID Group to the Health Protection Board and to the SGC in theevent that an outbreak either crosses borders or it is evident that drastic measures need to be inplace to prevent this from happening.
The risk rating is dependent upon whether we have small pockets of setting outbreaks, or whetherthese have spilled in to community spread and how well contained this is, and how able the localacute trust is able to manage bed demand against capacity.
Community spread and prevalence monitoring is shared with key stakeholders via the COVIDSurveillance Dashboard daily, whilst demand management is covered separately in the CommunitySitrep. A third summary document, a Vaccine Dashboard, complements these two resources.
5.2 Capabilities: Surveillance and Intelligence
Community spread/
prevalence
Demand Management
Health Protection Board
Essex SCG COP SCG
Local Partners and Providers
Communications Cell
5.1 Capabilities: Prevention5.7 Thurrock Surveillance and Intelligence
Indirect harm
In addition to informing direct responses for COVID-19 the cell will have an additional responsibility to research the indirect impacts of COVID-19, namely lockdown measures on the health and wellbeing of the residents of Thurrock with a view to making strategic and policy recommendations about how these can be mitigated. While more questions will rise over time some initial areas of focus are:
• Primary Care, namely patients with Long Term Conditions. For example, what are the short and long term impacts that COVID-19 and how can services be reopened safely?
• Mental Health including monitoring referral trends into services, the impact of lockdown on the mental health of our residents and how we can continue to protect mental health and deliver critical services.
• Children's health and Wellbeing and educational attainment.
• Economic impacts, namely number of people claiming job seekers allowance and universal credit.
• Crime and domestic/sexual violence
• While these will not generate alerts, they will be reported to Health Protection and Health and Well Being boards as and when necessary
32
5.2 Capabilities: Surveillance and Intelligence5.1 Capabilities: Prevention5.7 Thurrock Surveillance and Intelligence
33
The next three slides show the changing landscape of Thurrock from January 2021 to March 2021. The darker blueareas show the highest prevalence. The map on the left additionally shows the care homes affected while that onthe right shows schools affected. This is just one of the reports run daily that allows us to focus our resources on theareas of high need.
January 2021
LSOAs
Unique Postcodes 21/12/2020 04/01/2021
30-39 2 2
20-29 8 27
10-19 78 67
0-9 10 2
TOTAL 98 98
5.2 Capabilities: Surveillance and Intelligence5.1 Capabilities: Prevention5.7 Thurrock Surveillance and Intelligence
34
As you can see from the lighter shading by February there were no more areas showing over 20 unique post codes in any SLOA.
February 2021
LSOAs
Unique Postcodes 08/02/2021 10/02/2021
30-39 0 0
20-29 0 0
10-19 8 6
1-9 90 92
0 0 0
TOTAL 98 98
5.2 Capabilities: Surveillance and Intelligence5.1 Capabilities: Prevention5.7 Thurrock Surveillance and Intelligence
35
As you can see from the lighter shading by March there is a clear pattern through the middle of Thurrock where there are no cases noted. Most of the care homes and schools whilst still under surveillance were in recovery with no new cases reported
March 2021
LSOAs
Unique Postcodes 15th Mar 17th Mar
30-39 0 0
20-29 0 0
10-19 0 0
1-9 70 66
0 28 32
TOTAL 98 98
Ongoing monitoring of localised Setting Outbreaks, Community Transmission and Demand v Capacity
5.3 Capabilities: Surveillance and Intelligence
Surveillance Dashboard and
Community Sitrep
We bring together data on: testing; contact
tracing; local service use; local outbreak
intelligence, hospital bed occupancy, community
bed availability and population mobility to
determine a level of risk to the wider System
Manage Individual Outbreaks Locally throughdetails set out in settings based protocols,
Monitoring by Thurrock HPB,Inclusion in SCG COP and Weekly Report
Level 0Individual Setting Outbreaks which are managed according to setting outbreak control plans and have not spread into community transmission.No evidence of geographical outbreaks or hotspots.No evidence that Prevalence and/or Community Transmission is Increasing.
Form Outbreak Control Team and Member Oversight BoardPlan for setting if setting based, with management by OCT
including DPH & PHE Health Protection Team,Monitoring by Thurrock HPB
Inclusion in SCG COP and Weekly Report
Level 1Individual setting outbreak which is not under control and/or is suspected to have spilled into community transmission.OR some evidence of Geographical Outbreaks or Hotspots.OR some evidence of increased prevalence or community transmission (test and trace evidence)(Can be escalated to level 2 if multiple indications)
Explicit Alert to SCG,Formal alert to the MSE Modelling Cell and MAIC,
Formal alert to other local health and care partnersthrough Thurrock ICP,
Discussion with Surveillance and Intelligence functions of ECC andBarking and Dagenham plus their DsPH
Level 2Individual setting outbreak which is confirmed to have spilled into community transmission.OR increasing evidence of Geographical Outbreaks or Hotspots.OR increasing evidence of increased prevalence or community transmission (e.g.. early indications of bed occupancy trends increasing / continued test and trace increasing trends with no explanation)(Can be escalated to level 3 by DPH if multiple indications)
Begin implementation of capacity plans,Escalation into Emergency Response Mode – SCG Lead,
Escalation through PH to Central Government if additional lockdown powers required
Level 3Evidence of large Geographical Outbreaks or Hotspots.Definitive evidence of increased prevalence or community transmission (e.g.. continued bed occupancy trends / exponential rises in test and trace activity with no explanation)Any other indication that causes alarm - Director of Public Health concern
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5.1 Capabilities: Prevention5.7 Thurrock Surveillance and Intelligence (continued)
36
We have created and maintained a Surveillance Dashboard and a Community Sitrep for Thurrock. In these resources we aim to inform alerts based on the amount of community spread that there is in the population alongside the ability of the System to meet demand. It is important to ensure sufficient health and care capacity continues to be available should increased community transmission of COVID-19 result in increased demand for health and care services. The first Outbreak Control Plan alert levels worked well in giving a good understanding of our population and we will continue to use to manage escalation and de-escalation of our response:
• Level 0 - means that we only have localised setting specific outbreaks that are under control;
• level 1 - means that we suspect that there may have been some additional community spread;
• level 2 – means that community spread is extending / confirmed and options need to be considered to arrest this, and;
• level 3 – signified a considerable amount of community spread and demand on services is expected to rise imminently. At level 3 we can say we are in an additional ‘wave’ and concentrations need to be on supressing that wave and ensuring that local health care systems can cope with demand. During all levels regular updates are given to the health protection board. Level 3 requires resumed action by the SCG in terms of a major incident.
Mitigating harms caused by lockdown
5.3 Capabilities: Surveillance and Intelligence
Series of analyses/reports
that looks at potential harm to
Long Term Condition Patients,
Mental Health, Increasing
Vulnerabilities and domestic abuse.
(Due to potential time – lags in data sets this is a long
term research work stream. The work plan will evolve
over time as more questions are highlighted and need to
be answered.)
No Action required – continue monitoring
No Evidence of:Serious harm to specific individualsHarm to large groups of individualsHarm that may have large financial implications if left unchecked.
No Action required – continue monitoring
Evidence of:Harm to specific individualsHarm to large groups of individualsHarm that may have large financial implications if left unchecked.
All harm identified is currently being mitigated against.
Employ a Population Health Management Approach:Who, what, where, when, how?
Engage with relevant teams / organisations.Implement
Evidence of:Serious harm to specific individualsSerious harm to large groups of individualsHarm that may have large financial implications if left unchecked.
One or more aspect of harm identified is not currently being mitigated against.
Urgent action that is proportional and relevant to the Identified harm
Lockdown harm is having a potentially permanent impact on groups of our population.
Evaluate the harm on children’s health and wellbeing.This is a longer term piece of analyses due to time lags on data. We will use the brighter futures survey to ascertain how the wellbeing of children has changed during the academic year of the COVID-19 pandemic and lockdown combined with data on educational attainment in the following years and school attendance rates going forward. It is important that we identify any issues and put support and processes in place to give our children the best chance of recovering, both in terms of health and wellbeing but also in terms of missed education. A sustainable economy for the future is dependent on this.
While there is no formal alert system for the potential indirect harm caused by COVID-19 it is important to investigate and mitigate against this for two reasons:
1) To ensure that indirect harm is not of greater significance than direct harm avoided by actions taken to suppress virus transmission.
2) The impacts of lockdown are likely to affect different cohorts of people to differing extents with the greatest burden falling on more deprived communities. As such lockdown risks potentially increasing health inequalities.
Moving forward we will continue to monitor and investigate the impact of lockdown and seek to find ways to mitigate risk. Findings will be RAG rated according to actions being taken to mitigate and reported to the health protection and health and well-being boards.
5.1 Capabilities: Prevention5.7 Thurrock Surveillance and Intelligence (continued)
37
Good Practice, Issues and Lessons Learnt: Surveillance and Data
As the pandemic has progressed the understanding and learnings relating to the pandemic have equally progressed. Throughout the last 12 months this progression has been reflected in the natureof the data with which the Surveillance Cell has been able to work.
The key developments throughout the course of the pandemic to data have been:
Provision of Identifiable Information
Initial data feeds were limited to non identifiable or aggregated data, with limited potential for the Local Authority to carry out the detailed surveillance and contact tracing work that has subsequently become central to the COVID-19 efforts.
As identifiable information has been made available in the form of daily line lists it has followed that surveillance has been able to identify geographic hotspots within the local area more readily. Furthermore, it has facilitated work with the contact tracing team to investigate potential links between cases and outbreaks.
From a prevention standpoint, in providing demographic information it has also been possible to target specific cohorts more easily by understanding amongst which groups we are seeing cases –whether that be by age, gender or other characteristics.
PHE Support
The intelligence offer from PHE has been critical in the Local Authority work to date. PHE East have provided ongoing support in the form of high quality epidemiological resources, expert advice, training and development sessions specific to COVID analysis and through the facilitation of weekly discussions at a regional level.
Joint working
The work carried out in Thurrock has been complemented at all times by work at both local, ICS and regional level. Through the joint working with stakeholders from other council departments, regional LAs, the NHS, the local Acute Trust and other key external organisations and individuals it has been possible to provide a more complete and more robust surveillance offer in Thurrock
The key developments discussed previously represent a selection of the most impactful contributions to providing a high quality and highly effective surveillance offer. There have of course been challenges in reaching the current position and as such there have been lessons to be learned:
Data Quality
The Surveillance cell is only able to work with the data it is given access to. Ultimately it is the quality of that data which dictates the quality of the surveillance offer. Whilst data quality from most sources is now high, there remain specific areas which are sub-optimal. Specifically the completeness of data fields in terms of testing data remains a challenge, with a large proportion of data fields remaining blank. The coding of ethnicity data is a similar challenge, exacerbated by the use of a NHS coding structure that differs from that used by the ONS. As such it has become increasingly important to manage expectations of the nature and depth of analysis that is possible.
Data Volume
A related matter to data quality is data volume. The surveillance cell has access to an ever growing cache of pandemic resources. However, it is increasingly difficult to identify the new resources that would add significant value. Given constraints on capacity, finding the time to understand and interpret new resources remains an ongoing challenge. It is however crucial to remain abreast of these developments and as such factoring in dedicated time for understanding each and every new resource is important.
Data Access
The timelines for accessing some data, particularly from the NHS, have been lengthy. A period of eight weeks to gain a login for a key dashboard has occurred on two separate occasions. This created capacity issues within the Surveillance Cell in the first instance. By planning ahead for such a delay in the second instance the disruption was minimised.
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5.1 Capabilities: Prevention5.8 Surveillance and Intelligence: Good Practice and Lessons Learnt
Communications and engagement with our residents, businesses and stakeholders will be key in positively influencing behaviour and ensuring maximum compliance with guidance to prevent and reduce the risk of transmission of COVID-19. As lockdown guidance has relaxed, it has become more nuanced and complex and this presents a challenge in terms of communications to our residents, staff, businesses and stakeholders.
Communications will be both proactive in terms of regular positive messages and reactive in the sense that we may wish to target additional or specific messages to different population cohorts or localities in response to intelligence and local surveillance information that shows early signs of outbreaks or risk of outbreaks.
We have set up a Communications Cell comprising of senior public health and communications staff from Thurrock Council. The communications cell will manage all proactive communication to residents, businesses and other settings related to COVID-19 and receive local intelligence from the surveillance cell through the Thurrock Local Operations Centre to tailor messages and distinct settings or geographies in the event of outbreak or increased risk of outbreak.
The Communications Cell will adapt the current COVID-19 communications strategy to support the refreshed Local Outbreak Plan and ongoing management of the epidemic in Thurrock. The cell will also work with the Settings Based Prevention/Outbreak Management Hubs to further develop setting specific messages and products for employees, customers, residents and service users in that specific setting, including explaining the Settings Based Protocols and stakeholder responsibilities under them.
The Cell will also investigate mechanisms to better target specific and relevant communications messages at different population cohorts using and triangulating intelligence held in existing data sets such as Xantura and TCCA.
The Cell will liaise with other key stakeholders including the third sector and local NHS partners to coordinate communications messages such that there is a coordinated and consistent message to residents, businesses and employees across the borough.
5.1 Capabilities: Prevention5.9 Thurrock Communications and Engagement
OVERARCHING AIM
• Positively influence the behaviour of the population of Thurrock, employers
and other stakeholders, such that risk of COVID-19 transmission is reduced
whilst allowing as much of the economy and public services to operate
KNOWLEDGE
• Review the COVID-19 communications strategy to support the refresh if the Thurrock COVID-19 Outbreak Control Plan
• Coordinate communications strategy on COVID-19 within the Council and across other key stakeholders to ensure consistent messages to residents and employers
• Communicate proactive messages on the risk of COVID-19 to residents and employers to encourage behaviour that is complaint with government guidance and reduces risk
• Develop specific relevant communications messages and products to different sectors and settings clear explanation of requirements and responsibilities of different stakeholders, as specified in the Settings Based Protocols
• Use existing data sets and products such as Xantura to segment the population into different risk cohorts, and develop a targeted and nuanced messages at different population cohorts
• Increase the proportion of residents who become tested for COVID-19 when they develop symptoms
• Ensure maximum compliance with the Test and Trace pathway including self-isolation of contacts 39
4
0
TACTICS COMMUNICATION CHANNELS
Will include:
• Thurrock Council social media channels: Facebook, Twitter, Instagram, YouTube and LinkedIn
• E-newsletters: Thurrock News, Housing News and Business Buzz
• Thurrock council website
• Economic development channels: Business Buzz, Love Grays, Thurrock Business, Thurrock Opportunities website
• Direct marketing: Letters and call to relevant businesses and residents in the borough
• Print/digital resources: Posters (A4/A3 outdoor), social media graphics
• Press updates
The Communications Strategy will make good use of national assets and locally focused materials. There will be several strands:
• Widely targeted information highlighting what is expected of people generally and explaining Government guidance
• Specifically targeted information facilitated through stakeholders for specific population cohorts at differing risks, for example those with additional needs or underlying health conditions
• Setting specific communications and products that seek to promote safe working practices/operation to allow the economy to reopen safely
• Setting protocol specific products explaining the responsibilities of stakeholders under the protocols and what to do in outbreak situations
• Dedicated campaigns on Test and Trace
Initial products will include:• A digital campaign across existing council channels will reach a wide audience across the
borough including Thurrock News e-newsletter, social media accounts (Facebook, Twitter and Instagram) and thurrock.gov.uk website.
• More bespoke information can be delivered to specific groups using mail-outs and digital e-newsletters through contact information obtained through previous contact made as part of shielding or Thurrock Coronavirus Community Care and through data analysis on risk factors.
• Additionally street signs can be put up in areas likely to see higher concentrations of people. This will also allow this campaign to work in conjunction with the exiting ‘reopening non-essential shops and transport communications strategy’.
5.1 Capabilities: Prevention5.9 Thurrock Communications and Engagement (continued)
Who: Businesses and workplaces
How:Facilitated by the Business, finance and economic recovery group.
A series of actions to ensure effective communications.
• Tailored postal and digital communications supporting and guiding to national resources and guidance and explaining the Test and Trace programme.
• Mapping existing communications and linking in with multiple stakeholders regarding their current and existing communications e.g. Trade association, chamber of commerce, HSE to prevent duplication
Impact: Businesses and workplaces are linked into the
outbreak control planning & test and trace and have effective risk assessments.
Businesses know how to access test and trace and have confidence in the system.
There is clarity within businesses and workplaces as to what is required of them and they communicate effectively with their staff as a result.
5.1 Capabilities: Prevention5.9 Thurrock Communications and Engagement (continued)
Who: Schools and Educational settings
How:Facilitated by Brighter Futures partners, Education and Schools Recovery Group. A series of actions to ensure effectives communications.
• Easy read versions to distil key points of the schools MOU and protocol for managing outbreaks
• Video communications to support infection control and vulnerable children in the shielded group produced by partners is shared with schools.
• Phone support to schools and settings from Public Health Programme Managers to support with implementing guidance around managing outbreaks and test and trace.
• Digital communications shared through head teachers briefings from the corporate director weekly.
• Joint DPH and DSC communication on key public health messages.
• Face to face meetings between DPH & Academy Chain CEOs
Impact: School staff have a clear understanding of their
responsibilities around outbreak management and test and trace allowing them to respond effectively to any cases that are confirmed or suspected.
Increased confidence in families following clear communications from schools and settings reinforcing local and national messaging.
Who:Care Homes How:Facilitated by the Clinical hub, Adult social Care contracting and compliance team for care homes. A series of actions to ensure effective communications.
• Digital communications to care homes to share protocols and guidance to support national directives and changes in guidance in relation to the Care Home Protocol, Prevention of COVID-19 in Care Homes, Managing outbreaks and Test and trace arrangements locally
• Advice and guidance regarding visiting and testing
• Easy read versions of the guidance and the outbreak control protocols are produced to aid staff understanding of responsibilities and necessary actions.
• Phone support to homes to support outbreak management.
• Ensure homes are able to access vaccinations and support them to do so
Impact: Care Homes staff and residents have a clear
understanding of test and trace allowing them to fulfil their responsibilities effectively for any cases that are confirmed or suspected.
Increased confidence in staff and residents to respond to advice in relation to test and trace.
Who: Vulnerable groups and the shielded
How:Facilitated by TCCA, Xantura and Stronger Together. A series of actions to ensure effective communications.
• Postal and email communications to those in the shielded group, those with known Covid-19 vulnerabilities and/ known to a service to support with accessing guidance, explaining the local plans to control outbreaks and details of the test and trace service and accessing short term emergency support to allow them to isolate if advised.
• Easy read versions of guidance produced.
• Video communications from trusted local voices.
• A guide produced to support stakeholders with sharing key points with vulnerable groups.
• Framework of practical support for self-isolation in place
Impact: Confidence in test & trace and a willingness to
follow advice from those that are most vulnerable.
A collective understanding of support available and a system response to sharing information and supporting those most vulnerable with communications and understanding.
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The aim of a local testing strategy is to make testing easy to access across the population and different settings.
Responding to Symptomatic SituationsA combination of national, regional and local testing infrastructure operates within Thurrock fortesting resident with symptoms. Residents can order a test, or book an appointment at thefollowing sites in Thurrock by calling 119 or through www.gov.uk/get-coronavirus-test
• Local Testing Site: Grays Beach Car Park (walk up)
• Local Testing Site: Orsett Heath Car Park (walk up)
• Local Testing Site: Canterbury Parade Car Park (walk up)
• Mobile Testing Unit: Grover Walk Car Park , Corringham (drive through)
A further Mobile Testing Unit is situated at Crown Road Car Park, Grays. This is “off portal”, which
means that residents can simply turn up to be tested without having to book an appointment.
Testing staff and their household contacts with symptoms
NHS, care home (including private sector care home), teachers and Thurrock Council staff and their
household contacts can access drive through testing provided by the Mid and South Essex Hospital
Group. NHS staff can book through a dedicated NHS testing hub and council and care home staff
through a council provided hub. The council hub directs all staff reporting COVID-19 symptoms to
testing facilities and provides follow up on return to work.
No COVID-19 test is 100% accurate and a risk of a ‘false negative’ (a negative test result where the
individual is actually infectious) presents a serious outbreak risk, where a test result is used to
allow a symptomatic worker to return to work in settings with people at high risk of COVID-19
symptoms such as care homes. Thurrock has developed a local strengthened protocol for return to
work arrangements for staff working in care homes and other high risk settings, requiring staff who
test positive to self isolate for 10 days and symptomatic staff who test negative to continue to
isolate for seven days to reduce the risk of a false negative result.
5.4 Capabilities: TestingResponding to Outbreak Situations
The settings based protocols that sit below this Outbreak Control Plan specify detailedtesting arrangements for managing and controlling outbreaks including criteria fordetermining when an outbreak has commenced and is outbreak is over. For example theThurrock Care Home protocol requires weekly testing of all residents and staff during anoutbreak as a mechanism to identify new cases that need to be isolated. The home maycomplete this themselves but should they need support to do so the council has acontract in place with Commisceo who provide on-site testing of all residents andasymptomatic staff.
We have extended this within the surge capacity arrangement to cover all areas of highpositivity that may require testing at a larger scale. In these circumstances, it will be theresponsibility of the Operations Control Centre to organise enhanced on-site testing inconjunction with the setting in question and in consultation with the Settings BasedOutbreak Control/Prevention cell.
Responding to variants of concernAlthough Thurrock have not experienced any variants of a variant of concern, such asthe South African variant, a multi-disciplinary response has been set up to effectivelymobilise required testing. Learning from other local authorities has informed this plan.
In the event a variant of the virus is identified in Thurrock, and surge PCR testing isrequired in a particular post code area, plans are in place to mobilise quickly. Theseinclude provision for the rapid stand up of door to door teams to deliver/pick up PCRtests, using tried and tested election poll card delivery routes, a surge testingcommunications plan, and pick up and drop off distribution centres. Locations for thedistribution centres are proposed to be based in libraries and could also be establishedfor the collection and drop off of PCR tests at other easily accessible sites.
5.1 Capabilities: Prevention5.10 Thurrock Testing Strategy
Testing of Residents without symptoms
Around one in three people who are infected with COVID-19 have nosymptoms (meaning they are asymptomatic) and could be spreading thedisease without knowing it. Offering more widespread testing toasymptomatic individuals will enable early identification and isolation ofpositive cases, which is important to breaking the chains of COVID-19transmission.
Rapid turnaround Lateral Flow Device (LFD) testing are a fast and simpleway to test people who do not have symptoms but may still be spreadingthe virus. The tests perform best when levels of the virus are at theirhighest. The test detects proteins that are present when a person hasCOVID-19, and high levels of the virus are present. They are currentlybeing used in some settings such as care homes and schools for thepurposes of asymptomatic testing. A confirmatory PCR test is required infor LFDs carried out in key high risk areas and with home testing kits.
A Community Testing TCG reporting to the SCG operates to monitorcommunity testing capacity and includes representation from theThurrock DPH.
LFD Testing is currently available in Thurrock for all adults over 18, and secondary and college pupils.
5.4 Capabilities: Testing
43
If adults are not able to access testing through their workplace, home test kits can bepicked up through the Pharmacy Collect and Community Collect programmes. As ofmid-April 2021, over 80% of Thurrock’s pharmacies have signed up to participate inPharmacy Collect. In addition, local walk through test sites are temporarily providinghome test kits at designated times each day.
Thurrock has set up 2 Asymptomatic Test sites for LFD testing , through the CommunityTesting Programme. These are dual sites, also offering Community Collect. Further localasymptomatic test sites and Community Collect distribution centres may be added infuture, as lockdown eases, and as the temporary LFD kit distribution at test sitesceases. An additional 5 asymptomatic test sites have been identified and approved.
Information about accessing asymptomatic tests is included on our websitehttps://www.thurrock.gov.uk/coronavirus-covid-19/getting-test
5.1 Capabilities: Prevention5.10 Thurrock Testing Strategy (continued)
Rapid access to testing and results of the test are key to being able to prevent and control COVID-19 outbreaks. The national approach to COVID-19 testing includes five separate pillars through which testing is delivered. The testing pillars cover a number of pathways. Each pathway, irrespective of location includes the same steps of: requesting a test; testing; test analysis and; reporting.
5.4 Capabilities: TestingCOVID-19 PCR (antigen) testing
Can be used in three broad scenarios:• Proactive screening of individuals without COVID-19 symptoms to confirm that they are not
infected with COVID-19• Testing of individuals who have developed COVID-19 symptoms to determine whether they have
active COVID-19 symptoms and need to self-isolate and provide details of their contacts• Testing of all individuals in a particular setting like a school or care home when and confirm
when an outbreak is over or during unexplained increase in rates .
Proactive Screening with PCR
Proactive screening aims to detect COVID-19 before symptoms occur, allowing those who areinfected to self-isolate before they pass the virus on. Proactive screening at population levelrequires a huge number of tests to be undertaken on a regular basis and if offered to everyone,would quickly overwhelm finite testing and laboratory resources. It therefore has to be targeted atsettings where it is most beneficial; namely at front line workers who interact with residents in veryhigh risk settings and who are at high risk of COVID-19 complications or hospitalisation if theybecome infected.• At present there is a proactive screening protocol of offering weekly PCR testing and twice
weekly LFD testing to all front line staff in care homes and domiciliary care as a mechanism forearly detection and self-isolation of staff. Details are set out in the Care Home and DomiciliaryCare Outbreak Prevention and Management Protocol.
• MSE Hospital group tests all patients on admission and all patients prior to discharge to carehomes to confirm their COVID-19 status. COVID-19 positive patients are never dischargeddirectly into care homes other than the designated setting
• NHS Partners test front line staff asymptomatically.
As part of our response to the very high case rates seen in Thurrock during the winter months,Thurrock Council has been offering asymptomatic PCR testing to for adults who cannot work fromhome. Local surveillance data shows a that there is continued and enduring higher prevalence andpositivity rates amongst working aged adults, and particularly younger working aged men.Communication has been targeted to this cohort to access asymptomatic PCR testing.
Prior to the return of schools in March 2021, all school aged children were offered a one–off PCRtest, prior to school based LFD testing, in order to help reduce transmission at the start of on-siteschooling.
There are three tests available:
• PCR (antigen) test which seeks to detect active infection. Tests are sent to a lab for analysis with
results usually within 24 hours.
• Antibody test, which seeks to detect antibodies to determine whether or not a person has been
infected with COVID-19 in the past.
• Lateral Flow test (LFD) which seeks to find positive cases with high levels of the virus, and provides a
rapid result (30 minutes)
Overall responsibility for ensuring adequate day to day testing capacity that responds effectively and
rapidly to current level of outbreak threat in Thurrock rests with the Health Protection Board, with
Strategic Oversight through the Health and Wellbeing Board.
5.1 Capabilities: Prevention5.10 Thurrock Testing
44
Testing in Outbreak Situations (cont.)
Where our surveillance cell identifies clusters of community cases within a small geography
or locality or within a large setting such as a major factor or logistics centre, we will
consider deploying a mobile unit (MTU) to that locality to support with testing. The
decision will be taken by the Health Protection Board and request made through the
Community Testing TCG
The national protocol on contact tracing does not provide for testing of contacts of positive
cases unless they become symptomatic. In situations where the number of contacts in a
setting required to quarantine presents a risk to the operational viability of that setting or
where backfill staff arrangements such as agency staff present an additional risk (for
example in care homes), we will consider extending testing to contacts to allow them to
return to work early where this is clinically safe to do so. Further details will be set out in
the relevant settings based protocol where appropriate and can be discussed on a case by
case basis by the relevant Settings Based Outbreak Control/Prevention Cell.
5.4 Capabilities: Testing5.1 Capabilities: Prevention5.10 Thurrock Testing (continued)
45
Antibody Testing
Antibody testing forms Pillar 3 of the national strategy. Antibody tests seek to identify
Immunoglobulin M and G (IgM and IgG) made in response to COVID-19 infection. It is
thought that the best chance of detecting IgM is from 14 days after COVID-19
symptom onset to 21 days after symptom onset, and the best chance of detecting IgG
if from 18 days after symptom onset, with levels declining slowly week by week after
this time.
Antibody tests cannot be used to confirm active infection or infectiousness due to the
time delay between active infection and antibodies being produced.
At present we are unclear what level of immunity different concentrations of IgM or
IgG provide against future COVID-19 infection or for how long, although it is
reasonable to assume that testing positive for antibodies may provide some level of
short term immunity. However, until further research is available, a positive antibody
test result should not be used to assume that an individual has long term immunity to
COVID-19 or cannot be re-infected or be infected. As such a positive antibody test can
show whether or not a person has been infected with COVID-19 in the past, but never
be used as a reason to ignore infection control and prevention advice or dispense with
PPE.
Antibody tests are currently available to NHS staff in Mid and South Essex and will be
available to adult social care staff in the near future. However their practical
application at present is limited to a surveillance tool to ascertain the percentage of
the population who have already been infected with COVID-19.
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5.1 Capabilities: Prevention5.11 Thurrock Testing Sites
Testing Sites in Thurrock
5.1 Capabilities: Prevention5.4 Testing (continued)
Asymptomatic Testing Options
5.1 Capabilities: Prevention5.12 ThurrockTesting Programme
48
NATIONAL: SERCO – 15,000 call handlers
REGIONAL: PH – 3000 trained clinical staff
A database called CTAS as been developed by national government to manage the records of casesand contacts in Tiers 3 and 2. It includes a web based resident facing offer to collect contactinformation. There are four ways of escalating a record in CTAS
Direct allocation.
Records that when entering the system are automatically allocated to tier one due to their status, for example a record identified as a care home resident is automatically assigned to tier 1 follow up in the system without progressing through the CTAS questionnaire
Automatic escalation.
When a case provides certain responses to questions, e.g. “working in a health or care setting” the record is automatically assigned to tier one follow up upon completion of the questionnaire
Call handler escalation
Following successful phone-based contact, if a person provides contextual information not directly captured by CTAS questions that suggest a Tier 1 response is required or where the case is unwilling to provide information
Central escalation
CTAS team will identify any records or events that need escalation and have not been captured from the other three escalation mechanisms, for example a cluster of cases in particular post code or small geography
• Has attended healthcare for non-COVID reasons• Works in a prison or other place of detention• Works in a special school• Lives in a homeless hostel/shelter/refuge or similar residential setting• Leads the call handler to believe the case has other risks not adequately disclosed• Cannot identify all contacts without disclosure of name to employer/third party• Is unwilling to provide all information required
3. Consequence management• Identified impact on local public sector service or critical national infrastructure due to a high
proportion of contacts needing to quarantine e.g. school/care home• Cases or contacts unable to comply with quarantine restrictions, e.g. homeless, other complex
social issues.• Likely high profile media / political concerns/interest
4. Increased disease frequency or severity that warrants local investigation• 2+ case in schools• High workplace absenteeism• Reported high numbers of hospitalisations
Interface between Tier 1 East of England Health Protection Team and Tier 1Local Authority Contact Tracing
Records of cases and contacts are downloaded each day from CTAS via Power BI to a local CentralRepository System database.
All cases and contacts are allocated out daily to dedicated call handlers who provide a telephone callto affected Thurrock residents to collect contact information and offer wellbeing support and guidanceon self-isolating.
Plans are in place for cases to be made available from CTAS at the point where a case receives aninvite to complete their details so that contact can be attempted almost immediately (“Local 0”). Thisgives more assurance that contact is made more quickly thus reducing further risk of further infectionand also the added benefit of residents gaining support from call handlers with local expertknowledge.
The following criteria will be used to decide which cases are escalated to Tier 1:
1. Cases where liaison with an educational/childcare setting or employer is required• Case has attended an educational setting whilst infectious• Case has attended work whilst infectious and is unable to identify all of their contacts
2. Complex and high risk settings. The case:• Lives or works in a care home/long term care facility• Is a healthcare worker who has been in contact with patients• Is an emergency services/border force worker who has been in contact with residents
5.1 Capabilities: Prevention5.13 Thurrock Test and Trace Criteria for Tier 1 Escalation and Data Flows
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Call process for Cases
1. Confirms information recorded is correct. If incorrect, Contact Tracers amend system.2. Checks all household contacts are correct and that information provided on them is accurate.3. Check for any other contacts not already declared by the case.4. Clarify symptom date, test date and isolation end date with case and ensure they understand the
guidance to be followed.5. Inform case the national system does not alert GP’s of positive results and ask if they would like us to
do it on their behalf. Alternatively, case can inform GP if they do not wish for us to do this on theirbehalf.
6. Case offered support during isolation, e.g. food provision, assistance with collecting prescriptions, ifthey feel lonely and wish to speak with someone and/or financial support.
7. If financial support is required, case is signposted to the Test and Trace Support Payment page begintheir application for the £500 grant. Contact Tracers will also provide cases with their unique CTASID, if they do not remember it or are unable to find the notification sent to them by the NationalTeam.
8. If they require support with food, prescriptions or befriending, they are provided with the number tocall the TCCA (Thurrock Coronavirus Community Action) for them to assist. If urgent, Contact Tracerswill escalate to the volunteer service directly rather than going through the TCCA.
9. If any other kind of support is required, the case will be signposted to the correct department thatcan assist them.
10. Those that do not require support, are still offered both the TCCA and Thurrock Council Test andTrace team number in case they find themselves needing any support in the future.
11. Notes about the call and anything that happened in the call are recorded in the case record in CRS.12. Any soft intelligence gathered during the call that is of concern is passed to the relevant Hub leader,
to confirm with the relevant setting.13. Case is closed.
NB Cases that are or have recently been in hospital, will be assigned to senior contact tracer so thatanother welfare call can be scheduled in a couple of days/weeks to check on their welfare and if theyneed any support.
Call process for Contacts1. Confirm information recorded is correct. If incorrect, Contact Tracers will amend on
the system.2. Clarify isolation end date with contact and ensure that they understand the guidance
to be followed. Also go through the steps they would need to take if they startedshowing any symptoms of Covid-19.
3. Find out where they work or attend school and record in CRS.4. Contact offered support during isolation, e.g. food provision, assistance with collecting
prescriptions, if they feel lonely and wish to speak with someone and/or financialsupport.
5. If financial support is required, contact is signposted to the Test and Trace SupportPayment page for them to begin their application for the £500 grant. Contact Tracerswill also provide cases their unique CTAS ID, if they do not remember it or unable tofind the notification sent to them by the National Team.
6. If they require support with food, prescriptions or befriending, they are provided withthe number to call the TCCA (Thurrock Coronavirus Community Action) for them toassist. If it is urgent, Contact Tracers will escalate to the volunteer service directlyrather than going through the TCCA.
7. If any other kind of support is required, the case will be signposted to the correctdepartment that can assist them.
8. Those that do not require support, are still offered both the TCCA and ThurrockCouncil Test and Trace team number in case they find themselves needing any supportin the future..
9. Notes about the call and anything that happened in the call are recorded in the contactrecord in CRS.
10. Any soft intelligence gathered during the call that is of concern is passed to therelevant hub leader, for the to confirm with the relevant setting.
11. Contact is closed.
NB Contacts that are or have recently been in hospital, will be assigned to senior contacttracer so that another welfare call can be scheduled in a couple of days/weeks to check ontheir welfare and if they need any support
5.11 Thurrock Local Test and Trace
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5.1 Capabilities: Prevention5.4 Testing (continued)
Good Practice, Issues and Lessons Learnt
A range of testing sites have come on stream throughout recent months. Aprocess of local site identification, working with key officers within the councilhas led to rapid identification and set up of sites when required.
A process for managing the community, member and business liaison followinga site visit prior to the set up of a site is now in place and is under constantreview. This means that residents, businesses and councillors are notified aswell as broader communications channels used to convey messages about newtest sites.
Good partnership working with teams such as Highways, Parking Enforcement,Cleaning and Greening and Environmental Protection is in place to ensure sitesare well prepared ahead of go live. The correct officers are included indiscussions about any changes to access routes, reduction in parking availabilityand potential impact of sites in relation to generator noise and light.
Thurrock took part in a regional programme of offering asymptomatic PCR testkits for collection to 2 cohorts: families and pupils returning to school, andadults who cannot work from home (including Thurrock Council front lineteams) from December 2020 to March 2021. A distribution centre model wasadopted, using a council owned base initially, and then rolling out to libraries(staffed by library staff). These were very successful and well received in thecommunity and provided a valuable model that can be rolled out in futureeither for a variant of concern or as part of the Community Collect programme.
Next Steps
We have a comprehensive testing offer within Thurrock, both in terms of capacity andgeography. However, as lockdown eases we recognise that some of our testing sites mayno longer be available to us, particularly those situated in car parks, and those in halls thatmay start to be used.
We will keep all sites under review, particularly those where a 6 month licence is in place,taking into consideration testing volumes at sites and feedback from communities andbusinesses. We will continue to identify potential LTS sites to ensure that we retain walkthrough PCR testing for residents unable to drive, should existing sites be returned to theiroriginal use. It is likely that we would look to establish the smaller LTS models with lesstesting capacity as less space is available.
As restrictions ease, testing will be much more agile than it has been previously – we willlook to establish less static sites and take testing out to communities and workplaces.,with the ability to flex in times of outbreak or in response to variants of concern. Wewould want to work with DHSC to establish a 7 day MTU offer more suited to thisapproach. For asymptomatic testing, we will work with employers to set up the mostsuitable and convenient testing infrastructure, which is likely to be a hybrid of sites withinthe community and a roving testing offer.
As outlined previously, we will continue to respond quickly in outbreak situations, usingdata from sites to discover trends and patterns where we could optimise capacity orpotentially improve performance. We can stand up a rapid testing offer using MTUs andhome test kit distribution for variants of concern or localised community outbreaks.
As the testing landscape changes, we will work to ensure that we continue tocommunicate this to residents and businesses. Our Communications Cell is adept atmanaging these messages. Our website clearly sets out testing options and social mediachannels are used to target messages to particular groups or in certain areas.
5.1 Capabilities: Prevention5.14 Thurrock Testing: Good Practice and Lessons Learnt
5 1
Cases and contacts are assigned to Contact
Tracers to begin welfare calls and to gather any relevant information
operate from 22/03/21)
Case has been at a setting (i.e. workplace, school, care
home, etc.) during their infectious period.
All cases and contacts are exported from Power BI
dashboard, daily and uploaded into CRS (Local 0 will operate from
22/03/21)
Contact Tracer makes contact with case
YES
High risk and vulnerable communities settings and traveller sites - an email sent to the Hub leader of positive case for action.e.g. positive case lives in a HMO, the Hub lead makes contact with the manager HMO to gather more information on other residents that reside at that property. Info is passed back to Contact Tracers to contact and begin a welfare call, offer support and ensure they understand guidance.
Workplace settings - in-depth Risk Assessment (RA) is completed with the case, such as contact details for a manager at the workplace, how the case travels to work, if they have any other jobs they work at the same time, if they have any contacts at their workplace, if anyone else had recently tested positive at their workplace, if they have any concerns about their workplaces covid-19 protocols, etc.. RA is sent to Workplace Hub for case investigators and EHO (Environmental Health Officers) to action further.
Name and address of setting is recorded on CRS and ‘not infectious’ box is ticked to make Hubs aware.
YES
YES
Contact Tracer completes call process
Setting in workplace, high risk and vulnerable
communities or a travelers site?
Recorded on CRS. Case is asked follow up questions, such as if they have any contacts at their setting.
Case/contact is reassigned back to the team, for resident to be called again.
Information recorded on CRS and alert sent to
relevant Hub of positive cases at a setting.
NO
NO
NO
5.1 Capabilities: Prevention5.15 Thurrock Test and Trace: Local Zero Test and Trace Process
5 2
Case 1
A resident that had been made aware that they were a contact of a positive covid 19case contacted us. They had not been alerted at this point by national test andtrace. We established that the resident was indeed a close contact. The contact hadcorrectly started to self isolate but had no family and friends in the local area, inaddition as she was paid weekly she was running low on finances. We liaised with anumber of agencies to ensure that she was correctly registered on the system andtherefore receiving her CTAS ID, we then assisted her in completing the application toreceive the support payment that was then available to her, we also arranged for thelocal volunteers to pick up some shopping for her. The resident was extremely gratefuland emailed the following:
I hope you don’t mind me emailing you. I just thought I’d email you to let you know that, Ihave received my payment for my track and trace. I am so grateful for what you done to helpme and my family I cannot thank you enough. You are a credit to the Thurrock Council Team.All the best to you. stay safe
Case 2
We supported an asylum seeker that had been relocated from London to Thurrock.4 days after his arrival he tested positive for Covid-19.As he had just recently arrived in the area he had no friends or family around him thatcould support him through his isolation.We provided him with an emergency food parcel so that he would have some food andalso provided him with toiletries.We contacted the special line for Asylum Seekers to make them aware of the situationhe was now facing and contacted Red Cross to assist in providing him further supportin terms of clothing.
5.16 Thurrock Test and Trace: Case Studies
Case 3
All Thurrock residents returning from hospital have enhanced welfare calls following the completion of their isolation. This enables T and T to ensure they have the strength and support they need
On one such welfare call we had made contact with a daughter of an elderlyresident. The daughter broke into tears on our phone call, that someone hadreached out to offer support. The resident had been discharged from hospitalthe previous night and the daughter was not living in the local area. Despite theage of the resident, prior to admission to hospital the resident was veryindependent with the daughter arranging for shopping to be delivered on aweekly basis. The daughter had arranged for shopping but was extremelyworried about her mum as she had not managed to get out of bedindependently, had soiled the bed linen and was having difficulty generallymoving. No support had been put in place upon discharge where the residenthad no carer support previously. We have made good links with our colleaguesin the community social work team, as such we referred this case immediatelyto our colleagues who promptly arranged for an assessment to be carried outthat afternoon. Support was put in place for this resident on initially a shortterm basis to allow the resident to recuperate. We also contacted our links withAge concern to arrange for some basic cleaning tasks to be carried out in theresidents home to ensure that this remained a safe environment whilst theresident regained her health.
The daughter rang a few days later to express her gratitude as she was notaware of where to turn for assistance given how independent her mum had
been and that our call had relieved so much stress for herself and her family.
7.6 Supporting Vulnerable Communities to Self-Isolate
.
5.17 Test and Trace Variants and Mutations (VAM) and Enduring Transmission
53
Approach
The PHE HPT will notify Council of a case of VAM (Variants and
Mutations), the new term encompassing the VOCs and VUIs (Variants of
Concern and Variants Under Investigation) via an email to the SPOC email
address.
DPH will also be notified/copied in. DPH will immediately inform TCG,
Leader, Emergency Planning and relevant bodies
The information will include details of the actions that the HPT would like
support on; for example, all non-engaging cases will be passed on to the
LA after 24 hours for more locally focussed efforts on establishing
contact.
A script will be provided by HPT to ensure accurate and timely
investigation by Thurrock test and trace teams
Should wider testing/surge testing be required this will be made clear in
the communication from the HPT. Local surge testing arrangements in
Thurrock can be mobilised within 3 days.
An IMT will be convened for the management of a cluster (HPT, LA,
national and local colleagues).
We will ensure adequate staffing both in test and trace and in order to
extended testing/surge testing as part of a response to a single case of
VOC/cluster
National process flow for the management of VAM incidents and clusters :provided by the East of
England Health Protection Team 2021
Issues
Enduring transmission is a concern in certain settings; warehouses, foodprocessing/producing plants transport etc. and their interconnectedness via social andfamily networks to care homes (discussed in cell updates). Transmission in one setting mayhave an impact on others. It is therefore crucial that we continue close surveillance oftransmission and case rates, and tailor both our testing strategies and communications toreach community groups where we continue to see higher rates of transmission. This isparticularly important during the coming months before vaccination is offered to youngerworking age people.
Longer terms issues in care homes need to be considered including deprivation, care homefunding quality of care, staff skills and training, provision of IPC services. Clarity on whetherthe round 3 ASC IPC fund will be made available would help inform plans such as fiscalincentives to care home staff to enable self-isolation, and we will continue to reducevaccine hesitancy resulting from concerns of post vaccine side effects and addressconcerns regarding loss of wages.
Delayed contact tracing by tiers 3 and 2 could affect the delivery of prompt and appropriatereferrals to tier 1. This would in turn affect the timely response of Thurrock services,however our move to “Local 0” contact tracing from day 0 of case report should helpreduce this impact.
7.6 Supporting Vulnerable Communities to Self-Isolate
.
5.17 Test and Trace Variants and Mutations (VAM) and Enduring Transmission
54
Next Steps
Continue proactive work with workplaces, care homes and vulnerable settings (IPC
training, raising awareness of vaccination).
Using surveillance information to monitor transmission rates, and detect incidents and
outbreaks early and working collaboratively with the local HPT/PHE. This includes
management of VAM cases and clusters.
Focused work on improving vaccination coverage rates among BAME and social care
staff continues. We are doing this through a social marketing research via Upshot
Marketing and through webinars to address vaccine hesitant population.
Prompt contact tracing is required by tiers 3 and 2 and prompt and appropriate referrals
to tier 1, supported by “Local 0” local roll-out.
Enhanced IPC training identified and commenced in care homes.
Continued enhanced links with education, health care, high risk and workplace cell
members, and continued support from Covid Marshalls as the Roadmap opens up local
shops and services.
THURROCK
Residents unable to access
vaccines/testing
Deprivation
VACCINE HESITIANCY
High Risk Population
7.6 Supporting Vulnerable Communities to Self-Isolate
.
5.17 Identified causes of Enduring Transmission
55
BTUH
Unknown premises(HMOs)
Families unable to
isolate
Residents unable to
access testing
Vaccine Supply
Businesses not
supporting isolating
staff
Complacency
Lack off PPE
THURROCK
Comms Strategy
Multi-disciplinary
high risk cells
Vaccine hesitancy webinars
Upshot report
7.6 Supporting Vulnerable Communities to Self-Isolate
.
5.17 Identified Approach to Reduce Enduring Transmission
56
Engagement with key
stakeholders
Surveillance
IMT and Reporting Structures
Targeted testing high
risk populations
Engagement with Faith Leaders
Additional test sites
Proactive engagement
with businesses ahead of Roadmap
Social media
messaging
Covid Marshalls
5.2 Capabilities: Surveillance and Intelligence5.1 Capabilities: Prevention5.17 Moving between Epidemic & Endemic Phases
57
Managing Movement between Alert Levels
Local Alert Levels are described above, and these will be used to inform escalationand de-escalation of the local response as described. In this way we can beconfident that the local response will be flexed to accommodate both the currentepidemiology and the pressure on the health and care system.
The local move between epidemic and endemic phase management will beoverseen by the Health Protection Board. This will support the statutory HealthProtection duty of the Council and DPH under the 2013 Regulations, allow co-ordination of Health Protection responsibilities across Thurrock Council, our localNHS partners and PHE / UK Health Security Agency, and give us a local forum forrapid escalation when required.
Variants and Mutations
Whilst monitoring of Variants and Mutations (VoM) remains the remit of PHE/HealthProtection, information is cascaded from PHE to the LA Contact Tracing team andSurveillance Cell. Routine sequencing of Thurrock’s positive tests is undertaken,with around 20% of tests sequenced at the time of writing. Information on VOMwould inform LA surge testing strategies.
Local Area Risk Categorisation
For the majority of scenarios it will be most effective to deal with within the localarrangements, where local community spread will largely be manageable withinlocal COVID-19 arrangements.
However, depending on the prevalence and progression of the virus local systemswill be designated into three ‘escalation’ categories this will enable Thurrock toengage specialist expertise and resource to be drawn down from regional andnational levels to augment the local systems.
Data surveillance monitoring will inform UTLAs being designated (by the nationalcommand structure) in one of the following categories:Area(s) of concern – a watch list of areas with the highest prevalence, where thelocal area is taking targeted actions to reduce prevalence – for example additionaltesting in care homes and increased community engagement with high risk groups
Area(s) of enhanced support – for areas at medium/high risk of intervention wherethere is a more detailed plan, agreed with the national team and with additionalresources being provided to support the local team (e.g. epidemiological expertise,additional mobile testing capacity)
Area(s) of intervention – where there is divergence from the measures in place inthe rest of England because of the significance of the spread or because affectingnational infrastructure. In this instance, a multi-agency national incident resourcewill be deployed to significantly bolster local resources to respond to the incident.Further Guidance can be found athttps://www.gov.uk/government/publications/containing-and-managing-local-coronavirus-covid-19-outbreaks/covid-19-contain-framework-a-guide-for-local-decision-makers
Test and Trace presents additional challenges to some individuals to self-isolate for ten (10) days if they or a household contact tests positive for COVID-19 or if they are contacted by NHS Test and Trace because they have been identified as a contact of a case.
Thurrock Council in partnership with Thurrock Council for Voluntary Services set up Thurrock Coronavirus Community Action (TCCA) early in the epidemic to support vulnerable individuals to cope during the epidemic. This included:
• Residents on the government’s ‘Shielding’ list who are at very high clinical risk of COVID-19 who have been asked to self-isolate (known as Category A, circa 12,500 residents)
• Residents with underlying health conditions that place them at increased risk of COVID-19 but who are not on the Government’s ‘shielding list’ (known as Category B, circa 40,000 residents)
• Residents with other vulnerabilities for example those with mental health problems or who are at risk of domestic violence (known as Category C)
TCCA has operated a dedicated telephone support service throughout the epidemic. Outbound calls were made to every new Shielded resident who requested support via the National Shielding Support Service during periods of national and local lockdown, and appropriate support has been provided where required. The service maintained a master database of the needs and individual characteristics of shielding residents in order to ensure that their needs were met. The service provides a range of support services that can be accessed via the telephone to all risk categories through a network of volunteers including:
• Help to access essential supplies like food and household products
• Medicines collection and delivery
• Practical help like gardening, cleaning and dog walking
• Befriending
The service initially operated 9am-3pm weekdays and 10-12pm on weekends; however it has now reduced its operating hours to 9am-3pm Monday to Friday.
National and local information has shown us that the effects of the pandemic will be felt on our community for a long time yet. The successful partnership between the Council and CVS in providing TCCA will be built on for our approach as we come out of lockdown. We have a plan in place for expanding a programme called 'Our Road' which seeks to use volunteers to support their neighbours and communities in building resilience and confidence post-lockdown. Our newly-agreed Collaborative Communities framework and the Stronger Together partnership will be crucial to rolling this out in the next few months.
7.6 Supporting Vulnerable Communities to Self-Isolate
TCCA links to our operating model for Test and Trace in order to assess and target support at residents
who may need it proactively. TCCA will be the primary mechanism for implementing the Framework Of
Practical Support For Self-isolation. The process by which this is done is set out on the next page.
Contact tracers ask all contacts whether or not they are vulnerable and/or need additional support using
an agreed script. Where potential vulnerability or support needs are available, contact tracers explain the
support offer of TCCA and ask whether or not the contact consents to pass their contact details to TCCA.
Where consent is obtained, TCCA follow up with the contact and either arrange support through the
volunteer network or broker support through other council or wider stakeholder services.
Test and Trace has access to patient identifiable COVID-19 positive case information, via CTAS enabling us
to cross reference positive cases with our CAT A data base. Where a positive case is also recorded on our
data base as a CAT A resident, we will arrange a proactive phone call to make the same support offer that
we make to all contacts, and where required, refer details of the case the TCCA.
CAT A residents who test positive of COVID-19 are at significantly increased risk of complications from
COVID-19. In these circumstances we will also ask the resident’s permission to share their positive test
result with their GP practice, and if given, alert the GP surgery and request clinical following up and
monitoring of their patient.
Test and Trace Support Payments
From October 20 to April 21, Thurrock made 4343 Main scheme and 304 Discretionary scheme payments
to eligible residents. The scheme is now being extended to include Parents and Guardians who are not
legally obliged to isolate, but who have to care for a child that has been told to isolate as a contact of a
positive case in school or nursery.
5.18 Thurrock Test and Trace Supporting Vulnerable Residents to Self-Isolate
58
Contact Details Obtained by Contact
Tracer
TLOC obtains case identification via CTAS
On CAT A database?
End
Contact tracer asks contact if they
require additional support to self-isolate
Additional support
required?
Contact tracer informs individual of
TCCA support available
TCCA support required
Consent gained to pass details to TCCA
Contact tracer passes name, telephone
number, address and type of support required
to TCCA
TCCA call handler records details on
4me including specific code ID’ing
interaction as T&T
TCCA Triage function informs other Council services if requested /
applicable
TCCA call handler makes contact with resident to
arrange support as required including external referral if
appropriate
Contact tracer calls case to ascertain if they require additional
support to self-isolate & request permission to
inform case’s GP
Contact tracer cross references case ID
with CAT A database
Wider support brokered / provided
End
NO
YESYES
NO
YES
NO
Contact tracer informs case’s GP that they have a CAT A patient who has
tested positive for COVID-19 to ensure
clinical follow up
7.7 Flow diagram: Supporting Vulnerable Communities to Self-Isolate (continued)5.18 Thurrock Test and Trace Supporting Vulnerable Residents to Self-Isolate - Process
Contact tracer calls case to ascertain if they require additional
support to self-isolate
59
Risk/Issue National / local risk Possible mitigation measure
TCCA contact centre has reduced in capacity. If demand increases, contact centre might not be able to cope.(This was more of a risk during periods of highest infection rates but may still arise as we emerge from lockdown.)
Local - Staff are now well-practised in taking calls from more vulnerable residents so should be able to support appropriately
- Continued communications encouraging use of webform compared to telephone number.
- Ongoing monitoring of TCCA activity via Stronger Together partnership
Potential increase in work for TCCA / contact tracer staff due to new expectations in LA framework about additional contact requirements around those in the national T&T dataset identifying as Clinically Extremely Vulnerable or Clinically Vulnerable.
Local • Work to ascertain numbers currently underway (framework only released on 9th
March 2021). However, as above, staff are well-practised in making these contacts and we are confident these can be managed.
The number of volunteers available to support TCCA has been decreasing as more return to work.(Demands on volunteers have reduced more recently, so it is hoped that the volunteer capacity remains manageable)
Local - Communications reiterate that people ask family/friends for help before approaching TCCA, and that shielded patients can continue to access priority slots for online shopping. This is written in script of call handlers as well.
- Continued roll out of Our Road programme to encourage community networking and resilience
The new national framework now suggests that the Medicines Delivery Framework will be extended to cover both those shielding and those self-isolating as a case/contact – so this should reduce demand for TCCA volunteers to deliver medicines
7.8 Risks and Mitigation: Supporting Vulnerable Residents to Self-Isolate.5.18 Thurrock Test and Trace Supporting Vulnerable Residents to Self-Isolate
60
7.6 Supporting Vulnerable Communities to Self-Isolate
.
5.18 Thurrock Test and Trace Supporting Vulnerable Residents to Self-Isolate –Next Steps
61
Next steps
Review arrangements for information flow in TCCA on all CEV and CV
individuals, and from Contact Tracing re those self-isolating.
Work with OurRoad team to help embed messages on self-isolation, as well
as grow the volunteer and community capacity to support individuals
expressing need.
Draft briefing for call handlers on the extension of the Medicines Delivery
Service.
Consider opportunities to test people’s desire for support to reconnect after
lockdown as well as having the practical and emotional needs of shielding
met
Extend Self-Isolation Support Payments to to include Parents and Guardians
who are not legally obliged to isolate, but who have to care for a child that
has been told to isolate as a contact of a positive case.
Key Points
The Framework Of Practical Support For Self-isolation operating model will
be included in the wider Contain Framework, and will be in place by the end
of March.
TCCA is already set up to be able to support those who are self-isolating and
cannot otherwise access food etc.
Thurrock already has a code on the system to be able to report on how many
TCCA support due to a self-isolation requirement from T&T, and this is
reported on every month.
Contact Tracing team will shortly able to start identifying contacts from day 1
of positive case report, facilitating rapid identification of need in those
residents self-isolating.
Section 6:
Prevention and Management of COVID-
19 in Thurrock
8.1 Variation in Risk
As the COVID-19 epidemic has progressed we have learnt more about the risk that the virus poses. There is now clear evidence that the risk of both contracting the virus and the risk to an individual’s health once infected with COVID-19 is not the same across the population. Certain communities and population groups are at increased overall risk of COVID-19 by nature of variation in risk of becoming infected in the first place, and variation in health outcome once infected.
Overall risk of COVID-19 to different communities and population groups can be thought of as a function of both likelihood of exposure and consequence to health of exposure.
Some settings, both residential and workplace increase the likelihood of exposure to COVID-19 and hence infection: This can be because there is a higher chance that a COVID-19+ person will access the setting, because the setting’s environment facilitates COVID-19 transmission, or because of behaviours or tasks undertaken within the setting.
Equally, the risk to health from becoming infected varies from group to group dependent on a range of factors including age, ethnicity, number of underlying health conditions and lifestyle factors like weight and smoking status
Figure 7 suggests where on average, different cohorts of residents may fall on these two dimensions of risk (exposure and consequence). For example, children and young people in schools settings have the lowest risk as there is some research evidence that suggests that they are less likely to contract COVID-19 and may be less effective at transmitting COVID-19 and strong evidence that they are highly unlikely to suffer significant adverse health consequences if they do become infected.
Conversely nursing home residents spend all of their time in a high risk setting and are at significantly increased risk of adverse health consequences from COVID-19 when compared to other population groups.
Human behaviour and risk mitigation practices such as infection control and PPE are not factored into the diagram but can have a significant impact on where an individual lies on the ‘risk of exposure’ access. Additionally there is likely to be variation between different individuals within a population cohort in terms of where they lie on the ‘consequence’ (y) axis depending on their individual health status in terms of lifestyle and numbers of underlying health conditions
6.1 Overview
Figure 7
63
6.2 Thurrock Vaccination Programme
From December 2020, areas began to provide COVID-19 vaccinations to their populations in linewith the Joint Committee on Vaccination and Immunisation (JCVI) guidance on priority groups.Locally our lead partner in this was EPUT (Essex Partnership University Foundation Trust), withsupport from the MSE Hospital Foundation Trust, Thurrock CCG and the four Primary CareNetworks. Thurrock Council is working closely with Thurrock CCG on monitoring and oversight ofthe roll-out of the vaccination programme, and on addressing inequalities in uptake.
Much of this work has been approached at a Mid and South Essex level, with the current details onavailable vaccination sites published on this website: https://www.essexcovidvaccine.nhs.uk/
Thurrock Council took the lead responsibility for identifying social care staff eligible for thevaccination under priority group 2. Eligible staff were provided with letters to present at vaccinationsites. Some care home staff were initially vaccinated at Basildon Hospital and not recorded as carehome workers, which may affect uptake figures in that category. The Council has supportedvaccination of staff within special schools and those within mainstream education supportingchildren with Special Educational needs. The rationale for this is that staff are working directly toprovide support to children with the most complex care needs where it is impossible to maintainsocial distancing and adhering to PPE requirements would be much more challenging.
Vaccinations are key to the management and control of the pandemic. Currently Thurrock arevaccinating cohorts 1-9. If there are issues with the supply of vaccines or access, this is escalatedthrough the clinical and specialist hubs.
Addressing Inequalities in Vaccine UptakeMid and South Essex HCP were asked to submit a plan to NHS England in February 2021 detailinghow inequalities in vaccination uptake amongst ‘hard to reach’ groups would be identified,monitored and addressed. An officer from EPUT was assigned to lead this approach across the HCPgeography, and a plan is in place to address this for Mid and South Essex. Some of this work willinclude:• Conversations with leaders of local Mosques to discuss opportunities and identify solutions with
the Muslim community• Exploring how we can provide vaccination facilities for some women, so they are able to receive
their vaccine in a dignified way in a private area just for them• Working with partners to make sure we can reach out to the homeless and rough sleeping
community
• Support for vulnerable women and other groups, such as asylum seekers and refugees, to accessthe vaccine
• Providing specific accommodations, adapted clinic and communications for people with sensoryimpairment, through working with ECL Sensory Care
• The Essex Learning Disability Partnership (ELDP) is working with the local health and social caresystem to support adults with learning disabilities get vaccinated
There is more local work underway in Thurrock to ensure our population inequalities are recognisedand appropriately addressed as part of the above approach, including webinars to address vaccinehesitancy among local workforce and communities, and mobile vaccination clinics.
One example of a local initiative is a piece of social marketing research currently underway by thelocal system via Upshot Marketing. This aims to explore perceived barriers to taking up the vaccineparticularly amongst local populations including BAME groups, and test possible communicationstrategies to see what might encourage vaccine uptake in the future. This work should becompleted by May 2021 in order to inform wider roll out plans beyond the JCVI priority groups.
A steering group is in place comprising of partners in Public Health, Thurrock CCG, CouncilCommunications, Communities team, Thurrock CVS and Upshot Marketing to monitor progress, andadvise on relevant community connections to publicise the research appropriately. The work willalso include targeting health and social care staff, as there are also inequalities in their vaccinationuptake.
64
In recognition of the differing risks of COVID-19 faced by different cohorts of our residents, we will develop specific protocols setting out how we will prevent and manage COVID-19 outbreaks in different settings and communities managed by setting specific ‘hubs’
Thurrock developed and implemented protocols covering prevention, outbreak management and test and trace for all settings. These are managed by four Outbreak Prevention and Control Hubs:
• Care Homes, Domiciliary Care and Primary Care
• Workplaces and Business
• Schools, Early Years and Post-16 Institutions
• Vulnerable population in residential and non-residential and High Risk Communities
• Socially disadvantaged and Community settings
Cases, contacts and outbreaks in specific settings will continue be managed in line with the protocols.
Existing relevant structures that form part of the COVID-19 response and recovery structure of Thurrock are used as the Outbreak Prevention and Control Hubs. Figure 8 show details of hubs already functioning with required stakeholders around the table. The hubs are used as a reference group for adapting and refining settings protocol following learning from situations to ensure they remain fit for purpose as the epidemic develops.
The hubs will also be used by the Communications Cell as a consultation mechanism for specific communications messages/products aimed at specific settings and adapt communication following soft intel from the hubs.
8.1 Supporting High Risk and Complex Settings and Communities: Prevention and Outbreak Management Hubs
BUSINESSES, WORKPLACE
& PUBLIC VENUES HUB
Structure used: Finance, Business and Economic Cell (TCG sub-group)
Frequency: Weekly
Chair: Director of Place, TBC
PH Lead: Senior Public Health Programme Manager
Protocols: Businesses, Workplaces and Public Venues
PRIMARY CARE & ADULT
SOCIAL CARE
Structure used: Existing Care Home Hub (to be expanded)
Frequency: 3 x a week
Chair: Deputy Chief Nurse, TCCG
PH Lead: Senior Public Health Programme Manager
Protocol(s): - Care Homes
- Primary Care
- Domiciliary Care
COMMUNITIES HUB
Structure used: Stronger Together Board
Frequency: Fortnightly
Chair: Strategic Lead – Communities and Equalities, TBC
PH Lead: Protocol Manager and Strategic Lead PH – MH
Protocol(s) - Vulnerable populations in residential settings
- Community settings
SCHOOLS, EARLY YEARS AND
POST-16 INSITUTIONS HUB
Structure used: Schools & Early Years Cell (TCG sub-group)
Frequency: Bi- Weekly
Chair: AD Education & Skills, TBC
PH Lead: Senior Public Health Programme Manager
Protocol(s) - Schools- Early Years
6.3 Thurrock Prevention and Outbreak Management Hubs
Figure 8
65
Scope• Businesses and other employers in Thurrock. Three major ports, food/drink processing companies employing 10+ staff.
• High risk considerations: high volumes of employees travelling or living together with frequent movement between businesses/areas. Vulnerable employees not identified. Impact of self-isolation on viability of (parts of) a business. Language barriers. Lack of awareness of, understanding of or engagement with infection prevention/control measures on the part of employers/employees. Less mechanised settings. Catering/hospitality settings serving large numbers of public making contact tracing challenging. Large number of visitors for public venues/events e.g. theatres and sports stadiums, and high consequence environments such as food distribution centers, etc.
AIM: • To reduce the risk of and prevent the transmission of COVID-19 within business, workplaces and public venue settings and limiting the spread of infection between these settings and the community. This
may include people residing in and travelling in and out of the Borough.• To assist in managing the subsequent impacts on local businesses, workforces and the public attending public venues.
OBJECTIVES:• To identify and work with the high-risk businesses, workplaces and public venues for preventative and outbreak management measures. • To promote prevention by ensuring that businesses have access to relevant information, advice and support. • Rapidly identifying and confirming COVID-19 cases, clusters and outbreaks when they occur and providing a coordinated response to reduce the threat of transmission to local workforces and the
community.• Supporting businesses and workplaces to interpret Public Health guidance and prevention and control measures to allow settings to remain open and continue to operate, where possible. • Outbreak management and contact tracing, including specialist guidance to high risk businesses experiencing an outbreak (and to trace contacts that have attended public events)
Existing infrastructure/assets• Many national and local organisations already provide information, advice and guidance to
businesses (see stakeholder list below). • Stakeholders, Partnerships and existing groups:
• Business, Finance and Economic Recovery cell• Thurrock Business Board• South East Local Enterprise Partnership (SELEP)• SELEP• Economic Development and Skills Partnership• Health and Safety Executive• Unions• Essex Chambers of Commerce• Federation of Small Business• Trade associations• Food Standards Agency
• National Test and Trace programme. • PHE Health Protection Team outbreak management function.
Current processes/responsibilities
• Multiple organisations provide information, advice and guidance to businesses
• PHE Health Protection Team lead on outbreak risk assessment and management
• Contact tracing – only as carried out through PHE / national Test and Trace.
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Risk/Issue National / local risk Possible mitigation measure
Too many businesses locally to fully keep track of developments on an individual basis?
National and local Mapping of which organisations provide what level of information, advice, guidance and support to which types of businesses. Identify high risk businesses and workplace settings for prevention.
Business/organisational trust in Outbreak Management and impact on Business?
National and local Proactive communications and engagement on notifying early to mitigate and minimise risk on operations of business.
Potential difficulties in obtaining all required information – e.g. all details of contacts etc..Business/Employer willingness to share information or send letters?
National and local Develop targeted communications, standardised messaging to roll out which stipulate importance of providing required information if contacted by T&T.Protocols for escalation where businesses or workplaces do not engage?
No integrated outbreak management function with links to other cells and functions.
Local Finance, Business, and Economic Recovery Cell (FBE)Workplaces Outbreak Prevention and Management Operational Group (WOPMOG)Interface with Outbreak Control Team
Unknown capacity/resource requirements for outbreak management –large numbers of businesses and workplaces, not all of equal risk.
National and local High risk workplace settings and employee numbers have been identified.Resource allocation on Outbreak Management to be continuously monitored via FBE and WOPMOG.
6.4 Businesses, Workplaces and Public Venues, Risks and Mitigation
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Good practice:
- An array of officers across the local authority pool their local knowledge and expertisevia the forums set out in this document to ensure national policy and guidance isconsistently adhered to when liaising with our businesses and workplaces.
- The council website and Business Buzz e-newsletter were used to good effect to keepworkplaces and their staff updated with the latest national and local guidance andpolicies, including the local testing offer.
- The establishment of a tiered approach between contact tracers and EnvironmentalHealth Officers (EHOs) uses scarce resources more effectively; case investigatorsprogress the initial contact tracing and Public Health escalate cases to the EHOs whereappropriate, thus freeing up EHO time to concentrate on site inspections.
Issues:
- Locally, Thurrock experienced challenges with the recruitment of additional EHOs tosupport site visits following high demand and low supply across the country.
- Determining whether seafarers or hauliers were self-isolating in our hotels within theborough was at times unclear.
- Enquiries from workplaces might be received via a number of routes such asdepartmental email addresses or phone numbers including the general enquiries emailaddress. The same was the case for enquiries from employees, usually those whowished to remain anonymous.
6.4 Businesses and Workplaces: Good Practice, Issues and Lessons Learnt:
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Lessons Learnt:
- Restructuring the investigation process between contact tracers and EHOs was invaluable.
- Ensuring the contact centre had the correct details to forward COVID-19 enquiries reducedresponse time and increased efficiency.
- Proactive work with our port and hotels via the EHOs was critical to ensure effectiveinformation sharing and the ability to advise and support these workplace settings whereappropriate.
Workplace Case Study
19th February 2021
CommencedCase Investigation
• Contact made with Mears Group to establish policies and procedures in place.
• Overarching internal risk assessments requested
• Request for disclosure of case and contacts lists for the past 14 days in line with Public Health Act 1985.
20th February 2021Disclosure Received
• Concerns over self-isolation of contacts were noted on the email response from Employer.
Risk Assessment Received 18th
February 2021
• Information gathered from employer rapidly established setting in cluster status.
• Identified employer as not following PHE guidance for self-isolation of contacts.• Employer was requesting contacts to return back to work upon negative test results.• Disclosure of staff contacts and confirmed cases was not accurately reported.
Challenges:
50 Employees Status: ClusterMaintenance
Multi-disciplinary approach:
• Out of hours Public Health Officer was requested to liaise with company’s General Manager to enforce immediate mandatory 10 days self-isolation of contacts.
• Case was discussed during weekly TLOCC meeting for monitoring purposes. • Discussed onward management of workplace during WOPMOG-2 meeting.• Environmental Health Team arranged an unannounced site visit to ensured compliance
regarding advice given. • An agreement between Employer and Public Health Thurrock to share case and contact
list in standardised format is ongoing to monitor status of setting.
• Risk assessment for a single case received from Thurrock’s Contact Tracing Cell.• Case investigation commenced within 24hrs.
20th February 2021 Out of hours Public Health Director made contact with employer to ensure all close contacts of the confirmed case were self-isolating in line with government guidance.
22nd February 2021
• Continued dialogue to ensure advice given by Public Health lead had been implemented and going forward all cases and contacts would be notified to Local Authority 9th March 2021
EHOs unannounced site visit confirmed advice had been implemented.26th February 2021 Further Cases
Case Investigator: Mr. Noor Shaikh Public Health Officer
• Site placed in active cluster status.• Case reviewed in multi-disciplinary
meetings TLLOC and WOPMOG-2 to monitor status of the workplace
Overview:
Outcomes:
• Policies and procedures at the workplace were updated and brought in line with Government & PHE guidance for employers.
• Site de-escalated from cluster status on 10th March 2021.• Workplace remained committed to sharing information and seeking help and guidance
from Thurrock's Public Health Team.• Site adopting workplace LFT testing of staff after Thurrock’s referral to Government’s
scheme March 2021.
10th March 2021Cluster status removed
11th January 2021Case Investigation Commenced
• Contact made with company to establish policies and procedures in place. Overarching internal risk assessments were requested
• Request for disclosure of case and contacts lists for the past 14 days in line with Public Health Act 1985. –notifiable disease.
12th January 2021Disclosure Received
• Investigation highlighted: 11 confirmed cases in the past 14 days.
• Workplace setting was placed into an active Cluster status by Public Health Lead: Kev Malone
Risk Assessment Received 10th January 2021
• Rise in cases• Staff mingling and not social distancing, and mixing between branches• Complaints from Trading Standards and members of public• Delivery drivers congregating in the restaurant area• Failure by business to disclose full list of cases and contacts
82 Employees
Cluster: January 2021
Food outlet
• Risk assessment completed with business • 2 unannounced EHO visits – to assess Covid measures and ensure they
are being followed• Site monitored for 28 days to ensure decline in cases
• Historically, the workplace had low single case figures. • Early January 2021 these cases rose dramatically and intervention was
needed
Multi-disciplinary meeting12th January 2021
Concerns raised to EHOs about rise in cases, further intelligence filtered through to Public Health team from Trading Standards and members of the public.
EHOs unannounced site visit to assess Covid measures.
Further Cases Received
Reviewed in multi-disciplinary meetings, with Environmental Health and Public Health leads to monitor the status of the workplace. Ongoing communication with business when cases are identified.
EHOs unannounced site visit to ensure compliance with advice
Workplace Case Study
Case Investigators: Noor Shaikh & Catherine Mahoney
Overview:
Challenges:
Multi-disciplinary approach:
Outcomes:
• Advice provided to workplace on better procedures to have in place regarding strict social distancing
• Change of process for drivers collecting food waiting in the restaurant area
• Policies and procedures at the workplace updated
Scope• The scope of this work will be focused on CQC registered care homes and other care providers
including working age adult homes, domiciliary care, supported living services, nursing homes, housing with care schemes, primary care and related services.
• The PHE/LA standard operating procedure (Care Home COVID-19 Protocol) provides a framework for the joint management of COVID-19 outbreaks in care homes and similar settings including extra care housing and supported housing. This includes the four key objectives of:
• Preventing Outbreaks before they occur including IPC advice/training proactive weekly screening for COVID-19 in all asymptomatic staff
• Rapid and proactive management of outbreaks including enhanced weekly testing of all residents and staff during an outbreak and strengthened definition of outbreak as one confirmed case in resident or staff member
• Support to care for COVID-19+ residents including option of step up to isolation unit
• Enhanced ongoing support to staff to provide care for residents during COVID-19 epidemic including GP, individual care planning, community geriatrician and additional equipment.
• Contact Tracing
• Development of protocols to support primary care and domiciliary care to ensure tracking, advice and reporting for all services in health and social care
• To provide ongoing support and advice in line with changing government guidance and the reopening of services including visits in care homes
Aim: To minimize the COVID-19 infections and related deaths in care homes in Thurrock reducing transmission, protecting the vulnerable and preventing increased demand on healthcare.
• Plan and prepare with Care homes, domiciliary care, Primary Care and other care providers, ASC and CCG a comprehensive COVID19 testing approach for staff and residents• To provide facts, information and guidance to care homes on the latest approach to preparing for and managing COVID19 outbreaks in care settings• Guide the Care providers during an outbreak and provide access to specialist PH advice• Record and monitor all relevant outbreak data for reporting • To organize and chair Integrated Management Team meetings when outbreaks escalate in care environments
Existing infrastructure/assets• PHE provided Line list (contact records from tracing activity)
• Outbreak management and prevention approach (Proactive and Preventative Management of COVID19 outbreaks in care homes – Thurrock Model)
• SOP – PHE-LA Joint Management of Care Home Covid-19 Outbreaks in EoE
• Xantura – recording of all homes, domiciliary care providers, dentists, opticians and GP surgeries in outbreak and exposure
• SitRep
• Capacity Tracker (filled in by Care homes and Domiciliary Care for MSE)
• Homes can test themselves in outbreak due to pillar two capacity at this time
• HPT advice and guidance
Current processes/responsibilities
• Documented service engagement with Commescio for testing proactive and outbreak management testing if needed
• Clinical hub (bi weekly oversight meeting to co ordinate responses for care sector in outbreak) recently stood down from x3 weekly
• MDT weekly call regarding COVID19 positive cases for all care sector providers
• All care sector providers with positive cases contacted x3 weekly to ensure they are supported and early identification of escalation
6.5 Care Settings
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Risk / Issue Local/national Possible mitigation measure
1. Other care providers or settings may be missed as part of the scope
Local CQC inform local cell of any newly registered units in ThurrockScope extended to extra care and domiciliary care agenciesX3 weekly meetings with multi agency team to ensure all care providers identified
2. Very high risk setting in terms of both transmission and consequence of infection
Local Protocol sets out detailed actions to address these risks including IPC and enhanced testing of staff and residents and step up facilities for COVID+ residentsIPC enhanced trainingIPC enhanced audits in placeStaff prioritised for vaccinationWebinars for vaccine hesitant staff
3. A danger of competing priorities / lack of capacity within care home staff which will detract from outbreak management
Local Care Homes have signed up to Protocol and additional funding provided by TBC conditional on adherenceFunding allows for staff to isolate for enhanced time periodA range of on-going support is available from TBC, TCCG, GPs and NELFT.Daily calls between Care Home Hub staff and Care Home Managers if required during outbreakX3 weekly calls to all homes and domiciliary care providersDedicated communications products that can be accessed if requiredRegular communications to all homes and services
4. Non-compliance of staff with self-isolation due to low pay
Local Additional funding provided via TBC to provide for care home staff to self isolateFunding for IPC measures to enhance safety for visiting
5. Staff present on-going risk of bringing COVID-19 into home from the community or cross infecting homes where working across multiple sites
Local 7 day testing of all asymptomatic staff PCRTwice weekly LFD testing for all staffDaily LFD testing for staff for homes in outbreak/exposureEnhanced self-isolation protocol of 14 rather than 7 days for staff who test COVID-19+ and a requirement to self isolate for 7 days for any COVID-19 symptomatic staff even after single negative test resultProtocol prohibits use of staff across multiple sitesStaff do not retest for 90 days post positive test unless symptomatic Enhanced IPC training including CPD modules for staffICP webinars for staffComms and posters supplied to all care providers regarding car sharing, cleaning, shared spaces
6. Risk of operational viability of home if multiple staff members become contacts of an infected case and need to self-isolate at the same time
National Specific dedicated communication products for care environments including care sharing, space, PPE, complacencyExploring if self-isolation period for contacts could be reduced through further enhanced testing including antibody testing.
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Good Practice
Developing and implementing care home, primary care and domiciliary care protocols andthe governance structure surrounding it worked really well. Thurrock under the guidance ofthe DPH chose to restrict visitors to care homes throughout the pandemic, this led to someconfusion initially as homes were advised to go above and beyond the National guidance. Itwas imperative to build on existing relationships and networks within the care sector at bothtactical and strategic level to communicate the agreed process for visiting.
Due to the success of the clinical hub, working closely with the CCG, ASC, Community andfrailty care teams and many specialist services we will continue to work in this way focussingon reset and recovery priorities for the sector
Many PH professionals and affiliated staff have worked in different roles during the pandemicand this has bought with it a mix of specialisms who may have previously worked in silosboth in their own teams and externally. This has also increased knowledge of roles,responsibilities and priorities within services
The pandemic has highlighted the need to approach care and services in many differentways, virtual MDTS and GP surgeries have played an essential role during the pandemic andthese may be continued going forward.
6.5 Care Settings: Good Practice, Issues and Lessons
73
Care homes in escalating outbreaks required enhanced guidance and IMTs were used effectivelyand in a timely manner to ensure that all residents had care plans appropriate to their needs, thatGP and affiliated professionals had access to the correct information at the same time in order toeffectively manage the outbreak and the care of the residents.
Lateral Flow Testing for care homes was initiated by the DHSC and this was later rolled out fordomiciliary care workers, this enhanced the weekly PCR testing, initially Thurrock supplied twiceweekly PCR testing for the homes however this was not effective due to the pillar 1 capacity and thedelay in the return of swab results and therefore ended after two months.
Care homes were able to use visiting PODS to ensure residents could still see family due to fundingby ASC
:
Clinical Governance regarding care homes and related settings (including dentists, GPsurgeries, domiciliary care and opticians) is provided, discussed an agreed at theclinical hub. The clinical hub members include but are not limited to:Deputy Chief Nurse CCGCare Home Nurse LiaisonCQCContinuing Health CareSpecialist Services (frailty, stroke, St Lukes Hospice)Vaccination Lead NurseASCASC brokerageMedicines ManagementPrimary Care SpecialistIPC Nurse Specialist
Issues, best practice and developing themes discussed at the clinical hub can ifnecessary be escalated to both the tactical and strategic meetings to ensure thatissues are not isolated. These meetings are pan Essex and are the escalation route toCIMT if required.
PH-ASC daily support systems to care homes, domiciliary care, GPs and related healthproviders in outbreak or exposure, PPE and safe staffing level, initially there wasconcern that this may be overwhelming for the homes however the feedback wasthat this was welcomed and encouraged and therefore continues.
Knowing the care home and domiciliary care managers and building relationships has
been key to developing the response to Covid-19 n care homes and similar settings.
6.5 Care Settings: Good Practice, Issues and Lessons:
74
Issues/Lessons Learnt
Issues with the late return of test results via Pillar 1 resulted in the homes being ableto support their own testing for homes in outbreak and exposure via Pillar 2 and thishas worked well for the homes – it has led to more timely results, this has alsoimpacted on the out of hours PH response as most results via Pillar 1 were beingreturned out of office hours.
Care homes were not as prepared regarding IPC as they thought – continued workthroughout the pandemic has shown significant areas of concern which we havebeen able to address by employing IPC specialists to work with all the homes toupdate their protocols and to offer CPD accredited training.
Vaccines role out collection of data BTUH initially meant a large cohort of care staffwere vaccinated but this was not recorded therefore there is work in place to ensurethat the data capture is a true reflection of those vaccinated across Thurrock
Staff need regular training and updates to prevent complacency
Care homes did not have up to date IPC protocols, this was addressed by employingspecialist services to update and work with homes
Some GP surgeries appeared initially unclear regarding Covid safe measures, this washighlighted at the clinical hub.
The protocol for GP surgeries was shared and all GPs asked to respond that they hadreceived it.
Lessons Learnt (cont.)
PH in partnership with the CCG primary care lead attended the GP Partnership meetingsweekly to answer questions, give advise and respond to any issues raised.
Main areas noted were the lack of effective mask wearing when the surgery was emptyand the lack of cleaning high touch areas. Phones and shared facilities were not cleanedbefore and after use and staff did not always wear their masks effectively when notinteracting with patients. These issues were noted by the close working relationshipbetween the practices, the CCG and PH as we were able to link outbreaks to shared areas,staff work patterns and particular staff members.
GPs were quick to respond to the sessions and were offered additional training regardingPPE.
Many GPs and staff commenced working in bubble type groups to enable them to isolatestaff if required and still be able to run clinics.
Care staff have been affected by the loss of residents during Covid and thereforecounselling and support have been offered. Partners such as St. Lukes have stepped in tosupport affected homes.
Care Home Thurrock
• On 10/10/20 the index case identified as positive – protocol followed, staff member isolatedand whole home testing organised for 13th October. Staff index case identified as part ofthe pro-active weekly staff screening
• Week commencing 12th October
• Whole home testing for all staff and residents completed by Pillar 1 provider on 13th October
• Initial results received 15th and 16th October. Originally 7 positive cases identified andtherefore the home declared to be in outbreak and all relevant paperwork sent to Clinicalhub and East of England CRC
• Over the course of the weekend this increased to 33 cases (25 residents and 8 staffmembers, which includes the index case).
• During the weekend on call PH lead CCG, CHC and ASC had a systems call x 2 to ensure care,communication and actions were identified. Reactive comms statements were prepared andagreed by the Leader of the Council. Line lists were sent out on the 16th and further contacttracing on staff members was undertaken by Thurrock T and T. (at the start of the outbreak itwas decided in Thurrock we would have a 24 hour emergency response to covid situations byensuring an on call PH practitioner)
• A Geriatrician was on standby in case required over the weekend and ambulance staff madeaware of COVID status of the home. The ambulance service and hospital were made awareof the covid status and escalating need of the home.
• Head office for was asked to mobilise staff from other homes in its company to offer supportshould it be required with the caveat of remaining in that home and not moving aroundhomes. This was also reiterated should the home require agency staff that they mustcommit to working in that home and no where else.
• Staffing at the weekend was stable but was an emerging picture which would need to bemonitored in order to support the staff and residents.
• The home was contacted twice daily by PH lead and ASC to ensure they were coping, hadenough PPE and felt supported – this was agreed with the home in order that they didn’t feeloverwhelmed.
6.5 Care Settings: Case Study:
75
Week commencing 19th October
GP for the home had virtual consultations on 19th as some of the residents in the home were displayingsymptoms. Advance care planning in place for residents and families of those affected have been madeaware of the status of their relatives and that of the home. This was an outbreak with a significantattack rate of at least 50% of the home.
19/10/2020 An IMT was held including ASC, brokerage, CCG, primary care, Manager of home, deputymanager, PH – index case and transmission throughout the home discussed and several areashighlighted to be of concern. Working with the home we arranged an urgent IPC review whichhighlighted further issues. PH reported the outbreak to the CQC as agreed in guidance and casediscussed at the clinical hub. Immediate measures put in regarding PPE wearing. Agreed further IMT forreview following week. It was noted at the IMT that residents had passed away and thereforebereavement counselling and support offered by partners including St. Lukes Hospice (part of theclinical hub). Clinical support was also offered. NLEFT and EPUT also engaged to assist where necessary.
24/10/2020 reported to PH lead that results not back for the home via Pillar 1, laboratory spoken to bylead and result returned shortly afterwards,
Week commencing the 26th October
27/10/2020 IPC report shared with colleagues and quality team from CCG supported home to completeaction plan and implement changes.
28/10/2020 follow up IMT review, home stable and staff beginning to return to work. Noted thatfurther support was required to ensure awareness and understanding of PPE and IPC.Due to the close working of the clinical hub members and the care home providers we were able torespond at speed to the escalating issues at the home, mobilise assistance, IPC training, audit,oversight, counselling and address issues and complexities at speed. The care home managers know theclinical hub staff by name and have a 24hr a day contact number which allows another layer of support– this may not be practical on a larger scale.
IPC Solutions engaged to commence work throughout Thurrock for all care homes as a joint projectbetween the CCG and PH.All staff offered vaccine in first cohort and take up very high
ScopeThe individuals covered are likely to be amongst those we have locally determined in Thurrock to be in categories B (clinically vulnerable to COVID but not shielding), or C (heightened vulnerability to the impacts of COVID). These include:
• Rough sleepers and those at risk of homelessness
• Those known to drug & alcohol services
• Those in Sheltered Housing
• Residents of HMOs
• Those living on traveller sites
• Those experiencing domestic or sexual violence
• Those with mental ill-health, LD and autism
• Those known to Probation
• Those in faith communities accessing places of worship
• BAME communities
• Unaccompanied Asylum Seeking Children
Aims & Objectives
- To bring together various forms of intelligence to better profile our high risk communities
- To use this intelligence to ensure those at high risk are supported to access testing and with identification of contacts
- To use this intelligence in order to support preventative & control measures in high risk settings
- To build relationships with the communities
- To ensure those at highest risk are offered vaccinations
Existing infrastructure/assets• Socially-vulnerable communities protocol
• Residents in high-risk settings protocol
• PHE-LA MOU for socially-vulnerable communities
• High-risk settings weekly cell group
• Stronger Together fortnightly group
• Xantura data system – reports identifying vulnerable groups
Current processes/responsibilities
Stronger Together Partnership to facilitated relationships with external providers, third sector and Council departments.
Assess the risk of different high risk settings and take appropriate action.
Sharing of intelligence/trends within the local community on emerging issues
Cascading of preventative and control measures in high-risk settings
Management of outbreaks in high-risk settings
6.6 Vulnerable Populations and High Risk Communities
76
Risk/Issue National / local risk Possible mitigation measure
Difficult to fully identify all in this group if not all are known to services
National and local Vulnerability mapping to better estimate high risk groups and key settings
It could be difficult to make contact with some of these individuals – transient populations, lack of current contact details etc..
National and local Strong partnership links with officers most likely to have alternate contact details or other insight – e.g. Housing Solutions team etc., and link into teams with existing outreach functions (e.g. rough sleepers).
Potential difficulties in obtaining all required information – e.g. all details of contacts etc.
National and local Develop targeted communications, standardised messaging to roll out across wider teams which stipulate importance of providing required information if contacted by T&T.
There 17 Traveller sites within Thurrock -Three Council managed and 14 private sites within the borough. Each site has been allocated a Travel Liaison officer. Full knowledge of activities within the sites are challenging.
Local Communications on T&T to be factored into the existing wider work programme around Buckles Lane High risk cell and traveller liaison teams meet weekly to discuss (this can be escalated if needed)Soft Intel and relationship building through allocated Travel liaison Officer
Each ‘contact’ could take longer than average, given the complexities of some of these individuals.
National This should be factored in to contact tracing capacity plans – allow more than the average 30 minutes given in the national guidance.Data to be captured on average length of time for contact to be traced, in order to inform any future need to change capacity.
A number of unidentified high risk setting within the borough that are unknown to the Council.
Local and National Build working relationship with National and Local organisations such as the National Asylum Seekers, Ofsted, CQC and local Children’s commissioned services and housing.
6.6 Vulnerable Communities and High Risk Settings: Risks and Mitigation
77
As the pandemic has progressed, a number of lessons have been learnt, some of whichare detailed below:
Good Practice and Learning:
The data available from central government to inform the support required for ourmost vulnerable communities changed formats a few times during the course of thepandemic. This informed our approach to ensure modifications could be easily made,and to dedicate an appropriately-skilled worker to it.
The rapid establishment of the TCCA showed us that the partnership working betweenCouncil and the voluntary sector can work incredibly well, and should inform ourapproach going forward
Initially the TCCA call centre was set up in isolation to the usual points of contact tothe Council (Thurrock First / the main contact centre), with a separate database anddedicated workers redeployed from other areas of the Council. As time went on anddemand decreased, we reduced the opening hours for TCCA and absorbed theincoming calls function into the existing contact centre. This helped standardise thecall handling approach with other Council functions.
It was absolutely imperative to share understanding of communications that had goneout from various stakeholders to similar patient groups, in order to reduce duplicationand avoid resident/patient complaints. This was particularly the case for the shieldedpatient group, who were receiving letters from hospital trusts, GPs, national letters,the Council etc.. Colleagues across the Stronger Together partnership were able toadvise and collate a list of communications that they were aware of, especially duringthe first few months.
6.6 High Risk and Vulnerable Communities: Good Practice, Issues and Lessons:
78
IssuesProducing the protocol documents and gaining agreement from Health ProtectionBoard was only step one in ensuring the processes detailed within were understoodand followed by all stakeholders. We had several instances where high-risk residentialsettings that we had not been aware of suddenly went into outbreak, and we had notshared the protocol documents with them because we had not known of theirexistence. Regular discussions with stakeholders about possible settings were thereforekey.
We had several unusually high risk settings which cut across different protocols andlead to some confusion at the time of which outbreak control process was appropriate.They were risk assessed individually depending on the type of setting, services theyoffer and the residents occupying the setting.
This has presented an opportunity. as high risk settings have become known we havebeen able to flag the address as a possible high risk setting to the contact tracing cellfor onward investigation. This is used to cross-check residents within our vulnerablecommunities.
In May/June 2020, we asked GPs to text their clinically vulnerable (locally known ascategory B patients) patients with a message advising them of TCCA and to reiterateCOVID guidance. In hindsight, it was difficult to coordinate that activity as it wasvoluntary per practice, and undertaken at different times; and a lesson learnt would beto standardise the management of that communications programme a bit better.
6.6 High Risk and Vulnerable Communities: Case Studies
79
Example of collaborative working with internal and external organisations
Example 1:
• Case on Dashboard of a person that was possible residing at a traveller site.
• Attempted contact by Tier 3 and 2 – failed
• T&T call handler alerted by system that address was possible located on a traveller site
• Call handler advised High Risk Settings Manager
• Settings Manager discussed case with Traveller liaison officer who supported the site
• Traveller Liaison Officer spoke to a family member, explained the importance of contacting T&T Thurrock.
• Approval given by family member for contact to be made between T&T and case.
• T&T called case and contact made, Welfare support offered, and information gathered on close contacts.
Example 2:
• Case on Dashboard of a person that was residing at a HMO, with 3 other people
• T&T established that he was an Asylum seeker who had just moved into the area
• The property was managed by Clearsprings, case manager on annual leave, no forwarding number given to case
• Arranged for the case to be given support with basic provisions of food and clothing by the Red Cross
• Contacts established and isolated
• Contact was made with Clearsprings, who internally alerted their safeguarding and another case manager
• The HMO team were informed as the property was not registered with Thurrock Council
• Relationships have now be built with Clearsprings to avoid this situation again and information given on other services that would be applicable to their service users needs
• Working with Clearsprings on the offer of vaccinations to this vulnerable group.
6.6 High Risk and Vulnerable Communities: Example of multidisciplinary Working
Example 1:• Case on Dashboard of a person that was possible residing at a traveller site.• Attempted contact by Tier 3 and 2 – failed• T&T call handler alerted by system that address was possible located on a traveller site• Call handler advised High Risk Settings Manager• Settings Manager discussed case with Traveller liaison officer who supported the site• Traveller Liaison Officer spoke to a family member, explained the importance of contacting T&T Thurrock.• Approval given by family member for contact to be made between T&T and case.• T&T called case and contact made, Welfare support offered, and information gathered on close contacts.
Example 2:• Case on Dashboard of a person that was residing at a HMO, with 3 other people• T&T established that he was an Asylum seeker who had just moved into the area• The property was managed by Clearsprings, case manager on annual leave, no forwarding number given to case• Arranged for the case to be given support with basic provisions of food and clothing by the Red Cross• Contacts established and isolated• Contact was made with Clearsprings, who internally alerted their safeguarding and another case manager• The HMO team were informed as the property was not registered with Thurrock Council• Relationships have now be built with Clearsprings to avoid this situation again and information given on other
services that would be applicable to their service users needs • Working with Clearsprings on the offer of vaccinations to this vulnerable group.
Settings : Schools & Early YearsAim : To provide a collaborative and coordinated approach to preventing and managing COVID-19 single cases, clusters and outbreaks inEducation & Early Years Settings• Ensure the setting and its staff and students implement prevention measures and robust infection control practice • Ensure that the setting and its staff follow the pathway when a positive case or outbreak is reported
Context ScopeApproximately, 29,926* 3- 18 year olds attend school in Thurrock in 2019/20 (Source: School Census). The below represents the schools and colleges in Thurrock;
:
Structures/Assets
• Education and Children’s (includes early years) Recovery Group ( Thurrock TCG Sub group).
• School Leads Forum• Early Year Managers Forum• SEND Improvement Board• Brighter Futures Annual Survey• CYP & Families COVID -19 support line led by the Schools Wellbeing Service (SWS) &
Educational Psychology Team• PHE-LA Forum – Management of COVID in Education• The Thurrock Proactive Prevention and Management protocol for COVID-19 outbreaks in
Schools and Early Years Settings.
Current process/responsibilities
• PHE- LA MOU a collaborative framework for management of COVID19 outbreaks in schools and early years settings.
• Twice Weekly Education Recovery Group for wider discussions on theme or areas relating to education and schools. Prevention messages also cascaded through this avenue
• NELFT have their own separate organisation protocol for re-starting of services• Conduct IMTs to facilitate wider discussions on impact of covid outbreaks or confirmed
cases across vulnerable groups settings
6.7 Schools and Early Years
6.7 Schools and Early Years: Risks and Mitigation
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Risk/Issue Local/national Possible mitigation measure
Parental Confidence in home to school transport. The DfE advise thatSocial distancing guidance to passengers on public transport will not apply.
Local and national • Discussions ongoing – risk assessment being complied on individual case• Public Health Support available to schools on risk assessment via the Schools
and Early Years Hub • Specific communication being planned to reassure parents and children – digital
communication.
2 Parents not feeling confident about sending children back to school (risk to development, socialisation, quality of education )
Accuracy in compiling line lists. (transmission risk)
Local and national • Animated video aimed at parents of young children on safe school opening and attendance available for schools
• Local Communications Campaign. • Collaborative approach in developing CV19 protocol with head teachers, early
years managers and senior academy trust members.
3. Operational viability; - For school, if large numbers of staff become positive or contacts of a case and need to self-isolated
Local and national • Pupil teacher ‘social bubble’ system to limit contacts in outbreak situation • Additional dedicated communication materials planned to communicate risk
to head teachers, stress importance of 2m+ social distancing in staff room • Mostly addressed through robust school risk assessment and independent IPC
peer review
4. Operational viability for special schools to be able to open to all their pupils with complex medical needs in cases where Aerosol generating procedures are necessary due to special requirements within the setting to implement infection control measures.
Local • CCG infection control and specialist school nursing supporting schools• Schools advised to follow infection control measures stipulated within the AGP
Guidance• Virtual school offer in place • System wide school guidance and digital communication developed and shared with
partners5. Lack of social distancing and congregation at schools gates
obstructing easy flow during busy school drop off and pick up times thereby exacerbating the transmission of C19
Local and regional • Continuous communication via Thurrock Council residents newsletters, DCS weekly news letter to reiterate adherence to social distancing measures.
• Presence of Covid Marshalls at schools where this is an issue
• Joint DPH and DCS communication to parents and carers• Identify parental peer support to champions
6.7 Schools and Education Settings: Good Practice, Issues and Lessons:
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Good Practice and Learning:Developing and implementing an education protocol and the governance structure surrounding itworked really well. In the initial stages following return to school and laying out the outbreakmanagement process, schools utilised the national helpline. Although this was helpful in giving timeto roll out the education and early years protocol, it however meant some schools receivedcontradictory messages. It was imperative to build on existing relationships and network intoschools to communicate the agreed local process for reporting outbreaks. This meant that schoolsfelt better advised and supported.
It became apparent early in the pandemic that the experience of implementing the protocol differedby school depending on what type of school it is, who attends it, class sizes and aspects of itsbuildings and facilities
Although most schools are academies and can implement actions independently, schools valuedmaking connection with the Council on its COVID-19 response through the schools and early yearsprotocol. The education cell will consider how this might be continued in a sustainable wayespecially after COVID-19 and in relation to other engagement opportunities
For large secondary schools and some schools who experienced high number of cases, undertakingindependent Infection Prevention and Control(IPC) audits or peer review of their COVID-19measures was valuable. All independent IPC visits had identified robust processes in place forprevention and outbreak control. This provided further reassurance of their measures and theadvice received to staff, parents and the wider school community.
Schools that experience prolonged outbreaks/clusters tend to have multiple index cases from familyor community transmission. Regular discussions with the contact tracing cell meant more emphasiswas laid on exploring out of school and household interactions for cases linked to schools.
Proactive measures such as digital communication via video animations have been recognized bythe Regional DfE Commissioner and through regional networks as good practice.
We noticed outbreaks linked to school transmission generally show a sharp increase in cases whichwas usually contained within a few weeks because contacts were identified in index case(s) andnew cases already self isolating. It demonstrated that the protocol in place was well embedded.
Conducting outbreak control process sessions for headteacher and early years settings enabled usbuild better relationships and communicate the appropriate messages to schools locally.
School transport for both in borough and out of borough was an ongoing risk and challengeparticularly for large school catchments areas or special schools. Building a process to notify thetransport team of cases numbers and vice versa and being visible to provide advice supported theteam. There is an opportunity to explore further work linked to school transport with schools
Issues:Following a few outbreaks – which were very well contained, we observed the possibility of bias.Cases within schools have very high visibility either within the press or on social media comparedto community or workplace transmission. This contributed to increased vigilance among someschools and parents and increased testing uptake of asymptomatic testing uptake.
Some schools noted a greater need for Lateral Flow Device (LFD) roll out to engage LA (PH andEducation) and the wider local system following a successful implementation of the local response.
Special Schools recognized that while implementing the local response for education that most ofthe national guidance were more generic and lacked consideration in the additional vulnerabilitiesand complexities faced by their population groups and school set up. Special schools were facedwith the challenge of interpreting these to suit their population group and associated complexities.Another challenge was around cross working of staff within special schools in social care provisionand the risk of further transmission.
There were instances where some children’s homes registered with Ofsted as an education bodyalso provided accommodation for children meaning that the provision of support cut across severalsettings. Collaborative IMTs were a great avenue for facilitating appropriate PH advice anddiscussions on the wider social and safeguarding impact
29th September 2020
Case reporting from School
• Index Case identified, risk assessment conducted and protocol for self-isolation initiated. Lack of appropriate social distancing.
• IPC and COVID secure measures scrutinised and advice provided where possible.
• Wellbeing support for families who might need it following safeguarding
Risk Assessment Received 29thSeptember 2020
Week of the 05/10/20
• IMT request by PH Lead. This was multi-professional and needed to consider the wider social and safeguarding impact if the school were to be shut or mass testing required.
• IMT quickly established a link between all cases and where cross-contamination had occurred.Discussed links in relation to the wider social and safeguarding impact following the schools set up.
• An agreement between PH and Education to establish appropriate contacts in relation to cases following discrepancies in numbers and
• Reactive communication was prepared by the school in collaboration with the PHE and LA teams to mitigate any negative press should that arise.
• Index case reported on the 29/9/20. Notification received from the school. Risk assessmentadequately completed by settings lead in collaboration with school.
• Risk assessment established some areas of concerns lined to social distancing.• Over the course of the week cases rapidly increased. An outbreak was established as cases where
linked in place, time and persons. Two bubbles were affected.• Information gathered from school rapidly established setting was in outbreak and the wider.• Established discrepancies in the number of contacts associated with cases following the rapid
increase. PH Lead in collaboration with Head teacher and Education leads worked to cross-referencecontacts and cases. Contact Tracers also supported this process by contacting all contacts andestablishing interactions. This was to ensure all contacts and cases were isolating accordingly. 8th October 2020
Confirmation that theaffected bubbles are all isolating.
29th - 31st September 2020
• Continued dialogue with school to ensure advice given by Public Health lead is beingimplemented.
• More cases notified. Discussion at the Education Cell to suppose school in managing this outbreak
• Ensuring communication to parents and staff around accessing testing when symptomatic
• Line list against each case• Further cases reported. Outbreak declared
as cases where more than 2. • Enhanced communication to staff and
families
9th October 2020School informed Public Health and Education colleagues of decision to close school for a period of time
Further Cases; 7th October Outcome:
• IMT attendees agreed that that there is no Public Health reason to close the school following impact across two bubbles resulting in large numbers of staff and pupils self-isolating.
• With the nature of this schools set up and the types of pupils close monitoring was ensured by PH and Education colleagues.
• Following Clear messaging to staff updating on current situation as well as reiterating covid secure messages especially around social distancing amongst staff.
• It was however also recognised that school might consider other operational risk associated with large numbers of staff self-isolating. As a result, school further established operational risks needed further mitigation and decided to close for a week to allow for proper deep cleaning, time for cases to recover and contacts to
27th October 2020Outbreak declared over.
• Further cases reported which was rapid• IMT requested to discuss the rapid increase
and further robust risk assessment conducted
• Operational risk within school identified as numerous staff isolating.
Week of the 28/9/20
6.7 School and Early Years: Case Study
Section 7:
Finance
Thurrock Council received an initial grant from Central Government to implement Outbreak Management Plans and continued to receive further allocations . Day to day budget monitoring is the responsibility of the DPH/TLOCC Lead. Examples of initiatives funded include:
Testing: additional testing of care home staff and affiliated professionals. Asymptomatic testing of adults who cannot work from home. Making test sites accessible and safe
Tracing: Local contact tracing team and Environmental Health Officers to support workplaces
Compliance measures: Local Covid Marshals. Grants for business adaptations.
Communication and Marketing: targeted social media marketing based on risk groups
Support to CEV/vulnerable groups : community outreach and support to access vaccination programme
Support for self isolation: discretionary payments (allocation of £286,000 plus local £40,000 Thurrock funding)
Targeted intervention: research into vaccine uptake in BAME community
Specialist support: trauma based training
Utilisation of local sectors: community outreach via CVS
Support for educational outbreaks: support for SEN pupils to access lessons. Support for vulnerable children to access provision.
Other: resilient resourcing of TLOCC, based on a model of seconding existing staff with knowledge/networks in place into TLOCC and backfilling their substantive roles.
7. Finance
Item Amount (£s)
Government Grant (initial determination for LA Test & Trace support)1,050,883
Additional Containment Grant - Contain Outbreak Management Fund (COMF) – Oct/November 2020 (1st allocation) 2,594,774
COMF allocation (2nd allocation) 697,364
Total 4,343,021
Spend to date:
Set up of Test and Trace (initial determination monies) 303,557
Testing 164,975
Tracing 80,147
Compliance measures 228,500
Communication & Marketing 35,000
Support to CEV 50,000
Support to vulnerable groups 10,363
Support to self isolate 40,000
Targeted intervention 25,000
Specialist support 40,000
Utilisation of local sectors 100,000
Support for educational outbreaks 5,000
Other 187,543
TOTAL 1,270,085
Figure 9
Figure 9 shows a high level budget allocation with corresponding spend to date in key areas:
For up to date information on COVID-19 in Thurrock please visit
www.thurrock.gov.uk/coronavirus