DRAFT IN DEVELOPMENT Last Update : 16th July 2020 - Local Outbreak Control Plan for Covid-19 infection

 
DRAFT IN DEVELOPMENT Last Update : 16th July 2020 - Local Outbreak Control Plan for Covid-19 infection
Local Outbreak
Control Plan for
Covid-19 infection

DRAFT IN
DEVELOPMENT
Last Update : 16th July 2020
DRAFT IN DEVELOPMENT Last Update : 16th July 2020 - Local Outbreak Control Plan for Covid-19 infection
Contents (cross linked to the Local Outbreak Control Plans seven areas)
Glossary                                   Supporting Vulnerable People 2 6
                                           • Barking and Dagenham’s support offer
Introduction                               • Specialist support hub

What are the key components                Methods for Testing 3
                                           • National portal & MTU arrangements
Guiding Principles                         • Additional testing capacity

Local Outbreak Control Plan seven areas    Data Integration 5
                                           • Local reporting arrangements
Governance 7                               • GDPR & Data Security
• National governance                      • Roles & Responsibilities
• Role and responsibilities in London
• Local governance                         Communications & Engagement 1 2 3        4   5   6   7
• Escalation Criteria                      • Build on prevention messages
• Range of levers available to encourage   • Raise awareness of NHS Test & Trace
  compliance locally                       • Support area outbreak plan
• Local lockdowns
                                           Risk Matrix
Settings 1 2 4
• Setting specific action cards
• Surge capacity planning
DRAFT IN DEVELOPMENT Last Update : 16th July 2020 - Local Outbreak Control Plan for Covid-19 infection
Glossary
BAME: Black, Asian and Minority Ethnic       LOCP: Local Outbreak Control Plan
CCG: Clinical Commissioning Group            LCRC: London Coronavirus Response Centre
CQC: Care Quality Commission                 MDT:   Multi-Disciplinary Team
DPH:   Director of Public Health             MTU: Mobile Testing Unit
GDPR: General Data Protection Regulation     MSOA: Middle Layer Super Output Area
HMO: House of Multiple Occupation            PCN: Primary Care Network
HR:    Human Resources                       PHE: Public Health England
IMT:   Incident Management Team              PPE: Personal Protective Equipment
JBC:   Joint Biosecurity Centre              SPOC: Single Point of Contact
LBBD: London Borough of Barking & Dagenham   UTLA: Upper Tier Local Authority
LA:    Local Authority
DRAFT IN DEVELOPMENT Last Update : 16th July 2020 - Local Outbreak Control Plan for Covid-19 infection
Introduction
This document is intended to outline seven steps in local preparedness to prevent, control and manage Covid-19 incidents
and outbreaks, if and as when they emerge. It describes our local whole system response and it has been developed with a
wide range of stakeholders and overseen by the Health Protection Board. It is signed off by the Recovery & Legacy Group
and approved at the Health and Wellbeing Board on 28 July 2020. This Plan is iterative and will be regularly updated, as
further evidence and guidance emerge.

London as a global city, with celebrated diversity and numerous ports of entry has an established ‘world class’ health
protection system. The local and London public health response will be designed around these responsibilities and existing
health protection good practice. Together with our partners we will utilise local governance and partnership arrangements to
ensure the design of our Local Outbreak Plan Control Plan for Covid-19 infection is developed and delivered to meet local
needs.

Within these plans we will need to consider what preventative measures are required, how the situation in schools and care
homes are monitored, possible scenarios and what strategies are needed to manage an outbreak in these settings (such as
temporary closures to allow the deep cleaning of facilities). As part of our local response, will be able to draw on the expertise
and support of the London Coronavirus Response Centre (LCRC).

The main aim of the Plan is to:
Build on existing plans to prevent and manage outbreaks in specific settings, ensure the challenges of Covid-19 are
understood, consider the impact on local communities and ensure the wider system works together to contain the spread of
infection locally.
DRAFT IN DEVELOPMENT Last Update : 16th July 2020 - Local Outbreak Control Plan for Covid-19 infection
What are the key components of our Local Outbreak Plan?
       A document, easily understood & shared to provide assurance in preventing & managing outbreaks
       • Practical and in simple language and clear objectives
       • Likely to have a web based version for easy access and sharing
       • Primary audience include local decision makers, advisors and stakeholders most likely to be affected by
          the plan. It should be accessible to the general public to build confidence and trust

       Content developed to enable day to day working & rapid escalation of actions if / when required
       • Detailed governance arrangements with clear roles and responsibilities
       • Mapped interfaces with key stakeholders and flow of information day to day and in case of outbreak
       • Trigger points for escalation outlined
       • Key processes to be followed proactively day to day (e.g. infection control) and in case of outbreak
       • Develop or plug into existing plans for high risk locations / vulnerable people
       • Summary of risks associated with each theme, and suggested mitigations
       • Proactive and reactive communications and engagement plans including pre-prepared / example
         materials, and usage of data to tailor messaging to clusters

       Supported by key tools
       • Templates e.g. SITREP, readiness, tracing data to receive
       • Checklists and other proformas
       • National assurance and support framework
Guiding Principles
Barking and Dagenham’s Local Outbreak Control Plan (LOCP) is guided by the principles and legislative framework specified in the
document below and signed by Association of Directors of Public Health, Faculty of Public Health, Public Health England, Local
Government Association, Solace and UK Chief Environmental Officers Group.

There are four principles for the design and Operationalisation of LOCPs arrangements, including local contact tracing, if needed.
They are stated below:

     1. Be rooted in public health systems and leadership

     2. Adopt a whole system approach

     3. Be delivered through an efficient and locally effective and responsive system including being informed by timely access to data
     and intelligence

     4. Be sufficiently resourced

Read the document here
Backup

Our Covid-19 Local Outbreak Plan builds on existing plans to manage outbreaks in specific settings,
ensure the challenges of Covid-19 are understood, considers the impact on local communities and
ensure the wider system capacity supports the Director of Public Health

      Capacity             Stakeholders                     Scale                  Integration & Delivery               Communication
                                                                                                                        & Engagement
  • Increased capacity    • Significant and sustained  • Plans must be able to      • Requirement to integrate      •   Requirement for comms
    requirements for:       increase in number of        deal with outbreaks at       with new bodies, including:
      o Community                                                                                                       campaign, with more
                            stakeholders, including:     an unprecedented scale       o NHS Test & Trace
          engagement        o Residents                  across multiple                                                frequent and consistent
      o Testing                                                                       o Support and Assurance           messaging & broader
      o Contact tracing     o Employers                  locations and facility           teams
                            o PHE                        types simultaneously                                           scope and channels
      o Infection control                                                           • Requirement to integrate
      o Support for         o NHS                                                                                       (e.g. The leader, cabinet
                                                                                       multi-source data to support     members, Director of
          vulnerable        o Facilities e.g. schools, • Some plans will involve       local decision making
          people                hospitals                coordination across                                            Public Health, CEO
      o Enforcement                                                                 • Requirement to collaborate        school leaders,)
  • Specialist expertise    o Joint Biosecurity Centre   other London boroughs         with PHE Health protection •
                                (JBC)                    and in some cases                                              Requirement for
    required                                                                           teams, MDT LA, CCGs,             proactive comms and
  • Mutual aid              o National government        London as a whole             hospitals, GPs, around
    arrangements            o Local & national media                                                                    comms plans
                                                                                       infection control, advice on
    available               o Community, faith and                                     ground, delivery etc.
                              voluntary sector
Local Outbreak Control Plans seven areas
              1

              2

              3

              4

              5

              6

              7
Governance
The Director of Public Health is the identified Barking and Dagenham                                               7
NHS Test and Trace Programme single point of contact (SPOC)
The Director’s primary role is to give assurance that the key organisational elements outlined below are aligned
and functioning effectively.
Who are the key decision makers?
 Level        Decision maker(s)                                    Co-ordination, advice and engagement

 Individual   Individuals or bodies responsible for that setting   •   London Coronavirus Response Centre
 setting      (e.g., Head Teacher, restaurant owner)               •   Director of Public Health and team
                                                                   •   Multi-functional Silver Groups

 London       Depending on the specific action required            •   Covid-19 Health Protection Board (Local
 Borough of   decisions may be taken by the:                           Outbreak Control Board)
 Barking &    • Acting Chief Executive                             •   Barking and Dagenham Strategic Gold
 Dagenham     • Director of Public Health                              Command
              • Acting Deputy Chief Executive/Monitoring
                 Officer/Gold Commander

 London       Agreed cross-boundary decisions will be              •   Local Resilience Forums
              implemented at London system level through the       •   GLA
              London Coronavirus Response Centre                   •   New Contain/Joint Biosecurity Centre
                                                                       Support and Assurance Teams

 National     Under specific escalation scenarios
Roles and responsibilities in London                        1   2   3   4   5   6   7

 A Joint Agreement between the LCRC and the London
 boroughs Directors of Public Health for supporting the
 management of Covid-19 outbreaks and complex
 settings has been agreed. This Joint Agreement
 provides a framework for joint working between the
 LCRC and the public health structures in the London
 boroughs (LA) for managing Covid-19 outbreaks.
 Details the following:

 • Summarised roles by setting (LAs and LCRC).
 • Brief Standard Operating Procedures/Roles and
   responsibilities for London boroughs and LCRC, by
   setting type

 This Agreement will be kept under monthly review
 initially due to the rapidly changing regional situation
 and guidance, and fluctuating capacity across the
 system. This document is therefore intended to be
 flexible and adaptable for local operation due to the
 different support and capacity arrangements available in
 local systems in London.

 Read the document here.
Local Governance
                                                                                              1      2       3       4      5         6   7
 • Chaired by Director of Public Health and include                            •   Chaired by Cabinet Member for Social Care &
   the whole system membership including PHE,                                      Health Integration and includes Chief Officers,
   EHOs, PCN/GP, HR, B&D Collective                                                Met Police, Healthwatch, DPH, CCG, GP
                                                                                   Governing Body members, elected members. If
 •   Oversee development of and provide assurance                                  local lock-down needs to be imposed, Leader will
     that there are safe, effective and well-tested                                chair the Board;
     Local Outbreak Plans in place to protect the
     health of local population during Covid -19                               •   Political and partnership oversight of strategic
     pandemic.                                                                     response and proactive engagement with the
                                                                                   public.
 •   Read the Terms of Reference here                 Covid-19      Health
                                                                               •   Read the Terms of Reference here
                                                       Health        and
                                                      Protection   Wellbeing
                                                        Board       Board
                                                                               •   London boroughs of Barking and Dagenham,
                                                                                   Redbridge and Waltham Forest and includes all
                                                                                   Category 1 responders;
   Supported at a national level by Government
                                                            Tri Borough
Departments (CCS/RED), TTCE programme and                    Resilience        •   Responsible for determining Council’s overall
                                                                                   proactive management and emergency response,
         Joint Biosecurity Centre and at a                     Forum               deployment of local resources and escalate need
  regional level by Local Resilience Forums and                                    for mutual aid, if needed.
Integrated Care Systems (e.g., for mutual aid and
                    escalation)                                                •   Read the Terms of Reference here
Covid-19 Health Protection Board Incident Management Team
In case of local complex settings outbreak or community cluster that needs investigation, LCRC or Director
of Public Health will convene an Incident Management Team (IMT) that will report to Covid-19 Health
Protection Board. The purpose of the IMT is to agree and coordinate the activities of the key stakeholders
involved to manage the investigation and control of an individual outbreak situation. This includes assessing
the risk to the public’s health and ensure control measures are implemented as soon as possible.

Notification of an incident or outbreak will come via various sources (e.g. LCRC, Enforcement, local schools
etc.) and this will trigger data flow. Incident Management Team meeting may be convened when there are:
• 2 or more cases in a setting
• A single case in complex setting

Cases in three household at an MSOA level (Director of Public Health likely to be the main lead for IMT)

Read the IMT meeting Terms of Reference and Agenda here
Escalation criteria
Setting                              Criteria for escalation                                                    Escalation to:
                                                                                      Covid-19 Health Protection Group       Strategic Gold Command
                                                                                                                            (Recovery & Legacy Board)

Events /gatherings (any setting )    -    Death of a child                            Yes - immediate                    Yes - immediate briefing needed
                                     -    Outbreak linked to a major public           Yes – immediate                    Yes – immediate briefing needed
                                          building, faith gathering or event in the
                                          borough
Schools/Childcare/Early Years        -    More than one case in a school/EY           Yes                                Yes – routine reporting only
                                          setting

                                     -    Setting not able to contain outbreak
                                     -    School closure                              Yes – immediate                    Yes – immediate briefing needed
                                     -    Media interest in outbreak/cases            Yes                                Yes
Adult social care/Supported Living   -    More than 6 cases in ASC setting            Yes                                Yes – routine reporting only
                                     -    Setting not able to contain outbreak
                                     -    Cases linked to a hospital outbreak         Yes                                Yes
Large employers                      -    More than 6 Cases in setting                Yes                                Yes
Homeless setting                     -    More than 6 cases in setting                Yes                                Yes – routine reporting only
                                     -    Setting not able to contain outbreak        Yes                                Yes
Council as workplace                 -    Any outbreak                                Yes                                Yes
Local businesses                     -    More than 6 cases in setting                Yes                                Yes – routine reporting only
                                     -    Setting not able to contain outbreak        Yes                                Yes
The five steps for introducing a local lockdown:

ü Monitoring. PHE will work with the joint biosecurity sector by looking at data on the spread of coronavirus
  and people's behaviour across the country. They will look for emerging trends, rising cases and other
  indicators, while taking into account local factors.

ü Engagement. If monitoring identifies local problems, NHS Test and Trace and PHE will work with the
  relevant local authority to develop a deeper understanding of the problem and identify solutions. They will
  work with local agencies to keep the local community informed at every stage, so they know what they
  need to do.

ü Testing. Testing at a local level will then be scaled-up, combined with contract tracing through NHS Test
  and Trace to try to control the virus at that stage.

ü Targeted restrictions. If the virus continues to spread, activities at particular locations will be restricted
  and individual premises will be closed. Hotspots will have access restricted, with people who have spent
  time there tested and contact tracing carried out for anyone who tests positive.

ü Local lockdown. If the previous measures do not stop the spread, local lockdowns will be extended
  across whole communities, with businesses and schools shut down as people are urged to stay at home.
Local Lockdowns                                                                                                1     2      3     4      5     6   7

• At present, there are limited powers given directly to Local Authorities to impose Lockdowns on the population level. Most powers under
  the Health and Social Care Act 2012 and the amended Public Health (Control of Disease) Act 1984 and associated regulations, give
  statutory responsibilities to Director of Public Health to plan and oversee outbreak control and management or detain individual cases
  that pose infectious risk to the general population, via designated ‘Proper Officer’, who is appointed by PHE London.

• Schedule 22 of the Coronavirus Act 2020 provides further powers relating to events, gatherings and premises. For the purposes of
  preventing, protecting against, delaying or otherwise controlling the incidence or transmission of coronavirus or facilitating the most
  appropriate health care response, events or gatherings can be restricted or other requirements imposed and premises can be closed.

• Schedule 21 of the Coronavirus Act provides extensive powers to public health officials (PHE’’s Proper Officer, police and immigration
  officers that exist for the period that the Secretary of State has declared that: coronavirus constitutes a serious and imminent threat to
  public health in England, and that the powers conferred by the Schedule will be an effective means of delaying or preventing significant
  further transmission of coronavirus. This is currently not passed on to Local Authorities.

Further information is awaited on the following:
• Governance
• Regulations of this etc.
• What stage (within action cards) is it implemented
• Recovery following local lockdown

Read the document here.
If collaboration and co-ordination efforts are insufficient, established
pathways may be used to escalate decision making to higher levels
                         National                                                         National level1

                         London                                        London Coronavirus Response Centre

                                                                                     London borough level
                                                              Deep local infection
                         UTLA                                   control expertise        C-19 Health
                                                                                          Protection
                                                                                                              Health &
                                                                                                              wellbeing   Lead public communications
                                                                                            Board     Chief    Board
                                                   Council Chief Exec. DPH                           Exec &
                                                  Ultimately accountable for                                              Public facing oversight
                                                                                                      DPH
                         Sub-UTLA                                 escalation
                                                                                                 Strategic Co-            Liaison with Ministers as needed
                                                                 Rapid deploy resource            ordination
                                                                                                 Group (Gold)

                         Setting                Individuals or bodies responsible for that setting (e.g., Head Teacher, restaurant owner,
                                                Care Home manager, faith leaders etc)

                         1. National level may include NHS Test and Trace service (including Contain/JBC), Chief Medical officer,
        Test and Trace   Whitehall, Cabinet Office Briefing Office (COBR) etc.
Settings
Prevent and manage outbreaks – NHS Test and Trace

  The London Coronavirus Response Centre working with the London boroughs provides an integrated
  Covid-19 Test and Trace service, designed to control the virus and enable people to live a safer and more
  normal life

                                                             Test
                                                                       Rapid testing, at scale, to identify and treat those with the virus
                       Test

                                                             Trace
                                                                       Integrated tracing to identify, alert and support those who need to self isolate

    Enable                              Trace
                                                             Contain   Identify outbreaks using testing and other data and contain locally and minimize spread

                    Contain
                                                             Enable

                                                                       Use knowledge of the virus to inform decisions on social and economic restrictions

                      Continuous data capture and information loop at each stage that flows through Joint Biosecurity Centre to recommend actions

                       Underpinned by a huge public engagement exercise to build trust and participation
 Note: Test, Trace, Contain, Enable diagram is illustrative only
The table below summarises the role of the Council and LCRC in managing local
outbreaks as part of the Test and Trace system:
Range of levers available to encourage compliance locally

The Health and Wellbeing Board has a mandate to                … and are well-placed to encourage
provide public communications and provide local                compliance
accountability…
                                                                      Behavioral nudges
                                                                      • Social media
                                                                      • Tailored local marketing
                               Health and Wellbeing
                                                                      • Local champions
                               Board will:
 Resource         Comms.       • Provide public-facing                Active communication
Deployment                       delivery oversight of NHS
                   Lead                                                 • Public Q&A forums
   Lead                          Test & Trace locally
                                                                        • Press calls
                               • Provide timely
                                 communications to the
                                 public                               Political engagement
                               • Act as liaison to Ministers          • Possible option for Ministers to chair
          Public                                                        combined Local Outbreak Control
        Health Lead              as needed
                                                                        Boards until legislation is approved
What is our approach to local containment?

●   It is of utmost importance that we understand the geographic spread of the virus and take rapid steps in order to
    contain any potential outbreak and keep our communities safe.

●   In order to do that, we need to know what is happening, and have robust principles for decision making, co-
    created and agreed by all stakeholders.

●   These principles are set out in the Contain Framework (previously called the playbook/toolkit).

●   We will then ensure that decision makers have the guidance they need via the Action Cards.

                              Contain Framework                            Action Cards
Prevent and Manage Outbreaks in various settings                             1    2     3    4   5   6   7

   Setting       Schools &     Care       Hospitals   Places of   Workplaces     Community
                 Early Years   Settings               Worship                    Clusters

   Action Card   Read the      Read the   Read the    Read the    Read the       Read the
                 document      document   document    document    document       document
                 here          here       here        here        here           here

   Plans/Risk    Read the      Read the   Read the    Read the    Read the       Read the
   assessment    document      document   document    document    document       document
   tools         here          here       here        here        here           here
1     2    3     4     5    6    7
Surge Capacity Resource Plan

From September onwards into the winter months we will be managing the usual winter pressures, other communicable
diseases along with Covid-19. We have been advised that no modelling of demand has been done. Therefore, our services will
have to flex to meet the peaks and dips in demand over the next 10 months.

The Covid-19 Health Protection Board will need to consider where additional surge resourcing will be needed across the
Council as part of the business continuity planning process. The Board will recommend to the Recovery & Legacy Group the
use of the £1,566,647m Local Authority Covid-19 Test & Trace Service Support Grant Determination 2020/21. The
purpose of the grant is to provide support to local authorities in England towards expenditure lawfully incurred or to be incurred
in relation to the mitigation against and management of local outbreaks of Covid -19. The majority of the Grant will be held as a
contingency and will be deployed based on need as it arises or is anticipated on a case by case basis.

Actions
• Mutual aid plans are developed by LCRC and London boroughs
• Discussions between Tri-Borough Resilience Forum and at the London level are taking place to agree escalation
  points/mutual aid mechanisms
• Director of Public Health and Consultants may be required for surge capacity for BHR wide local outbreak investigation and
  contact tracing
• Escalation points for surge capacity/large outbreak plan to be developed and agreed including recovery process.
Supporting
Vulnerable People
Supporting vulnerable residents                                                                      1    2      3       4     5   6   7

Supporting vulnerable residents through our front line services is core Council business. Our Community Solutions
Service will be ensuring that a comprehensive system of support is and remains in place as we all respond to Covid-19 at
the individual and at the community level. Working together with our partners, we want to ensure that no one becomes
more vulnerable or is left without appropriate support as a result of the rollout of the national Test and Trace service.

Where the contact tracing process identifies a complex case or one involving a high-risk location, the case will be referred
to LCRC and the Director of Public Health and his team to deal with. These teams have worked in this way for many years
and have tried and tested ways to deal with such complex cases.

All referrals from the LCRC for the supporting vulnerable resident pathway will come to the Director of Public health as the
Council’s single point of contact. The Public Health team will undertake their normal health protection practice which is:

• Check the resident is not known to council services in respect of safeguarding. If known the case is directly referred to
  social care as per existing protocol

• If the resident is not known to services, the Public Health team will refer the resident to the Adult Intake Team in
  Community Solutions. The intake team will assess the residents needs and put a support package in place for the
  duration of the isolation period

Contact: intaketeam@lbbd.gov.uk or phone 020 8227 2915 if you would like further advice or support.
Recap…support   offer support offer
 Barking and Dagenham’s

• Barking & Dagenham Citizens Alliance Network
              1
  (BD-CAN) – generalist support for vulnerable members
  of the community who lack support networks and need
  help with simple, practical tasks

• The Specialist Support Hub – specialist support for
                  2
  our vulnerable residents, including anyone who
  currently receives adult social care services or who has
  been identified as extremely vulnerable by the NHS

• Community Solutions – integrated front door support
              3
  on issues ranging from homelessness, debt advice,
  benefits support, job support, food, early help

• Central food hub – coordinated access to food supply
  managed across a network of distribution sites
Specialist support hub

 Main community partners are the ILA and DABD:

 Supports the following residents:
            1
 • Anyone who is shielding – who has received a letter from
   the NHS telling them they are extremely vulnerable
 • Anyone who receives adult social care, whether arranged
                                                              •   Food shopping (the resident pays for
   by the Council or arranged privately
                                                                  the food shopping but not the service)
 • Anyone living in specialist Council accommodation such
                2
   as sheltered housing, a hostel or a domestic violence      •   Medication
   refuge                                                     •   Gas and electricity top up
 • Anyone who has recently come out of hospital and needs     •   Referrals on to other partners including
   support                                                        Reconnections
 • Anyone who is not known to social care, but who is
            3
   believed to be especially vulnerable due to additional
   needs
Supported access pathway for vulnerable residents                                    1    2    3    4       5   6   7

A supported access pathway is also under development to address some of the risks with applying the
national model locally. This approach is based on Community Solutions, B&D Collective, NHS and
other colleagues working together to support our most complex and vulnerable residents by using
relationships of trust, wherever they may exist. We recognise that in order to support people best we
need to take a person-centred approach which builds on existing relationships.

This means that in developing a pathway for ‘supported access’ we recognise that the initial referral
point could come from a variety of locations depending on who the resident feels most comfortable
with for example: GP, pharmacist, faith leader, food bank, other B&D Collective organisation, social
worker, local public services (like mental health, SEND etc), housing officer, Facebook, mutual aid
provider etc.

Residents who go through the supported access pathway is also intended to put in place the support
the resident might need to enable them to participate in testing and possible 14 day self isolation (e.g.
translation, food and supplies, financial support etc.

The supported access pathway will evolve from our learning from the BD-Can programme and
Community Solutions Specialist Support Hub.
Local Testing
Capacity
Access to Testing                                                                              1    2     3    4     5      6   7

This section outlines arrangements for local testing to ensure rapid access for residents and settings. Whilst, in the
majority of cases it is expected that testing will be done through the national testing process, localised capacity has also
been created as we recognise that many of our residents will struggle to engage for a variety of reasons with the
national testing system.

Since May 28 2020 anyone (including the under fives) with symptoms can get a test via a the NHS portal
https://www.nhs.uk/ask-for-a-coronavirus-test Most testing is via self-test swab kits either from home delivery, fixed or
mobile drive thru or for whole home testing. There are a range of online portals for key workers, care homes,
employers of key workers

There is also a North East London local offer which offers individual home or drive through tests to essential workers
and has also been focussed on care settings, using a self-test model by staff who then test residents. This model, using
the capacity at the Barts Lab, is being flexed to support other local settings to target and proactively test in possible
hotspot locations, like care homes unable to access the care home portal (non CQC registered, non-elderly population),
hostels and temporary group housing for the homeless, and similar locally identified locations. In the event of an
outbreak we will draw on this local testing capacity if necessary to expedite access to testing in the borough.

Where appropriate the Director of Public Health may need to arrange for the rapid deployment of mobile testing units to
assist in the management of a local outbreak. A response of this or a similar nature may require activity across a range
of local partners, and the Covid-19 Health Protection Board will provide the means of coordinating that action.
Methods for testing                                                                                     1      2   3       4       5   6   7

The primary method for testing is the national testing portal.

                                    Key workers (inc. teachers and
    Residents directed to                                                                                              Residents
                                   social workers) directed to testing
     testing via comms                        via comms
                                                                                                                   Key workers
     Residents who have            Key workers access priority
   symptoms access testing          testing through dedicated                                                      Care settings
    online or by calling 119                  website

                         Book testing via
                        following options                                 Care settings directed to national
                                                                            testing portal for that setting
   Mobile testing        Drive through
                                                   Home test kits
       unit                  testing

                                                                           Care setting access testing for
                      National testing should                            symptomatic and non-symptomatic
                                                                         residents via a national care home
                    offer a 48-72 hr turnaround                                     testing portal
Additional Testing Capacity                                                                             1     2     3      4     5      6   7
In the case of large outbreaks we may need to expedite testing. Access to these tests will be determined on a case
by case basis, requiring a specific request from Director of Public Health

    LCRC

                                               LCRC identifies a situation
   MTU cell
                   Intelligence data          where enhanced investigation                   Notified by DPH

London Borough                                        is required.
  of Barking &
   Dagenham
                                                                                                                Standard MTU
                                              LA/LCRC identifies need for                                    operating procedures
                                                 local testing at scale                                          are followed.

                                                        Can LBBD                                             DPH notifies MTU cell
                                       Yes.           support scale of            No.
                                                                                                            and confirms number of
                                                     testing required?                                      tests needed and day of
                                                                                                            testing (as early as next
Read the document here                                                                                                day).

                                                                          Setting lead or LA notifies
                                                                          all people who need to be
                                                                                    tested.
Data Integration and
Joint Biosecurity Centre
Arrangements
Data sharing and reporting
In the context of Covid-19 this means:

• Timely data flows from testing to be able to predict and intervene in outbreaks
• Updated evidence on spread of infection and control measures

Daily data reports will be provided at regional level for London on numbers of cases and contacts successfully
traced and numbers escalated to the LCRC. Weekly epidemiology and quality monitoring reports will provide further
granularity on programme effectiveness.

Scoping work with London stakeholders across the NHS, local government and Directors of Public Health have
highlighted the need for borough level data to identify individual support needs, track local disease transmission
and inform testing capacity. This will be provided by the Joint Biosecurity Centre. Additional epidemiological
modelling will be provided by PHE London to further understand disease transmission at borough level.

Alongside this the Director of Public Health will need to work closely with the Joint Biosecurity Centre, which has
the role of bringing together data from testing and contact tracing, alongside other NHS and public data, to provide
insight into local and national patterns of transmission and potential high-risk locations and to identify early potential
outbreaks so action can be taken.
GDPR and Data Security

We are required to adopt a proactive approach to sharing information by default, in line with the Instructions of the
Secretary of State, the Statement of the Information Commissioner on Covid-19 and the Civil Contingencies Act. The
Secretary of State has issued 4 notices under the Health Service Control of Patient Information Regulations 2002 requiring
the following organisations to process information: NHS Digital, NHS England and Improvement, health organisations,
arm’s length bodies, local authorities, GPs.

These notices require that data is shared for purposes of coronavirus (Covid-19) and give health organisations and local
authorities the security and confidence to share the data they need to respond to coronavirus (Covid-19). They can be
found here https://www.gov.uk/government/publications/coronavirus-covid-19-notification-of-data-controllers-to-share-
information.

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

Public Health England Covid-19 Testing Data Sharing Contract in place. Start date: 26 June 2020. End date: On expiry of
the Covid-19 – Notice under Regulation 3(4) of the Health Service Control of Patient Information Regulations 2002
(currently 30th September 2020)
Local data reporting                                                                                                                    1       2        3     4       5        6     7
Current Council reporting mechanisms are outlined in the table below.

                                                                                                                                                               LBBD produced
                          Reports sent to DPH                                               Data sets in public domain
                                                                                                                                                                  reports

                Confirmed covid                             Coronavirus in the       Death registrations     COVID-19 outbreaks         Deaths involving
 Report                                Test and Trace
                                                                                       and occurrences            in care homes          COVID-19 by
                  cases (from                              UK by local authority                                                                             Cases by care setting
  title                               report (LA level)                                                                                deprivation (ONS)
                    LCRC)                                       (HM Gov)                     (ONS)                     (PHE)
                                                                                   • All cause and           • suspected or                                  • List of care setting
                                     • Confirmed cases
                                                                                     COVID-related             confirmed outbreak
               • Cases by pillar       in Test and Trace   • Daily confirmed                                                           • COVID-related         affected by Covid-19
Dataset/                                                                             deaths by date            of COVID-19 in care
                 with postcode,      • Cases completed       cases                                                                       deaths by MSOA      • Total confirmed and
                                                                                     registered, date and      homes
 report          age at onset,       • Total number of     • Rate of cases (per      place of death          • By upper and lower      • Age standardised      suspected cases in
                 ethnicity, gender     contact reported      100,000)                                                                    death rate by         Barking and
contents                             • Contacts
                                                                                   • By upper and lower        tier local authority,
                                                                                                                                         London boroughs       Dagenham care
                 and occupation                            • Cases by MSOA           tier local authority,     region and PHE
                                       completed                                     region and country        centre                                          settings

Frequency                                                         Daily
                     Daily                  Daily                                   Weekly (Tuesday)         Weekly (Thursday)            Infrequently                Daily
of reporting

               • Age-specific
                 rate of cases                             7-day moving
                                                                                   Excess deaths in
 Further         (per 10,000)                              average of cases
                                                                                   2020 compared to
analyses       • COVID-19                                  for Barking and
                                                                                   the 5 year average
                 cases by LSOA,                            Dagenham and
  done           MSOA and                                  London
                                                                                   (2014-2018)
                 Ward
List of reports to the Director of Public Health
Subject                Content                                                                      Sender                              Sender email                               Frequency
Contact Tracing Update Notification that the daily contact tracing update by UTLA, daily COVID-19   Contact Tracing Cell: data and      WNCoV.datacontacttracing@phe.gov.uk        Daily
yyyymmdd               surveillance reports and exceedance reports have been uploaded to the        surveillance
                       PHE SharePoint site – reports no longer included in email                    Field Service, National Infection
                                                                                                    Service, Public Health England
PHEC Daily COVID-19      Daily PHE regional report summarising data on laboratory-confirmed         PHE London Incident                 ICC.London@phe.gov.uk                      Daily
surveillance report      COVID-19 cases and reported COVID-19 outbreaks/clusters                    Coordination Centre

LCRC Daily Data          London Coronavirus Response Cell Daily Data Summary (cases and             PHE London Incident                 ICC.London@phe.gov.uk                      Daily
Summary and LSAT         situations) and LSAT Postcode Data (line listing with postcode, age)       Coordination Centre
data
PHEC Weekly COVID-19 Weekly report summarising data on laboratory-confirmed COVID-19                PHE London Incident                 ICC.London@phe.gov.uk                      Weekly
surveillance report  cases; reported COVID-19 outbreaks/clusters; syndromic surveillance            Coordination Centre
                     indicators; and hospital and ICU/HDU admissions
Care homes COVID-19      Information for each care home in borough on the following:                DHSC Covid-19 Testing               COVIDCareHomeTestingReferrals@dhsc.gov.uk Twice per week
Order Report for Local   • Registered places                                                        Programme
Authorities (contains    • Total no. of residents
local data only not      • Number / % of symptomatic residents
London)                  • Total no. of staff
                         • No. of tests requested
                         • No. of tests delivered
DHSC testing London      • DHSC pillar 2 testing regional dashboard for London                      DHSC Covid 19 team                  Tom.addey@adphlondon.org.uk on behalf of   Weekly
dashboard                                                                                                                               John.Mitchell@dhsc.gov.uk
NHS Digital pillar 2     • NHS Digital has produced Pillar 2 Testing Dashboards using current       NHS Digital Pillar 2 Service Team   ccsm@nhsdigital.nhs.uk                     N/a - dashboard
testing dashboard          data to provide anonymous counts of Covid-19 tests completed and
                           tests which are deemed void, aggregated by Upper Tier Local
                           Authorities
Daily Exceedance Report Regional daily exceedance report. An exceedance means that an area has PHE Contact Tracing Cell: data           WNCoV.datacontacttracing@phe.gov.uk        Daily
                        a greater than expected rate of infection compared with the usual      and surveillance
                        background rate for that location. Areas are RAG rated and in depth
                        reports are produced for areas that have exceeded (RED reports). These
                        are shared with the appropriate DsPH.

                                                                                                                                                   40
Pillar 1 testing (NHS/PHE labs)                                                                           Pillar 2 testing (commercial partners)

                                                                                                                                                                                                                                                     Results
                                          care home
                                          initial
                                          cases referred                              All postive results reported into the SGSS (second generation surveillance system)
                                          for testing

               Care home direct contact              Results reviewed by LCRC                                             Results flow into CTAS                           Daily review by Field Services (PHE)
                                                     London Coronavirus response cell
               School direct contact                 (part of Health protection, PHE)                                     Complex case identifed at Tier 2
                                                                                                                          e.g. care homes, vulnerable people

                                                                                                                                                                                                                                                     Assimilation
                                                                                                                          referred to Tier 3, LCRC*
                                                     All outbreaks and received cases                                                                                      Data from HP zone extractred by FS
                                                     input into Hpzone

                                                     Information from SGSS and HPzone combined

Data flows                                           LCRC reports includes results from
                                                     Pillar 1 and Pillar 2
                                                                                                                                                                           FS reports includes results from
                                                                                                                                                                           Pillar 1 ONLY (at the moment)

for Covid-19
cases and                                                                                         Reports to DPH in local authorities, some to wider
                                                                                                                    stakeholders
situations                                           From LCRC                                                                                                                                                       From FS

                                                     Daily summary           - Number of new and cumulative cases (pillar 1                                    Exceedance reports Daily new cases reported with statistical assessment of
                                                                             and 2, from SGSS)                                                                                        impact on trend, localities where number of new cases
                                                                                                                                                                                      exceed expected trend are highlighted
                                                                             - List of new situations e.g. care homes created
                                                                             by LCRC (from HP-Zone, gives name of

                                                                                                                                                                                                                                                     REPORTING
                                                                             establishment, daily list)
                                                                             - Complex cases and situations notified from                                      PHE Daily            - Number of new and cumulative cases (pillar 1 only, from
                                                                             Tier 2 contact tracing                                                            Surveillance reports SGSS)
                                                                              - Cumulative number of situations by type                                                               - Graph of age and sex distribution of total cases (pillar 1
                                                                             (from HP-Zone)                                                                                           only, from SGSS)
                                                                              - Cumulative number of confirmed and                                                                     - Number of new outbreaks of suspected or confirmed
                                                                             suspected deaths of care home residents (from                                                            COVID-19 in care homes for prior week and cumulative
                                                                             HP-Zone)                                                                                                 total (from HP-Zone)

                                                     Daily Individual data Line listing to all boroughs of new cases with
                                                                             postcode and age

                                                     Weekly reports:         Weekly summaries of the above data                                                Weekly reports          Summary of surveillance systems reports

               * care home residents, schools and connected workplaces are mandatory fields for data entry.
               Care homes, schools and other situations are escalated as per protocol
               Postcode and workplace "coincidences" are picked up by CTAS and HP zone and reviewed
               Regular surveillance reports reviewed by PHE LCRC/ FS
Information received
                 Query from settings or           Information from Local
                                                                                                        All positive results reported into the SGSS (second
                 member of the public                Authority, Other
                                                                                                      generation surveillance system). Results flow into CTAS.               Notifications from GP or other
                 re. school, workplace,            PHEregions, Devolved
                                                                                                      Complex case or setting identified at Tier 2 and referred                    healthcare settings
                   prison, hostel, care             Adm, International
                                                                                                                               to Tier 1
                          home                            office

                                                                      London Coronavirus Response Cell (Tier 1) receive notification/information/query from setting, LA or GP
                                                                                                              or referral from Tier 2

                                                                                                                                                                                                                    Risk assessment
                 SINGLE CASE IN A SETTING                                       Information on case, outbreak or community cluster uploaded to HPZone (PHE case
                 Clinical team provide advice and manage contacts,                                            management system)
Data flows for   testing and infection control
                 Clinical team provide information materials to the
Outbreak         setting
                 Clinical team recommend ongoing control measures              Clinical team gather information and conduct risk assessment with the case or setting
Management       DPH notified

                                                                                              OUTBREAK (2 OR MORE CASES) IN A SETTING OR A CASE
                                                                                                           IN A COMPLEX SETTING

                        Hospital
                                                     Prison and            hostel/homeless           school/educationa             workplaces           care homes and           community        faith and other
                                                  prescribed places            services                  l settings                                    other care settings       clusters             settings
                 Hospital lead outbreak             of detention
                 response; LCRC provide

                                                                                                                                                                                                                    Outbreak management
                   advice and support
                                                  Arrange IMT with         Arrange incident management meeting when required with setting and relevant stakeholders
                                                  setting and              including Local Authority (DPH, EHOs, adult social care, children and young persons services)
                                                  relevant
                                                  stakeholders
                                                  including
                                                  Healthcare, MoJ
                                                  or Home Office.

                                                                                                       Coordination and lead for outbreak agreed

                                                                            RESPONSE - case finding, contact tracing, isolation, testing (if appropriate by PHE/NHS pillar 1, 2, MTU or Find
                                                                                                      and Treat), decontamination, advice and communication
Communication and
Engagement
1    2     3    4     5    6    7
Communications strategy to target three distinct themes
 These support all 7 areas of the local outbreak control plan.

 1.   Build on prevention messages (link with town centres campaign on reopening local businesses).

 2.   Raise awareness of test and trace (pan-London campaign in development to be adapted to meet local objectives).

 3.   Support LOCPs – Reactive communications actions rooted in area action plans.

 Objectives include:

 • Fulfil our legal duties of warning and informing (as set out in the Civil Contingencies Act 2004) and any other legislation
   introduced
 • Ensure we provide a single point of truth in terms of communications for key partner organisations locally and that all
   groups remain on message
 • Identify risks and vulnerabilities that could impact on our communications work
 • Scope opportunities to address misinformation
 • Ensure communications and actions around contact tracing are linked in with wider work being done by the Council on the
   digital divide.
1    2    3     4    5    6    7
Build on prevention messages

 Current activity                                            Next steps

 •   Town centre and Heathway campaign: Working with         Consider wider dissemination of prevention messages via
     businesses to safely reopen. Social distancing /        print and digital channels.
     prevention is being heavily promoted

 •   External comms: Prevention messages continue to be
     shared via social media and digital channels such as
     One Borough newsletter

 •   Internal comms: The internal team continue to provide
     messaging around staying safe in and outside of the
     workplace on Yammer, and via staff news letters
1    2     3     4      5   6   7
Raise awareness of test and trace
 Current activity                                          Next steps

 •   Limited information on testing on /covid19 hub.       •   To address trust issues and encourage compliance we
     Weekly promotion of mobile testing unit.                  will need to ensure the pan-London campaign is
                                                               adapted to reach Barking and Dagenham specific
 •   Pan-London comms group has completed                      audiences. Activity should be highly targeted using local
     research on test and trace attitudes in London.           advocates and partner channels to reach our
     Only 44% of people would know how to get a test           audiences.
     (less amongst over 65s and BAME groups) 35%
     know little or nothing about test and trace (higher   •   Develop a stakeholder map that breaks down audience
     amongst younger and BAME groups).                         specific channels and advocates.

 •   Pan-London campaign (Keep London safe) is             •   Adapt the core script for Barking & Dagenham and
     being developed with a communications toolkit for         update key channels / share with partners.
     use. Core script for frontline services should be
     ready w/c 22 June along with a 40 second video        •   Create area specific videos with partners.
     script.

 •   Visuals will also be focus grouped ready to be
     issued by end of month.
Support area outbreak plan                                          1   2   3   4    5   6   7

Next steps

Using the insight and stakeholder mapping from the London test and trace
campaign we will identify communications actions that need to support the area
action plans.

As part of the wider toolkit content will be packaged and ready to go in the event
of an outbreak.

Keep London Safe campaign is in development
Local Planning Guides
• https://www.lbbd.gov.uk/sites/default/files/attachments/1-Local-comms-planning-guide-29-
  June.pdf

• https://www.lbbd.gov.uk/sites/default/files/attachments/2-LA-comms-matrix-planning-tool-
  29-June.xlsx

• https://www.lbbd.gov.uk/sites/default/files/attachments/3-Local-Outbreak-Plans-press-
  handling-guide-29-June.docx

• https://www.lbbd.gov.uk/sites/default/files/attachments/Letter-to-LAs-on-data-access_9-
  July-2020.pdf.
Risk Matrix
Risks and threats                                                                            1    2     3     4     5   6   7

The Council is responsible for addressing issues of low-take up and engagement with hard-to-reach groups and
communities. Our challenge is that the assumption that most of the contact and engagement with the testing and tracing
regime will be managed through the app, website and phone and direct engagement with the public.

There are potentially several barriers to users successfully engaging with the proposed national model, which will be
particularly relevant to Barking and Dagenham:

•   Gaining local communities’ trust with regards to national contact tracing initiative
•   Digitally excluded groups being missed
•   Residents without access to an email account being disadvantaged
•   Residents facing financial hardship as a result of Covid-19, who would usually have access to a smartphone, but no
    internet connection (due to insufficient funds)
•   Demand for tests exceeds the number of tests available
•   Tracing programme is unable to meet demand
•   Exacerbating existing inequalities through the (method of) delivery of messages
•   Access issues beyond our control are reflected negatively on the Council
•   Those concerned about surveillance/ data protection may not engage with the contact tracing programme
•   Covid-19-related fraud and scams undermining trust in the national programme and individual representatives
Risk matrix (to be populated further)
               HIGH

                            • Outbreaks in care settings, shared living, HMOs, special schools, school transport
 HIGH RISK
                            • Places of worship such as churches, mosques

               LIKELIHOOD   • Lack of engagement with NHS Test and Trace and inability to contain local spread
 MEDIUM
  RISK                      • Outbreaks in people with substance misuse, hostels, DV Refuge and refugee
                            •   Data sharing and publishing data to engage communities
                            • Outbreaks in workplaces such as Town Hall, Roycraft or Frizlands

STANDARD
   RISK
               LOW
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