Surrey COVID-19 Test and Trace - Local Outbreak Control Plan - Surrey County Council
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Surrey
Local Outbreak
Control Plan
COVID-19 Test and Trace
30 June 2020
VERSION CONTROL
Document Control
Name of document Surrey Local Outbreak Control Plan COVID-19 Test and Trace
Version and date Version 1.0 - 30/06/2020
Owner Surrey Local Outbreak Engagement Board
Author Surrey County Council Public Health - Test and Trace Programme Team
(Ruth Hutchinson, Lisa Harvey-Vince, Tony Hill, Richard Davis, Gail Hughes)
Next review due This plan will be continually reviewed as:
• local protocols and processes are developed through task and
finish groups,
• changes to national guidance occur, and
• lessons are identified from testing the plan and real-life events.
Signed Joanna Killian – Chief Executive Surrey County Council
30 June 2020 Ruth Hutchinson – Interim Director of Public Health, Surrey County Council
Margot Nicholls – Consultant in Health Protection, Public Health England
South East
2|Page
Table of Contents
Glossary of Terms 5
List of Figures 6
1.0 Introduction 7
2.0 Contact Tracing 9
2.1 Contact Tracing 9
2.2 NHS Test and Trace Service 9
3.0 High Risk Places, Locations and Communities 11
3.1 Trigger of the plan 11
3.2 Outbreak Control Teams (OCT) 12
4.0 Context – A picture of Surrey 13
4.1 Overview of Surrey County and the health needs of its residents 13
4.2 Surrey’s health and care landscape 13
4.3 The impact of COVID-19 on Surrey 14
5.0 Legal Context 16
5.1 Coronavirus Act 2020 16
5.2 Health Protection Regulations 2010 as amended 16
5.3 Data Sharing 17
6.0 Local Governance 18
6.1 Governance overview 18
6.2 Surrey Local Outbreak Engagement Board 18
6.3 Surrey COVID-19 Health Protection Operational Group 18
6.4 Surrey Local Resilience Forum 19
7.0 Communications and Engagement 20
7.1 Public Engagement 20
7.2 Stakeholder Engagement 21
8.0 Data Integration 22
8.1 Data objectives 22
8.2 Data arrangements currently in place 22
8.3 Data arrangements that need to be set up 23
9.0 Local Testing Capabilities 24
9.1 Testing arrangements currently in place 24
9.2 Testing arrangements that need to be set up 25
10.0 Supporting Vulnerable People 26
10.1 Supporting vulnerable people arrangements currently in place 26
10.2 Supporting vulnerable people arrangements that need to be set up 26
11.0 Specific High-Risk Settings & Communities 28
Appendix 1 - PHE South East SOP – PHE-LA Joint Management of COVID-19 Outbreaks in the SE of England 29
Appendix 2 - Surrey Local Outbreak Engagement Board Terms of Reference & Membership 29
Appendix 3 - Surrey Covid-19 Health Protection Operational Group Terms of Reference & Membership 29
Appendix 4 - Care Homes (Adults) 30
Appendix 5 – Children’s Homes 32
Appendix 6 - Schools 34
Appendix 7 - Prisons and other prescribed places of detention 36
Appendix 8 - Other Workplaces 37
Appendix 9 - Major Tourist Attractions 39
Appendix 10 – Faith Settings 40
Appendix 11 - Black Asian and minority ethnic (BAME) Communities 41
Appendix 12 - Homeless community 42
3|PageAppendix 13 – Gypsy, Roma and Traveller Communities 44 Appendix 14 – Hospitals 46 Appendix 15 - Primary Care 49 Appendix 16 - Mental Health & Community Trusts, and Hospices 52 Appendix 17 - UK Ports of Entry 54 4|Page
Glossary of Terms ADPH Association of Directors of Public Health BAME Black, Asian and Minority Ethnic CCA Civil Contingencies Act CCG Clinical Commissioning Group CQC Care Quality Commission DHSC Department of Health and Social Care DPH Director of Public Health EH Environmental Health GRT Gypsy Roma and Traveller HPOG Health Protection Operational Group HPT Health Protection Team ICP Integrated Care Partnership ICS Integrated Care System IG Information Governance JBC Joint Biosecurity Centre LGA Local Government Association LHRP Local Health Resilience Partnership LRF Local Resilience Forum LOEB Local Outbreak Engagement Board MIG Multi-agency Information Group NHS BSA NHS Business Services Authority NHS-E NHS England OCT Outbreak Control Team ONS Office of National Statistics PCN Primary Care Network PH Public Health PHE SE Public Health England South East RCG Recovery Co-ordinating Group SCC Surrey County Council SCG Strategic Co-ordinating Group SECAMB South East Coast Ambulance Service SOP Standard Operating Procedure TIAC Tactical Intelligence and Analytics Cell TCG Tactical Co-ordinating Group UTLA Upper Tier Local Authority WHO World Health Organisation 5|Page
List of Figures Figure 1 – NHS Test and Trace Service (Tiers) Figure 2 - Map of Surrey County, districts and boroughs Figure 3 – COVID-19 Test and Trace Governance Overview Figure 4 – Relationship between the SCG, LOEB, HPOG 6|Page
1.0 Introduction
As part of the government’s COVID-19 recovery strategy, the NHS Test and Trace service was
launched on 28th May 2020 with the primary objectives to control the COVID-19 rate of reproduction
(R), reduce the spread of infection and save lives. This will help return life to as normal as possible,
for as many as people as possible, in a way that is safe, protects our health and care systems and
releases our economy.
Achieving these objectives requires a co-ordinated effort with local government, NHS and other
relevant organisations at the centre of outbreak response with development and actioning of Local
Outbreak Control Plans for COVID-19 Test and Trace. National government funding of £300m has
been provided to local authorities in England. On 10th June it was announced that the funding is
based on the 2020/21 Public Health Grant allocation, and for Surrey County Council this is
£3,477,690 paid in one instalment in June 2020.
This plan is primarily about controlling outbreaks, however preventing spread of the virus is still
critically important to prevent localised outbreaks and to avoid a second wave of the pandemic.
Surrey residents need to continue to follow national guidance on staying at home if symptomatic,
social distancing, washing hands, and using face coverings in public places. The communications plan
will address how to encourage the public to follow this guidance.
The aim of the Local Outbreak Control Plan – COVID-19 Test and Trace, is to protect the health of the
population of Surrey by:
• preventing the spread of COVID-19
• early identification and proactive management of local outbreaks
• co-ordination of capabilities across agencies and stakeholders and
• assuring the public and stakeholders that this is being effectively delivered
In Surrey this Local Outbreak Control Plan builds on existing health protection plans already in place
between Surrey County Council (SCC), Public Health England (PHE) South East (SE) Surrey and Sussex
Health Protection Team (HPT), the 11 Surrey District and Borough Council Environmental Health
Teams, Surrey Heartlands Integrated Care System (ICS), Frimley Health and Care ICS, and Surrey
Local Resilience Forum (LRF):
• Kent, Surrey, Sussex Public Health England Centre Outbreak/Incident Control Plan (2014)
• Local Agreement between the Local Environmental Health Services of Surrey, East Sussex,
West Sussex and Brighton and Hove, and Public Health England South East Horsham Health
Protection Team (2019)
• Surrey Local Health Resilience Partnership (LHRP) Memorandum of Understanding:
Responsibilities for the Mobilisation of Health Resources to Support the Response to Health
Protection Outbreaks/Incidents in Surrey (2019)
• Surrey LRF Pandemic Influenza Plan (2019)
7|PageThe Department of Health and Social Care (DHSC) has advised that the Local Outbreak Control Plan is
centred around 7 themes:
1. Planning for local outbreaks in care homes and schools (e.g. defining monitoring arrange-
ments, identifying potential scenarios and planning the required response).
2. Identifying and planning how to manage other high-risk places, locations and communities
of interest including sheltered housing, dormitories for migrant workers, transport access
points (e.g., ports, airports), detained settings, rough sleepers etc (e.g. defining preventative
measures and outbreak management strategies).
3. Identifying methods for local testing to ensure a swift response that is accessible to the en-
tire population. This could include delivering tests to isolated individuals, establishing local
pop-up sites or hosting mobile testing units at high-risk locations (e.g. defining how to priori-
tise and manage deployment).
4. Assessing local and regional contact tracing and infection control capability in complex set-
tings (e.g., Tier 1b) and the need for mutual aid (e.g. identifying specific local complex com-
munities of interest and settings, developing assumptions to estimate demand, developing
options to scale capacity if needed).
5. Integrating national and local data and scenario planning through the Joint Biosecurity Cen-
tre Playbook (e.g., data management planning including data security, data requirements
including NHS linkages).
6. Supporting vulnerable local people to get help to self-isolate (e.g. encouraging neighbours to
offer support, identifying relevant community groups, planning how to co-ordinate and de-
ploy) and ensuring services meet the needs of diverse communities.
7. Establishing governance structures led by existing Covid-19 Health Protection Boards and
supported by existing Gold command fora and a new member-led Board to communicate
with the general public.
The Association of Directors of Public Health (ADPH), Public Health England (PHE), Local Government
Association (LGA) and others, have published guidance on the Guiding Principles for Effective Man-
agement of COVID-19 at a Local Level to support this work.
8|Page2.0 Contact Tracing
2.1 Contact Tracing
Contact tracing is a fundamental part of outbreak control. When a person is tested positive for
COVID-19, they are contacted to gather details of places they have visited, and people they have
been in contact with. Those who they have been in contact with, are risk assessed according to the
type and duration of that contact. Those who are classed as ‘close contacts’ are contacted and
provided with advice on what they should do e.g. self-isolate.
Close contacts include:
• Direct close contacts: Direct face to face contact with a case for any length of time, including
being coughed on or talked to. This will also include exposure within 1 metre for 1 minute or
longer
• Proximity contacts: Extended close contact (within 1-2m for more than 15 minutes) with a
case
• Travelled in a small vehicle with a case
PHE have produced a pictorial guide describing Contact Tracing.
2.2 NHS Test and Trace Service
The national NHS Test and Trace service, which went live on Thursday 28th May 2020, has been set
up to undertake contact tracing for COVID-19. The service consists of three tiers as shown in Figure 1
below:
Figure 1 – NHS Test and Trace Service (Tiers)
9|Page• Tier 3 – Around 20,000 call handlers have been recruited by external providers under
contract to DHSC to provide advice to contacts using national standard operating procedures
(SOP) and scripts as appropriate. An automated app will also be launched nationally for
people to report symptoms, access testing and complete an online questionnaire, which will
speed up the identification of contacts.
• Tier 2 – Around 3000 dedicated professional contact tracing staff have been recruited by
NHS providers to interview cases to determine who they have been in close contact with in
the two days before they became ill and since they have had symptoms. They will also
handle issues escalated from Tier 3. Appropriate advice following national guidance is given
to cases and their close contacts.
• Tier 1 – PHE Health Protection Teams will investigate cases escalated from Tier 2. This will
include complex, high risk settings, and communities such as care homes, schools and
special schools, prisons/places of detention, healthcare and emergency workers, health care
settings, and travelling in small vehicles where it has not been possible to identify contacts;
and places where outbreaks are identified e.g. workplaces. Advice following national
guidance will be given to cases, their close contacts and settings/communities as
appropriate. An outbreak is defined as 2 or more cases (suspected and /or confirmed) linked
in place/time. An outbreak will trigger this plan as detailed in section 3.1.
More information on NHS Test and Trace is available at https://www.gov.uk/guidance/nhs-test-and-
trace-how-it-works and it can be accessed at https://contact-tracing.phe.gov.uk/ . On registration
with the service, people are asked to provide contact details, so that results and advice can be
provided by email, text or phone. For those with hearing impairment they can provide next of kin or
friend details, and parent/guardian details for children.
When it is launched, the NHS COVID-19 app is designed to supplement the core elements of the Test
and Trace service by increasing its speed and reach, especially for those who have been in close
contact with someone who has tested positive but are not known to them, for example on public
transport.
10 | P a g e3.0 High Risk Places, Locations and Communities Tier 3 and Tier 2 contact tracing may identify high risk places, locations and communities of interest which need additional support to control the spread of COVID-19. The Guiding Principles for Effective Management of COVID-19 at a Local Level specifically identifies care homes and schools for outbreak management, but it is for Local Authorities and partners to identify other high-risk places, locations and communities of interest. Section 12.0 of this plan identifies additional specific settings for Surrey. In the event of an outbreak, PHE SE Surrey and Sussex HPT are responsible for co-ordinating outbreak management and will work closely with the Public Health team at Surrey County Council, the 11 Surrey Environmental Health Teams, Local NHS Trusts, and the two ICS to facilitate a timely and proportionate outbreak response. COVID-19 SOPs will be developed for specific high-risk place, locations and communities to ensure all relevant partners are clear on their roles and responsibilities and action needed, especially for outbreak management, based on national SOPs where and when these are available. These SOPs will assist in determining the resource capabilities and capacity implications. In the event of a localised community outbreak, public transport associated with that area will need to be considered by the Outbreak Control Team (OCT), including local messaging to passengers. But it clearly can only become a reality when the mobile phone app is in place nationally, most of the public use it, and the government decides how to respond to increased incidence of COVID-19 associated with a particular transport route/hub. 3.1 Trigger of the plan The Surrey Local Outbreak Plan will be triggered when there are suspected or confirmed COVID-19 outbreaks in any setting type. The Kent, Surrey, Sussex Public Health England Centre Outbreak/Incident Control Plan defines an outbreak as a greater than expected occurrence of an infection compared with the usual background rate for that particular place and time. The threshold for this has not yet been defined for COVID-19 in the UK. An outbreak could also be defined by a number of people linked by time and place, usually two or more people. An Outbreak Control Team (OCT) may or may not be convened for either of these situations – see section 3.2. A local lockdown would be one tool that may need to be deployed by the OCT, subject to new legal powers being issued and data interpretation by the Joint Biosecurity Centre. PHE SE Surrey and Sussex HPT and Surrey County Council gather intelligence on COVID-19 outbreaks via the national Test and Trace service, laboratory results, and local partner intelligence about suspected outbreaks. Where surveillance or intelligence identifies the need for additional testing, more detail is given in section 9. PHE will initially conduct the risk assessment with the setting, provide infection control advice and request testing as appropriate, following PHE internal SOPs that are being developed for responding to COVID-19 cases and outbreaks in specific setting types. Local Authorities will provide support to the outbreak setting and may be asked to provide additional capacity for contact tracing, as needed. 11 | P a g e
3.2 Outbreak Control Teams (OCT) In the event of an identified outbreak and in line with PHE SE SOP - PHE-LA Joint Management of COVID-19 Outbreaks in the SE of England (Appendix 1), PHE will convene a multiagency Outbreak Control Team (OCT) meeting to coordinate the partner response. There are well established processes in place for convening OCTs and mobilising responses to outbreaks, as detailed in the health protection plans listed in 1.0 above. For many settings the response to outbreaks is well practised. Where an OCT does need to be convened, this will follow the process described in the PHE SE SOP - PHE-LA Joint Management of COVID-19 Outbreaks in the SE of England. 12 | P a g e
4.0 Context – A picture of Surrey
4.1 Overview of Surrey County and the health needs of its residents
Over 1.1 million people live in Surrey, which is one of the most densely populated shire counties in
England. Surrey has a complex geography with a mixture of rural, semi-rural and urban areas and is
comprised of 11 borough and district councils (Figure 1).
Figure 2. Map of Surrey County, districts and boroughs
Surrey residents generally live long healthy lives - average life expectancy and healthy life expectancy
are amongst the highest in the country. Surrey residents also do well on aspects of social life which
we know contribute to health and wellbeing, such as employment and education. Levels of deprivation
are relatively low however there are significant health inequalities within Surrey in small areas which
have worse health outcomes, greater health care use and higher estimated rates of risky health
behaviours.
A key health and care challenge facing Surrey is the aging population. Surrey has the 4th highest
number of people aged 80 years and over (67,388), out of the 149 upper tier local authorities. Surrey
also has the third highest number of care home beds, registered with the Care Quality Commission
(CQC) in the country with 13,626 beds, after Kent (14,579) and Hampshire (13,876).
Local communities, including those living in the most materially deprived areas, are involved in
activities to improve outcomes for residents. A substantial proportion of the ageing population are
healthy with secure incomes who actively volunteer to support their local communities.
4.2 Surrey’s health and care landscape
The health and social care landscape in Surrey are complex and evolving. This includes:
• two Integrated Care Systems (ICS)
• five Integrated Care Partnerships (ICPs)
13 | P a g e• a Voluntary, Community and Faith sector
• 127 GP practices organised into 24 Primary Care Networks (PCNs)
• 209 community pharmacies providing NHS services
• 11 District and Borough Councils
• Five acute hospital trusts
• 424 CQC registered care homes
Surrey has 379 maintained schools and academies, as well as 110 independent schools, 13 colleges
and 2 Universities. There are 5 prisons in Surrey.
4.3 The impact of COVID-19 on Surrey
The data below provides a snapshot of the impact of COVID-19 in Surrey as of mid-June 2020, based
on the information local partners have used to manage the COVID-19 response.
Cases
There have been 3,019 laboratory confirmed cases of COVID-19 in Surrey (reported by PHE as of the
24th June 2020). This is a rate of 253.7 cases per 100,000 population, which ranks Surrey 88th out of
150 Upper Tier Local Authorities (UTLA) in England, in terms of cases of COVID-19.
To account for the different population sizes, PHE publishes rates because areas with larger
populations will tend to have more cases than those with smaller populations. Although rates are
easier to compare than the raw counts, it is also relevant to note that they do not take into account
other factors that may affect the numbers of cases in an area, such as the age of the population or
the amount of testing carried out.
Eligibility and access to testing has been different between areas and has evolved over time. Surrey
experienced a higher number of cases earlier on in the pandemic, when testing was more limited,
and this may influence the number and rates of cases when compared to other areas.
Deaths
The first registered death involving COVID-19 in Surrey occurred on the 14th March 2020. Up to the
19th June 2020, 1,330 deaths involving COVID-19 have been registered in Surrey. Note that this
includes deaths occurring in Surrey hospitals but is not specific to Surrey residents. Of these deaths:
• 876 (66%) occurred in hospital
• 383 (29%) occurred in care homes in Surrey
• 71 (5%) occurred in other community settings (including residential home and hospices)
• At the end of May, 23% of all CQC registered care homes in Surrey had registered COVID-
19 related deaths.
• 50% of the largest (>50 beds) CQC registered care homes in Surrey had registered COVID-
19 related deaths
COVID-19 related deaths include both deaths where a person had a laboratory confirmed positive
result for COVID-19, as well as clinical suspicion of unconfirmed COVID-19.
14 | P a g eThese numbers are based on Surrey local registry data, which includes all deaths occurring in Surrey
(irrespective of where the person was a resident). Deaths of non-Surrey residents mostly occur in
Surrey hospitals. Local registry numbers are used for internal reporting and planning processes
because the number of deaths occurring in Surrey are important for managing the response to the
COVID-19 crisis. ONS figures for COVID-19 related deaths are lower because they are limited to
Surrey residents.
Outbreaks (as at 23rd June 2020)
• 209 CQC registered care homes have reported COVID-19 outbreaks in Surrey. Nineteen of
these care homes have had repeat suspected/ confirmed outbreaks.
• 49% of all CQC registered care homes in Surrey have reported a COVID-19 outbreak
(suspected and confirmed).
• Reigate and Banstead Borough Council have the highest number of CQC registered care
homes in Surrey at 89 followed by Tandridge District Council at 48 and Waverley Borough
Council at 47. The highest numbers of COVID-19 outbreaks in care homes were reported in
Reigate and Banstead and Waverley Boroughs.
• Approximately 80% of the largest (>50 beds) care homes in Surrey have reported COVID-19
outbreaks (suspected and confirmed)
• There have been 13 outbreaks in children’s settings, with none of these having a second
outbreak.
• 4 of the 5 prisons in Surrey have reported small COVID-19 outbreaks since the start of the
pandemic
15 | P a g e5.0 Legal Context
The legal context for managing outbreaks of communicable disease which present a risk to the
health of the public requiring urgent investigation and management sits with:
• Public Health England under the Health and Social Care Act 2012
• Directors of Public Health under the Health and Social Care Act 2012
• Chief Environmental Health Officers under the Public Health (Control of Disease) Act 1984
and suite of Health Protection Regulations 2010 as amended
• NHS Clinical Commissioning Groups to collaborate with Directors of Public Health and Public
Health England to take local action (e.g. testing and treating) to assist the management of
outbreaks under the Health and Social Care Act 2012
• other responders’ specific responsibilities to respond to major incidents as part of the Civil
Contingencies Act 2004
Specific legislation to assist in the control of outbreaks is detailed below. An Outbreak Control Team
could request an organisation that has the legal powers to take specific actions, but the final
decision lies with the relevant organisation.
5.1 Coronavirus Act 2020
Under the Coronavirus Act 2020, the Health Protection (Coronavirus Restriction) (England)
Regulations 2020 as amended set out the restrictions of what is and is not permitted, which when
taken together create the situation of lockdown. Any easing of lockdown comes from amending or
lifting these national Regulations. The powers of the Police to enforce lockdown also flow from these
national Regulations. Any enforcement will need to be considered carefully. The view of Surrey
Police is that they will continue to police by consent, with enforcement being a last resort
(particularly if it has geographic limits to it as this could trigger conflict).
‘Localised’ lockdown would require further government regulations that are designed to be used
locally. Currently there are no such regulations. The Joint Biosecurity Centre (JBC) will be issuing
further information about how local movement restrictions may need to be increased if infections
increase again.
Schedule 21 of the Coronavirus Act 2020 gives powers to designated Public Health Officers to direct
persons to go immediately to a specified place for screening and assessment, and then impose
restrictions on that person e.g. travel, activities, and contact with others, for a specified period.
These powers can only be used in exceptional circumstances after all reasonable measures for
voluntary co-operation have been exhausted. Their use must be necessary and proportionate in the
interests of individual and public health. There are two Public Health Officers for the South East of
England.
5.2 Health Protection Regulations 2010 as amended
The powers contained in the suite of Health Protection Regulations 2010 as amended, sit with
district and borough council environmental health teams.
16 | P a g eThe Health Protection (Local Authority Powers) Regulations 2010 allow a local authority to serve
notice on any person with a request to co-operate for health protection purposes to prevent,
protect against, control or provide a public health response to the spread of infection which could
present significant harm to human health. There is no offence for those not complying with this
request for co-operation.
The Health Protection (Part 2A Orders) Regulations 2010 allow a local authority to apply to a
magistrates’ court for an order requiring a person to undertake specified health measures for a
maximum period of 28 days. These orders are a last resort mechanism, requiring specific criteria to
be met and are labour intensive. These orders were not designed for the purpose of ‘localised’
lockdowns, so it is possible that there may be a reluctance by the courts to impose such restrictions
and the potential for legal challenge.
5.3 Data Sharing
There will be a proactive approach to sharing information between local responders by default, in
line with the instructions from the Secretary of State, the statement of the Information
Commissioner on COVID-19 and the Civil Contingencies Act 2004. Data-sharing to support the
COVID-19 response is governed by 3 different regulations:
• the four notices issued by the Secretary of State for Health and Social Care under the
Health Service Control of Patient Information Regulations 2002, requiring several
organisations to share data for purposes of the emergency response to COVID-19
• the data sharing permissions under the Civil Contingencies Act 2004 and the Contingency
Planning Regulations 2005
• the Statement of the Information Commissioner on COVID-19
17 | P a g e6.0 Local Governance 6.1 Governance overview The following diagram provides an overview of the COVID-19 Test and Trace governance at national, regional and local level. Figure 3 – COVID-19 Test and Trace Governance Overview 6.2 Surrey Local Outbreak Engagement Board The Surrey Local Outbreak Engagement Board (LOEB) is a member-led oversight board, chaired by the Leader of Surrey County Council. The LOEB is a subgroup of the Surrey Health and Wellbeing Board. The primary roles of the LOEB are to have political oversight relating to outbreak response, provide direction and leadership for community engagement, and be the public face of the local response in the event of an outbreak. Full Terms of Reference and membership are in Appendix 2. 6.3 Surrey COVID-19 Health Protection Operational Group The Surrey COVID-19 Health Protection Operational Group (HPOG) will bring together senior professional leads from the organisations involved. The HPOG will report to the LOEB. The primary roles of the HPOG are the ongoing development and delivery of the Local Outbreak Control Plan, work with the relevant LRF Cells, and make recommendations to the LOEB on allocation of resources. The Chair is the Director of Public Health. Full Terms of Reference and membership are in Appendix 3. National guidance in Guiding Principles for Effective Management of COVID-19 at a Local Level states that the Local Authority Chief Executive, in partnership with the Director of Public Health and Public Health England Health Protection Team are responsible for signing off the Local Outbreak Control Plan. 18 | P a g e
The HPOG will also work closely with the following regional groups:
• PHE South East Contact Tracing Operational Group
• PHE South East Regional Test and Trace Oversight Group
• PHE South East Schools Cell
6.4 Surrey Local Resilience Forum
The Surrey Local Resilience Forum (LRF) will support local health protection arrangements working
with HPOG and LOEB directly through the Strategic Co-ordinating Group (SCG), Recovery Co-
ordinating Group (RCG), Tactical Co-ordinating Group (TCG), and the following Cells:
• Multi-agency Information Cell (MIG)
• Tactical Intelligence and Analytics Cell (TIAC)
• Testing Cell
• Resident Welfare and Volunteer Cell
The LRF structure will be expected to manage the deployment of broader resources and local testing
capacity to rapidly test people in the event of a local outbreak.
Figure 4 – Relationship between the critical roles (SCG, LOEB, HPOG (in Surrey))
19 | P a g e7.0 Communications and Engagement
The response to COVID-19 has been coordinated through the LRF’s Multi-Agency Information Group
(MIG). The MIG is represented by all partner organisations in Surrey including:
• Surrey County Council (Chair)
• Surrey Heartlands Integrated Care System
• Surrey Police
• Borough and District Councils
• Public Health England (PHE)
The Chair of the MIG sits on the Strategic Coordination Group (SCG) and ensures communications
activities are coordinated across the county and aligned to the strategic direction of the LRF.
The MIG will continue to lead the communications response to COVID-19 and any communications
activities relating to the Local Outbreak Control Plan are aligned to:
• wider public warning and informing messaging
• communications campaigns pertaining to the latest Government advice and guidance, and
• wider stakeholder communications about COVID-19 in general
Through the MIG, key messages can be facilitated for key sectors including the business sector and
wider health sector. Messages can also be cascaded by the Borough and District Councils to
residents and stakeholders.
The Director of Communications for Surrey County Council (Chair of the MIG) will sit on the HPOG
and advise the Director of Public Health and the LOEB on the communications strategy for the Local
Outbreak Control Plan - COVID-19 Test and Trace.
7.1 Public Engagement
Recognising that public engagement and trust is crucial, an external communications and
engagement strategy will be developed in order to:
1. Ensure communications plans are in place to support the Local Outbreak Strategy and
communicate key developments to our residents
2. Consolidate the National Test and Trace campaign locally to motivate compliance
3. Aid in the development of best practice
The communications and engagement plan will provide an overview of the key target audiences, as
identified by the HPOG and how they will be reached. The plan will ensure that Surrey residents and
businesses understand both the national Government messaging as well as the Local Outbreak
Control Plan and any potential ‘local lockdown’ measures and how this impacts them.
The communications approach will include traditional offline channels and networks as well as geo-
targeted digital engagement tactics to ensure messaging can be targeted at residents within a few
20 | P a g ehours of a notification of a local outbreak. This will ensure the widest reach possible across the different demographics in Surrey. The communication and engagement plan will also outline how specific groups will be reached using online platforms, including how residents can be targeted by their locality (home or work) and /or their profession. The engagement plan will also give consideration as to how we reach other at-risk groups such as the BAME and ‘shielded’ community. To deliver messaging effectively, the communications team will work with the HPOG as well as monitor Government advice to provide real-time updates on the Test and Trace service and signpost people to the correct Government sources to gain information. 7.2 Stakeholder Engagement The HPOG is responsible for communicating the engagement strategy between agencies and other fora, including the LRF SCG, RCG, TCG, Cell Leads, LOEB, PHE and other Boards. The HPOG will also manage the coordination of key messages and communication activities with partners and will keep the LEOB informed on key developments that impact on the agreed communications or operational response. 7.3 National Engagement The Director of Communication for Surrey County Council sits on the communications sub-group of the Good Practice Network (GPN), which advises the National Outbreak Control Plans Advisory Board (see Fig.3). This is a communication coordinating group for the 11 lead local authorities. The Director of Communications for Surrey County Council also sits on the weekly Local Public Services briefing with the Executive Director for Government Communications to ensure coordination of campaigns and messaging. 21 | P a g e
8.0 Data Integration
Please read this in association with sections 3.1 and 5.3
8.1 Data objectives
The available data will be used to:
• Review daily data on testing and tracing
• Identify complex outbreaks so that appropriate action can be taken in deciding whether to
convene an outbreak control team
• Track relevant actions (e.g. care home closure) if an outbreak control team is convened
• Identify epidemiological patterns in Surrey to refine our understanding of high-risk places,
locations and communities
• Provide intelligence to support quality and performance reporting to the Local Outbreak
Engagement Board
• Ensure that those who require legitimate access to the intelligence for different purposes
can do so, regardless of organisational affiliation, whilst ensuring Information Governance
(IG) and confidentiality requirements are met
8.2 Data arrangements currently in place
The assumption is that existing arrangements for notifying PHE SE Surrey and Sussex HPT about
individuals with positive COVID-19 test results via the Test and Trace service will remain.
The LRF TIAC has responsibility for ensuring the intelligence needed to support the COVID-19
response is sourced and provided in appropriate formats for different groups in the LRF. The TIAC
has core representation from the Surrey County Council Public Health team, the Clinical
Commissioning Groups (CCG), SCC Analytics and Insight with others co-opted as required. The cell
has links to the SCG cells which change as these structures change.
Surrey Heartlands ICS has mature IG co-operation arrangements including an ICS IG lead. The CCG
and SCC have set up systems with partners for recording and delivering data-sharing agreements
and data workflows.
TIAC have provided a suite of surveillance products to support the COVID-19 response to date. TIAC
reports daily on outbreaks in care homes, schools and prisons. Testing information currently
available (including testing in key workers) is being tracked by the testing cell and reported through
health service surveillance which is shared with the SCG. Updates on deaths (COVID-19 and non-
COVID-19) in different settings is shared daily with the death management and care settings cells,
with weekly summaries provided to system leaders.
Data to support these intelligence products is sourced from PHE SE HPTs, from Office for National
Statistics (ONS), the Surrey local registry office, local health and care partners, national COVID-19
reporting and latterly the Test and Trace reports provided to local authorities. The national JBC may
also provide data in the future, but this is yet to be clarified. Of relevance for this plan is daily reporting
by PHE on outbreaks in care homes, schools and prisons and the hospital onset COVID-19 reporting to
NHS-E.
22 | P a g eThe Surrey County Council Public Health team also now receive the Contact Tracing Upper Tier Local
Authorities (UTLA) report daily, the Contact Tracing Epidemiology report (weekly), and will receive the
Contact Tracing quality and monitoring report (weekly).
Using internal tools, the Surrey County Council IT and Digital department have developed an
integrated database, workflow and intelligence reporting system to provide the intelligence required
for the local programme to support vulnerable people which provides a model for the intelligence
platform
8.3 Data arrangements that need to be set up
The Joint Biosecurity Centre, which has the role of bringing together data from testing and contact
tracing, alongside other NHS and public data, will provide insight into local and national patterns of
transmission and potential high-risk locations, and identify early potential outbreaks so action can be
taken.
The resource capabilities and capacity implications for partners involved in this workstream is
dependent on the precise requirements of the end users for the intelligence platform, and the ease
and convenience of dataflows. It is anticipated that the following arrangements will need to be set
up:
• a task and finish group which will be established by and report to the TIAC, to oversee the
data integration work
• map and secure regular automated dataflows from a variety of organisations to provide the
intelligence to support our system. This includes but is not limited to data from the national
testing programme, the community testing programme (Mobile Testing Units (MTU)), and
the national contact tracing programme. It is currently unclear whether the national JBC will
provide a single source of data
• apply the Information Governance models of compliance
• establish purpose and future uses
• define data sets, ownership and rules of disclosure
• agree and define role-based access
• agree outputs of categories of data i.e. personal, pseudonymised, etc.
• define retention and closure of records
• agree information sharing protocols in a timely fashion as a matter of priority
• develop a local intelligence platform with role-based access to support the objectives
identified above in collaboration with the end users. The institutional owner of the platform
will need to be determined as part of the discussion about data flows, but the working
assumption is that this should sit with SCC
• develop insight reports to support the various governance structures
23 | P a g e9.0 Local Testing Capabilities
9.1 Testing arrangements currently in place
The LRF Testing Cell has oversight of arrangements for testing of:
• essential workers (including staff from Surrey’s local public sector agencies, national public
agencies based in or assigned to Surrey, suppliers of essential services/contractors, agency
workers, interims or consultancies directly engaged by Surrey’s public agencies, and other
organisations or businesses who are directly assigned to support the response)
• residents (including care home residents and those in group living settings such as extra care
and supported living and prisoners in Surrey prisons)
• wider resident testing as per government guidance.
Testing capacity in Surrey is comprised of a combination of local and national provision.
National testing provision is via:
• regional testing centres including those at Chessington, Gatwick, Guildford, Heathrow, and
Twickenham
• mobile testing units (MTU) which are deployed in various locations around the county for a
few days at a time
• postal/courier swab kits.
Local testing provision is via:
• acute hospitals
• in Surrey Heartlands a hybrid community testing model which until recently utilised SECAmb
as well as mobile testing units
• in Surrey Heath via the Frimley ICS, which commissions East Berkshire Primary Care (EBPC)
Ltd to manage the Farnborough Satellite Testing Centre, and to carry out mobile testing
where required. EBPC also support the national programme by offering a testing service to
care homes.
•
The main routes into testing are as follows:
• Symptomatic residents can apply via the NHS website, or by telephoning 119, to either be
tested at a regional testing site, mobile testing unit, or receive a home testing kit.
• Essential workers can be referred individually via the Surrey Testing Hub for Surrey
Heartlands (until 30 June 2020) or via the GOV.uk site, or in bulk via the GOV.uk site
• Care homes can request whole-home testing for all residents (irrespective of symptoms) and
asymptomatic staff via the GOV.uk site.
• Acute hospital patients and staff (including those who are asymptomatic, where indicated by
clinical need) can be tested in the hospital setting
• Outbreak testing – At the point of notification, PHE will request testing of symptomatic (and
sometimes asymptomatic) individuals where appropriate, in order to inform outbreak
management in various settings, including care homes, prisons and hostels.
• Where there are difficulties testing via the above routes, the local testing teams can be
contacted via syheartlandsccg.testing@nhs.net (Surrey Heartlands) and
ebpc.covid19@nhs.net (Surrey Heath, via Frimley ICS)
24 | P a g e9.2 Testing arrangements that need to be set up
Councils may need to arrange for the rapid deployment of mobile testing units to assist in the
management of a local outbreak.
Local testing capacity will continue to be expanded to accommodate the increased demand for
testing as the eligibility criteria is widened nationally, and the introduction of new technology (e.g.
antibody tests and rapid PCR tests).
In Surrey Heartlands the Memorandum of Understanding with SECAmb is due to finish at the end of
June 2020, therefore local delivery of community testing needs to be considered for the following
types of scenarios:
• Swabbing in new care home outbreaks
• People being admitted to care homes from their own house
• Cases within the homeless population
• People in domiciliary care and supported living - symptomatic and asymptomatic
• Prison single cases and outbreaks
• Looked after children/ vulnerable adults and children
• If major issues beyond initial outbreak in any setting e.g. safeguarding/multiple deaths
• Schools/special schools/ boarding schools
This plan will be updated once new arrangements are in place.
There is work in progress to establish a mechanism to allow people who are not eligible for testing
via national routes to be referred into the Surrey Heartlands community testing model.
25 | P a g e10.0 Supporting Vulnerable People
10.1 Supporting vulnerable people arrangements currently in place
The LRF Resident Welfare and Volunteer Cell has oversight of arrangements for supporting
vulnerable local people isolating in their own homes, or who are in a vulnerable group in another
setting, and who have no other means of support. The support offered is the provision of food and
medicines and/or befriending calls as required. This response is co-ordinated at county level, and the
service is usually delivered via volunteers operating at district and borough level, SCC services or the
Voluntary, Faith and Community Sector to meet the needs of people in diverse communities in the
following categories:
• Category A - Extremely clinically vulnerable people who are shielding. This currently covers
approximately 41,100 people in Surrey, and the scheme is well developed for these people
• Category B - Clinically vulnerable people (over 70s, people with specific medical conditions
and pregnant women). Our estimate is there are approx. 330,000 in this group, but fewer
than that have registered for support through this scheme
• Category C - Other vulnerable people (not at increased risk due to medical reasons) who are
at risk due to the restrictions put in place through social isolation, worsening mental or
physical health, risk of violence. It includes homeless people who need to self-isolate, people
with specific disabilities, or at-risk factors where social isolation exaggerate or worsen
illnesses or their circumstances, those who need safeguarding such as children and
vulnerable adults, traveller communities including GRT, financially vulnerable, and BAME
community.
The scheme is still maintaining oversight of specific needs that may arise and has, to date, supported
Category C people on adhoc basis, when required.
Surrey Heartlands have also worked with GP practices who are supporting their shielded patients at
home in conjunction with Surrey County Council
10.2 Supporting vulnerable people arrangements that need to be set up
It is anticipated that most people will be able to self-isolate for the maximum two-week period
without any support.
PHE have confirmed that three questions have been included in the NHS Test and Trace
questionnaires for people to self-identify as vulnerable or that they, or someone they care for, may
need support. This information will be provided to NHS Business Services Authority (BSA) who will
text people with the relevant local authority helpline details and provide links to websites that allow
them to find the numbers of their local support helplines. People requiring support will need to call
the local authority helpline, as local authorities will not be provided with a list of individuals who
have self-identified as vulnerable.
A mechanism for including people who have requested support via the helpline while they self-
isolate as a result of Test and Trace, will need to be included in the food and medicines support
scheme, where it is identified that they have no other means to get help. As people will be self-
26 | P a g eisolating for a short period of time (either 7 or 14 days), this support will need to be timely, and
flexible to support a cohort of people that will be constantly changing. A set of sharing schedules
under the existing information sharing framework between LRF partners will need to be developed
to include sharing data on those self-isolating due to COVID-19, who require support.
The LRF Resident Welfare and Volunteers Cell are looking into how to support these individuals
while addressing the challenges of:
• the unknown demand for urgent food and medical supplies that may fluctuate in scale at
any given time based on the number of outbreaks and specific setting type
• the reduced volunteer pool as many return to work and life as usual, though the volunteer
pool is still relatively large at present.
• how to factor in decommissioning of SPECTRUM (urgent11.0 Specific High-Risk Settings & Communities
Standard Operating Procedures have been/will be developed for the following settings and
communities, using the information provided in appendices 4 to 17.
This plan focuses on outbreaks in high risk settings and communities as identified in the appendices
below. Outbreaks may occur in other settings e.g. supported living, supported housing schemes,
domiciliary care; houses of multiple occupation, and the same principles will be used to manage
outbreaks in these settings.
In each appendix further work is identified to develop local protocols and processes, which will be
taken forward in task and finish groups led by Surrey County Council Public Health team members
with support from HPOG members and relevant specialists.
Appendix Setting/Community
4 Care homes (Adults)
5 Children’s Homes
6 Schools (primary and secondary), early years settings, universities/colleges and
special schools
7 Prisons and other prescribed places of detention
8 Other Workplaces including:
• Council (both Surrey County Council and District and Boroughs) owned
premises – offices/depots, libraries, leisure centres, day centres
• Private commercial premises – retail, offices, leisure service and hospitality
services (clubs, gyms, hairdressers/barbers, beauticians, pubs, restaurants,
hotels, campsites etc), indoor event venues (conference centres, theatres,
cinemas etc), outdoor event centres (racecourses, sport venues etc),
manufacturing (food, engineering etc)
• Critical national infrastructure sites
9 Major Tourist Attractions
10 Faith settings
11 Black and minority ethnic (BAME) communities
12 Homeless community
13 Gypsy, Roma and Traveller communities
14 Hospitals
15 Primary Care
16 Mental health and community trusts, and Hospices
17 UK Ports of Entry
28 | P a g eAppendix 1 - PHE South East SOP – PHE-LA Joint Management of COVID-19 Outbreaks in the SE of England 20200611 PHESE LA SOP OUTBREAKS.pdf Appendix 2 - Surrey Local Outbreak Engagement Board Terms of Reference & Membership 20200629 Surrey LOEB ToR - Final.pdf Appendix 3 - Surrey Covid-19 Health Protection Operational Group Terms of Reference & Membership Surrey HPOG Terms of Reference_Final.pdf 29 | P a g e
Appendix 4 - Care Homes (Adults)
Objective
The objective is to reduce and eliminate new cases of COVID-19 and deaths from COVID-19 in Care
Homes in Surrey.
Context:
There are 424 CQC registered care homes in Surrey, including:
• 8 Surrey County Council adult care homes
• 4 Surrey County Council Learning Disabilities care homes
The rest of the market is independent/private.
What’s already in place:
All partners within Surrey LRF Community Care Settings Cell, Testing Cell and Logistics Support
Group have worked closely with Surrey Care Association to implement a package of measures to
support care homes in Surrey, including:
• Provision of Personal Protective Equipment (PPE) supplies based on a prioritisation
framework that prioritises health and social care overnight settings
• Infection Prevention and Control (IPC) training offer to all care homes
• In the Surrey Heartlands CCG area, the training is delivered by 42 trainers/super
trainers and includes the use of PPE and practical test swabbing
• In the Surrey Heath CCG area, the training is delivered/supported by the Frimley
ICS Infection Prevention & Control Team and the care homes leads.
• Testing -
• Symptomatic staff (as essential workers) can be referred to either the national
testing programme, the Surrey Testing Hub (Surrey Heartlands area), or the
Frimley ICS system (Surrey Heath CCG area); for testing at a regional site, mobile
testing unit or to receive a home testing kit.
• Symptomatic residents are tested when PHE requests testing upon initial
notification of an outbreak
• Whole home testing can be requested via the national Care Home Portal, for
residents (irrespective of symptoms) and asymptomatic staff in all adult
registered care homes. This whole home testing is prioritised at national level to
those homes with an outbreak, those with 50 beds or more, and those identified
by Directors of Public Health.
• Clinical support is being offered with weekly check ins and clinical interactions 24/7 by a
clinical lead in identified GP practices for each care home
What else will need to be put in place:
Testing arrangements for individuals prior to a new care home admission or transfer to another
care setting (excluding hospital) still need to be put in place. A local protocol for care home
staff/residents being identified via Test and Trace will be developed to consider/address the
potential impact on the workforce.
Local outbreak scenarios and triggers:
PHE will consider the severity and spread of the outbreak, current control measures, the wider
context and will jointly consider with the local authority the need for an Outbreak Control Team
(OCT).
30 | P a g eResource capabilities and capacity implications:
Staffing
• Additional IPC training and support for care homes
• Ongoing provision of PPE until care homes can source PPE through normal supply routes
or the PPE Portal for small care homes (less than 24 beds)
Links to additional information:
Adult Social Care guidance can be found at
https://www.gov.uk/government/collections/coronavirus-covid-19-social-care-guidance and
https://www.gov.uk/apply-coronavirus-test-care-home
31 | P a g eAppendix 5 – Children’s Homes
Objective
The objective is to reduce and eliminate new cases of COVID-19 in Children’s Homes and Special
Schools (Residential) in Surrey.
Context:
In Surrey there are:
• 6 Surrey County Council Children’s Community Homes
• 2 Surrey County Council Learning Disabilities Children’s Homes
• 1 Surrey County Council Crisis Mental Health Residential Children’s Home
• 5 Surrey County Council Residential Special Schools
The rest of the market is independent/private, and semi-independent providers for children aged
16+
What’s already in place:
Partners within the Surrey LRF Community Care Settings Cell and Testing Cell have worked to put
in place measures to support Children’s Homes and Special Schools in Surrey, including:
• Provision of Personal Protective Equipment (PPE) supplies based on a prioritisation
framework that prioritises health and social care overnight settings
• Infection Prevention and Control (IPC) training offer to all Children’s Homes delivered by
42 trainers/super trainers, including training in the use of PPE and practical test swabbing.
Although the initial focus has been on adult care homes, this training will be extended to
Children’s Home settings.
• Testing -
• Symptomatic staff (as essential workers) can be referred to either the national
testing programme, the Surrey Testing Hub (Surrey Heartlands area), or the
Frimley ICS system (Surrey Heath CCG area); for testing at a regional site, mobile
testing unit or to receive a home testing kit.
• Symptomatic children are identified for testing after PHE receive initial
notification of an outbreak
• Staffing continuity has been provided for Children’s Homes
PHE have produced internal Standard Operating Procedures (SOP) for test and trace of single
cases and outbreaks in special schools (residential).
What else will need to be put in place:
We need to develop a SCC SOP which incorporates established processes and procedures to
ensure Children’s Home and Special schools’ staff, parents, Surrey County Council, and healthcare
colleagues are aware of how to access testing for symptomatic children and how to respond to an
outbreak.
PHE will continue to update internal Standard Operating Procedures (SOP) for test and trace of
single cases and outbreaks in special schools (residential).
Local outbreak scenarios and triggers:
PHE will consider the severity and spread of the outbreak, current control measures, the wider
context and will jointly consider with the local authority the need for an Outbreak Control Team
(OCT).
32 | P a g eResource capabilities and capacity implications:
Staffing
• Ongoing IPC training and support for Children’s Homes with outbreaks
• Ongoing provision of PPE until Children’s Homes can source PPE through normal supply
routes or the PPE Portal for small Children’s Homes (less than 24 beds)
Links to additional information:
• https://www.gov.uk/government/publications/coronavirus-covid-19-guidance-on-
isolation-for-residential-educational-settings/coronavirus-covid-19-guidance-on-isolation-
for-residential-educational-settings
• https://www.gov.uk/government/publications/coronavirus-covid-19-guidance-for-
childrens-social-care-services/coronavirus-covid-19-guidance-for-local-authorities-on-
childrens-social-care
33 | P a g eAppendix 6 - Schools
Including:
• Primary and secondary, early years settings, universities/colleges & special schools
Objective:
The objective is to enable all educational settings in Surrey to open fully and to identify and
eliminate all cases of COVID-19.
Context:
In Surrey there are:
• 1332 Childminders
• 574 Day nurseries/Sessional preschools/Nursery units of Independent Schools
• 299 Primary Schools
• 57 Secondary Schools
• 23 Special schools
• 110 Independent schools
• 13 Colleges
• 2 Universities
• 6 Language Schools
What’s already in place:
Most schools have been operating throughout the pandemic and have their own procedures in
place to reduce risks to staff and pupils. As schools prepare for wider opening for all pupils,
specific COVID-19 risk assessments are being undertaken to implement national guidance on
effective protective measures such as social distancing, cleaning, and infection prevention and
control.
PHE have produced internal Standard Operating Procedures (SOP) for test and trace of single
cases and outbreaks in educational settings including childminders, nurseries, special schools,
boarding schools, schools and further education colleges, and universities.
What else will need to be put in place:
PHE will continue to update internal Standard Operating Procedures (SOP) for test and trace of
single cases and outbreaks in educational settings including childminders, nurseries, special
schools, boarding schools, schools and further education colleges, and universities.
We need to develop a SCC SOP which incorporates established processes and procedures to
ensure schools, parents, Surrey CC, and healthcare colleagues are aware of how to access testing
for symptomatic people and how to respond to an outbreak.
Local outbreak scenarios and triggers:
PHE will consider the severity and spread of the outbreak, current control measures, the wider
context and will jointly consider with the local authority the need for an Outbreak Control Team
(OCT). An OCT may be required for a complex outbreak such as:
• there has been a death at the school/college
• there are a large number of vulnerable children
• there are a high number of cases
• the outbreak has been ongoing despite usual control measures
• there are concerns on the safe running of the school
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