Barnet Local Outbreak Control Plan for COVID-19 infection

Barnet COVID-19 Health Protection Board

18.09.2020

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 Barnet Health Protection Board. It is signed off by Barnet’s Chief Executive Officer, Director of Public Health, PHE Health Protection Team and Health Protection Board and published first on 30th June 2020. Health and Wellbeing Board will ratify the Plan on 23rd July. This is a live and iterative document and will be regularly updated, as further evidence emerge.

The main aim of the Plan is to:

• Build on the 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.

Guiding Principles Barnet’s Local Outbreak Control Plan 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. There 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

Further details are specified can be downloaded here.

Local Outbreak Control Plans seven areas

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ContentsGovernance• National governance• Role and responsibilities in London• Local governance • Local lockdowns

Settings • NHS Test and Trace • Prevent and Manage Outbreaks in various

settings• Surge Capacity Resource Plan

Supporting Vulnerable People • Defining vulnerable • Impact on vulnerable groups • Current process

Methods for Testing • Methods for testing • Additional Testing Capacity

Data Integration • Data Integration and Joint Biosecurity Centre• Local Data Reporting• Data reporting during an outbreak • GDPR and Data Security

Communications & Engagement• Communications Strategy• Aims of the Communications Strategy• Research• Full Communications Plan

Risk Matrix

Appendices

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5

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2 6 71 543

National governance

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Roles and Responsibilities in London

Roles and responsibilities between PHE London Corona Response Cell (LCRC) and Local Authorities in London are agreed in Joint Agreement can be downloaded here.

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Local Governance Lead: Tamara Djuretic, DPH LBB

Health and Wellbeing

Board

Borough Resilience

Forum

Covid-19 Health

Protection Board

• Chaired by Member Lead for Health and Wellbeing and include Strategic Directors, VCS, Healthwatch, DPH, CCG, GP Governing Body members, elected members. If local lock-down needs to be imposed, Leader will chair the Board;

• Political and partnership oversight of strategic response and proactive engagement with the public.

• Chaired by Chief Executive of the Council and include all Category 1 responders;

• Responsible for determining Council’s overall proactive management and emergency response, deployment of local resources and escalate need for mutual aid, if needed.

• Download the ToR here.

• Chaired by Director of Public Health and include the whole system membership including PHE, EHOs, PCN/GP, EHOs, H&S, PH;

• Oversee development of and provide assurance that there are safe, effective and well-tested Local Outbreak Plans in place to protect the health of local population during COVID – 19 pandemic.

• Download the ToR here.

Supported at a national level by Government Departments (CCS/RED), TTCE programme and Joint

Biosecurity Centre and at a regional level by Local Resilience Forums and

Integrated Care Systems (e.g., for mutual aid and escalation)

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Local Lockdowns

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COVID-19 Containment Framework: A guide for local decision makers was published on 17th July and can be accessed here . This framework sets out how national and local partners will work with the public at a local level to prevent, contain and manage outbreaks. Additional powers are given to Local Authorities to close individual premises, public outdoor spaces and specific events. This should be done only with discretion and with advice from Director of Public Health. Secretary of State would also need to be informed before any local lock-down is imposed.

The five steps for introducing a local lockdown:

✓Monitoring. PHE will work with the Joint Biosecurity Centre by looking at data on the spread of coronavirus and people's behavior across the country. They will look for emerging trends, rising cases and other indicators, while taking into account local factors.

✓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.

✓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.

✓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.

✓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 lockdown: London region phased approach to outbreak response

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The table below outlines the London region escalation framework. Key local actions are outlined in the proceeding slides. Further information on the stages of prevention, response & escalation can be found in appendices .

Epidemic Level

Borough 7-day cases per 100,000

Epidemic Phase Key epidemic measures to be considered

Wider Local Authority actions Wider Political leadership actions

1A 0 - 20 Areas requiring watching brief Testing and Contact tracing

Community outreach and supportMass media campaignsReinforce prevention messagingSupport local readiness including best-practice sharingInput into assurance of local readiness

Lead incident response and plan/implementation of actionsIncrease testing capacityMonitor and maintain test positivity <5%Trace complex cases, identify contacts, within scope of Tier 1bLead delivery of local public comms & engagement planIdentify and plan for most vulnerable

Build local outbreak readiness incl. outbreak control plansBuild local capacity and capabilityEnsure the necessary local preventative actions are enactedProactively monitor local data/analytics feedsEnsure local schools, business, care homes COVID-secureDevelop ad test proposed escalation routes and criteria

Regional Trigger point:London Regional rate >20 per 100,000

Actions: Point for cross-regional assessment on epidemic evolution and agreement of enhanced regional or national NPIs to be considered and/or requested

1B 20 - 25 Areas of national concern

All of the above plus:Increase MTU accessWiden Testing and screening optionsTargeted campaignsStrengthen CT activityCommunity Outreach

Organise and scale up MTU and testing activityReduce test positivity <5%Ensure at risk communities engagedMonitor care homes, hospitals, workplaces for outbreaks

Assure local readiness incl. capability/capacityWork with PHE, NHSTT, JBC to implement range of available interventions aDraw on stakeholders to access additional support & resourceSupport co-ordination across boundaries including sub-regions

2 25 - 50 Areas of enhanced support

All of the above plus:Reintroduce epidemic controlsClose settings driving epidemicMandatory masksRestrict social contactsRestrict religious gatherings

Scale up testing rate to >500-1000 per 100,000Manage public communicationsSupport most vulnerable communitiesConsider use of local authority powers to reduce transmission riskWork with sub-regional, regional and national partners

Drive E2E system readiness and optimise performanceProvide integrated dashboards to support local monitoringProactively monitor data and flag issues with regional and national teams

Regional Trigger point:London Regional rate >40 per 100,000

Actions: Point for cross-regional assessment on epidemic evolution and agreement of enhanced regional or national NPIs to be considered and/or requested

3 >50 Areas of intervention

All of the above plus:Consider local lockdownTarget intervention dependent upon drivers

Lead delivery of local public comms & engagement planDraw on stakeholders to access additional support & resourceSupport co-ordination across boundaries beyond a UTLA

Manage lifting/lowering of national restrictions as appropriateProvide guidance on demand to support local capacity buildParliamentary accountability for the health of the nation

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Start

Monitoring of cases/test numbers by LCRC and JBSC

Outbreak or “Area of concern” (1B – 20 to 25 cases per 100k population) confirmed by LCRC and JBSC

IMT convened by DPH and/or LCRC

Local monitoring by LBB and NHS partners

Local Outbreak Plan measures actioned relating to:Enhanced testing, Targeted and broad community engagement,Communications, Support for vulnerable people, Liaison with partners within Barnet and across boundaries.

IMT reviews potential actions relating to high risk areas (venues, events, travel etc):• Close businesses premises, • Close schools, • Close health facilities, • Close community facilities, • Close other high risk venues for transmission, • Close open air public areas, • Cancel events, • Consideration for transport impacts,• Isolation/testing/tracing of key at risk individuals

Legal framework for these actions sits with: Coronavirus Act 2020, Public Health Act (1984), Health Protection Restrictions (Coronavirus Restrictions)(England)(No. 3) Regulations 2020, Food Safety Act 1990, Food Safety & Hygiene (England) Regulations 2013, The Health Protection (LA Powers) Regulation 2010

25+ cases per 100k population:LBR identified as “Area of Enhanced Support (2)

Joint Bio-Security Centre escalationEnd

Engagement with identified organisations to develop and implement action plan

Engagement with identified individuals to request isolation/testing/tracing

and/or

Enforcement action required

Enforcement action required

Agreement to comply with requests by organisation(s)

Agreement to comply with requests by individual(s)

End

End

DPH/CPH to follow Schedule 21 of the Coronavirus Act 2020

End

Enforcement action plan drawn up by Public Health and Enforcement lead – inc’s Police / Environmental Health

Enforcement action plan signed off by CMT/BRF Gold Group

Enforcement action plan implemented via IMT with appropriate enforcement

Enforcement actions monitored via IMT

IMT recommends to revoke enforcement when appropriate

Enforcement action plan revoked by Gold CMT/BRF Group

End

Leader and Members informed

Communications agreed and actioned

Covid-19 Health Protection Board and Health & Wellbeing Board informed

Secretary of State informed(and updated every 7 days)

DPH informs Regional Support and Assurance Team and soc.incident@dhsc.gov.uk

Local Lockdowns: Protocol for implementing local powers under the Contain FrameworkLead: John Hooton, CEO and Tamara Djuretic, DPH LBB

Local Lockdowns: Protocol for implementing local powers under the Contain Framework additional notesLead: John Hooton, CEO and Tamara Djuretic, DPH LBB

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IMT Liaison with Gold

IMT convened by DPH and/or LCRC

Local outbreak plan measures actioned:• Enhanced testing• Targeted & broad community engagement• Communications• Support for vulnerable people• Liaison with partners within Barnet and across

boundaries

IMT reviews potential actions relating to high risk areas (venues, events, travel etc):• Close businesses premises, (1-5)• Close schools, (1)• Close health facilities, (3)• Close community facilities, (3)• Close other high risk venues for transmission, (3)• Close open air public areas, (3)• Cancel events, (3,6)• Consideration for transport impacts,• Isolation/testing/tracing of key at risk individuals

(2)

• CMT/BRF Gold will be informed that an IMT is being convened,• Minutes/action notes of each IMT meeting will be sent to CMT/BRF Gold members within 24 hours of

meeting,• CMT/BRF Gold will be informed of any engagement plan arising from an IMT,• CMT/BRF Gold will be informed as soon as it is agreed that an enforcement plan needs to be developed

Local Lockdowns: Protocol for implementing local powers under the Contain Framework additional notesLead: John Hooton, CEO and Tamara Djuretic, DPH LBB

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Details relating to enforcement governance

Enforcement action plan drawn up by Public Health and Enforcement inc Police/Environmental Health

• DPH will liaise with the CE, Enforcement Lead and CMT/BRF Gold during the development of the enforcement action plan to ensure there is early sight of suggested actions,

• Sign off can be achieved outside of CMT/BRF Gold Group meetings to ensure rapidity of action,

• The final decision within CMT/BRF Gold Group rests with the CE,

• CE and DPH signed letter will go to any party subject to enforcement action that this is now in place, via enforcement lead

• Leader, Chair of the HWB Board and Council members are informed that a plan is being developed and when the plan is signed off,

• IMT, Covid-19 Health Protection Board and Health and Wellbeing Board should be informed as soon as CMT/BRF Gold decision is made,

• CE office will inform Secretary of State (and provide updates at least every 7 days),

• DPH will update CMT/BRF Gold throughout the life of the IMT and enforcement action,

• DPH will provide an assurance briefing with any IMT recommendation to revoke enforcement actions,

• CE and DPH signed letter will go to any party subject to enforcement to revoke the action,

• DPH will inform all key stakeholders that action has been revoked.

Enforcement action plan signed off by CMT/BRF Gold Group

Enforcement action plan implemented via IMT with appropriate enforcement

Enforcement actions monitored via IMT

IMT recommends to revoked enforcement when appropriate

Enforcement action plan revoked by CMT/BRF Gold Group

End

Local lockdowns: Timeline for implementing local powers under the contain frameworkLead: John Hooton, CEO and Tamara Djuretic, DPH LBB

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DPH will liaise with the CE,

Enforcement Lead and

CMT/BRF Gold during the

development of the

enforcement action plan to

ensure there is early sight of

suggested actions

Enforcement action plan

drawn up by Public health

and Enforcement Lead

Minutes of meeting

circulated to all

CMT/BRF GOLD

GROUP members.

Enforcement plan signed

of by GOLD GROUP

All enforcement action under review

must be communicated back to

CMT/BRF GOLD.

Minutes of meeting circulated

to all CMT/BRF GOLD GROUP

members

Enforcement actions

monitored via IMT

Sign off can be achieved outside

of CMT/BRF Gold Group

meetings to ensure rapidity of

action,

The final decision within

CMT/BRF Gold Group rests with

the CE

Enforcement action plan

implemented via IMT with

appropriate enforcement

CE and DPH signed letter will

go to any party subject to

enforcement action that this

is now in place, via

enforcement lead,

Enforcement action plan

revoked by GOLD GROUP

IMT recommends to revoke

enforcement when appropriate

• Leader and Council members are informed that a plan is being developed and when the plan

is signed off,

• IMT, Covid-19 Health Protection Board and Health and Wellbeing Board should be informed

as soon as Gold decision is made,

• CE office will inform Secretary of State (and provide updates at least every 7 days),

• DPH will update CMT/BRF Gold throughout the life of the IMT and enforcement action,

• DPH will provide an assurance briefing with any IMT recommendation to revoke enforcement

actions,

CE and DPH signed letter

will go to any party subject

to enforcement to revoke

the action,

DPH will inform all

key stakeholders

that action has been

revoked

24 hours turned around

48 hours turned around

Local lockdowns: National governance and responsibilities

National decision-making will take place through the government’s Local Action Committee command structure, which can escalate concerns and issues to the COVID Operations Committee to engage ministers across government. Examples of additional national support include:• Increased access to testing

resources & contact tracing data• Deep dive epidemiological reports• Access to surge resources via the

JBC eg. behavioural science & project/incident management support.

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Prevent and Manage Outbreaks: NHS Test and Trace

• Contact tracing is a core public health intervention measure to stop spread of infectious disease, have been around for decades. It’s used to identify all who may have been exposed to an infectious disease to either offer a prevention (e.g. vaccine or antibiotics or immunoglobulin) or recommend quarantine (in case of COVID-19);

• Contact tracing is a specialised skill and it is used in containment phases of the pandemic to prevent sustained community infection spread;

• Anyone who is being tested positive for COVID-19 is contacted by NHS Test and Trace and asked to self-isolate and identify any contacts (being together for longer than 15 minutes within 2m distance) who would be advised to self-isolate too;

• Tier 3 – 15, 000 call handlers operated by SERCO for simple contact tracing

• Tier 2 – 3,000 NHS Health Professionals – This tier will receive a download of all COVID-19 confirmed cases and triage to Tier 3, if simple or Tier 1 if more complex. They’ll also receive referrals from the app, when operational

• Tier 1 – PHE Regional centre (PHE LCRC) – Up to 75 people - Complex outbreaks in settings (schools, prisons, health centres, care homes). Detailed process map on escalation from PHE LCRC to Local Authorities is specified in Appendix I.

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Prevent and Manage Outbreaks in various settings Lead: Senior Management LBB Public Health-Janet Djomba, Emma Waters, Rachel Wells, Julie George, Mike Koumi

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Setting Action Card Plans/Risk Assessment Tools

School and Early Years Download action card here. LCRC Documents accessible from SharePoint

Universities Download action card here.

Care Settings Download action cards for:- Care homes- Day centres- Supported living- NCL infection prevention control

support guidance

LCRC Documents accessible from SharePoint

Healthcare Settings Download action card for:- Healthcare settings- Hospitals

Workplaces Download action card here. Download- Corporate risk assessment example- Staff risk assessment form example

Prevent and Manage Outbreaks in various settings Lead: Senior Management LBB Public Health-Janet Djomba, Emma Waters, Rachel Wells, Julie George, Mike Koumi

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Setting Action Card Plans/Risk Assessment Tools

Places of Worship Download places of worship- Outbreak action card- Outbreak management for public

health teams action card- Engagement action card

Community Clusters Download action card here.

Indoor Leisure Settings Download action cards for:- Leisure centres- Libraries

Houses of Multiple Occupation Download action card here.

Preventing an outbreak linked to a town centre is critical to our local outbreak strategy. The following actions are being taken to support COVID secure reopening of town centres:

• Prior to businesses reopening on 17 June (non-essential shops), 4 July (hairdressers) or 10 July (beauty salons) enforcement officers hand delivered letters to all businesses in relation to safe reopening.

• Enforcement officers are have a presence in the main town centres as well as across the borough checking for compliance and providing advice. They will also be available to support businesses on-site in the event of an outbreak.

• Town centre community advisor volunteers are on-site promoting social distancing and safe use of our town centres.

• Our Test and Trace Communications Plan outlines our approach to communicating with residents around social distancing and face coverings.

Prevent and Manage Outbreaks: Town CentresLead: Clair Green, Director of Assurance, Declan Khan Head of Investigations and Enforcement Operations, James Armitage, Regulatory Services (RE)

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Surge Capacity Resource Plan• 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 Council Management Team the use of the £1,599,177m 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. Some resources will be used for preventative approaches, including communication strategy and engagement with local communities.

• Mutual aid plans are developed by PHE LCRC and LAs, where 75 staff are available at LCRC to manage outbreaks across London in complex settings;

• Discussions between BRFs and LRF/SCG are taking place to agree escalation points/mutual aid mechanisms and scenario testing is scheduled for beginning of July;

• Current on-call Consultants in PH rota in place 8am – 8pm, 7 days a week will be fully utilised for local outbreak investigation and contact tracing.

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Escalation criteria Setting Criteria for escalation Escalation to:

Covid-19 Health Protection Group Barnet Borough Resilience Forum

Events /gatherings (any setting ) - Death of a child Yes - immediate Yes - immediate briefing needed

- Outbreak linked to a major public building,

faith gathering or event in the borough

Yes – immediate Yes – immediate briefing needed

Schools/Childcare/Early Years - More than one case in a school/EY setting Yes Yes – routine reporting only

- Setting not able to contain outbreak Yes Yes

- 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 Yes Yes

- Cases linked to a hospital outbreak Yes Yes

Large employers - More than 6 Cases in setting Yes Yes

Housing options (e.g. Student blocks,

homelessness settings, immigration

accommodation)

- 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

Healthcare setting - Any outbreak Yes Yes – routine reporting only

Local businesses - More than 6 cases in setting Yes Yes – routine reporting only

- Setting not able to contain outbreak Yes Yes

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Supporting vulnerable people

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Barnet aims to ensure all residents are able to stay safe and protect other across our community.

We recognise that some residents require assistance in order to achieve this. For the purposes of COVID-19 outbreak management, a vulnerable person is anyone who may struggle to meet the following four key areas for outbreak control:

• Prevent the spread of infection by practising social distancing and hygiene measures• Get a test for coronavirus if they display symptoms• Help to trace others if they test positive and have been in close contact with other people• Self-isolate-for those displaying symptoms, who have been in close contact with someone who has

tested positive, and/or who has received a positive test result

Our support for vulnerable people will focus around these four areas, recognising the crucial role played by our partners across NCL and the borough, including voluntary organisations, mutual aid groups, businesses and faith groups.

Supporting vulnerable people: Impact on vulnerable groups

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Homelessness BAME Mental Health Learning Disabilities

Unpaid Carers Other Groups

Download guidance for day centres here.

An updated communications document will be available when the plan is next updated

Download action card for supported living for people with mental illness or learning disability here.

Download guidance to support people with LD or dementia to self isolate here.

Download guidance to for unpaid carers:- Same

household- Different

household

Download impact checklist for general vulnerable groups here.

To support our most high-risk groups, Barnet has developed action cards which aim to address the specific needs

of complex groups. These will be used in conjunction with setting specific action cards. Furthermore, we will be

completing the vulnerable groups, ‘Impact Checklist’ embedded below to capture the needs of diverse groups for

whom an action card has yet to be developed.

Vulnerable

group

Supporting

Documents

Support vulnerable people self-isolating: Current processLead: Jess Baines-Holmes, Assistant Director for Adults Joint Commissioning

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Throughout the pandemic Barnet has been committed to ensuring a comprehensive support system has been in

place to support vulnerable residents. Working together with our partners and voluntary sector, we will ensure that

support continues to be available. Below is a simplified version of the support system in place from August.

Resident needing to isolate is identified as vulnerable via NHS test & trace.

Vulnerable resident is required to self-isolate after being in close-contact with someone who has tested positive.

LCRC notifies LBB who support with referral to

VCS organisation if necessary.

VCS organisation to support food needs or prescription

delivery.

If mental health support required, signposted to Barnet

Wellbeing Hub.

If complex case, referral made to Barnet Prevention and

Wellbeing Service.

Step 1.

Step 2.

Step 3.

Key workers

Care settings

Residents

Residents who have symptoms access testing online or by calling 119

Key workers access priority testing through dedicated

website

Book testing via following options

Mobile testing unit Drive through

testingHome test kits

National testing should offer a 48-72 hr turnaround

Care setting access testing for symptomatic and non-symptomatic residents via a

national care home testing portal

Residents directed to testing via comms

Key workers (inc. teachers and social workers) directed to testing via comms

Care settings directed to national testing portal for that setting. Where testing

portal unavailable, NCL will provide testing kits as needed.

Methods for testingLead: Katie Wood (LBB BECC) and Hannah Logan (NCL STP)

The primary method for testing individual cases remains the national testing portal. More detailed process maps for MTU’s and key worker testing process can be found via embedded documents below.

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Download Key Worker testing process map

Download MTU process map

Additional Testing Capacity Lead: Katie Wood (LBB BECC) and Hannah Logan (NCL STP)

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LCRC identifies a situation where enhanced investigation is

required.

LA/LCRC identifies need for local testing at scale

DPH notifies MTU cell and confirms number of tests needed and day of testing

(as early as next day).

LCRC

London Borough of Barnet

MTU cellIntelligence data Notified by DPH

Yes (<30 tests

required).

Can LBB support scale of testing

required?

No (> 30 tests

required).

Setting lead or LA notifies all people who need to be

tested.

In the case of an outbreak we will need to expedite testing. Access to these tests will be determined on a case by case basis, requiring a specific request from DPH.

Standard MTU operating procedures are followed.

Testing capacity is being coordinated

at an NCL level.Download MTU process map

Data Integration and Joint Biosecurity Centre Arrangements Lead: Oliver Taylor and Brian Johnston

• Data flow for incident management and outbreak investigation with Tier 1 PHE LCRC is specified in Appendix I.

• Role of Joint Biosecurity Centre is to be clarified further during July 2020.

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Local data reporting Lead: LBB Public Health Intelligence-Brian Johnston and Oliver Taylor

Download current LBB reporting process map and view Barnet’s Weekly COVID-19 dashboard.

Confirmed COVID-19 cases (from LCRC)

• Cases by postcode• Cases by age at

onset

Test and Trace report (LA level)

• Confirmed cases in Test and Trace

• Cases completed • Total number of

contact reported • Contacts completed

Report title

Dataset/report content

s

Frequency of

reporting

Daily Daily Daily Weekly Infrequently

• Age-specific rate of cases (per

10,000)• COVID-19 cases

by MSOA

Further analyses

done

7-day moving average of cases for Barnet and

London

Daily

Reports sent to DPH Data sets in public domain

Coronavirus in the UK (HM Gov)

• Daily confirmed cases in Barnet

• Daily confirmed cases in London

• Rate of cases (per 100,000) for

London boroughs

Death registration and occurrences by local

authority (ONS)• COVID-related

death registrations by place of death

• COVID and non-COVID death

registration for Barnet

Deaths involving COVID-19 by local area and deprivation (ONS)

• COVID-related deaths by MSOA

• Age standardised death rate by

London boroughs

LBB produced reports

Cases by care setting

• List of care setting affected by Covid-

19 • Total confirmed

and suspected cases in Barnet

care settings

Current LBB reporting mechanisms are outlined in the table below.

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List of reports to the Director of Public Health

Data reporting during an outbreak

• During local outbreak, data will flow as described in Appendix I;

• Further details on all suspected cases (identified by Contact Tracing and outbreak investigation); positive cases (LCRC) and those tested via increased local testing capacity (CLCH and LCRC) will be analysed daily and reported into Incident Management Team;

• Data will be anonymised and shared on ‘need to know’ basis in order to contain further spread;

• Individual line listing of cases will not be shared beyond Director of Public Health and LCRC Named Lead.

GDPR and Data Security

• Agencies will assume they are required to adopt a proactive approach to sharing information by default, in line with the Instructions of the Secretary of State, the Statement of the Information Commissioner on COVID-19 and the Civil Contingencies Act.

• The Secretary of State has issued 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).

• These 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.

• Local data sharing agreements are being developed. The draft can be downloaded here.

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Communications and EngagementLead: Lorna Gott and Lily Barnett

A communications strategy has been developed to support the Local Outbreak Control Plans.

• It is driven by data and insight on local attitudes and behaviours, and the demographic makeup of Barnet.

• It outlines how we will provide clear, effective communications advice and guidance to Barnet residents, businesses and communities on NHS Test and Trace.

• It will be supported by a practical tool kit of communications campaign materials to support ongoing prevention messages, and reactive content to support the rapid response in the event of a local outbreak.

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Aims of the communications strategyLead: Lorna Gott and Lily Barnett

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The overall aim of the communications strategy is get people to have a test if they have symptoms, comply with self-isolation if required, and help prevent widespread local outbreaks.

More specifically we’ll aim to achieve this by:

• Raising awareness of the NHS Test and Trace service and increasing levels of testing across Barnet.

• Building trust, confidence and engagement with NHS Test and Trace across all our communities.

• Providing a rapid response in the event of local outbreaks, ensuring key stakeholders have a clear understanding of the Local Outbreak Plans.

ResearchLead: Lorna Gott and Lily Barnett

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Our campaign will respond to national insight that tells us there is:

• Low awareness of how and where to get a test

• Low symptom knowledge

• Low understanding of isolation

In London attitudes to NHS Test and Trace have been identified as follows: (GLA June 2020)

• Just 44% of Londoners say that they would know how to get a test, compared to 46% who said they would not.

• Black, Asian and Minority Ethnic (BAME) Londoners and those over the age of 65 years are least likely to say they’d know how to get a test for coronavirus.

• 35% say they know little or nothing about NHS Track and Trace, 52% a fair amount and 13% a lot.

• Younger Londoners and ethnic minorities are more likely to say they know little about the service.

Full communications plan

The full communications strategy can be found here.

This is a working document and will be developed further as we work with our communities and stakeholders to best achieve the aims.

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Risk matrix

HIGH RISK

MEDIUM RISK

STANDARD RISK

LIK

ELIH

OO

D

HIGH

LOW

• Outbreaks in care settings, hospitals, shared living, HMOs, special schools, school transport

• Places of worship such as synagogue and Middlesex University

• Lack of engagement with NHS Test and Trace and inability to contain local spread

• Outbreaks in people with substance misuse, hostels and DV refugee

• Data sharing and publishing data to engage communities

• Outbreaks in workplaces such as Colindale or Barnet House

• Outbreak in Brent Cross Shopping Centre

Appendices

• PHE LCRC Data Flow in outbreak control and management

• Incident Management Team ToR and Agenda

Setting

Care

settings

School and

Early YearsWorkplace

Health

settings

Prison/custodial

institutions

Homeless

and/or hostelCommunity cluster

London

Coronavirus

Response

Centre

response

- Receive notification from Tier 2

- Gather information and undertake a risk assessment with the setting

- Provide advice and manage cases and contacts, testing and infection control

- Provide information materials to the setting

- Recommend ongoing control measures

- Convene IMT if required

- Provide information to DsPH and advice/recommendations for ongoing support

- Communicate and coordinate with other LAs, regions, devolved administrations

and internationally as required.

- Receive notification from Tier 2

- Support Local Authority in their

risk assessment of and response

to an identified community

cluster

Local

authority

response

- Prevention work and respond to enquiries

- Support wider aspects of the response, such as support for any vulnerable contacts

who are required to self-isolate, as per London’s 6 Point Plan and national 7 themes

of outbreak management plans

- Follow-up and support the setting to continue to operate whilst managing the

outbreak, including, if required, support with infection prevention and control

measures and PPE access

- Participate in IMT if convened by LCRC

- Organise testing and Mobile Testing Unit deployment as required

- Local communications e.g. briefings for Cllrs, local press inquiries, comms with the

public

- Liaise with CCG, GPs and other healthcare providers to provide ongoing healthcare

support to setting

- Receive notification from Tier 2

- Convene IMT

- Provide support to community

which may include translated

materials, support to self-isolate,

advice and enforcement

- Liaise with the local CCG, GPs

and other healthcare providers

- Local communications (e.g. Cllr

briefing, local press inquiries,

comms with public)

Appendix I – PHE LCRC Data Flow

SINGLE CASE IN A SETTING

Hospital

hostel/homeless

services

community

clusters

Arrange IMT with

setting and

relevant

stakeholders

including

Healthcare, MoJ

or Home Office.

Info

rmat

ion

rece

ived

R

isk

asse

ssm

ent

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

or referral from Tier 2

Notifications from GP or other

healthcare settings

All positive results reported into the SGSS (second

generation surveillance system). Results flow into CTAS.

Complex case or setting identified at Tier 2 and referred

to Tier 1

Query from settings or

member of the public

re. school, workplace,

prison, hostel, care

home

Information from Local

Authority, Other

PHEregions, Devolved

Adm, International

office

Out

brea

k m

anag

emen

t

Information on case, outbreak or community cluster uploaded to HPZone (PHE case

management system)

Clinical team gather information and conduct risk assessment with the case or setting

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

IN A COMPLEX SETTING

school/educationa

l settings

care homes and

other care settings

workplaces

Arrange incident management meeting when required with setting and relevant stakeholders

including Local Authority (DPH, EHOs, adult social care, children and young persons services)

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

faith and other

settings

Clinical team provide advice and manage contacts,

testing and infection control

Clinical team provide information materials to the

setting

Clinical team recommend ongoing control measures

DPH notified

Hospital lead outbreak

response; LCRC provide

advice and support

Prison and

prescribed places

of detention

Outbreak Management

Data flows for COVID-19 cases and situations

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

care home

initial

cases referred

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

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

LCRC reports includes results from FS reports includes results from

Pillar 1 and Pillar 2 Pillar 1 ONLY (at the moment)

From LCRC From FS

Daily summary Exceedance reports

Daily Individual data

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

Line listing to all boroughs of new cases with

postcode and age

Reports to DPH in local authorities, some to wider

stakeholders

Res

ult

sA

ssim

ilati

on

REP

OR

TIN

G

PHE Daily

Surveillance reports

- Graph of age and sex distribution of total cases (pillar 1

only, from SGSS)

All postive results reported into the SGSS (second generation surveillance system)

- Number of new outbreaks of suspected or confirmed

COVID-19 in care homes for prior week and cumulative

total (from HP-Zone)

Daily new cases reported with statistical assessment of

impact on trend, localities where number of new cases

exceed expected trend are highlighted

- Number of new and cumulative cases (pillar 1 only, from

SGSS)

- List of new situations e.g. care homes created

by LCRC (from HP-Zone, gives name of

establishment, daily list)

- Number of new and cumulative cases (pillar 1

and 2, from SGSS)

- Complex cases and situations notified from

Tier 2 contact tracing

- Cumulative number of situations by type

(from HP-Zone)

- Cumulative number of confirmed and

suspected deaths of care home residents (from

HP-Zone)

Appendix II – Incident Management Team (IMT) meeting ToR and Agenda In case of an outbreak in complex setting or a community cluster outbreak, Incident Management Team Meeting may need to be convened either by PHE LCRC or LBB. Below is an attachment including ToR and proposed agenda. If LBB is convening the meeting, Director of Public Health or Consultant in Public Health with Health Protection Lead will chair the meeting.

View the terms of reference here.

Appendix III – Stages of prevention, response & escalation

Appendix III – Stages of prevention, response & escalation. London Framework for escalation and management

Notes:• Number of cases – count, rates, positivity• Are things improving? – cases trend, ranks, exceedances• Is the outbreak contained? – number of community outbreaks, location (e.g.workplace, households, care homes), MSOA data, positivity rates