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Southend-on-Sea Local Outbreak Management Plan How we will reduce and manage coronavirus outbreaks, and improve vaccination uptake.

July 2021

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Document History

Version Date Author Commentary

V1.5 08-03-2021 KR, KG First draft

V2.2 12-03-2021 KR, KG, EG Second draft

V3.1 16-03-2021 KR, KG, BP Third draft

V4.2 22-03-2021 KR, KG Fourth draft

V4.3 23-03-2021 KR, KG Fifth draft

V4.4 26-03-2021 KR,KG Sixth draft

V4.5 01-07-2021 KR, KG, SAM Seventh draft

Document Approval Name Project Role / Title RACIQ* Approver**

Ali Griffin Chief Executive A Yes

Cllr Cheryl Nevin Cabinet Member A Yes

Krishna Ramkhelawon Director of Public Health AR Yes

Bharat Pankhania Public Health Lead R

Katie Gardner Operations Manager R

Tricia D’Orsi NHS Executive Lead CQ

Aidan Rave Reg. Partnership Lead CIQ

Aliko Ahmed Reg. DPH CIQ

* Key: R - Responsible for delivery, A - Accountable, C - Consulted, I - Informed, Q - Quality Assurance. ** Denotes formal approvers of this document.

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Table of Contents 1. Southend-on-Sea Covid-19 Pandemic Management Plan (April 2021) ........................ 4

2. Introduction ................................................................................................................... 5

2.1. Background ............................................................................................................ 5

2.2. Assumptions .......................................................................................................... 6

2.3. Objectives .............................................................................................................. 6

3. Governance .................................................................................................................. 7

3.1. Context ................................................................................................................... 7

3.2. Governance Structure & Decision-making ............................................................. 9

3.3. Delivery and Operations ....................................................................................... 11

3.4. Risks and Issues .................................................................................................. 12

4. Data Integration .......................................................................................................... 13

4.1. Data sharing ......................................................................................................... 13

4.2. Surveillance ......................................................................................................... 13

4.3. Proposed Test and Trace Tier 1 escalation routes .............................................. 15

5. Operations .................................................................................................................. 17

5.1. Processes and data flows .................................................................................... 17

5.2. Management of Variants and Mutations (VAM) cases and clusters ..................... 18

5.3. Settings ................................................................................................................ 19

5.4. Local Containment and Incident Management ..................................................... 21

5.5. Standard Operating Procedures/ Flowcharts ....................................................... 21

5.6. Resource & Capacity Planning ............................................................................ 22

5.7 Contact Tracing Service ...................................................................................... 23

5.8 Local Testing ........................................................................................................ 28

5.7. Supporting Isolation ............................................................................................. 30

5.8. Supporting Vaccination ........................................................................................ 31

6. Communication and Engagement approach .............................................................. 33

6.1. Southend Approach ............................................................................................. 33

7. Key Lessons and Feedback ....................................................................................... 40

7.1. Good Practice ...................................................................................................... 40

7.2. Local & Wider Feedback ...................................................................................... 42

8. Glossary ..................................................................................................................... 48

9. Appendices ................................................................................................................. 49

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1. Southend-on-Sea Covid-19 Pandemic Management Plan Aim: to reduce the harm posed by Covid-19 to the wider health, wellbeing and economy of the people of Southend. To achieve this, we need to make plans for ongoing implementation of the following process: Track, Trace, Test, Support and Vaccinate.

Objectives: Prevention of COVID-19 virus transmission Provision of accessible testing Containment of outbreaks in all settings Support the vaccination programme Provision of effective communication & engagement with communities Reduce inequalities and support socio-economic recovery

Governance: Plan is overseen by the Health and Wellbeing Board, with political leadership from the Oversight and Engagement Board and delivered by the Health Protection Board with enhanced support from the Essex Resilience Forum

Assumptions & Enablers: Ongoing risk of outbreaks and emerging variants and mutations Supporting community resilience and continued support with public health messaging Resources will be available nationally and locally to sustain the local management &

response Delivering and sustaining the vaccination programme as an on-going preventative

activity

Prevention & Resilience

Management & Response

Recovery & Learning Review learning

Risk Management

Roles &

Responsibilities

Engagement & Communication

Enforcement

Test, Trace & Isolate

Surge testing

Outbreak control Enhanced Contact Tracing

Effective PPE

Infection Prevention &

Control Covid-Secure

environment

Continue vaccination

Working with Communities to improve wellbeing

Surveillance/ Intelligence

Economic recovery

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2. Introduction 2.1. Background On 22nd February 2021, the government announced their Roadmap to exit the national lockdown. Whilst implementing this plan, it is expected that we will be able to suppress a rise in the number of Coronavirus (SARS-CoV-2) infections. Only when the government is sure that it is safe to move from one step to the next will the final decision be made. The decision will be based on four tests:

the vaccine deployment programme continues successfully evidence shows vaccines are sufficiently effective in reducing hospitalisations and

deaths in those vaccinated infection rates do not risk a surge in hospitalisations which would put unsustainable

pressure on the NHS our assessment of the risks is not fundamentally changed by new Variants of Concern

(VOC) and Variants Under Investigation (VUI)

The aim of this strategic plan is to reduce the harm posed by Coronavirus Disease (Covid-19) to the wider health, wellbeing and economy of the people of Southend. To achieve this, we need to make plans for ongoing implementation of the following process: Track, Trace, Test, Support and Vaccinate. We aim to ensure that spread of the virus is minimised and enable our communities to continue living with COVID, whilst supporting a safe return to more normality.

All local authority in England have to develop a Local Outbreak Management Plan, led by the Director of Public Health. This should deliver effective health protection planning and response, built on resilience and learning and embedding good practice and continued engagement across a plethora of communities within Southend.

The Local Outbreak Management Plan (LOMP) is required to cover seven themes:

1. Higher-risk settings outbreak management, communities and locations such as care homes, hospitality, hospitals and schools

2. Vulnerable and underserved communities 3. Compliance and enforcement 4. Ensuring clear governance and reporting 5. Resourcing and capacity planning 6. Communications and engagement, including building community resilience 7. Data integration and information sharing

The plan reflects the approach to the end-to-end COVID-19 response including:

Dealing with enduring transmission and effective deployment of community testing; Contact tracing and working with the PHE Health Protection Team to develop an

enhanced approach to identify earlier source of infection; Support for self-isolation and promoting a Covid-secure environment; Effective public health surveillance and responsive outbreak management; Collective approach to vaccine roll-out;

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Responding to Variants of Concern (VOC) & Variants under Investigation (VUI) and surge testing.

The Variants and Mutations (VAM) Response Plan, attached in the appendices, provides a framework for Southend-on-Sea Borough Council to lead on the local response to new variants, along with partners. This includes the following elements: enhanced contact tracing, testing of contacts, targeted case finding, cluster investigations and surge testing (testing of asymptomatic individuals within a defined geographical area).

2.2. Assumptions Endemic COVID-19 COVID-19 is likely to become endemic in the UK and across the world. Not everyone will be able to have the vaccine, and some may refuse it or be unwilling to receive it. In all likelihood, annual vaccination will be required. Vaccinating the whole world will be the key public health issue of the next decade, and possibly longer. Therefore, a combination of approaches – biological, social, environment and legislative – will be needed to disrupt and prevent the transmission of the virus and enable us to live safely with COVID-19. Firstly, we will need to support the national Roadmap to exit lockdown over the next 3 months in a safe and measured manner, whilst we continue to deliver the first and second dose of the vaccine. As we continue to learn about the evolution of this virus, study the efficacy of the vaccine and prepare for the worse, this plan lays out our approach to reshape our local capability to track, test, trace and support those who are impacted for the forceable future. 2.3. Objectives This document outlines the plan for local outbreaks management of COVID-19 in Southend-on-Sea in collaboration with other partners and neighbouring local authorities. It has been developed in close collaboration with the current NHS Test and Trace Support and Assurance team and Public Health England. The key objectives of the LOMP are to protect the health of the population of Southend by:

• Preventing the spread of COVID-19 and associated disease; • Pro-active management of high-risk settings which would be complex and

problematic if an outbreak were to occur; • Early identification and proactive management of outbreaks to reduce risk to life; • Co-ordinating capabilities across partner authorities, agencies, and stakeholders; • Building trust with citizens, communities, organisations and businesses to enable

them to play their full part in keeping Southend safe and to reduce health inequalities; • Assuring the public and stakeholders that this plan is being effectively delivered; • Enable economic recovery through controlled relaxation of ‘lockdown’, underpinned

by a robust and effective infection control strategy.

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3. Governance 3.1. Context The legal context for managing outbreaks of communicable disease which present a risk to the health of the public requiring urgent investigation and management sits:

• With Public Health England under the Health and Social Care Act 2012; • With Directors of Public Health under the Health and Social Care Act 2012; • With Chief Environmental Health Officers under the Public Health (Control of

Disease) Act 1984; • With NHS Clinical Commissioning 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;

• With specific responsibilities to respond to major incidents as part of the Civil Contingencies Act 2004;

• In the context of COVID-19 there is the Coronavirus Act 2020.

This underpinning context gives Local Authorities (Public Health and Environmental Health) and Public Health England the primary responsibility for the delivery and management of public health actions to be taken in relation to outbreaks of communicable disease through the local Health Protection Partnerships (in Greater Essex, this is the Local Health Resilience Partnership). These arrangements are clarified in the 2013 guidance Health Protection in Local Government. With regards to the powers to deal with individuals, we can apply for a Part 2A Order in cases requiring examination, isolation or quarantine. The Coronavirus Act gives powers to designated Public Health Officers (in PHE), if all reasonable measures for voluntary cooperation have failed. These are for exceptional circumstances for imposing requirements on people for the purposes of screening, assessment, and possible restrictions afterwards. Please see Legislative Powers in local government for Outbreak Control in the Appendices for more details. Compliance and Enforcement Southend Borough Council will have powers to close individual premises, public outdoor places and prevent specific events – see Powers to impose restrictions on settings and members of the public. This means that the Council will no longer have to make representations to a magistrate in order to close a premise. Premises which form part of essential infrastructure will not be in scope of these powers. We will need to seek government guidance as required. These powers should be used with discretion, and under the advice and guidance of the DPH. The Health Protection Board will work closely with the Essex Resilience Forum’s Compliance and Enforcement Tactical Coordination Group (TCG), to ensure a consistent and joined up approach across Greater Essex, aimed at protecting local citizens whilst seeking to achieve compliance with both legislation and guidelines. The Council will notify the ERF of any such action to ensure effective co-ordination both strategically and operationally.

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In any event, in exercising any of these powers the Council must notify the Secretary of State as soon as reasonably practicable after the direction is given and review to ensure that the basis for the direction continues to be met, at least once every 7 days. They should NOT be applied to settings of national importance without prior consultation with the setting owner and the Regional Partnership Team, who will work with the relevant government department to determine the best course of action. Ministers have similar powers to take action against specific premises, places and events, as well as a power to direct the Council to act and to consider whether the Council’s direction is unnecessary and should be revoked. Southend-on-Sea is a popular seaside resort and with the expected rise in staycation holidays, we will expect the local tourism industry to grow this year. We are planning with partners including the Police, on the need to deploy additional resources and ensure high level of visibility both on the ground as well as through media communication in supporting compliance to the public health measures and crowd management. Enhanced plans are in place this year as part of our annual Operation Heatwave to ensure that summer activities are carried out safely across the Borough, including: Step 1 (29 March):

• Increased resources to deal with higher footfall in our parks, seafront, open spaces. • Additional toilets and first aid across all seafront • Additional marshaling of car parks • Parking suspensions on seafront parking bays and car parks as necessary • Key media message is ‘Don’t Visit Southend’ & support webinars • Continue to support with queues at takeaway premises that are open • Safety Advisory Group planning sessions for events – accepting applications now for events

later in the year and beyond 17 May and 21 June. Step 2 (12 April):

• Pavement licenses in place for hospitality outdoor areas • Identified pinch points where the highway will be used and barriered for pedestrians • Additional resources for Regulatory Services to monitor and enforcement activity • Additional Covid Ambassadors to be in place • Southend key media message changes to ‘Visit Southend Safely’ after 29 March • Refreshed town centre Covid signage and ‘welcome back’ messages

Step 3 (17 May):

• Review of Steps 1 and 2 and any amended guidance from government • Continued necessary business engagement, including webinars • Deploy additional police resource to support busier beaches

Step 4 (19 July - delayed):

• Review of Steps 2 and 3 and any amended guidance from government will influence response to Step 4

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Intelligence on any non-compliance with coronavirus restrictions is received either directly by the regulatory services teams or through direct linkage into Essex Police. Enforcement metrics are reported into the Health Protection Board and all non-pharmaceutical interventions to support compliance and engagement are also reported to the Oversight and Engagement Board. We will continue to review our approach in dealing with any new challenging situation, such as large-scale impromptu gatherings, whilst respecting human rights of expression and effective engagement to diffuse these within the powers conferred upon the local partnership. Shielded People Shielding is a set of advice and support for Clinically Extremely Vulnerable (CEV) people to help protect themselves from the risk of exposure to SARS-CoV-2. If the DPH feels it is appropriate to consider ‘Shielding’ locally, they will need to escalate this to the regional team. The reintroduction of shielding in a local area is a decision that must be taken by Ministers on the advice of the CMO. This has now been withdrawn as enough of these individuals have been fully vaccinated. 3.2. Governance Structure & Decision-making 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. The decision-making model follows the approach to civil emergencies, based on the concept of subsidiarity, which is where decisions should be taken at the lowest appropriate level, with co-ordination at the highest necessary level. At regional level, this is delegated to the Regional Partnership Team (RPT) whose role is to: provide a crucial link between local and national government, represent Whitehall working within local structures and provide a report back to

ministers, offer advice about escalating critical issues, rapidly scale up responses.

Local authorities should alert RPT in instances where they are considering that the closure of a premises is necessary to manage local outbreaks. RPT will provide advice as to whether that premise is of national significance and therefore whether the relevant government department needs to be consulted before action is taken. The LOMP has be developed and is implemented with support from the wider system and under the overall leadership of the Southend Health and Wellbeing Board. Two Southend-centric Boards were formed and will continue to operate with distinct roles and responsibilities:

• Southend Health Protection Board - Responsible for the development and implementation of the local outbreak control plan and will be led by Director of Public Health. The core membership includes the Chief Executive of the Council, Public Health

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England, the local NHS body (Southend CCG and the MSE Health & Care Partnership), The Director of Adult Social Care (DASS) and Director of Children Services (DCS).

• Outbreak Control Oversight and Engagement Board- Provides political ownership and public-facing engagement and communication for outbreak response and responsible for scrutiny and assurance. The core membership includes cross-party Councillors, including the Chair of the Health and Wellbeing Board, the Leader of the Council and the Chair of the People’s Scrutiny Committee; the Cabinet Member for Community Safety; the Chief Executive; Director of Public Health; and representatives from Southend CCG and the Essex Police and Crime Commissioner.

PHE CCDC and the Health Protection Team will continue to provide expertise in communicable disease control, epidemiology and outbreak management, while also acting as the conduit with the regional and national advice and support teams. Essex LRF Strategic Co-ordinating Group - Gold emergency planning group across Southend, Essex and Thurrock, to support, co-ordinate and partner with broad local groups to aid with the delivery of outbreak management plans. They will be required to cascade information between themselves to manage the impact of further outbreaks of COVID-19. The Southend Health Protection Board will also work with the Essex Resilience Forum to support with co-ordination across Greater Essex and for a direct link into national government.

The two new Boards will be subgroups of the Health and Wellbeing Board and have signed off the Local Outbreak Management Plan. The Terms of Reference of these Boards are included in the Appendices.

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The Chief Executive is central to the coordination and decision-making process as vice-chair of the Health Protection Board, joint chair of LRF’s Recovery Coordination Group, chair of the Southend COVID-Gold Command and a core member of the Oversight and Engagement Councillors Board. Southend COVID-Gold Command focuses on both pandemic management and recovery. The new Recovery Coordination Group will focus on recovery in terms of the reopening, economic support, skills, restoration of services and mental health support. This will feed into the Health Protection Board and Southend’s COVID-Gold group where needed.   3.3. Delivery and Operations The figure below shows what we have established to support the planning and operational management of this outbreak plan. This is reflective of the settings we are required to proactively review using both local and national data and intelligence, support with advising on infection prevention and control and in responding to any suspected and actual localised outbreak. This has been revised with a reduced number of cells in adopting a more sustainable model of delivery based on the national Outbreak Management Response Toolkit (OMRT).

The number of key operating cells have been merged, to streamline our response. The Workplace Cell has merged with the Comms and Engagement Cell in order for colleagues working in economic development and the town centre to focus on planning for the recovery. The Vulnerable People’s Cell has merged with the Supporting Self-Isolation Cell to form the ‘Enable and Support’ Cell, which will now also incorporate colleagues from enforcement who manage our Covid Ambassadors. The cells will have dedicated capacity, as part of redeployment, reprioritisation and partly funded by the national pandemic funds (COMF -

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Contain Outbreak Management Fund), and will be crucial in the ongoing support to the Health Protection Board. Mid & South Essex CCGs IPC team lead the Southend Social Care IPC service provision in close collaboration with the Public Health team. Southend CCG represent the borough in vaccination planning across the MSE system.

3.4. Risks and Issues

The effective implementation of this plan is predicated on the latest national guidance with this document remaining a dynamic plan having due regards for evolving evidence and updated legislation and national policy reviews. In principle, these are the key challenges and opportunities:

We have an ongoing review of risk assessment of our settings with relevant mitigating action as necessary. Risks and issues will be recorded and maintained via a Situation Report (Pandemic Management’s SitRep) and reviewed by the Southend’s Operations Manager through the COVID-19 Pandemic Operations Management Team and significant entries will be escalated to the Health Protection Board for further action or escalation as required. Key risks at the start of the project will be agreed by the Health Protection Board and added to the Public Health Risk Register, with proposed mitigations.

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4. Data Integration 4.1. Data sharing 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 (CCA). The Secretary of State has issued four 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 and GPs. These notices require that data is shared for purposes of COVID-19 and give health organisations and local authorities the security and confidence to share the data they need to respond to COVID-19. The data sharing permissions under the Act and the statement of the Information Commissioner all apply. Under the 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. 4.2. Surveillance

Objectives:

• To have robust timely data flows from all the local, regional and national data sources including NHS Test and Trace data, as well as new data sources such as vaccination data

• To ensure appropriate data governance and access rights are in place so information can be effectively shared with partners, enabling them to take evidence-based, targeted and focused actions

• To share identifiable data with appropriate teams for actions to prevent transmission and spread of COVID-19

• To interpret this data to provide an analysis of where and how the infection is affecting our communities and to provide early warning signals of emerging trends, complex outbreaks and future scenarios.

• To develop new surveillance techniques especially around backward contact tracing and NHS-app data.

Current and New Processes and Responsibilities Current responsibilities The surveillance cell undertakes a meaningful daily data review of COVID-19, and wider data that is rapidly communicated across the system through primarily via daily Programme Team meetings. Weekly in-depth analysis is provided for cell leads and Southend’s Health Protection Board which include longer term strategic direction. Identifiable data is shared daily with the cells for education, care homes, health settings, workplaces and HMOs for action to prevent further Covid-19 transmission. New responsibilities Finding new ways of identifying and interrupting transmission chains, using both soft and hard intelligence. Surveillance analytics to inform backward contact tracing. Who is involved in this activity? Richard Warren – Operational Performance & Intelligence Tom Dowler – Group Manager - Operational Performance & Intelligence Krishna Ramkhelawon – Director of Public Health Smita Kapadia – Consultant in Communicable Disease control

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Inequalities - Case Count

This presents a general picture of how inequalities are distributed across Southend

Data sharing with local agencies is shared based on need and sensitivities. Key partner agencies receive data via the Health Protection Board, although we need to improve our access to local Police and Hospital data. Daily data reviews and analytical work are undertaken under the direction of the Pandemic Management’s Consultant in Communicable Disease and the DPH. Deep-dive analysis is also undertaken by the Data and Intelligence Cell and independent additional public health intelligence capacity is brought in as and when required (e.g. in the review of excess deaths in care homes). A number of key areas are being monitored:

• Change in trends and variation in any defined population groups • Identifying outbreaks and risk to ensure a swift response • Cases in high risk settings such as workplaces, schools, care homes and health

settings • Enhanced contact tracing surveillance using common exposure and postcode

coincidence reports • Burden of COVID in relation to hospitalisation, mortality, daily infection rate and R

rate • Specific areas such as excess mortality in care homes, infection level across wards

and more disadvantaged communities, explore the outputs of IMTs • The prevalence of different variants across Southend • Vaccine uptake by geography, age and ethnicity • Testing rates over time and where testing is most prevalent • Waste water analysis to identify levels of the virus in the community • Google Mobility Data, showing movement of population and general locations that

they are visiting • NHS 111 Covid-related interactions • NHS QR code venue alerts • Hospital admissions / episodes • Although vaccine data is shared for small areas and particular demographics,

identifiable vaccine data is not available. This would allow analysis of whether cases are prevalent for this group. Access to data on non-vaccinated individuals would enable specific targeting

Data sharing with local agencies is shared based on need and sensitivities. Key partner agencies receive data via the Health Protection Board, although we need to improve our access to local Police data on enforcement.

Change in trends will be monitored in line with our local knowledge and experience, but also with respect to the EoE’s five-level alert framework which is provided below.

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4.3. Proposed Test and Trace Tier 1 escalation routes We continue to work to improve our understanding of the data flows and management processes. This includes:

• Data types and format • Intended Information Governance guidelines and compliance requirements • Frequency • Feedback reporting

PHE information sharing proposal

• Outbreaks and complex situations – shared through local health protection systems and their existing systems;

• Vulnerable people and others who self-identify as needing support – three questions included on web-tool to allow people to self-identify as vulnerable or think that they need support;

• Daily activity reports – propose to share information with each LA on the number of cases and contacts reported daily in their area;

• Weekly epidemiology and performance reports – detailed draft reports have been developed for local areas. Propose to provide at UTLA level or possibly SOA.

Information flow & management processes National infection service is expected to flag potential issues, clusters and general epidemiological findings. Southend Public Health Intelligence team provides interpretation and deeper local insight and analysis. Hospital and police data need to be shared with the Local Authority to improve contact tracing and ensure our DPIA data flows allow for this. Local flow shown below:

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5. Operations 5.1. Processes and data flows Outbreak control processes in Southend are integrated with the strategic regional outbreak control approach for the East of England. The DPH is responsible for the outbreak

management plan and its implementation supported by Public Health England. PHE’s HPT provide access to specialised public health advice and support, often leading on complex outbreak investigation and management. This will be through the implementation of a three-tier model. Escalation routes and criteria between the three tiers have been defined and these are detailed in section 5.5. The Plan will address the roles required for staff in Tier 1b of this model.

Local processes for Southend High level process A common high-level process (shown below) will be used in the management of local outbreaks in Southend. This process will ensure consistency in approach, and appropriate quality control and governance measures can be applied. Where settings require specific outbreak control plans these will be informed by the common high-level process outlined here. The common Memorandum of Understanding in the appendices section, in collaboration with PHE, covers the following settings:

• Schools & Educational settings • Care homes • Workplaces • Healthcare settings • Vulnerable and Underserved communities • High-risk settings or communities • Larger events, especially as we are a coastal town

Public Health England

Standard Operating Procedures & Track & Trace ScriptsPublic Health England Central Co-ordinating Function

Tier 3: National Contract Tracing provided by external provider.Providing communication & provision of advice to contacts according

to SOPs and scripts.Difficult issues escalated to Tier 2

Tier 2: National Contact Tracing provided by NHSPProviding interview of cases & identification of contacts.

Respond to Tier 3 escalations.Complex issues escalated to Tier 1

Tier 1b: Local network provided in-county, lead by local Director of PH.

Providing response to local complex issues & outbreaks and providing local preventative

support, advice & guidance. Respond to Tier 2 escalations. Provide liaison between national programme and local areas

Tier 1a: Contact Tracing provided by NHSPs. Development of guidance, protocols and clinical governance. HPTs, Field Service,

Border health, tracing of flights and large scale events.

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High level outbreak control process for Essex & Southend

5.2. Management of Variants and Mutations (VAM) cases and clusters

Southend has developed a VAM Response Plan which describes how we will deliver additional targeted testing and enhanced contact tracing. Additional testing will be delivered under direction of the DHSC in specific identified areas, at postcode level, following the discovery of new COVID-19 VAM.

The process for managing our response to VAM cases is outlined in the VAM Response Plan, located in the appendices.

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5.3. Settings This is a summary of our approach to preventing and managing any local outbreak across the seven main settings. We will need to ensure we deal with enduring transmission: Through proactive work with workplaces and vulnerable settings (IPC training, raising

awareness of vaccination) Enhanced use of surveillance information to detect incidents and outbreaks early and

working collaboratively with HPT/PHE. This includes management of VAM cases and clusters.

Work on improving vaccination coverage rates among BAME and marginalised communities and social care staff.

Care settings (including homes for people with learning disabilities and in mental health care, domiciliary, extra care, residential living, day care, children’s homes and care homes) - All of Southend’s care providers are being supported with infection control guidance and training as appropriate. Part of our local surveillance and engagement includes a review of effective and regular testing and issues of vaccine hesitancy. We have been working collaboratively with East of England and in line with the Memorandum of Understanding to establish processes to manage outbreaks and reduce financial burden. Collaborative working across the partnerships is important to ensure the care market is working collectively and is responsive in a crisis. Please see our appendices to read our Case Study – Care Setting Sector Learning from Covid-19. Schools and Educational settings - Detailed guidance with a PHE-agreed flowchart has been issued to all schools and early years’ settings. We are holding regular webinars for school leaders with Director of Education and Early Years and DPH. Maintaining an open engagement with public health will support local surveillance, help early intervention and mitigate impact on schools and the wider community. Please see our appendices to read our Case study – Early learning in School Outbreak and Risk Assessment. Continued communications with all schools and parents from the DPH and Director of Education will reinforce infection control measures and Government guidance at the time, including continued emphasis on home testing. Mitigation by all settings is driven by the setting’s risk assessment, which will continue to be updated in light of the wider return to schools. Only as a last resort, and through consultation and agreement with PHE will partial or full closure be considered. Healthcare Settings - The CCG Infection Prevention and Control (IPC) team and Primary care team follow up COVID outbreaks in NHS organisations, ensuring appropriate processes are followed to control outbreaks identified and prevent future outbreaks. Updates are subsequently provided to the health settings cell to report into the health protection board. All providers of healthcare to NHS patients have IPC policies and guidance which mirror those produced nationally. Compliance monitoring processes are in place. Surveillance systems identify possible infection transmission which is investigated. If outbreak is suspected this is reported to NHS England regional team and to the CCG.

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Incident management Teams are stood up with representation from CCG specialist team and PHE Health Protection Consultant. Workplaces (including retail businesses) – Networking is being developed as new guidance on easing of restrictions is progressing. Advice and support is provided in line with national guidance to businesses and workplaces through a variety of communication methods. Business risk assessments and safety measures will be reviewed, as necessary, to ensure they adhere to current government guidelines. Communication channels are established to disseminate essential alerts for outbreaks effectively as needed for the protection of public health. Regular open webinars led by the Oversight and Engagement Board and the DPH, are in place to provide advice and ensure continued two-way dialogue with businesses and workplaces to maintain safety and ensure that they are supported with complying with national legislation and guidelines. The government is publishing action cards to help businesses and other organisations work effectively with their local public health teams to manage an outbreak. These will be continuously updated as we learn about the most effective ways of dealing with outbreaks. We are working with Public Health England and DHSC to ensure that venues, their customers and staff are alerted via the NHS App or Text Message when they have been in contact with a positive case. Vulnerable & Underserved Communities – this will cover a wide range of areas and we have delineated our efforts to the following (1) Sheltered housing/ hostels (2) BAME residents (3) Gypsies and travelers (4) People who are homeless (5) People who are shielding (6) People with learning disabilities and (7) People living with long COVID (8) Refugees & No recourse to public funds (NRPF) (9) Vunerable under 60s, (10) Sex workers (11) People who suffer with Drugs and Alcohol dependency (12) Prison releases (13) HMOs. We are building on existing support mechanism across these areas to maximise engagement with staff working in these settings and how we actively engage with these more vulnerable people. Where relevant welfare assessments will be undertaken and information and guidance provided in the relevant format to ease engagement. Wider high risk locations & communities – This will include transport linkage (e.g. taxi drivers, rail services), the seafront, public places (e.g. leisure centres, libraries), place of faith gatherings and food premises. We are working on a detailed approach to establish more robust preventative measures appropriate to the setting. C2C train provider will regularly share their covid-secure management plan. Promoting many of the measures introduced during lockdown such as contactless payment, PPE use and social distancing are key to mitigate any list of local spread of the virus. A more innovative approach to our prevention campaign is essential, such as using hyper-local digital sites and direct communication with younger age groups, to ensure people continue to take responsibility for their behaviour. Events including Southend United Football Club - Southend is a destination town which usually hosts large number of events throughout the year, this includes those both on private and Council owned land. Southend has a comprehensive events application process, and where an event requires the input from the Southend Safety Advisory Group a multi-agency

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approach will be taken, including the event organisers, Essex Police, Environmental Health, Highways, Essex County Fire and Rescue, East of England Amb. Service, the Emergency Planner, the Coastguard and other interested parties, including the landowner where appropriate. Guidance provided by government will be taken into account, and all aspects of the plans will be reviewed for those visiting and working at an event. Webinars and direct communications will be made with Event organisers to signpost them to risk assessments and controls that they can put in place to manage their event in a COVID-secure way. The Southend United Football Club has been operating to EFL (English Football League) rules with respect to operating throughout the pandemic. As spectators are invited back into the stadium we will work with the Safety Advisory Group for Southend United Football Club, which co-ordinates internal and external partners. This multi-agency advisory group will review all aspects of spectator safety and undertake match day inspections to ensure the clubs safety plans are property implemented. 5.4. Local Containment and Incident Management All local suspected outbreaks will be investigated by the Director of Public Health through the Public Health Intelligence and Data Cell and with specialist expertise from the PHE Health Protection Team (HPT). Where these are small and contained, such as in a year group in one school, we will utilise PHE’s operating procedure for responding to Incident Management which is part of business as usual. Where a suspected outbreak is multi-faceted, we will utilise PHE’s operating procedure alongside our locally developed Incident Management Team Agenda (IMT) template, which was produced following our local table-top exercise. This will facilitate the wider team engagement and help direct resources more effectively in containing a complex outbreak. An IMT Process Flow is attached in the appendices, outlining the process of convening IMT’s. 5.5. Standard Operating Procedures/ Flowcharts A new overarching Memorandum of Understanding was developed between PHE and Local Authorities and was formally signed off at the end of March 2021. This document details how the system operates, and defines who does what when there is a suspected case. It provides clarity to all involved in a single consolidated document that can be applied to all settings, outlining the procedures for how we will respond to a suspected case in any setting. Until this is signed off, we will follow the Standard Operating procedures provided by PHE for each of the following settings, now in operation:

Care Settings Educational & Early Years Settings Workplaces NHS Hospital Settings Socially Vulnerable

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Other SOPs will be developed as required and these will all be reviewed regularly, following good practice, to improve how we respond collectively. 5.6. Resource & Capacity Planning Resources TTS Support Grant & Contain Outbreak Management Fund (COMF) - Local authorities across England will receive national funding to support the development and action plans to reduce the spread of coronavirus in their area, for 2021-22. This resource will enable Southend-on-Sea, to retain a local service, support some additional capacity and continue to upskill communities. Much upskilling has taken place across the system and we are regularly reviewing the demands of the programme to adjust our staffing model accordingly. We are having capacity planning sessions in order to deploy resources effectively across the system, with a view that most of the pandemic management will be delivered with the minimal COMF. Key areas where we will need COMF resourcing include: Public Health capacity for Communicable Disease Control; Contact Tracing service to manage higher risk areas, plus digital; LFD testing capacity; Communications and social marketing; Community support capacity for those who may need to isolate; Some supplementary redeployment of skilled staff locally; Compliance and enforcement such additional COVID Ambassadors.

This plan will be reviewed at intervals by the Health Protection Board to ensure it is being deployed optimally in managing testing capacity, effective contact tracing, suspected outbreaks and in delivering the communication and engagement strategy – which is also supporting the NHS-led vaccination programme. A detailed costing will be agreed via the Southend COVID-Gold Command. Additionally, if we face a surge after exiting the lockdown and into the winter, additional funding may be required to fund the need for safe discharge planning of recovering COVID patients. Test and Trace Support Payment scheme is to be extended until 30 June. The eligibility criteria have expanded to allow one parent or guardian to be paid if they have to take time off work to care for a child who is self-isolating (where the parent or guardian isn’t required to self-isolate). Funding available to English councils for discretionary payments is also increasing to £20 million per month through to the end of June. The department have organised a call for councils on Friday morning to talk through these changes in more detail. Southend Emergency fund is a central fund set up by Shared Space to support residents and community groups across the town who are or have been impacted by Covid-19. So far, they have raised £219,000 and SBC have so far invested £25,000 in In Year Grants, £30,000 for Clinically Extremely Vulnerable and £52,000 in the Winter Covid Grant so over

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£100,000 in the past year. The Southend Emergency Fund has been instrumental in getting funding out quickly to community groups to support our residents in need. Local NHS & Social Care Capacity This element of capacity planning is led by the Mid & South Essex CCGs with NHS England. The NHS leads on capacity planning for health in particular. The governance arrangements include health representation on Southend’s Health Protection Board. Emergency and response plans are discussed based on joint scenario planning and further development will be initiated as part of the Winter Planning cycle with strategic alignment of COVID-19 vaccination with the flu vaccination programme. Please see appendices for the draft Local NHS and Social Care restoration governance structure. The Essex LRF has an Excess Death Management (EDM) plan, which has been tested in the past 12 months and will readily be implemented as and when required in the system. The EDM Tactical Co-ordination Group (EDM TCG) will provide a monitoring function who will collate data and intelligence regarding the trajectory of the Pandemic. They will provide reporting to the Tactical Leads to assist decision making when considering the need to implement a PMART (Pandemic Multi-Agency Response Team) response. The Essex LRF also declared a major incident in December 2020, based on the critical demand on the NHS and the heightened demand on Social Care. This led to enhanced and swift collaboration and escalation in bed management, to allow the hospital to free beds safely. The Council has the ability to set up additional dedicated beds and this will need to be funded externally. We have also reviewed other social care provision, such as domiciliary care, supported living, day centres, etc, to ensure the right level of support in in place. Looking forward to subsequent phases of the pandemic, we must consider the impact that Covid-19 has had on mental health in our workforce and in the wider community. Conditions such as Long Covid, PTSD, anxiety, agoraphobia, OCD and other mental health conditions that have been aggravated or brought on by the pandemic will need to be considered in future commissioning cycles and capacity planning. 5.7 Contact Tracing Service The current joint service for the Essex and Southend Contact Tracing Service is being reviewed in line with changes nationally both in terms of Test and Trace as well as changes to the management of cases. Below is a description of how our contact tracing service currently operates. Essex and Southend Contact Tracing Service (ESCTS) ESCTS operates weekdays 8am - 8pm and weekends 10-4 pm and is structured on a shift basis with a complementary mixture of staff. The operation is further enhanced with support from Environmental Health Officers from Southend-on-Sea Borough Council, who lead on

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local investigations of incidents and a number of external providers to support contact tracing amongst vulnerable groups. Additionally, the response includes input from existing SBC staff including 3 public health data analysts, our public health consultant, a project manager and the DPH, with specialist support from PHE’s HPT. Contact Tracing within Essex has evolved over the last nine months. Initially it was solely as part of local outbreak management but then expanded to provide support to the national Test & Trace team picking up cases they were unable to contact, as part of the move towards Local Contact Tracing Partnerships. Both elements of contact tracing incorporate support from Southend’s EHO team where local level data and intelligence can be vital.

In addition to the above arrangements with ESCTS, the intelligence team in Southend triangulate date from a large number of sources which when overlaid with local contact tracing information drives areas of focus. The intelligence team identifies high risk settings enabling the Authority to undertake early interventions, including deep dives into area of particular focus, be that backwards contact tracing or gaining an understanding from positive cases or contacts about setting that they have attended or worked at. Liaison with other teams within the organisation, or external partners, is always key to gaining further insight or leading to further investigations which may reveal issues that need to be addressed. There are arrangements in place for Southend to respond to cases referred by HPT and ESCTS and those identified as uncontactable through the National and ESCTS process. Contact tracing as a skill has been developed since the initial Outbreak Plan and contact tracing of positive cases currently has a combined success rate of 90%. Below outlines the complete process from Southend’s perspective.

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Links with Region, DHSC and PHE Of crucial importance to the past and ongoing success of any local endeavours has been the positive, supportive and facilitative relations with Region, DHSC and PHE. This has been demonstrated daily by the strong operational support from HPA consultant support as well as the fast, reactive and positive support from DHSC and Regional colleagues around access to testing facilities and developments. Southend and its people have benefitted hugely from this approach and would wish to see close partnership working develop further in the future. The role of PHE Health Protection Team includes:

1. Collect basic information on cases, incidents and outbreaks reported to the HPT. 2. Provide initial infection control advice to the setting. 3. Inform the LA of the case(s)/ incident/ outbreak/ issue reported to the HPT. 4. Hand over the responsibility for managing the incident/issue to the LA, except

incidents in GPs, dental practices and private healthcare. 5. Provide health protection expert advice to the Incident Management Team (IMT). 6. Provide ongoing support to the LA for identification and management of clusters

and outbreaks, including Surveillance meetings. 7. Notify the LA of a case of VAM. Inform LA of cases who have not engaged with

the HPT after 24 hours of initial contact. Discuss the need for surge testing and an IMT.

8. Provide advice on the interpretation and implementation of national guidance.

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Settings – Outbreak Management (Responding to an outbreak of >=2 linked cases) Identifying and isolating individuals at significant risk of infection from a setting can reduce the risk of an outbreak developing. The contact tracing team works alongside a setting to identify close contacts, breaches in control measures and errors in a workplace risk assessment to reduce the risk of transmission across the setting. There is a joint responsibility between the PHE Health Protection team and the Essex & Southend Contact Tracing Team to provide this support and outbreak management. Cases associated with workplace and education settings will be directed to ESCTS through a number of different routes, including from the setting directly. Where necessary a situation will be escalated to a Consultant in Public Health (CPH) for discussion on next actions and ongoing management of the situation. If appropriate and agreed by the CPH, an Incident Management Team (IMT) will be called to review the case data, risk assessment, and gather guidance and support from many system partners. The setting will receive ongoing support from the contact tracing service or Southend Environmental Health Officers for the duration of the outbreak or at any point where additional help is required. All outbreaks are managed by a Team Lead or a settings contact tracer with oversight and support from the Operational Lead.

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Agreed MOUs with PHE exist to ensure all parts of the system understand their role in the management of outbreaks. Terms of reference are also in place for IMT’s. Next steps: Southend would like to be able to influence the outcome of more of the positive case calls by receiving cases sooner. ESCTS has requested to be part of the Local 0 initiative and has also put itself forward to become an Early Adopter for the new ITS system which should have a positive impact on Southend case completion rates and reduce follow-up delays. Furthermore, we are exploring the option of developing our own Southend-specific contact tracing service to enable us to respond more rapidly to new cases in the Borough and use our local knowledge to make effective interventions and follow-up on these. Our current contract with Provide (ESCTS) comes to an end in September 2021 and more work will happen over the coming weeks to complete an options appraisal and a cost-benefit analysis, ensuring that staff capacity, training, IT systems, ITS rollout and timescales are considered and risk assessed before coming to a conclusion. We are looking at improving our current model where we have a pool of in-house members of staff who can be seekers and contract tracers, with relevant training. Please see our Case Study – Seekers team. These individuals can be deployed to a range of functions, such as door knocking and surge testing, to ensure that we are prepared for a third wave and have enough flexibility and availability in our system to enable us to respond. With regards to EHO deployment, we have agreed out-of-hours arrangements which cover Southend boundaries, to support any unexpected surges and build more resilience across South East Essex local authorities. The process we would be looking at as part of a Southend-specific contact tracing service is drafted below:

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5.8 Local Testing Symptomatic (LTS): Most of the testing for those who have symptoms of covid-19 will be done through the national testing PCR sites, booked either through the NHS website or calling NHS 119. The options will be to go to a drive-through test centre, attend a walk-through LTS, or have a test delivered to be taken at home and returned/posted. There are drive-through test centres operating as mobile testing units (MTUs) and are strategically located at Southend Airport (this is shared with Essex and Thurrock) and Hamlet Court Road. The list of dates and sites is available on the Council website. Asymptomatic (ATS): SBC were quick to set up 3 ATS over the course of January with our first ATS open on 4th January. These were closed in May due to the wide availability of home testing kits across the Borough in almost all pharmacies and libraries. We have been working with local businesses to facilitate access to PCR testing and support any local outbreaks where required, sometimes with the use of PCR testing kits. Schools are instrumental in supporting staff and secondary pupils by distributing LFD home testing kits. We also set up 3 mobile testing units and a fourth ATS specifically for school pupils and their families to provide testing for the return to school in March 2021. We will

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also support and provide guidance to Care homes where they are unable to provide LFD testing on site for visitors. In March 2021 we have set up a pop up weekend testing site in one of our local parks which was receiving a high number of visitors on sunny weekends to try and encourage those who wouldn’t normally go to a testing centre to get a test. We deployed marshals to talk to people using the park and encourage them to use the testing site. Please see below a map of our Local Testing Sites.

Daily contact testing: Southend has now implemented DCT for workplaces, under the guidance of the DPH operating under a regional framework (agreed in June 2021). Hospital sites: Testing of patients admitted to hospital or attending the emergency department is arranged by the hospitals. Hospitals will also test patients being discharged in to care homes even if they are not symptomatic. Unplanned and equity: We worked with the voluntary sector to arrange PCR testing for rough sleepers, sex workers, people with No Recourse to Public Funds, Refugees, and offer tests in sexual health clinics. There will be situations in which these arrangements are inadequate. For example, a person in temporary accommodation without a phone, internet access or transport. For these rare occasions we can employ Commisceo Primary Care Solutions. This will be undertaken through the service currently commissioned by the NHS. The DHSC’s Strategic Reserve can be deployed in support of local outbreaks when requested by the Director of Public Health to provide surge capacity, e.g. to deal with any Variant of Concern (VOC). This will need to be agreed. Next steps:

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We will need to maintain a flexible approach to respond to peaks and troughs going forward. We made ensured that our current arrangements can be easily adapted and expanded upon according to demand and need. We are not tied into long-term inflexible arrangements and have tried to use Council-owned assets where possible so that sites can remain in place for the rest of the year if needed, and become well-known and familiar to the public. The Community Collect initiative represents a way for us to move the testing offer from emergency response into business as usual as there is an opportunity to do this with relatively low effort in the long-term. For this reason, we have chosen to set up collection sites at our libraries and the plan is that these will have a minimal impact on normal proceedings. Going forward, we will be monitoring closely the registration metrics of home-testing kits to see whether people will in fact register home test kits in practice. An emergency response to testing will need to be available to step in at any moment, and our good relationship with St. John’s Ambulance and their offer of providing mobile testing units to support us during the return of schools should remain on offer to support surge testing and other initiatives. A potential reduction in availability of PCR testing sites will be managed by including PCR test kits in the offer at the test collection sites if needed for surge testing, or using our team of seekers to drop test kits at individual homes if people are self-isolating or shielding. Different hours could be considered for offering different tests so that symptomatic and asymptomatic individuals are not visiting during the same time slots. Our focus will be on creating simple messaging to encourage take-up of testing and we plan to continue to offer onsite testing in order to monitor the spread of the virus and ensure that access to testing is equitable. We would welcome national guidance that enables us to create this simple messaging for all testing audiences. 5.7. Supporting Isolation Activity has focused on providing those who need to isolate with effective support and guidance of how best to support themselves during a period of isolation (including financial support/guidance around sick pay), including, where appropriate, directing to local support services such as the Southend Coronavirus Action Line and Good Neighbours scheme for example. The Southend Coronavirus Action Helpline provides advice and information to the public and professionals, including: referrals to support available for people needing to self-isolate, such as assistance with food, medicines or financial supports available; information relating to testing and vaccinations; and advice to businesses and schools. The Council continues to work very closely with local community, voluntary and faith organisations as part of its community resilience work, including funding a grant making body to ensure there is sufficient capacity to support for vulnerable people in all parts of our community to self-isolate as required. This work will remain in place at least throughout the period of the roadmap.

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It is a legal requirement to self-isolate if someone test positive or are told to self-isolate by NHS Test and Trace or people arrive in the UK from a country with a high coronavirus risk. Compliance with this requirement is difficult to verify and is happening more often, principally because of the economic impact on the individuals concerned.

A recent local review of claims has shown that the vast majority of these are rejected (2,086 applications – 19% approved; 68% refused). The information synthesis covered October 2020 to February 2021. Almost half of the claimants (47%) did not provide the stipulated information, with another 25% deemed not be eligible as there was no proof of actual loss of income. Discarding any potential fraudulent claims, this level of refusal could be a challenge in influencing those who are contacts or positive cases to remain in self-isolation. More engagement is required to support claimants and in managing the self-isolation process, to reduce the risk of workplace or community transmission.

More engagement is planned as we need people to fully understand the criteria before they claim, and to be willing to provide supporting evidence (bank statements, self-employment details). For example, you are not entitled if you have no loss of earnings. We need to improve people’s awareness of the basic criteria and the evidence that is needed in order to qualify for an award in all communication with them. This message could be made more explicitly at all stages of testing and contact. Locally, we are reviewing the website and claim form, as well as the ways we contact applicants. 5.8. Supporting Vaccination Each of our Primary Care Networks were able to identify and set up a Local Vaccination Sites, train staff and develop new processes and procedures in a very short space of time in order to ensure that the vaccination programme began through December and January. By the second week of January there were 5 Local Vaccination Sites across Southend. Supplies of vaccine have been intermittent with often less than a week’s notice as to the time and size of the next delivery. Despite this the sites have continued to operate efficiently with all vaccine delivered being used in the same week. This has been as a result of fantastic collaboration between GP practices, Southend Clinical Commissioning Group, the local council, the voluntary sector and Essex Partnership University NHS Foundation Trust (EPUT).

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These sites have followed the national guidance in order to vaccinate the most vulnerable in our population, including care home residents and staff, front line NHS and social care workers and more recently have provided sessions to ensure local rough sleepers have been vaccinated as well as a session that was delivered at a local mosque. Once the Local Vaccination Sites were established EPUT also opened up some larger scale Vaccination Centres that have enabled wider patient choice and enabled greater coverage of our population. Staff involved in vaccinating at all of the sites, whether clinical or non-clinical, have undergone much training, are working different shift patterns in different environments in order to deliver this vaccination programme and their commitment and endeavours should be recognised. We are making best use of the case studies and resources on COVID-19 behaviours including vaccine hesitancy. We have already been applying some of these with support from our Communication and Engagement Cell. Much of our communication and engagement work at the moment is focused on addressing vaccine hesitancy and those cohorts/population groups where uptake is poorest based on local data and intelligence. We are actively looking for ways to increase uptake, especially in care settings, and make vaccinations accessible for everyone in Southend, including vulnerable groups. Southend were the first area to roll out the vaccination programme to the Homeless community we have successfully administered the vaccine to 109 individuals in conjunction with local charity HARP, including to women in prostitution. We are working to make vaccination more accessible to the BAME community as well and have opened a pop-up Vaccination Clinic at West Road Westcliff Mosque and have been discussing holding a Twilight Clinic during Ramadan. We are also holding a Covid Conversation specifically aimed at BAME communities, and will hear from BAME clinicians on the vaccine, testing and how to find reliable information. To maximise the impact and minimise the risk of an upsurge in cases, on the ongoing vaccination campaign, we need to continue with a clear, consistent communication to the public about the need to remain vigilant, observe the guidance and not become complacent. ‘Hands-Face-Space’ is still the mantra.

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6. Communication and Engagement approach There is lots of national information and resources to promote the NHS Test and Trace scheme nationally and to support local authorities to communicate with residents about testing, the importance of self-isolation especially after travelling from high-risk countries with new variants and improving vaccination uptake. We are using that content, and will localise it where needed, and then share and communicate through relevant channels and methods. Of vital importance is the principle that we are using the data available to us to identify communities we need to target (both geographical, demographic etc), and how best to tailor this messaging. This insight will be crucial to ensure we are targeting where we are seeing emerging issues and areas that are not adhering to social distancing measures, where we might need to increase testing rates or tackle issues such as vaccine hesitancy. The Get Tested local campaign is a good example of where we have used local content and a variety of channels to promote and encourage community testing across a variety of audiences. 6.1. Southend Approach The Covid-19 Community Engagement and Communications Cell is one of the Southend Pandemic Management Cells that has been established to deliver operational management and response to the current Covid-19 pandemic. The Cell’s primary purpose is to ensure that accurate Covid-19 information is communicated to Southend residents and to community organisations. Residents and partners are encouraged to provide feedback and they are mobilised to support efforts to keep everyone safe. The Cell includes representation from: Southend Association of Voluntary Services (SAVS - including Cell Lead); NHS Clinical Commissioning Group; Southend-on-Sea Borough Council (including Communications representation; Public Health representation; and Engagement and Participation representation); and other invited organisations such as Everyone Health, as required. In addition, the business cell representative will join the cell meetings going forward to cover communication and engagement with the business community and links will be made with a police liaison. The Cell, through its dedicated Council Communication Team Officers, NHS Clinical Commissioning Group Communication Teams and SAVS officer, has adopted a range of digital and non-digital methods to communicate testing, vaccination, staying safe and Covid-19 information to Southend residents and the wider public and visitors to Southend. The Cells communication focus has been on promoting stay safe protocols through “hands, face, space” messaging, getting tested at local sites, encouraging vulnerable people to contact the Coronavirus helpline, adhering to lockdown restrictions, promoting vaccination uptake, and advising about discretionary grant payments for affected businesses. All communication has been regularly updated in-line with the changes implemented by central government and the Council’s Health Protection Board.

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A key part of our strategy is aimed at preventing the spread of the virus and encourage use of community testing. We have been pushing our local ‘Stay Safe, Stay Apart’ campaign, hands, face and space messaging that encourages people to socially distance and participate in good public health measures and visible ‘Shop Safe, Shop Southend’ signage and messaging in our high footfall shopping areas to support the return of non-essential retail for example and encourage residents to shop locally. We will also continue to consider the use of local influencers to get messages across to younger harder to reach audiences that are not engaged with council digital channels, and through briefings and toolkits, use councillors to promote, encourage and myth bust on issues such as testing and vaccination.

To respond directly to an outbreak our communications is two-fold – firstly direct and targeted communications to support the outbreak. There will be a generic approach which will be tailored to the relevant audience. Communications guidance and templates have been issued by DHSC which we follow and adapt where appropriate. In these instances, the setting will be provided with these templates and supported with finalising and issuing these via established channels. The second element would be any wider communications required in relation to local outbreaks, for example managing public/media interest and scrutiny around local outbreaks and communicating what residents or businesses need to do such as testing or isolating. This will include identifying local spokespeople such as Councillors, headteachers or community leaders. Communication with Southend residents:

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Digital Communication

• Dedicated Council and NHS web pages are updated regularly: Council Coronavirus: https://www.southend.gov.uk/coronavirus Covid-19 Vaccination: www.essexcovidvaccine.nhs.uk

• Radio and TV coverage- Inviting Council lead officers to participate in chat programmes and news reports.

• Media releases – proactively issuing both local information and response to national information to local media.

• Social Media - Daily, timely organic social media posts and campaigns with up-to-date information have been promoted on Facebook, Instagram, and Twitter. The hashtag, #StaySafeSouthend has been used for the Covid-19 based posts on social media. The information has provided both localised content and content provided by Public Health England. In January, a day long “Tweet-a-thon” took place to increase testing uptake. Every 20 minutes, new messages were issued, including those from prominent people in the community and Council, such as the Southend Mayor receiving his vaccination and the opportunity to see inside a testing centre. Two covid vaccination themed short updates, undertaken by health professionals, were also shared on social media:

• Dr Alex Shaw COVID-19 vaccination Q&A: https://youtu.be/k6PhdC2fKvU • Sandra Pearson COVID-19 vaccination top tips: https://youtu.be/gj9YFzAQZH8 • “Influencer” campaigns – In an attempt to reach a younger demographic, the Council

used social media influencers (people with verified accounts and large followings) to communicate key stay safe messages. Two campaigns were actioned, the first campaign, pushed general “hands, face, space” safety messaging along with our #ProtectYourFam hashtag and the second used influencers to push messages and information about what was allowed in terms of gatherings over the Christmas holiday period which worked well.

• Paid Social Media Adverts – to target and maximise the interaction with Southend residents, Facebook and Instagram was used for key campaigns Particular examples include age specific targeting with safety messaging including 13–24-year-olds were targeted with adverts showing famous Southend landmarks wearing masks alongside the hashtag #ProtectYourFam and the “Don’t visit Southend” campaign targeting day trippers.

• The messaging was promoted to the local voluntary and faith sector via the SAVS newsletter database and social media channels.

• Supporting Other Public Health Campaigns – Firstly, the #Quit4COVID short film (screenshot below) was used to target smokers and asked them to consider stopping smoking as part of their pandemic efforts. This video received national recognition. Secondly, community leaders were part of the NHS campaign promoting the Flu/Covid-19 vaccination uptake and helping to dispel any myths.

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Social influencers we’ve worked with:

Non-Digital Communication

• Print Adverts - testing uptake and testing centres were advertised in local magazines and newspapers. We will also look at opportunities for “earned” content through, for example, media opportunities, partnerships, and paid for opportunities such as our Get Tested editorial and advertising campaign with the Southend Echo.

• Billboards – Key located billboards around the borough were commandeered specifically for Covid-19 messaging.

• Ad-vans – four large ad-vans were deployed around the borough to promote stay safe messaging, advertising the testing sites and other Covid-19-related information.

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Community engagement activities The Cell wanted to ensure that both Southend residents and community organisations had the opportunity to fully engage and collaborate with the public sector on the Covid-19 pandemic response at a local level. This has been achieved through online ‘Community Conversation’ events that have been hosted by SAVS, reactive outreach and supported by Council officers and NHS colleagues and VCS staff and through establishing a Community Connector scheme. The ‘Community Conversations’ provide those attending with an opportunity to hear from the Director of Public health, Council Officers and NHS leaders on the current national and local Covid-19 information (including data; testing and vaccination information) as well as providing an opportunity for attendees to ask questions; give comment and opinion; shared lived experience and provide feedback to the Council and the NHS. SAVS who set up and hosted the events provided a safe and neutral space for the conversation. Targeted events have focused on diverse communities; young people; homeless and rough sleepers; supporting those with a disability; Southend Mosques; resident associations; Southend hospital; and faith groups. Following each ‘Conversation’ outstanding questions and information are resolved by the team, SAVS sends a summary email with useful links and resources out to all attendees and releases an audio recording as a Podcast for accessibility and further impact. NHS Colleagues have also engaged Patient Participation Groups and other forums to provide Covid-19 vaccination information, including delivering a presentation to the Southend Interfaith Working Group. So far, 12 ‘Community Conversation’ events have taken place with an average of 50 people attending each event and over 450 unique individuals have attended the events. During a young persons targeted event, the young people present were able to share their Covid-19 stories, experiences, and challenges. The event for people living with a disability was fully assessed for access requirements and was able to provide closed caption technology and a live BSL Interpreter. The concerns about vaccine hesitancy are being tackled through the targeted ‘Community Conversations’ and is included as a delivery mechanism within the future strategic Covid-19 communications plans. Reactive outreach Considering intelligence gathered from residents, community organisations and other Cells, reactive and timely outreach was undertaken in conjunction with regulatory services and public health to particular community and faith groups. A high support/high challenge approach was used to ensure the groups were acknowledged for its efforts and supported to follow the guidance while also challenging appropriately where needed. The outreach resulted in building lasting relationships with the groups and ongoing engagement.

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Community Connector Scheme In recognition of the importance of a conversational approach, peer support and modelling behaviours to bridge the digital divide a Community Connectors project has been developed. The project, hosted by SAVS enables community members, leaders, influencers, volunteers, and staff to sign up to receive up to date, localised, reliable, and timely information. It can be used to keep themselves, their family and community safe, disseminate it wider in their networks, engage in conversations with community members and provide us with regular feedback on the local situation. The connectors receive a weekly newsletter prepared by SAVS. As of week, beginning 03/03/2021, over 90 connectors were recruited. A coordinator has been funded to scale the project up and as we move out from the Covid -19 crisis link the residents and community organisations with relevant sources of support information. Weekly emails have been issued to the Community Connectors and, due to the success of this project, a dedicated project worker (3 days per week) has been recruited to continue its work to build relationships with residents and community organisations. Next steps:

• The cells activity will remain focused on basic messaging around being COVID safe, testing and vaccination while transitioning part of the capacity to support activity related to recovery building on existing relationships and interventions.

• We will continue to develop our approach to mobilise residents and partners by information sharing and conversations to support them to see the seriousness of the situation while also building a sense of hope through by highlight and supporting community resilience

• To develop an ‘In conversation with…’ series of short films between a local expert and a community member or key organisation. Each conversation will have a themed approach to explore shared experiences and questions.

• To further explore the use of ‘WhatsApp’ as a mechanism for communicating with Community Connectors

• To continually review and update communication methods with community organisations and Southend residents particularly residents who may be digitally excluded using appropriate paper sources including newsletters, magazines, billboards, public transport and NHS and Council systems such as Council Tax Demand letters, test centre boards with maps, supermarket posters and refuse service vehicles.

• The ‘Community Conversation’ general events will continue on a regular basis and targeted events will be planned in response to identified needs, currently an event is planned for African Churches in Southend.

• For ‘Community Conversation’ event attendees to be sent a link to complete a short survey to evidence if they had found the virtual events helpful and to also provide the opportunity for attendees to make comments in how to improve the events.

• To continue to increase the number of Community Connectors and broaden the reach of individuals and community organisations receiving the weekly communication email.

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• Storytelling as an approach to ensure that the Community Connectors talk about their experiences during Covid-19, as well as exploring why they believe Community Connectors bring benefits to ensuring residents are part of the Covid-19 solution.

• To implement, as required, the COVID-19 (Coronavirus) vaccination communications action plan for both the Mid and South Essex Health and Care Partnership and the Council to tackle vaccine hesitancy.

• To implement the Governments ‘Tackling False Information’ toolkit. • To continually monitor and review communication and engagement approaches,

ensuring a focus on our diverse communities as well as working age adults, young people and areas affected most by deprivation to tackle inequality in relation to Covid-19 and uptake of testing and vaccines.

• Facilitate approaches for residents to feedback into the Local Authority, the NHS and SAVS, including a ‘Covid 19 vaccination – Your experience’ survey supported by Healthwatch Essex.

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7. Key Lessons and Feedback 7.1. Good Practice The response to this pandemic continues to present new challenges and well as new findings about how the virus is spreading and the variability of impact on our population. To support the development of a more robust approach to our local outbreak control, the regional Directors of Public Health and other partner agencies continue to share lessons learnt and the most effective and reliable interventions in managing this pandemic. A number of key networks are accessible to the team via the Knowledge Hub (khub.net). We continue to join a number of national and regional webinars to share good practice, develop shared protocols and plan innovative interventions. Here are a few actions we’ve taken in Southend that have benefitted our overall response:

• Early intervention with workplace cases through our workplace reporting helpline and engaging directly with cases to have a conversation about settings and potential contacts – as NHS T&T often didn’t ask a case about their workplace. This provided information and insight into key areas for concern, interrelations between cases and allowed us to identify where there was confusion with messaging and correct this with targeted communication. E.g. Workplaces requiring a negative test to return to work.

• Building relationships and key contacts with larger localised businesses to support, advise and create a key point of contact.

• Daily positive case line list review to ensure prompt follow up. • Meetings with businesses including the CCDC formally through IMT’s or informally to

provide advice, review if there was specific support that could be provided accounting for the diverse nature of businesses and challenges. E.g. Business PCR screening, daily case and contact updates from business leads.

• Clear cell reporting lines so actions are quickly targeted. • Daily, open to all ‘drop in’ surgery with CCDC to raise specific issues and obtain

advice promptly for action with minimal delay. • An ‘investigate not castigate’ approach to business and residents to ensure a public

health focus rather than enforcement based method for intelligence gathering prompted greater openness and sharing of information.

• Use of an aide-memoire rather than a rigid script to ensure that we flex our response to the individual case.

• COVID Conversations events leading to greater mobilisation of residents and community partners and also access to timely intelligence as a result.

• We have conducted a Table Top Exercise on 08/06/2021 where we have tested the Local Outbreak Management Plan against hypothetical outbreaks, acting on the learning gained from that experience. More Table Top Exercises are planned for the future.

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Risks

• Lack of access, visibility, or delay in receipt of crucial contact tracing data and information.

• Inadequate training and support for key officers with new IT systems and processes • Capacity for response if cases escalate to an unmanageable level. • Variants and Mutations and the impact of these on case rates, resources and the

vaccination program. We must also consider the impact that Covid-19 has had on the wider determinants of health. This includes the financial impact it has had on our population, the mental health impact on our workforce and in the wider community. We will need to consider what support we should be putting in place to prevent people developing these longer-term conditions or worsening pre-existing conditions. Those with conditions such as Long Covid, PTSD, anxiety, agoraphobia, OCD, finance-related stress and other mental health conditions that have been aggravated or brought on by the pandemic may be left feeling unsupported at this time if services are reprioritised to respond to the pandemic and focusing only on the physical impacts of Covid-19. Issues

• National initiatives where there was lack of transparency and failure to communicate and inform local teams hampered and frustrated our response and created additional work. E.g. Daily Contact Testing workplace pilot lack of awareness and communication to SBC.

• Lack of ability to easily access to key contact information for national companies, in particular those not part of a Primary Authority Partnership.

• No visibility or effective perceived use of QR code data or customer contacts collected.

• The ESCTS CRM was not used at local level due to lack of training, support and gaps in information.

• Local business reporting line was not widely used by local businesses. • Absence of a full understanding of the business landscape within the Borough as,

prior to COVID, enforcement did not sit with council - e.g. Manufacturing companies. • Inability to link non-SBC residents to workplace settings located in the Borough, which

resulted in the scale of outbreaks being under-estimated. • National guidelines changing frequently and unexpectedly can lead to confusion –

the government guidance is constantly changing and being updated; the Council and NHS leaders must manage how it reaches out to residents and community organisations to ensure that accurate and timely Covid-19 information is widely disseminated.

• Feedback loop and process of post virtual event - the ‘Community Conversations’ can involve a considerable amount of follow-up work with Council officers and NHS colleagues.

• Reaching out to residents in the community with accessibility needs and residents having no use of technology e.g., internet/social media - the Comms and

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Engagement Cell must continually review how it adapts to new ways of sharing information with residents and community organisations.

• ‘Community Conversations’ - continuing to deliver events that are current and ‘fresh’ in content and delivery so that residents and community organisations engage in a meaningful way.

• Responding to challenging opinions and criticism - can provoke sensitive discussions to keep residents and community organisations engaged and responsive to the pandemic and ‘roadmap’ out of the pandemic.

• Inaccurate media reporting – local media reporting inaccurate information can provoke sensitive management and response by Council and NHS officers with media outlets, residents, and community organisations.

Opportunities Start –

• Daily priority for action and intervention report using consolidated data from all available relevant data sources and algorithms to escalate – such as Postcode, Common Exposures, Line list, Hpzone, CTAS etc.

• Directory of points of contact for National Businesses with regards to formal contact tracing.

• Use of QR code and customer data to minimise onward transmission and assist with enhance contact tracing – e.g. ECT intelligence log

• opportunity of bringing in local contact tracing in-house would speed up our response to new cases, and allow us to enrich data by linking with databases held by the LA, enhancing our ability to respond.

Stop –

• Duplication of activity by facilitation of data visibility and effective, prompt and proactive sharing of information.

Change –

• System to identify and understand the landscape for businesses and settings – such as size, type, location, number of employees, contact.

• To support with risk assessment and targeted intervention or assistance. When businesses have been contacted proactively they have generally been grateful for assistance and advice.

7.2. Local & Wider Feedback Assurance We have tested our plans, including table-top exercises with partner agencies in Southend, across wider Essex as well as across the South East of England. The Essex Resilience Forum (LRF) has been instrumental in facilitating better resilience and collaboration and planning for worse-case scenarios in dealing with outbreaks, capacity planning and

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response to a surge in hospital admissions (including declaring a major incident on one occasion) and excess death management plan. As we are aiming to mark the first anniversary of the LRF’s mobilisation and collective response, many of the lessons learnt have now been enshrined in our practice. Testing Testing will continue to play an important role alongside the vaccine in supporting to save lives in 2021 and the longer term. Our strategy aims to minimise or alleviate harm and our priorities are: - test to diagnose; test to safeguard; test to find; test to maintain and test to enable and promote testing as the norm. We aim to support the increase in home channel testing available for LFDs and PCRs where necessary. More webinars giving training and reassurance to schools and businesses for setting up their own test sites/facilities; and more support provided alongside this. National Support is needed to clarify the need to undertake PCR confirmatory testing in a way that makes sense to the public and doesn’t undermine or question the value of LFD testing. A clear direction is required on the timing when every LFD positive test will require PCR confirmation to overcome the challenge of false positives as the prevalence declines. We would welcome some local control over the national testing resource (PCR, MTUs) to enable us to initiate a response to an identified need for example in response to a local surge in cases or an outbreak at a high priority site. We would always welcome more information in advance to changes to community testing/rapid testing. Contact tracing LOCAL - Feedback from the joint contact tracing service (ESCTS) has been a challenge to understand exactly what has been done with some settings and when. We will now move to establish a more Southend-specific service which is more responsive and sustainable. NATIONAL – We have raised concerns around the inconsistency of isolation periods in relation to onset of symptoms. There is concern that isolation periods are shortened. Lack of timely communications in relation to workplace pilots and testing which subsequently resulted in local resource implications and potentially unnecessary intervention. Lack of visibility to provide local feedback where businesses have endeavoured to engage with national testing schemes and have not had a timely response. We hope that the introduction of a new national contact tracing system and approach will minimise these drawbacks.

Enhanced Contact Tracing (OIRR – Outbreak Identification Rapid Response) - triage and algorithms at common exposure and data sources to prioritise settings and direct where more detailed intervention is required. Shared learning and understanding of best practice, what are the resources, requirements and expectations – setting intervention, case calling, calling contacts of cases, visits, local

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IMT’s, risk assessment, etc. A comprehensive toolkit and standardised documentation looking at the most efficient and effective way to deliver the greatest Public Health benefit. Reduce duplication and overlap by increased visibility of information and data and by ensuring comprehensive information gathering on first contact. Including, comprehensive assessment of all potential contact opportunities, work, social, household, education, healthcare etc. Feedback from workplace cases and automated response suggest that workplace contacts have not been fully explored. Also reduce contacts’ frustration - ‘I have been called so many times I am fed up of answering questions’. National support required:

A cohesive system to bring together information in an effective and informative manner with appropriate access across all systems, visibility and sharing of data and actions.

Reduce barriers to information sharing such as a single secure method of data and information exchange.

Access to the dashboard directly by authorised local authority contact tracing officers, e.g. for logging contacts. This ensures contacts which may be missed by the national system are supported, have access to the isolation payments, captured effectively and reduces administration.

Access to Health Protection Zone – appreciating that options will need to be considered to facilitate this.

Appropriate training and support in new systems and methods as required. Reduce silo working between PHE, National and Local.

Outbreak management and VOC We have clear plans to enact any increase in testing locally, with several both LFD and PCR testing sites in operation. Timing can be extended as necessary. We will need to agree a clear surge testing protocol with PHE as part of a response to a single case of non-travel related VOC/cluster. A more dedicated Outbreak Management Operations Team has been reconfigured as part of the LOMP to help facilitate the management of Variants and Mutants.

We will need to further develop our contact tracing teams and work with PHE and neighbouring LAs to look at the requirements for enhanced contact tracing.

The Essex LRF played a central role in co-ordinating MACA during the December health and social care crisis and this forum will continue to offer a space for discussion, escalation and co-ordinated county wide action.

Regional/National Support: The PHE CCDC will continue to be an active Cell lead both strategically through their

regular contribution to the HPB, as well as for operational advice to the DPH and the designated cells on the management of cases and outbreaks.

We continue to collaborate with the ADPH/PHE/the Essex-wide DPH network, to plan our response and communications.

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We need more consistent and prompter communication from national teams; DHSC, DfE, etc to enable implementation of fast changing national policy at the local level. This is particularly critical is planning to effect communication with the public on surge testing with VOC risks.

The Regional Partnership Team needs to better communicate the ‘surge capacity testing’ protocol and what resources can be deployed at short notice, liaising with Essex LRF and DPHs.

COVID-secure Opening of Leisure, Culture and other Businesses

• General high-level messaging in the Covid business newsletter – planned for closer to opening dates

• Providing re-opening risk assessment templates / reopening checklists for businesses and settings to use

• Ensuring sport/leisure clubs and other social settings are included in information and guidance communications around re-opening

Key barriers identified - we are not certain of the effectiveness of the Covid newsletter so can’t be sure what messages are landing or not. Local networks have more traction and will be used to supplement messaging or provide more detailed support/engagement.

National risk templates or re-opening checklist would be really useful – we have some used previously for hospitality and tourism businesses but a more generalised template / checklist that could be locally customised would reduce workload for us.

Enduring transmission Key areas when we have concerns and continue to address these:

• Enduring transmission is a concern in certain workplace settings; warehouses, food processing plants, transport links and their interconnectedness via social, education and family networks to care homes as well as healthcare settings.

• Longer term issues in care homes need to be considered including level of deprivation, care home funding, quality of care, staff skills and training, provision of IPC support.

National/Regional Support required: Prompt contact tracing by tiers 3 and 2 and prompt, appropriate referrals to tier 1. This is essential in defining the outline for local enhanced contact tracing. Dissemination of lessons identified from the ‘fast track tracing of all cases pilots’ will

be crucial to ensure more LAs sign up and advise self-isolation promptly to prevent transmission.

Vaccines Development of an Equality Impact Assessment and Communications and Engagement Plan to promote awareness of the vaccination programme and how to access vaccines in

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collaboration. This has included holding social media activities, community events for the general public, meetings with local faith leaders, information publicity and media campaigns. Outreach work through our community ambassadors and outreach clinics has helped improved uptake. Work to make reasonable adjustments at vaccination clinics has helped uptake locally such as making sure of appropriate privacy and transport. The national communications campaign has helped raise awareness of the vaccination programme as well. We are working to improve access and awareness of the vaccination programme with our BAME communities, people with mental health problems and learning difficulties, the homeless, sex workers, victims of domestic abuse, traveller communities, carers (paid and unpaid) and those with substance misuse problems. Social Care Staff uptake is being reviewed at present and we are in the process of identifying the reasons that people are not accessing the vaccine. National support required:

• Further social marketing activities and support from DHSC and PHE in the production

and publication of information materials and sharing best practice. • Interpreters available to contact to directly discuss any fears individuals may have. • Myth busting sessions with residents that are in cohorts that are not taking up the

vaccine to counteract ‘Fake News’ which can easily spread on social media and messaging sites which can cause residents to be mis-informed.

• Regular delivery of vaccine to ensure that planning can occur. • Support to tackle vaccine hesitancy – with a focus on the BAME community, research

has stated people who are hesitant in taking the vaccine is because of mistrust in the government and not knowing the long-term effects of the vaccine.

Cross Boundary Working Sharing data with neighbouring local authorities permits more effective detection and management of cross-border issues. Intelligence sharing between LAs continues to improve. Southend works closely with Essex and Thurrock to ensure best alignment in local advice and communication and this is channelled via the Essex LRF and the three HPBs. The latter provide an effective platform to align our response across the NHS and Essex Police. We also work closely with the East of England’s Directors of Public Health to share and embed best practice. Excess Death Management The ‘Lessons Learned’ exercise sought to obtain feedback and insight on what had gone well within the Essex EDM response as well as key learning and recommendations for improvement to feed into next steps for both EDM ‘Stand-by’ and ‘Scale-up’ planning.

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A number of key themes emerged, including ‘fit-for-purpose’ storage (with sustainability in mind), clarifying roles and responsibilities and improving relationship management – all of these were addressed and mitigated for. To ensure that we can produce a comprehensive LOMP, some of the key issues raised above will need to be addressed nationally.

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8. Glossary

ASC Adult Social Care ADPH Association of Directors of Public Health BAME Black, Asian & Minority Ethnic CCA Civil Contingencies Act CCDC Consultant Communicable Disease Control CCG Clinical Commissioning Group COMF Containment Outbreak Management Fund CTAS Contact Tracing Advisory Service CEV Clinically Extremely Vulnerable CMO Chief Medical Officer DASS Director of Adult Social Care DCS Director of Children Services DfE Department for Education DHSC Department for Health and Social Care DPH Department Public Health DPIA Data Protection Impact Assessment EDM Excess Death Management EHO Environmental Health Officer EFL English Football League EPUT Essex Partnership University NHS Foundation Trust ERF Essex Resilience Forum ESCTS Essex Southend Contact Tracing Service HPB Health Protection Board HPT Health Protection Team IMT Incident Management Team IPC Infection Prevention Control ITS Integrated Tracing Service LA Local Authority LFD Lateral Flow Device LOMP Local Outbreak Management Plan LRF Local Resilience Forum LTS Local Testing Site MACA Military Aid to the Civil Authorities MOU Memorandum of Understanding MTU Mobile Testing Unit OIRR Outbreak Identification Rapid Response OMRT Outbreak Management Response Toolkit PCR Polymerase Chain Reaction PHE Public Health England PMART Pandemic Multi-Agency Response Team PPE Personal Protective Equipment RCG Recovery Co-ordination Group RPT Regional Partnership Team SCG Strategic Co-ordination Group SOA Super Output Area SOP Standard Operating Procedure SPOC Single Point of Contact TCG Tactical Co-ordination Group T&T Track and Trace TTS Test and Trace Service TTTS&V Track, Trace, Test, Support and Vaccinate UTLA Upper Tier Local Authority VAM Variants and Mutations VOC Variant of Concern VUI Variant Under Investigation

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9. Appendices Title Last updated Legislative Powers in local government for Outbreak Control 29 June 2020 Powers to impose restrictions on settings and members of the public 22 July 2020 Terms of Reference for Oversight and Engagement Board and Health Protection Board

29 Sept 2020 / 17 Nov 2020

SBC/PHE Memorandum of Understanding 04 May 2021 Case Study - Care Setting Sector Learning from Covid-19 22 March 2021 Incident Management Team Agenda 24 Sept 2020 IMT Process Flow 01 Jul 2021 Testing Campaign Plan Feb-May 21 20 Feb 2021 Case Study - Seekers team 24 March 2021 Vaccination Campaign Plan 16 Feb 2021 VAM Response Plan 01 Jul 2021 Covid-19 Roadmap timeline 4 March 2021 Case study – Early learning in School Outbreak and Risk Assessment 22 March 2021 Local NHS and Social Care Restoration Governance - Draft 15 March 2021 Contact Tracing Process Flows for each cell (These flows are a work in progress and continuously updated)

16 June 2021