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WEST SUSSEX

COVID-19 LOCAL OUTBREAK CONTROL PLAN

Version 1.2

AUGUST 2020

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West Sussex Outbreak Control Plan v1.2 Version control

Version Date updated

Changes made to LOC Plan main document

Changes made to LOC Plan appendices

1 30.06.2020 First version First version 1.1 19.08.2020 Accessibility updates; new

sections on outbreak management (1.5) and on C19 contain framework (3.16);

Accessibility updates, new appendices added (tourism sector, briefing on containment framework); C19 HPB TORs updated to v2

1.2 24.08.2020 No changes - Updated Schools and educational settings appendix

- new Out of school services appendix added.

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Contents 1 INTRODUCTION ................................................................................................................................... 4

LINKS WITH OTHER PLANS ............................................................................................................................ 4 PURPOSE OF THE LOCAL OUTBREAK CONTROL PLAN ......................................................................................... 5 DEFINITION OF COVID-19 OUTBREAK ........................................................................................................... 5 ACTIVATION OF THE WEST SUSSEX LOCAL OUTBREAK CONTROL PLAN .................................................................. 5 OUTBREAK MANAGEMENT ........................................................................................................................... 5

2 CONTEXT ............................................................................................................................................. 7

ABOUT WEST SUSSEX ................................................................................................................................. 7 IMPACT OF COVID-19 SUMMARY ................................................................................................................. 9

3 LEGAL CONTEXT AND MUTUAL AID ARRANGEMENTS ......................................................................... 15

KEY REGULATIONS .................................................................................................................................... 15 COORDINATION AND MUTUAL AID ARRANGEMENTS ........................................................................................ 17

4 NHS TEST AND TRACE PROGRAMME .................................................................................................. 18

5 GOVERNANCE STRUCTURES AND RESPONSIBILITIES ........................................................................... 20

LOCAL BOARDS ........................................................................................................................................ 22 SUSSEX RESILIENCE FORUM ........................................................................................................................ 22

6 LOCAL OUTBREAK CONTROL PLAN KEY THEMES ................................................................................. 24

MANAGING OUTBREAKS IN WEST SUSSEX CARE HOMES AND SCHOOLS ................................................................ 24 IDENTIFYING AND MANAGING HIGH RISK PLACES, LOCATIONS AND COMMUNITIES .................................................. 27 LOCAL TESTING CAPACITY - TESTING IN SUSSEX ............................................................................................... 29 CONTACT TRACING IN COMPLEX SETTINGS ..................................................................................................... 33 DATA INTEGRATION .................................................................................................................................. 34 SUPPORTING VULNERABLE PEOPLE ............................................................................................................... 40 PREVENTION ........................................................................................................................................... 42

7 COMMUNICATIONS AND ENGAGEMENT ............................................................................................ 43

8 EQUALITY MONITORING .................................................................................................................... 45

EQUALITIES DUTY ..................................................................................................................................... 45 PROTECTED CHARACTERISTICS IN WEST SUSSEX .............................................................................................. 46

9 APPENDICES ...................................................................................................................................... 48

HIGH RISK AND COMPLEX SETTINGS ........................................................................................................................... 48 LOCAL BOARDS TERMS OF REFERENCE ....................................................................................................................... 48 OTHER APPENDICES ............................................................................................................................................... 48

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Glossary

A&E – Accident and Emergency

BAME – Black, Asian and Minority Ethnic

BSUH – Brighton and Sussex University Hospitals

C19 – COVID-19

CCG – Clinical Commissioning Group

CEHO – Chief Environmental Health Officer

COBR – Cabinet Office Briefing Rooms

CQC – Care Quality Commission

D&B – District and Borough councils

DHSC – Department of Health and Social Care

DPH – Director of Public Health

DsPH – Directors of Public Health

DASS – Director of Adult Social Services

EHT – Environmental Health Teams

HPAG – Health Protection Assurance Group

HPT – Health Protection Team

HWB – Health and Wellbeing Board

ICS – Integrated Care System

JBC – Joint Biosecurity Centre

KSS – Kent Surrey and Sussex

LA – Local Authority

LOCP - Local Outbreak Control Plan

LOEB - Local Outbreak Engagement Board

LSCC – Logistics and Supply Chain Cell

MAIC – Multi Agency Information Cell

MDT – Multi Disciplinary Team

MOU – Memorandum of Understanding

MTU – Mobile Testing Unit

NHS – National Health Service

NPI – Non-Pharmaceutical Interventions

OCT – Outbreak Control Team

PCN – Primary Care Network

PH – Public Health

PHE – Public Health England

PHEC – Public Health England Centre

PRH – Princess Royal Hospital

QVH – Queen Victoria Hospital

SASH – Sussex and Surrey Healthcare

SCG – Strategic Co-ordination Group

SE – South East

SECAmb – South East Coast Ambulance Service

SMG – Senior Management Group

SOP – Standard Operating Procedure

SPFT – Susses Partnership Foundation Trust

SRF – Sussex Resilience Forum

T & T – Test and Trace

TCG – Tactical Co-ordination Group

ToR – Terms of Reference

UTLA – Upper Tier Local Authority

WSCC – West Sussex County Council

WSHT – Western Sussex Hospital Trust

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1 Introduction This document is the Local Outbreak Control Plan for West Sussex. While it has been published by West Sussex County Council, it outlines how national, regional and local organisations and responses work together as an interdependent system (see section 5.1.1) which is geared up to prevent and contain the spread of COVID-19 (Coronavirus). While the plan does outline changes in the way that the system works together, it also builds on many of the structures and processes that are already in place and working well. The plan outlines a comprehensive framework to support action, but it will require further development and detail as delivery and the response to COVID-19 continues.

The Department of Health and Social Care (DHSC) has provided two core pieces of guidance related to the contents of Local Outbreak Control Plans. Firstly, plans should outline the required governance arrangements [as detailed in Chapter 5], and secondly, plans should be centred on the following themes:

• Defining monitoring arrangements, identifying potential scenarios and planning the required responses for local outbreaks in care homes and schools.

• Identifying and planning preventative measures and outbreak management strategies for other high-risk settings, locations and communities

• Defining how to prioritise and manage deployment methods for local testing to ensure a swift response that is accessible to the entire population.

• Assessing local and regional contact tracing and infection control capability in complex settings with the potential need for mutual aid to increase capacity from other local authorities and/or health and/or government agencies.

• Integrating national and local data and scenario planning through the materials and service provided by the new national Joint Biosecurity Centre.

• Supporting vulnerable local people to self-isolate by: o encouraging neighbours to offer support o identifying relevant community groups and resources to support them o ensuring services meet the needs of diverse communities.

• Establishing governance structures led by existing COVID-19 Health Protection Boards and supported by existing Gold command forums and a new councillor-led Board to communicate with the general public.

Links with other plans This Local Outbreak Control Plan (LOCP) builds on the following existing health protection plans already in place between West Sussex County Council (WSCC), Public Health England (PHE) South East (SE) Surrey and Sussex Health Protection Team (HPT), the seven West Sussex District and Borough Councils, Sussex Health and Care Partnership, and Sussex Local Resilience Forum (LRF):

• Kent, Surrey and Sussex Public Health England Centre (KSS PHEC) Outbreak/Incident Control Plan (2014)

• Joint Health Protection Incident and Outbreak Control Plan, Kent Surrey and Sussex Local Health Resilience Partnerships (2020)

• Local Agreement between the Local Environmental Health Services of Surrey, East Sussex, West Sussex and Brighton and Hove, and Public Health England South East Health Protection Team (2019)

• Sussex Local Health Resilience Partnership (LHRP) Memorandum of Understanding: Responsibilities for the Mobilisation of Health Resources to Support the Response to Health Protection Outbreaks/Incidents in Surrey (2019)

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• Sussex Resilience Forum Pandemic Influenza Plan (2020) • Communicable Disease Outbreak Management: Operational Guidance (2013) • PHE Infectious Diseases Strategy 2020 – 2025 (2019) • Standard Operating Procedure PHE & LA Joint Management of COVID-19 Outbreaks in the SE

of England (2020)

Purpose of the Local Outbreak Control Plan

1.2.1 Aims and objectives The aim of the West Sussex Local Outbreak Control Plan is to protect the public’s health by:

• Preventing and containing the transmission spread of COVID-19 • Ensuring a timely, effective and coordinated approach is taken in the event of an outbreak in

West Sussex • Instilling and maintaining trust and confidence by ensuring that the West Sussex residents and

stakeholders are engaged and well informed throughout the outbreak

Definition of COVID-19 Outbreak The definition of a COVID-19 outbreak used throughout this plan is:

“Two or more suspected or confirmed cases of COVID-19 linked in place or time.”

Activation of the West Sussex Local Outbreak Control Plan The West Sussex Local Outbreak Control Plan will be triggered where there are suspected or confirmed COVID-19 outbreaks in any setting. Member organisations of the COVID-19 Health Protection Board (see section 5.2) will be notified as well as West Sussex County Council Tactical Management Group and Strategic Management Group, and the Sussex Resilience Forum Tactical Coordination Group.

Outbreak Management Prevention and control of infectious diseases have always been core activities for Public Health and the NHS. Detailed operational guidance and well-established organisational structures, roles and processes already exist to support effective response to infectious disease outbreaks, and this includes COVID-19. The Local Outbreak Control Plan builds on these. The standard framework for managing outbreaks of infectious disease is: 1

• Outbreak recognition – initial investigation and risk assessment • Outbreak declaration – decision made regarding declaring an outbreak and convening

Outbreak Control Team • Outbreak Control Team – convened in line with guidance • Outbreak investigation and control activity including contact tracing • Communications strategy agreed and delivered • End of outbreak declared and final report with recommendations and lessons learnt

produced

1 https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/343723/12_8_2014_CD_Outbreak_Guidance_REandCT_2__2_.pdf

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In the event of a COVID-19 outbreak, PHE South East Health Protection Team and WSCC will make a decision on whether an Outbreak Control Team is required guided by a risk assessment. PHE and WSCC will be core members of any OCT for an outbreak in West Sussex. Following joint discussions between PHE South East Health Protection Team and WSCC, partners that should be notified and considered for the purpose of inclusion in the OCT are:

• The District / Borough(s) affected (this is usually through the Environmental Health Team) • The management of the establishment if contained to one site. (E.g. Headteacher of a school,

Manager of a care home, business or workplace) • West Sussex CCG

Additional membership may be required dependent on the outbreak setting. If an OCT is convened, member organisations of the COVID-19 Health Protection Board (see section 5.2) will be notified as well as West Sussex County Council Tactical Management Group and Strategic Management Group, and Sussex Resilience Forum Tactical Coordination Group.

The OCT will be chaired by a representative of PHE SE Health Protection Team (usually the Consultant in Communicable Disease Control). The role of the OCT is to agree and coordinate the activities involved in the management, investigation and control of the outbreak. The OCT will:

• Assess the risk to the public’s health • Ensure the cause, vehicle and source(s) of the outbreak are investigated and control measures

implemented as soon as possible • Seek legal advice where required.

1.5.1 Cross-border outbreaks If the outbreak crosses Kent Surrey and Sussex PHE Centre (KSS PHEC) or LA boundaries there will need to be close liaison with neighbouring PHECs, Local Authorities and Local Resilience Forums. Cross-border outbreaks will usually be led by the area where the outbreak is first identified or where the majority of cases reside or where the source/hazard exists. Where the outbreak crosses LA boundaries the relevant DsPH will need to establish and maintain good communication with the neighbouring authority.

1.5.2 End of outbreak The OCT will decide when the outbreak is over and will make a statement to this effect. Following the outbreak, the OCT will undertake a constructive debrief, identify lessons learnt and produce a final outbreak report.

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2 Context

About West Sussex

2.1.1 Geography The county covers an area of 768 square miles and is predominantly rural in character but with some large towns. The county is made up of seven districts; Adur; Arun; Chichester; Crawley; Horsham; Mid Sussex and Worthing. The majority of the population lives in the four largest towns: Bognor Regis; Crawley; Horsham; and Worthing. Forty-two percent of the county’s resident population, and over half of its businesses are located in rural areas.

The county has numerous seaside resorts, market towns, museums, galleries, theatres and historic properties which make it a popular destination for tourists and visitors. West Sussex is also home to the South Downs National Park, which runs through the counties of Hampshire, West Sussex and East Sussex. It is the newest and most populated National Park in the UK, with 112,000 people living there and over 2 million living within 5 kilometres of its boundary.

2.1.2 Population demographics West Sussex county has an estimated population of 864,000. Overall, the county has an older population compared with England. In 2019, 23% of the population (198,800 people) were aged 65 years or over, compared with 18% nationally. In contrast, below county level, Crawley has a younger population, with less than 14% of the population aged 65+ years and 22% are aged 0-15 years.

Figure 1: West Sussex population

West Sussex is less ethnically diverse compared with England, with the majority (89%) of the population identifying as White British ethnicity, which is higher than the average for the South East and England (80%). The Black Asian Minority Ethnic (BAME) population are broadly younger than the general population with the largest proportion being of working age. A total of 21 languages are spoken by at least 500 people in West Sussex, with Polish the most widely spoken, and approximately 13% of residents in Crawley do not use English as their main language.

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2.1.3 Deprivation West Sussex is one of the least deprived areas in the country; in relation to the Index of Deprivation (2015) the county ranks 131st of 152 upper tier authorities (1 being most deprived, 152 being least deprived). At a neighbourhood level in the 2019 MHCLG Index of Deprivation, areas within three wards in Arun and one ward in Crawley fall within the 10% most deprived areas in England. These wards are Courtwick with Toddington, Marine, and Bersted in Arun and Broadfield South in Crawley. The map below shades the county from bright yellow for the least deprived areas to dark blue for the most deprived areas.

Figure 2: National Index of Multiple Deprivation (IMD) Deciles (2019) in West Sussex

2.1.4 Health and social care services West Sussex has over 325 schools; 93 GP practices grouped into 19 Primary Care Networks (PCN); 157 community pharmacies; 356 CQC registered care homes; hospitals with A&E departments at Chichester, Worthing, Haywards Heath and additional NHS hospital sites across the county. In addition, a proportion of the residents of West Sussex access health services in neighbouring areas including Surrey, Brighton and Hove, Portsmouth and Southampton.

2.1.5 Transport links There is an extensive public transport system including buses, rail and air travel networks linking the County with other cities and hubs i.e. London, Brighton, Portsmouth and Southampton. Gatwick Airport is one of the major international gateways. Several road networks link the County and other areas including the A27/M27 providing links to Portsmouth and Southampton and; the A23/M23 connecting London with Brighton and providing access to Gatwick Airport. While the towns of West Sussex are generally well connected2, some rural parts of the county remain underserved and isolated from the main transport networks across the county and the South East. This presents some challenges for those relying on public transport for access.

2 WSCC- https://www.westsussex.gov.uk/media/8996/01_about_west_sussex_2019.pdf

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Impact of COVID-19 summary

2.2.1 Shielded and Vulnerable in West Sussex

The shielded patient list includes patients identified by GPs and hospital doctors and those identified using a clinical algorithm for specific conditions. People excluded from this list include those who have been asked to be removed from the list, some patients identified by the algorithm but who a GP or hospital doctor do not consider as clinically extremely vulnerable, or patients who have self-referred. NHS Digital publish frequent updates and provide information on the numbers, age groups and gender of people at lower tier local authority. Overall, across England there are over 2.2m people on the shielded patients list, representing 4.0% of the England population.

Table 1: West Sussex residents on the shielded list Data as of 11 June 0-18 19-69 70+ All on List % of

population on list

Adur 70 1,275 1,175 2,520 3.9% Arun 215 3,345 4,610 8,170 5.1% Chichester 155 2,545 2,775 5,475 4.5% Crawley 245 2,295 1,405 3,945 3.5% Horsham 155 2,480 2,310 4,945 3.5% Mid Sussex 190 2,530 2,475 5,195 3.5% Worthing 130 1,990 1,705 3,825 3.5% West Sussex 1,160 16,460 16,455 34,075 4.0%

As data are available at a District and Borough level (and below), information is confidential, with highly restricted access.

2.2.2 Cases (Positive Tests) There are a range of datasets relating to testing, including testing in the NHS, in care homes and in the community, alongside data relating to contact tracing. While each dataset has a specific purpose such as identifying outbreaks in settings, it can mean that providing a clear, concise view of infections in the

This section summarises the current position, as of end of June 2020. This summary does not include issues relating to the wider or longer-term impact of the pandemic, such as economic, educational or wider social and health outcomes.

West Sussex is a large county with considerable diversity, therefore in describing the impact of COVID-19 we will aim to monitor data at the lowest geography possible.

In thinking of the impact of COVID-19 we have considered how different groups/areas may be affected at different points (i.e. from exposure, infection, hospitalisation, death) and have identified the range of datasets that are currently available to us, more data may be available in future. A summary of data sources in section 6.5.5

Note: Terms such as shielded, vulnerable and “at risk” have been frequently used interchangeably when referring to people considered to be at greater risk of harm from COVID-19. NHS Digital have provided local areas with a shielded patient list. It is noted that this list was originally referred to as the vulnerable patient list. While it is known that many people, roughly defined as those who are normally at risk of influenza (estimated at 19 million people nationally) are at higher risk from COVID-19, the shielded patient list refers to a group who have been advised by the Chief Medical Officer to completely “shield”.

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county can be challenging. Data accessibility has improved, and it is anticipated that data available to local authorities will further improve in detail, coherence and timeliness. Data on the total number of tests, and negative and void tests are now becoming available to the County Council. Testing data are available to WSCC at District and Borough level.

2.2.3 West Sussex compared with surrounding areas PHE publishes a weekly surveillance report which provides, at upper tier LA level, data on cases per 100,000 population. Maps are provided for new cases (cases recorded between 8th June and 14th June) and cumulative cases (below). These highlight the need to be watchful of surrounding areas.

Figure 3: Cumulative Cases - Rate of COVID-19 per 100,000 Population to 17 June

Figure 4: New Cases - Rate of COVID-19 per 100,000 Population to 17 June

Source: Public Health England Weekly Coronavirus Disease 2019 (COVID-19) Surveillance Report Summary of COVID-19 surveillance systems

2.2.4 Care Home Outbreaks in West Sussex Overall, 41% of care homes in West Sussex have had an outbreak, with a peak period of care homes reporting outbreaks from the end of March to mid-April. Across West Sussex the percentage of care homes who have had outbreaks range from 67% in Horsham down to 25% in Arun.

Care Homes Reporting an Outbreak of a Confirmed (or Suspected) Outbreak of COVID-19 to PHE from w/c 2nd March to w/c 8th June

Overall the rate of cases per 100,000 population are lower in West Sussex than areas to the north and west (Surrey and Hampshire) but higher than Brighton and Hove and East Sussex.

Overall the rate of new cases per 100,000 population in the period 8th June to 14th June has been lower than surrounding areas.

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Table 2: Percentage of Care Homes who have had an outbreak (period of w/c 2nd March to 8th June) Local Authority All outbreaks Number of care

homes %of care homes that have

reported an outbreak

Adur 8 17 47.1 Arun 25 100 25.0 Chichester 23 46 50.0 Crawley 8 20 40.0 Horsham 29 43 67.4 Mid Sussex 27 52 51.9 Worthing 27 78 34.6 West Sussex 147 356 41.3

2.2.5 People Reporting Symptoms in West Sussex (NHS Pathways) This information relates to triage of people contacting NHS 111 (calling and online) and 999 and coronavirus symptoms triaged through NHS Pathways by callers to NHS 111 and 999. People are recorded if they have been triaged/completed online assessments and have been identified as having potential COVID-19. It is important to recognise that these are assessments, not people, as some people over the period shown may have more than one assessment.

Note: There have been some changes to the system over this time and these have been noted on the graph.

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2.2.6 Hospitalisation Data are available to local authorities on individual NHS Trust admissions, bed occupancy, use of intensive care beds and oxygen. Data is provided on a daily basis.

Most of this data are not in the public domain but will form a core part of the early warning indicators in the system.

A challenge for West Sussex is that for many residents, notably those in Crawley and Mid Sussex, the acute hospital serving them is based outside of the county or ICS boundary, at the Surrey and Sussex Healthcare NHS Trust hospital in Redhill and the Royal Surrey Hospital Trust in Guildford. Access to NHS data tends to be easier from providers within ICS boundaries. As part of the early warning system, we will need to monitor change at the Brighton and Sussex University Hospitals Trust, Surrey and Sussex Healthcare NHS Trust and Western Sussex Hospital NHS Trust.

2.2.7 COVID-19 related deaths in West Sussex The Office for National Statistics (ONS) release weekly deaths broken down to local authority level, of all deaths and COVID-19 deaths. This dataset will be published every week and includes deaths outside of hospital. Weekly deaths are provided for 2020, and from March 31st COVID-19 deaths relate to any death involving COVID-19, based on any mention of COVID-19 on the death certificate. Two sets of tables are available from the ONS, one set based on the date of registration and one set based on date of occurrence of death. There can be a time lag between a death taking place and the subsequent registration.

The tables presented here include deaths that occurred up to 12th June but were registered up to 20th June. This means there may be some revisions to the dataset for recent weeks, notably in relation to deaths by date of occurrence as registrations are subsequently made. This chart relates to date of occurrence not registration.

Note: We have chosen to use data of occurrence as this is key to informing provision relating to death management such as mortuary storage and crematoria capacity.

Overall, the number of deaths in West Sussex increased considerably (and above previous high levels) during the period of the end of March to the second week in May.

COVID-19 death occurrences, where COVID-19 was noted on the certificate, started being recorded at the end of March. These increased through April and May and have declined from the end of May.

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The impact of COVID-19 on care homes was evident by the fact that by early/mid-April the highest proportion of deaths, overall, were taking place in care homes.

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The number of deaths where COVID-19 was mentioned on the death certificate differ across the county, with Mid Sussex and Crawley having higher mortality rates than other areas. This may reflect a higher underlying infection rate in these areas.

Figure 5: Data released by the ONS for the period March to May

2.2.8 Economic impact of COVID-19 COVID-19 is having a significant impact across the County’s economy. Businesses are being hit hard, residents are losing their jobs and livelihoods, and the implications of the aviation industry crisis on Gatwick Diamond Economic Area are far-reaching and impact the local, regional and national economies. A study by the Centre for Cities estimated that Crawley will be the most vulnerable city in the country, with over half of its jobs either in vulnerable or very vulnerable sectors3. This has significant financial implications for the borough’s residents.

3 https://www.centreforcities.org/blog/what-does-the-covid-19-crisis-mean-for-the-economies-of-british-cities-and-large-towns/

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3 Legal context and mutual aid arrangements

Key regulations The legal context for managing outbreaks of communicable disease which present a risk to the health of the public requiring urgent investigation and management sits with:

• Public Health England under the Health and Social Care Act 2012 • Directors of Public Health under the Health and Social Care Act 2012 • Chief Environmental Health Officers under the Public Health (Control of Disease) Act 1984 • With NHS Clinical Commissioning Groups4 to collaborate with Directors of Public Health and

Public Health England to take local action (e.g. testing and treating) to assist the management of outbreaks under the Health and Social Care Act 2012

• Other responders specific responsibilities to respond to major incidents as part of the Civil Contingencies Act 2004

In the context of COVID-19 there is also 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 (sometimes these are Local Health Resilience Partnerships) and local Memoranda of Understanding. These arrangements are clarified in the 2013 guidance Health Protection in Local Government5.

3.1.1 Public Health England (PHE) PHE has responsibility for protecting the health of the population and providing an integrated approach to protecting public health through close working with the NHS, LAs, emergency services, and government agencies. This includes specialist advice and support related to management of outbreaks and incidents of infectious diseases.

3.1.2 Local Authorities – Social Care and Public Health Under the Care Act 2014, Local Social Care Authorities have responsibilities to safeguard adults in their area. LA responsibilities for adult social care include the provision of support and personal care (as opposed to treatment) to meet needs arising from illness, disability or old age.

Under the Health and Social Care Act 2012, Directors of Public Health in County and unitary councils have a duty to prepare for and lead the local authority (LA) public health response to incidents that present a threat to the public’s health.

3.1.3 Clinical Commissioning Groups (CCG) Under the Health and Social Care Act 2012, CCGs have responsibility to provide services to reasonably meet health needs and power to provide services for prevention, diagnosis and treatment of illness.

4 And NHS England in the case of Prisons and custodial institutions 5 Protecting the health of the local population: the new health protection duty of local authorities under the Local Authorities (Public Health Functions and Entry to Premises by Local Healthwatch Representatives) Regulations 2013

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Medical practitioners have a statutory duty to notify suspected and confirmed cases of notifiable diseases to PHE, under the Health Protection (Notification) Regulations 2010 and the Health Protection (Notification) Regulations 2020. The LA Legal Powers document in Appendix 3 gives further detail.

3.1.4 District and Boroughs The powers contained in the suite of Health Protection Regulations 2010 as amended, sit with District and Borough Environmental Health teams. Details are set out in Appendix 3.

The Health Protection (Local Authority Powers) Regulations 2010 allow a local authority to serve notice on any person with a request to co-operate for health protection purposes to prevent, protect against, control or provide a public health response to the spread of infection which could present significant harm to human health. There are also powers to require action in relation to school pupils, decontamination of premises and risks from dead bodies. Details in Appendix 3.

The Health Protection (Part 2A Orders) Regulations 2010 allow a local authority to apply to a magistrates’ court for an order requiring a person to undertake specified health measures for a maximum period of 28 days (extendable). These Orders, if considered proportionate to the risk available, require specific criteria to be met. Consideration of and preparation of applications for these Orders should be carefully planned to identify specific actions to address evidenced risk and can be escalated in stages or made conditional in order to address any concerns as to their use for localised infection control measures. As potential criminal charges may arise from breach or non-compliance and as compensation for financial impact may be ordered by the court applications for the orders should be used in more serious instances when other measures are not considered viable.

3.1.5 Coronavirus Act 2020 The Health Protection (Coronavirus Restrictions) (England) Regulations 2020 set out the restrictions of what is and is not permitted by residents and businesses, which together create the situation of lockdown. Any easing of lockdown comes from amending or lifting these Regulations. The powers of the Police to enforce lockdown also flow from these national Regulations. Local councils do have powers to close down businesses in breach. ‘Localised’ lockdown to limit specified communities or types of businesses in an area would require further Regulations. At this time, there are no such Regulations. The powers set out above and detailed in Appendix 3 should therefore be considered.

3.1.6 COVID-19 Contain Framework The Government guidance ‘COVID-19 contain framework: a guide for local decision-makers’ was published on 17th July 2020. This covers new local and national powers, governance structures (covered in section 5 of the plan) and escalation requiring regional and national involvement.

1. New powers

a) Local powers

Upper Tier Local Authorities (UTLAs) will have powers to close individual premises without representation to a magistrate, public outdoor places and prevent specific events. This must be done taking into account advice from the Director of Public Health and the UTLA must notify the Secretary of State.

b) National powers

Ministers have similar powers to take action against specific premises, places and events, as well as a power to direct UTLAs to act or to revoke LA direction. They are also able to:

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• Close businesses and venues in whole sectors or within a defined geographical area including countywide

• Impose general restrictions on movement of people (including stay at home or entering or leaving areas)

• Impose restrictions on gatherings • Restrict local or national transport systems • Mandate use of face coverings in a wider range of public places

2. Escalation

Where there a large number or cases and/or a significant increase, local systems will be designated into three ‘escalation’ categories which would enable specialist expertise and resource to be drawn down from regional and national levels to augment the local systems.

• area(s) of concern – a watch list of areas, where the local area is taking targeted actions to reduce prevalence - supported by Regional Test and Trace resource

• area(s) of enhanced support – for areas at medium/high risk of intervention where there is a more detailed plan, agreed with the national team and with additional resources being provided to support the local team (e.g. epidemiological expertise, additional mobile testing capacity, engagement with high risk groups) – increased national support / resource

• area(s) of intervention – where there is divergence from the measures in place in the rest of England because of the significance of the spread, decision making is shifted to national levels with a detailed action plan in place, and local resources augmented with a national support – testing, comms, engagement, closure and movement restrictions. A multi-agency national incident response team will be dispatched.

Coordination and mutual aid arrangements The range of agencies, including the police, holding the various powers set out above means there is a need to coordinate actions and planned interventions to make best use of the powers available. Under mutual aid arrangements, collaborative agreements create a shared responsibility between the NHS, LAs and PHE in dealing with COVID-19 outbreaks. Several Mutual Aid Memorandums of Understanding are currently in place, such as the Sussex Local Emergency Planning Group MOU (the Local Authority Resilience Partnership) between the Local Authorities i.e. WSCC, District and Borough Councils. Furthermore, mutual aid arrangements are available by request for example, through Sussex Resilience Forum.

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4 NHS Test and Trace programme In response to the current novel coronavirus (COVID-19) outbreak, which began in late 2019, the UK Government has set out its COVID-19 recovery strategy. A central part of this response is the National Test and Trace Service which was launched in May. The primary objective of the Test and Trace Service is to control the COVID-19 rate of reproduction (R), reduce the spread of infection and save lives. Local Authorities, in collaboration with key partners, have been given the responsibility to develop Local Outbreak Control Plans to reduce the spread of the virus in their geographical areas. The Local Outbreak Control Plans will put in place measures to identify and contain outbreaks and protect the public’s health.

4.1.1 Test and Trace programme – Contact tracing Contact tracing is a fundamental part of outbreak control. When a person is tested positive for COVID-19, they are contacted to gather details of places they have visited, and people they have been in contact with. Those who they have been in contact with, are risk assessed according to the type and duration of that contact. Those who are classed as ‘close contacts’ are contacted and provided with advice on what they should do e.g. self-isolate.

PHE have produced a pictorial guide describing Contact Tracing.

4.1.2 NHS Test and Trace Service The national NHS Test and Trace service, which went live in May, has been set up to undertake contact tracing for COVID-19. The service consists of three tiers as shown in Figure 6.

Figure 6: NHS Test and Trace Service (Tiers)

• Tier 3 – Around 20,000 call handlers have been recruited under contract to PHE to contact people who have tested positive for COVID-19, to determine who they have been in close contact with in the two days before they became ill and since they have had symptoms. Advice following national standard operating procedures (SOP) and scripts is given to close contacts as appropriate. An automated app which is currently in development may also be launched nationally for people to report symptoms, access testing and complete an online questionnaire

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• Tier 2 – Around 3000 dedicated professional contact tracing staff have been recruited by the NHS where there are difficult/more complex issues to address which have been escalated from Tier 3. Appropriate advice following national guidance is given to cases and their close contacts

• Tier 1 – PHE Health Protection Teams will investigate cases escalated from Tier 2. This will include complex, high risk settings, and communities such as care homes, special schools, prisons/places of detention, healthcare and emergency workers, health care settings; and places where outbreaks are identified e.g. workplaces. Advice following national guidance will be given to cases, their close contacts and settings/communities as appropriate. An outbreak is defined as 2 or more cases (suspected and /or confirmed) linked in place/time. An outbreak will trigger this plan as detailed in section 1.4.

NHS Test and Trace is accessed on-line at https://www.gov.uk/guidance/nhs-test-and-trace-how-it-works. On registration with the service, people are asked to provide contact details, so that results and advice can be provided by email, text or phone. For those with hearing impairment, they can provide next of kin or friend details.

4.1.3 Local Authority Test and Trace funding On 10th June 2020, the Government announced funding allocations to support Local Authorities develop and deliver their plans in relation to the mitigation against and management of local outbreaks of COVID-19. West Sussex was allocated £3,178,715. Grant conditions include upper tier authorities working closely with their lower tier partners and ensuring those partners are given opportunities to deliver the outcomes this grant is meant to support where delivery by those partners would be the most efficient and cost-effective means of delivery.

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5 Governance structures and responsibilities Figure 7: West Sussex COVID-19 response governance structure overview

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5.1.1 Local, Regional and National Roles and Leadership The table below outlines the local, regional and national leadership roles

Level Place-based leadership Public health leadership

LOCAL LA Chief Executive, in partnership with DPH and PHE HPT to:

a) Sign off the Outbreak Management Plan led by the DPH

b) Bring in wider statutory duties of the LA (eg DASS, DCS, CEHO) and multi-agency intelligence as needed

c) Hold the Member-Led Covid-19 Engagement Board (or other chosen local structure)

DPH with the PHE HPT together to: a) Produce and update the

Outbreak Management Plan and engage partners (DPH Lead)

b) Review the daily data on testing and tracing

c) Manage specific outbreaks through the outbreak management teams including rapid deployment of testing

d) Provide local intelligence to and from LA and PHE to inform tracing activity

e) DPH Convenes DPH-Led Covid-19 Health Protection Board (a regular meeting that looks at the outbreak management and epidemiological trends in the place)

f) Ensure links to LRF/SCG REGIONAL Regional Lead CE in partnership

with national support team lead, PHE RD and ADPH lead

a) Support localities when required when there is an adverse trend or substantial or cross-boundary outbreak

b) Engage NHS Regional Director and ICSs

c) Link with Combined Authorities and LRF/SCGs

d) Have an overview of issues and pressures across the region especially cross-boundary issues

PHE Regional Director with the ADPH Regional lead together

a) Oversight of the tracing activity, epidemiology and Health Protection issues across the region

b) Prioritisation decisions on focus for PHE resource with LAs

c) Sector-led improvement to share improvement and learning

d) Liaison with the national level

NATIONAL Contain SRO and PHE/JBC Director of Health Protection

a) National oversight for wider place

b) Link into the JBC especially on the wider intelligence and data sources

PHE/JBC Director of Health Protection (including engagement with CMO)

a) National oversight identifying sector specific and cross-regional issues that need to be considered

b) Specialist scientific issues e.g. Genome Sequencing

c) Epidemiological data feed and specialist advice into JBC

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Local Boards

5.2.1 West Sussex COVID-19 Health Protection Board As part of the Test and Trace Programme, Local Authorities, led by the Directors of Public Health, have been tasked with setting up a COVID-19 Health Protection Board (C19 HPB). In West Sussex, the existing West Sussex Health Protection Assurance Group (HPAG) acts as the C19 HPB, as it is a well-established group with a remit for health protection across the county. The Board is chaired by the Director of Public Health, and additional members have been invited to ensure wider engagement with key partners including District and Borough Environmental Health Officers, as well as current HPAG members such as PHE and NHS (full membership details and Terms of Reference (ToR) of the C19 HPB can be found in Appendix 2.1) . The West Sussex C19 HPB will provide strategic oversight of health protection regarding COVID-19 across the county, including prevention, surveillance, planning and response, to ensure they meet the needs of the population.

The Board will be supported by and work in collaboration with West Sussex County Council SMG, Gold command. The Board’s responsibilities include (further details are included in the ToRs, Appendix 2.1):

• The ongoing development and delivery of the West Sussex Local Outbreak Control Plan • Making recommendations to relevant public bodies and agencies for the allocation of

resources to support the effective delivery of the Plan • Receiving and acting on data and intelligence • Overseeing arrangements for all agencies working with local communities and services to

make the NHS Test and Trace programme as effective as possible • Advising on communications strategy for the Local Outbreak Control Plan, especially for

the member led Local Outbreak Engagement Board • Making recommendations for the wider COVID-19 response and policy agenda

5.2.2 Local Outbreak Engagement Board To support the delivery of the Local Outbreak Control Plans and ensure public engagement, Local Authorities have a responsibility to form Local Outbreak Engagement Boards (LOEB). In West Sussex, the LOEB is a member-led6 subgroup of the Health and Wellbeing Board and is responsible for providing direction and leadership for community engagement and public facing communications, as the public face of the local response in the event of an outbreak. Draft Terms of Reference, including membership are in Appendix 2.2.

Sussex Resilience Forum The Sussex Resilience Forum (SRF) will support local health protection arrangements working with C19 HPB and LOEB directly through the Strategic Co-ordinating Group (SCG) or if in place the Strategic Recovery Group (RCG), Tactical Co-ordinating Group (TCG), and the following Cells:

• Multi-agency Information Cell • Logistics and Supply Chain Cell

o Test and Trace Support

6 Member-led refers to elected members

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o Testing logistics • Vulnerability and Wellbeing Cell

The logistics and supply chain Cell will include the support to operations for the test and Trace and testing. The LRF structure will be expected to manage the deployment of broader resources and local testing capacity to rapidly test people in the event of a local outbreak.

Requests for Sussex Resilience Forum partner support can be activated via the C19 Specific SRF Tactical Coordination Cell (TCC) Escalation Protocol.

Figure 8: Links between C19 HPB, LOEB and LRF Three critical local roles in outbreak planning, alongside community leadership

5.3.1 Other Pan-Sussex level working In addition to close working as part of the Sussex Resilience Forum, the West Sussex Local Outbreak Control Plan reflects robust partnerships across the Sussex Health and Care Partnership (the Integrated Care Partnership which brings together NHS commissioners and providers, public health, social care and other providers), Local Authority Public Health teams, district and borough councils teams and the PHE Surrey and Sussex Health Protection Team.

Sections within the Plan relating to data integration, and testing capacity have been jointly developed with Brighton and Hove and East Sussex Councils’ Public Health Teams, PHE and NHS partners. There are strong operational and strategic links across the Public Health Teams including regular meetings between Directors of Public Health. These arrangements provide benefits in working at scale and in working with organisations operating over a wider geographical footprint (e.g. NHS Trusts), as well as recognising that outbreaks may span more than one Local Authority.

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6 Local Outbreak Control Plan Key Themes The Government’s guidance identifies key themes which the Local Outbreak Control Plans should cover. These are: care homes and schools; high risk places, locations and communities; local testing capacity; contact tracing in complex settings; data integration; vulnerable people; local governance.

Managing outbreaks in West Sussex care homes and schools

6.1.1 Identifying and managing outbreaks in care homes Care homes are expected to follow national guidance on Admission and Care of Patients in a Care Home during COVID-19. Care homes should inform the Surrey and Sussex PHE Health Protection Team (HPT) of a single possible or confirmed case of COVID-19 within the care home.

Figure 9: COVID-19 Case and outbreak definition for care homes

The HPT will also provide initial testing for symptomatic residents, provide advice and support along with WSCC and NHS partners to help the care home to manage the outbreak. PHE HPT provide daily outbreak notifications report to WSCC and the CCG. Further details on care home outbreak management are included in Appendix 1.1 and Figure 10 below. As part of WSCC support for care homes, there are Sussex Level MDT meetings that focus on risks, issues and support to Care Providers, the Sussex Care Home Group and the West Sussex Care Home Groups. These meetings share initiatives, approaches to care homes, issues affecting the market and how the respective agencies can support. Once a week a PH led Incident Management Meeting discusses care homes with COVID-19 related concerns identified via WSCC, CCG, PHE, GPs or via NHS NECS tracker. The group agree the risk, approach and support that can be offered. Often WSCC lead the contact by the Care and Business Support team.

6.1.2 Further advice and PPE for care homes Care homes:

• WSCC Adult Social Care, with support from Public Health have created a resource to support care providers - an online resource hosted in the Provider Zone of Connect to Support. The site includes specific tiles including Infection Control and PPE and Testing which provides guidance and signposting, in addition a daily provider newsletter is issued to 1500 individuals

Possible case of COVID-19 in the care home:

• Any resident (or staff member) with symptoms of COVID-19 (high temperature, new continuous cough, or loss of or change to the individual’s sense of smell or taste), or new onset of influenza like illness or worsening shortness of breath.

Confirmed case of COVID-19:

• Any resident (or staff member) with a laboratory confirmed diagnosis of COVID-19.

Outbreak:

• An outbreak is defined as two or more confirmed cases of COVID-19 OR clinically suspected cases of COVID-19 among individuals associated with a specific setting with onset dates within 14 days

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representing care providers in West Sussex, this is supported by a small staff resource – the Provider Advice and Information Team.

• WSCC, in partnership with the CCG, are also providing infection prevention and control training to care homes.

Figure 10: CCG Flow Chart showing the infection prevention and control support offered to Care/Residential Homes with suspected/confirmed cases

6.1.3 Identifying and managing outbreaks in schools and early years settings PHE SE Surrey and Sussex Health Protection Team produced some guidance for the management of COVID-19 in childcare and educational settings. Further details on local arrangements for schools are also included in Appendix 1.3. HPT developed a planned approach to COVID-19 cases and outbreaks which defines an outbreak in a school as either:

• Two or more confirmed cases of COVID-19 among students or staff in the school/college within 14 days or;

• An overall increase in sickness absence reporting where parents report illness with suspected COVID-19 (but where no tests have been done or results are available)

In the event of an outbreak or suspected outbreak in a school, PHE SE Surrey and Sussex Health Protection Team will be notified by the school, and through Test and Trace service where there are confirmed cases. The HPT will undertake the risk assessment and provide public health and infection prevention and control advice for outbreaks and individual suspected or confirmed cases in

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accordance with national guidance or local SOPs. HPT will also notify WSCC of any COVID outbreaks in schools/educational and early years settings. On receipt of information the WSCC Education Cell will ensure that colleagues in Public Health are aware of the situation and will contact the school to offer any support required. In addition, the cell will ensure that West Sussex Communications Team are aware to enable them to assist the school accordingly.

Monitoring and management of outbreaks in schools and early years settings

HPT will undertake a risk assessment to consider the severity and spread of outbreak, current control measures and the wider context and provide public health and infection prevention and control advice in accordance with national guidance and local guidance (Appendix 1.3).

PHE HPT will inform West Sussex County Council Public Health team (pending local discussions) and jointly consider need for Outbreak Control Team (OCT). The HPT (or OCT) will help the school to identify contacts who need to isolate (any symptomatic contacts will be encouraged to access testing). HPT will also provide the school/early years settings provider with letters to be sent to contacts and non-contacts.

The HPT may advise widespread swabbing of the staff and student population, particularly in the early stages of T&T. However, it is important to note that primarily this would be to add to overall understanding of COVID-19 transmission rather than to inform the management of individual outbreaks. Arranging this will require discussion with partners in the local system.

6.1.4 Further advice and information for schools and early years settings • Department of Education’s helpline for schools - 0800 046 8687 - should respond to all

queries from schools (particularly in relation to published guidance) • WSCC Education sub-cell organising training on infection prevention and control to the

schools and early years. • Regular cascades of information, national and regional are provided for schools and early

years settings.

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Identifying and managing high risk places, locations and communities

Due to certain risk factors and transmission dynamics that are favourable for the spread of the virus, some communities, places and locations are hotspots or at high risk for the spread COVID-19. These include crowded areas, mass gatherings, religious events, public transport settings, homeless housing and seasonal worker dormitories with shared hygiene facilities, certain workplaces such as meat processing plants, certain professions such as health and social care workers, and communities with poor access to services. Details on local arrangements for specific high-risk places, locations and communities are included in the appendices. West Sussex has strong functional economic relationships with London, Surrey, South Hampshire (including the ports of Portsmouth and Southampton) and Brighton & Hove and provides gateways to international markets through Gatwick Airport and Shoreham Port7. It is also a tourist destination with historic coastal resorts, seaside attractions, countryside and market towns and villages. These characteristics may present a challenge in controlling the spread of COVID-19, particularly as businesses and tourist areas reopen.

To identify at a local level places and communities who may be at higher risk of the impact of COVID-19, partners from upper and lower tier LAs and other local organisations will need to undertake work to map out locations and also understand opportunities for non-pharmaceutical interventions (NPIs) centred on specific locations.

In thinking of how geographically targeting of NPIs may work at a local level, the experience under lockdown provides some guidance, for example:

• Public places which may be closed or have restricted access such as playground, sports facilities, beaches, parks etc

• Settings that are regulated and/or inspected – this includes care homes, schools, specific businesses

• In additions to specific locations there is the issue of mobile “settings” such as transport, deliveries, and events which can be supported and subject to control.

6.2.1 Preventative measures and outbreak management strategies There is a wide range of settings that are considered high risk, care homes and schools have been addressed above. Tier 3 and Tier 2 contact tracing may identify high risk places, locations and communities which need additional support to control the spread of COVID-19. As a preventative measure, settings will be advised to implement COVID-19 risk assessments and national guidance on effective protective measures such as social distancing, cleaning, and infection prevention and control. JBC ‘Playbook’ will also be used once available. In the event that there any parallel investigations taking place by any enforcement authority such as Health and Safety Executive (HSE) in relation to the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (RIDDOR) a representative of that authority will be invited to join the OCT, where appropriate, to ensure any conflict of roles are managed.

6.2.2 Outbreak management In the event of an outbreak, PHE SE Surrey and Sussex HPT are responsible for co-ordinating outbreak management and will work closely with the West Sussex County Council, including public

7 https://www.westsussex.gov.uk/media/11971/economic_growth_plan.pdf

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health teams, NHS and the district and borough Environmental Health Teams (as required, depending on the location of the outbreak) to facilitate a timely and proportionate outbreak response. Further details included in the Appendices

There is a need to develop local COVID-19 SOPs for specific high-risk place, locations and communities which would be implemented in the event of an outbreak. These will include clear roles and responsibilities and action needed, especially for outbreak management, based on national SOPs where and when these are available. These SOPs will assist in determining the resource capabilities and capacity implications.

6.2.3 Activation of the plan The West Sussex Local Outbreak Control Plan will be triggered where there are suspected or confirmed COVID-19 outbreaks in any setting type. PHE Surrey and Sussex HPT and West Sussex County Council will gather intelligence on COVID-19 outbreaks via the national Test and Trace service, laboratory results, and local partner intelligence about suspected outbreaks. More detail is given in the appendices. PHE will initially conduct the risk assessment with the setting, provide infection control advice and organise testing as appropriate, following internal SOPs that are being developed for responding to COVID-19 cases and outbreaks in specific setting types. WSCC will provide support to the outbreak setting and additional capacity for contact tracing, as needed.

6.2.4 Outbreak Control Teams (OCT) In the event of an identified outbreak and in line with PHE SE SOP - PHE-LA Joint Management of COVID-19 Outbreaks in the SE of England, where required, PHE will work with WSCC Public Health Team to set up a multi-agency Outbreak Control Team (OCT) meeting to coordinate the partner response. There are well established processes in place for convening OCTs and mobilising responses to outbreaks, as detailed in the health protection plans listed in 1.0 above. Where an OCT does need to be convened, this will follow the process described in the PHE SE SOP - PHE-LA Joint Management of COVID-19 Outbreaks in the SE of England. If an Outbreak Control Team (OCT) is required, following joint discussions between PHE Health Protection Team (HPT) and WSCC, partners that should be notified and considered for the purpose of inclusion in the OCT are:

• The District / Borough(s) affected (this is usually through the Environmental Health Team) • The management of the establishment if contained to one site. (E.g. Headteacher of a

school, Manager of a care home) • West Sussex CCG

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Local testing capacity - Testing in Sussex

6.3.1 Testing provision The Sussex ICS has access to 2 regional testing centres at Gatwick and the Brighton Amex Stadium and 1 locally commissioned satellite testing centres at Bexhill. The Bexhill site is on the national portal.

Mobile Testing Units (MTU) are being used across the county with deployment being prioritised via the LRF and the regional testing cell. The MTU are available to stop in a location for 1-3 days to test local residents. These are available by car or on foot and require a booked appointment. Deployment of the MTU is coordinated by the local authority and the military, with partners, based on local need. There are additionally MTU which can be deployed if outbreaks occur. MTUs can respond rapidly to change in need. It rotates to Bognor twice a month to replace the Drive Thru and provide wider community access.

Antibody Testing – As of the 3rd Augusts all NHS staff have been offered antibody testing and clinics continue to allow access. Testing has been rolled out to community pharmacists and dentists. Currently social workers and other key council staff have been offered testing by Sussex Community Foundation Trust. By Mid-September care home and domiciliary care staff will have been offered testing. All groups can currently access testing through SCFT but further options are being explored for care homes staff.

PCR (Polymerise Chain Reaction) swab testing for asymptomatic NHS staff is only undertaken as part of the SIREN research where 10% will be tested with both antibody and antigen tests. If there is an outbreak that will also activate testing of asymptomatic staff in the outbreak areas.

Through the national portal, whole care home testing is being rolled out and a revised time scale of the 7th September for all over 65 and dementia care homes to be part of the programme. This includes weekly staff testing and monthly patient testing. This will then be rolled out other care homes.

The Sussex Central Booking Team is an additional resource put in place to assist organisations with the administration of testing. The team are able to advise on testing criteria, assist with booking on the national website and book for assisted or non-assisted community testing where appropriate.

Table 3: Testing capacity SITE TOTAL TESTS PER DAY WITH

SUPPLY CONSTRAINTS CURRENT WORKING HOURS

TOTAL TESTS PER DAY WITH NO SUPPLY CONSTRAINTS CURRENT WORKING HOURS

Max theoretical capacity

RSCH/BSUH 907 1357 2488 WSHT 200 710 with Panther live 1154 ESHT 40 256 256 SASH 32 96 96 QVH 50 50 TOTAL 1179 2469 4044

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Pathology Laboratories have a daily ask of 2000 tests with the ability to increase to 3000 for SWABs (Antigen Testing) through the increase of staffing to 24/7. There are currently limitations on equipment, reagents and Southampton lab is used for extra capacity for ESHT but has no further capacity.

With the significant increase in demand through restoration and recovery programme, whole care home testing and other demands ie SIREN a full capacity and demand review is occurring in respect to the laboratories. This will include servicing, life of equipment, interconnectivity, new equipment, external support and all the administration that is required to support this.

There are currently 1100 tests per day per lab antibody testing. Which currently all labs are able to achieve, the only limitations are administration at reception and freezer capacity for long term storage.

6.3.2 Testing pathways currently in place There are several different ways that testing can be accessed by Sussex residents and staff: • Symptomatic residents can apply via the NHS website, or by telephoning 119, to either be tested

at a testing site, mobile testing unit, or receive a home testing kit. • Essential workers can be referred individually via the Sussex Central Booking Team or via the

GOV.uk site (some are eligible for asymptomatic testing). • Care homes can request whole-home testing for all residents (irrespective of symptoms) and

asymptomatic staff via the Care Home Portal. • Acute hospital patients and staff (including those who are asymptomatic, where indicated by

clinical need) can be tested in the hospital setting. Staff testing may take place as part of an outbreak, otherwise staff will go through central bookings or national portals to arrange testing.

• Outbreak testing – At the point of notification the Health Protection Team at Public Health England will arrange testing of symptomatic individuals where appropriate, in order to inform outbreak management in various settings including care homes, prisons and hostels. This will be arranged through the central booking team. If more than two symptomatic individuals the home will be risk assessed and whole care home testing undertaken, those who are –ve will be tested on day 4-7 then 6 weeks after the symptomatic patient the home will be tested then return to the pillar 2 testing regime.

• Other individuals that require symptomatic or asymptomatic testing and are unable to access it through other routes can get tested by contacting Sussex Central Booking Team, for example to facilitate placements of children or vulnerable adults in care settings such as foster care, supported accommodation, care homes or for new domiciliary care referrals. This testing is currently delivered by Assisted Swabbing teams from the Sussex Community Foundation Trust and East Sussex Healthcare Trust.

6.3.3 Current issues in testing There are a number of issues that are being discussed related to gaps in testing or changes in provision that are required. These include:

• Home testing availability for clients who require testing before admission to a care home or residential setting, or before new domiciliary care is put in place, who aren’t symptomatic.

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This is currently carried out by assisted testing teams or couriers, but home testing kits would be more appropriate.

• Home testing availability for those who won’t meet the online ID check or don’t have an email address, for example those experiencing homelessness. This testing currently needs to be carried out by the assisted testing team.

• Where necessary, there is need to set up targeted testing with BAME communities including asymptomatic testing in high risk settings

6.3.4 Ongoing Testing Requirements Ongoing testing requirements will need an integrated flexible model, to ensure no community is disadvantaged and to ensure all the national requirements and local needs are met. The current funding for the programme is through the COVID-19 funds that NHS can access. A business case will need to be developed to ensure ongoing funding past 1st October. This may require a review of provision and prioritisation of services.

The model should include:

• Mass testing which can be delivered through: o Drive Thru whether static sites as stated above, national and local centres or using the

Mobile Testing Unit. (These increasingly will take walk-ins as well as those driving-through)

o Home Testing Kits delivered through the national portals. Access and delivery of this may change with time and local ownership has been indicated regionally.

o University, schools may be delivered through pillar 2 awaiting guidance

• Niche-testing for those who need support: o Supported through the central booking team directing people to the service most

appropriate for the individual or group. o This could be through a national/Drive Thru or to a local service o Local services could be a mixed model of:

Locally delivery and pick up of swabs for self-swabbing whether to individuals or group (home, organisation, community) as required by public health, safeguarding teams or as appropriate.

Undertaking of swabs which require an assistant. A trained individual would need to be involved to actually undertake the swabs.

A modified walk-in set up for larger numbers, this may be supported by the MTU if the national model is able to change. This may be within a town centre, village, industrial estate, factory, university etc where an outbreak is occurring to get larger numbers in a contain area.

For care homes/other environments where outbreak support and management is required, testing in response to PHE or it may need individuals to be trained to enable them to undertake whole home swabbing. This may be linked to other support that will be provided in these settings.

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6.3.5 Testing Capacity Investments • With the current models and understanding of demand will be monitored to over the next

month to ensure flexibility and capacity to manage outbreaks. Leading to greater understanding of requirements in the flu season. There is already stress in the system, so a review of the pathology aspects has started and this will be followed by the testing models.

• The future models will require investment and commissioning. • National guidance on on-going requirements for testing will need to be taken into account

including point of care testing and flu/Covid-19 all in one test. • Running costs associated with new centrally funded testing machine at ESHT. The case for an

additional machine at ESHT is awaiting national agreement. • Point of Care testing equipment should be available by October the costs of running these

and the impact on other testing will be taken into account.

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Contact tracing in complex settings

6.4.1 Definition of complex settings The NHS Test and Trace service Tier 1 will identify and investigate outbreaks in complex settings as set out in the Test and Trace Tier system. PHE Health Protection Team’s Standard Operating Procedure (SOP) identified some of the complex settings and high-risk settings for escalation to Tier 1, which include cases:

6.4.2 Local arrangements Details of arrangements in some complex settings such as prisons, homeless communities, and workplaces are included in appendices.

• Cases living or working in care home/long term care facility or other care facility for those with complex needs

• Cases in Healthcare workers • Cases in Emergency Services workers • Cases in Border Force and Immigration officers • Cases who attended healthcare for non COVID reasons • Cases in those living or working in Prison or other places of detention • Cases in those attending or working in special schools • Cases in those living in homeless hostels or shelters or refuges and similar residential settings • Cases attending Day care centres for older/vulnerable people • Cases with concerns about deductive disclosure • Cases where contacts can’t be identified without disclosure of name to employer or other third

party • Cases or employers unwilling to provide information

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Data integration

Given COVID-19 knows no administrative boundaries, it is obviously vital that work to tackle the pandemic is conducted as seamlessly as possible across different geographies and organisations.

For this reason, sections relating to pan-Sussex workstreams, including this section on data integration, have been drafted jointly across the three local authorities within the Sussex Health and Care Partnership i.e. Brighton and Hove, East Sussex and West Sussex councils. In relation to data, strong local and regional links have been developed, including a weekly South East Health Public Health Intelligence meeting led by Public Health England, bi-lateral working between authorities on specific issues and cross-organisational working and data sharing agreements established at speed on specific datasets.

6.5.1 Data objectives To combat the pandemic at a local level, it is vital that there is access to timely and robust data; including data relating to testing, the number of cases, local outbreaks in places such as schools, hospitals and care homes, hospital use and deaths. There is an increasing range of data being produced relating to COVID-19 and datasets have expanded as the response to the pandemic has developed. Some datasets are in the public domain, others are, and will remain, confidential and restricted. At a local level Public Health, local authority and NHS staff are seeking to maximise the use of available data to ensure a quick, targeted and transparent response. To do this we need to ensure that we have good access to data being produced including by the Joint Biosecurity Centre and NHS; we need to be vigilant of change such as increasing number of cases or hospital admissions; we need to produce clear summaries to support staff tackling outbreaks; and we need to support the transparency and accountability of decisions taken. Much of this work will be coordinated Sussex wide, through the Sussex COVID-19 Data and Modelling Group whilst ensuring a local focus. Objective 1: Staff in local authorities will secure access to the range of data available, for this we will:

• Have a clear understanding of the data flows, such as test and trace data and information from the newly established Joint Biosecurity Centre, and raise concerns where information is not forthcoming;

• Work with local and regional partners to gain access/develop further data feeds which will inform outbreak control measures (such as Public Health England, Environmental Health)

• Ensure the Sussex Integrated Dataset (SID), an anonymised linked record level dataset, is developed to support this workstream; in relation to COVID-19 this will help to understand infection rates in specific areas and groups and in the longer term understand the recovery and on-going support needs of people affected.

THIS IS BEING DRAFTED BEFORE THE WORK OF THE JOINT BIOSECURITY CENTRE BEING ESTABLISHED AND CLARITY OF DATA FLOWS HAS BEEN RECEIVED AND WILL NEED TO BE REVISED IN LIGHT OF THIS

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• We will work with partners in District and Borough Councils to utilise data, for example to identify high risk groups and settings and tackling outbreaks. We will explore how data systems can be shared and accessed.

Objective 2: Using the range of data, we will be highly vigilant (“proactive surveillance”) in monitoring change:

• There will be proactive surveillance by reviewing a broad range of indicators which may provide an early warning of outbreaks or possible community transmission

• We will have, and further develop, our understanding of high-risk places, locations and communities

Objective 3: Staff tackling outbreaks will have access to robust and concise information and be supported in their use of data; this will include:

• Information relating to the local response to outbreaks (e.g. care homes or schools), including providing an understanding and quantifying the numbers involved and the areas/settings impacted

• Help to identify similar settings of concern • Modelling possible scenarios.

Objective 4: We will seek to maximise the transparency of local decisions:

• There will be consistent reporting to each local authority Outbreak Engagement Board and support where possible wider dissemination working with local Communication teams

• Provide data to the public in a clear and transparent way, and demonstrate how this information is used, to inform local decisions.

• Clearly note the sources of data and which datasets are, and are not, in the public domain.

6.5.2 Data arrangements currently in place Existing arrangements for being notified by the PHE Local Health Protection Team (PHE HPT) about individuals with positive COVID-19 tests will remain in place. Across Sussex there is a Covid-19 Data and Modelling Group, which reports to the Local Health Resilience Partnership (LHRP). This was established in March 2020 as a response to the pandemic and is comprised of staff from Public Health Intelligence teams, CCGs, the Sussex ICS, Sussex Partnership NHS Foundation Trust, Adult Social Care and the University of Sussex. The group’s focus has been around modelling the pandemic, for example modelling hospital activity and deaths. It is currently (June 2020) developing a series of early warning indicators which are currently being developed into a shared tool, which will be used to alert when indicators are increasing across Sussex and for each council and require further investigation. The group is also coordinating efforts to ensure that evidence of inequalities is collected and analysed. Data to support this plan is sourced from a range of data sources, including PHE HPTs, the Office of National Statistics (ONS), the Sussex local registry offices, local health and care partners, national

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COVID-19 reporting, Public Health England daily and weekly reporting (including Test and Trace reports provided to local authorities) and the Care Quality Commission. Public Health England have confirmed, subject to the correct data sharing protocols being in place, that Local Authority Public Health teams can receive record level datasets including postcode (with other identifiers removed). Of relevance for this plan is daily reporting by PHE on outbreaks in care homes, schools and prisons and the hospital on-set COVID-19 reporting by trusts to NHS England. The three Sussex Public Health teams also receive the Contact Tracing Upper Tier Local Authorities (UTLA) report daily, the Contact Tracing Epi report (weekly), and will receive the Contact Tracing quality and monitoring report (weekly). Links to the national Joint Biosecurity Centre (JBC) have yet to be made.

6.5.3 Data arrangements that need to be set up It is anticipated that the following arrangements will need to be set up:

• Extend the role of the Sussex Data and Modelling Group, currently reporting to the Sussex Local Health Resilience Partnership, to oversee the data integration work.

• Map and secure regular automated dataflows from a variety of organisations to provide the intelligence to support our system. This includes but is not limited to data from the national testing programme, the community testing programme (Mobile Testing Units (MTU)), and the national contact tracing programme. It is currently unclear whether the national JBC will provide a single source of data

• Agree information sharing protocols. • Develop insight reports to support the various governance structures.

6.5.4 Data sharing and Data security Given the challenge of tackling this pandemic, all agencies will assume they are required to adopt a proactive approach to sharing information by default, in line with the Instructions of the Secretary of State, the Statement of the Information Commissioner on COVID-19 and the Civil Contingencies Act. The Secretary of State has issued 4 notices under the Health Service Control of Patient Information Regulations 2002 requiring the following organisations to process information: NHS Digital, NHS England and Improvement, health organisations, arm’s length bodies, local authorities, GPs. These notices require that data is shared for purposes of coronavirus (COVID-19) and give health organisations and local authorities the security and confidence to share the data they need to respond to coronavirus (COVID-19). These can be found here https://www.gov.uk/government/publications/coronavirus-covid-19-notification-of-data-controllers-to-share-information The data sharing permissions under the Civil Contingencies Act 2004 and the statement of the Information Commissioner all apply. Under the Civil Contingencies Act 2004 (CCA) and the Contingency Planning Regulations, Category 1 and 2 responders have a duty to share information with other Category 1 and 2 responders. This is required for those responders to fulfil their duties under the CCA

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Table 4:Data integration tasks Action (Sussex Wide) Date Lead Officer Internal /External

partners involved

• Expand role of the Sussex Covid Data and

Modelling Group to include data integration to support Local Outbreak Control Plans at a Sussex and UTLA level.

• Readjusting plans to reflect what the JBC will

provide to local areas.

WSCC Principal manager, Public

Health Research unit

Sussex wide Data and Modelling

Group (membership

above)

• Complete work on early warning indicators

• Modelling possible subsequent waves of the pandemic, based upon the assumptions published by SAGE and working.

WSCC Principal manager, Public

Health Research unit

Data and Modelling Group,

University of Sussex

(modelling)

• Map and secure regular automated dataflows from a variety of organisations to provide the intelligence to support our system. This includes but is not limited to data from the national testing programme, the community testing programme (SECAMB/Mobile Testing Units (MTU)), and the national contact tracing programme PHE, HPT, NHS.

Note: It is currently unclear whether the national JBC will provide a single source of data. This includes data to provide evidence of inequalities and high-risk groups.

WSCC Principal manager, Public

Health Research unit

Sussex wide Data and Modelling

Group (membership

above)

Local data group for vulnerable groups cell?

Action (Individual LA)

• Work with District and Borough councils to widen the access to and sharing of data relating to local outbreaks, settings and events.

• Establish named contacts for data in each of the local authorities, specifically in relation to: o Communities at higher risk of infection and

the impact of COVID o Specific settings and events at a local level

Note: it is anticipated that named contacts should, at least, include Environmental Health staff, and community development/engagement.

WSCC Principal manager, Public

Health Research unit

West Sussex CC

• Provide updates as requested to senior managers and local Members, and report to the PH Functional Cell and respond to external requests for information.

WSCC Principal manager, Public

Health Research unit

West Sussex CC

• Work closely with the local HPT, lead PH Consultant to establish systems to identify and examine outbreaks.

WSCC Principal manager, Public

Health Research unit

West Sussex CC

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• Work closely with West Sussex Test and Trace sub-group to support decisions taken in relation to testing capacity.

WSCC Principal manager, Public

Health Research unit

West Sussex CC

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6.5.5 Data Sources to Support the LOCP

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Supporting vulnerable people

Supporting vulnerable people arrangements currently in place West Sussex County Council in partnership with district and borough councils, launched Community Hubs across the county offering assistance to those who need additional help and support due to the impact of COVID-19. This may include those who for any reason are without a local support network, are alone, struggling to cope, worried, unwell, need information, advice and guidance or cannot get medicine, food or other essential supplies. Over 14,000 inbound contacts have been received either by telephone or online since its launch on 25th March.

The Community Hub response at county level, has been complemented during the first phase of lockdown by a raft of local support mechanisms operating at district and borough level, involving their D&B staff, voluntary and community organisations and neighbourhood activity. Largely the West Sussex response can be described as meeting the requirements for 3 groups of individuals:

• Extremely clinically vulnerable people who are shielding. This currently covers over 35,000 people in West Sussex and has been led by WSCC.

• Clinically vulnerable people (over 70s, people with specific medical conditions and pregnant women) and those locally identified as requiring support e.g. known to WSCC, District & Boroughs or health partners such as the homeless, and those who need safeguarding such as children and vulnerable adults.

• Other vulnerable people (not at increased risk due to medical reasons) who are at risk due to a change in circumstances, or the impact of the restrictions put in place through social isolation, worsening mental or physical health, risk of violence.

The Community Hub has provided centralised coordination of support to those in the clinically vulnerable groups who were advised to shield. Those identified by a GP or clinician as being in the extremely clinically vulnerable group were encouraged to register with the national shielding service to access a weekly free food parcel, medicine delivery or assistance from the NHS volunteers. The Community Hub worked closely with the National Shielding Service to locally manage any additional needs such as welfare, wellbeing, social contact or care and support requirements.

The Community Response Team was established to provide on the ground support for those requesting immediate help from the Community Hub. West Sussex residents can contact the Community Hub between 8am-8pm 7 days per week either by phone on 0330 222 7980 or www.westsussex.gov.uk/covid19communityhub

The range of support offered via the Community Hub has grown as it developed and now includes contract arrangements for the provision of food and basic supplies. An extensive programme of outbound calls has been scheduled to ‘keep in touch’ with those shielding, already known to health & social care services, or who have made contact via the Community Hub. This has enabled a regular check-in to identify any change in circumstances, practical information and advice (e.g. digital coaching to facilitate online access) or an onward referral to voluntary, community or partner organisation.

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Across West Sussex, local authorities and health partners commission and work closely with Community and Voluntary Organisations to provide services to vulnerable people. Working in partnership with the voluntary sector has proactively adapted, to continue to deliver services, utilising new approaches (e.g. digital), addressing the specific needs resulting from COVID-19 which are ever more complex and varied as circumstances evolve. Working together all partner organisations are collaborating to ensure that vulnerable people and those who find themselves temporarily in need of support can get the help they require. Together across West Sussex we have collectively responded to tens of thousands of requests for support, advice and guidance.

6.6.1 Changes in national guidance Following the most recent government announcement on 22nd June outlining a phased relaxation of shielding advice in response to the latest scientific evidence, West Sussex County Council will continue to work with key partners to support shielded residents. The Community Hub will provide on-going support during the July transition phase, following which the nationally organised arrangements for food delivery will cease for the extremely clinically vulnerable. It is intended to maintain the Community Hub for the foreseeable future to support those who are impacted by COVID-19.

6.6.2 Supporting those who are self-isolating PHE have confirmed that three questions have been included in the NHS Test and Trace questionnaires for people to self-identify as vulnerable or that they may need support. This information will be provided to NHS Business Services Authority (BSA) who will text people with the relevant local authority helpline details and provide links to websites that allow them to find the numbers of their local support helplines. The West Sussex Hub provides support and information relating to other issues such as financial support whilst self-isolating. A list of people will not be provided directly to local authorities daily, as the preferred option of local government colleagues was to use communication from NHS BSA.

A mechanism for including people who have requested support via the helpline while they self-isolate as a result of Test and Trace, will need to be included in the food and medicines support scheme, where it is identified that they have no other means to get help. As people will be self-isolating for a short period of time (either 7 or 14 days), this support will need to be timely, and flexible to support a cohort of people that will be constantly changing. The West Sussex Community Hub will continue to meet this support offer.

6.6.3 Ongoing monitoring of systems to support vulnerable people The Community Hub will continue to assess:

• The patterns in demand for food, medicine and support, acknowledging that this may fluctuate in scale and geographical distribution at any given time based on the number of outbreaks and specific setting type

• The resource requirements to maintain the Community Hub offer, including the urgent critical need response, proactive outbound contact and regular ‘keeping in touch’ calls.

• Any amendments required to the contracted food and supplies provision, including the balance of urgent same day demand with scheduled home delivery.

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• How best to sustain the Community Hub to meet demand generated by a second wave and consider how to embed the principles and approach into the longer-term prevention model to support health and social care systems.

Prevention It is important that outbreak activity in West Sussex is focussed on prevention as well as response. There are two aspects to this. Firstly, organisations and individuals should aim to prevent infection from COVID-1 9 through activities and actions in line with government guidance such as: social distancing; cleaning, handwashing and hygiene procedures; COVID-19 risk assessment; encouraging home working. Secondly, action should take place to reduce exposure to behavioural risk factors which increase the risk of diseases associated with poorer COVID-19 outcomes such as diabetes and cardiovascular disease.

The appendices include further information on prevention of COVID-19 spread in high risk and complex settings such as prevention in workplaces, BAME population, homeless housing. Furthermore, district and borough councils are currently in the process of drafting their own C19 prevention plans which contain tailored approaches to preventing the spread of COVID-19 within their localities.

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7 Communications and engagement Effective communication is a key element in managing and mitigating the COVID-19 pandemic. The Local Outbreak Engagement Board will play a key role in public facing communications and engagements, to strengthen national and local messages.

A comprehensive communications plan is in development to support the delivery of the LOCP. The LOCP communications plan aims to set out communication activity required during set up and roll-out of the local outbreak plan and also what would be required during any local outbreak. As part of outbreak management, Public Health England (PHE) also plans and delivers communications particularly for specific settings where an outbreak has been identified. This plan therefore aims to facilitate and support the work of PHE South East Health Protection Team, Outbreak Control Teams (where convened) and other agencies to ensure communications are consistent, timely and reach the targeted audiences.

Clearly this subject matter has the potential to cause anxiety and worry for residents, organisations and businesses and will require clear, simple communication which addresses questions and gives clear information about what they need to do when and how.

It is vitally important that the communications activity targets all groups and demographics as the approach will only work if everyone takes action and follows the guidelines. The communications approach will use insight to target specific groups who are traditionally hard to reach and, in particular, those who appear to be more affected by COVID-19, for instance there is evidence to show the BAME community is affected disproportionately. Similarly, some disabled groups will be more vulnerable to the effects of COVID-19.

This work on reaching hard-to-reach groups will be done by using multiple channels and utilising community groups and teams both within WSCC and more widely through the voluntary and community sector. This work will be developed further in the coming weeks.

Set-up communications • The setting up of a Local Outbreak Engagement Board and the plans around local outbreak

should be open and transparent without causing alarm amongst the community. • The County Council should be clear about the ask from Government, our roles and

responsibilities, and what that could mean for communities. • Particularly key will be communication with stakeholders who might be impacted or affected

by the plans. • The communications approach prior to any outbreak would be clear key messaging across all

County Council channels. • All communications will be written with due consideration to patient confidentiality • We aim to reach our residents and stakeholders in a variety of ways to ensure messaging

was widespread. We will work closely with district and borough and health partners as well as the voluntary and community sector to make sure we reach as many of our residents as possible.

• A key area of consideration is that much of the messaging around prevention of a local outbreak or action to take when there is one, could be different to the messaging being promoted nationally by Government or, indeed, locally by neighbouring authorities who do not have an outbreak. Therefore, it is really important that the messaging is clear and has direct calls to action for local residents.

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Key messages • We all have a part to play in keeping our community safe from the spread of COVID-19,

building on the good work and efforts of individuals, communities and organisations to date • We know that COVID-19 has impacted on all of our lives and many of us have made huge

sacrifices; not seeing family and friends for many weeks. We also know this has been a tragic time for so many people. However, to try and keep our community safe we need to ask people to continue to take action for a little bit longer.

• Even while restrictions are easing, we must continue do our bit by following current government guidance on social distancing socially distant - stay at least 2 metres (3 steps) away from anyone you do not live with (or anyone not in your support bubble) when outside your home

• Stay at home if you are symptomatic (high temperature, new continuous cough, or loss of or change to the individual’s sense of smell or taste)

• Good hand hygiene is essential – wash your hands with liquid soap and water often – do this for at least 20 seconds. Use hand sanitiser gel if soap and water are not available

• Cover your mouth and nose with a tissue or your sleeve (not your hands) when you cough or sneeze and put used tissues in the bin immediately and wash your hands afterwards

• If there is a local outbreak, that is we start to see a spread of COVID-19 in a specific place we, as a local community will need to work together and take action

• That local place might be a care home, school or workplace. It could be a street or neighbourhood, part of a community or a town or city. It could even be an organisation.

• It is essential that people get tested if they are symptomatic with symptoms of COVID -19 or when they have been told to get a test by the contract tracing service as this will help understand where the virus is circulating

• If you are advised that you are a contact of a case and need to self- isolate at home it is essential that you do

• We have been asked by Government to make sure we have plans in place to limit the spread of infection and contain the virus

• These plans include putting in place more staff to monitor the spread of infection and contain the virus

• If a part of our community was affected, we might, as a community, need to take action, and this could involve asking buildings or businesses to carry out cleaning or even close temporarily to prevent further spread

• We would only take these steps if we thought residents were at risk of COVID-19

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8 Equality monitoring

Equalities duty Under the Equality Act 2010, public bodies are subject to the public sector equality duty which requires them, in the exercise of their functions, to have due regard to the need to:

• Eliminate unlawful discrimination, harassment and victimisation and other conduct prohibited by the Act.

• Advance equality of opportunity between people who share a protected characteristic and those who do not.

• Foster good relations between people who share a protected characteristic and those who do not8.

The equality duty covers the following nine protected characteristics:

Additional factors which should be considered include employment status, family and friend carers, and people who have recently experienced homelessness or rough sleeping (most of whom are currently accommodated).

8.1.1 Equalities related COVID-19 risk factors Evidence has shown that people with some protected characteristics are also at increased risk of infection and/or death from COVID-19, alongside other risk factors9. The risk factors identified are outlined below:

• Age – diagnosis rates increase with age and deaths from COVID-19 have an older age distribution

• Gender – risk of dying is higher in males than females • Deprivation - People who live in deprived areas have higher diagnosis rates and death rates

than those living in less deprived areas – especially among people of working age. • Ethnicity – Risk of dying higher in BAME groups than in White ethnic groups (highest in Black

ethnic groups and Bangladeshi ethnicity, but also people of Chinese, Indian, Pakistani, Other Asian, Caribbean and Other Black ethnicity)

8 https://www.equalityhumanrights.com/en/advice-and-guidance/your-rights-under-equality-act-2010

9 PHE Disparities in the risk and outcomes of COVID-19 https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/890258/disparities_review.pdf

• Age • Disability • Gender Reassignment • Marriage and Civil Partnership • Pregnancy and Maternity • Race • Religion or Belief • Sex • Sexual Orientation

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• Occupation - men working as security guards, taxi drivers and chauffeurs, bus and coach drivers, chefs, sales and retail assistants, lower skilled workers in construction and processing plants, and men and women working in social care, nursing auxiliaries and assistants had significantly high rates of death from COVID-19.

• Inclusion health – increased deaths among people born outside the UK and Ireland and higher diagnosis rate among rough sleepers.

• Living in a care home - there have been 2.3 times the number of deaths in care homes than expected – from COVID-19 and other causes.

• Co-morbidities – diabetes, hypertensive diseases, chronic kidney disease, chronic obstructive pulmonary disease and dementia; an increased risk of adverse outcomes in obese or morbidly obese people.

Protected characteristics in West Sussex Figure 11:Overview of protected characteristics in West Sussex

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8.2.1 Local arrangements Details on local arrangements relating to outbreak management are included in the Appendices and the equality monitoring report in Appendix 4. The Sussex BAME COVID-19 disparity programme is addressing the disproportionate impact of COVID-19 on people from BAME backgrounds. The programme has two work streams: 1. Workforce programme – focused on BAME health and care staff across Sussex. 2. Population programme - BAME and Vulnerable group Locally Commissioned Service – delivered

through GP surgeries Part A – Proactive and reflective BAME specific activities

• Identify BAME patients from practice list who might benefit from specific interventions to reduce their risk of COVID-19 related mortality;

• Improve communication and engagement with local BAME communities, working with BAME community and voluntary sector and improving diversity of patient participation groups.

Part B – Reactive care to vulnerable individuals • Offer a supportive monitoring protocol for patients in vulnerable groups who

develop COVID-19.

The programme includes community research and engagement and looking for alternative appropriate methods to ensure information reaches these communities. WSCC and Crawley Borough Council are also working together to respond to inequalities in the impact of coronavirus in Crawley, including engaging with the voluntary sector and local faith communities. Communications and engagement about test and trace, advice to self-isolate, and outbreak planning and response will be coordinated with these wider programmes.

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9 Appendices

High risk and complex settings

Appendix 1.1 Care homes (Adults) Appendix 1.2 Children’s Care homes Appendix 1.3 Schools and educational settings Appendix 1.4 Out of school childcare settings Appendix 1.5 Black Asian Minority Ethnic Groups Appendix 1.6 Homeless communities Appendix 1.7 Gypsy, travellers and Roma communities Appendix 1.8 Faith Settings/places of worship Appendix 1.9 Other workplaces Appendix 1.10 Prisons and other prescribed places of

detention Appendix 1.11 Hospitals Appendix 1.12 Primary care Appendix 1.13 Mental health and community trusts Appendix 1.14 UK Ports of Entry Appendix 1.15 Tourist attractions and travel accommodation

Local Boards Terms of Reference

Appendix 2.1 COVID-19 Health Protection Board Terms of Reference

Appendix 2.2 Local Outbreak Engagement Board Terms of Reference

Other appendices

Appendix 3 Local Authority Powers Appendix 4 COVID-19 Contain Framework briefing Appendix 5 Equality monitoring report Appendix 6 PHE-LA SOP