Introduction
All upper tier Local Authorities were required to produce a Local Outbreak Management Plan by the end of June 2020. This latest update incorporates changes to the plan in the light of the current phase of the pandemic response and publication of the Government’s COVID-19 Response – Spring 2021 document.
Local Authorities have a significant role to play in the identification and management of COVID-19 outbreaks. Directors of Public Health, and Local Authorities Public Health teams, have a leadership role in ensuring there are plans in place with the necessary capacity and capability to deploy resources in a timely way to respond to COVID-19 outbreaks and help prevent spread.
The aim of the Local Outbreak Management Plan is to define how local government works with the NHS Test and Trace Service to ensure a whole system approach to preventing and managing COVID-19 outbreaks. Responding to local outbreaks must be a co-ordinated effort across Public Health England local health protection teams, the NHS, Social Care, Education, Police, the private sector, employers and the community and voluntary sector. Members of the general public also have a vital role to play in reducing spread of the virus and preventing outbreaks, both in terms of following national guidance and social distancing guidelines, following good hand and respiratory hygiene practices, arranging testing and self-isolating as required.
Governance and Partnership Arrangements
Working in partnership is crucial to preventing spread and responding to local outbreaks. While the response to outbreaks will be led by the local Directors of Public Health, success will require a co-ordinated partnership response. Which agencies are involved will depend somewhat as to the outbreak setting, but it is critical that all organisations understand the plan and the role and actions they are expected to take in a response.
Managing outbreaks in workplaces, specific settings such as schools and care homes and within the community is a core function of public health and environmental health. It has therefore been important that arrangements to manage local COVID-19 outbreaks have built on existing plans and structures.
The following governance arrangements support the Torbay Local Outbreak Management Plan. These are described diagrammatically in Appendix 1.
Regional arrangements
Figure 1: Regional Test, Trace, Contain & Enable Board, Regional Delivery Group and interdependences
A new Regional Delivery Group has been established to sit under the Regional Test, Trace, Contact & Enable Board. The Delivery Group’s primary role is to consider the actual delivery of the strategic decisions made by the Board. The Delivery Group has identified the following key priorities and programmes and have identified two Directors of Public Health to work alongside Public Health England colleagues to help drive the priorities:
- Testing
- Contact Tracing
- Vaccinations
- Communications
- Surveillance and Intelligence
- Health Protection and outbreak management
Devon and Torbay Covid-19 Health Protection Board
This is chaired by the Director of Public Health for Devon County Council, with the Torbay Council Director of Public Health as vice chair. This Board is an Executive-level Partnership Board and has the following key responsibilities:
- Local outbreak management plan
- Resource deployment
- Data and intelligence (linking to national Joint Biosecurity Centre)
- Leading the local Public Health response alongside PHE and NHS Test and Trace
- Assurance and reporting to Local Outbreak Engagement Boards and LRF
Members include:
- Devon and Torbay Councils, Devon district and unitary councils (public health, social care, environmental health and housing, public protection), PHE, CCG, Police, schools and colleges, business and tourism, military liaison. Plus in advisory capacity: Consultant in Public Health/Public Health Intelligence; Communications Lead; DCC Equalities Officer.
Torbay Local Outbreak Engagement Board
This is chaired by the Leader of the Council.
Responsibilities include:
- Political oversight of the local delivery of the local outbreak management plan and response
- Communicating and engaging with residents and communities.
Members include: Police, ICO, CCG, GP/PCN representative, Headteacher, South Devon College Principal, CDT, Healthwatch, Faith leader representative, ‘Imagine This Torbay’, Torbay Together, TDA/business leaders, LA officers.
Torbay Covid-19 Tactical Cell
Chaired by Torbay Public Health, this cell oversees and manages delivery of the Local Outbreak Management Plan, including the prevention of and response to outbreaks in all settings. Members include public health, community safety, environmental health, adult social care, education, and communications, NHS and Peninsula Testing lead. The cell reports to the Torbay Covid-19 Incident Management Team and links formally to both the Devon & Torbay Covid-19 Health Protection Board and the Torbay Local Outbreak Engagement Board. The Cell also links to the Recovery Cell so that response and recovery planning continue in parallel.
Key Themes
1. High risk settings, communities and locations
The plan addresses capability to respond all local COVID-19 outbreaks. However there are settings which are potentially more likely to have outbreak, or to be more complex to deal with. Torbay has had specific plans in place with pre-agreed actions to respond to cases and outbreaks in these higher risk settings. Standard operating procedures have been developed detailing how we will respond to outbreaks in settings such as schools, hospitals, businesses and hostels. Settings based action cards and standard operating procedures have been developed for all risk settings and are used to guide outbreak prevention and response.
Throughout 2020/21 cases and outbreaks have been managed in all settings, in particular with strong partnership arrangements supporting outbreaks in the care sector, schools, and businesses. Learning from outbreaks has been fed back into management plans to enable a continued improvement in the response.
2. Vulnerable and underserved communities
We know from the number of local people identified within the ‘shielding’ category as a response to COVID-19 that there are many people and families who need particular support during this pandemic. There are also some people and families who find self-isolation difficult and may require additional support in order to self-isolate. The local authority has worked with key partners in the statutory, voluntary and community sectors to ensure that people who do need additional help are guided to appropriate help and support. Details are included in section 8.
3. Compliance and enforcement
Torbay Council developed a ladder of intervention, leading through to closures and wide community restrictions, which was endorsed through the Tactical Cell and the Devon and Torbay Health Protection Board in 2020.
Our emphasis is on partnership with local business and residents to promote Covid safe behaviours and pre-empt the need for more formal action as far as possible.
Local good practice example
Settings Intelligence and Enforcement Group
The Public Health response team has established a weekly Settings Intelligence and Enforcement Meeting involving Environmental Health, Licencing, Legal and Police. This increases to twice weekly in times of high activity. The group pools intelligence from all partners and follow up action is agreed on a collaborative basis, focusing initially on prevention. Public Health feeds in issues identified through contact tracing, settings based cases and outbreaks, Community Champions, and through the public inbox.
The partnership has enabled a more rapid response and a lower level intervention to tackle non-compliance at an early stage. All parties have found the collaborative approach valuable. The forum is also being used to support business re-opening in line with the Government Roadmap.
4. Resourcing
Over £300m was allocated nationally to support implementation of test, track and trace at local authority level. Torbay has an allocation from the Local Authority Test and Trace Service Support Grant, and additional funding to support specific components of the programme.
Funding has been allocated to support the following areas:
- Outbreak response
- Local track and trace capability
- Regional and local testing capacity
- Support for vulnerable groups, including physical and mental wellbeing
- PPE and infection control
- Vaccination delivery
- Communications and engagement.
5. Communications and engagement
Providing up-to-date guidance, information and advice to the general public and key stakeholders is a key element of the plan. Agreeing the local message and the communication channels to ensure there is consistency in the messaging from key local organisations is vital to avoid confusion. Engaging and involving stakeholders and key individuals in the development and delivery of the message is also crucial.
A communications and engagement plan has been developed focusing on behaviour change and key messages to particular target audiences such as young people and working age adults in order to build trust and confidence within the general public, communities and partners. Communications leads across PHE and wider Devon liaise closely, in particular ensuring clear responsibilities and communications routes during outbreaks.
The local outbreak engagement board has responsibility for communicating and engaging with residents and communities. A communications lead sits on the Torbay Local Outbreak Engagement Board in an advisory capacity.
Local good practice example
Torbay Covid Champions
Torbay Covid Champions programme was introduced in October 2020 and has developed into a network of over 200 local people. Champions are from a wide range of backgrounds, with representation from education, businesses and the care and voluntary sectors as well as members of local communities. They receive regular information - through regular bulletins and webinars - about the management of the pandemic and how to operate in a Covid safe way, and to share with their networks. Champions are also a valuable source of advice to the Council, helping to shape messages in a way that will have most impact locally and reach as many members of the community as possible.
6. Data integration and information sharing
The need for local, timely, high quality data and surveillance is a critical factor. A consistent method of data collection and integration is being agreed across the South West. This enables transparency and consistency for data analysis, interpretation and comparison purposes.
The Department of Health and Social Care National Testing Programme, NHS Digital and NHSX have developed a data dashboard which is available for local use. This data dashboard, alongside the data produced by the Joint Biosecurity Centre, and local data and intelligence provide the COVID-19 Health Protection Board with the necessary timely data and surveillance information to prevent and control the transmission of COVID-19 and to work with the Local Outbreak Engagement Board to engage with and communicate with stakeholders and the wider public.
The agreement of local data flows, pathways and information sharing protocols is a key priority. Locally intelligence work has focused on:
- Mapping high risk locations and communities of interest
- Sharing intelligence to map cases and contacts
- Data integration
- Assessing local rates of infection and any patterns of spread.
Core aspects of response
7. Testing
Nationally, NHS Test and Trace brings together four tools to control the virus.
There are two pillars to the national testing service:
Pillar 1 Local NHS lab based testing for key workers and others (Torbay pillar 1 capacity has been helpfully deployed to support testing of residents and staff in care homes and other key groups).
Pillar 2 Commercial testing for NHS, Social Care and other sectors expanded to include members of the public with symptoms. Testing is delivered through regional testing units (RTUs), mobile testing units (MTUs like the one deployed in Torquay) and local testing units providing agile deployment during outbreaks.
Pillars 3, 4 and 5 Cover antibody testing, surveillance and diagnostics.
Ensuring access to testing for both people who have symptoms and those who do not (asymptomatic) is a critical component of the Government’s recently published roadmap. Both symptomatic and asymptomatic testing capacity has increased significantly.
The use of lateral flow devices for regular testing of asymptomatic people is being increased significantly through the NHS Test and Trace programme and this will include the ability to collect kits, or to order tests online for home delivery. These tests are focused three objectives:
- Test to Protect (those in highest risk and prevent transmission)
- Test to Find positive cases (help reduce transmission in the community)
- Test to Enable (support return to social and economic activities)
Community based asymptomatic testing has been introduced for specific sectors:
- NHS and care staff
- Schools and colleges
- Workplaces where cannot work from home.
In Torbay provision is through a combination of workplace based testing, home testing, and at an Assisted Testing Site in Paignton which has been operational since 5 March 2021. The local testing strategy complements national testing routes and focuses on:
- Support for symptomatic testing
- ‘Test to find’ asymptomatic testing
- Development of surge capacity in the event of new variants or major outbreaks.
As restrictions are lifted, having a comprehensive local and national testing programme is crucial to help identify asymptomatic people who are infectious and ensuring that they isolate to help break the chain of transmission.
If a new Variant of concern (VOC) is identified by Public Health England, Operation Eagle is activated. This includes surge (PCR) testing in an agreed location identified by PHE with associated communications, tracing and control measures to help reduce any onward transmission. Torbay, in collaboration with partners within the Peninsula, has been developing local plans to respond swiftly if required to undertake surge testing.
8. Contact tracing
There are two key elements to the National Contact Tracing Programme:
- The NHS App
- Call handling and contact tracing operating across 3 Tiers:
Tier 3: a national call-handling service of approximately fifteen thousand individuals who will provide advice to contacts using scripts;
Tier 2: a national service comprising approximately three thousand health care professionals interviewing cases and identifying contacts.
Where Tiers 3 and 2 identify complexity or a context of concern (e.g. a school, health setting, care home, work-base) they will escalate to:
Tier 1: a regional and local service provided by Public Health England Health Protection Teams
Local good practice example
Local Enhanced Contact tracing and Covid Marshals
Torbay has established a local enhanced contact tracing function which has been operational since December 2020. This works in partnership with NHS Test and Trace, receiving cases who have not been able to be contacted within 24 hours, and identifying their contacts for Test and Trace to follow up. This function is integrated into the Torbay response team, enabling a more streamlined approach to tracing and follow up both for individuals within the community and those who are associated with risk settings such as schools and factories.
The contact tracing team is supported by local Covid Marshals who make contact with households who have not responded to calls from the contact tracing service to ensure individuals and contacts are isolating and able to access any support they need.
Early learning has been fed back into the service enabling us to improve both our completion rates and our customer satisfaction. The move to a recognisable local number, and the introduction of the Covid Marshals on the ground, has led to steadily improving completion rates (contacts successfully identified to ensure they isolate). Feedback from those called by the team has been generally very positive and several have offered to provide case studies of the helpfulness of the service and the importance of responding to contact tracing calls and following covid safe practices.
9. Support for self-isolation
All cases notified to the Torbay Public Health response team with contact details receive an email or telephone call signposting them to support for self-isolation. Through a strong partnership with the voluntary sector, individuals and households are able to obtain help with shopping, prescriptions, isolation, mental wellbeing, financial support and other help and advice.
Local good practice example
Torbay Community Helpline
The Torbay Community Coronavirus Helpline was set up by the Torbay Community Development Trust and partner organisations in early in 2020. Since then it has dealt with more than 17,000 calls, and has more than 1000 volunteers. Services developing from the helpline have included rapid response, a good neighbours’ network, telephone befriending, transport, and hospital discharge support. Existing voluntary sector service provision taking referrals from the Community Covid helpline include foodbanks, financial advice, digital support, domestic abuse services, handypeople services, housing support, and mental health support.
10. Outbreak prevention and management
A key element of the local plan is promoting measures to prevent outbreaks. This includes communicating key guidance and advice to the general population as well as ensuring targeted evidence-based preventative measures such as high-quality infection prevention and control advice and training to those who work in higher risk settings and work with or care for the most vulnerable people.
Local good practice example
Education Covid prevention and response
Torbay Education and Public Health teams have worked closely together to support schools, since the first case in a Torbay school in March 2020. A strong programme of prevention and response is in place, with regular network meetings, resource packs and webinars to ensure schools and early years settings are confident in their outbreak processes. Local schools have worked magnificently through the year to keep staff and children safe, responding rapidly and effectively to each new case to isolate contacts and prevent spread. Cases remained relatively low through the Autumn lockdown when schools were open and other settings were closed, as a testament to the controls in place in the education sector. The numbers of critical workers and vulnerable families is high in Torbay, with between 25 – 40% of normal attendance through lockdown. Attendance, and participation in asymptomatic testing, has been above 90% across Torbay as children return to school post lockdown. Learning and best practice has been regularly shared back with schools and early years settings throughout the year.
Strong partnership arrangements, underpinned by protocol, have enabled an effective outbreak response across all settings. This will continue.
Local good practice example
Care home Covid prevention and response
Torbay established a Proactive Care Homes Group in April 2020 and this has run throughout the pandemic, focusing on prevention and response in the care sector. There is a weekly Covid newsletter, regular Devonwide webinars, and strong support from the local Trust and Quality Assurance and Information Team for all care providers. Torbay has a high proportion of older people and it has been a priority for us to protect and support our care home residents and the staff who care for them. This coordinated approach has enabled us to take an oversight of cases and outbreaks, identify and act on key themes, and feed back lessons learned. We aim to build on this strong partnership working into the future. A care homes visiting group was also established to support homes in developing visitor pods, screens, communications technology, and other ways of keeping in contact with families as this is so crucial to wellbeing.
Local good practice example
Working with business and tourism
Torbay is a prime holiday destination and the tourist economy supports many local livelihoods. The Council Public Health, Environmental Health, Licencing and Communications teams, as well as Business Support, have worked very closely with the business and tourism sectors on outbreak prevention and response. Dedicated resources were produced in 2020, and a series of training events and webinars held to share advice and guidance and good practice case studies. This process is being revisited March – June alongside the gradual reopening of the business and tourist sector. Learning from 2020 has been the need for building good relationships, and the use of real examples and peer forums, to make the message more compelling. There are some excellent examples of Covid safe practice within the Bay which we make efforts to share widely to encourage other organisations. In this we have been strongly supported by the Business Forum and the English Riviera BID Company, which help us to reach out to business and tourist settings across the area. The Local Outbreak Engagement Board has also been an important forum, bringing together stakeholders who have been able to highlight concerns from their networks, and take back the key information and learning. Every setting with cases is followed up to ensure contacts have been traced and isolated, and opportunities taken to improve environmental controls. The Public Health response team can be contacted 7 days a week by organisations reporting a case or seeking advice.
11. Surveillance
A comprehensive surveillance system is critical to enable early identification of new variants of the COVID-19 virus. PHE currently have a programme to undertake genome sequencing on approximately 5% of all positive COVID tests. This random sequencing enables early identification of new variants of concern.
A number of Local Authority areas in the South West have been involved in a pilot wastewater project. This project analysis the contents of wastewater to identify the presence of COVID-19. This is often an early warning sign of an increase or outbreak in a specific setting which enables further investigation and early intervention.
12. Interface with vaccine roll out
Torbay Council has been working with partners across Devon and the South West to support the delivery of the vaccination programme to our residents on a prioritised basis to ensure the most vulnerable are protected as rapidly as possible.
The mass vaccination programme, led by the NHS, is the priority to help prevent and reduce COVID-19 mortality and morbidity and help protect the health and care system. The local authority has played a crucial role in ensuring the programme roll out considers the needs of those most vulnerable individuals and communities to avoid health inequalities in relation to vaccine uptake.
There are two phases to the vaccination programme. Within phase 1 those most vulnerable are prioritised into nine priority groups identified by the Joint Committee on Vaccine and Immunisation (JCVI). The top four cohorts were all offered a first dose by 15 February and will be offered their second dose by mid May; cohort 5 and 6 first dose will be offered by 15 March, with all cohorts 1-9 (over 50) being offered a vaccination by 15 April.
Local focus
Addressing inequalities
Torbay Public Health has established a local vaccine inequalities group to focus on vaccine delivery and uptake to groups who may be less likely, or find it less easy, to access vaccination. We work closely with colleagues in Devon and coordinate approaches. Initial activities have been a dedicated vaccination session for local people who are homeless or in temporary accommodation, with the opportunity being taken to offer additional health and wellbeing input. Use of the Devon vaccination bus to support uptake in larger workplace settings is being planned.
13. Implementing the roadmap and living safely with COVID
The Government published its COVID-19 Response – Spring 2021 document on 22 February 2021:
The roadmap sets out four steps for easing restrictions. Before proceeding to the next step, the Government will examine the data to assess the impact of the previous step. This assessment will be based on four tests:
- The vaccine deployment programme continues successfully
- Evidence shows vaccines are sufficiently effective in reducing hospitalisations and deaths in those vaccinated
- Infection rates do not risk a surge in hospitalisations which would put unsustainable pressure on the NHS
- Our assessment of the risks is not fundamentally changed by new Variants of Concern.
The Government roadmap describes a number of steps, subject to meeting the four key tests above, no earlier than the following dates:
Step 1: 8 March 2021
- Schools and colleges are opened for all students
- Recreation or exercise outdoors with household or one other person
- Care homes residents can nominate one visitor who can be tested and visit resident indoors
29 March 2021
- Stay at home message ceases
- Rule or 6 or two households outdoors (no indoor mixing)
- Outdoor sport and leisure facilities
- Organised outdoor sport allowed
Step 2: 12 April 2021
- Indoor leisure
- Rule of 6 or two households outdoors
- All retail and personal care premises
- Outdoor hospitality
- Domestic overnight stays
Step 3: 17 May 2021
- Indoor entertainment and attractions
- Rule of 6 or two households indoors
- Domestic overnight stays
- International travel (subject to review)
Step 4: 21 June 2021
- No legal limit on social contact
- Larger events
- Nightclubs
Actions which sit alongside the roadmap are:
- maintaining virus transmission as low as possible
- high-quality national and local surveillance systems to monitor transmission and identify variance emergence as well as identifying local cases and outbreaks as quickly as possible
- a comprehensive and effective national and local Test, Trace, and isolation programme
- an effective vaccination programme to protect the most vulnerable from serious illness.
Predictions around future rates of infection vary but it is clear that we will have to live with COVID-19 to a degree for some considerable time. It is likely that we will continue to see isolated cases and the occasional outbreak, even when rates are low. Living safely with COVID will require significant effort and action from each one of us.
In Torbay this means we will maintain our excellent partnership working across all sectors to identify and prevent cases and outbreaks, promote good infection control measures, implement testing programmes, and support roll out of the vaccines. Crucially we will continue to engage with our population to work towards a safe opening up of the local economy, and social participation, supporting our community to recover and thrive.
Appendix 1
Torbay Covid-19 Tactical cell
