PCC CCC Local Outbreak Plan - Roles and responsibilities · If infection levels do increase the Community Rapid Response lead(s) are embedded within the Incident Management Team,

Roles and Responsibilities for delivery of the Local Outbreak Management Plan

in Cambridgeshire and PeterboroughUpdated in line with the COVID-19 Contain Framework:

A guide for local decision makers (published by Government 17 07 2020)

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2 Roles and Responsibilities for delivery of the Local Outbreak Management Plan

Introduction

On 17 July 2020 government set out guidance to local decision makers on how they work together to contain COVID-19. The Contain Framework clarifies which powers sit with national government and which with local government. This includes the roles played by key officers in Upper Tier local authorities (Cambridgeshire County Council and Peterborough City Council), in particular the Director for Public Health and Chief Executive.

The decision making model follows the tried and tested approach already adopted when dealing with emergencies. It is based on decision making being made at the lowest appropriate level, with co-ordination at the highest level necessary.

Decision making is focused on the teams of people working on the ground to prevent, control and manage COVID-19 – in our schools, workplaces, care homes, health care settings, amongst our socially excluded groups and in our wider communities – and the speed with which these teams can access the advice and decision making powers of the Upper Tier local authority. These decisions are carried out together with local politicians, public health and health system partners and our wider public services.

If we need further advice and support the route to national government, through our regional support team, also needs to be swift and decisive.

This document sets out the roles and responsibilities of the main players in the national, regional and local system that have been established to combat the impact of COVID-19. It clarifies where decision making powers lie and the governance that surrounds these powers.

Roles and Responsibilities for delivery of the Local Outbreak Management Plan in Cambridgeshire and Peterborough

Roles and Responsibilities for delivery of the Local Outbreak Management Plan 3

Government decision-making

National decision making around COVID-19 takes place through the Local Action Committee command structure. This is a hierarchy of meetings involving the relevant Secretaries of State, Ministers, the Chief Medical Officer, senior public health, health and social care staff, senior officers from the national test and trace system and senior civil servants. It is the way government engages with Ministers across all relevant government departments.

Minsters are the only people who have the power to implement the following restrictions:

• closing businesses and venues across whole sectors, such as food production or non-essential retail, or a geographical area, such as towns or counties;

• imposing general restrictions on movement of people, including requirements to ‘stay at home’, or to prevent people staying away from home on overnight stays, or restrictions on entering or leaving a defined geographical area;

• imposing restrictions on gatherings by limiting how many people can meet and whether they can travel in and out of an area to do so;

• restricting local or national transport systems by closing them entirely, or introducing limits on capacity or geographical restrictions;

• mandating the use of face coverings in a wider range of public places than currently required by national guidance.

Ministers also have powers to take action against specific premises, places and events. They have the power to direct Upper Tier local authorities to act. They will consider if actions taken by Upper Tier local authorities are necessary and whether they need to be revoked.

To assist government in exercising its powers three categories for government intervention have been defined. They are:

• area(s) of concern – a watch list of areas with the highest prevalence, where the local area is taking targeted actions to reduce prevalence;

• 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;

• area(s) of intervention – where changes are needed from the measures in place in the rest of England because of the significance of the spread, with a detailed action plan in place, and local resources augmented with a national support.

Before taking action government makes sure the right amount of local support is in place to rapidly enforce and implement outbreak containment measures.


Upper Tier Local Authorities decision-making

Cambridgeshire County Council and Peterborough City Council are the Upper Tier local authorities for Cambridgeshire and Peterborough. Under the Contain Framework Upper Tier local authorities have new powers to:

CLOSE INDIVIDUAL PREMISES CLOSE PUBLIC OUTDOOR PLACES PREVENT SPECIFIC EVENTS

Upper Tier local authorities can now take these actions without having to make representation to a magistrate. Upper Tier local authorities do not have the power to lock down areas, this powers rests with Government.

There are two key roles within Upper Tier authorities key to the exercising of these new powers. They are:

Director of Public Health who is responsible for providing public health advice and is accountable for controlling local outbreaks, working with Public Health England and the local Health Protection Board

Chief Executive who is responsible for exercising these new powers on the advice of the Director of Public Health. The Chief Executive will liaise with the Local Resilience Forum’s Strategic Co-ordinating Group, to ensure that partners’ resources can be deployed to support the action to be taken, and will liaise with government via the Regional Support and Assurance team.

The Upper Tier local authority has to satisfy itself that three conditions have been met before it can give a direction under these powers, that the direction:

• responds to a serious and imminent threat to public health in the local authority’s area;

• is necessary to prevent, protect against, control or provide a public health response to the incidence or spread of infection;

• and that the prohibitions, requirements or restrictions imposed by the direction are a proportionate means of achieving that purpose.

Wherever possible, actions to address outbreaks of COVID-19 will be undertaken in partnership with local communities, on the basis of informed engagement and consent. Before exercising any of these powers the Upper Tier local authority must notify the Secretary of State as soon as they are able and the decision must be reviewed at least once every 7 days.


In addition to these new powers the Upper Tier local authority Chief Executive will ensure their officers support the council and its partners in preventing, controlling and managing outbreaks of COVID-19. This will include:

• Ensuring COVID related grants are used to deliver the Outbreak Plan;

• Leading multiagency proactive and responsive communications as part of the Warn and Inform Cell;

• Leading engagement with communities, working closely with the District and City leads and their communications teams;

• Providing leadership and support for relevant elements of the Local Outbreak Control Plan for example the Director of Education jointly leading the work to support Schools and Early Years providers to be COVID secure;

• Providing a 24/7 Emergency Planning Team on-call facility;

• Supporting vulnerable groups & communities particularly those at higher risk from COVID-19.

In certain instances, decision-making will be referred to the national level. This includes cases where:

• local leaders request an intervention from government where they do not have the powers to act themselves for example, a request for a different approach to help protect those who are shielding that is based on local data;

• multiple outbreaks require resource prioritisation by Ministers for example, where an outbreak requires more resources than local decision-makers can access through their own system;

• outbreaks raise issues of national importance for example, impact on critical infrastructure, major parts of the economy or on wider sectors such as food or energy production; or

• local capabilities and controls are exceeded for example, local community protection actions are not effective, or the scale of the outbreak calls for the use of wider or more intrusive powers.


Regional Assurance and Support

This team comprises of senior Public Health England and local government expertise. It provides a crucial link between local and national government. This team represent government by working within the local structures and reporting back to Ministers. They offer advice about escalating critical issues and help to speed up responses between local and national government. If decisions needed to be referred to national level it is done through this regional team.

Health Protection Board – Public Health System Leadership

This Board provides the public health leadership and infection control expertise. It is linked to the designated Public Health England regional lead, the NHS, Environmental Health and other key partners.

The Director for Public Health is responsible for the Local Outbreak Plan which sets out how the partners will work together to prevent, control and manage outbreaks of COVID-19.

The Health Protection Board is supported by a Programme Delivery Group that helps with the implementation of the Local Outbreak Plan across the system. This Group is chaired by a District Council senior officer. It has as strong focus on forward planning and monitoring to ensure that the priority actions outlined in the Local Outbreak Control Plan are delivered, risks are identified and mitigated, and the relevant workforce, training and IT infrastructure is in place to support a potential future surge in outbreaks.

Specifically the Health Protection Board will:

• Review the epidemiology and local trends for COVID-19;

• Oversee the implementation and revision of the Local Outbreak Control Plan;

• Ensure resources to manage outbreaks are in place;

• Ensure escalation to the Local Resilience Forum’s Strategic Co-ordinating Group, via the Upper Tier Chief Executive, for the deployment of partner resources;

• Provide regular updates on COVID-19 to the Local Resilience Forum;

• Oversee the commissioning and deployment of testing and tracing resources;

• Receive a summary of the weekly data and information from the Surveillance Cell and ensure appropriate and timely sharing across agencies;

• Oversee the operation of the Outbreak Control Centre;

• Ensure effective communications and community engagement including working with District and City Councils through the Community Rapid Response.

Member Engagement Board – Political LeadershipThis Board leads the approach to public engagement and wider community leadership, ensuring there are plans in place to provide comprehensive and timely communications to the public and where required a link to Ministers.

The Board will:

• Engage directly with residents by meeting in public;

• Oversee proactive and responsive communications;

• Provide community reassurance;

• Provide political leadership and support for each partner agency so they can fulfil their role in preventing, controlling and managing COVID-19.


Local Resilience Forum Strategic Co-ordinating Group – Multi-Agency Leadership

The Strategic Co-ordinating Group co-ordinates resources across a range of public agencies. The Upper Tier Chief Executive being responsible for liaison with the Local Resilience Forum to ensure the deployment of these resources in response to COVID-19.

The Local Resilience Forum’s Strategic Co-ordinating Group will::

• Co-ordinate multi agency capability to ensure a consistent and effective response;

• Conduct emergency planning exercises to test the effectiveness of the Local Outbreak Control Plan;

• Ensure effective communications and shared awareness of the situation;

• Direct planning and operations, beyond the immediate response, to manage the multi-agency response to COVID-19.

Where required the Strategic Co-ordinating Group will stand up a Tactical Co-ordinating Group to ensure the delivery of operations across partner agencies.

The Local Resilience Forum has a range of other groups that have been established to support the response to COVID-19, these include:

• The Community Reference Group comprising County, District & City Council community support officers and Community & Voluntary Sector partners. Its role includes overseeing support systems for people who are self-isolating so they can get help with essential supplies. Ensuring that the COVID-19 related risks for vulnerable groups are well managed and working across geographical, economic and social boundaries to develop and support community networks to address the impact of COVID-19;

• The Warn and Inform Group which ensures all communications related to COVID-19 are consistent across the public agencies and in tune with Public Health England’s messages;

• Safety Advisory Groups, a multi-agency network which focuses on health and safety and COVID secure advice for event organisers. These groups operate at a District, City and County-wide level. They access public health advice and escalate to the Upper Tier local authority Director of Public Health if there are concerns about whether an event should proceed;

• The Recovery Group which supports our recovery from the impact of COVID-19 on our services and our communities.


Joint Bio-Security Centre

The Joint Bio-Security Centre has been set up to help break the chains of COVID-19 transmission through expert analysis and insight that will enable evidence-based decisions at a national and local level.

This is achieved by:

• Early identification of community transmission and outbreaks;

• Expert and transparent assessment of the drivers and concentrations of COVID-19 risk;

• Analysis and insight to optimise the impact of interventions;

• Seamless join-up with key partners to enable effective response to outbreaks.

The Joint Bio-Security Centre brings together data, information and knowledge from new and existing sources to derive unique and timely insight. It has built strong partnerships with public health organisations across the UK to maximise collective expertise and capacity. It works with NHS Test and Trace to ensure the analysis and insight is driving the most appropriate operational and policy decisions.

Joint Bio-Security Centre supports the powers that are in place to allow containment of COVID-19, strengthening coordination across government and the local-to-national response.

NHS Test and Trace

The NHS Test and Trace service ensures that anyone who develops symptoms of COVID-19 can be quickly tested to find out if they have the virus. It helps to trace close recent contacts of anyone who tests positive for COVID-19 and if necessary notifies them that they must self-isolate at home to help stop the spread of the virus.

NHS Test and Trace feeds information to Cambridgeshire and Peterborough through the surveillance cell.

This is considered alongside other data to inform the actions we take. In areas where infection rates are higher NHS Test and Trace is linking directly with local contact tracing services to ensure we contact as many people as possible to help stop the spread of the infection


Public Health England

At the national level Public Health England provides advice and guidance to those involved in preventing, controlling and managing COVID-19. It is part of the national decision-making structure and it co-ordinates national programmes in response to the virus.

At the regional level Public Health England, through its Health Protection Team, are directly involved in managing outbreaks in complex settings across Cambridgeshire and Peterborough. This includes:

• Receiving formal notification of cases and outbreaks;

• Declaring outbreaks;

• Conducting the initial risk assessment of an outbreak;

• Providing advice for all outbreaks;

• Contact tracing;

• Sharing data to inform the operational response to an outbreak.

The Public Health England Health Protection Team may decide to set up an Incident Management Team to help manage a local outbreak. The Health Protection Team will invite local authority Public Health and Environmental Health Officers, and the relevant setting lead, to join the Incident Management Team to help manage the outbreak on the ground.

The Health Protection Team has an identified link person who sits on the Cambridgeshire and Peterborough Health Protection Board and is the key point of contact for advice and support.

Cambridgeshire and Peterborough Outbreak Control Centre

The Cambridgeshire and Peterborough Outbreak Control Centre is at the heart of our response to COVID-19. We set out in the next five sections where the decision making powers and escalation routes are so that action on the ground can be taken swiftly. The Outbreak Control Centre is made up of five key areas of activity.

The government’s Contain Framework describes the range of outbreaks that require action on a sliding scale as follows:

• Cases – which refer to individual cases of COVID-19;

• Clusters – which refer to two or more cases associated with a specific setting, in the absence of evidence of a common exposure or link to another case;

• Outbreaks – which refer to 2 or more confirmed cases associated with a specific setting with evidence of a common exposure or link to another case;

• Community spread – which refers to sporadic or linked cases on a limited or extensive basis.


Outbreak Control Centre

1 Surveillance Cell

The Surveillance cell meets daily, and reviews and analyses the latest data on tests, positive cases, outbreaks, hospital admissions, inpatients with COVID-19, GP data, NHS 111 calls, test and trace activity and deaths. Data about population behaviours and risk factors is also reviewed, including information about traffic and travel and school attendance.

A daily summary of the current situation is provided to the Outbreak Management Team, highlighting areas where action should be considered based on the trend.

The Surveillance cell comprises officers from the local authority Public Health and Business Intelligence teams and data and Intelligence leads from the Clinical Commissioning Group.

Further analytical work is undertaken outside the Surveillance Cell meetings, often by the Public Health Intelligence team.

2 Outbreak Management Team

The Outbreak Management Team receives the daily information from the Surveillance Cell. Their interpretation informs the advice and actions taken by the Outbreak Management team on any COVID-19 cases, clusters, outbreaks or community spread.

The Outbreak Management Team also receive notifications from Public Health England Health Protection Team on incidents and outbreaks associated with Covid-19 through a single point of contact email address.

The Outbreak Management Team is supported by multi-agency cells for care homes, schools, workplaces, vulnerable populations groups, and specific arrangements for NHS and healthcare settings. The Risk Assessment for an outbreak will normally be carried out by the Public Health England Health Protection Team, and the recommendations of the risk assessment will be delivered locally by these multi-agency cells.

Depending on the scale of outbreaks this may include prevention and infection control advice, whether additional testing is needed, whether local contact tracing would be helpful and whether any additional capacity is required from partners.

In some cases an outbreak is large or significant enough to set up a separate multi-agency Incident Management Team, and the decision to do this can be taken by either Public Health England or the Local Authority Outbreak Management Team.

For each level of outbreak we also have a detailed community response.

The Outbreak Management Team is advisory with the accountability for decisions sitting with the Director of Public Health.

To ensure join up the Outbreak Management team comprises local authority Public Health – including a representative from the surveillance cell – settings’ leads, communications’ and communities’ representatives, Environmental Health and representatives from the Clinical Commissioning Group.


3 Incident Management and work in settings

Incident Management Teams are normally called around an outbreak in a specific setting, although they may be called when there is a general rise in cases in an area . Some are set up and managed by the Public Health England Health Protection Team and their decisions sit within the Public Health England governance arrangements.

The Director of Public Heath will call a local incident management team in consultation with the on-call Public Health Consultant, the relevant setting’s lead, District Council Environmental Health and Public Health England.

The Upper Tier local authority is responsible for setting up local Incident Management Teams –most workplace Incident Management Teams are the responsibility of the Upper Tier local Authority.

The main remit of the Incident Management Team will be to agree and coordinate the activities to manage and control the outbreak. If decisions need to be authorised swiftly by the Upper Tier local authority Director of Public Health and Chief Executive easy and rapid access to this decision making is available. Strategic Leadership and oversight of the public health actions taken sits with the Health Protection Board.

The Incident Management Team acts on behalf of the organisations involved in the outbreak and can include identifying the need for and providing local testing, ensuring delivery of tests to isolated individuals, mobilising public health advice and communications and community engagement on social distancing, hygiene and infection control.

Mutual aid can be accessed through the Upper Tier local authority making a request to the Local Resilience Forum’s Strategic Co-ordinating Group. If political leadership is required it will be accessed by the Upper Tier authority liaising with the Member Engagement Board.

Not all outbreaks have an Incident Management Team, some are managed through the setting’s cell, led, or supported, by a local authority Public Health Consultant.

The government has recently published Action Cards to help businesses and other organisations to work effectively with local public health teams

4 Community Rapid Response

Outbreaks of COVID-19 have an impact on surrounding communities irrespective of the level of outbreak. That is why we have established Community Rapid Response mechanisms across Cambridgeshire and Peterborough.

These teams are led in Cambridgeshire by each of the District Councils and Cambridge City Council and in Peterborough by the City Council. The local authority community teams work with a range of voluntary and community sector partners, faith leaders, community leaders, local politicians, business leaders and other relevant spokespeople to ensure our communities are kept safe and that we do all we can to work together to prevent, control and manage the spread of COVID-19.

When infection rates are low these community response teams work closely with communications leads to re-inforce ongoing public health messages about prevention . If infection levels increase these community response teams are vital in:

• ensuring messages get through to the right people so they know what to do, how and where to get tested;

• supporting to help people self-isolate, if that is required;

• working with people to mitigate any barriers to taking action to keep themselves and their families safe;

• adding capacity to local testing and where required adding capacity to local contact tracing.

If infection levels do increase the Community Rapid Response lead(s) are embedded within the Incident Management Team, part of the system that has quick and easy access to the local decision-making powers, local leadership and the wider resources available through our partners.

The prevention of the spread of COVID-19 can only be achieved with the full co-operation of our communities.

The examples of help and support are already considerable.


5 Local Test and Trace

Local Test and Trace is an integral part of incident management. The local authority Public Health team have resources focused on commissioning and mobilising additional testing, symptomatic and asymptomatic in accordance with need. We are also developing our capacity and capability around local contact tracing to enhance the contract tracing available through the NHS Test and Trace service.

District and City Councils (including Peterborough City Council lower tier functions)

In addition to leading the Community Rapid Response teams for their area the District and City Councils have a range of other critical functions

Their Chief Executives are ensuring their organisation’s capacity and capability is directed to deliver action to prevent and manage outbreaks.

District Councils have the lead responsibility for a range higher risk settings including Houses of Multiple Occupation, Homeless and other hostels and other workplaces at high risk. Environmental Health Officers provide preventive advice to these settings and other workplaces.

They lead ‘on the ground’ local contact tracing and outbreak management for these settings in partnership with the Public Health England Health Protection Team and Upper Tier local authority Public Health. Environmental Health also lead on enforcement powers under the 1984 and 2020 Acts and regulations.

District Hubs and City Council Contact Centres can be contacted by residents who are asked to self- isolate through NHS or local test and trace and can provide additional support such as the delivery of food and medicines through community services and local voluntary networks.

District and City Councils participate in wider preventive work and campaigns playing a leading role in community reassurance, through engaging with their communities and community leaders, and by working with local Councillors.

Their Communications Officers are responsible for proactive and reactive communications working with partners through the Local Resilience Forum’s Warn and Inform Cell and City Councils are key to ensuring the hospitality industry, leisure services, libraries, arts and cultural facilities are COVID-19 secure.

Key Partners


NHS Clinical Commissioning

Group and NHS England

The Clinical Commissioning Group, acting on behalf of NHS England, co-ordinate the local NHS and healthcare provider response to COVID 19 at a strategic, tactical and operational level. This work is overseen by the Infection, Prevention and Control Board.

The Clinical Commissioning Group ensures all commissioned providers are COVID-19 secure and have infection control plans in place which are robust. It offers infection control support to care homes and working in partnership with the Health Protection Team leads on outbreak management within care homes.

The Clinical Commissioning Group ensures a senior lead is co-ordinating action and senior representatives are part of the Health Protection Board.

NHS Provider Agencies Every NHS Provider has an infection control plan in place which prevents and manages outbreaks in their settings. The NHS providers also provide commissioned testing, swabbing and contact tracing.

Cambridgeshire and Peterborough Combined Authority

The Cambridgeshire and Peterborough Combined Authority, led by Mayor James Palmer, has a major role to play in supporting businesses to be COVID secure, in helping them to recover from the impacts of COVID-19 and ensuring our local economy is resilient and able to face the on-going challenges of living and working with COVID over the coming months.

PoliceThe Police have a key role in supporting the public health system with prevention and enforcement measures with individuals, premises and within communities. The police lead the Local Resilience Forum’s Multi-Agency Incident information flow between the partner agencies.

Healthwatch A statutory body which has a specific role on the Member-led Engagement Board.

Voluntary and Community Sector Organisations

Voluntary and Community Sector organisations play a key role in supporting their communities in preventing and mitigating the impact of COVID-19.

They help to share public health messages, support people who are more vulnerable to COVID-19. They support these services with plans to prevent spread of infection. They play a critical in working with District and City Councils as part of our co-ordinated community response and are key players in the Local Resilience Forum’s Community Reference Group.

Residents

The support and commitment of our residents is paramount to preventing the spread of COVID-19. As individuals, families, friends and communities maintain public health measures they are actively preventing themselves and others from acquiring or passing on COVID-19.

Following national social distancing, hygiene and test and trace guidance is essential for us all as we continue to combat the impact of this infection.

For further updates and information please check our websites which will be regularly updated www.cambridgeshire.gov.uk and www.peterborough.gov.uk

PCC CCC Local Outbreak Plan - Roles and responsibilities · If infection levels do increase the Community Rapid Response lead(s) are embedded within the Incident Management Team,

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