While it is necessary to have some local flexibility, it has been agreed, both in the development of the LOMP and the proactive and reactive response to a coronavirus (COVID-19) outbreak, that it is also important to be consistent.
The South West Regional Directors of Public Health have agreed to the following working principles:
- We will work together as a public health system, building on and making use of the existing close working relationships we have between the Local Authority public health teams and the UK Health Security Agency (UKHSA). We will try to ensure we make the best use of the capacity and capability of the regional public health workforce.
- While recognising local sovereignty, we will use a common language to describe the local governance arrangements:
- COVID-19 Health Protection Board
- Local Outbreak Management Plans
- Local Outbreak Engagement Board
- We will ensure that we all work to an agreed common set of quality standards and approaches in the management of local outbreaks, utilising and building upon already agreed approaches such as those defined within the Core Health Protection Functions Memorandum of Understanding (MoU). The MoU is a document signed by agencies in the South West including local authorities, district councils, UKHSA, clinical commissioning groups and the Port Authority. The document describes a set of key principles on how the agencies will work together to protect the health of the population from the adverse health effects due to infection, contamination and other hazards.
- We will take a continuous learning approach to the planning and response to coronavirus outbreaks, sharing and learning from one another to ensure we provide the most effective response we can.
- We will ensure that there is an integrated data and surveillance system established, which alongside a strong evidence-base, will enable us to respond effectively to outbreaks. It is proposed that a COVID-19 Regional Data and Intelligence Framework is developed which will enable directors of public health (DsPH) to have access to the necessary information to lead the COVID-19 Health Protection Board.
- We will commit to openness and transparency, communicating the most up-to-date science, evidence and data to colleagues, wider partners and the public.
- We will ensure that within our planning and response to coronavirus we will take the necessary actions to mitigate and reduce the impact of coronavirus on those most vulnerable, including black, Asian and minority ethnic communities.
- We recognise that DsPH have a system leadership role in chairing the COVID-19 Local Health Protection Board. We commit to engaging with key partners, including all levels of government (upper, lower-tier local authorities, towns and parishes and wider partners and communities), key stakeholders including the community and voluntary sector to ensure a whole system approach.
- We accept that we are currently working in a fast-changing, complex environment. DsPH are having to respond to changing evidence, national guidance, demands and expectations. We will commit to working proactively and always to public health first principles (to protect and improve the health of the population).
- We will make sure that our LOMP includes a strong focus on prevention and early intervention to ensure the most important settings, for example, care homes and schools, as well as high-risk locations and communities, identify and prioritise preventative measures to reduce the risk of outbreaks.
Working in partnership is crucial to help prevent the spread of the virus and swiftly respond to local outbreaks.
While the response to outbreaks will be led by the local DsPH, success will require a co-ordinated partnership response.
This will involve numerous agencies, some of whom are mentioned above, working together.
The agencies involved will often depend on where an outbreak occurs, but it is critical that all organisations understand the plan, 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 not new and is a core function of public health and environmental health.
It is therefore important that the creation of any new arrangements to manage local coronavirus outbreaks build on existing plans, for example, the Care Homes Resilience Plan and link in with existing structures and arrangements such as the Health Protection Sub-Committee of the Health and Wellbeing Board and the Local Resilience Forum (LRF) and are able to fulfil any reporting requirements by other bodies.
The following governance arrangements will support the LOMP, and the way in which the boards will work together is also described in an image below.
Devon and Torbay COVID-19 Health Protection Board
This Board will be chaired by the Director of Public Health for Devon County Council with the vice chairs being the Director of Public Health for Torbay Council and the Devon County Council Deputy Director of Public Health.
This Board is an executive-level partnership board and will have the following responsibilities:
- Local Outbreak Management Plan and resource deployment.
- Data and intelligence (with the Joint Biosecurity Centre).
- Leading the local public health response with UKHSA (and NHS test and trace).
- Assurance and reporting to the Local Engagement Outbreak Board and the LRF.
Membership will include:
- the Clinical Commissioning Group
- the police
- unitary and district councils (environmental health officers/housing)
- the fire and rescue service
- public protection
- social care
- schools and colleges
- higher education
- economy, enterprise and skills
- business and tourism
- military liaison
As well as the above, in an advisory capacity, membership will include consultants in public health/public health intelligence, a communications lead and the Devon County Council Corporate Equality Officer.
Team Devon Local Outbreak Engagement Board (LOEB)
This Board will be chaired by Cllr John Hart, the Leader of Devon County Council and will have the following responsibilities:
- Political oversight of the local delivery of plan and response.
- Communicating and engaging with residents and communities.
Membership will include:
- the Health and Wellbeing Board Chair
- the CCG Chair
- district council leader
- portfolio holders
- the police
- higher education
- the Devon Association of Local Councils (town and parish councils)
- the voluntary and community sector/equality and diversity – working on a ‘hub and spoke’ basis with communities.
As well as the above, in an advisory capacity, membership will include the Director of Public Health and a communications lead.
COVID-19 Tactical Management Group
The COVID-19 Tactical Management Group (TMG) will receive notifications of suspected or confirmed cases of coronavirus cases from PHE.
The role of the group is to carry out a dynamic risk assessment and link with the appropriate setting lead to ensure they are aware of the notification.
In collaboration with the setting lead, an agreement will be reached on the most appropriate person(s) to lead the local response.
The locally designated lead, working with the Local Health Protection Team (UKHSA) and important local partners (see an overview of organisational involvement and roles) will follow the agreed standard operating procedures protocols to take the necessary actions to contain the outbreak. This could include the setting up of an outbreak control team.
If an incident or suspected case is raised directly with a setting lead this intelligence will be passed onto the TMG who will liaise with the Local Health Protection Team to triangulate data and intelligence.
Good local relationships often mean service leads/managers are notified informally before a form notification is made.
The staffing of TMG will vary depending on the number of incidents and while it is expected that additional capacity and capability will be brought into the group as necessary, depending on the scale and complexity of outbreaks, there will be a core group of staff identified to ensure the group can function effectively during the pandemic.
To support local decision-makers and delivery of LOMPS a Regional Partnership Team has been established. These are matrixed teams between the Joint Biosecurity Centre (JBC) and Department of Health and Social Care (DHSC Contain, which will work alongside UKHSA regional teams).
The NHS Test and Trace Regional Partnership Team will act as a link between local and national government to escalate critical issues, feedback decisions regarding regional interventions from the Centre, share learning, and provide local outbreak readiness assurance.
The South West Regional Support and Assurance Network is:
- Regional Convenor (Department of Health and Social Care)
- Regional Director of Public Health
- Regional Lead (Joint Biosecurity Centre)
A Regional Test, Trace, Contain and Enable Board (RTTCE) has been established as a joint commission by the South West Directors of Public Health and UKHSA SW.
The Board will work alongside the SW Chief Executive Forum and Regional Strategic Coordination Group (ResCG). Membership of the RTTCE is drawn from the Local Authority COVID-19 Health Protection Boards operating in the South West. Its function is to:
- ratify, review and update the Regional Outbreak Management Plan (ROMP)
- oversee and support the implementation of the ROMP
- provide cross-boundary consistency on testing, tracing, containment
- have oversight of LOMP exercising arrangements (for example, assurance on activity, identify and sharing best practice)
An illustration of the Regional Test, Trace, Contain and Enable Board, Regional Delivery Group and its interdependences and its interdependences can be seen below.
Notes on the Regional Test, Trace, Contain and Enable Board, Regional Delivery Group and its interdependences diagram:
- The Regional Partnership Team provides the conduit between National Structures (NCRC) regional and local delivery through local authority directors of public health (DsPH).
- Governance for regional coordination and the implementation of the Regional COVID-19 Response Strategy 9RCRS) will be provided through the joint (RPT and DsPH) SW RTTCE Board.
- Translating national direction and policy into regional coordination and local delivery will be through the PHE SW’s RCRS.
- Seven programmes led by SW programme leads.
- Integrated working, coordination and support provided through the SW Regional Delivery Group.
- Using shared situational awareness to prioritise the scope and scale of COVID-19 response.
- Implementation of local response delivered by local authority DsPH through discreet, responsive and pre-emptive plans, in collaboration with PHE SW.
A new Regional Delivery Group has been established to sit under the Regional Test, Trace, Contact and 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 two directors of public health to work alongside Public Health England colleagues to help drive key priorities and programmes which have been identified as:
- contact tracing
- surveillance and intelligence
- health protection and outbreak management