Covid Control Plan: Focus on Prevention

Our primary focus in tackling Covid-19 has continued to be on prevention. To support this, we have put in place a range of wraparound teams which include dedicated public health resource alongside sector leads, who have led much of this approach by providing advice, training and resources to ensure wide-spread knowledge of applicable guidance within respective settings and provision of iterative feedback on practical learning from outbreaks managed by the team. The wraparound teams have also been able to consider setting specific issues or areas and translate and apply the relevant guidance while also liaising and supporting the workforce, which has also led to scoping future potential issues.

The basic principles of our control measures are threaded throughout our outbreak management response from our wraparound engagement to surveillance via our Single Point of Contact (SPOC). These principles are based on the pillars that underpin health protection action, and more specifically relate to COVID-19:  

• Removing the source of infection – rapid Test, Trace, and Isolate protocols
• Interrupting transmission – implementing guidance and enhanced controls
• Protecting persons at risk – business continuity plans and risk assessments
• Preventing recurrence – continuous improvement and reflective practice

 

Outbreak management response

Jump to: 

• Wraparound response
• Wraparound settings
• Single Point of Contact service
• Outbreak management
• Local Authority outbreak management
• Outbreak escalation
• Infection prevention and control

Wraparound response

As part of our collaborative approach and to ensure support to priority settings, we put in place a dedicated Public Health Guidance team and ‘wraparound’ arrangements for a range of settings (see below).

Dedicated Public Health staff have been assigned to themed wraparound areas, linking a lead officer from Public Health to other officers and stakeholders who provide support for different sectors or settings.

This has allowed us to ensure a rapid and consistent approach in response to queries with appropriate expertise, using the latest guidance and building multi-agency responses and perspectives. The team supported regular communications to settings, for example, daily bulletins to schools, information / evidence sessions on specific subjects, question and answer sessions and bespoke webinars. The team have also produced a range of ‘good practice’ guides, including for school staff and workplaces, for council staff, highlighting effective control measures and acting as an aid memoir of how staff can improve practice.

The purpose of the wraparound approach is to provide a multi-agency response to government and public health guidance, building a proactive and preventative approach to support key stakeholders working with the leads within those areas who have the setting specific knowledge and expertise.

There are currently 14 wraparound teams in place (which also link with a range of their own sector specific meetings) and although much of the core practice is the same across all sectors, this targeted approach ensures dissemination of key messages, that sector-specific support and actions are implemented in relation to relevant guidance to best service our residents and workforces.

Wraparound settings 

• Adult Social Care (including care homes)
• Children’s Social Care (including residential homes)
• Transport
• Day centres for people with complex needs
• Early Years (including Community Family Hubs)
• Sport, exercise, and leisure
• Supported accommodation settings
• Young people and transition
• Workplaces and businesses
• Drug and alcohol services
• Schools and education
• Higher and further education
• Homelessness response
• Licensed premises

 

Each wraparound has developed an ‘early intervention and outbreak’ pathway which provides information on how settings report suspected and / or confirmed COVID-19 cases to our COVID Single Point of Contact and the North East PHE Health Protection Team. Importantly, the pathways also provide general prevention advice, information, and key resources.

 

Single Point of Contact service (SPOC)

An essential component of our prevention-led approach has been to widely-promote our universal SPOC service which offers early intervention support to enable timely and appropriate testing, isolating and contact tracing in every suspected or confirmed case in the city. This provides the core mechanism to escalate our outbreak response and reduce the risk of serious outcomes or further transmission with close monitoring of where vulnerable populations or large numbers are impacted.

Its core functions are to provide:

1. Rapid high-quality, proportionate public health support to residents, workplaces and wraparound settings
2. A real-time surveillance system for changes in trends in settings and communities in advance of confirmed case data.

 

The SPOC protocol includes:

• Same-day triage of all notifications for the nature of the incident, population within the setting and any associated intelligence.
• Manage all ‘green’ notifications where routine advice can be implemented.
• Provision of appropriate health protection advice and guidance to ensure test, trace and isolate guidance is followed and ongoing monitoring established.
• Escalating any setting of concern (i.e. ‘amber’) to the Local Authority Outbreak Team for review and discussion with the North East PHE Health Protection Team or Public Health Senior Management Team by exception.

The triage process includes assessment of the risk in order to take appropriate action within the structured governance arrangements:

 

GREEN	Notification for information only Routine public health guidance can be actioned to implement appropriate controls (by SPOC or wraparound)   Intelligence shared with colleagues / partners in wraparound setting for monitoring and assurance purposes
AMBER	Outbreak team case-based review is required by request of Senior Public Health Officer. Further investigations and information are required for risk assessment by multidisciplinary team with Outbreak Control Team / Assurance Review structured response A complex setting with a vulnerable population requires further risk assessment and Outbreak Team oversight
RED	Information provided indicates immediate and significant further action is required in partnership with Senior Public Health Officer and HPT Associated with outbreaks that cannot be managed with current control measures or where there is serious risk to public health Incident has substantial political, regional or communications implications   Information provided confirms incident exceeds capacity of a ‘green’ or ‘amber’ wraparound response

 

All settings are encouraged to notify us about any suspected or confirmed cases  and can do so easily at any time by completing an online form, available at: https://publichealth.newcastle.gov.uk/covid19notifications

Outbreak management

The SPOC service provides the point of contact between the local authority and the North East PHE HPT. We work closely together, sharing intelligence and providing outbreak support and appropriate escalation.

A joint agreement is in place between the North East PHE Health Protection Team and the North East Association of Directors of Public Health. This sets out that settings with populations with greater vulnerability or potential complexity are routinely led by PHE. This agreement is subject to local discussion of each outbreak incident and often results in collaborative working to support both outbreak management and business continuity within settings. 

The formal North East Public Health system arrangements for COVID-19 rapid response and outbreak management framework sets out that the North East PHE Health Protection Team will lead on outbreaks within ‘Complex’ settings with the most vulnerable service users. The local authority will manage outbreaks within settings with lower risk populations, initially through the SPOC service or the internal outbreak management team depending on the nature of the incident. Day Care services will be agreed on a case-by-case basis and healthcare settings within Newcastle routinely manage their outbreaks as part of internal organisational infection control protocols.

 

Local authority outbreak management

Where outbreaks cannot be managed within the SPOC service due to the nature of the incident, cases are passed to the local authority Outbreak Management Team who will review the intelligence gathered to conduct a more detailed investigation to produce descriptive epidemiology or notify the North East PHE Health Protection Team in line with setting specific agreements in place described above.

Incidents escalated by SPOC are subject to agreement from Supervising SPOC officer and identified as AMBER during the triage process, at which point they are added to our internal ‘watchlist’ for further review.

 

Outbreak escalation

The local authority Outbreak Management Team review each incident escalated by SPOC, i.e. those triaged as AMBER at a daily Case Based Review. This is a key element of our audit and assurance process which operates via our bespoke Case Management System.

At the daily Case Base Reviews, actions are agreed and allocated collaboratively by the Outbreak Management Team. The attending Consultant in Public Health is the accountable officer for escalation decisions and actions. Oversight of the process is provided by the Assistant Director of Public Health.

For settings where the local authority is the lead organisation, the Outbreak Team will conduct an initial investigation and produce a descriptive epidemiology to understand the specific setting and to assess risk. This process may involve gathering data and intelligence facilitated by wraparound colleagues, in particular the Public Safety and Regulations team who are best placed to collate relevant data through existing expertise and relationships with businesses.

Where it is agreed a formal Outbreak Control Team process is required, the lead organisation (local authority or HPT) will provide Chair and secretariat for the process.

Infection Prevention and Control (IPC)

COVID Control Group has oversight and assurance of IPC expertise and capacity, where necessary agreeing funding and directing priorities. The SPOC, Public Health Guidance and Outbreak Management teams support continuous improvement and reflective practice within the health protection response at a strategic level through the COVID Control Group and, operationally, working closely with IPC colleagues in shaping the training content, sharing practical learning from outbreaks and agreeing training plan priorities.

IPC delivery includes a workstream focused on preventative actions through wraparound settings and targeted priority groups that are identified through public health intelligence, building capacity across the system to embed effective control measures into routine practice, upskill workforces and address risks of inequalities.