Worcestershire Outbreak Control Plan - (OCP) For the prevention and management of outbreaks of COVID-19 (Coronavirus)
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Worcestershire Outbreak Control Plan (OCP) For the prevention and management of outbreaks of COVID-19 (Coronavirus) 2 July 2021 v1.5
Foreword
Throughout the COVID-19 outbreak, multiagency partners have come together with the
commitment, expertise, and resources to limit the impact of COVID-19 in Worcestershire. The
system responded quickly in March 2020 to manage the demands that COVID-19 placed on
services and communities, with our most vulnerable residents being supported to stay safe and
well. As we continue to adapt to changing COVID-19 restrictions and measures, and support the
NHS vaccine roll-out programme, we must continue our focus on saving lives.
A successful, local approach to preventing and managing outbreaks in communities and places in
Worcestershire relies on the strong partnerships and systems we have established. Building on
existing relationships with Public Health England (PHE), District Councils, NHS partners, Police and
others, as well as the many communities, settings and venues in Worcestershire, we aim to reduce
the number of new community cases of COVID-19 and the impact on Worcestershire businesses
and residents, especially the most vulnerable.
The national Test, Trace and Isolate programme accompanies existing prevention and
management measures, including social distancing and hand hygiene. Our OCP sets out the
priorities for outbreak prevention and management and how we will engage with communities
and businesses to help people play their part in identifying symptoms, getting tested, managing
outbreaks and self-isolating to keep others safe across Worcestershire.
Cllr Simon Geraghty Cllr Karen May Paul Robinson Simon Trickett Dr Kathryn
Leader of Cabinet Member with Chief Executive, Chief Executive Officer Cobain
Responsibility for Worcestershire County at NHS Herefordshire Director of
Worcestershire
Health and Wellbeing Council and Worcestershire Public Health
County Council
CCG
Worcestershire’s Local Outbreak Response Team (LORT)
Email: wcchealthprotection@worcestershire.gov.uk Phone: 01905 845491
Monday to Sunday 9am to 5pm
Contents
1 Introduction..................................................................................................................................... 4
Purpose ................................................................................................................................ 4
Local Context ....................................................................................................................... 4
2 How we work................................................................................................................................... 8
Background .......................................................................................................................... 8
Legal and Policy Context ...................................................................................................... 8
Governance ........................................................................................................................ 10
Learning and Assurance ..................................................................................................... 11
Operational Response........................................................................................................ 12
Data Integration and Information Sharing......................................................................... 12
3 Priorities for outbreak prevention and response .......................................................................... 14
Priority 1: Communications and Community Engagement ............................................... 16
Priority 2: Preventing Infection and Outbreaks ................................................................. 18
Priority 3: Supporting Settings and Communities.............................................................. 23
Priority 4: Supporting Vulnerable People and those Self Isolating .................................... 26
Priority 5: Resourcing the Response .................................................................................. 28
4 Delivering the Local Response....................................................................................................... 33
Local Outbreak Response Team (LORT) ............................................................................. 33
Incident Management Teams (IMTs) ................................................................................. 33
Version Control ................................................................................................................................. 36
Glossary ............................................................................................................................................. 37
Appendices Table .............................................................................................................................. 37
Page 3 of 37
1 Introduction
Purpose
Coronavirus (COVID-19) is an infectious disease caused by the SARS-COV-2 virus. Each Local
Authority (LA) is required to produce and maintain a local OCP specific to COVID-19. OCPs are used
to describe the arrangements and processes for preventing and managing outbreaks, living with
COVID, and how the wider impacts of COVID-19 on local communities can be reduced.
This plan builds on established plans and existing processes to describe how Worcestershire will
address the key themes identified by the Contain Framework and the Department of Health and
Social Care (DHSC) as critical in tackling this pandemic. This plan also draws on the Association of
Directors of Public Health (ADPH) Guiding Principles for Effective Management of COVID-19.
For Worcestershire, five key priorities have emerged from the LGA’s seven themes, in consideration
with the existing system and in consultation with partners and stakeholders, detailed in this plan.
This plan and its appendices are dynamic documents, able to respond to changes in national
guidance and learning from local experience.
Local Context
Worcestershire has a population of around 592,000 people living in rural and urban areas, profile
provided at Table 1 and Table 2. Several factors are understood to increase the risk of a person
being more unwell should they contract COVID-19. Around 20,386 people in Worcestershire are
highly vulnerable and are described as ‘clinically extremely vulnerable (CEV)’. People aged over
70, people from Black, Asian, and Minority Ethnic communities, people with excess weight and
people with pre-existing poorer health are more likely to be very unwell with COVID-19.
Almost 100,000 people living in Worcestershire are aged over 70, and, although many people are
healthy, there are areas where people’s health is not good. Around 4% (25,000 people) living in
Worcestershire describe their ethnicity as from Black, Asian, and Minority Ethnic communities.
The ethnic split of Worcestershire’s residents is provided in Table 3 below.
The situations that people live in can increase vulnerability. Where possible, people experiencing
homelessness in Worcestershire have been provided with temporary accommodation to protect their
health and the health of others. Worcestershire has 46 Lower Super Output Areas (LSOAs) that are in
the 20% most deprived LSOAs in England as shown below at Table 4.
Supporting settings to respond and live with COVID-19, and to prevent and manage outbreaks
protects people who are more likely to become seriously unwell should they contract COVID-19.
Employment across Worcestershire, by occupation is provided at Table 5 below.
COVID-19 dashboards are available via LG Inform, enabling benchmarking via the Local Government
Association, and also on Worcestershire County Council’s (WCC’s) Coronavirus webpage describing
the number of cases and outcomes over the period of the pandemic is updated daily. Data is available
at County and District level.
Cases in different types of settings are recorded and guide preventative action and response in
similar settings. National and local data continues to inform the prevention and management of
outbreaks, ensuring that actions are data driven and intelligence lead. Escalation and trigger
points and actions have been described and agreed with NHS partners.
Page 4 of 37
Table 1. Age Profile Resident Population 2018
Table 2. Population by age. Source: Public Health England (PHE Public Health outcomes Framework)
Page 5 of 37
Table 3. Ethic split of Worcestershire’s residents. Source: LG Inform Plus
Table 4. Worcestershire Lower Super Output Areas that are in the 20% most deprived LSOAs in England.
Source: Public Health England, SHAPE
Page 6 of 37
Table 5. Occupation major group of employment for Worcestershire. Source LG Inform Plus: LG Inform Plus
Page 7 of 37
2 How we work
Background
The national NHS Test and Trace service responds to many cases and simple outbreaks rapidly,
identifying contacts and ensuring the actions required of contacts are understood. Our local response
works alongside this and is focused on managing more complex situations and cases using local
knowledge and expertise to tackle local outbreaks, in addition to supporting the community and local
settings to manage and live with COVID-19 in a secure and considerate manner.
Legal and Policy Context
The Director of Public Health is employed by the County Council and has a primary and legal
responsibility for the health of their communities, including being assured that the arrangements in
place to protect the health of the communities are robust and implemented. The development and
deployment of Local Outbreak Implementation Plans is the role of the local Director of Public Health.
In two tier areas, many of the powers to support the delivery of outbreak controls are the
responsibility of the six district councils and their Environmental Health teams. In Worcestershire
these are discharged by the shared regulatory service, Worcestershire Regulatory Services (WRS).
The legal framework for managing outbreaks that present a risk to the health of the public and
require urgent investigation and response is complex as it vests duties and powers with Government
and tiers of local government. Existing powers are contained in the following legislation:
• The National Health Service Act 2006, was amended by the Health and Social Care Act 2012
enabling the Secretary of State to exercise duties in relation to protecting public health from
disease by passing regulations, arranging for their discharge by LAs, and further arrangements
enable discharge through other bodies, including CCGs.
• The Public Health (Control of Disease) Act 1984 (district council) provides a range of powers in
relation to entering premises to identify the presence of notifiable diseases. LAs can make an
application to impose restrictions or requirements on persons or premises. For the latter, this
includes closure; detaining a conveyance or movable structure; decontaminating; or order a
structure be destroyed. With respect to persons, similar powers are available to detain,
require them to take medication or other actions to prevent transmission of disease.
• The Health and Safety at Work Act 1974, enforcement of the provisions and regulations of
this Act are divided between District Councils and the Health and Safety Executive depending
on the nature of the activity. It is now generally accepted that the provisions of the Act and its
associated legal framework can be applied to COVID-19.
• The Health Protection (Local Authority Powers) Regulations 2010 (SI 2010/657), made under
the Public Health (Control of Disease) Act 1984, provides LAs powers to require persons to do,
or refrain from doing so, by preventing, protecting against, controlling or providing a public
health response to the spread of infection..
New Powers in Relation to COVID-19
To supplement the above, the Government has provided a framework of other legislation of controls.
The Secretary of State issued a direction that Environmental Health Officers from district councils and
Trading Standards officers from the County Council be responsible for policing business compliance.
At WCC, working group regularly reviews relevant legislation to ensure preparedness to act, if
necessary. Relevant powers from such legislation is summarised below:
Page 8 of 37
• The Coronavirus Act 2020 was introduced on 10 February 2020 to enable imposition of
proportionate requirements (e.g. screening and isolation) and other appropriate restrictions,
on individuals where a Public Health Officer: “Has reasonable grounds to suspect that an individual
in England is, or may be, infected or contaminated with coronavirus and considers that there is a risk
that they will infect or contaminate others, or where they have reasonable grounds to believe the
individual has recently travelled from a specified infected area.”
• Relevant powers exist for PHE in Schedule 21, in relation to infected persons that are similar
to those in the Public Health (Control of Disease) Act 1984. Similar powers appear in Schedule
22 in relation to the closure of premises, by Ministerial directions. The use of Schedule 21
must be done in consideration of the Mental Capacity Act 2005 and the Mental Health Act
1983, both are described in this context below.
• Mental Capacity Act 2005, where the person lacks the mental capacity to understand the risks
associated with the decision not to self-isolate, the Mental Capacity Act should be followed as
far as possible. This includes supporting the person to understand the issues in order that
they can make their own decision and looking at how self-isolation could be achieved in a way
that is least restrictive of their rights and freedoms. This may involve providing accessible
information and exploring concerns the person has regarding available accommodation.
• Mental Health Act 1983 cannot be used to compel people to undergo testing, receive
treatment or isolate themselves if these measures are unconnected to the person’s mental
disorder. Mental health professionals do not have the power to use reasonable force for the
purposes of enforcing Schedule 21 of the Coronavirus Act.
• The Health Protection (Coronavirus, Restrictions) (England) (No. 3) Regulations 2020 – Upper
Tier LAs have the power to close premises, public outdoor places and restrict events with if
necessary and proportionate to do so, in order to respond to a serious and imminent threat
to public health and control COVID-19 transmission. To enact these powers LAs must ensure
all three essential criteria are met:
1. That there is a serious and imminent threat to public health.
2. It is necessary for the LA to impose restrictions to protect public health by preventing and
protecting against the spread of infection in the area.
3. That the restrictions are a proportionate means to prevent the spread of infection.
When the County Council issues a direction, they notify the Secretary of State. When
required, a direction will be given to a premises outlining all the relevant information. The
direction will be reviewed at least every seven days and can be lifted when there is no
longer a serious and imminent risk to Public Health. The recipient of a direction has a right
to appeal through a Magistrates Court. The direction may only apply to:
• the owner/occupier of the premises hosting an event to which the direction relates;
• the organiser of such an event; and
• any other person involved in holding such an event. This does not include people planning
to attend who have no involvement in its organisation. People who attend such an even
will not be committing an offence as a result of a direction.
If someone ignores or obstructs a direction this is an offence and a Fixed Penalty Notice
may be issued.
• The Health Protection (Coronavirus, Restrictions) (Local Authority Enforcement Powers and
Amendment) (England) Regulations 2020, implemented in December 2020 provide a
framework of processes for dealing with non-compliance with COVID-19 controls. The
regulations empower officers to issue Improvement, Restriction and Immediate Restriction
Notices that enable them to direct changes to prevention activity within businesses. This
includes prohibiting a business from opening/trading. The regulations are supported by non-
statutory Government Guidance. The approach provides a framework enabling LAs to
respond proportionately to those that trade in an unsafe manner, breaching relevant COVID-
19 provisions. Failure to comply and breaches of the notices are criminal offences subject to
an unlimited fine if tried before a Magistrates Court.
Page 9 of 37
Additional Legal Responsibilities
Additional legal responsibilities are relevant in the delivery of this OCP:
• The Care Act (2014) requires LAs to safeguard adults in their area. This encompasses the majority
of public services provided by Councils with potentially vulnerable adults. More specifically, the
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.
• The Health and Social Care Act (2012) requires CCG’s to provide services to reasonably meet
health needs and powers to provide services for the prevention diagnosis and treatment of illness.
• Medical practitioners have a duty to notify suspected/confirmed cases to PHE, under the
Health Protection (Notification) Regulations 2010 and the Health Protection (Notification)
Regulations (2020). PHE work with LAs on communication to specific settings to ensure timely
notification of outbreaks.
Governance
The Government’s Contain Framework makes clear that local governance of COVID-19 outbreak plans
builds on existing practice.
Governance arrangements for the Local COVID-19 outbreak plans are shown in the diagram in
Appendix A.
Worcestershire’s OCP is delivered though the local COVID-19 Health Protection Board and a
Member-led Local Engagement in Outbreaks (LEO) Board. These boards are linked with existing
multi-agency governance arrangements and report to the Health and Wellbeing Board and West
Mercia Local Resilience Forum (LRF) Tactical Co-ordinating Group (Worcestershire).
The local COVID-19 Health Protection Board provides public health leadership and infection control
expertise, linked to the PHE regional lead, NHS, environmental health, and other key partners. This is
an officer led board with representation from Education, Adult Social Care, NHS, and other partners,
supported by existing command structures.
A tactical group, the Outbreak Management Cell meets daily during periods of high transmission,
reducing to twice weekly as COVID-19 infection rates reduce, and reports to the COVID-19 Health
Protection Board. It consists of Public Health Consultants, members of the Local Outbreak Response
Team (LORT), NHS and other relevant partners. This group manages the operational aspects of all live
situations and outbreaks and provides regular review of situations.
The Member-led LEO Board provides political ownership, being a link to minsters. It also leads on
public-facing communication and engagement, ensuring they are both comprehensive and timely,
whilst maintaining community cohesion to support the response.
The West Mercia Local Resilience Forum (LRF) Tactical Coordinating Group (TCG) provides
multiagency co-ordination that is key to the delivery of testing and plans for recovery and co-
ordination of multi-agency support. Key members of the TCG include Emergency Services,
Worcestershire County and District LAs, NHS, PHE, Environment Agency and the Armed Forces. The
TCG also provides resource coordination, and link to NHS Test and Trace. The council Chief Executive
is responsible for the deployment of resources and liaison with the LRF (for example, for mutual aid),
and with Whitehall via Regional Support and Assurance teams, described further in Government’s
Contain Framework.
Page 10 of 37District level COVID-19 Incident Management Teams (IMTs) are arranged, with relevant partners, in
order to help advice and support district councils, explore specific issues and examine drivers of
COVID-19 transmissions locally. For example, providing guidance to all House of Multiple Occupation
license holders on how to prevent transmission within shared accommodation, or providing
messaging to support the local community and signpost people who require further support. Each
Public Health Consultant leads on a different district with local Chair’s for each group.
In addition, the existing WCC command structures underpin governance of the OCP, building on
existing practice within the Council. In March 2020, WCC’s Chief Executive triggered the internal
command structure response, used to respond to exceptional events. The Strategic Leadership Team
take responsibility of Gold Command. The Gold, Silver and Bronze command groups provide
workstreams, resource coordination, efficient decision making. Appropriate recovery groups are
being established across the command structure in line with the Government’s easement of
restrictions and move towards living with COVID-19.
Learning and Assurance
Assurance is provided via the governance structure outlined above. The OCP is reported to the COVID
-19 Health Protection Board as a means of providing assurance to partners and ensuring engagement
with the plan. This supports the system approach with representatives attending the board.
In July 2020 an exercise was completed through the LRF testing how the LORT and the OCP would
respond and be enacted to outbreaks in two different settings, a hostel housing asylum seekers and a
form employing seasonal workers. The promoted awareness of the OCP amongst partners, whose
feedback and the resulting actions were then added to the OCP. The plan was tested, in reality, during
peaks of COVID-19 in November 2020 and January 2021. In addition, the opportunity was taken to
review the OCP and WCC’s response to a local Variant of Concern (see section regarding surge testing)
during a taskforce visit with the Cabinet Office in February 2021, following which feedback was
incorporated into Worcestershire’s COVID-19 response.
Lessons have been learnt and processes refined constantly as the OCP has continued to be further
embedded. For example, a prioritisation framework has been developed for the LORT to ensure
resource and actions are targeted to have the greatest impact during times of high demand. The scale
of action escalates from proactive activities to reduce transmission, to that aimed at mitigation,
targeting where the LORT can make the greatest difference.
WCC recognises the absolute importance of having strong relationships with regional colleagues, in
particular to implement exercises such as surge testing, of developing shared systems to improve
information sharing, and improving ways of working with partners, such as the voluntary sector.
As the pandemic has progressed, WCC has refined its approach to communications and engagement,
increasing resource and taking more proactive and targeted actions, linking messaging to the Public
Health response and data. This is key to creating local ownership; sharing key messages and data on
what is driving transmission.
Intelligence has been key and the baseline for then developing clear pathways for turning information
into action. For example, drilling down into hyper-local data, reviewing with Public Health consultants
at Outbreak Management Cell to then focus IMTs, communications, COVID Advisors, other resources,
and working with partners to create action to reduce transmission.
WCC will continue to constantly develop and improve its response to the pandemic, working in
partnership, and sharing learning and information across the system.
Page 11 of 37Operational Response
Daily management of outbreaks is undertaken by the LORT, comprising of Consultants in Public
Health, Environmental Health Officers (EHOs), Public Health Practitioners and dedicated Team
Leaders and Responders, with the ability to draw on additional specialist knowledge and advice of,
NHS partners and NHS Infection Prevention and Control (IPC) professionals as required.
The LORT is available Monday to Sunday 9am to 5pm with provision for out of hours working.
Working to Standard Operating Procedures (SOPs) developed for different settings and situations, the
LORT provides a single point of contact (by email or telephone) to respond to complex situations,
additional capacity in outbreak management, and a local perspective to settings and communities.
The LORT supports settings in the prevention of outbreaks and consequence management as a result
an outbreak in complex settings or groups, this may include supporting vulnerable people to access
support through Worcestershire’s Here2Help (H2H) service. Members of the LORT receive additional
training in contact tracing skills, communicating risk, infection prevention and control, supporting
IMTs and modern slavery awareness. In addition, Public Health has developed subject matter experts
to support the LORT, for example relating to outbreak in education, or adult social care settings.
A record of high-risk settings and any action taken is maintained and available for insight and modelling.
There are dedicated communications and engagement professionals who work alongside the
LORT, the wider LEO Board and the COVID-19 Health Protection Board.
Further detail is available under Priority 5: Resourcing the Response.
Data Integration and Information Sharing
We continue to collate, analyse and interpret data to direct and support the local response. Good quality
data is key to the management of COVID-19 and we integrate national and local data and scenario
planning, including surveillance data and intelligence made available through the Joint Biosecurity Unit.
A local multiagency digital solution (Nimrod) is used to record and manage activity relating to
situations and outbreaks, which in turn informs local intelligence on high risk settings, ensures
effective operational tracking and provides insight to direct prevention focused activity with settings
and communities. Nimrod is shared and used by IPC, WRS and is available to Worcestershire
Children’s First and the WCC’s Adult Social Care quality assurance team.
Reporting from Nimrod is well integrated with existing arrangements for strategic and operational
reporting to partners and command structures, which is key to timely and well-informed decision
making. Insight from outbreak management is also used to build a greater understanding of our
communities and settings, and to support recovery.
Intelligence from Nimrod, NHS Test and Trace and other epidemiological tools are used to focus
proactive LORT activity, local contact tracing, backwards tracing (to understand where COVID may
have been acquired from, whilst forming connections between cases) and COVID Advisor
deployment. Granular testing and vaccination data are being used to understand equality and equity
issues with regard to testing and vaccination strategies. New models of testing and vaccine rollout are
being deployed as a result of this local intelligence.
Page 12 of 37In addition, WCC will take on board new and innovative surveillance techniques as they become
available, for example, the sewage surveillance provided by the DHSC.
Clear, concise public facing data at County and District level is available to support Elected Members
in the engagement role, and to support communication and trust building with members of the
public. To assist with this, data dashboards have been built and published which are updated
frequently:
• COVID-19 situation data: https://www.worcestershire.gov.uk/COVIDdashboard
• COVID-19 vaccinations data:
https://www.worcestershire.gov.uk/homepage/648/worcestershire_covid-
19_vaccinations_dashboard
Page 13 of 373 Priorities for outbreak prevention and
response
Seven themes from the Contain Framework for the OCP can be seen in figure 1 below. From these,
five key priorities have been identified for Worcestershire. Fig 3 shows how these map into the
seven themes and core aspects of the response. The priorities link to wider plans that focus on
tackling health inequalities, improving wellbeing and supporting the local economy during the
recovery phase of the pandemic.
The themes titled ‘7 Data integration and information sharing’, ‘8 Surveillance’ and ‘4 Governance’
are embedded within our response, and throughout this document, specifically at Section 2.
Fig 1. Contain Framework COVID-19 OCP themes
Theme no
Governance guidance: theme
/code
High-risk settings, communities and location
1
e.g. care home, prisons, hospitality, hospitals and education
2 Vulnerable and underserved communities
3 Compliance and Enforcement
4 Governance
5 Resourcing
6 Communications and engagement, including community resilience
7 Data integration and information sharing
Fig 2. Contain Framework Core aspects of response
Approach
Governance guidance: core aspects of the end to end COVID response
no/code
8 Surveillance
9 Community testing
10 Contact tracing
11 Support for self-isolation
12 Interface with and role in vaccine roll out
Outbreak management, including enhanced contact tracing, in partnership
13
with PHE Health Protection Teams (HPTs)
14 Responding to Variants of Concern
15 Action on enduring transmission
16 Ongoing role of Non-Pharmaceutical Interventions (NPIs)
17 Activities to enable ‘living safely with COVID’ (COVID secure)
Page 14 of 37Fig 3. Five Priorities for Worcestershire linking to the core themes and
aspects of the COVID response
Priority Worcestershire priority detail Links
Priority 1 Communications and Community Engagement 1
• Dedicated communications support and a communications plan to 2
provide messages to communities and businesses, clear 6
communication during outbreaks, and support for the LEO board to
9
maintain community cohesion.
• Frequent messaging/reminders on NPIs and preventing household 11
transmission. 12
• Targeted comms re self-isolation, outbreak management, testing, in 14
support of variants of concern. 16
17
Priority 2 Preventing Infection and Outbreaks 1
• Ensuring appropriate measures are in place to prevent the spread of 2
infection across all settings and communities. 3
• addressing inequalities 12
• Enforcement as prevention 13
• Risky Venue Alerts 15
• Action on enduring transmission 16
• Interface with vaccine roll-out 17
Priority 3 Supporting Settings and Communities 1
• Support for high risk settings (e.g. workplaces, prisons, migrants, and
homeless people) 10
• Defined processes for outbreaks, SOPs plus tailored approaches
• Early reporting, response and support; to include risk assessments and 13
promoting prevention activity
• Roles and responsibilities, working with partners 17
Priority 4 Supporting Vulnerable People and those Self Isolating 2
• Maintaining H2H support to those self-isolating, including an Enhanced
Hardship Fund 11
• Support for businesses with CEV employees
• Supporting communities to safely return to daily activities 16
• Addressing health inequalities and mitigating the impact of COVID-19
on our most vulnerable 17
Priority 5 Resourcing the Response 1
• The ability to direct local testing capacity to prevent and manage
outbreaks. Easy access to testing. 2
• Assessing local and regional contact tracing capability in complex 5
settings using insight of communities.
• Defined roles and reporting with PHE and NHS Test and Trace. 9
• Establish resources for prevention and management of outbreaks: 10
infection prevention control (advice and PPE provision), community
swabbing, cleaning, support and enactment of powers. 13
• Enhanced Contact Tracing
14
• Surge testing / Variants of Concern
• Maintaining LORT and other COVID-19 related surge activity to 17
continue living safely with COVID
Page 15 of 37Priority 1: Communications and Community Engagement
Communication, listening and engagement with communities is key to building trust and inspiring
people and businesses to participate in what is required of them to prevent cases and outbreaks of
COVID-19 and enable living safely with COVID as we move forward with the pandemic.
A focused communications and engagement approach aims to:
• empower communities, providing them with the resources, knowledge and understanding
to actively make good choices when responding to, and living with, COVID-19;
• educate communities, by being a reliable source of up to date, accurate, plain speaking
information. We will be human in our communications and supportive in outbreak
situations; and
• engage with communities and stakeholders, using feedback and responses to target our
messages, developing strong relationships of trust and respect.
We strive to help communities and businesses to understand the importance of following the
guidance so that everyone in Worcestershire feels able to help prevent the spread of COVID-19
and knows what to do if they have symptoms. Non-Pharmaceutical Interventions (NPIs) such as
‘hands face space’ remain priorities as we acknowledge the challenges presented by places
reopening post-lockdown, and misconceptions around protection from vaccines. WCC provide
frequent reminders on NPIs and preventing household transmission, enabling residents to live with
COVID as restrictions are lifted, ensuring they maintain good habits which minimise transmission
for both individuals and for businesses.
A dedicated communications and engagement professional works alongside Elected Members and
Partners in the LEO Board and the COVID-19 Health Protection Board. Day to day communications
support are linked to the LORT and the Outbreak Management Cell.
A Communications Cell has been established with stakeholders, including the University of
Worcester, the Inter-Faith Forum, Worcestershire’s prisons and the Chamber of Commerce. This
group feeds into the LEO Board and enables communications with settings and communities
around prevention of outbreaks, support for vulnerable communities, the importance of rapid
testing and adherence to self-isolation requirements. Honest, clear communication with the media
will protect communities from stigma, while delivering key messages to the public.
A detailed local communications and engagement strategy is available (see Appendix B) and aims
to compliment national and regional communications campaigns.
In addition, following the Government’s publication of its roadmap out of national lockdown,
Spring 2021, a communications timeline is being developed to align with significant dates for the
lifting of restrictions, setting out appropriate local messaging to support these key events.
Targeted communications
WCC support and reinforce PHE and NHS messaging and use government materials where possible
and appropriate to do so. In addition, comms support Public Health, reviewing COVID data
together daily/twice weekly at the Outbreak Management Cell, to understand local issues and
writing prescribed, tailored messaging to address them via the appropriate channels, such a press,
social media, key stakeholders or influencers.
Page 16 of 37Engaging with our residents has been important in helping them understand what we need them
to do at certain points during the pandemic. We have reached out via a Q&A video format.
Questions on different topics have been submitted and then our Director of Public Health has
recorded the answers, which are then made public on our website and social media channels.
The comms team has worked to segment and target residents as we move through the pandemic,
looking at areas geographically, and using data to determine behaviors, focused by COVID data to
target messaging to those groups.
Self-isolation comms have focused on why residents may choose to not self-isolate, addressing
barriers, offering reassurance and promoting H2H and the Enhanced Hardship Fund (see Priority 4).
WCC has been keen to support residents that do not have English as a first language, identifying
relevant languages and providing translations, but also working to identify the best ways to
distribute them either directly, through employers, community partners, or locations such as local
shops or GP practices.
The under 30s are particularly difficult to reach and not natural consumers of council news.
Our solution has been to create The Rona Hub. This is an online space aimed younger adults, under
30, to share information and updates on tackling the pandemic. The content is promoted through
preferred platforms on social media such as Instagram as well as through key influencers. This is a
diverse group of our residents whose members span further education and entry level
employment as well as being graduates and younger parents.
Kath’s COVID Catch Up is a monthly podcast which aims to investigate various issues at different
stages of our response to the pandemic. We have covered the national lockdowns, invited guests
to talk about specific issues, including our younger generations and support provided by women
for International Women’s Day.
Finally, communications have been key in supporting community testing; announcing facilities and
options and encouraging take up through various resources such as posters, social media,
newsletters, and the press. In addition, comms support is key to the success of surge testing,
interacting with the community to encourage participation and reassure during the response.
Page 17 of 37Priority 2: Preventing Infection and Outbreaks
We aim to provide local leadership on the delivery and promotion of the preventative measures to
enable living with COVID-19, reducing transmission in our settings and communities.
Primary preventative approaches are included in the SOPs for all settings (see Priority 3). The
Boards and LORT have key roles in directing and promoting prevention measures that protect
health. Alongside communications and engagement approaches, the actions below are a key
feature in the SOPs across different settings.
Prevention measures
1. Infection Prevention and Control
• Maintain and promote continued compliance with national restrictions, including
COVID-19 business restrictions, as these are eased following the Government’s
roadmap COVID-19 Response - Spring 2021
• Maintain the importance of NPIs, effective handwashing and good respiratory hygiene.
• Promote the appropriate and effective use of PPE or face coverings in different settings.
• Ensure clarity on effective cleaning regimes relevant to different settings.
• Ensure that the public and employers follow appropriate absence measures, including
early symptoms reporting, access to testing, self-isolation and, where appropriate
ensuring financial support is offered via relevant routes.
• Provide support, guidance, and training relevant to different settings.
• Ensure that there is access to subject matter experts, who can provide specific guidance
to relevant settings as required.
• Deployment of district COVID Advisor capacity via the shared regulatory service, WRS, to
areas of highest case numbers and to settings identified as offering a potential risk to local
communities e.g. school gates, supermarkets as requested by the Secretary of State.
2. Addressing Inequalities
• Additional or tailored support for those most vulnerable based on ethnicity, age, or
circumstance (e.g. homeless communities, migrants, low paid).
• Ensure communication is accessible and understandable to all (for example, translation
services, communications in multiple languages, establishing relationships with faith
leaders within the communities).
• Ensure access to services including testing, and H2H for vulnerable groups.
• Support for self-isolation via H2H and the Enhanced Hardship Fund.
• Consider the impact of measures taken (risk of isolation, violence, unemployment) and
use resources to mitigate risk.
• Encourage and support regarding the vaccination programme to promote take up via the
Vaccine Inequalities Programme (below).
• Work with local partners such as those working with persons experiencing rough sleeping
or homelessness to ensure harder to reach groups have equitable access to support,
guidance, and tools for protecting themselves and others against COVID-19.
3. Physical and Organisational Measures
• Support settings to create physically distanced environments.
• Support settings to reinforce the measures and messages to users, for example, providing
signage to schools and public areas.
• Ensure that the importance of social distancing, regardless of setting is maintained in all
messaging and advice provided.
Page 18 of 374. Enforcement as Prevention
• Assess intelligence from a wide range of sources to allow the deployment of enforcement
or COVID Advisor capacity (27 FTEs) from WRS to tackle forms of non-compliance,
including decisions on whether advisory or formal intervention is most appropriate.
• Use the dedicated (7 FTEs) COVID enforcement team within WRS to tackle evidence of
non-compliance in an intelligence-led way.
• Utilise the COVID Advisor capacity from WRS to encourage compliance amongst the
public and advise business operators on how they can comply; particularly targeting
areas with higher case numbers or locations where risky behaviour or non-compliant
actions are identified.
• Deliver contact tracing for cases referred from the National Test and Trace system where
it has failed to contact people (Lost to Follow Up contact tracing) with face to face
contact (door knocking) via either WRS or district officers where local telephone capacity
does not yield success.
• Formal enforcement interventions will utilise a range of legislation available to officers at
district and county level including:
i. Health and Safety at Work Act and associated regulations,
ii. Public Health (Control of Disease) Act 1984 and regulations made by the Secretary
of State for the restriction of behaviours or the public and businesses
iii. Where incidents require an immediate response, local partners will call upon
Public Health England to exercise powers under the Coronavirus Act 2020
• Feed intelligence of illegal gatherings to local policing
• Use the district IMT meetings to flag concerns of noncompliance which can be
investigated and enforcement resources such as the COVID Advisors can be directed
appropriately.
In addition, to prevent the need of the use of the Coronavirus legislation, local guidance for managing
those who are unwilling to self-isolate when symptomatic-19 has been developed with Public Health
at WCC, West Mercia Police and Herefordshire and Worcestershire Clinical Commissioning Group
(CCG). This guidance can be found in Appendix C and outlines how situations can be managed to
support individuals who do not comply. The guidance also outlines the process for escalating any
situations that may require the use of the Schedule 21 to PHE.
Risky Venue Alerts
There are several ways that WCC receives alerts regarding venues that are not operating in a COVID
secure manner:
• Partners at district IMTs can raise concerns;
• COVID Advisors may experience issues in the field;
• Whistle blowers can contact the LORT of the COVID Advisor teams directly; and
• Backwards contact tracing can highlight places of common exposure which could suggest
poor COVID controls.
Each of the methods above are used to inform and describe settings which could create a risk of
onward community transmission of COVID-19. The setting would then be contacted by the COVID
Advisors or WRS to discuss their COVID-19 risk assessment and offered support in how to become
more COVID secure. If the organisation does not engage then other enforcement options may be
considered.
Page 19 of 37Enduring transmission
In some places transmission has continued (enduring transmission) and infection rates remain
high, above the national average, for longer periods of time. When Worcestershire rates are
considered at district level (c.100,000 population per district) it appears that higher rates have
endured in districts where there is a younger, more economically active population. Particularly in
Redditch, where many of the workforce are in manual/skilled or lower paid occupations without
the ability to work from home and often in ‘high contact’ or ‘high risk’ occupations. There is also a
concern that there may be lower engagement with testing and/or compliance with contact tracing
and self-isolation requirements where a person is fearful of losing a job or income or where the
test and trace rules are not fully understood.
To understand the reasons behind enduring transmission WCC work to understand local factors
which could contribute. For example, Worcestershire has two prisons, HMP Hewell in Bromsgrove
and HMP Long Lartin in Wychavon. Significant outbreaks at these institutions affect the local rates
in these areas and can lead to increased community transmission where employees live.
To take the example of Redditch given above, Redditch is well known as being an industrial centre.
Many of the businesses in Redditch have continued to function during lockdown as they
manufacture goods for essential services such as the medical industry. As more businesses have
remained functional during times of high transmission it stands to reason that they are more likely
to experience outbreaks. Therefore, learning that has been gained through the LORT is shared with
these organisations to support them and help to prevent sustained transmission in these settings.
The district IMT meetings link industry, the voluntary sector the district council, the NHS and Public
Health, bringing together key people that understand the local area and can suggest insights into
local behaviours and perceptions which are invaluable in focusing efforts on reducing enduring
transmission. The district IMTs are often used to focus communication campaigns, direct COVID
Advisors and spark actions which result in specific communities becoming the focus, to understand
why transmission rates may be high. In addition, backwards contact tracing is used to gain a
narrative and understanding of local behaviours and activity. This has helped to understand the
reasons for a local increase, such as a local nursery outbreak which resulted in several family
clusters, or several individuals, that lived in the area and worked in areas of higher transmission.
An example of where the district IMT meeting has served to reduce enduring transmission is in
Redditch. An exceptional IMT was called to review potential causes for transmission and how they
could be tackled. The IMT focused on increasing vaccination uptake in hard to reach eligible groups
and offering asymptomatic testing to groups where there had been increased rates of transmission
along with a package of support for self-isolation. This worked to strengthen engagement with key
groups in the community. This multiagency approach allows evidence to be discussed and
collaborative pathways of progressing initiatives to be found, the ownership for this work is then
system wide. Understanding from national research shows that there is not a single silver bullet to
prevent enduring transmission as many factors contribute to it. Therefore, this holistic approach
aims to target enduring transmission in a multifaceted manner.
WCC has observed patterns of infection where one household member has tested positive and
many other household members have subsequently tested positive. The ability to self-isolate, as
recommended, away from other household members is challenging in overcrowded
accommodation or where there are household members that require hands on care and support,
for example younger children or more frail family members.
Page 20 of 37Measures that are being taken:
• Continued focused communication campaigns, through community leaders and workplaces
around each of the measures that reduce transmission in workplaces and private homes.
• Enhanced support provided to workplaces, engaging at the earliest stages of outbreaks to
ensure workplaces understand the value of quality contact tracing and ensure that risk
assessments and working practices are optimal.
• Continuing to provide additional support for self-isolation, tailored at individuals and
families. This offer supports people to access self-isolation grants and resolve practical
barriers to self-isolation, for example, through H2H.
• Shared learning from outbreaks with workplaces, care homes and other high-risk settings.
• Gaining insight into behaviors of local communities which can then be targeted with
additional support or communication campaigns.
• Ensuring equitable access to the tools required to reduce the impact of the pandemic such
as symptomatic and symptomatic testing.
• Supporting organisations such as schools, care homes and workplaces to encourage a
normalization of COVID-19 isolation and testing and empower individuals to make the
right choices through these settings by allowing people to take time of sick and supporting
people to work from home.
Interface with vaccine rollout
The COVID vaccination programme is a vital component for support the country to recovery from the
2020/21 pandemic. The vaccination programme is delivered by the NHS as the lead agency with close
collaboration with LA and other partners to ensure we support all communities to access and receive
their vaccination/s. The vaccination programme in our area is operated across the Herefordshire and
Worcestershire STP, with oversight held within the NHSE West Midlands region. The vaccination
programme covers the whole eligible population which, at time of writing, includes all aged 16 and over.
What has been done so far:
• Set up a network of vaccination centres across Herefordshire and Worcestershire to
ensure local access for all residents. Every resident is within 45 minutes travel time of a
vaccination centre and 95% of the population within 10 miles
• Offered vaccination to all, and administered first doses to 97% of care home residents,
clinically extremely vulnerable, over 80s and housebound people
• Delivered the vaccination programme in line with the priority guidance of the Joint
Committee on Vaccination and Immunisation
• As of 7/3/21, delivered a total of 333,861 doses across Herefordshire and Worcestershire,
of which 318,133 doses are first doses (over 50% of eligible population). 97% of over 65s
have received their first dose with all having been invited for vaccination
• On course to have offered the vaccine to the whole eligible population in line with the
national targets of JCVI 1 to 9 (over 50s and any age at risk population) by mid-April and
full population ahead of the end of July
• Developed and enacted a partnership approach with all agencies, community leaders and
individual people, to encouraging uptake of vaccination within all communities,
particularly those where historical vaccine acceptance has been lower. Uptake of the
COVID vaccine is higher within all groups than the 20/21 flu vaccination programme
What we are planning to do:
• Maintain the current delivery model, progressing down the age cohorts for both first and
second doses, in-line with JCVI guidance
Page 21 of 37• Stepping up delivery capacity to manage second doses for the population who are most at
risk, whilst continuing to deliver first doses to younger populations
• Maintaining discussion and opportunity for vaccination for individuals and communities
who were unable or chose not to attend vaccination at the point of initial invite
• Plan for future capacity and infrastructure able to deliver an ongoing programme as
determined by the JCVI and NHS England
With regard to local take up of vaccinations, WCC will continue to work in partnership with the
CCG to support the roll-out, as demonstrated for unpaid carers. In this instance, the CCG identified
and made slots available at two vaccination clinics for Worcestershire’s unpaid carers and enabled
an online local booking system. WCC contacted all known carers, using Adults Social Care Records,
and worked with Worcestershire Association of Carers, YSS and other County organisations to
widen the offer to as many known unpaid carers as possible. Over 14,500 people were contacted,
and once completing an online check to assure eligibility, in line with the Green Book, were
contacted for vaccination.
Volunteer support
H2H works closely with the CCG to coordinate the volunteer offer for vaccination clinics. Of 449
new volunteers coming forward between 1 January 2021 and the end of February 2021, 85%
indicated an interest in supporting vaccination clinics. At the end of February, H2H volunteers had
gifted over 6000 hours of support for vaccination clinics.
Vaccine Inequalities Programme
The Vaccine Inequalities Programme has been established to predict and address inequalities
within the COVID vaccination programme across the Herefordshire and Worcestershire STP area.
The aim of the programme is to ensure that every eligible person in our population has the
opportunity to receive the COVID-19 vaccination at the earliest opportunity, in line with the
national JCVI prioritisation framework.
The programme steering group has representatives from key partner organisations and will
coordinate delivery of workstreams to identify key local issues and support implementation of
measures to increase vaccine uptake in priority groups and underserved communities. To facilitate
“opportunity” for different groups, geographies, communities, and circumstances in our
population will require a range of adjustments that will be best co-produced with those that we
are aiming to vaccinate. The programme will therefore work closely with local partners
organisations and the community, to utilise existing knowledge, relationships, and experience. To
remove barriers to vaccination, the programme will be guided by the needs of underserved
populations to address concerns raised by vaccine-hesitant groups and resolve operational issues
(for example, access to vaccination centres).
Page 22 of 37Priority 3: Supporting Settings and Communities
Standard Operating Procedures (SOPs)
Partnerships, pathways and processes are in place to support a wide range of settings, including
many which are considered high risk with regard to COVID transmission. Settings include Care and
Residential Homes, Schools, Early Years and Childcare settings, Prisons, Drug and Rehabilitation
centres, temporary accommodation and workplaces (list not exhaustive).
A range of SOPs have been developed to guide the management of situations and outbreaks. Each
outlines setting specific guidelines and actions for prevention of cases and outbreaks, response to
cases or clusters, and the support available in the event of an outbreak. Pathways are included in
SOPs and set out the processes to follow in different settings, the role of the LORT and PHE, and
the resources that can be used to tackle the outbreak. Further resources, including Action Cards,
are available from PHE to support management of an outbreak. The intention is to ensure that the
management of outbreaks is comprehensive and consistent across Worcestershire, drawing on the
skills, partnerships, and capacity to respond quickly.
The SOPs are live documents, frequently updated to reflect changing guidance, and should never be
an alternative to good judgement where circumstances dictate ‘doing the right thing’ must take
precedence. SOPs and guidelines are reviewed routinely to ensure they remain an accurate
description of how situations should be managed. SOPs are listed below. Additional SOPs or guidance
will be developed where other settings or communities are identified:
• Residential and Care Homes;
• Workplaces (either open to the public, or not open to the public);
• Education, including Early Years and Childcare settings;
• People Experiencing Homelessness; and
• Prisons.
Support for settings
WCC provide support over and above the management of outbreaks across a wide range of settings.
The LORT provides a clear first point of contact, 7 days a week, responding to queries in addition to
outbreak support. The LORT is a local system leader in COVID-19 advice, particularly bespoke advice
and guidance for high risk settings. Relationships have been built with various sectors including
adult social care, Worcestershire Children’s First, the homeless sector and Worcestershire
workplaces to ensure accurate advice is rapidly available when needed most.
In addition, the LORT is building relationships settings enabling it, over time, to better understand
the complexities and individual challenges to provide tailored support. Public Health consultants
have areas of specialism or focus such as schools, workplaces, or adult social care and are always
available to offer advice and guidance.
In addition to operational SOPs, resources and comms have been developed and are sent to settings
regularly in conjunction with IPC, Public Health and WCC’s Quality Assurance team, tailored for
various settings such as Adult Social Care, School and Early Years settings or workplaces.
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