The report details progress on Surrey’s Local Outbreak Management Plan including key outcomes and milestones to date, challenges and next steps going forward.
Ruth Hutchinson - Director of Public Health (SCC)
Caroline Chapman - Senior Public Health Contact Tracing Lead (SCC)
Charlotte Keeble - Covid Vaccination Programme Director, Surrey Heartlands Integrated Care System (ICS)
Alison Mason - Senior Public Health Lead (SCC)
Lisa Harvey-Vince - Senior Public Health Lead (SCC)
Lisa Andrews - Public Health Principal (SCC)
Clare Curran - Cabinet Member for Children and Families (SCC)
Sinead Mooney - LOEB Chairman and Cabinet Member for Adults (SCC)
Gavin Stephens - Chief Constable of Surrey Police
Key points raised in the discussion:
National update - Roadmap out of national lockdown for England
1. The Director of Public Health (SCC) noted:
· the publication of the Covid-19 Response: Summer 2021 plan on 5 July which outlined Step 4 of the roadmap out of national lockdown for England which began on 19 July.
· Step 4 was a fundamental shift concerning how people protected themselves alongside the targeted interventions to reduce risk.
· the Surrey Local Outbreak Management Plan mirrored the key bullet points within Step 4, focussing on delivering the vaccination programme, enabling the public to make informed decisions through guidance - communications was key - rather than through legislation, managing the risks at the border and retaining contingency measures to respond to unexpected events - such as the increase in cases in the south west.
· the updated Covid-19 Contain Framework: a guide for local decision makers on 5 August, detailing how local authorities could act and what powers they had, and outlined the key protections that remained in place: symptomatic testing and targeted asymptomatic testing in education and high-risk workplaces, self-isolation remained a legal requirement for those who tested positive, as of 16 August fully vaccinated adults and those under 18 years identified as a close contact of a positive case no longer needed to self-isolate - a PCR test was recommended - and rules for travel to England such as quarantine depending on countries on the amber or red list.
· in place of legislation Step 4 set out cautious guidance both for individuals and for businesses in the community; key was a gradual and safe return to the workplace, the wearing of face coverings in crowded areas such as public transport, letting fresh air in, minimising the number and proximity of social contacts, encouraging businesses at large events such as festivals to use the NHS Covid Pass particularly in high-risk settings.
Local update - Local Outbreak Management Plan
2. The Director of Public Health (SCC) noted:
· that Surrey’s Local Outbreak Management (formerly Control) Plan was re-published to reflect the changes from Step 4 of the roadmap and the revised Contain Framework.
· Surrey’s Covid Management Group had ceased, replaced by the Surrey Heartlands ICS Resilience and Emergency Preparedness, Resilience and Response Board (EPRR) from September, a Managing Director from NHS Frimley CCG sat on the Board and the terms of reference would be reviewed including the relationship with the LOEB and ensuring representative membership.
· following the first meeting of the EPRR Board next week, she would share the EPRR Board’s terms of reference with Board members and would provide clarity on how that Board would interface with the LOEB, ensuring ongoing oversight.
Contact Tracing - National and Local updates
3. The Senior Public Health Contact Tracing Lead (SCC) noted:
· the challenge of contact tracing in terms of meeting the changing case numbers, with twenty daily cases in May, doubling and doubling again to one hundred daily cases in June.
· despite the increase in case numbers, the contact tracing team was coping well due to colleagues in safeguarding for example being trained to make contact tracing calls, all cases received were completed in Surrey.
· as daily cases further increased to over five hundred and then increasing again in July, cases had to be passed back to the national contact tracing team.
· on 6 July changes made reflected the national increase, which saw the introduction of ‘Local 4’ giving people a four hour opportunity to complete an online questionnaire before cases were passed to contact tracing.
· on 16 July as cases were too high some boroughs and districts in Surrey reverted to ‘Local 24’, after a four hour opportunity to complete an online questionnaire and twenty hours of national contact tracing, Surrey County Council were given the cases the national team could not reach.
· on 16 July the national Integrated Tracing System computer programme was suspended until further notice due to the high case numbers.
· on 22 July all of Surrey reverted to ‘Local 24’, that system continued and the case numbers are being monitored regularly, staff numbers are being increased and recruitment is underway.
· on 18 August the Contact Tracing Delivery Group was formed, with a view to report into the EPRR Board.
· between 16-22 August Surrey’s Local Contact Tracing service reached 74.5% of those cases referred from the national team - most weeks 70% of cases were reached - and of those 67.2% were completed - some refused to engage or were unavailable.
Testing update: Symptomatic/Asymptomatic
4. The Senior Public Health Contact Tracing Lead (SCC) noted:
· symptomatic testing - those with symptoms could access PCR testing through the roving Mobile Testing Units (MTUs), Local Testing Sites (LTSs) and regional drive-through test sites; further highlighted an infographic around symptomatic testing produced by the Communications Team (SCC).
· asymptomatic testing - twice-weekly rapid lateral flow device (LFD) testing was recommended for symptom-free individuals and tests were available from Agile Testing Units (ATUs), participating pharmacies and were orderable online; further highlighted an infographic around asymptomatic testing produced by the Communications Team (SCC). There was a focus on Under-Represented Groups (URGs) and Disproportionately Impacted Groups (DIGs). Those with a positive LFD test result needed to take a PCR test.
· the distribution of the testing sites was mapped across Surrey and was reviewed three times a week at the Public Health (SCC) data meetings taking into account outbreaks and meeting the needs within Surrey.
5. The Covid Vaccination Programme Director, Surrey Heartlands ICS noted:
· that as of 22 August 2021 Surrey Heartlands administered 1,464,237 vaccinations - 773,448 first doses and 690,789 second doses.
· welcomed the recent confirmation by the Joint Committee on Vaccination and Immunisation (JCVI) that 16 and 17 year-olds could get vaccinated, 57% of that age range in Surrey Heartlands had received their first dose which was the second highest in the south east behind Frimley.
· welcomed the extension of the vaccination programme by the JCVI to children aged 12 to 15 who were at increased risk. GP practices had identified those eligible children and had written to their parents raising awareness of their eligibility and then booking them in with an appointment.
· JCVI confirmation was awaited concerning children aged 12 to 15 who were not at an increased risk, plans for a vaccination programme for that group was underway through working with education leads.
· over the past six weeks planning had been underway for a phase three of the vaccination programme which was due to commence on 6 September 2021, JCVI confirmation was awaited and the system was ready to implement the programme once confirmed.
· phase three of the vaccination programme would run in two stages, the first on September to mid-October and the second in mid-October to 17 December.
· stage one would be for those deemed most at risk such as adults aged 16 years and over 16 years who were immunosuppressed or clinically extremely vulnerable, those living in residential care homes for older adults, all adults aged 70 years, and frontline health and social care workers.
· stage two included all adults aged 50 years and over, and adults aged 16-49 years who were in an influenza or Covid-19 at risk group.
· Surrey Heartlands ICS was working with colleagues across systems to develop and deliver a number of mobile pop-up vaccination clinics: at the University of Surrey linking in with the universities as part of their induction programmes, at Pride events across Surrey including Godalming Pride, and at Wentworth Golf Club for the upcoming championship.
6. The Chairman congratulated Surrey Heartlands ICS and Frimley ICS for their achievements to date in terms of the high percentages for both doses of the vaccine. She asked for an indication of how quickly the notification might come through authorising phase three and how quickly the systems in Surrey could galvanise their phase three vaccination programmes.
- In response, the Covid Vaccination Programme Director, Surrey Heartlands ICS emphasised the fluid situation noting the daily communications from NHS England - the notification could come through quickly.
- The Covid Vaccination Programme Director, Surrey Heartlands ICS added that Surrey Heartlands’ plans were being assured daily and the mobilisation would be within days. If confirmation from the JCVI was received on children aged 12 to 15 years who were at increased risk, mobilisation of a school-based programme could happen as quickly as 13 September.
7. The Senior Public Health Lead (SCC) noted that many of the two hundred and fifty Community Champions would be from groups eligible for the third dose. She asked how much notice would be provided on the start of the third phase of the vaccination programme, so it could be included within the weekly briefing provided to Community Champions along with the eligibility.
- In response, the Covid Vaccination Programme Director, Surrey Heartlands ICS noted that the eligibility list was available publicly online, Surrey Heartlands had prepared high-level communications for health and social care workers noting what to expect once confirmation was received on the third phase. She was happy to share that communications piece and liaise offline with the Senior Public Health Lead (SCC) on preparing communications once confirmation had been received on the start of phase three and on the eligibility.
8. A Board member welcomed the identification of the New Berry Lane car park, Hersham as a location for testing.
Cllr Chris Sadler left the meeting at 3.09 pm
9. The Chairman later asked for Board members to be kept informed on the move to phase three of the vaccination programme.
Variants of Concern and Surge Testing
10. The Senior Public Health Lead (SCC) noted that:
· a Variant Under Investigation (VUI) was one which had mutations that had strong evidence of causing significant adverse effects and transmission of the variant within the UK or internationally. Nine VUIs were currently being monitored in the UK.
· a Variant of Concern (VOC) was one with increased transmissibility, a change in epidemiology an increase in the severity of the infection and escape from immunity derived from natural infection, and also associated with the decrease in effectiveness of the vaccine. Nine VOCs were currently being monitored in the UK.
· information on the VOCs and VUIs continued to be shared in the weekly Covid-19 Intelligence Summary and the lower tier local authority information on the variants was shared nationally.
· in Surrey and nationally the samples of the PCR positive tests were sent for whole-genome sequencing to determine what variants were circulating in the community, the number of samples being sequenced had reduced due to lab capacity and increased Covid-19 cases recently.
· at present there were no large surge or targeted variant testing operations in Surrey or planned in the imminent future.
· the Public Health Team (SCC) continued to support and work with the Districts and Boroughs, Public Health England and the Department of Health and Social Care to carry out surge or targeted testing required in response to VOCs.
· the Surrey Local Resilience Forum (SLRF) had put together a Surge and Targeted Testing Framework and Checklist, outlining the roles and responsibilities, the notification process, strategic scope, planning and delivery as well as the standing down procedure - it was out for consultation in Surrey.
Managed Quarantine Service (MQS)
11. The Senior Public Health Lead (SCC) noted that:
· currently in Surrey there were two hotels under the MQS operated by the Department of Health and Social Care to allow quarantine of anyone that had come back from a ‘red list’ country.
· one of the hotels was accommodating some of the returning British nationals and refugees from Afghanistan - recognising other health needs.
· the Public Health Team (SCC) and Emergency Planning Team (SCC) were working with the Department of Health and Social Care, local NHS colleagues and Environmental Health teams to resolve any issues at MQS hotels.
Tim Oliver left the meeting at 3.15 pm
Immigration Reception Centres (IRC) / Additional Facilities
12. The Senior Public Health Lead (SCC) noted that:
· the Immigration Reception Centres (IRCs) were separate from the MQS, they were commissioned by the Home Office and there was one hotel in Surrey commissioned in July as a temporary overspill due to the significant number of people that were coming across the English Channel over summer.
· some of the capacity at other IRCs such as in Kent were overwhelmed and one of the main IRCs closed on 4 August for essential security upgrades.
· the hotel was used for a maximum of five days before the transfer to alternative settings, it was anticipated that the hotel would be in operation for between four and five months.
· the Home Office organised security and transport of people to the hotel, monitored the health and welfare needs, and organised Covid-19 testing.
· the Public Health Team (SCC) was working closely with the Emergency Planning Team (SCC), the NHS and Public Health England, meeting regularly to resolve any health and welfare issues.
· there were a couple of other additional facilities in Surrey, there were two facilities in asylum settings for those undergoing the formal immigration and asylum processes: one facility was for short stay for families and single males and the other for long stay primarily for women and children.
· the bridging hotel opened on 22 August and was for refugees coming back from Afghanistan, the Public Health Team (SCC) was working with the Home Office to understand the needs there.
13. The Chairman asked whether there was additional work needed to mitigate any risks concerning the MQS accommodating British nationals and refugees from Afghanistan.
- In response, the Senior Public Health Lead (SCC) noted that colleagues in Sussex where the majority of the refugees were being looked after in the hotels there, had put in place quite a number of practical measures to address the welfare and health needs, and Sussex had made an offer to Surrey County Council to extend that support to the Surrey hotel.
- The Chairman requested an email update to Board members on the offer from Sussex; recognising the support from the public for refugees from Afghanistan.
- The Director of Public Health (SCC) referred to the bridging hotel in Staines, noting the work by colleagues in Surrey Heartlands with regard to the health provision for the refugees from Afghanistan, including midwives and GPs.
Schools and Universities
14.The Public Health Principal (SCC) noted:
· the differing position compared to last year and the preparatory work undertaken over the summer.
· Public Health (SCC) and Education (SCC) colleagues continued to provide support to Surrey schools and early years settings throughout the easing of the Covid-19 restrictions, in anticipation of the new school year communications went out containing updates on the changes and guidance.
· the comprehensive Schools Covid-19 Operational Guidance from Department for Education covering early years, primary and secondary schools, and further education including universities; which contained key differences:
- bubbles were no longer required for children.
- there was no longer a recommendation for face coverings unless there was an outbreak in a particular setting.
- self-isolation for those under 18 was no longer a requirement if they were a close contact but they were requested to get a PCR test and schools were no longer required to be doing contact tracing as the NHS Test and Trace service took over.
- testing remained in place so in Surrey all secondary school age children were requested to have on-site asymptomatic LFD tests twice weekly.
- infection control measures should continue including good hygiene, ventilation - including CO2 monitors - and cleaning.
· preparation was underway regarding communications going out to schools, supplemented by leaflets produced by the Department for Education for early years settings and primary and secondary schools; guidance included Covid-19 safe measures and support for children’s emotional wellbeing and mental health.
· all of Surrey’s university settings had access to LFD testing and continued to encourage uptake of the vaccine, working closely with the University of Surrey around a pop-up vaccination site on campus, as well as considerations over international students returning to the county.
· that the same rules applied from 16 August whereby fully vaccinated adults and those under 18 years identified as a close contact of a positive case no longer needed to self-isolate but a PCR test was recommended, if tested positive self-isolation was required.
· the dynamic situation as a result of the start of the school year.
Children, Families and Lifelong Learning (CFLL) update
15. The Cabinet Member for Children and Families (SCC) noted:
· the holiday camps run over the summer holidays which linked into the food programme for disadvantaged groups, having visited the camps she noted that they were well organised and children had a good time through the activities and learning about nutrition - although established due to the pandemic, she hoped such camps could continue in future years.
· Surrey County Council continued to support those who faced financial challenges, food poverty and fuel poverty - to be aided over the winter through Government grants.
· the emotional wellbeing and mental health support being offered through the new Child and Adolescent Mental Health Services (CAMHS) and Emotional, Wellbeing and Mental Health (EWMH) contract which would be ramping up in schools throughout September. Details on the waiting times, access and advice to the range of services for different needs were included in the report, as well as the focus on reducing the backlogs inherited over the last year.
· a response to an action from the June Informal Board meeting concerning:
- Minute item 21/21: The Cabinet Member for Children and Families (SCC) will follow up the action concerning the difficulty of getting dental appointments for Looked After Children and Care Leavers with the Corporate Parenting Board, providing an update at a future Board.
- a steady increase in the completion of dental checks for Looked After Children had been recorded making more progress since the restrictions lifted, particularly on checks for children who had been looked after for more than one year; whilst more work was need concerning those children who had gone into the care system or had been looked after for less than one year to reach the levels of dental checks pre-pandemic - work with staff was ongoing to ensure that appointments were being booked.
- feedback from foster carers and providers highlighted the difficulties in registering children and young people with new dental practices, particularly when they went into care and for those looked after for a short period. To address the issue, escalation should be made to Linda Cunningham - Surrey-wide CCG Designated Nurse for Looked After Children.
- the recent changes to Surrey County Council’s Tableau recording system which enabled planned dental appointments to be captured, so the focus could be on unmade dental appointments.
- historically children who were two years old or under had their dental checks at the same time as their initial or their review health assessment, during Covid-19 the health assessments were likely to be undertaken virtually and so dental checks were not being done - the backlogs needed to be cleared.
- foster carers and other providers still reported increased waiting times for appointments which was impacting on the speed of recovery, dental surgeries were being contacted regarding children who were previously registered there to check when their last appointment was made and when their next appointment could be.
- service managers were scrutinising dental checks for those who were looked after for less than one year and performance would be monitored weekly until it reached its expected level.
16. The Chairman welcomed a future update in three months’ time to allow the service to address the backlog.
17. The Senior Public Health Lead (SCC) noted:
· that support continued to be provided to care homes experiencing outbreaks, ensuring that the appropriate controls were implemented and that testing continued, and encouraged vaccine uptake in staff working closely with the Surrey Minority Ethnic Forum and local GP practices.
· the first dose rate was 89% and the second dose rate was 79% for care home staff, noting the upcoming 11 November deadline to have all care staff fully vaccinated - unless exempt - to comply with the legislation.
· infection prevention and control training would continue to be offered for care homes throughout the winter period, ensuring the continuation of key measures such as Personal Protective Equipment (PPE) and testing.
· work was underway with Human Resources teams and external providers such as Surrey Care Association to get the messaging out to the workforce or anyone deployed to care homes on the requirements going forward.
· on 16 August 2021 fully vaccinated adults and those under 18 years identified as a close contact of a positive case no longer needed to self-isolate - a PCR test was recommended, however an additional requirement for care staff was that they must take part in a strict testing regime of both PCR and LFD tests to continue working.
· from 16 August 2021 staff working with clinically extremely vulnerable residents must undertake a risk assessment to determine whether they could continue to work. The Public Health Team (SCC) continued to work with the health and safety team and Adult Social Care (SCC) to provide input to that risk assessment.
Adult Social Care (ASC) update
18. The Chairman as Cabinet Member for Adults (SCC), provided an update on Adult Social Care noting:
· the focus in Adult Social Care on winter pressures and preparedness, and importance of collaborative working with health partners.
· the ongoing close partnership working with providers across the county, which was vital in managing Covid-19 within the care home setting at the start of the pandemic.
· the importance of a more sustainable funding position for Adult Social Care going forward, linking to winter pressures and the ongoing pressures from Covid-19.
19. The Chief Constable of Surrey Police noted that:
· since the gradual easing of restrictions, enforcement activity around Covid-19 had been low, however the majority of the additional surge funding was used to address general policing pressures that had arisen following the lifting of lockdown.
· following the lifting of all restrictions on 19 July 2021 there had been a series of days where work levels were equivalent to New Year's Eve each day.
· levels of serious and sexual violence had risen, with the remainder of the surge funding being used to resource specialists in the Sexual Offences Investigation Team (SOIT).
· the partnership working relationships around the MQS were working well, and Surrey Police looked forward to extending that provision over the coming days and weeks in supporting arrivals from Afghanistan to ensure that they received the right support.
· from a policing perspective he was keen to be involved in the modelling discussions to help plan ahead for the autumn and winter.
1. Noted the report.
2. Would continue to provide political oversight of local delivery of the Local Outbreak Management Plan.
3. Would continue to lead the engagement with local communities and be the public face of the local response.
4. Members would ensure appropriate information on the programme and on COVID-19 in Surrey is cascaded within their own organisations and areas of influence.
Actions/further information to be provided:
1. The Director of Public Health (SCC) will provide Board members with the Surrey Heartlands ICS Resilience and Emergency Preparedness, Resilience and Response Board (EPRR) terms of reference; and will provide clarity on how the EPRR would interface with the LOEB.
2. The Senior Public Health Lead (SCC) will liaise with the Covid Vaccination Programme Director, Surrey Heartlands ICS on the high-level communications piece prepared for health and social care workers, in order to prepare a similar piece for Community Champions once confirmation had been received on the start of phase three and on the eligibility.
3. The Covid Vaccination Programme Director, Surrey Heartlands Integrated Care System will keep the Board informed on the move to phase three of the vaccination programme.
4. Concerning the Managed Quarantine Service hotel accommodating British nationals and refugees from Afghanistan, the Senior Public Health Lead (SCC) will provide an email update to Board members on the offer from Sussex; recognising the support from the public for refugees from Afghanistan.
5. The Cabinet Member for Children and Families (SCC) will provide a future update in three months’ time concerning the difficulty of getting dental appointments for Looked After Children and Care Leavers.
6. TheChief Constable of Surrey Police will be invited to provide an update from a policing perspective / will be involved in the modelling discussions at the informal private Board meeting to help plan ahead for the autumn and winter (see minute item 27/21, action 2).