Guidance

Toolkit 4: the incident management team (IMT)

Published 21 January 2025

This toolkit acts as resource to support the establishment of IMTs and provide guidance on how they operate. It includes guidance to support the development of terms of reference, as well as a template for agendas and meeting minutes. The form and function of IMTs may differ according to who is responsible for the outbreak management.

Developing terms of reference

Aims

The IMT should agree their incident aims at the first meeting.

The primary aim of an IMT is to protect public health by identifying the source and cause of infection and transmission, and deciding upon, and coordinating, control measures to reduce transmission and outbreak-related harm.

IMTs should also seek to inform future approaches to outbreak management by identifying what went well and poorly in the past. Where appropriate, they should add to the evidence base about sources and transmission dynamics of infectious agents and the effectiveness of outbreak control measures.

The IMT should agree incident objectives to define both the scope of IMT work and to support ongoing monitoring of progress. Objectives may include the following:

• to secure appropriate membership of the IMT and agree the role of the IMT Chair and IMT members
• to review the epidemiological, microbiological, and environmental evidence and verify if an outbreak is occurring
• to develop and maintain a dynamic awareness of risk and other relevant factors associated with the outbreak
• to develop a tactical and strategic approach to outbreak investigation, control measure implementation, and communication, informed by risk assessment findings
• to ensure outbreak-related decision making considers the ethical and health equity impacts of the outbreak and any associated interventions
• to allocate responsibilities for outbreak investigation, control measure implementation, and communication across the IMT
• to ensure that outbreak control measures are proportionate, equitable and safely implemented
• to discuss, agree and, where necessary, arbitrate any extraordinary funding requirements, escalating unresolved issues as appropriate
• to agree, and subsequently oversee delivery against, approaches to communication with professional partners, elected members, the media, and the public to maintain awareness of outbreak progression and recommended actions as required (a single communications lead should be promptly identified to facilitate coordination)
• to determine when the outbreak can be considered over, informed by ongoing risk assessment
• where required, to produce reports summarising the events and decisions during the outbreak and identifying lessons learned for the purposes of audit and to inform future practice
• to make recommendations regarding the development or modification of systems and procedures to prevent a future occurrence or similar incidents and, where feasible, oversee the enactment of these recommendations

Leadership

The IMT will usually be chaired by a consultant in health protection or a principal/senior health protection practitioner (UKHSA). This is unless the members agree otherwise (for information related to escalation of outbreaks see section 9 of the main body of the communicable disease outbreak management guidance).
Local authority directors of public health (DsPH), or their nominated lead, may wish to chair meetings where there are wider implications for local public health or a the situation requires a major contribution.

Outbreaks confined to NHS trust premises – whether acute, community, or mental health – will usually be led by the relevant trust in accordance with their operational plans and with the advice and input of UKHSA. The NHS will engage the relevant local authority, the Food Standards Agency (FSA) and the DPH as required and based on local arrangements.

Outbreaks confined to UK service personnel, or the defence estate will usually be led by defence public health consultants and environmental health teams with input from UKHSA health protection teams.

The FSA may take responsibility for outbreaks related to national food or feed related incidents.

Membership and roles

The membership of the IMT will be determined based on:

• the situation
• population at risk
• magnitude of the incident
• the infectious disease agent
• the control measures required
• specialist expertise
• the assessed level of risk to public health

Members must be prepared to represent their organisations and have the delegated authority to agree to the mobilisation of resources and allocation of required funding. Any conflicts of interest should be declared by members as soon as they become apparent.

Where possible, a representative from the UKHSA will attend all IMT meetings with a few exceptions (for example, in the instance of a non-complex outbreak confined to a hospital environment).

If not represented as members, then the relevant DsPH and local authority public health team should be informed that an IMT has been established and updated on any important decisions.

Where concerns regarding an organisation’s response to an outbreak, a representative of the IMT, or the organisation leading outbreak management are raised, these should initially be discussed with the IMT chair. If the issue cannot be resolved by discussion between parties, the issue should be escalated to the UKHSA regional deputy director or local DsPH and senior colleagues within the relevant organisation.

Typical membership

The typical membership of an IMT includes:

• consultant in health protection (UKHSA)
• environmental health officer (local authority)
• DPH (or nominated deputy) (local authority)
• Field Services consultant epidemiologist or senior epidemiologist (UKHSA)
• Field Services  consultant in public health infection, (UKHSA)
• Field Services data / epidemiological scientist (UKHSA)
• microbiologist (NHS Trust)
• NHS commissioner (NHS England/ integrated care board)[note 1]
• relevant service provider(s) (NHS/local authority/other)
• communications officer (nominated communications lead organisation)
• administrative support (organisation leading outbreak management).

Note 1: where an outbreak impacts NHS services or requires NHS response.

Additional members who may be required, as determined by nature of the outbreak

Note: Membership will be based on the scale, nature, skills, resource and situation awareness required as part of the outbreak. The list below is therefore illustrative of representatives who may be considered but would not be typically required.

Wider UKHSA representatives

• emergency planning and preparedness lead
• national topic specific expert
• food water and environment microbiologist / scientist
• health protection surveillance/information officer
• infection prevention and control (IPC) representative
• reference microbiology services representative
• relevant regional health equity lead

Local partner agencies

• ambulance trust representative
• community IPC nurse (NHS or local authority)
• IPC lead (NHS)
• integrated care board (ICB) representative (NHS)
• legal advisor and/or data protection advisor (UKHSA or local authority as appropriate)
• local authority education department (local authority)
• emergency planning (NHS or local authority)
• NHS England regional team (NHSE) representative
• NHS consultant from relevant speciality (NHS) or general practitioner (NHS)
• NHS medical microbiologist, pathologist, or clinical scientist (NHS)
• pharmaceutical advisors (medicines management/optimisation)
• police representative
• water company representative

Other Government Departments and Agencies

• Animal and Plant Health Agency (APHA) representative
• Care Quality Commission (CQC) representative
• Department for Environment, Food and Rural Affairs (DEFRA) representative
• Department for Education (DfE) representative
• Department of Health and Social Care (DHSC) representative
• Environment Agency (EA) representative
• Food Standards Agency (FSA) representative or Food Standards Scotland (FSS) representative
• Health and Safety Executive (HSE) representative
• His Majesty’s Prison and Probation Service (HMPPS) representative
• Home Office (HO) representative
• Medicines and Healthcare products Regulatory Agency (MHRA) representative
• senior health protection representative for Devolved Administrations

Community representatives

• representative from affected setting
• representative from voluntary community or social enterprise (VCSE) with experience or links to relevant population or group

Administration

Administrative support should be provided by the lead agency for the incident. The lead agency should be take minutes for all meetings and share them with members and other stakeholders as agreed during the meeting. Minutes will include a log of all the risk assessments the IMT make, the decisions the IMT take, the actions the IMT agree, and the reference number for the relevant UKHSA case and incident management system record. Documentation relating to the incident should be retained by the incident lead organisation. Supporting agencies should maintain all documentation and records, in accordance with relevant data legal requirements and policies, and any decision of the IMT, in order to ensure appropriate record retention schedule.

Meetings

The frequency of meetings should be determined by the initial and ongoing dynamic risk assessment. Meetings may be either in person or virtually (details to be advised by the organiser in advance of each meeting).

Depending on the nature and scale of the outbreak, and the number and level of responders, it may be necessary to establish specific cells to support the IMT. In these circumstances the IMT will always have primacy.

Roles and responsibilities of typical members of the IMT

Note: these tasks may vary according to the nature or circumstances of the outbreak.

UKHSA consultant in health protection (CHP)

Typical responsibilities, noting these may vary depending on the identified outbreak lead, are to:

• declare an outbreak, following appropriate consultation
• ensure appropriate stakeholders are informed and updated, including liaising across UKHSA and devolved public health organisations as appropriate
• convene and chair the IMT unless alternative arrangements are agreed
• ensure timely risk assessment, investigation, and response, taking account of ethical and health equity considerations
• provide advice on, and support the coordination of, outbreak control measures
• provide epidemiological advice and support analysis and interpretation of data
• ensure all documentation relating to the outbreak is correctly managed and disseminated, incorporating information governance and data protection requirements
• ensure, where a constructive debrief is held, that lessons identified are disseminated and acted on
• coordinate production of an outbreak report where required and ensure recommendations are acted on
• ensure records are maintained in an order that enables them to be disclosed in civil or legal proceedings, should it be necessary.

Environmental health officer (representative of the chief environmental health officer)

Typical responsibilities are to:

• investigate potential outbreak sources and secure mitigations to reduce outbreak risk where the local authority is the enforcing authority or where it is the primary authority for companies that operate across local authority boundaries
• advise the IMT where enforcement falls to another body, for example the HSE, FSA, APHA
• notify the FSA in accordance with statutory requirements outlined in Section 5.2.2 of The Food Law Code of Practise (England)
• provide help and advice, including investigation and sampling, in relation to cases and contacts, and/or food, water and environments, where appropriate
• liaise with UKHSA laboratories for analysis of samples
• liaise with the FSA for risk management advice on sample results and other food safety findings, where required according to the Food Law Code of Practice (England)
• provide reports to the local authority
• undertake necessary enforcement actions including identification, seizure, removal and safe disposal of contaminated food within their local authority area
• ensure infection control advice is implemented in settings or contexts where environmental health officers (EHOs) have authority, working in conjunction with UKHSA, NHS and local authority IPC nurses or others
• monitor the progress of environmental health investigation and the impact of environmental health intervention and provide updates to the IMT
• if required, work with local authorities to progress investigations, as necessary, and agree, where more than one local authority is involved, which local authority is the lead local authority
• report to, and liaise with, colleagues in their environmental health department and those in other local authority departments and neighbouring districts as required
• ensure continuity of evidence where needed to support subsequent criminal prosecution processes

Director of public health

Typical responsibilities are to:

• inform and manage communication with the leader of the council and elected members
• support mobilisation of local authority resources and response
• lead, or support if others leading, local communication and community engagement activities
• provide a link to specific settings, such as adult social care services, schools and early years or wider local authority services
• provide population advocacy and expert advice in relation to health equity issues
• contribute to the identification of additional support where of value, including amongst the local voluntary, community and social enterprise sector
• provide system leadership and assurance
• liaise with other local authorities

UKHSA Field Services (FS) consultant epidemiologist/senior epidemiology scientist

Typical responsibilities are to:

• provide advice to the IMT on epidemiological aspects of the outbreak
• set up, lead, and deliver a dedicated ‘epidemiology cell’ as part of the UKHSA incident response
• lead the epidemiological investigation of the incident on behalf of the IMT, including producing outputs and insights, questionnaire production, and identifying research questions
• deliver descriptive epidemiology outputs, and analytical studies as required, as part of outbreak investigation work
• if required, contribute to cross-boundary, multi-region, and national epidemiological investigations and, where necessary, lead these investigations. This should include identifying and escalating analyses on inequalities and settings associated with outbreaks
• undertake reactive field research studies as required to provide insights to inform outbreak management decisions.
• deploy staff into the field to undertake data collection and other field activities as determined necessary by the IMT

UKHSA consultant microbiologist or UKHSA consultant in public health infection (Field Services) or NHS consultant microbiologist

Typical responsibilities are to:

• present and interpret relevant microbiological information (including whole genome sequencing (WGS) findings) to the IMT
• provide guidance on the microbiological aspects of outbreak investigation and control
• identify resources to enable rapid microbiological testing
• arrange testing of relevant samples and arrange further investigations by other laboratories as agreed by the IMT, for example typing/sub-typing or WGS
• liaise with microbiologists in other laboratories (UKHSA and NHS), including local and national reference laboratories, involved in the investigation
• advise on or review communications needed with microbiological colleagues and assist in briefings
• participate, as necessary, in site visits to support the review of premises and support pathways for the procurement of samples
• assist clinical and health protection colleagues with treatment and prophylaxis protocols

In addition, the consultant in public health infection will:

• deliver public health microbiology support for the regions in which they are based
• provide microbiological expertise to UKHSA HPTs and local authorities
• support NHS trusts and UKHSA HPTs in the investigation, management, and control of community outbreaks and healthcare associated infection (HCAI) in acute trusts
• liaise with consultant microbiologists, directors of infection prevention and control, laboratory teams, CHPs, EHOs, senior trust managers and DsPH

NHS commissioner

Typical responsibilities are to:

• inform and manage communication within NHS services
• provide advice to the IMT on implementation of related outbreak control measures
• support the identification and mobilisation of NHS resources
• liaise with other NHS services or commissioners as appropriate

Relevant service providers

Typical responsibilities are to:

• support incident management and provision of relevant provider resources
• support effective planning in the context of ongoing service provision
• ensure appropriate mitigating activity happens

UKHSA communications lead

Typical responsibilities are to:

• liaise with the incident lead to establish an incident spokesperson
• work in collaboration with other IMT members, if spokespersons are needed from other agencies involved in the incident
• coordinate a communication plan, including the most effective routes of communication
• identify parties that need to receive information and any specific communication needs (for example language requirements) of groups, with consideration of accessibility and acceptability for groups who may experience health inequalities, such as inclusion health groups
• coordinate media handling for UKHSA HPTs in close liaison with partners
• work in collaboration to prepare proactive and reactive media statements for release as appropriate
• ensure appropriate heath protection advice is made available to the public and media throughout an outbreak, including appropriate messages articulating UKHSA HPTs advice and ensure this information is accessible to all targeted communities (working with voluntary, community, and social enterprises where appropriate to support this)
• provide communications advice to the IMT
• monitor press and social media coverage of the outbreak

Template agenda for IMT meeting

(Title of outbreak)

(Date, time and venue)

1. Introductions
2. Apologies
3. Minutes and actions of previous meeting (for subsequent meetings)
4. Purpose of meeting

• Agree chair and terms of reference including aims (at first meeting)
• Confirm incident arrangements
• Confirm terms of reference remain accurate and valid in subsequent meetings

5. Situation update and review of evidence

• Epidemiological (including agreeing and review of case definition and international situation if relevant)
• Microbiological/phylogenetic
• Environmental (and food chain where relevant)
• Health equity and safeguarding considerations
• International

6. Current risk assessment (See toolkit 3 and summary table 3.1.6) 7. Control measures

• Resources, lead agency and timeframe

8. Next steps, including further investigations

• epidemiological
• microbiological
• environmental (and food chain where relevant)
• international (if relevant)

9. Communications

• internal
• external
• public
• media
• stakeholders
• others

10. Legal and other issues

11. Review of agreed actions and decisions recorded

12. Any other business

13. Date of next meeting and any change to IMT membership

Note that a risk register may be used by IMTs if deemed appropriate.

Template IMT meeting minutes

(Title of outbreak)

(Date, time and venue)

1. Introductions

• note attendees and representing organisation

2. Apologies

• note apologies and non-attendance, including representing organisation

3. Minutes and actions of previous meeting

• note if minutes agreed or amends recommended
• update action log

4. Purpose of meeting

• record summary of discussion

5. Situation update and review of evidence

• record summary of discussion under relevant headings

6. Current risk assessment

• record important concerns or challenges raised 
• record risk assessment considerations and score (see toolkit 3.1.6)

7. Control measures

• record important concerns or challenges raised 
• record decisions, actions, action owner and timeframe

8. Next steps, including further investigations

• record important concerns or challenges raised 
• record decisions, actions, action owner and timeframe

9. Communications

• record important concerns or challenges raised
• record decisions, actions, action owner and timeframe

10. Legal and other issues

11. Review of agreed actions and decisions

12. Any other business

13. Date of next meeting and any change to IMT membership

• insert date, time and location of next meeting