COVID-19 contain framework: a guide for local decision-makers

Question 1

Overview and purpose

Accepted Answer

This is a guide for local decision-makers in England. It sets out how national, regional and local partners should continue to work with each other, the public, businesses, and other partners in their communities to prevent, manage and contain outbreaks of coronavirus (COVID-19). The framework applies to the autumn and winter period, and will be reviewed and updated as necessary in spring 2022.

This framework sets out:

the roles and responsibilities of local authorities and local system partners, and the support local authorities can expect from regional and national teams, as well as the decision-making and incident response structures
the core components of the COVID-19 response across the spectrum of outbreak prevention and management, including to variants
the requirements of local authorities on the continued COVID-19 response, as well as how this should be factored into local outbreak management plans (LOMPs)

The framework should be read in the context of the government’s COVID-19 Response: Autumn and Winter Plan 2021 and the government’s overall public health objectives for responding to the COVID-19 pandemic.

For practical details about implementation including guidance on outbreaks in specific settings such as adult social care, prisons and education, please ask your regional partnership team (RPT) for access to the Outbreak Management Response Toolkit (OMRT).

Question 2

The next phase of the response

Accepted Answer

The country is learning to live with COVID-19, and the main line of defence is now vaccination rather than lockdown. Data continues to show that the link between cases, hospitalisations, and deaths has weakened significantly since the start of the pandemic.

Autumn and Winter Plan

Over autumn and winter, the government will aim to sustain the progress made and prepare the country for future challenges, while ensuring the National Health Service (NHS) does not come under unsustainable pressure. As set out in the COVID-19 Response: Autumn and Winter Plan, the government plans to achieve this by:

Building our defences through pharmaceutical interventions: vaccines, antivirals and disease modifying therapeutics.
Identifying and isolating positive cases to limit transmission: Test, Trace and Self-Isolation.
Supporting the NHS and social care: managing pressures and recovering services.
Advising people on how to protect themselves and others: clear guidance and communication.
Pursuing an international approach: helping to vaccinate the world and managing risks at the border.

Test, Trace and Self-Isolation Strategy: identifying and isolating positive cases to limit transmission

While vaccination is our main line of defence, we will continue to need to test and trace, and to self-isolate in order to break chains of transmission. The Test, Trace, and Self-Isolation system remains critical to the government’s plan for managing the virus over the autumn and winter. It helps to find positive cases and make sure they and their unvaccinated contacts self-isolate, breaking chains of transmission. This helps reduce pressure on the NHS, as well as enabling individuals to manage their own risk and the risk to others. Testing is also crucial to enable genomic sequencing that can identify potentially dangerous variants.

To summarise, the strategy for the autumn and winter period is as follows.

We will continue to expect everyone with COVID-19 symptoms to self-isolate and take a polymerase chain reaction (PCR) test. Over autumn and winter PCR testing for those with COVID-19 symptoms will continue to be available free of charge.
Regular asymptomatic testing will continue to help find cases and break the chains of transmission. It will be focused on those who are not fully vaccinated, those in education, and those in higher-risk settings such as the NHS, social care, and prisons. Public access to lateral flow devices (LFDs) via GOV.UK and pharmacies will continue in the coming months to help manage periods of risk. At a later stage, as the government’s response to the virus changes, universal free provision of LFDs will end, and individuals and businesses using the tests will bear the cost.
Community testing will continue to support local authorities to focus on disproportionately-impacted and other high-risk groups.
The legal requirement to self-isolate for 10 days if an individual tests positive for COVID-19 – and for close contacts who are 18 and over and not fully vaccinated – will remain. We will continue to provide practical and financial support to those who are eligible and require assistance to self-isolate. Local authorities will continue to play a critical role in managing financial support by administering and raising awareness of the Test and Trace Support Payment scheme (TTSP).
We will continue with contact tracing throughout autumn and winter to enable us to check with all positive cases whether they need support to self-isolate and to alert their close contacts. Local authorities will continue to play an essential role in this. We have seen the success of Local Tracing Partnerships (LTPs) that are now the norm with over 300 in operation.
We will also continue to encourage the use of NHS COVID-19 App this winter to help individuals manage risk and make informed decisions.
The Health Protection (Coronavirus, Restrictions) (England) (No.3) Regulations 2020 (‘No.3 Regulations’) which give local authorities the power to issue a direction imposing restrictions, requirements or prohibitions in relation to individual premises, events and public outdoor places have been extended until 24 March 2022.
We will continue to support and work with local authorities and local areas facing particular challenges. This includes support for areas with enduring transmission and national support for an enhanced response in areas with particularly challenging disease situations. The government will also continue to provide access to the Education Contingency Framework, which provides guidance on the principles for managing local outbreaks of COVID-19 in all education and childcare settings.

Local authorities have always played a critical role in public health protection, emergency response and infectious disease control. Despite COVID-19 being unprecedented in its impact and scale, local authorities have carefully led the response in their communities. Local authorities will remain critical in supporting the Test, Trace and Isolate system this autumn and winter. The UK Health Security Agency (UKHSA) is committed to empowering local leaders, ensuring they have the appropriate tools and resources, and working in partnership to co-design the ongoing response to COVID-19 and other threats to the security of the nation’s health.

Autumn and winter health risks

Winter is always a challenging time for the NHS. This winter could be particularly difficult due to the impacts of COVID-19 on top of the usual increase in emergency demand and seasonal respiratory diseases such as influenza (flu). It is a realistic possibility that the impact of flu (and other seasonal viruses) may be greater this winter than in a normal winter due to very low levels of flu over winter 2020 to 2021. There is considerable uncertainty over how these pressures will interact with the impact of COVID-19.

It will be increasingly necessary to be able to flex the system to react to different levels of virus prevalence across the country. Seasonality, waning immunity or a more transmissible or vaccine-escaping variant could result in a significant resurgence of COVID-19 in the autumn and winter. Other health protection threats are expected to rebound as society returns to normal. Respiratory syncytial virus (RSV) and norovirus returned at unseasonal levels during the summer. Influenza activity remains unpredictable this winter following disrupted transmission in 2020 to 2021. Other viruses and bacterial diseases may also cause outbreaks this winter.

NHS England is working with local colleagues via its regional teams to develop detailed plans to ensure that they are ready to deliver a booster programme in line with the Joint Committee on Vaccination and Immunisation (JCVI) guidance. They will continue to work closely with partners including local authorities and voluntary organisations to ensure equal access and to maximise uptake of both COVID-19 and influenza vaccines. Both the COVID-19 and influenza vaccination programmes are important for individual and public health, especially over winter 2021 into 2022. Where operationally expedient, COVID-19 and influenza vaccines may be co-administered.

UKHSA will work with NHS England to ensure that winter plans also include appropriate assumptions and mitigations for potential resurgences of COVID-19 and other health threats that impact on care capacity. Local authorities should continue to iterate their LOMPs, bearing in the mind the specific sets of challenges that the autumn and winter will bring in dealing with not just COVID-19 but other infectious diseases.

Question 3

Ways of working

Accepted Answer

Roles and responsibilities

There have been no changes to roles and responsibilities for local authorities since the summer. While COVID-19 continues to present an unprecedented challenge, well-established local, regional and national arrangements for public health and emergency planning and response continue to form the basis of the response. The decision-making model follows the tried and tested approach to civil emergencies, based on the concept of subsidiarity. National, regional and local teams have been working in partnership for many months to develop and deliver the response to the virus.

Local authorities and Directors of Public Health (DsPH)

All local authorities are engaged in activities designed to respond to COVID-19 in their areas. In 2-tier areas, DsPH work closely with their district colleagues to ensure joined-up tracing, enforcement and support for self-isolation.

Local systems will include emergency planning mechanisms which are widely used, including local resilience forums, supported by the Department for Levelling Up, Housing and Communities (DLUHC), and engaging a full range of partners. This includes all of the emergency planning responsibilities of category 1 responders and where necessary the deployment of regional and local resilience forums. Close working throughout the pandemic has strengthened and developed these existing partnerships.

While local arrangements will reflect local systems, clear governance is essential to ensure that each area operates effectively. Local governance of COVID-19 builds on existing practice and structures:

the Director of Public Health (DPH) has a statutory duty for the COVID-19 local outbreak management plan (LOMP); supported by wider local authority teams as necessary
the local authority chief executive is responsible for the local response, providing strategic leadership and direction, shaping local communications and engagement, and deploying local government resources
local authorities, through their elected mayors and council leaders, are accountable to their local community for the local response, decisions and spending undertaken
councillors, as local systems leaders, and local community leaders can facilitate systems relationships and community engagement
the Civil Contingencies Act 2004 provides that other responders, through the local resilience forum (LRF), have a collective responsibility to plan, prepare and communicate in a multi-agency environment
the local ‘gold’ structure provides resource coordination, and links to COVID-19 regional partnership teams and other key category 1 responders from the local system
local authorities have legal powers relating to public health which include the ability to impose restrictions on settings and members of the public

COVID-19 regional partnership teams

The COVID-19 regional partnership teams (RPTs) led by UKHSA and the Office for Health Improvement and Disparities (OHID) play a pivotal role in connecting the national and local response by:

working collaboratively to bring their collective capability together in support of local areas, working in partnership as necessary with local DsPH, chief executives and local authority leaders or elected mayors, and wider system partners
working closely with national teams to support policy and operational co-ordination across UKHSA, NHS England’s regional teams, DHSC, and other key government departments

RPTs work closely with local authorities and wider local systems to support their response, ensuring they are able to implement their COVID-19 local outbreak management plans. They provide ongoing oversight and assurance, escalating risks and issues as needed including via the national local action committee command structure; providing additional support and escalating requests for surge assistance; as well as identifying good practice for spread and scale.

Each region also has a UKHSA Health Protection Team (HPT) who play a key role alongside local authority partners to combat outbreaks and deal with enduring transmission. They include specialist expertise in communicable disease control, epidemiology, outbreak management and related issues. They have a strong regional focus which enables effective professional working relationships with DsPH and, in partnership with their teams, are an integral part of the expert local response to COVID-19. They provide local DsPH with access to highly specialised public health advice and support. They will also lead on complex outbreak investigation and management.

National government

Ministers are accountable for setting the overall framework for the COVID-19 response with a national communications strategy, enabling and supporting the local response, including through provision of funding and for ongoing oversight and intervention where necessary. Ministers also work with the devolved administrations and international governments as required.

The Secretary of State for Health and Social Care takes policy and operational decisions on the COVID-19 response, as appropriate. Oversight of the ongoing incident response takes place through the government’s local action committee command structure (bronze, silver, gold) where local and regional concerns are escalated, and issues for discussion and decision by ministers across government are taken. Recommendations on escalation of issues or requests for significant surge support can be taken by the ‘gold’ incident management structures to ministers for final decision.

Ministers have powers to take action against specific premises, places and events, or to implement more substantial restrictions, as detailed in the Regulations section below.

National and regional assurance

In overseeing locally led COVID-19 response delivery, UKHSA will set strategic and policy direction, clinical governance guidelines for community interventions, regulatory and compliance standards and managing such things as test kit allocation to local authorities.

UKHSA actively monitors domestic and international trends and patterns in epidemiology to inform national and local response activity to COVID-19. A range of indicators are used as part of this monitoring activity, including:

case detection and testing rates – covering all ages, including over 60s and additional age categories (such as primary and secondary school ages), ethnicity and geographies
incidence and prevalence – at regional and sub-regional level, including from surveillance studies
trajectory – rates at which cases are, or are predicted to be, rising or falling
pressure on the NHS – occupancy and admissions
variants – descriptive and analytical epidemiology of variants
vaccine uptake and vaccine effectiveness against a) infection b) hospital admission and c) death – across regions and local authorities, different populations, and the impact on case rates, hospitalisation and mortality
effectiveness of operational response – testing infrastructure and usage, effectiveness of contact tracing, uptake of self-isolation financial and non-financial support, compliance and enforcement performance
local characteristics – mobility, deprivation, ethnicity, data on reported contacts

These indicators, alongside extensive engagement with the scientific community within the UK and internationally, as well as qualitative insights from HPTs across the country create a holistic overview to inform response activity.

If ongoing national and regional oversight and assurance or local gold command identifies a serious concern in the epidemiology (for example very rapidly rising rates or something potentially suggestive of a variant) that may pose a risk nationally, the national local action committee response structure will be used to consider activating support such as outlined below. This will usually be at the request of the local system and via the regional partnership team. The government will remain vigilant and monitor the data closely, taking action to support and protect the NHS when necessary.

In preparation, the government has undertaken contingency planning in case Plan A is not sufficient to keep the virus at manageable levels. So that the public and businesses know what to expect, the Autumn and Winter Plan 2021 outlines a Plan B for England which would only be enacted if the data suggests further measures are necessary to protect the NHS. The government remains committed to doing whatever it takes to prevent the NHS from being overwhelmed.

Guiding principles for future engagement

On 1 October 2021, NHS Test and Trace (including the Joint Biosecurity Centre), the COVID-19 managed quarantine service, and the health protection functions of Public Health England (PHE) joined together to establish UKHSA. The immediate priority of UKHSA is to lead the UK government’s ongoing response to the COVID-19 pandemic, whilst continuing to manage other routine infectious disease and external health threats.

UKHSA will continue to build on existing relationships, and on the ways of working established during the COVID-19 pandemic. UKHSA will work collectively with partners to develop a future engagement framework that best supports regional and local teams to deliver against public health threats and facilitate the co-design of future policies and responses.

Question 4

The core COVID-19 response

Accepted Answer

Test

Testing, both symptomatic and asymptomatic, performs a central role in identifying people who have the virus. It enables their contacts to be traced and helps ensure people self-isolate and/or get tested to prevent onward spread. The government has announced that symptomatic and asymptomatic testing will remain in place to help identify positive cases and reduce the risk of transmission to others, regardless of vaccination status. Testing, tracing and self-isolation will remain a centrepiece of the UK’s ongoing response to COVID-19.

Free PCR testing for people with COVID-19 symptoms and free lateral flow testing, particularly for people working in higher risk workplaces and in education settings will continue in England as part of the government winter plan.

Local authorities and their DsPH have been crucial partners in delivering testing, helping to establish regional and local test sites, prioritising and directing the use of mobile test units and communicating with the public about the availability of testing and encouraging uptake.

Symptomatic

PCR testing for symptomatic people is a top priority – we will continue to operate a network of testing sites, as well as the option to order PCR tests to self-test at home. At national level we will continue to use communications and marketing channels to reach different groups in the population to underline the importance of getting tested if an individual experiences COVID-19 symptoms. Materials will continue to be available to local authorities (including in a wide range of community languages) for local use.

Contact tracing will also continue to identify the contacts of positive cases. All contacts of a positive case will be asked to take a PCR test as soon as possible if they are identified as a contact and those who are 18 and over and not fully-vaccinated will, as now, be told to self-isolate. Further information on this is provided within the Self-isolation section.

Asymptomatic

Rapid asymptomatic testing is another tool to help reduce the spread of the virus, while supporting people to manage their own risk and the risks to others. Since the asymptomatic testing programme began, it has found over 680,000 positive results, and today, around a quarter of positive tests come from LFDs. The government will therefore continue to provide the public with access to free lateral flow tests in the coming months. People may wish to use regular rapid testing to help manage periods of risk such as after close contact with others in a higher risk or poorly ventilated environment, or before spending prolonged time with a more vulnerable person.

An overview of the current asymptomatic testing available is set out below. The COVID-19 Outbreak Management Response Toolkit provides a more detailed view of the different channels, including:

targeted community testing
universal offer (which includes GOV.UK, pharmacy collect)
NHS
education
higher education
vulnerable settings (NHS Staff, adult social care, hospices, prisons, and independent healthcare providers) private sector
public sector

We will continue regular asymptomatic testing of staff and service users in vulnerable settings. Staff and service users in these settings are at greater risk of COVID-19 due to the vulnerability of residents and the ease at which infection spreads in these closed or semi-closed settings, even with high levels of vaccination. Given the increased risk in these settings, routine testing is used to help keep vulnerable people and staff safe and secure. This will allow staff to continue to provide critical services to the communities they serve.

At a later stage, as the government’s response to the virus changes the universal free provision of LFDs will end, and individuals and businesses using the tests will bear the cost. The government will engage widely on the form of this model as it is developed, recognising that rapid testing could continue to have an important role to play in future.

Targeted Community Testing

Targeted community testing (TCT) supports local delivery of asymptomatic testing to disproportionately impacted and under-served groups, reflecting local priorities and insight. These groups are more likely to experience existing health inequalities, suffer worse outcomes and are less likely to take up the vaccine. They are also the groups most likely to live in areas with enduring transmission of the virus. Local authorities use a range of methods to reach these groups – including using community venues and mobile services – to take testing to the heart of communities using trusted partners, to develop tailored communications, and to increase access to testing.

This flexibility means local authorities can get testing to people that might not usually seek it out, for instance from larger fixed testing sites. Targeted community testing has been one of the most successful channels at finding positive cases. Since July 2021, TCT has a ‘positivity rate’ that is higher than any other supervised testing channels ^{[footnote 1]}. Later, as the universal free provision of asymptomatic testing reduces for the general population, and vaccination rates rise in most groups of people, it will be more important than ever for local authorities to consider the differential impact of the virus and ensure testing services are available and accessible for disproportionately impacted and under-served groups.

Trace

A critical step in the control of community transmission is the fast and efficient tracing of people who have tested positive and their close contacts. All positive cases, regardless of age or vaccination status, will continued to be contacted for 3 reasons:

to provide them with public health advice to self-isolate and to check whether they need support to do this
to determine who they might have been in contact with
to establish how and where they might have been infected

We have seen the success of LTPs that are now the norm with over 300 in operation. LTPs work alongside the national trace team to ensure we reach the greatest possible proportion of positive cases as quickly as possible, bringing invaluable local knowledge, resource, and expertise.

In addition to the standard local tracing partnership model, many local authorities have adopted the Local – 4 approach. Under this model, LTPs take responsibility for contacting new cases immediately after a 4-hour window for self-completion is passed, as opposed to only taking cases that national colleagues have not reached within 24 hours.

Recently, we have worked with local authorities experiencing capacity issues due to high case rates to prioritise cases by postcode area. Hybrid operating models for local tracing have ensured the right work is done at the right place and time. Going into the autumn and winter period we are building on this work by investigating IT system updates designed to give local authorities more flexibility over how they prioritise cases that come to them first and to provide better tools with which they can set their capacity limits.

The pilot of local authorities tracing contacts of cases was completed this summer with the evaluation showing benefits to the approach. Further discussions are underway about next steps for the approach and the appropriate time for further roll-out given current case rates. We will continue to work closely with local authorities on future innovations.

NHS COVID-19 app

The NHS COVID-19 app has played a key role in breaking chains of transmission since its launch in September 2020. The app is a key health protection tool, preventing as many as 2,000 cases a day in July. It informs users if they have been exposed to someone known to have tested positive for COVID-19, either through direct contact with a positive case or following a check-in to a venue where there has been an outbreak and advising on actions they can take to protect others. Since 16 August 2021, the app has advised potential contacts who are vaccinated to take a PCR test rather than self-isolate, in line with self-isolation policy changes outlined below.

We have made key metrics from the app available at local authority level to support decision-making and planning, including where to target marketing and communications. This data can also be used to help encourage business and event organisers’ uptake of the official NHS QR codes to support venue check-ins. The NHS COVID-19 app can also support detection and management of variants. Local authorities can request tailored messaging alerts be sent to app users in their area to provide advice about variants and signpost them to testing.

Self-isolation

As well as maintaining the current legal requirements to self-isolate for positive cases and those contacts who are 18 and over and not fully vaccinated, as well as the associated legal duties for employers, the government will continue to offer practical and financial support to those who are eligible and require assistance to self-isolate. This support has been extended until 31 March 2022. Self-isolation remains an essential part of our targeted response to this pandemic and has been vital in reducing transmission.

Since 16 August 2021, contacts who are fully vaccinated, under the age of 18, clinical trial participants or who cannot be vaccinated for clinical reasons no longer have to self-isolate, but self-isolation remains vital for people with COVID-19 symptoms, those who test positive for COVID-19 and close adult contacts who are not fully vaccinated. All contacts, whether they are exempt from self-isolation or not, will continue to be strongly encouraged to take a PCR test as soon as possible after being identified (with the exception of very young non-household contacts, where parents and guardians will be given public health advice).

In August 2021, we extended the Workplace Daily Contact Testing scheme to a number of sites providing essential public services to enable non-household contacts who would otherwise have had to self-isolate to attend work and undertake other essential activities. Following the recent clinical study of daily contact testing for the general public (using home LFD tests rather than on-site testing), use of daily testing as an alternative to self-isolation for adult contacts who are not fully vaccinated is under review.

Local authorities will continue to play a critical role in supporting people on low incomes who are required to self-isolate by delivering financial assistance via the Test and Trace Support Payment scheme (TTSP) and Practical Support Payment (PSP) schemes and raising awareness of the support available. To date, TTSP has supported nearly 300,000 people to stay at home and self-isolate – this has helped to encourage testing uptake, reduce transmission and prevent hospitalisations and deaths.

Earlier in 2021, we worked with local authorities to co-produce a framework for practical, social and emotional support for those self-isolating and in July 2021 we updated the framework. Further details on these schemes are provided in the funding section.

Vaccines

Local authorities, working with NHS colleagues, continue to play a key role in delivering the vaccine programme as set out in the COVID-19 vaccines delivery plan. DsPH and their teams, working closely with national Screening and Immunisation Teams, bring in depth experience and play a decisive role in understanding the population of an area. Increasing vaccination rates overall and especially among people in disproportionately impacted groups remains central to the national and local COVID-19 response.

The NHS will be rolling out a booster programme to protect those most vulnerable to COVID-19 through the winter months, after the government accepted the JCVI advice to offer a booster vaccine dose to individuals who received vaccination in Phase 1 (JCVI priority groups 1 to 9). The JCVI advises that this should be no earlier than 6 months after completion of the primary course, and that the booster programme should as far as possible be deployed in the same order as during Phase 1.

The government has accepted the 4 UK chief medical officers’ (CMOs) advice to extend the offer of universal vaccination with a first dose of Pfizer vaccine to all children and young people aged 12 to 15 not already covered by existing JCVI advice. Healthy children in this age group will primarily receive their COVID-19 vaccination in their school with alternative provisions in place for those who fall outside this group. The NHS is preparing to deliver a schools-based vaccination programme, which is the successful model used for vaccinations including for HPV and diphtheria, tetanus and polio (DTP), supported by GPs and community pharmacies.

Guidance for schools on the COVID-19 vaccination programme for children and young people can be found on GOV.UK.

Funding

Since the start of the pandemic, the government has allocated over £12 billion directly to local authorities through a number of grants. This includes providing support to businesses and vulnerable households, compensation for irrecoverable loss of income, and for the public health response.

The Contain Outbreak Management Fund (COMF) is the primary source of funding to support local authorities to deliver their outbreak management plans and implement measures to tackle enduring transmission, and enhanced response activity in areas with particularly challenging disease situations. The COMF has distributed £2.1 billion to English local authorities since June 2020 and supports public health activities directly related to the COVID-19 response, such as: testing, non-financial support for self-isolation, support to particular groups (for example, rough sleepers), communications and engagement, compliance and enforcement.

It is expected that all funds will be spent by the end of March 2022 and local authorities are required to submit monthly monitoring forms detailing how the funds have been spent. Guidance and the grant determination letters covering these payments can be found online.

For the financial year 2021 to 2022 £400 million was allocated using the Department for Levelling Up, Housing and Communities’ COVID-19 relative needs formula, which is weighted according to population and deprivation, allowing for funding to be directed appropriately. These payments were distributed to both upper tier and lower tier local authorities on a 79% to 21% split, as a single payment.

Since September 2020, local authorities in England have received £280 million to administer the TTSP scheme and support low-income workers who are required to self-isolate, cannot work from home and will lose income as a result. In addition, the government has made funding available to local authorities for discretionary payments to support people who fall outside the scope of the main scheme, but who will face hardship if they are required to self-isolate. This funding was increased in March 2021, with £20 million per month available to local authorities to support more people in their areas.

In the first 6 months of the 2021 to 2022 financial year we have provided over £85 million to local authorities to fund practical support schemes supporting those who are self-isolating. In addition, funding is provided to support the Medicines Delivery Service, which provides free delivery of prescription medicines to those who are self-isolating.

TTSP, PSP and the Medicines Delivery Service will continue to the end of March 2022.

UKHSA is committed to achieving value for money, publishing our expenditure in line with current requirements, and delivering the greatest impact on virus transmission that we can, through all the actions we take. Local authorities should be guided by the same principles.

Surveillance and data

Surveillance will continue to play a critical role in preventing, understanding and responding to outbreaks. Surveillance can also help us to assess the impact of measures taken to contain the virus and to inform current and future actions.

Robust population surveillance programmes are essential to understand the rate of COVID-19 infection, and how the virus is spreading across the country. The National Surveillance Programme, which currently includes the Office for National Statistics COVID-19 Infection Survey and the Imperial College London and Ipsos MORI REACT study, provides the necessary information and intelligence to develop shared situational awareness to prioritise the ongoing planning and response to COVID-19.

UKHSA also has real-time surveillance data from:

laboratory systems (people who test positive, age, sex, location and so on)
number of tests and where they were carried out
outbreaks
rates by upper tier local authority (UTLA), lower tier local authority (LTLA), borough, postcode and super output areas
vaccination rates and vaccine efficacy
hospital admissions, in general and to intensive care units etc
deaths

Wastewater monitoring is also carried out on an ongoing basis across around 70% of the population of England. It helps us to understand where the virus is circulating geographically, regardless of whether people have symptoms or have been tested, and to swiftly identify future potential spikes in infection.

This is shared with DsPH for information and action as appropriate. Further detailed information of the data resources available to local authorities can be found in the OMRT.

Communications and engagement

Communications have highlighted key messages and advised the public to practice safer behaviours. Local authorities will continue to tailor local public health messaging appropriately in their areas, considering a range of factors including the epidemiological situation, demographics, outbreak settings and the nature of the outbreak. These communications should also focus on building community resilience by providing the knowledge and resources to enable individuals to protect and care for themselves and others, and on enhancing the day-to-day health and wellbeing of communities to reduce the negative impacts of COVID-19.

We continue to work in partnership with local authorities to advise and support on appropriate local communications plans, using behavioural insights and research into audience segmentation, as well as direct experience of what has worked across the country and internationally. In addition, the government will continue to make available a comprehensive and up to date range of assets available at the coronavirus resource centre.

Local politicians, MPs, local authority chief executives and DsPH also have an important role in community engagement to reinforce national messaging, encourage compliance, and understand the barriers to individuals engaging with the testing, tracing, self-isolation response and vaccination. This will continue to be critical as we exit national restrictions and learn to live safely with COVID-19, particularly for those individuals and communities that are at higher risk.

Compliance and enforcement

The Health and Safety Executive (HSE) and local authorities are the lead enforcement authorities for business related COVID-19 compliance and enforcement. Businesses are responsible for taking precautions to protect people against COVID-19 in their health and safety risk assessments, taking government guidance into consideration. The enforcement allocations between HSE and local authorities are explained in HSE’s enforcement allocation guidance. Local authorities will continue to be the main enforcement authority in retail, hotel and catering, office and consumer or leisure settings while, in general, HSE inspectors lead on enforcement in more industrialised settings such as manufacturing. District authorities in 2-tier areas have responsibility for environmental health. County councils in 2-tier areas have responsibility for public health, which includes issuing directions under the No. 3 Regulations. Enforcing authorities can issue improvement or prohibition notices where they identify breaches of health and safety measures.

As of 19 July 2021, many of the measures that were in place have moved from legal requirements to advice and guidance. With fewer regulations to enforce against and with some of the enforcement powers for local authorities also removed, they will carry out less enforcement work. Local authorities will still have an important role in supporting businesses and public places to be COVID-safe, for example by improving knowledge of infection prevention and control, ensuring spaces are well ventilated, and explaining the relevant regulations and guidance.

Local authorities may be able to use resources previously deployed for COVID-19 compliance and enforcement to support businesses and public places to follow guidance, where available. They can also continue to use marshals, stewards or their equivalents for ongoing support, such as providing in-person advice and support to businesses and to the public. These resources could be considered as part of local outbreak management planning in areas of higher risk, or where there is demand from businesses or the public locally for this type of intervention.

Under the government’s COVID-19 Response: Autumn and Winter Plan, local authorities will retain powers under the No. 3 Regulations until 24 March 2022 and will also play a role in ensuring that employers comply with their obligations under the self-isolation regulations.

Autumn and Winter Plan B

The Autumn and Winter Plan 2021 included a contingency plan (Plan B) which would be used if the NHS was likely to come under unsustainable pressure. These contingency measures envisage:

communicating to the public that the risk level had changed; and
requiring mandatory vaccine-only COVID-19-status certification in certain settings; and
requiring face-coverings in certain settings.

Local authorities would hold the compliance and enforcement responsibility with respect to businesses and events’ organisers implementation of mandatory certification. The government has published more details about what mandatory COVID certification would involve. This will give local authorities the opportunity to consider how they would operationalise the compliance and enforcement approach in advance and engage in discussions with their business community.

Local authorities would also play a role in compliance and enforcement of mandatory face-coverings in business settings. The government will specify what settings will require mandatory face-coverings if Plan B is enacted. Decisions regarding face coverings in education settings are not in scope here and should follow the principles set out in the Contingency Framework.

Regulations

The Health Protection (Coronavirus, Restrictions) (England) (No.3) Regulations 2020 (‘No.3 Regulations’) have been extended until 24 March 2022 and may be used right up to the date of expiry. The No.3 Regulations give local authorities the power to issue a direction imposing restrictions, requirements or prohibitions in relation to:

individual premises, except when they form part of essential infrastructure
events
public outdoor places

The No.3 Regulations are made under the Public Health (Control of Disease) Act 1984. The main difference between the No.3 Regulations and the parent Act is that the regulations enable a local authority to close premises without prior recourse to a Magistrate’s Court to enable swift intervention.

Under the No.3 Regulations, ministers also have powers to take action against specific premises, places and events, as well as to direct local authorities to act, and to consider whether a local authority direction is unnecessary and should be revoked.

The Public Health (Control of Disease Act) 1984 gives local authorities the ability to make an application to a Justice of the Peace in the Magistrates’ Court to impose restrictions or requirements to close contaminated premises; close public spaces in the area of the local authority; detain a conveyance or movable structure; disinfect or decontaminate premises; or order that a building, conveyance or structure be destroyed.

As set out in the autumn and winter plan (see further detail above) contingency measures would be introduced if the NHS was likely to come under unsustainable pressure. In the event of these measures being required and proportionate, ministers could use powers within the Public Health (Control of Disease) Act 1984 to implement more substantial restrictions. These include:

closing businesses and venues in whole sectors or geographies
imposing general restrictions on people’s movements or gatherings
restricting or closing local or national transport systems
mandating use of face coverings in public places

Any regulations would be subject to appropriate parliamentary scrutiny.

Question 5

Local action to respond to prevalence and outbreaks

Accepted Answer

Local Outbreak Management Plans

COVID-19 LOMPs are based on the proven practice of breaking chains of transmission and preventing and containing outbreaks. It is therefore important that LOMPs set out an effective response to outbreaks, especially of variants of concern, and in higher risk settings. LOMPs should reflect the core ongoing response including the national UKHSA tools and services that effectively support and enable this local response.

Local outbreak planning and management is led by upper tier local authorities (UTLAs) within a national framework, supported by UKHSA regional and national teams, and other government departments as needed. In 2-tier areas, county councils work closely with district, borough and city councils, particularly recognising the role they play in supporting community compliance and business enforcement. Each UTLA already has a local outbreak plan developed in line with the Association of Directors of Public Health guiding principles that set out how local systems should work together to develop and implement the plans, including across geographical and administrative boundaries.

These 4 principles, which should enable maximum effectiveness, are that plans should:

be rooted in and led by public health
adopt a whole system approach
be delivered through an efficient and locally effective system
be sufficiently resourced, both financially and with expertise

Local plans should be regularly refreshed to reflect learning from exercises, incidents, good practice and remain aligned with the overall national response as it evolves. They should also enhance, expand and reinforce the outbreak work of the HPTs within UKHSA and, as a minimum, cover the following themes:

higher-risk settings, communities and locations
vulnerable and underserved communities, including the clinically extremely vulnerable (CEV) and groups who have been disproportionately impacted by COVID-19
compliance and enforcement
governance
resourcing
communications and engagement, including community resilience
data integration and information sharing

Plans should also reflect the approach to the core aspects of the end-to-end COVID-19 response, including:

surveillance
targeted community testing, local contact tracing, and support for self-isolation
outbreak management, including responding to variants
responding to enduring transmission, where appropriate
support for vaccine roll-out, in particular plans to tackle disparities in vaccine uptake

The updating of LOMPs should involve local and regional system partners, building on the extraordinary work undertaken so far during this pandemic. These should include HPTs, voluntary and community sector partners, the business community, blue light responders, integrated care systems and local NHS providers. Effective actions to respond to COVID-19 also require strong partnership with local communities, on the basis of tailored communications and engagement, and informed consent. Each local system is therefore required to publish and maintain its LOMP.

Operational support

Local authority activity, using local resources in line with individual LOMPs, will remain the primary mechanism to respond to incidents and outbreaks of COVID-19 through the autumn and winter period. National support will continue to be available to help respond to some outbreaks, depending on the speed and scale of response required. Local authorities have access to dynamic testing provision, HPT investigation and contact tracing capabilities as well as mechanisms to support individuals with self-isolation. Through their respective RPTs they can call on national assets across testing, tracing and self-isolation. In addition, several specialist national teams may be available to support local authorities, further details on their capabilities and how to request them are included in the OMRT. The process for a variant outbreak is outlined below.

Education settings

Outbreak management in education settings and any further measures in education settings to reduce transmission should follow the principles set out in the Contingency Framework.

Enhanced Response Areas

UKHSA will provide enhanced support to local areas facing challenging disease situations, where the evidence suggests short-term additional support could slow or bring rates down. With prevalence varying across the country, the Enhanced Response Areas (ERAs) are designed to respond early to unusual rises in cases allowing more time to manage the disease and its impacts locally to avoid overwhelming local NHS pressure.

Since they were established, we have continually refined ERAs to ensure flexibility in our response to the changing epidemiological picture and will continue to do so. The current iteration of ERAs are a targeted addition to UKHSA’s outbreak management and prevention approach.

The current ERAs approach includes:

supporting reduction of high-risk social mixing, through communications and coordinated guidance, including national funding to enhance local communications efforts
increasing case finding, through for example additional asymptomatic testing
reducing the transmission risk in schools, by enabling DsPH to work with education settings to stand up onsite testing, and discretion to work with secondary schools and colleges on the proportionate temporary reintroduction of face coverings
contributing to local vaccination efforts through additional logistical support including extended opening hours and community outreach
providing logistical support for example through helping coordinate a ground campaign, for example door knocking in key neighbourhoods to support the response

Recommendations to add an area are made through the local action committee bronze, silver and gold (BSG) structure. The BSG process considers specific proposals from areas seeking to become ERAs. RPTs are a local authority’s single point of contact for ERA related queries. Areas are asked to present a proposal which demonstrates how it will address the specific drivers of transmission in line with the current iteration of ERAs. A weekly local authority data sense check is also conducted which includes case rates across the age groups, case rate trajectories, hospital pressures and vaccination rates.

Centrally developed aspects of ERAs are funded nationally. Local areas are expected to fund local costs from their existing COMF budget. A local authority which has exhausted their COMF can discuss making a separate case for additional funding with their RPT.

Enduring transmission

Areas experiencing enduring transmission are those parts of the country where the case rate has remained above the national or regional average for a prolonged period. Analysis indicates that enduring transmission is linked to wider socio-economic challenges, rather than being a short-term outbreak and is linked to long-standing patterns of deprivation and health inequalities. The support UKHSA will offer to local authorities experiencing enduring transmission will recognise the specific characteristics and drivers of higher transmission rates in each area.

Areas that will be eligible for additional support as areas experiencing enduring transmission will be designated through BSG using analysis of historical case rate data and local insight from RPTs and local DsPH.

Once designated as an area experiencing enduring transmission, local authorities will be offered a menu of support measures which they can chose to implement as part of a localised plan, developed with the backing of national and regional teams, depending on the epidemiological context.

While each localised plan would be tailored the specific characteristics and drivers of higher transmission rates in each this area this could include:

access to testing capacity and communications support for hyper-local targeted testing
support to plan and maintain public health workforce capacity for COVID-19 response
capacity to support workplaces and businesses to be COVID-19-secure
national COVID-19 vaccines programme support to an area’s local planning and activities, including supporting uptake of vaccination boosters in autumn
data and insight support, including evaluation of impact and sharing of ‘what works’

Centrally developed aspects of enduring transmission support are funded nationally. Local areas are expected to fund local costs from their existing COMF budget. A local authority which has exhausted their COMF can discuss making a separate case for additional funding with their RPT. As with ERAs, the single points of contact for local authorities will be their RPT.

Variants

As with other viruses, COVID-19 can mutate, creating new variants. A variant could have characteristics which may increase the risk of rapid transmission or severe disease or reduce the protection of vaccines. Vigilance is key to minimising the threat variants may pose. We have increased surveillance and detection capabilities since the beginning of the pandemic. Improvements include increasing genomic sequencing capacity, assessing potential harm, developing and deploying rapid genotyping tests (reflex assays) to identify specific variants and conducting wastewater surveillance.

To determine the right response, variants are assigned a public health management level.

Local authorities play a critical role in responding to variant outbreaks through the processes set out in their Local Outbreak Management Plans. HPTs and local authorities work with their local community and partners to investigate cases and clusters and may establish an incident management team if needed. The response may include additional: testing, tracing and self-isolation support, rigorous outbreak management, and national and local communications. It is vital that local authorities work with their communities to raise awareness of the risk from variants and to seek their cooperation with the response using targeted, culturally sensitive communications that drive greater compliance with the response.

Higher risk situations may trigger additional national support following local and national assessment. The national response framework will seek to understand the impact of the variant, gather local intelligence from HPTs, and continuously monitor the national risk. If it is decided that the risk requires escalation, national partners will engage further with HPTs and local authorities to determine the best support that can be deployed to assist in responding to the variant and consider whether a national incident management team (IMT) is required.

To confront this risk, national partners have developed a range of tools to reduce the risk of variants emerging, stop and slow importation of the most dangerous variants, identify new variants and outbreaks, and ensure that we are ready to respond if outbreaks occur.

Question 6

Next steps

Accepted Answer

This Framework will be reviewed in the spring of 2022 and updated as necessary, considering developments and lessons in the response to COVID-19.

UKHSA will work collectively with partners to develop a future engagement framework that best supports regional and local teams to deliver against public health threats and to facilitate the co-design of future policies and responses.

Correct up to 18 September 2021. ↩

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This guidance was withdrawn on 7 April 2022

Applies to England