Agenda item: 9a

Paper no: 7

Title of Report: Covid Incident Response

Status: TO NOTE

Committee: Governing Body Date: 27/01/2021

Venue: Virtual meeting

Elaine Newton, Director of Planning and EPRR/ Accountable Presented by: Emergency Officer Executive Lead sign Dr Claire Fuller, Accountable Officer Date: 21/01/2021 off: Elaine Newton, Director of Planning and EPRR/ Accountable Author(s): Emergency Officer; Stephen Haynes, Covid Incident Director; Cell leads

Governance Conflict of Interest: None identified  The Author considers: Previous Reporting: N/A (relevant committees/ forums this paper has previously been presented to) Freedom of Open – no exemption applies. Part I paper suitable for  Information: The publication. Author considers:

Executive Summary This report presents a high level summary of the Covid Level 4 incident response, both across Surrey Heartlands Integrated Care System partners and with the Surrey Local Resilience Forum to reflect the multiagency effort.

It headlines the issues that have presented throughout the second wave, and how they have and continue to be responded to and mitigated.

There is a supplementary paper on the agenda which covers in more detail the mass vaccination programme.

Governing Body 27/01/2021/ Covid Incident Response Page 1 of 8 Implications What is the health • Objective 1: Continue to work towards achieving sustainable impact/ outcome and systems. is this in line with the • Objective 2: Develop collaborative working and organisational CCGs’ strategic change, at both place and scale. objectives? What is the financial/ Covid-19 expenditure logs are being maintained to record resource required? additional resource requirements associated with the incident response e.g. Incident Coordination Centre, individual programmes, such as mass vaccination, testing; surge and Independent Sector capacity. What legislation, Civil Contingencies Act 2004; policy or other NHS Act 2006 (Sec 252A) as amended in Health & Social Care Act guidance is relevant? 2012 sec 46; The Health Protection (Coronavirus, Restrictions) () (No. 4) Regulations 2020 – grants the Government emergency powers; NHS England EPRR Framework Is an Equality Not for this paper specifically but for programmes e.g. Mass Analysis required? Vaccination programme Any Patient and N/A Public Engagement/ consultation required? Potential risk(s)? A risk log is being maintained for Incident Management Group (including (SHCCP) and Covid Management Group (LRF) reputational)

Recommendation(s) (1) TO NOTE the report

Next Steps (2) Covered in Section 9, Future Plans.

Governing Body 27/01/2021/ Covid Incident Response Page 2 of 8 Covid Incident Response

1. Regional and Surrey Heartlands ICS perspective 1.1. The pandemic has followed a clear dynamic across the South East region and across the constituent Integrated Care System (ICS) cluster. From the east in and , pressures have moved across Sussex into Surrey Heartlands and these continue to progress into Hampshire and the Thames Valley. 1.2. In contrast to the response in wave 1 of the pandemic, the NHS has been required to manage the delivery of a significant amount of elective care and deal with the usual increases in demand over the winter period. 1.3. We are now in the super-surge stage of providing Intensive Care Unit (ICU) beds in all of the regions hospitals with significant increases in Intensive Therapy Unit (ITU) bedded capacity in all of the Surrey Heartlands sites. A huge amount of effort has created multiple staged increases in ICU capacity in all three Surrey Heartlands trust locations, alongside additional hospital beds providing oxygen therapy to Covid patients. 1.4. Attendance rates at A&E departments and subsequent admissions are now broadly in line with pre wave 1 levels. This has resulted in challenges in terms of flow and resulted in delays in ambulance handovers at the A&E interface. 1.5. The NHS has clinically-led escalation plans in place to manage significant pressure and minimise patients being transferred out of area only when in the best interests of patients. Transfers are managed at regional level and clinically directed, to ensure the most unwell get the expert care they need and patients brought closer to home as soon as is possible. 1.6. The challenge of ultimately repatriating those who have been transferred will continue for the next few months – dependent on their clinical condition and ability of their home trusts to link into local rehabilitation and re-ablement pathways.

2. Surrey Heartlands – our local challenges 2.1. Each of our hospital trusts face a series of ongoing challenges but all have in common the need to maintain staffing levels and support those in the front line to deliver high quality care in the face of extreme pressures. 2.2. Staff Covid-related sickness and the need for self-isolation is challenging all of our providers, notably the ambulance service, community and social care partners, primary care and mental health services. 2.3. Ashford and St Peter’s Hospitals Trust responded to a call from NHS England/ Improvement (NHSE/I) regional colleagues for significant increases in ITU capacity in the early stages of wave 2 and created an additional 10 ICU beds in 7 days. Further surge capacity has subsequently come online to meet rapidly increasing needs.

Governing Body 27/01/2021/ Covid Incident Response Page 3 of 8 2.4. The Royal Surrey Hospital has continued to deliver urgent cancer services to high priority patients whilst maintaining care to Covid patients from within, and outside of, the ICS footprint. The trust has supported other Surrey Heartlands and out of area sites with mutual aid for ITU patients. 2.5. Surrey and Sussex Trust continues to receive the highest number of daily ambulance arrivals in the patch whilst delivering high quality critical care to those requiring definitive interventions on an hour by hour basis. This is against a backdrop of significant estates infrastructure challenges, which we are working with the trust to manage. 2.6. Our community, domiciliary and other care providers have flexed capacity and revisited their admission criteria to meet the increasing and evolving need for out of hospital provision in response to the heightened requirement for increased provision. 2.7. Our place-based leadership and their teams are in constant communication with local providers to ensure the best options for care delivery and expansion of complementary schemes including Covid at home and oximetry.

3. Managing the Local Response 3.1. The ICS has created a framework to help manage the pandemic response in line with the Level 4 incident status declared by the NHS nationally. This includes an early day (7/7) gold level Incident Management Group chaired by the Accountable Officer. 3.2. The ICS also participates in daily NHSE/I regional calls to ensure that Surrey Heartlands keeps pace with all national policy, reporting requirements and management developments in the pandemic response. 3.3. Our Incident Control Centre is staffed 12 hours per day and acts as a pivot point for all inter-regional and local communications in the pandemic response. The traffic through the Incident Control Centre is currently running at more than double the activity levels we saw at the beginning of wave 2 and continues to support our teams to maintain situational awareness. 3.4. To underpin the daily management of the pandemic we have reinforced and refined the reporting and information gathering processes, taking learning from the wave 1 challenge. The Incident Management Group call now has access to a daily situation report (SitRep) prepared by the Surrey Heartlands Urgent Care team. This presents an update on the position at each of our acute hospitals in terms of ITU capacity, A&E and overall demand profiles and any immediate risks. 3.5. The SitRep information is also used to update the daily regional calls with NHSE/I and includes position updates on community care capacity and a progress report on the repatriation of patients, both out of and in to, the Surrey Heartlands footprint.

Governing Body 27/01/2021/ Covid Incident Response Page 4 of 8 3.6. The ICS is also engaged in work to proactively model the likely impact of the pandemic in terms of pressure on resources in the coming months. This dovetails into work being led by public health colleagues to profile the current and anticipated spread of Covid and the likely outcomes in terms of hospitalisation and capacity requirements. 3.7. In terms of primary care, we gather daily readouts from our teams who monitor the demands and mitigate the risks that the pandemic places on our GP and allied resources. These include risks to overall practice resilience and workforce sickness levels and is presented by a RAG rating tool at each daily Incident Management Group meeting. 3.8. From a clinical perspective, we have enacted key steps to reinforce the redeployment of CCG clinical staff. These include redeploying CHC staff to support the Seacole unit expansion and GP clinical leads to support the widening vaccination programme. 3.9. We have also started rolling out our vaccination programme. Further information is provided via separate paper on the Vaccination programme.

4. Additional support 4.1. Our system is engaged with national NHS initiatives in response to the pandemic including the deployment of military resources. 4.2. As part of , the ICS is in liaison with regional colleagues and the Ministry of Defence in the distribution of troops for general duties and more focussed expertise in support of the local health response. 4.3. Military personnel have begun to arrive in the ICS footprint at both acute and vaccination sites and in support of the ambulance service. They will work alongside our health service teams to assist in day-to-day tasks of a non-medical nature to create much needed headroom for pressurised staff. 4.4. In terms of Local Resilience Forum involvement, the ICS receives weekly updates from numerous cells formed within the Covid Management Group, which meets weekly at this time. These include sub groups focused on Mass Vaccination, PPE, Logistics, Testing and the emergency services. 4.5. Via the Covid Management Group the ICS also maintains oversight of challenges regarding the management of deaths and body storage, where we are using the facility at and the onsite mortuary capacity at each of the Surrey hospitals, as well as maintaining close liaison with the funeral sector.

Governing Body 27/01/2021/ Covid Incident Response Page 5 of 8 5. Testing 5.1. The Local Resilience Forum Testing Cell is working with partners to provide community outbreak testing for high-risk settings across Surrey Heartlands, such as care homes, extra care settings and prisons. 5.2. This testing is provided locally using a local courier service and our laboratory based at St Peter’s Hospital – known as ‘Pillar 1’ testing. 5.3. Testing pathways have been set up for individuals moving settings (such as from the community into care homes), essential workers (where the national capacity is not available) and vulnerable symptomatic individuals who are not able to access testing via the national route. 5.4. The Testing Cell is also working closely with the Surrey County Council Public Health Team on developing the Surrey Targeted Community Testing programme for asymptomatic testing, aiming for implementation during February 2021.

6. Personal Protective Equipment (PPE) 6.1. Nationally funded fit testers have been working with all our acute trusts since December to provide support and assist with the transition from the 3M masks, to using the new FFPS masks. The aim is to achieve a UK supply route. 6.2. All Trusts across Surrey have increased their own held PPE stock supplies, and the PPE portal now have all Surrey Heartlands GP practices registered to order PPE supplies.

7. Workforce 7.1. Staff wellbeing continues to be a priority. A resilience Hub has been established to support the wider system (inclusive of health and social care and volunteers) and to provide support and information on mental health. This includes 1:1’s, workshops and more complex intervention where required. It is based on a rapid assessments and treatment model. Our Resilience Hub was one of the first in the country. 7.2. We are rolling out training for Mental Health First Aiders as a system and this will also increase support for staff. 7.3. Additionally, all partners have their own initiatives to support their staff’s physical and mental health and we continue to work together to share, adopt and adapt. 7.4. Staff absence has increased and is higher than in wave 1. We expect this to reduce as the vaccine is rolled out. We are monitoring the reason for staff absence (including sickness, childcare issues, stress etc) and using this information to provide support to individuals or groups of staff where appropriate. Work with NHSE is also underway to understand how community Covid rates increase staff absence for staff living in those areas.

Governing Body 27/01/2021/ Covid Incident Response Page 6 of 8 8. Communication and engagement activity 8.1. Our response has also included a significant element of communications and engagement activity to support our operation response. This has included: • Local support and execution of national campaigns (Flu, Help Us Help You, NHS 111 First) with targeted messaging and assets created and delivered across the ICS, all based on national messaging. • Working collaboratively with partners to create consistent and joined up messaging around operational pressures, local Covid-19 outbreaks (including very targeted communications to support local outbreaks on a borough by borough basis) and reiteration of national ‘stay at home’ messaging. This has also included more creative approaches including the use of frontline staff as key spokespeople. • Continuing to spread key messages through targeted engagement with local communities and partners through regular engagement activity. • Working collaboratively with partners to support the wider work of the Local Resilience Forum through a Multi-agency Information Group, with strong representation from health. • Robust communication support to the Covid-19 vaccination programme, including the setting up of a dedicated vaccination enquiry telephone and email service to manage the significant enquiries coming into the CCG from both stakeholders and members of the public. • Ongoing communication to patients, public and stakeholders on our recovery programme and how we are managing operationally in order to prioritise the care of those who are most unwell.

9. Future plans 9.1. Looking ahead, we will continue to work with partners and local providers to manage operational pressures and lead the system response. Consistent with this, the CCG/ ICS Executive Team have agreed with Committee Chairs how to manage governance business continuity escalations in order to reduce workload pressures, whilst ensuring the oversight of the pandemic response and other CCG business is not unduly compromised. This is documented in terms of the impact on the corporate committee cycle, and further consideration will be given to the broader incident assurance operating model. 9.2. We will also continue to roll out our vaccination programme, where we are inviting those in the JCVI priority groups to get vaccinated. As well as a mass vaccination centre at Epsom Racecourse, as a system, we have also mobilised GP-led vaccination services and we are also actively vaccinating clients and care home staff in line with the national priority groups. A separate update paper on the Vaccination Programme provides further details on this area.

Governing Body 27/01/2021/ Covid Incident Response Page 7 of 8 9.3. We will continue to publish updates on the CCG website and these will include information on the vaccination programme, including Frequently Asked Questions. 9.4. We will also focus on restoration and recovery, including continuing staff welfare and support, as well as resilience and sustainability of resourcing for the workstreams – testing and mass vaccination - which will continue into the future.

Governing Body 27/01/2021/ Covid Incident Response Page 8 of 8 Multi-agency Response Structures Revised 20/01/21 Government Briefing Rooms

Department of Health and Social Care Ministry of Housing, Communities and Local Government NHS Test and Trace Programme Coordination with regional groups: NHS England and Improvement - National • Multi-agency Information Group • LRF Chairs Joint Biosecurity Centre • SCG Chairs • TCG Chairs NHS England and Improvement – Regional Public Health England – Regional Regional Structures Oversight Group

Frimley Collaborative Surrey Heartlands Integrated Care Public Health England – SE Schools Surrey Health and Well-being Board Clinical Commissioning System (ICS) Cell Groups ICC Incident Coordination Centre (ICC)

Surrey Local Outbreak Engagement Board Surrey Strategic Coordinating Group

Frimley ICS Surrey Heartlands ICS Health Providers Health Providers Multi-agency Information Group Frimley Hospital Ashford & St. Peter’s Hospital Coordinates internal and external Virgin Care Royal Surrey Hospital Surrey & Sussex Hospital communications and messaging Supports all aspects of the multi-agency COVID-19 Management Group Epsom & St. Helier Hospital Surrey Tactical Coordinating Group (incorporating the Health Protection SECAmb structure. and Operational Group (HPOG) (concurrent incidents) SCAS (Patient Transport) Practice Plus (formerly Care UK) Surrey & Borders Partnership COVID-19 Vaccination First Community Health Programme CSH Surrey Vaccination Prioritisation Surrey Covid-19 Recovery Coordinating Multi-agency Information Cell (MAIC): Group Group: Coordinates the Common Operating • Humanitarian (Health and Social Care Picture (COP) for the range of issues SHICS Incident / Community, Voluntary and Faith / affecting Surrey, including: Logistics Cell LRF Vaccination Management Group Children and Younger People) • Covid-19 Pandemic Operational Support Cell • Economic (Economy and Retail) • EU Exit end of transition (D20) • Infrastructure (Place, Travel and • NHS Winter pressures Resident Welfare and Transport / Climate and Air Pollution) • Other emergencies Volunteering Cell Local Vaccination Sites Cell • Environmental (Place, Travel and • Frimley Transport / Climate and Air Pollution) Death Management Cell • North West Surrey • Guildford & Waverley Local Outbreak Incident • Surrey Downs Management Team (s) COVID-19 Testing Cell • East Surrey (CRESH)