1    Introduction

1.1       On 31 December 2019, the World Health Organization (WHO) was informed of a cluster of cases of pneumonia of unknown cause detected in Wuhan City, Hubei Province, China. The UK has been responding to a COVID-19 outbreak since 31 January 2020 when it was confirmed that a Level 4 National Incident has been declared for NHS England and NHS Improvement. On 11 March 2020 the World Health Organisation declared COVID-19 a pandemic.

1.2       The Oldham COVID-19 Outbreak Management Plan has been developed to meet national requirements for Local Outbreak Management Plans, as set out in the national COVID-19 Contain Framework. The Contain Framework sets out how national and local partners will work with the public at a local level to prevent, contain and manage outbreaks. Successful management of local outbreaks is a core element of NHS Test and Trace’s ambition to break the chains of COVID-19 transmission to enable people to return to and maintain a more normal way of life.

1.3       This Local Outbreak Management Plan provides local direction and guidance to collectively manage and prevent the spread of COVID-19 across our communities, ensuring that preventative action is taken at an early stage and that local and national systems can work effectively in partnership to manage COVID-19. The plan supplements the existing Oldham Health Economy Outbreak Plan (2018) by providing specific management arrangements to effectively respond to the unique threats posed by the COVID-19 pandemic. 

1.4       The GM Combined Authority and GM Health & Social Care Partnership have developed a COVID-19 Management Plan which follows the same principles as the local outbreak management plans in each of the 10 GM local authorities. The GM plan supports our local plans with clear approaches to collaboration, joint working and mutual aid through the Local Resilience Forum. 

1.5       This document will continue to be reviewed and revised in response to changes in national requirements and advice, and to incorporate learning from implementation.

2    Aims, objectives and scope

2.1    Aims

2.1.1    Our aim is to reduce the spread of COVID-19 through prevention, containment and suppression of outbreaks, and mitigate the impact of COVID-19 and the associated control measures on the local population.

2.2    Objectives of the Plan

• To provide an overview of the key control measures, including those relating to the Department of Health and Social Care (DHSC) test, trace, contain and enable approach and the seven associated national themes
• To provide an overview of the GM approach and how the national and GM tiers fit together
• Define governance, roles and responsibilities and command & control arrangements relating to COVID-19 management
• Set out communications and engagement arrangements with partner organisations and residents
• Outline how the impact of outbreaks on residents will be mitigated
• Outline the approach to surveillance using data and other sources of information to monitor the extent and impact of COVID-19 infection across Oldham

2.3    Scope

2.3.1    The plan is to read in conjunction with the existing Oldham Health Economy Outbreak Plan (2018); it is not intended to duplicate or replace the existing plan. 

2.3.2    The plan focuses on the key COVID-19 prevention and control arrangements, including vaccination and testing, in Oldham and the interface with the Greater Manchester COVID-19 Outbreak Control Plan and the national Contain Framework.

3    Oldham approach to preventing and managing transmission of COVID-19

3.1    Community Testing

The DHSC have stated in their community testing guidance that up to a third of individuals who test positive for coronavirus have no symptoms at all and can therefore spread the virus unknowingly. As such Oldham have widened out the testing offer for those with no symptoms. This utilises lateral flow devices with rapid results in approximately 30 minutes ensuring that positive cases are identified at the earliest opportunity. This is connected into the national contact tracing system providing an opportunity for positive cases and their contacts to isolate and break the chain of transmission at the earliest point.

On the 18 January 2021, Oldham commenced targeted testing at scale for those that could not work from home, setting up 4 large tests sites for twice weekly routine testing. This programme of work has now been extended until the end of June 2021, and Oldham are moving towards a different model to significantly increase the number of testing sites at smaller venues that are better suited to meet the needs of residents. By having more sites spread across the borough, residents and those visiting Oldham for work, education or to see a loved one in a Care Home, will have greater choice, less travel and in many sites there will be bilingual staff supporting the self-swab model.      

In addition to testing sites, we have an outreach testing and training provision to ensure that testing can be offered at large settings such as workplaces or community venues. We carry out the testing process on site whilst training the champions of those settings for a seamless handover. This is building a network of settings that can provide a sustainable model going forward. The settings are trained to be competent in basic infection, prevention and control, registering as a test site, registration for those attending, talking people through a self-swab, undertaking the analysis, interpreting the results and uploading of results to the national portal. 

In line with the national testing programme we are encouraging all residents to make regular testing a habit. Alongside the above testing provision, testing kits are available from nationally commissioned testing routes such as home delivery and pharmacy collect, and via locally established collection sites. Local collection has been established in our network of community libraries to supplement the national offer and increase ease of access to testing kits for local residents. 

3.1.1    Local Test Sites (LTS)

Oldham have established the locations of local test sites commissioned by DHSC to ensure that we minimise travel time for residents as much as is feasibly possible. Three LTS are currently in operation and plans underway to place a 4^th site in Failsworth. The 3 static sites are situated in:

• Southgate Street Car Park, Centre of Oldham OL1 1DN
• Peel Street in Chadderton, OL9 9JX
• Honeywell Centre, Hadfield Street. Hathershaw, OL8 3BP

Although the national booking portal is in use, Oldham continues to work with DHSC to remove this process for those residents that find digital access a challenge and ensure that testing is available for those that have not been able to book via the portal. 

3.1.2    Mobile Testing Units (MTU)

In addition to the static sites, mobile testing units are routinely used around the borough to ensure that wards with greatest travel distance or barriers in accessing a LTS have access to the MTU. Where data identifies areas of high transmission or low testing uptake, MTUs are strategically placed in these areas. Where larger outbreaks are identified, the MTUs move to the setting for proactive case finding.

3.1.3    Locally commissioned PCR testing

From the beginning of July 2020, Oldham commissioned a dedicated testing service to provide local testing from a clinical provider, ensuring that our local model meets the needs of the residents and core service, and flexible to changes in demand.

A key role of this service has been to offer door to door testing, alongside our community engagement teams, in areas of the borough where we have seen high case numbers/enduring transmission.

The commissioned service has also been providing routine asymptomatic PCR testing for health and social care staff, symptomatic testing for those working for Oldham Cares and staff providing system resilience at points of surge capacity. In addition to this, the commissioned service has provided pre-surgery testing and domiciliary support to a small number of residents that are unable to attend a test site or unable to undertake a self-swab though a home test/ postal kit.

Although new national testing programmes are replacing some of this local offer, we are retaining this local service to ensure we have flexible capacity to respond to outbreaks, and to support door to door testing. 

3.2    Contract Tracing

3.2.1    Local Tracing Partnership (tier2)

When an individual tests positive for COVID-19 they were first notified by text or email from NHS Test and Trace instructing them to isolate. The national contact tracing tier 2 team receive information about all positive cases and attempt to contact to ensure that isolation requirements are understood and to acquire a list of contacts that the positive case has been in contact with 2 days prior to symptom onset (or test date if there were no symptoms). If after 48hours, the national team have failed to make contact or been unable to acquire the contacts, the cases are securely passed to the Local Authority. Oldham Council only receives details of cases who are Oldham residents. 

Trained contact tracers have made significant progress in making contact with residents that the national team have been unable to contact. Where required bilingual contact tracers are available. The phone call includes instruction to isolate and asks for information of contacts, but in addition to this Oldham staff use this call as an opportunity to check if individuals have any support needs such as food deliveries or prescription collections for those without a local support network. In addition to this the team are also able to connect individuals into isolation payments for those that are eligible.

The team prioritises contact tracing for any cases that has been identified as a variant of concern and will escalate these cases immediately to the director of public health.

The GM Integrated Contact Tracing Hub (GM ITCH) serves as a resilience hub to support surges in demand that exceed local capacity utilising expertise and capacity from the Greater Manchester Fire and rescue service.

3.2.2    Tier 1

As part of the national test and trace service, contact tracing which involves complex settings, groups or individuals requiring local knowledge will be automatically passed to the GM Integrated Contact Tracing Hub (GM ICTH). This complex contact tracing is referred to as tier 1 and is locally lead. Cases that relate to an Oldham setting are passed to the Local Authority daily for contact tracing that can commence without delay. The notifications are received through the Single Point of Contact (established within the Oldham Public Health team). The team have developed a standard operating procedure that details escalation routes and key officers for each of the specific settings identified. This function of a SPOC also serves to escalate notifications to GM, particularly those that are across geographical boundaries within Greater Manchester.

3.2.3    Local Resilience

Oldham tier 1 and tier 2 serve different functions, with tier 2 supporting cases and tier 1 supporting complex settings, but both come together under the contact tracing steering group to share local intelligence and build local resilience. Over the coming months both teams will be trained to a high standard of contact tracing for both tier 2b and tier 1 to offer additional resilience to the local system.

3.3    Support for Self-isolation

Oldham Council has produced a range of materials for the public informing them about the self-isolation rules and regulations, and highlighting that self-isolation, after testing positive is required by law to prevent the transmission of Covid-19. Communication materials also raise awareness of how individuals and families can continue to shop online, receive food, household items and medical prescriptions to their doors as well as apply for financial support.

A self-isolation toolkit has been published on Oldham Councils website which includes a detailed guide on ‘how to’ self-isolate, comprehensive information about the available testing centres and the range of financial support available to self-isolating residents.

Since the onset of the pandemic, increased financial support has been made available to those in financial crisis (including as a result of COVID, fleeing domestic violence, loss of employment) via additional funding by the Local Welfare Provision Scheme, This provides essential items such as carpets/beds and bedding/white goods and furniture and now includes a COVID protection pack (face mask/anti-bacterial gel and spray) for all adults in households eligible for support.

As poverty is a real concern in Oldham, we have prioritised supporting our residents to access food and fuel throughout the pandemic. Food vouchers and welfare support has been routinely offered to families over the school holidays for low income families with children and young people. Individuals and families were also offered support with fuel via the Warm Homes team direct including crediting of pre-payment meters and provision of boiler repair/replacement service.

The Council has adapted and widened its Discretionary Test and Trace Support Payment eligibility criteria from 1 February 2021 to overcome barriers to self- isolation.

Over the next 6 months we will work with the Welfare Rights and financial inclusion team to support those claiming Test and Trace Support Payments with comprehensive support about maximising benefits and budgeting support.

3.4    High-risk settings, communities and locations

3.4.1    High-risk places, locations and vulnerable communities have been identified and considered in the development of this plan and in local standard operating procedures. Our approach to prevention and management involves close collaboration between the Single Point of Contact (Public Health Team), Environmental Services, our Helpline and five place-based teams and specialist services working in some of these high-risk locations. This ensures that our approach is rooted in our communities, and that we can mobilise support and resources across the borough in response to outbreaks.

The NHS Test and Trace service notifies the GM Contract Tracing Hub to undertake contract tracing which involves high risk settings or individuals requiring additional support.

We have established relationships with local high-risk settings which has ensured that they are aware of local arrangements and we encourage them to contact the Oldham Single Point of Contact as soon as they become aware of a case in their settings. This is to ensure that a swift response can be mobilised ahead of any notifications being communicated from the national team to Greater Manchester.

These measures are supplemented by weekly review of the common exposure data to identify COVID-19 hotspots and proactively deploy prevention measures.  

3.5    Compliance and enforcement (COVID secure)

3.5.1    In April 2020 the GM Covid-19 Compliance Group was created to establish a consistent approach to compliance across GM. Oldham representatives (Council and Police partnership) attend the GM Group and report to the local TCG with a focus on:

• Communicating and engaging with the community and local businesses to educate them on the restrictions in place and undertaking compliance visits to premises.
• Regularly meeting with partners, educational settings and local businesses to ensure the wider population is aware of, and engaged in, complying with
• Working closely with communications and engagement teams to secure insights from across our population are in place to inspire and change behaviours
• Carrying out multi-agency enforcement across the Borough using the Engage, Explain, Encourage and Enforce approach

3.5.2    Additional funding has been allocated to spend on compliance and enforcement of regulations. In Oldham we are continuing to focus on:

• Checking COVID-19 secure arrangements are in place in premises and engaging businesses about what more they can do, or ensuring premises are closed
• Providing bespoke advice to businesses each time the restrictions are changed
• Working closely with the police to communicate and engaging with the community and local businesses to educate them on the restrictions in place, and undertaking compliance visits to premises.
• Regularly meeting with partners, educational settings and local businesses to ensure the wider population is aware of, and engaged in, complying with restrictions
• Working closely with communications and engagement teams to secure insights from across our population are in place to inspire and change behaviours. To include a focus on promotion of handwashing, face coverings and maintaining space
• Carrying out multi-agency enforcement across the Borough using the Engage, Explain, Encourage and Enforce approach
• Promotion of NPIs like handwashing, face coverings and maintaining space

3.6    Surveillance, data integration and information sharing

Data to inform COVID-related surveillance and intelligence are crucial to identifying COVID-19 hot spots and outbreaks and monitoring impact of local response 

A local dashboard has been developed to regularly share data and intelligence through our COVID-19 governance structure and inform decision making. The dashboard includes latest data on cases, testing, outbreaks, hospitalisations, deaths, vaccinations and wastewater testing. Variation by age, ethnicity, gender and area of residence is considered to shape our approach to reducing inequalities.

Officers from public health, environmental health, business intelligence and district teams meet weekly to review latest data on cases, clusters and outbreaks and share formal and informal intelligence on the current situation. Data used includes:

• Positive case employment data
• Contact tracing employment data
• PHE Common exposures analysis
• Local intelligence from our engagement and place-based team

This ensures that any increase in cases is identified quickly and an appropriate response mobilised for example testing, engagement or enforcement.

The legislative framework supporting data sharing relating the management of the COVID-19 pandemic is the notice under regulation 3(4) of the Health Service Control of Patient Information Regulations 2002 which allows healthcare organisations, GPs, local authorities and arm's length bodies to share information to support efforts against coronavirus (COVID-19).[1]

Intelligence teams across Council, NHS, and other public sector organisations such as the Police, regularly share data to support the COVID-19 response (in line with the legislative framework).

3.7    Communication and engagement, including community resilience and promotion of key messages

A multi-channel communications and engagement plan has been developed to support the prevention and control of COVID-19. This plan includes providing information and advice on how to prevent the spread of COVID; action to take in response to symptoms and cases; how to access testing; how to access the vaccine and the importance of getting vaccinated; and how to access support during self-isolation and/or shielding.

Critical to our local plans is ensuring that we work alongside local communities to listen to and understand their needs and concerns and develop our approach accordingly. An approach to developing a network of community champions is underway with the Department of Health and Social Care, while the engagement and communications approach is also informed by and delivered in conjunction with Oldham’s Equalities Advisory Group for COVID-19, in order to help inform and shape our work. 

3.8    Governance

As the pandemic has evolved, we have refined local governance arrangements to meet the ever-changing requirements of COVID-19 to adequately meet the needs of the local population and align local arrangements with regional and national ones.

Our Strategic Coordination Group fulfils the role of the Health Protection Board, and meets twice weekly to oversee the local response to COVID-19. The Health and Care System Group coordinates the response to COVID from the Health and Care system, as well as being the co-ordinating vehicle for the development of a new integrated care system. Both these groups are supported by a range of thematic groups which lead the day to day delivery of the Local Outbreak Management Plan and wider system response. 

Both the Strategic Coordination Group and the Health and Care System Coordination Group report to the Strategic Response and Recovery Board which is Elected Member led and fulfils the role of the Local Outbreak Control Board for public engagement and community leadership, as well as providing assurance and input from across the local system to guide and shape the design and delivery of local plans.

3.9    Variants of concern

Our well-developed arrangements for hyperlocal testing and community engagement mean we are well placed to respond to variants of concern and variants of interest.

Our approach would be tailored to the situation and the communities affected, but would involve:

• Enhanced sequencing (with support from national system)
• Enhanced surveillance through wastewater testing
• Enhanced contact tracing, supported by the Greater Manchester Integrated Contact Tracing Hub and the regional PHE team, and ensuring good performance of test, trace & isolate systems
• Community engagement through our door to door engagement teams, community champions, partnership working with voluntary, community and faith sectors, and with local community anchor organisations such as schools and housing providers
• Communications activity tailored to the target population using local channels such as private WhatsApp and Facebook groups, in addition to mainstream media and social media channels
• Surge testing, through a combination of local testing sites, mobile testing units, door to door testing, and use of the national ‘postcode push’ system

3.10 Covid-19 Vaccination Programme

3.10.1 The Government plan for vaccines included a programme comprising 1) mass vaccination sites run by Regional NHS Teams and 2) local sites run by Primary Care Networks under nationally agreed Directly Enhanced Service contracts.

3.10.2 The national rollout plan was executed at rapid pace and the priority for rollout was set nationally by the JCVI, which advises that the first priorities for the COVID-19 vaccination programme should be the prevention of mortality and the maintenance of the health and social care systems. As the risk of mortality from COVID-19 increases with age, prioritisation is primarily based on age. The order of priority for each group in the population corresponds with data on the number of individuals who would need to be vaccinated to prevent one death, estimated from UK data obtained from March to June 2020:

• residents in a care home for older adults and their carers
• all those 80 years of age and over and frontline health and social care workers
• all those 75 years of age and over
• all those 70 years of age and over and clinically extremely vulnerable individuals
• all those 65 years of age and over
• all individuals aged 16 years to 64 years with underlying health conditions which put them at higher risk of serious disease and mortality
• all those 60 years of age and over
• all those 55 years of age and over
• all those 50 years of age and over

Achieving a high coverage across all population groups will contribute to reducing COVID-19 risks in the population and the associated inequalities.

In terms of mass vaccination centres, this is organized at Greater Manchester level and is located at the Etihad Stadium.

3.10.3 The Oldham vaccination programme was set up as operational from 6 sites within the five Primary Care Networks. It was first launched on 14 December 2020 in Glodwick in South Central PCN followed later that week in North PCN (Royton Health & Wellbeing Centre) and West PCN (CH Medical), then between Christmas and New Year at South PCN (Failsworth) and then in January at North Central PCN (ICC Building) and then East PCN (Moorside Medical Centre). During the course of February and early March additional ‘pop-up’ clinics have also been held at Greengate Street Mosque, the EIC Centre and Millennium Centre all of which have been targeted at encouraging greater levels of update in our BAME communities.

3.10.4 Now we have vaccinated a significant number of our residents, we are starting to clearly see and understand the impact and correlation between deprivation and ethnicity and this is being looked at in detail by our Equalities Advisory Group.

3.10.5 Measures to improve vaccine uptake locally

The next phase of rollout will continue to move down the Cohort list but will focus on supplementing the existing PCN clinics through a number of tactics as follows:

• Additional clinics run in hyper-local community facilities such as Mosques with community activists supporting and advocating for members of their own community
• A consistently applied methodology for call and recall and call back for those not reached in the first contact call for vaccination with an escalation process that results in a call from your doctor for patients who have not taken up the offer
• A sustained community engagement programme encompassing community engagement teams doing door to door myth busting, interpreting where there are language barriers and organising community transport where there are needs
• A highly targeted communications campaign that focuses on continued myth busting with specific parts of the community but also promotes and nudges behaviour for uptake

3.11 Enduring transmission

Oldham has experienced relatively high rates of COVID-19 throughout the pandemic, driven by structural inequalities such as deprivation, housing, and employment patterns. COVID-19 has exacerbated inequalities and disadvantage which already existed in the population related to gender, race, age and income, and has meant that the local population has been particularly adversely affected by COVID-19 and the measures to control it. Specifically, we know that challenges for our population have included:

• Impact of self-isolation on income and job security
• Digital and language barriers to accessing national test and trace systems
• In large multi-generational households a higher number of people are potentially exposed as a consequence of a case within the household
• Higher proportion of working age population in public facing roles, jobs where working from home is not possible or working in higher risk settings, where potential for transmission is greater
• Implementing COVID secure measures in small – medium sized businesses where space and resources are more limited

These structural inequalities and enduring risks for transmission remain, and as such the challenge for Oldham in managing COVID will continue to be significant. In this context our focus on COVID-19 and level of activity across all the themes identified in this plan, will continue to be greater than in areas which do not have these risks.

Ensuring all elements of our COVID-19 response has an explicit focus on reducing inequalities and providing additional support to communities which have been most significantly impacted will be central to our approach, including:

• Community champions programme
• Door to door community engagement
• Outreach testing in areas of lower uptake including door to door testing, and testing in faith settings
• Community vaccination clinics in trusted venues supported by community groups and organisations
• Support for high risk businesses to prevent and manage outbreaks and implement COVID-secure measures, for example through discretionary business grants (e.g. support for the taxi trade to fit screens)
• Targeted communications activity supported by community members and using private channels/groups such as WhatsApp
• Our ‘We are Oldham’ campaign focuses specifically on the additional risk that Oldham faces in controlling COVID-19 as lockdown eases and the part that everyone in the borough can plan in reducing transmission
• Support for self-isolation including widening of criteria for discretionary self-isolation payments. We will be reviewing update of at home testing among secondary school and college students to identify where additional targeted support is needed to increase uptake and putting plans in place accordingly

3.12 Outbreak Management

3.12. 1 The Oldham COVID-19 Prevention & Control Board, under the leadership of the Director of Public Health, will have the responsibility for declaring and managing local outbreaks in consultation with PHE North West and GM Integrated Contact Tracing Hub (GMICTH). 

3.12.2  Notifications of cases and/or outbreaks will come either via local reporting direct to the Oldham Single Point of Contact (SPOC), or via the GM ICTH to the Oldham SPOC. 

3.12.3  The Director of Public Health (or designated deputy) will convene the Outbreak Control Team (OCT) including members of the COVID-19 Prevention & Control Board, plus representatives related to the particular setting and/or community where the outbreak has occurred.

3.12.4  Following the declaration of an outbreak, the Director of Public Health (DPH) will lead the local response to an outbreak within Oldham, which will include the following elements:

Contacting an affected setting: (e.g. head of school; manager of care home) to get details of the situation, which would include numbers of possible and confirmed cases (and whether any are at high risk of severe COVID-19 disease), dates of onset of symptoms, numbers of people potentially affected (including numbers at high risk of severe COVID-19 disease), any wider risks, and potential impacts that would need support from the system.

Contact tracing: Much of the contact tracing will be done by the NHS Test and Trace service and GM Integrated Contact Tracing Hub. Local contact tracing will be carried out by the Council’s Environmental Health Team following referral to the Single Point of Contact, and local settings/services leads appropriate to the outbreak. 

Providing initial infection prevention and control advice: This may include signposting to existing guidance and sources of support, advice on isolation and exclusion and other infection prevention and control advice. This will be led by community infection prevention & control nurses/Health Protection Team. 

Ensuring that any symptomatic people who have not yet been tested are tested promptly: This will ensure actions are based as much as possible on confirmed cases, as well as helping to rule out situations that are not linked to COVID-19. In care homes all residents and staff will be tested regardless of their symptom status. This will be coordinated by the Test and Trace Manager, in collaboration with the commissioned testing service. 

Identifying any urgent support needs: This would include meeting health needs among cases and contacts to prevent detrimental effects on any underlying medical conditions (e.g. access to medication) as well as wider social impacts on individuals and communities and impact on services. The response to meet these needs will be coordinated through the Helpline and Place-Based Hubs. 

Notifying the wider system and communication: Early notification to the lead(s) for the wider system for that setting will ensure timely support for consequence management is available as early as possible and impacts on the wider system can be managed. It will also allow wider information and intelligence about the situation to be included in the risk assessment. Early warning to the communications lead can make sure that proactive and reactive communications messages are in place early. 

Communications and engagement: At every stage in this process communications will be important both to make sure that all parties are operating on the same information, to ensure transparency of actions taken, and to build trust across the system and with the public. Accurate recording of actions and decisions will also be important, both for management of the situation and to provide an audit trail of situation management.

Enforcement of control measures: Oldham will rely mainly on proactive engagement with communities to facilitate adherence to control measures. Legal enforcement under schedule 21 of Coronavirus Act 2020 will be an act of last resort and would be approved through the local SCG/Gold structure. Schedule 21 confers powers relating to potentially infectious persons and makes related provision.

[1] Coronavirus (COVID-19): notification to organisations to share information.