Annual Report of the Director of Public Health Havering’s response to the Covid-19 pandemic March 2020 to March 2022
Introduction
The subject of my report this year as Director of Public Health for Havering is the pandemic. Having been through the pandemic, we are all experts by experience. Nonetheless, I hope you will find this report interesting in that it focuses on what Havering Council and its many local partners did to protect residents from harm while continuing to deliver essential services. The focus on the Council is deliberate since I wish, as DPH for Havering, to acknowledge the huge contribution my colleagues made over the last two years. Even when focusing solely on the Council perspective, I am unable to highlight the important work of many people for which I apologise. I hope the activity I have chosen illustrates the range of tasks the Council participated in during the pandemic. Inclusion does not imply that it is more valuable than other activity that has been left out due to lack of space.
Likewise, no attempt has been made to capture the almost superhuman efforts made by colleagues in the NHS. The BHRUHT website provides some insight about their contribution for which I have nothing but admiration. This report is structured around a timeline, beginning at the start of 2020, when the world began to appreciate the risk posed by a new respiratory infection identified in Wuhan, China; through to the publication of Covid-19 Response: Living with Covid-19 by the UK Government in February 2022. The timeline lists key changes in UK Government policy between these two events and what happened in Havering in response. The bulk of the report is given over to a series of articles describing who did what and when in response to the pandemic. In many cases, particularly at the start of the pandemic, new services were created from scratch, with minimal notice or guidance, by colleagues with limited or no direct experience of what they were being asked to do. Nevertheless, invariably they rose to the challenge, working with partner agencies and the community and voluntary sector to provide for residents. More than anything, the pandemic demonstrated the strength of public services and community spirit in the borough, which I will not forget. We must now build on these invaluable assets to tackle the health and wellbeing challenges that we face as we recover from the pandemic including the 7 year difference in life expectancy between residents living in the most advantaged and disadvantaged communities within Havering and the more than 2/3rd of adults who are overweight or obese. The report ends with a small number of recommendations, reflecting my learning from the pandemic, to members of the Havering Health and Wellbeing Board and the Havering Place Based Borough Partnership who are collectively tasked with leading efforts to improve the health of residents and the quality of health and care services they receive. Mark Ansell Director of Public Health for Havering
The design of the report After the contents page, the report begins with a timeline showing key events in the course of the pandemic both nationally and in Havering.
16 Mar 2020
Modelling suggests that Britain could experience over 500,000 deaths in 3 months in the absence of effective measures to control transmission
18 Mar 2020
Government announces schools to close on 20 March to most children and young people
Click on a date shown on the timeline to link to an external website providing more information about the event shown.
Schools close
Click on a coloured button to the right of the page to go to an article providing information about an aspect of the local response to the pandemic. Click at the top of the article to return to the timeline.
Each article is colour coded as shown below to indicate how the activity described helped limit the harm caused by the pandemic: Protecting the NHS and social care – with an emphasis on the latter Actions affecting children and young people and efforts to minimise the harm caused to their development and education The various non-pharmaceutical interventions (NPIs) used to reduce transmission including lockdowns. The local contribution to testing and tracing designed to break chains of transmission in a more targeted way than other NPIs Support provided to individuals and businesses to help them comply with the COVID control measures and tide them over pending a return to normality Support to the vaccination effort The continued delivery of essential services throughout the pandemic.
The COVID alert level, which was designed to convey the overall level of concern about the pandemic at any point in time is shown alongside the timeline from the point of its introduction in May 2020
5 4 3 2 1
Risk of health care services being overwhelmed
Covid-19 no longer present in the UK
More detailed information about the course of the pandemic locally can be brought up by placing your cursor over the first date each month which will generate a ‘pop up’ showing (if the information was available at that time)
04 Mar 2021
the number of patients in BHRUHT hospitals with COVID-19 at that point; the number of Havering residents who had died with COVID-19 in the previous 7 days; the number of Havering residents who had tested positive that week and the % of Havering residents aged 12 and above who had been double vaccinated.
The peak in Havering of each of three waves of infection is indicated on the timeline. Clicking to the right of the timeline at that point will take you to more information about the local epidemiology of the pandemic. 22 Apr 2020
Wave 1 peaks in Havering with more than 240 inpatients with Covid-19 in BHRUHT
Epidemiology of Wave 1
The timeline is illustrated with campaign messages and headlines produced by the Council and partners. Click on the image to get more information about the story. Communications were a key element in the support provided to residents and businesses in the borough and engagement with the community helped the Council and partners to improve the services we offered.
28 Mar 2020
Living enewsletter goes out 5-7 days per week to keep residents informed #Havering Heroes #Havering Helps launched
After the timeline, there is a small number of recommendations based on learning from the pandemic that I think will help members of the Havering Health and Wellbeing Board and the Havering Placed Based Borough Partnership improve the health of local residents and the quality of health and care services available to them. As the DPH for Havering, I am responsible for the contents of this report. However, it captures contributions from many colleagues who are listed in the Acknowledgments section. We’ve collectively tried to make the report as readable as possible. However, in places various technical terms are used so a glossary and list of acronyms is provided.
Contents 2
Introduction
3
A note about the design of the report
5
Contents
6-20
Covid Response Timeline 2020 – 22
21-22
Recommendations based on learning from the pandemic
23
Council Services Articles
23-31
Delivering essential Council Service
32-38
Children and Young People
39-43
Non-pharmaceutical measures (NPIs)
44-52
Support provided to Individuals and Businesses
53-56
Vaccinating the population
57-64
Protecting the NHS and social care
65-72
Testing and Tracing
73-76
Epidemiology of pandemic
77
Glossary
83
Acknowledgements
Pandemic timeline 2020 – 22 31 Dec 2019
Chinese authorities notify the WHO of outbreak of pneumonia in Wuhan City
30 Jan 2020
WHO declares the outbreak of Covid-19 a Public Health Emergency of International Concern
31 Jan 2020
First UK cases confirmed
03 Mar 2020
Coronavirus Action Plan published. UK in initial ‘contain’ phase
10 Mar 2020
Havering Council activates its pandemic plan
12 Mar 2020
UK moves to second ‘delay’ phase of Coronavirus action plan
16 Mar 2020
Modelling suggests that Britain could experience over 500,000 deaths in 3 months in the absence of effective measures to control transmission
18 Mar 2020
Government announces schools to close on 20 March to most children and young people
19 Mar 2020
Government publishes Covid-19 Hospital Discharge Service Requirements – requiring the immediate discharge from hospital of anyone who does not require hospital care with the intention of releasing 15000 beds by 27 March
20 Mar 2020
Government requires entertainment, hospitality and indoor leisure businesses to close from 21 March, with Councils responsible for enforcement
21 Mar 2020
Government advises residents thought to be most vulnerable to severe illness to shield. Plans to deliver groceries and medicines to those shielding are unveiled. A national Covid-19 helpline launched
23 Mar 2020
Government announces wide-ranging restrictions on freedom of movement, enforceable in law to begin in 3 days
24 Mar 2020
Council closes non-essential services that can’t be provided remotely essential services continue after risk assessment; working from home becomes the norm for many
Schools close
Shielding
Examples of how Council Services adapted to pandemic or temporarily stopped with staff redeployed to support pandemic response.
24 Mar 2020
Council launches hotline
26 Mar 2020
• The first national lockdown comes into force. • The ‘Stay home, Protect the NHS, Save Lives’ campaign launched. • First ‘clap for our carers’
28 Mar 2020
Living enewsletter goes out 5-7 days per week to keep residents informed #Havering Heroes #Havering Helps launched
Covid19 Hotline
Non-Pharmaceutical Interventions (NPIs)
£4m financial support package to support residents, businesses and care providers
31 Mar 2020
02 Apr 2020
‘Admission and Care of residents during Covid-19 incident in a care home’ published. Visiting to care homes stopped
02 Apr 2020
Adult social care providers to receive £1/2 million funding
04 Apr 2020
Government launches plans to massively increase testing capacity
05 Apr 2020
Queen Elizabeth II broadcasts to the UK and Commonwealth
07 Apr 2020
Council publishes tips for home schooling
08 Apr 2020
Havering Emergency Food Distribution Centre operational and supporting residents who are shielding
• Havering voluntary sector response • Distribution Hub
Good to Know Information from Havering Counci l to help you get through the COVID-19 coronavirus pandemic
support for charities, not-for-profit organisations, and social enterprises
09 APR 2020
April 2020
10 Apr 2020
Council publishes Good to Know booklet - with information about the pandemic and where to find help is distributed to every household in the borough
10 Apr 2020
Government announces plans to ensure personal protective equipment (PPE) gets to where it is needed most
15 Apr 2020
Coronavirus (Covid-19): ‘Adult social care action plan’ published. All care home residents and staff with symptoms will be tested when capacity allows
PPE
• Social care during the pandemic • Care provider engagement • Havering Care Association • How the Pandemic impacted our nursing home • A Havering care home during the pandemic
20 Apr 2020
Coronavirus Job Retention Scheme enables employers to furlough staff to reduce redundancies. Councils will administer a number of other schemes to support businesses and residents in financial difficulties due to the pandemic
22 Apr 2020
Wave 1 peaks in Havering with more than 240 inpatients with Covid-19 in BHRUHT
24 Apr 2020
£20,000 emergency funding for local charities
28 Apr 2020
Emergency? Call our HOTLINE: 0800 368 5201
• Financial support given to local businesses • Financial Support Given to Individuals and Families
Epidemiology of Wave 1
Havering Council and MIND launch Covid-19 bereavement support line
30 Apr 2020
A temporary mobile drive-through unit providing PCR tests operates from Havering Town Hall car park for the first time
10 May 2020
A new Covid-19 alert system introduced to communicate the current level of risk to the public. Chief Medical Officers assess risk as level 4 – the second highest level - severe risk, high transmission
NHS Test and Trace service launches. Anyone with symptoms can now be tested; positive cases 28 May 2020 and their close contacts must continue to isolate; people testing negative and their households can stop isolating
Development of test and trace policy over the pandemic
01 Jun 2020
Phased reopening of schools, colleges, and nurseries begins. First step in gradual relaxation in Covid-19 control measures after 1st lockdown
Schools reopen (June 2020)
02 Jun 2020
PHE publish ‘Covid-19: review of disparities in risks and outcomes’ highlighting very significant inequalities in harm caused during the first wave of the pandemic
health inequalities
08 Jun 2020
Rules requiring travellers into UK to quarantine for 14 days come into force
13 Jun 2020
Households with one adult may be linked to one other household to form a single ‘support bubble’
16 Jun 2020
Clinical trials of dexamethasone show it reduces deaths resulting from severe Covid-19. The first of several effective treatments for people who are severely unwell with Covid-19
19 Jun 2020
The UK’s Covid-19 Alert Level is lowered from Level 4 (severe risk, high transmission) to Level 3 (substantial risk, general circulation)
24 Jun 2020
Laptops distributed to children in schools
29 Jun 2020
Stricter measures are reintroduced in Leicester following a spike in cases. The first of many disadvantaged communities that see the reintroduction of local control measures in response to ‘enduring transmission’
30 Jun 2020
Havering Outbreak Management Plan published setting out actions to prevent isolated outbreaks and quickly bring them under control should they occur
18 Jul 2020
LAs in England gain additional powers to enforce social distancing
01 Aug 2020
The shielding programme is paused for England and Scotland, but will continue for the areas where extra precautions have been introduced
03 Aug 2020
The month-long “Eat Out to Help Out” scheme begins, offering a 50% discount on meals at indoor venues, three days per week
24 Aug 2020
Launch of Doing My Bit (multi-award winning campaign)
14 Sep 2020
Covid communications
The majority of schools reopen for the autumn term
01 Sep 2020
12 Sep 2020
Public Protection – outbreak control service
First walk through coronavirus testing facility in Havering opens at Cherry Tree Lane Car Park in South Hornchurch
Introduction of PCR testing in Havering
‘Rule of six’ introduced in response to sharp rise in Covid-19 cases. Venues required to request contact details of patrons COVID-secure marshals to be introduced to ensure social distancing
14 Sep 2020
‘Hands. Face. Space’ campaign launched reflecting importance of airborne transmission
Launch of Havering (online)
16 Sep 2020
18 Sep 2020
21 Sep 2020
Publications of adult social care: coronavirus (Covid-19) winter plan 2020 to 2021 – in addition to existing measures, it includes plans for a designation scheme for premises to receive people leaving hospital who have tested positive for Covid-19 or who are awaiting a test result. The Director of Public Health (DPH) is asked to advise care homes on whether visiting should be allowed due to the infection levels. Care homes should plan to allow safe visiting based on his advice
The UK Covid-19 alert level is increased to level 4, meaning transmission is “high or rising exponentially”
22 Sep 2020
PM announces introduction of additional restrictions including all shop staff to wear face coverings, limits on the size of weddings and hospitality venues to close early
24 Sep 2020
The NHS contact-tracing app is made available for download
07 Oct 2020
Announcement that the NHS will offer ‘long covid’ sufferers help through a network of new specialist clinics
09 Oct 2020
Havering Council boosts NHS contact tracing capacity
14 Oct 2020
New three tier system of Covid-19 restrictions introduced that seeks to match restrictions to level of pressure on the NHS at regional level
05 Nov 2020
A second lockdown (but educational settings remain open) introduced in England for 4 weeks
09 Nov 2020
The Pfizer and BioNTech Covid-19 vaccine is reported to protect 90% of recipients from developing Covid-19. Trials of Oxford/AstraZeneca and Moderna vaccines will subsequently demonstrate similar levels of protection
11 Nov 2020
Havering included in first group of 50 local authorities to introduce rapid community testing with lateral flow devices
13 Nov 2020
Covid marshalls introduced in Havering
Schools remained open (Second National Lockdown November-December 2020)
Introduction of LFD testing
26 Nov 2020
Additional walk up PCR testing locations open in the borough
02 Dec 2020
Second lockdown ends and is replaced by a tighter version of the three-tier system. Most of the country including London is in Tier 2
02 Dec 2020
The MHRA concludes the Pfizer/BioNTech Covid-19 vaccine is safe and effective. Vaccinations in UK will begin the following week once supplies arrive. (Oxford / AstraZeneca vaccine approved by MHRA on 30 December 2020 and Moderna vaccine on 8 January 2021)
08 Dec 2020
UK resident becomes first person in the world given a Covid-19 vaccination as part of a mass vaccination programme
14 Dec 2020
The Health Secretary announces a new variant of SARS-CoV-2, first identified in Kent (will be re-named Alpha) is spreading faster in some areas of the country; it has changes to the spike protein that could make it more infectious
16 Dec 2020
London and parts of Essex and Hertfordshire put into Tier 3 following an increase in case numbers. First vaccinations offered at Queens Hospital
18 Dec 2020
First Covid-19 vaccines administered in Havering
19 Dec 2020
Stricter Tier 4 restrictions introduced in London and SE England. Plans for Christmas bubbles scrapped in Tier 4 areas and limited to Christmas Day elsewhere. Shielding also reintroduced in Tier 4 areas
22 Dec 2020
Havering registration team perform wedding two hours before the borough enters Tier 4 restrictions
• Vaccination of care home residents begins • First vaccine provided in the community to Havering residents
29 Dec 2020
Wave 2 peaks in Havering with over 700 new cases in a single day
31 Dec 2020
Havering schools switch to remote learning
Epidemiology of Wave 2
2021 04 Jan 2021
Chief Medical Officers recommend the COVID alert level moves from level 4 to level 5
04 Jan 2021
PM confirms a third lockdown starting 5 January
05 Jan 2021
England enters third national lockdown with similar restrictions to the first, including school closures to all pupils except for children of keyworkers and vulnerable children. Shielding reintroduced nationwide
05 Jan 2021
GPs told to stand down routine patient care in favour of COVID vaccinations
10 Jan 2021
Health Secretary tells the BBC that everybody in the top four most vulnerable groups will be offered a vaccine by 15 February
13 Jan 2021
Be Nice to Your Noggin campaign launched – Mental health campaign to support residents during the pandemic
15 Jan 2021
86 Havering residents die with Covid-19 during the second week of January 2021. The highest death toll reported for any single week in the borough during the pandemic
19 Jan 2021
Schools close again (Third National Lockdown January 2021)
“It starts as sadness then I feel myself shutting down.” #BeNicetoYourNoggin is a mental health and wellbeing campaign that helps you find help with what you’re going through.
Call for volunteers to support vaccination
21 Jan 2021
Better Days Are Ahead launch – Campaign to raise awareness of the importance of getting jabbed
05 Feb 2021
Health Secretary announces target to offer all adults over the age of 50 a first COVID vaccination by May
16 Feb 2021
An additional 1.7M people in England advised to shield
20 Feb 2021
PM announces target to offer every adult in the UK their first vaccination by 31 July
22 Feb 2021
Roadmap published setting out plans for a phased lifting of lockdown subject to four tests being met
25 Feb 2021
Chief Medical Officers recommend COVID alert level reduced from 5 to 4.
04 Mar 2021
New rapid testing site opens in Rainham
Phased reopening begins - schools reopen in England with a range of additional control measures
08 Mar 2021
22 Mar 2021
Covid one year on
23 Mar 2021
New rapid testing centre - Romford
29 Mar 2021
08 Apr 2021
Schools reopen (March 2021)
Phased reopening continues - Stay at home order for England comes to an end; two households or 6 people allowed to meet up outside
Study shows the vaccination programme is breaking the link between Covid-19 cases and deaths
Phased reopening continues – non-essential retail etc. reopens with social distancing measures
12 Apr 2021
16 Apr 2021
Trials of NHS COVID pass begin as a means of safely restarting public events
16 Apr 2021
JCVI advises pregnant women to receive the vaccine at the same time as other people in their age group following positive results from trials in the United States
18 Apr 2021
Indian variant (will be named delta) identified in the UK. PHE investigating whether it is more transmissible, causes more severe disease or is better able to evade immunity
28 Apr 2021
Version 2 of Havering Outbreak Management Plan approved – updated to reflect current situation and additional control measures
01 May 2021
Study finds people from a South Asian background were at greater risk of infection, hospitalisation and death during the second wave of the pandemic
More than 50 places 07 May 2021 to get tested in Havering
10 May 2021
The UK’s Covid-19 alert level lowered from 4 to 3 meaning the virus is in general circulation but not rising significantly
13 May 2021
Concern about number of cases of Indian (delta) variant. ‘Surge testing’ introduced in areas with cases in an effort to suppress transmission
17 May 2021
Phased reopening continues – pubs and restaurants reopen. Indoor mixing allowed for up to 6 people from two separate households
17 May 2021
People who have had both doses of vaccine can use NHS app as a vaccine passport ries wn Stoinside? Lockdosumm ary of what’s subtitle with
19 May 2021
Life in Lockdown booklet – Young people’s experiences of life in lockdown
21 May 2021
People in 8 areas where delta variant spreading fastest advised not to meet up indoors while non-essential travel to and from these areas is advised against
31 May 2021
WHO changes its variant naming policy to use Greek letters - the Kent variant is renamed Alpha and the Indian variant is renamed Delta
7 Jun 2021
New Havering project aims to keep Covid-19 infection rates low
11 Jun 2021
PHE report Delta variant 60% more transmissible than Alpha variant. But vaccination continues to protect - 2/3rds of people who caught the Delta variant and half who died from it had not been vaccinated
14 Jun 2021
PM announces 4-week delay to final step in relaxation of Covid-19 restrictions to allow further vaccination
30 Jun 2021
NHS announces plans for winter vaccination programme involving flu jabs and a third COVID injection for all adults over 50 and those with ongoing health issues
13 Jul 2021
Legislation approved requiring the compulsory vaccination of care home staff in England from October
17 Jul 2021
UK records more than 50,000 infections for a 2nd day; highest number since January 2021; All adults in the UK offered a first vaccine, 2/3rds have had both doses
18 Jul 2021
Concerns that pingdemic will affect the economy as number of staff identified as a close contact and told to isolate by NHS app grows
19 Jul 2021
England moves to last stage of roadmap - nightclubs reopen; end to compulsory mask wearing, social distancing, the rule of six in private homes and the work from home rule
20 Jul 2021
1.7 million pupils (23.3%) were absent from school the previous week. Over a million for COVID-related reasons, of which 1 in 20 had themselves tested positive
21 Jul 2021
CQC reports that 39,000 of the people who died after testing positive for Covid-19 in England between 10 April 2020 and 31 March 2021 were care home residents
26 Jul 2021
Daily COVID test scheme introduced for key workers as alternative to isolation for close contacts
02 Aug 2021
The NHS Covid-19 app tweaked so that fewer contacts are told to self-isolate.
06 Aug 2021
Young people aged 16 and 17 are invited to get their first COVID vaccination
The Outbreak Support Team
Vaccinating Havering – Phase 2
16 Aug 2021
People who are double jabbed are no longer required to self-isolate if they are identified as a close contact. Instead, they should take a PCR test, wear a face covering indoors, and limit their contact with anyone classed as clinically vulnerable
Havering Council announces plans for Covid-19 memorial garden
16 Aug 2021
01 Sep 2021
ThankYouth festival – Music festival to encourage young people to get tested and jabbed
03 Sep 2021
The JCVI decides against recommending vaccinations for healthy children aged 12−15, saying the direct health benefits of doing so would only be marginal. However, it suggests ministers may want to consider wider benefits
13 Sep 2021
Chief Medical Officers recommend that healthy children aged 12–15 should be offered a single dose of vaccine having considered the benefits to their education as well as direct health benefits
14 Sep 2021
Publication of winter plan for Covid-19 that largely relies on vaccination. ‘Plan B’ to be used if NHS comes under ‘unsustainable pressure’ adds in relatively modest NPIs
16 Sep 2021
The Autumn booster vaccination programme begins in England and Wales, starting with NHS staff
20 Sep 2021
Ronapreve is approved by the MHRA as a treatment for the “most vulnerable patients who are unable to build up an antibody response to COVID. It is the first of a number of treatments that attack the virus rather than manage the harm it can cause
23 Sep 2021
ONS report that life expectancy for men in 2020 had fallen for the first time in 40 years to 79 yrs, a figure last seen between 2012–14. The figure for women was 83, and remained relatively unchanged
01 Oct 2021
UK Health Security Agency (UKHSA) becomes operational combining health protection functions formerly provided by NHS Test and Trace, the Joint Biosecurity Centre and Public Health England
21 Oct 2021
Cases rise further to over 50,000 a day
07 Nov 2021
More than 10 million people have had third vaccine dose
09 Nov 2021
The Health Secretary confirms frontline NHS staff in England must have both doses of vaccines by April 2022. This requirement will be withdrawn before coming into force
11 Nov 2021
Regulations come into force requiring all care home workers, and anyone entering a care home, to be fully vaccinated, unless they have a medical exemption. Some staff choose to leave their employment rather than be vaccinated. The regulations are subsequently withdrawn on 15 March 2022
15 Nov 2021
The JCVI recommends booster vaccine for all adults over the age of 40, and also offering 16 and 17-year-olds a second dose
25 Nov 2021
Six countries from southern Africa will be added to the UK’s travel red list amid concerns of a new COVID variant (it will be named omicron) that may be more transmissible and have the ability to evade immunity
27 Nov 2021
Two cases of the Omicron COVID variant have been found in the UK
29 Nov 2021
The JCVI recommends all adults over the age of 18 should receive a booster vaccine and children aged 12–15 should be offered a second vaccine
06 Dec 2021
Health Secretary confirms there is community transmission of omicron variant in several communities within England, with over 300 cases confirmed
08 Dec 2021
Introduction of Plan B measures announced: Compulsory mask wearing in indoor public places; requirement for COVID pass to enter nightclubs and large venues and recommendation to work from home
10 Dec 2021
UKHSA predicts a million cases with omicron variant by end of December
12 Dec 2021
CMO recommends UK coronavirus (COVID-19) alert level increased from Level 3 to Level 4
13 Dec 2021
Booster jabs offered to everyone over 18 in England
22 Dec 2021
More than 100,000 new COVID cases reported in a single day for first time
• Schools remained open (Omicron wave November 2021-February 2022)
23 Dec 2021
Analysis by UKHSA suggests people catching omicron variant are 50-70% less likely to require hospital treatment
29 Dec 2021
Wave 3 peaks in Havering with more than 1300 residents testing positive in a single day
Epidemiology - wave 3
2022 01 Jan 2022
More than 160,000 cases reported in England the preceding day
04 Jan 2022
Despite huge case numbers, Omicron is causing less severe illness, with hospitalisations five times lower than at the same point in 2021
12 jan 2022
ONS estimate that 4.3 million people had a COVID infection in week ending 7 January
14 Jan 2022
UKHSA confirm the Omicron variant is relatively mild for most adults as vaccines give good protection against serious illness
19 Jan 2022
Prime Minister confirms England’s Plan B COVID measures will not be renewed when they expire on 26 January
26 Jan 2022
Havering Council says thank you to 600 volunteers
24 Feb 2022
All remaining legal enforced Covid-19 related restrictions withdrawn
24 Feb 2022
Future response to Covid-19 set out in Covid-19 Response: Living with Covid-19.
20 May 2022
CMO recommends reduction of COVID alert level from 4 to 3.
31 Aug 2022
CMO recommends reduction of COVID alert level from 3 to 2.
Schools & living with Covid-19 (February 2022 to present)
Recommendations based on learning from the pandemic These recommendations are directed primarily to members of the Havering Health and Wellbeing Board (HWB) and the Havering Place Based Borough Partnership (HBPBP) who collectively have local responsibility for the development and implementation of plans to improve the health of local residents, narrow health inequalities and improve the quality of health and care services.
1.
The pandemic has shown the progress that can be made if we succeed in mobilising all the assets in the borough including health and social care staff, but also services across the whole Council and other statutory agencies; schools, colleges and early years settings; the voluntary and community sector and residents themselves, to achieve a clear and shared goal. We need to achieve something similar if we are to tackle the intractable health problems that preceded the pandemic and remain after it such as widespread obesity and significant health inequalities between communities within the borough.
To mobilise the borough and its assets, the Council and other public agencies should:• Consciously adopt a whole systems approach bringing the whole community together to develop a shared comprehensive plan that identifies the contribution of all parties to deliver desired outcomes • Train and encourage staff to make every contact count – treating every contact with residents as an opportunity to address their immediate concerns but also prompt them to consider opportunities to improve their health • Adequately resource communication and engagement activity that made such a positive contribution to the local response to the pandemic • Build on relationships with the community and voluntary sector developed over the 2 years of the pandemic and strengthen its capacity and capability.
2.
Although we were all in it together, the harms caused by the pandemic were not equally distributed. Age and pre-existing illness greatly increased the risk of serious illness and death. However, the likelihood of poor outcomes also varied with ethnicity, socio-economic disadvantage, occupation and geography. As such, the pandemic highlighted pre-existing health inequalities between communities and population groups. These cannot be tackled by health and social care services alone; indeed differences in take up of effective treatments can further increase inequalities. Our plans to reduce inequalities in health and wellbeing must address: • The wider determinants of health – aiming to reducing inequalities in income, job opportunities, access to high quality housing and educational attainment. • The lifestyles and behaviours that predispose to ill health e.g. smoking, obesity, harmful use of drink and drugs that cluster in disadvantaged communities and otherwise vulnerable sections of the population e.g. people with learning disabilities • The places and communities we live in - so that the healthier option is the easier option e.g. to walk to school rather than drive; we are protected from environmental risks to health e.g. air pollution; and people, are supported to maintain their wellbeing and independence as far as is possible at difficult points in their life. • As well as access to high quality, integrated, accessible and culturally appropriate health and care services.
Recommendations based on learning from the pandemic
3. With regard to the development of health and care services, the pandemic demonstrated
• That the same service offer to all communities will not achieve equality of outcomes. The effectiveness of various NPIs, test and trace services and vaccination varied between different communities. Inequalities in outcomes were reduced when national policy allowed for local delivery including the development of hyperlocal solutions to meet the needs and preferences of specific communities. In the same way, the HWB and HBPBP enable residents to shape the delivery of effective services. To this end, investment in community engagement is essential. • That social care is essential to the operation of the whole health and care system. The benefits to the individuals and families supported and empowered day- in and day- out have never been in doubt. The pandemic showed that it is equally important to the effective functioning of the NHS. Social care providers must be equal partners in the development of integrated care services within Havering and equal care and effort must be given to ensure the viability of care providers in terms of finances and workforce. • How much more partners can achieve if they are able to share information. The dispensation that allowed information to be shared simply and quickly between partners during the pandemic e.g. to support vulnerable residents during shielding or encourage vaccination has since been withdrawn. As a result, data sharing or the lack of it is once again a significant barrier to the development of integrated health and care services and adoption of a population health management approach. A solution that meets legal requirements has been found in other integrated care systems and we must work to ensure that the NEL ICS does likewise as soon as possible.
Delivering essential Council services Activation of flu pandemic plan Years before Covid-19, the UK Government recognised that the rapid spread of a new infectious disease to which people had no immunity and that could cause serious illness was one of the biggest risks facing the country. Flu was thought to be the most likely threat and The UK Influenza Pandemic Preparedness Strategy and guidance for local areas set out how agencies would work together to minimise the direct harm caused, protect essential services and enable the country to return to normality at the earliest opportunity. Havering Council, with its statutory partners (e.g. police, hospital and community health care trusts, GPs, the ambulance service, care homes) last exercised its influenza pandemic plan in April 2019. In late January 2020, a future planning group was set up when we started to hear about the spread of a new infectious disease overseas. Comprising representatives from different Council services, it ensured we had a shared understanding of the growing threat and provided the chance to think how we would implement our pandemic plan if needed. The Council’s Director of Public Health asked the Chief Executive to activate the pandemic plan on 10 March 2020. As well as identifying expected impacts of a pandemic; the plan introduced a Gold, Silver, Bronze, command hierarchy, originally designed for use in major operations by the UK emergency services, to facilitate rapid decision-making and to maintain control of the overall response. The Gold commander (the Council’s Chief Executive) is in overall control of the organisation’s resources and formulates strategy. Silver (the Director of Public Health) is the tactical commander who manages implementation of the strategy, making it into a set of actions to be delivered by Bronze(s). Bronze directly controls the organisation’s resources. The pandemic plan identified a number of bronze groups, each led by a Director or Assistant Director, with their own areas of responsibility e.g. support to health and social care services; early years and education; council services etc. With some changes, e.g., the addition / deletion of some bronze groups and / or changes to the frequency of meetings and size of supporting team; the GSB command structure would design and oversee delivery of the Council’s response to the pandemic for the next 2 years. A borough Health Protection Board (HPB) was formally established, chaired by the Director of Public Health (DPH). The HPB fulfilled the role of silver in the command structure turning the strategy outlined in the pandemic into a detailed set of actions and monitoring delivery by the various bronze groups. The HPB membership expanded to include representation from local NHS bodies, the Metropolitan Police, London Fire Brigade, Army and voluntary sector organisations – as well as Council officers leading each of the bronze groups. At times there might be 25 or 30 participants meeting daily. Managing a complex agenda with so many participants would have been a challenge at the best of times but within a week, the Prime Minister had advised everyone to work from home if they possibly could. Like many other workplaces, we switched to remote working. Most officers involved in the HPB had a laptop or received one very quickly and the Council network coped with many more people logging on from home all at once. But we still had to learn to make remote meetings work for us. Two years later this seems very straightforward but at the time it took some thought. We needed to produce agendas that kept pace with events, e.g. announcements made by the Prime Minister the previous evening or publication of complex new guidance; develop and stick to an etiquette that ensured everyone was able to contribute but not at the same time; create a style of minute-taking that ensured actions were captured and assigned to the right bronze group with clear timescales, so that the HPB could oversee delivery of the response needed that day. We also had to remember that our response might be subject to review at some point in the future and ensure that minutes, risk logs and other documentation were robust enough to stand up to scrutiny.
Delivering essential Council services Council services during the pandemic Throughout the pandemic, the Council continued to provide most of its usual services, as well as the additional roles involved in responding to Covid-19, including supporting the NHS and social care providers. This involved working with statutory agencies, providers of commissioned services and community and voluntary sector partners. All of us responding to everchanging national guidance as well as what the pandemic was doing locally. All this activity was coordinated using governance arrangements set out in the Council’s pandemic plan and through virtual meetings – which now seem the norm but which took some getting used to at the time. The Council had to respond to the Non-pharmaceutical interventions (NPIs) introduced by the government to control the spread of infection in the same way as any other organisation. • For instance, when the first lockdown was announced, the Council had to decide • whether each service it provided could be undertaken by staff working from home. • i f not, was it essential that the service continued during the lockdown – and if so, how could this be done safely – which generated a huge amount of work on the part of the health and safety team. • i f the service wasn’t essential in the context of the lockdown, and couldn’t be undertaken remotely, could the staff released by pausing the service be redeployed to support the pandemic response in some other way? • As the pandemic continued, the Council looked to expand the range of services it could provide remotely – particularly for residents who were at high risk of severe illness from Covid-19. • And as the first wave declined, the Council worked to restart face-to-face services in a way that complied with the regulations in force at the time. The articles that follow provide examples of how the pandemic affected different Council services: • Corporate health and safety team • Recycling and waste collections • Bereavement services • Births, deaths and marriages • Civil protection • Adult social care • Libraries
Delivering essential Council services Corporate health and safety response to the pandemic Employers have a duty to ensure the safety of staff and customers and the Council’s Health and Safety team assist service managers to ensure they comply with relevant legislation. When the pandemic started, all essential services that could not be provided remotely needed advice as to how they could continue in the face of Covid-19. A checklist was produced to help managers ensure their staff were safe in the workplace wherever that might be. Risk assessments were needed for individual members of staff, the services they provided and the buildings they occupied. Anyone who continued to provide critical services face-to-face needed a personal Covid Risk Assessment. An online tool was created using information from the Association of Local Authority Medical Advisers to assess how vulnerable staff might be if they caught Covid-19 and what precautions were necessary. In some cases this meant that vulnerable staff were redeployed away from face-to-face services. Many staff were understandably very concerned about working on the front line, including in schools. There was a fear of catching Covid-19 and passing the infection onto their families who may be vulnerable. Staff needed reassurance and reliable information – but what we knew about Covid-19 was constantly changing. Each day we had to check for updates from the government, the Health and Safety Executive, Department for Education and other sources to ensure we were in line with all the relevant guidance. The team had to participate in frequent meetings, often every day, with Gold, Silver and Bronze groups to share what we knew. We found more staff were accessing our wellbeing arrangements and the health and safety team carried out Stress Risk Assessments with a focus on managing fear, uncertainty, isolation, anxiety etc. through the pandemic. Staff were very grateful for the support they were provided. PPE was in short supply at the start of the pandemic. We helped services to think how essential services could be redesigned to avoid the need for PPE. Where a job couldn’t be done safely without PPE, we assessed what was needed, ensured that staff were trained on how to use it and put in place a system so that staff could order what they needed from our PPE hub. Additional mandatory training was introduced including Infection Prevention and Control, handwashing and how to use and safely dispose of PPE. Many of the roles within the Council could be delivered from home, however, that also created challenges in terms of ensuring the health and safety of our staff. We needed to ensure that they had the right equipment; that it was set up correctly and staff weren’t isolated while working at home. A new online assessment form was developed to take account of the new arrangements and to allow staff to order equipment e.g. chairs, screens, etc. which was then taken from Council offices and delivered for use at home. There were positive outcomes from the work that we carried out; working with colleagues to solve problems and create solutions provided us with the motivation we needed to ‘keep going’ through some very long days, weeks and months. There was much greater interteam working and a greater appreciation amongst colleagues across the Council of the work that health and safety do and the importance of getting things right.
Delivering essential Council services Recycling and household waste collections During the pandemic, Havering and the company Serco worked together to ensure that recycling and household waste collections continued. Additional staff were needed to cover for increased staff absences due to infection and isolation. Some staff who were vulnerable to severe illness were unable to work long-term. Staff from non-essential Council services transferred over to the daily waste and recycling rounds to work with colleagues employed by Serco. For example, the Council’s grounds maintenance crews were redeployed while all grass cutting was stopped for approximately a month. Serco and Havering’s in-house frontline teams worked hard to keep staff safe, including: • team members were asked to work from home where possible and meetings were held via Zoom or Microsoft Teams • vulnerable staff were identified and reassigned • regular communications and guidance documents were provided and regularly updated with support and supervision • messages were reinforced by clear signage and operational guidance • staff were assigned to small “bubbles” to help limit contact between large groups • staggered start times were introduced • staff were transported to their beats in buses provided by Passenger Transport to enable social distancing • appropriate PPE and hand sanitiser were provided • staff were tested regularly as soon as this became available Serco implemented robust Covid plans, which were produced by their group leadership team. Although waste services experienced high absences initially so that key services had to be prioritised, the service rapidly adapted, Covid-related absences reduced and collections continued largely unaffected. Indeed, free bulky waste collections were offered to residents who were shielding and therefore could not attend the Gerpins Lane Reuse and Recycling Centre. Serco received a visit from the Health and Safety Executive to check compliance with Covid controls in the workplace, and feedback was overwhelmingly favourable.
Delivering essential Council services Birth, marriages and deaths The pandemic had a profound effect on the delivery of face-to-face services offered by the Registration & Bereavement Service, responsible for the legal registration of births and deaths and undertaking civil marriages, funerals, cremations and burials. Closing the services was not an option, but staff were naturally frightened and fearful of catching Covid-19 and putting loved ones at risk. We also had to adapt quickly to constantly changing guidance and legislation. This included: • The cessation of face-to-face registration of births, other appointments and civil marriages in March 2020. • The adoption of new procedures to allow remote registration of deaths, while continuing to issue death certificates from the Register Office. • Restriction of mourner numbers. • Closure of the grounds of the crematorium and cemeteries. We also had to help with the erection of a temporary body storage facility in the car park at the South Essex Crematorium. The facility was one of five ‘super hubs’ designed to cope with excess deaths across London. It remained on site until July 2020. The service was constantly in contact with funeral directors and mortuary colleagues to ensure we could manage the high number of cremations and burials. We divided the team into bubbles to minimise the risk that everyone would have to isolate at the same time. When one team was in the workplace, the other worked at home on tasks that could be done remotely. Everyone worked long days and gave up their time at weekends. We looked at new ways of working, collaborating and finding customer-focussed solutions to reduce face-toface contact which were successfully communicated and implemented – some of which have now become business as usual. As we re-opened a front-facing service for our bereaved customers, the team put aside their own fears and concerns and worked to provide a safe environment for our customers and each other. Screens had been erected and the team followed risk assessments and social distancing measures. Wearing PPE became second nature; interview rooms and reception areas were sanitised in between visits and restrictions on the number of occupants had to be observed. The team looked out for their colleagues and customers, putting others first, always with a positive attitude which belied any personal issues or problems they may have had themselves. During this time, staff faced their own bereavement, losing a beloved team member to COVID. Things were most difficult at the peak of the second wave in January 2021. A video blog was produced by Louise Roast, Head of Bereavement and Registration Services, at a time to tell of the reality of what was being experienced. There was no immediate relief when the pandemic subsided as the registrations team had to cope with the huge backlogs of work from processes that had to be paused while the focus was purely on meeting the needs of the newly bereaved. The Head of Service and all team managers were based in the workplace the whole time to help maintain the morale of colleagues and check on their welfare as they continued to pull together as a fantastic and dedicated team in the most extraordinary circumstances. The great majority of customers recognised the efforts of the team in the extraordinary circumstances of the pandemic “Thank you for your very helpful suggestion for the wording on our plaque which is fine and seems more intimate and friendly. I received an email from your team yesterday in which there was an apology for any delay as you are all so busy at the moment. There is absolutely no need to apologise. The job you do is difficult at the best of times and more so the way of life is for us all during the pandemic. We have experienced only kindness and consideration from all of the crematorium staff that we have had communications with. Thank you all for your help at what is a very difficult time for us.” Both teams were awarded ‘Covid Team of the Year’ during the staff Star Awards in 2021 in recognition of their work.
Delivering essential Council services Civil Protection Civil Protection set up and managed the Outbreak Control Service throughout the pandemic. Civil Protection staff also directly supported the pandemic response e.g. ensuring businesses complied with legislation during the lockdown and managing the thousands of people using parks and outdoor spaces in the borough. On re-opening, the service distributed Covid advice and provided face-to-face support to businesses on their re-opening particularly the large numbers of close contact services in the borough. The service continued with enforcement patrols to manage anti-social behaviour and littering, which escalated each time lockdown was lifted, as well as the need to provide a wide range of support for victims of domestic abuse, which saw a significant increase in numbers during the pandemic. Licensing teams were also busy addressing the new Pavement Licensing Laws, as businesses found themselves needing to create new space on the streets to operate safely. A huge range of enforcement work emanated from this, with unlawful structures being erected outside food and beverage suppliers and local public houses requiring work by licensing and planning colleagues as well as environmental protection and noise teams to address the volume of noise generated by outside drinking establishments. Due to a high number of staff needing to shelter during the pandemic, demand often exceeded staff availability and hence, Blue Nine Security Company were commissioned to support work in the borough to keep people safe.
Delivering essential Council services Adult Social Care (ASC) during the pandemic As well as supporting care providers, the Council’s Adult Social Care (ASC) services continued to deliver its ‘business as usual’ throughout the pandemic. We are proud of the work done to support and safeguard adults across Havering during this period. We have had to respond to unforeseen and unprecedented challenges; thinking and working differently. We are building on what we have learnt with our partners and the community. Most ASC staff moved to working remotely during lockdown and wherever appropriate, people were contacted virtually, which was challenging, as face-to-face assessments better suit the personalised approach we aim to provide. However, many clients were at high risk of severe illness due to age and / or pre-existing health conditions. Where a face-to-face visit was essential, a risk assessment was undertaken and the visit conducted in line with Standard Operating Procedures (SOPs) developed with the heath and safety team, using PPE and maintaining social distancing to minimise the risk to both staff and clients. The Coronavirus Act 2020 introduced easements allowing local authorities to vary from their usual responsibilities under the Care Act when necessary e.g. due to a sudden increase in demand or reduction in capacity due to staff illness or isolation. Havering Council did not make use of these easements and continued to provide all statutory services with appropriate adaptation. Business support colleagues amended our processes for statutory complaints, financial assessment, appointee and deputyship to fit with remote working. ASC staff worked with NHS and public health colleagues to ensure our approach to the discharge of patients from hospital was consistent with rapidly changing national guidance and understood by all stakeholders. ASC mental health services are integrated with the NHS and operate from NELFT premises that remained open. ASC staff attended on a rota basis so that social distancing could be maintained. In addition to colleagues who had to shield, mental health services had to cope with the loss of nursing staff who were seconded to frontline services e.g. inpatient wards and A&E psych liaison to make good increased rates of staff absence during the pandemic. Approved Mental Health Professionals (AMHPs) carry out a variety of functions under the Mental Health Act (MHA). One of their key responsibilities is to make applications for the detention of individuals in hospital. The Coronavirus Act 2020 allowed for temporary modifications to the MHA but these were not used in Havering. To fulfil this function, AMHPs must be available immediately. At the start of the pandemic, as per normal practice, two AMHPs were on the rota each day. At the start of the pandemic this increased to three due to the level of referrals and to limit the number of people each individual AMHP would see in a day to minimise the risk of large outbreaks. AMHPs are legally obliged to undertake assessments face-to-face. The team employed appropriate PPE and social distancing and continued to carry out face-to-face assessments at the individual’s home or in hospital throughout the pandemic. Occasionally AMHPs have to apply for warrants, particularly when a police presence is required, and attend magistrates’ court to have their applications heard. Courts are busy places, and social distancing was difficult. Eventually, the London magistrate’s court arranged for AMHPs to make their applications digitally. These arrangements are continuing, saving time travelling to and from court. Support, time and recovery (STR) workers help people with mental health problems or a learning disability to live their lives. STR workers continued to visit people during the pandemic but clients who were shielding had to be supported virtually. At times, the focus had to change from ‘working with’ to ‘doing for’ clients to ensure that people had the food, medication, monies, etc they needed during the lockdowns. The number of safeguarding concerns raised with ASC increased. ASC staff worked weekends and evenings to ensure that all referrals were reviewed and triaged in a timely fashion. The Safeguarding Service worked remotely but where required, face-to-face visits were carried out with appropriate PPE. We noticed an increase in domestic abuse and hoarding/self-neglect cases during the pandemic possibly where people had reached out to support neighbours and realised the difficult circumstances they were living in. Prolonged confinement within the home during lockdowns may
Delivering essential Council services Adult Social Care (ASC) during the pandemic have exacerbated problems such that older adults needed to flee domestic violence having lived with a partner for many years. Similarly, adults with cognitive impairments who didn’t understand why they could not go out clashed with their carer. There were also cases where adult children returned to live with their parents during the pandemic and engaged in aggressive or coercive and controlling behaviour. Since we have come out of restrictions, some issues have improved but we continue to see high levels of self–neglect and hoarding cases. Day centres closed for prolonged periods during the pandemic. Staff visited some vulnerable people who would normally have attended and offered virtual sessions for others. However, these mitigations did not fully compensate for the closure of day centres, which had a big impact on the wellbeing of individuals with a learning disability and their carers. ASC staff who normally provided services that closed during the lockdown nonetheless played a full part in the Covid-19 pandemic response e.g: • by supporting the Covid-19 hotline and proactively checking on the wellbeing of residents who were shielding and later encouraging residents to get vaccinated or calling residents who were isolating as part of the local test and trace service. • distributing PPE from the Yew Tree Resource Centre - recognised in the ‘#DoingMyBit’ campaign as an example of staff that had gone above and beyond the norm.
Delivering essential Council services Libraries and library staff during the pandemic During the first wave of Covid-19, public buildings such as libraries, were closed by law. Library staff with access to a laptop and the internet were redeployed to support Havering’s NHS Shielding help line. We contacted residents who were at the highest risk of being hospitalised by the virus and who had been advised to shield themselves and stay at home. We established the initial contact, explaining who we were, why we had called and worked with them to ensure they had everything they needed, such as access to food and medicines. Where residents were struggling, we offered help. For those who only had a few days’ provisions left, we organised food boxes to be delivered and where applicable highlighted any safeguarding issues to our colleagues in Adult or Children Social Care who continued to provide this essential service. Libraries continued with delivering books, orange refuse sacks and other Council printed material to housebound residents. Online services remained available from libraries i.e., e-books, audio, and reference resources. We saw a 40% increase in online materials being loaned and a 36% increase in new online borrowers. Libraries also ramped up their online presence e.g., Baby Bounce, story time, reading groups, knitter natter sessions, etc. Residents really appreciated access to sessions, especially for those who had not spoken to anyone all week. Residents said: “The Knit and Natter Zoom sessions run by Havering Libraries has filled the void for those of us not able to attend social groups during lockdown.” “I think this knit and natter on line is great. It keeps loads of people in touch with one another, who may have been isolated. Thank you.”
Children and Young People The response of education and childcare to the pandemic during the first lockdown The priority for education and childcare settings throughout the pandemic has been to minimise the disruption to children and young people’s learning, whilst protecting their health and wellbeing and that of their families. Their ability to achieve these twin aims developed rapidly from March 2020 onwards. Although we talk of schools closing during lockdowns, they remained open throughout for the children of Key and Critical Workers and pupils deemed vulnerable. Indeed, most schools and childcare settings also remained open during the school holidays to provide for these children. At the same time, they maintained close contact with the majority of pupils and their families, providing them with work to do at home. In general, secondary schools were better resourced and more used to this type of provision than primary schools. Most already had well-established learning platforms to provide work and pupils were familiar with submitting homework virtually, so the transition was easier. However, all schools had to address the digital divide between those families that had the necessary hardware and broadband access and those that did not. Schools developed their approach, making use of the limited government supplied devices and a wide variety of innovative ways to provide more devices and to utilise existing technology in the home. This included mobile phones, tablets, gaming machines and smart TVs. Schools provided internet access for some families, by distributing SIM cards and dongles. Leaders used school websites to post key messages, including video messages and “how to” information. Most schools offered a blend of textbooks, customised work packs, generic projects and on-line access to pre-prepared materials made by their teachers, or third parties. Technology also changed the way of working and communicating in schools, with the widespread adoption of virtual meetings for staff, parent-teacher meetings, meetings with other headteachers, clubs, staff socialising, peer support and assemblies. Education settings also played a critical role in reinforcing the public messaging relating to the pandemic. This included regular reminders to their local community about the key messages, such as “stay at home” during the lockdown and updating families about the regularly changing rules as lockdown was relaxed. They also played a significant community role, with many delivering food packages and medicine to vulnerable and shielding families. During this period, leaders talked of education settings taking a central role in their communities, which has permanently strengthened relationships between schools, wider community services and local families.
Children and Young People When schools reopen after first national lockdown Primary schools began a phased return at the start of June 2020 with the intention that all age groups would be back by the end of the month. However, within a week government paused the return of further age groups due to concern about the impact on rates of infection in the community. Instead, most primary school children returned to classes in early September. Secondary schools reopened for year groups 10 and 12 (aged 16–17) from 15 June. However, schools were instructed to continue to teach largely at home, and to keep face-to-face lessons to a minimum. As a result, most children and young people did not receive face-to-face education until the start of the new academic year in September having been at home for six months. At the start of the term, schools felt that while considerable learning time had been lost, this would be quickly made up and planned for a return to something like normality. Schools adopted various strategies to make it easier to return. For example, in one school, children returned in the September to their class teacher from the previous year before moving on to their new teacher a week later. Some schools created return to school videos particularly to support pupils transitioning to a new school. Headteachers reported these strategies were successful and well received by parents. Although a few families were reluctant to send their children back, most children were happy to return and keen to engage with learning. As the autumn 2020 term progressed, it became apparent that it would not be business as usual with rapidly increasing numbers of pupils unable to attend school, in some cases repeatedly, due to the high number of Covid-19 cases. This was a particularly difficult period as teachers taught classes in school and provided work for the many children at home, and coped with high levels of staff absence. The impact on pupils was variable, with some pupils repeatedly missing chunks of learning whereas others missed none. Schools did their absolute best to personalise teaching to the needs of the individual child. The use of third party and teacher developed on-line resources and Google Classroom, Teams and Zoom to deliver remote learning was further developed. Staff needed to be confident in using the technology, and this was an unprecedented period of staff development and innovation. This was all done at a time, pre-vaccination, when they were concerned about catching COVID and potentially passing it on to their own families. In addition to the demands of teaching and learning during the pandemic, school staff and pupils had to comply with the rapidly changing guidance from the Department for Education (DfE); designed to make schools as COVID safe as possible. This included one-way systems, social distancing, teaching in bubbles, enhanced cleaning, sanitisers etc. Eventually, schools would produce ventilation plans and risk assessments, supported by the Council’s Health and Safety team, when the importance of airborne transmission was recognised. Despite the thoroughness of these measures, cases of Covid-19 were a frequent occurrence amongst staff and pupils, inevitably so, given rates of infection in the community. After each case, schools had to identify who was a close contact, often an entire ‘bubble’, who then had to be excluded for the required isolation period. Schools had to provide the DfE with frequent updates regarding their situation. The Council’s Education and Childcare Bronze group, comprising of colleagues from the Council’s Education and Public Health teams, worked to ensure that all education establishments (early years settings; childminders; private, voluntary and independent childcare (PVIs), primary and secondary schools; independent schools; Special Educational Needs and Disabilities (SEND) provision; and sixth form/further education colleges) had a shared understanding of the prevailing DfE Guidance. The Bronze group also assisted schools and early years settings to implement effective infection prevention and control (IPC) measures. Prior to the pandemic, the specialist Health Protection Team (initially employed by Public Health England (PHE) and then transferred to the UK Health Security Agency) would manage an outbreak of infectious disease in a school, sometimes by convening a multi-agency Incident Management Team (IMT).
Children and Young People When schools reopen after first national lockdown This was impractical during the pandemic, due to the huge number of outbreaks and responsibility for providing first line support to schools was transferred to the Council’s Public Health Team, who escalated concerns to PHE if the outbreak was very large or resulted in serious illness. As a result, the Bronze group took the lead on: • providing regular guidance and support to settings including developing and regularly updating standard operating procedures (SOPs) that set out in detail what to do in different situations. • providing advice to individual schools or early years settings experiencing outbreaks, supporting them in complex situations, and how to communicate best with parents/the school community. • co-ordinating and/or participating in Incident Management Team (IMT) meetings in response to the most serious outbreaks, particularly those in SEND settings. • holding regular briefings for senior leaders to discuss rates of infection in the community, changes to guidance from PHE and the DfE, awareness of health and wellbeing of staff etc. • ensuring senior leaders were briefed on current understanding of the virus, how new strains were developing and their infectiousness, and the principles and development of Covid-19 testing (PCR and LFD) and vaccines Schools rapidly gained confidence in how to manage outbreaks, but the Council’s Public Health team continued to offer support and a listening ear, including during evenings and over the weekend, to help schools identify the close contacts of a newly reported case who would not be able to attend the following day.
Schools remain open (Second National Lockdown November-December 2020) The partnership between schools and the Council was tested even further over the New Year of 2020/21. Schools had remained open during the second four-week lockdown during November and although rates of infection increased rapidly in December (as the Kent/Alpha variant spread), the DfE told schools to prepare for face-to-face teaching when they returned from the Christmas holidays. In preparation, schools and Councils were asked to assist with the testing of pupils in years 11 to 13 and all staff in primary and secondary schools to minimise transmission over the holiday period. More than 23,000 PCR tests were given out before the end of term and then returned to collection points located at convenient locations across the borough and staffed by hardworking volunteers during the holidays. However, even as schools began to reopen in the New Year, the DfE instructed them to switch to remote learning until at least the February half-term.
Children and Young People During the third national lockdown By the time of the third lockdown, teaching staff were very adept at offering a variety of virtual opportunities using a range of high quality on-line resources including from the Oak National Academy, Joe Wicks PE, Charanga Music. Most schools were providing the full range of subjects. Schools were instructed to provide live on-line lessons, which was new for some and most extended their offer. Schools managed this very well, usually through teachers teaching from home, live-streaming lessons, usually providing opportunities for pupils to interact with the teacher and each other and teaching assistants were able to join the pupils they support in virtual classrooms. Many schools personalised timetables to ensure that where families were sharing a device, pupils of different ages were able to access the learning. There were also some cross-phase collaborations, joint lessons for primary and secondary age pupils. Schools continued to prioritise getting their most vulnerable pupils into schools and worked hard with families to achieve this. Early years settings provided invaluable support by ensuring children of keyworkers, such as teachers and teaching assistants, had access to essential childcare. During this period schools developed methods of on-line individual marking and feedback and leaders monitored the quality of teaching and pupils’ work. Schools reported that virtual attendance was in the main good, and there was a strong focus throughout the period on engagement of pupils. Schools reported that poor engagement of parents and carers, or their feeling unable to support their children, was a major barrier and they worked hard to support both pupils and parents and carers- often beyond matters of curriculum. Many schools reported that their relationships and engagement with parents and carers has never been better. Schools checked in regularly on the safety and well-being of their pupils, especially those who were absent, not fully engaged or of concern, at risk, or disadvantaged. Most schools put a strong emphasis on well-being, as they reported a rise in poor mental health. Many schools ensured that the curriculum included support for aspects of well-being and healthy living. Schools also made extensive and highly innovative adaptions to the curriculum in practical subjects, such as music, art, PE, drama, science and design technology, but nonetheless many aspects of these subjects simply could not be delivered remotely, due to the lack of group activity, lack of equipment and safety concerns. Many of these subjects therefore front-loaded the theoretical aspects of the curriculum, which led to some disengagement amongst pupils. Covering the practical requirements of exam subjects was a particular issue for secondary school teachers. Schools were very conscious of the strain on staff and often adopted rotas to spread the workload. The local authority offered access to a well-being and exercise programme, which was well attended. Staff training continued, either in Covid-secure environments or virtually, and Havering Education Services courses continued to offer a very wide range of training opportunities, including training designed to support remote learning and curriculum adaption and safety and safeguarding.
Children and Young People The spring and summer terms 2021 Following the third national lockdown, all primary schools reopened on 8 March 2021 whereas secondary schools opened in a staggered manner. The staggered start was to help secondary schools introduce asymptomatic testing with Lateral Flow Devices (LFDs). All secondary pupils were asked to take three supervised tests in school before switching to being tested twice a week at home. Their households and bubbles were also able to get tested. Staff in primary and secondary schools, their families and the childcare and support bubbles of pupils were also given access to testing. Early years staff were given priority access to local testing sites. School staff and volunteers had to put in place arrangements for testing students and then to supply tests to students and their families. This was a huge task, which the Education & Childcare Bronze group supported, by providing guidance and arranging for advice from the Council’s Outbreak Support Team who were already running Assisted Testing Sites in the community. In addition to testing, students and staff in secondary schools were encouraged to wear face coverings when social distancing was not possible. Despite or perhaps because of these additional responsibilities, the period up to the summer holidays was less disrupted as infection rates in the community remained relatively low and staff benefited from vaccination.
Children and Young People The autumn 2021 and spring 2022 terms The biggest development in the Autumn term of 2021 was the offer of vaccination to children aged 12-15 which the government decided should be done in schools. Schools remained open for face-to-face learning in the run up to and during the Omicron wave either side of the Christmas holidays. They continued with onsite assisted rapid testing, and ensured pupils and staff tested at home regularly. Messaging regarding infection prevention and control practices was regularly reinforced. Nonetheless, there were numerous outbreaks but schools were well practiced in managing these with support from the Council’s Public Health team. The omicron wave was huge but relatively short lived. When it became clear that few cases resulted in serious illness, Government relaxed Plan B and as spring progressed schools were able to consider a return to greater normality, including out of school visits or residential trips.
Children and Young People Schools and Living with Covid-19 – March 2022 onwards Schools moved quickly to relax control measures as set out in the Government’s ‘Living with Covid’ plan. They reported that most pupils were pleased to return to normality and continued to display great resilience. However, some were more anxious, especially children who were identified as clinically extremely vulnerable. Schools have identified a variety of harms due to the pandemic and the measures employed to control it. Schools reported that many pupils had also become physically less healthy, due to disrupted sleep patterns, poor diet and physical inactivity. Schools are now continuing to focus on supporting the mental health of pupils and some schools have offered enhanced Personal, Social, Health and Economic (PSHE) education programmes to help pupils with increased mental health needs. These concerns are likely to remain elevated for some time. Some pupils have exhibited poor behaviours for learning, found it difficult to engage with peers, exhibited anxiety and were often tired. Amongst younger pupils, they reported regression in aspects of socialisation, early reading/phonics, and physical capability. Schools have employed a variety of assessment approaches to establish a comprehensive baseline on return to school so that gaps in pupils’ understanding can be addressed. Leaders report that, nationally, vulnerable pupils seem to have fallen behind more than their peers, however they also report that some nervous, quiet and “unseen” pupils, as well as some middle attaining boys and very able pupils have flourished within the remote learning environment. Schools are now far better equipped and ready to implement effective remote learning at any point and better attuned to the ways different pupils like to learn and work. Some schools report that they have made learning more flexible to better meet the varied needs of their pupils. They also say that this has improved the quality of work that can be offered to pupils who are absent for an extended period of time. Most school leaders say that they have made lasting changes to the way they operate in many areas as they have found better alternatives to traditional received practice. Leaders spoke about using technology going forward e.g. parent-teacher meetings, cluster meetings, providing home learning/work, virtual meetings, continuing professional development (CPD) and governing body meetings. Many of these have been better attended and more effective than when they were held at night after work. There is a perception that the impact has been a better work-life balance for teachers and greater engagement with others. Now education settings are focussed on ensuring that this prolonged period of disruption will not have a long-lasting impact on children and young people, and damage their future prospects. They are targeting their resources on those children most impacted, ensuring that any ‘lost-learning’ is addressed, and young people are prepared for the future. Initially, in summer 2020 and refreshing in summer 2021, our schools were asked to develop curriculum recovery plans. These plans typically focus on recapping key building blocks of knowledge which cohorts appeared to have understood less well, in some cases taking pupils back a stage, filling gaps in practical subjects, enhancing the wider cultural curriculum and enhancing personal development opportunities that have not been available for four terms. These plans are continuing through the current academic year.
Non-Pharmaceutical Interventions (NPIs) Shielding and associated services On 21 March 2020, the Government announced that people identified by the NHS as being at high risk of severe illness should stay at home to protect themselves. This was called ‘shielding’. People advised to shield (later called Clinically Extremely Vulnerable or ‘CEV’) had one of a number of specific health problems including certain respiratory conditions, specific cancers, rare diseases or were receiving treatments that suppress the immune system. The shield list was expanded, as more became known about who became seriously unwell to include adults with Down’s syndrome and patients identified by their GP as high risk; and then to reflect the effects of social disadvantage and ethnicity. More than 15,000 people in Havering were told to shield. The NHS (via GPs) began writing to everyone on the Shield list with more detailed advice, while the government created a central ‘hub’ with a contact centre dedicated to contacting people and establishing their support needs. Recognising that some people would need urgent help e.g. to get food and medication, the government also asked councils to create their own local hubs and contact people in their area. To support this, shield lists began to be shared with councils from 2 April 2020. The sharing of NHS data with councils was possible because the Secretary of State for Health and Social Care issued NHS Digital with a so-called COPI Notice that required NHS Digital to share confidential patient information with organisations for Covid-19 purposes. The COPI notice was withdrawn at the end of the pandemic at which point the Council deleted all information provided by the NHS. Havering Council set up a distribution hub to hold and deliver food to people shielding and a Covid-19 hotline telephone number and email address to respond to residents’ enquiries. Each time the national guidance changed, we wrote to the shielding list, signposting them to the latest advice; we also made sure that care home with residents on the shield list were aware of the changes. By the time shielding requirements were relaxed the Council had been in contact with more than 99% of shielding residents or their families. This included around 3,000 emails, 6,000 phone calls received and over 20,000 outbound calls made. There were more than 370 visits made to resident’s homes where telephone contact had not been possible. As well as managing the sharing of data provided by the NHS, staff from the Council’s Data team also provided a link between those making and taking phone calls using the Covid-19 hotline and the distribution centre, co-ordinating the lists of people to call and the lists of food deliveries to be made, 7 days a week.
Non-Pharmaceutical Interventions (NPIs) Shielding and associated services The following letter was received from a Havering resident who wanted to share her experience and her gratitude for the support she received during the pandemic.
“In October 2019 I had an operation to remove a cancerous tumour from my breast and at the start of 2020 I began chemotherapy at Queens Hospital. Following the chemo, I then needed to attend hospital for 15 rounds of radiotherapy; by now we were at the height of Covid and I was terrified. Hospital staff were still awaiting their PPE and every day they were up close and personal with me as they measured where the radiation would be directed. I was completely alone as family members weren’t allowed to accompany patients. All staff were absolutely wonderful and put me at ease despite the risks we were all facing. When I was finally allowed to ring the bell at the end of my treatment, an extremely emotional time, again I wasn’t allowed to have anyone with me, but two lovely nurses accompanied me and videoed the smile on my little bald face so that my family could celebrate with me. I will never be able to thank our NHS enough. On top of that, I am also an informal carer for my elderly mum who is also Extremely Clinical Vulnerable. She relies on me to get her shopping which I was unable to do during lockdown and getting an on-line shopping slot was impossible. We therefore relied on our lovely volunteers who kept mum going with food parcels and spoke with her on the phone until it was safe for me to go out again. I don’t know what we would have done without them. When I was well enough to return to work (from home) the world had changed. Everything was on-line (not one of my strengths) so evenings were spent learning how to use MS Teams on YouTube (I’m still hopeless) and my confidence was at an all- time low. Fast forward to 2022 and three jabs later, I am enjoying being out and about again, although it took me a very long time to regain my confidence. I have noticed however, that my mum who used to be as sharp as a pin has mentally deteriorated somewhat probably due to lack of social interaction. We are both just glad to still be here”.
Non-Pharmaceutical Interventions (NPIs) We now have vaccines that reduce the risk of serious illness and treatments that can help people who develop serious illness despite immunisation. At the start of the pandemic, we had neither. We had to rely on non-pharmaceutical interventions (NPIs) to slow the spread of infection, prevent the NHS being overwhelmed and avoid the massive number of deaths initially projected. Over the pandemic, NPIs have varied reflecting the severity of the threat facing the country; what we knew about how the virus spread and more recently, our growing confidence that vaccination offers sufficient protection against serious illness that much higher rates of transmission are tolerable. NPIs either reduce the likelihood that a contact between individuals will result in infection or by reducing contact between individuals in different households. Reducing the risk of infection during a contact Developed from the ‘catch it, bin it, kill it’ messaging that predated the pandemic, people were initially encouraged to carry tissues with them and use them to catch coughs and sneezes;to bin the tissue and regularly wash their hands with soap and water or gel on the assumption that infection was most likely to be transmitted by the sneezing of large droplets onto surfaces and from there on to the hands of others. Later messaging to individuals was amended to: • first to ‘hands, face, space’ – as the importance of airborne particles was recognised and that transmission was most likely to happen within 2 metres, so people were encouraged to wear a face covering when social distancing was not possible and otherwise maintain a safe distance from people in other households. • and again to ‘hands, face, space and fresh air’ – to emphasise the benefits of good ventilation in dispersing airborne particles in enclosed spaces. Reducing contacts between individuals It has also been necessary to limit contacts between individuals in different households. Shielding sought to encourage the most vulnerable to isolate from wider society entirely when SARS-Cov-2 was in circulation and pending the development of an effective vaccine. Later on, testing and contact tracing sought to target restrictions on those who were infected and their close contacts. But for long periods, the population as a whole had to accept significant limitations on their freedom to meet people outside their household. At the start of the pandemic, controls escalated rapidly moving from advice to work from home where possible; to the closure of schools; then the closure of pubs and other social venues; until the first lockdown was imposed. Residents could only go outside to buy food, to exercise once a day, or to go to undertake essential work if they absolutely could not work from home. Lockdowns would be imposed three times in all. After each lockdown, the measures were reversed to a greater or lesser extent. Most restrictions were lifted after the first lockdown for the summer of 2020 when the pressure on the NHS was much reduced. New health and safety guidance on operating businesses in a COVID secure way was published. Most hospitality businesses were permitted to reopen and people were positively encouraged to eat out to help out. This lasted until the autumn when case numbers began to grow and restrictions were gradually ramped up again. The country then alternated between the tier system and lockdowns two and three as wave two grew and then grew again as the new Kent / alpha variant swept the country. In the spring of 2021, a roadmap out of lockdown was published by government that deescalated restrictions in four steps, with progress from one step to the next dependent on confirmation that the NHS was not coming under undue pressure.
Non-Pharmaceutical Interventions (NPIs) • Step 1 reopening of schools and colleges; outdoor gatherings allowed of either six people (the rule of six) or two households and outdoor sports permitted. • Step 2 reopening of non-essential retail and indoor sports venues; hospitality opened for outdoor service. • Step 3 the limit on outdoor gatherings increased to thirty; indoor gatherings allowed, but rule of six applied; the requirement to social distance from people in a different household was relaxed and large indoor venues reopened including cinemas, children’s play areas, hotels etc. • Step 4 removal of remaining legal limits on social contact – implemented on 19 July 2021. The Covid-19 Response: Autumn and Winter Plan 2021 confirmed that the UK’s first line of defence would be vaccination. Plan B, to be implemented if the NHS was likely to come under unsustainable pressure, allowed for the introduction of mandatory vaccine-only COVID-status certification and face coverings in certain settings. Very modest measures in comparison with the NPIs used earlier in the pandemic. Plan B was implemented in December 2021 during the peak of wave three but was withdrawn after six weeks when it became clear that vaccination continued to protect against serious illness despite the huge number of cases caused by the spread of the Omicron variant. In the absence of a new, more harmful variant, it appears that regular booster vaccinations will be enough to maintain adequate control on levels of serious illness caused by Covid-19. If so, it’s likely that NPIs will rapidly become an unpleasant memory for most people. However, we should all remember and take pride in the fact that the huge majority of UK residents came together with a common purpose – to protect the most vulnerable – and endured significant hardship until vaccination provided an alternative means of providing the protection we needed. Colleagues leading the Council’s communication and engagement efforts over the two years of the pandemic designed a series of innovative and effective approaches to share information about what was expected of residents and where they might get support but also to bolster that essential sense of collective purpose. At the same time, colleagues in the Outbreak Control Service worked with businesses across the borough to ensure they were compliant with regulations at the time and everyone, whether employees or customers, were protected and received consistent clear messages as to what was expected of them. Alongside these measures, the Council and partners provided a variety of support to individual residents and local businesses to tide us over until we could live with COVID without the need for significant NPIs.
Non-Pharmaceutical Interventions (NPIs) The Outbreak Control Service The Outbreak Control Service (OCS) was set up at the very start of the pandemic to ensure that different business sectors in the borough complied with changing legislation – e.g. the requirement for non-essential retail to close during the lockdown; and to help those businesses that could remain open to do so as safely as possible. Initially the team consisted of staff seconded from Public Protection who had a pre-existing role in enforcing health and safety in business premises and the know how to advise businesses about how they could prevent and respond to outbreaks. As businesses started to reopen during the summer of 2020, our COVID workload grew and business as usual activity restarted, so additional temporary staff were taken on. So that the OCS could: • Continue to ensure business compliance with changing restrictions and requirements • Analyse testing data provided by PHE to identify potentially linked cases of infection e.g. multiple cases in the same road or employed in the same work place. • Investigate these potential outbreaks to put right any weaknesses in control measures and ensure all close contacts had been reported to NHS Test and Trace (NHST&T). The OCS also managed a 30-strong team of COVID Marshalls who were recruited locally on temporary contracts to patrol high footfall areas in the borough and provide advice and guidance to residents about the need to comply social distancing requirements. Over the course of the pandemic, the Outbreak Control Service did more than 12,000 visits to 3,800 individual businesses to provide advice and guidance. This included more than a 1,000 visits in and around stage 4 of the government’s roadmap out of lockdown in July 2021 to ensure that businesses understood their continuing responsibilities to protect staff and customers from COVID as part of their duties under the Health and Safety at Work Act. Throughout the pandemic, the huge majority of businesses were willing to and accepted the advice given by the OCS. On only eight occasions, the OCS were obliged to issue a fixed penalty notice (FPN) to businesses that would not accept the advice given. Six FPNs were paid; two were not – the same trader in different locations. The Council subsequently initiated prosecution, the trader pleaded guilty on both counts and was fined as follows: • First offence: Fined £1,000 plus £500 costs • Second offence: Fines £3,000 plus £1,000 costs • Total victim surcharge: £190 No one within the OCS had powers to issue fines to individual citizens for breaches of COVID restrictions – these were matters for the police. In early 2021, a second team, the Outbreak Support Service, was created to deliver the Council’s new responsibilities for rapid community testing. This team would also provide support for the vaccination programme and residents required to isolate.
Support provided to individuals and businesses The Covid-19 Hotline The Council’s free to call Covid-19 hotline launched on 25 March 2020, the day before the first lockdown came into force to respond to residents’ COVID related concerns. When the pandemic hit, some Council teams were unable to continue with business as usual and had to close or scale back their day-to-day duties. This freed-up colleagues to support the pandemic response including the Covid-19 Hotline. On the 2 April 2020, government began to share a list of residents who had been advised to shield with the Council at which point a proactive outbound call centre operation began. The call centre was initially organised by Children’s Services Business Support team. Colleagues from Adult Social Care, Libraries and Neighbourhood Services contributed by making outbound phone calls during the day, into the evening and over weekends until everyone shielding had been contacted. Customer Services also administered a new Covid-19 email service for people who preferred this mode of communication. Things were a little fraught initially, as the team used spreadsheets to monitor both outbound and inbound operations and ensure that residents’ needs were passed on to the right team for a response. But a new computer system was then set up to ensure that nothing was missed and residents received their food parcels and medication; were allocated priority supermarket online shopping slots; or put in contact with sources of support for a range of well-being issues. Over time, staff providing the Covid-19 Hotline and e-mail service, together with colleagues in partner agencies became a well-oiled machine. During the summer, Council services reopened and staff returned to their business as usual. The hotline function transferred to Customer Services who took on additional temporary staff to accommodate the extra work. Later on, NHST&T invited Councils to participate in Local Contact Tracing and this additional role was taken on by the Covid-19 Hotline service. This arrangement made it easy to put residents who needed to isolate in contact with local sources of support if needed. Demand on the hotline rose and fell in line with rates of infection. Things were particularly pressured at the end of 2020, at the peak of Wave 2 when the team was working seven days a week including the Christmas and New Year Bank Holidays – an example of the dedication and commitment the team demonstrated throughout the pandemic to support Havering residents. A level of commitment and enthusiasm further demonstrated by quotes from the team themselves. KF - Customer Services Team Manager “I was proud to be a part and manage the COVID team for Havering during the strangest of times. I was completely overwhelmed with the passion, care and effort that every person gave on a daily basis. We were mentally and physically drained at times but sheer dedication and supporting each other proved that we could be and were one of the best performing teams in London. I met colleagues who I have never worked with before and built some fantastic relationships which some in turn have evolved into friendships.” MO - Customer Services Training Officer ’Everything was set up and sorted overnight, a telephone inbound team, a telephone outbound team and an email box, with staff being moved from their ‘day’ jobs to assisting our residents. ‘There were some difficult times - the different variants, positive cases surging, help with food, medication, finance and befriending, the services being 7 days a week, 365 days of the year, but they were also some of the most rewarding times as well. ‘The people I have met internally and externally have been inspiring, nothing being too much and no step too far for them to assist a vulnerable resident, showing the very best of Havering, how we can pull together and what we can achieve and I am proud to have been just a very small part of that.’
Support provided to individuals and businesses The Havering Community and Voluntary Sector response The Community and Voluntary sector were an essential part of the support offer available to Havering residents during the pandemic. A Community and Voluntary sector (CAVs) Bronze Group was set up, chaired by Paul Rose, Chair of the Havering Compact to coordinate between the Council and the community and voluntary sector. Members of the CAVS bronze participated in a wider group open to the whole of the sector facilitating two way communication and requests for support. Three community organisations, Tapestry, Havering Mind and Havering Volunteer Centre (HVC) engaged volunteers across the borough and worked with the Havering foodbanks and the distribution hub to deliver the following activities:• Food for shielding residents • Food for those on benefits • Hot food deliveries to vulnerable residents • Prescription collection and delivery • Priority supermarket delivery slots for those on benefits and/or shielding • Approved volunteers doing ‘click and collect’ for residents • Access to a professional counselling service • Mental health support • Professional care calls • Befriending calls • Transport for the vulnerable to vaccination sites • Distribution of medical equipment to GP surgeries • Dog walking During 2020 a virtual online community hub was developed. All services available from the Voluntary and Community Sector (VCS) could be found on this hub. The HVC recruited volunteers for the vaccination centres, promoted by the virtual hub, which significantly increased their capacity. The response structures allowed good collaboration between statutory partners and the CAVs. The meetings also created opportunities for CAVs organisations to share staff and allow key services to be ramped up quickly when needed.
Support provided to individuals and businesses Distribution Hub • 67,400 food items delivered to residents (up to March 2021 – end of shielding) • 13,280 household items (soap, toothpaste, toilet rolls) to residents (up to March 2021) • 26,000 food items to charities, supported housing etc. (Christmas 2020) • 30,000 household items (i.e. soap, toilet rolls) to charities etc. (Christmas 2020) • 3.2M items of PPE delivered to schools, care homes etc. (2020-2022) “The call went out and we responded” was how one member of staff described our approach to the operations over the past two years to collect and distribute thousands of items of food and household products and millions of items of PPE to needy residents, care homes and schools (amongst others) during the pandemic. “I was helping to coordinate PPE and food to those who were vulnerable and struggling and I felt quite overwhelmed at first. But seeing the importance of the tasks and working together (especially when my wife made Indian samosas for the team) kept up morale.” The response involved staff from the Council, Everyone Active, who manage sports centres in the borough, and volunteers from across the borough. “Nothing can totally prepare you for the reality of a pandemic lasting over two years; we can be proud of not only how quickly and effectively we got our operations up and running but also how we continually improved them and responded to the changing conditions.” In March 2020, a central Distribution Hub was set up at Hornchurch Leisure Centre (which was partially then fully closed for lockdown) which provided storage and a base from which we organised the delivery of food parcels and Protective Personal Equipment (PPE) seven days a week. We were lucky that some Everyone Active colleagues had warehousing experience, which helped immensely in managing the stocks of food and PPE and getting them out for delivery to various locations. The Council’s Passenger Transport crews delivered the food and PPE packages to wherever they were needed. In total, the hub delivered 1,640 parcels and donated 32,000 items to food banks and charities, while giving about one million items of PPE to care homes and frontline services. Thomas Fletcher, contract manager for Everyone Active was awarded the British Empire Medal (BEM) in the New Year Honours 2022 for his contribution to the hub. Our stock handling and delivery operations were, at times, running day and night (including in the snow!), seven days a week. It was certainly a busy, tiring and emotional – but also rewarding – experience. And our PPE and food delivery drivers became some of the most popular people in the borough during the COVID pandemic as they brought welcome relief – sometimes in desperate circumstances – to those in need. The following compliments reflect the gratitude of local residents and partner agencies for the efforts of Tom and his team. “My social security payment didn’t come and I don’t know what I would have done with the babies. I’m so grateful to have this food. Thank you very much.” – Christmas Eve 2020 “The baliffs came two days ago and emptied my flat. I have nothing. It’s nice to see someone in person and I really appreciate you bringing me this.” – Winter 2020 “Thank you so much for providing us with an amazing amount of food for our Christmas food delivery programme” – Tapestry, Hornchurch “Our people were so incredibly grateful. Thank you so much for making this possible.” – Hope4Havering, Romford “What was so great about this is that there were essentials that residents use on a daily basis.” – L&Q, Havering “The food helped so much... These were people who either didn’t qualify for food bank items or couldn’t get to the foodbank outlets.” – Peabody, Romford
Support provided to individuals and businesses Helping local services access Personal Protective Equipment (PPE) The pandemic resulted in a massive increase in worldwide demand for PPE and disrupted supply chains across the globe. Care homes which, pre-pandemic, used PPE in small amounts were unable to get it from their usual suppliers. The Council worked to ensure that PPE was available by:• Directly procuring PPE for providers to cover shortfalls and increasing costs prior to the government introducing a centralised system. • Maintaining a centralised stock of PPE at the central Distribution Hub with systems to deliver outof-hours and over weekends to providers who were running low. • Risk assessment and redesign of essential Council roles that couldn’t be undertaken remotely, with input from Public Health and Health and Safety teams, minimised the need for PPE so that available stocks could be directed to health and care services. • Development of a PPE tracker and dashboard to monitor use of PPE across all Council departments to ensure it was available where needed but used nowhere else. • At the very start of the pandemic, when supplies were most difficult, an appeal was made to local businesses for any unused PPE that could be used by health and social care. • Distributing items of PPE made by local schools and colleges. Care homes needed masks, gloves, aprons, visors, hand sanitisers and wet-wipes. All were in short supply at the start of the pandemic. In the initial weeks our procurement team worked to understand what was needed and then procure as much of it as possible on international markets, whilst trying to keep down the soaring prices. After sometime, we were able to join together with other boroughs and obtain some PPE stock via the London Resilience Forum which, alongside the private sector suppliers, allowed us to meet priority needs. This interim (but expensive) arrangement continued until November 2020 when the government put in place an effective national supply system which provided free PPE to local authorities for onward distribution.
Stocks of PPE in distribution hub
Support provided to individuals and businesses Support for businesses Good employment is essential to good health. In Havering, small and medium-sized businesses provide jobs for a sizeable proportion of the working population. The pandemic threatened the financial viability of businesses and supporting employers was a priority for the Council. The local authority had a number of new expectations placed on it because of the pandemic including the payment of grants to small businesses. Government chose to use the business rating system as the main means of supporting small businesses financially. The Council’s business rates team allocated mandatory grants totalling £50m. However, many businesses were ineligible e.g. businesses in shared accommodation that did not directly pay business rates or businesses registered in one borough but trading in multiple locations. So government also provided limited discretionary funds to councils to be allocated according to local need. There was an expectation that assistance would be made available quickly. In the absence of a pre-existing team to allocate the monies, the inclusive growth team took the lead ultimately distributing £9.8m of discretionary assistance across 4,000 payments. Throughout the pandemic, local businesses were supported to adopt covid-safe methods of trading to limit the risk of transmission. Despite the challenges, Havering businesses managed to sustain relatively high footfall levels in our high streets and local centres. Whereas some boroughs saw retail footfall decline by 80%, some parts of Havering saw these levels depressed by only 30% - footfall is a way of measuring the number of shoppers on the street and is a good expression of confidence in the measures in place for safe trading. Information was key to local businesses. Early in the pandemic, the Council established a telephone hotline support service to assist businesses to access support. Over the 15 months from April 2020 to June 2021, the hotline took nearly 10,000 inbound calls. The Council’s Business Briefing eNewsletter, which ordinarily would be published monthly, saw three editions some weeks. The Council made the promise – as it always has – that every edition would contain at least one ‘must-read’ feature and at a time when the availability of a grant was of key importance, each new issue was met with considerable enthusiasm. Local businesses have shown enormous resilience and innovation during the pandemic as the following case study demonstrates. The Council was approached by local business Quantum Group. Pre-pandemic they maintained bar cellar refrigeration equipment in hospitality venues that had closed. Quantum came under pressure that could easily have forced the company to collapse. With the support of the Council, Quantum pivoted its business to address new markets in air source heat recovery – the latest high efficiency residential heating systems at a time of rising energy costs and the need to lower carbon emissions. Two years later, Quantum had gone from being a business that was challenged to one with the opportunity for exceptional growth. It is now leading the field in training new starters in this technology and has already recovered all of the employees lost during the pandemic. It fully expects to be emerging much stronger than could ever have been forecast. The Council is proud of the way its staff responded to the economic threat posed by the pandemic and collaborated with local businesses to create new opportunities.
Support provided to individuals and businesses Financial support given to individuals and families The response to the pandemic had profound economical effect. Central government put in place a variety of different mechanisms to support people financially during the pandemic e.g. the furlough scheme. Government also provided local authorities with additional monies so that they could act as a further safety net:• At the start of the pandemic, Havering Council expanded the team processing housing benefit and council tax support to expedite an increase in claims. • The Council used £1.8m to give all residents in receipt of council tax support a discount of £150 on bills, benefitting 8,000 households in the borough. • The Council Tax Hardship Fund provided council tax relief to 10,672 working age residents at a cost of £1.6 million. • Discretionary Housing Payments (DHPs) assisted Havering tenants on low incomes with their rent payments. The payment was made on top of Housing Benefit and Universal Credit to assist tenants in exceptional financial need with their housing costs. Almost 1,000 awards were made over two years totalling £1.4m. • The Council also used monies provided by central government to provide £15 per week for each child getting free school meals during school holidays. The pre-existing Havering Emergency Assistance Scheme helps vulnerable and low income households and individuals in situations of emergency financial need. The scheme provides eligible residents with up to £100 a time in cash, as well as food vouchers and help purchasing other essentials including white goods. At the start of the pandemic, the Council committed an additional £2m from its emergency reserves to the scheme in anticipation of an increase in the number of residents in need of support. Councils also administered the national Test & Trace Support Payment Scheme (TTSP). From 28 September 2020 to 30 March 2022, the TTSP Scheme supported people on low incomes who were required to self-isolate providing £500 per self-isolation period. The London Borough of Havering worked with the Disablement Association of Barking & Dagenham (DABD(UK) to deliver the TTSP Scheme, focusing on the principle of encouraging, educating and supporting residents during this exceptionally challenging time. Two thousand Havering residents received payments totalling over £1million.
Covid communications summary It is always important to keep residents informed, engaged and in touch with their Council and community through good communications. But no one could have imagined just how crucial the role of communications would become in the Council’s response to the COVID-19 pandemic. It’s impossible to list all of the communications activity and campaigns used during the pandemic period – there are just too many to mention here. Instead, this article hopes to highlight some of the key methods and campaigns we used to keep residents informed and safe. Ordinarily, the Council used a number of tried and tested channels to keep residents updated. These included the quarterly Living in Havering magazine, the weekly Living residents’ newsletter, social media and advertising – such as on street boards and radio adverts.
Outbreak When the pandemic first hit and we were plunged into lockdown – our tactics had to change immediately. The communications team moved from a physical base at the Town Hall in Romford to remote working from home. This in itself was a huge step in how the team works – keeping in touch with each other, while also keeping up-to-date with the fast-paced changes that were happening. Another key change was that the print magazine was scrapped – it couldn’t be produced quickly enough to keep up with the pace that information was being released and also because of the fear of Covid spreading. Physical copies became obsolete for the time being. Instead, we increased the Living in Havering email newsletter from once a week to go out more regularly, as and when needed. We saw the appetite for information increase with the number of readers steadily increasing from around 56,000before the pandemic to more than 60,000, which is the current readership. At the height of the pandemic this meant seven days a week – as we responded to fast changing situations and last minute changes to Council services. Extra money from government meant we were able to bring in extra staff and devise new and more carefully planned out methods to help us reach the public and ensure they had the information they needed. We produced the “Good to Know” leaflet which went to all residents in the borough to to let them know what was happening and the help and support that was available to them. A few weeks into the pandemic and the scale of the challenge dawned. It became clear the Council would not be able to provide an effective response alone. We needed the help of our local voluntary and community and faith groups, but most importantly residents. This brought about our first campaign of the pandemic – #HaveringHeroes. The campaign called on volunteers to come forward to help the most vulnerable residents by delivering food, medicines and welfare checks. The response was phenomenal and at one point we even ran out of volunteer roles. The campaign also later saw local businesses pledging masks and gloves to help our frontline care workers. Havering Heroes captured and capitalised the overwhelming sense of community spirit early on in the pandemic. And this spirit would go on to define our borough’s journey through the crisis. Initially, Havering’s communications team used national and regional messaging and images supplied by the government in accordance with their guidance. However, after a few months – we realised this simply wasn’t going to be enough to influence positive changes in behaviour in our local communities. We needed something more relevant to Havering – we needed something based on our local knowledge and data; we needed something much more targeted. From that need, the # DoingMyBit campaign was born. We worked closely with our teams to keep local businesses up-to-date on available grants so they could continue to operate. This included promotion of local businesses, helping them to trade safely and shoppers to remain safe while out and about. The promotion of free parking using the Council’s media channels was also another area we promoted.
Covid communications summary #DoingMyBit #DoingMyBit was developed using the latest local Covid statistics (cases, testing numbers etc.) along with our local knowledge of the borough’s social, ethnic and economic make-up. It was designed to reflect the moving picture of the pandemic and create new partnerships with other local organisations. It was launched on Monday, 24 August 2020 across all media channels - print, digital, broadcast and word of mouth - with an aim to engage as many residents as possible in preventative messaging around COVID-19, with a special focus on targeting hard-to-reach and vulnerable communities. The campaign featured real people from in and around the borough who volunteered their time to help stop the spread of COVID-19. They included images of Romford Market traders and customers wearing masks, young residents maintaining social distancing in public spaces and libraries and residents from Havering’s Black Asian and Minority Ethnic (BAME) communities observing religious events such as Eid in accordance to the then government’s “rule of six”- no gatherings of more than six people. Key materials were developed in the Top 10 languages in Havering and shared on social media to target the specific groups, as well as paid-for advertising. We also advertised on large, roving ad vans which were regularly scheduled to drive around the borough’s most diverse and less affluent wards. We looked for new ways to reach our most vulnerable and hard-to-reach communities such as BAME residents, Eastern European groups, residents with disabilities and individuals with high levels of consumer debt. We were able to contact them through frontline Council teams, along with the voluntary, faith and community sector and local businesses. We also worked with an agency to produce targeted digital advertising around the #DoingMyBit campaign to help us reach BAME and younger demographics. This included social media games, the use of influencers and targeting key places such as shopping centres and festivals. This was to do two things. One, to see if younger people understood what they needed to do to keep safe, like wear masks, etc. For the BAME community it was to encourage vaccination by directing them to information and influencers in their language and from their community. Alongside this, we developed a #DoingMyBit toolkit for voluntary, community and faith groups, along with local businesses, to share with their audiences. The campaign resulted in Havering having the best Covid-19 testing rates and at one point the lowest number of cases in London. The campaign went on to win multiple communication industry awards and shaped the Council’s ethos for the remainder of the pandemic. The new and effective tactics deployed would also go on to be used in our Better Days Ahead campaign to support the roll-out of the Covid-19 vaccination.
Vaccination Communications As with earlier Covid messaging – when it came to vaccinations – our efforts had to be focused on the harder to reach audiences. This once again included the older and digitally isolated, the less well off, and some ethnic and minority communities. But our biggest challenge was reaching teenagers and younger people. We originally had plans to host a Zoom meeting for young people, but realised the likelihood of them attending a Council-run Zoom was low. But with the age group for the vaccine rapidly falling, we had to think about how we could reach them and reach them quickly. We eventually decided to host a series of events running over a number of weekends where young people could get their jab while being entertained or take part in some form of activity. We worked with an organisation called Youth Unity, who carried out street interviews to get young people’s thoughts on the Covid jab. This provided us with social media content but also informed us of the best ways to encourage young people to get jabbed. This included using celebrity influencers and a Youth Council member who showed us her trip to get the vaccine through an Instagram story. We also ran special pop-up vaccination clinics with our NHS partners to make it as easy as possible for young people to get vaccinated. The campaign’s tactics resulted in more young people coming forward for their jab and overall helped Havering to have one of the best vaccine uptake records in London.
Covid communications summary One of the key issues was encouraging staff in the care sector and social workers to get their jabs to protect themselves and others. We worked with services to offer information and vaccination sessions at Havering Town Hall. We created graphics for a series of pop up vaccination centres across the borough to appeal to residents to consider getting the jab. When we carried out a survey, social media was the biggest source of information.
Internal Communications It’s important not to forget our own staff. More than 60% live in the borough and they needed to be kept informed so they could be supported but also so they could respond to residents when out and about in the community, at home and at the school gates. We used our electronic internal newsletter to tell them about the local situation and where they could get help, jabs and how to keep themselves safe. Additional messaging from the Chief Executive also helped to keep up staff morale.
Legacy While the worst of the pandemic seems to be behind us – Covid remains a public health risk to our communities and has left a painful legacy for our borough. One year on from the first lockdown we published our Covid Memorial Book to mark the occasion. This captured both the scale of loss but also the incredible amount of good will seen throughout this unprecedented time. The Council has also since opened the new Covid-19 Memorial Woodland in Hornchurch Memorial Park. It is designed to be a place of remembrance and reflection with a tree planted for every life lost to Covid-19 in Havering. During the first two years of the pandemic - like many teams – the communications team was pushed to its limit. We had to adapt, learn on the spot and embrace new ways of working to perform effectively for the Council and residents. It was of course a challenging time – but one which brought about a new level of creativity and passion. Our enhanced skills and tactics are now proving effective in other Council communications. Most recently, our hugely successful fostering recruitment campaign and our response to the tragic Wennington fires. Our experience through the Covid pandemic means we are now better able to respond to the needs of residents than ever before.
Vaccinating the population Vaccinating Havering - care home residents and staff Protecting both staff and residents in care homes was a priority from the start of the vaccination programme. Within the first couple of weeks, teams of vaccinators were visiting care homes and staff were given priority at the vaccination hubs across Havering. Care home managers were required to report on progress to the DHSC. Take up amongst residents was more or less universal and the great majority of staff were also vaccinated. However, Government remained concerned that unvaccinated staff might be more likely to introduce the infection into care homes from the community at a time when visiting was suspended to prevent this. On 22 June 2021, regulations were laid in Parliament to make vaccination a condition of deployment (VCOD) so that by 11 November 2021 anyone working in a care home, including staff who visited care homes, had to be fully vaccinated. The priority was then to assist the undecided to reach an informed decision – ideally to be vaccinated before the deadline set by government. Thereby protecting residents and minimising the potential loss of social care staff who were already in short supply. The Council and NHS partners worked with care homes, providers of domiciliary care and the Council’s own adult social care workforce to minimise the impact of VCOD by providing a range of advice, guidance and direct support including: • Support to care providers to ensure vaccine uptake was reported accurately on Capacity Tracker. • The Director for Adult Social Care personally contacted all care homes shown to be struggling to understand staff concerns and encourage them to be vaccinated. • A dedicated seminar was arranged to provide advice and information to social care staff with concerns about pregnancy and fertility issues. • One-to-one advice from a GP or Public Health specialist was arranged for colleagues who wanted it. • Priority vaccine slots were arranged for care staff at existing vaccination hubs. • Roving vaccination teams visited care homes and locations convenient for homecare providers. In March 2022, government withdrew VCOD for care home staff and proposals for it to apply to frontline NHS staff when it became clear that the massive Omicron wave had caused fewer cases of serious illness and deaths than feared. government concluded that vulnerable people were themselves now adequately protected by vaccination and the additional safeguard of insisting that everyone involved in their care was also vaccinated was not required. Notwithstanding any ethical considerations, hopefully, the pros and cons of VCOD in terms of protecting care home residents will be subject to review. A small number of staff left employment rather than be vaccinated and it would be understandable if some care staff who accepted vaccination to meet the deadline feel less minded to do so again.
Vaccinating the population Vaccinating Havering - Phase 1 The Pfizer/BioNTech vaccine was approved for use in the UK by the Medicines and Healthcare products Regulatory Agency (MHRA) on 2 December 2020. In the following two years, Havering residents received more than half a million doses of Covid-19 vaccine. This is a huge achievement on the part of the NHS locally, involving GP-led Primary Care Networks; BHRUT and NELFT (the NHS Trusts providing services to the borough) and local community pharmacists; all supported by the Council, community and voluntary sector partners and hundreds of individual volunteers. The Havering Covid-19 Vaccination programme started with the first injection delivered at Queen’s Hospital Hub on the 15 December 2020. As directed by the Joint Committee on Vaccination and Immunisation (JCVI), the immediate priority groups were health and care professionals with the aim of protecting the NHS and the patients that use it. The following day vaccination of our oldest and therefore most vulnerable residents began at two new local vaccination sites (LVS) set up by GP-led Primary Care Networks at Raphael House in Romford and Hornchurch Library. Between Christmas Day and New Year’s Eve, teams of vaccinators went out to residents living in care homes in the borough. The speed of the local response was even more remarkable given the particular challenges entailed in storing, thawing and moving the Pfizer/BioNTech vaccine. Subsequently, as the AstraZeneca vaccine was approved and supplies became available, housebound residents were vaccinated, a monumental task given the demography and size of the borough. Vaccinations were given by a variety of local health care professionals including GPs, practice and community nurses and pharmacists with the assistance of a large volunteer workforce and a number of military personnel. On 1 March 2021, NELFT opened a Mass Vaccination Site (MVS) at The Liberty in Romford as the offer of vaccination was extended to the remainder of the adult population in order of descending age (and risk of severe illness).
Vaccinating the population Vaccinating Havering - Phase 2 Overall uptake of vaccination in Havering was high amongst the nine priority groups identified by the JCVI for phase 1 of the vaccination programme i.e. everyone aged 50 and above or with an underlying health condition that put them at higher risk of serious illness. However, uptake varied between population groups and communities, with lower uptake amongst more disadvantaged and non-white British communities. These differences became clearer as the offer of vaccination was made to progressively younger age groups. By the early summer of 2021, a significant number of younger adults had still to be double vaccinated, concern was growing about an increasing number of cases of the Delta variant and government was keen to complete the phased relaxation of non—pharmaceutical interventions (NPIs) after the third national lockdown. It was against this background that NHS partners and the Council collaborated in a further effort to increase the proportion of residents who were fully protected. During the pandemic, government put in place temporary legislation allowing the sharing of information e.g. between the NHS and councils, to facilitate the response to the pandemic. As a result, public health analysts within the Council were able to identify communities within the borough with lower uptake. We collaborated with these communities to design messages and campaigns to prompt residents to reconsider the value of vaccination. Vaccination was then promoted using digital signs, street advertising boards and vans, as well as the more familiar promotion through e-newsletters and targeted leaflet drops. In addition, Vaccination Ambassador training was provided to staff and community leads to empower them to address vaccine hesitancy with colleagues, friends and family and to signpost them to trustworthy and factual information. Making use of the good offices of trusted partners such as faith groups, webinars allowed residents to discuss their concerns with relevant public health and clinical specialists e.g. enabling women to discuss concerns about pregnancy and fertility so that they could make an informed decision about vaccination. Colleagues elsewhere in the Council looked for sites within these communities that could host a pop-up vaccination clinic, ideally somewhere that was easy to find and with a high footfall. In addition to using Council libraries, we were grateful for the support of a number of different partners, including supermarkets, colleges and places of worship who made space available. The Council converted one of its buses to provide a mobile base for staff providing pop-up clinics. Having found a location and agreed a time that NHS colleagues could run a clinic, we promoted it, making use of social media to ensure residents in priority areas and from communities with lower uptake were aware. The ability to share information between the NHS and Council also allowed the Council to create a call centre in June 2021, run by redeployed staff and volunteers from Havering Volunteer Centre, with access to health professionals, to contact residents who were un-or-partially vaccinated giving them an opportunity to talk to a clinician if they were still undecided. This collaborative approach underpinned each subsequent development of the vaccination programme including:• The autumn 2021 booster eventually offered to all adults over a shorter period than initially intended in response to the Omicron variant. • The spring 2022 booster offered to care home residents, people aged 75 and over and those who are immunosuppressed • The autumn 2022 booster offered to people aged 50 years and older, residents in care homes, those aged 5 years and over in a clinical risk group and health and social care staff. What was notable, and perhaps most important for the future, was the contribution of the Havering volunteers who worked across all settings, come rain or shine, forming a perfect partnership with health and social care professionals. This type of cooperation between statutory agencies and the community and voluntary sector would provide the foundation for a burgeoning Place-Based Partnership and bring the benefits of collaboration to other aspects of health and care.
Vaccinating the population Vaccination of children and young people On 21 July 2021, vaccination was offered to young people aged 12 – 17 with pre-existing health conditions. The Primary Care Network (GP led) clinic at Raphael House, Romford, was one of the first to offer vaccination to vulnerable youngsters. On 4 August all young people aged 16-17 were included. On 13 September 2021, the offer of vaccination was extended to all children aged 12-15 mainly to reduce disruption to education. The Government decided on a school based approach. The programme in NEL was led by East London Foundation Trust (ELFT) and Vaccination UK (the latter being the usual provider of school-based vaccinations but that lacked the capacity to undertake vaccination in all schools in a short period). In October 2021, two secondary schools in Havering agreed to trial how ‘in school’ vaccination would work. Thereafter the programme was rolled out. A second dose was offered to 12-15 year olds on 30 November 2021. A variety of models were employed including a repeat of the in-school offer for pupils only; an in-school offer for pupils and family members who had not yet received one or more doses of the vaccine; and the option to attend a local mass vaccination site including The Liberty - making it easier for parents to be present. Lastly, in the spring of 2022, vaccination was offered to children aged 5-11 as a one-off exercise. The vaccination of younger children was described as ‘non-urgent’ and delivery should not disrupt the provision of other childhood immunisations. It was provided at GP-run local vaccination sites rather than primary schools. The Council’s Childcare Bronze group, responsible for actioning Council decisions, and COVID response team, were instrumental in liaising between the vaccination provider and schools, assisting with the scheduling of clinics and providing communications for head teachers and letters to parents, explaining the value of vaccination. Despite a great deal of effort, uptake was at best modest. In addition, schools were targeted by a small but well organised anti-vax lobby. Nonetheless, the partnership of schools, the Council and NHS ensured that parents had reliable information regarding the benefits of vaccination so that they could make an informed decision as to whether their child should be vaccinated and provided the opportunity for this to happen with minimum disruption to their education.
Protecting the NHS and Social Care Social care during the pandemic Throughout the pandemic, social care providers were required to implement rapidly changing guidance issued by the Department of Health and Social Care (DHSC) and Public Health England (PHE) to protect the NHS and the recipients of care. Councils, particularly Adult Social Care Services, engaged with providers throughout the pandemic to resolve problems, reporting back to the government on progress and issues of concern while continuing to deliver relevant ‘business as usual’ functions e.g. safeguarding. The pandemic posed particular challenges for social care providers which are reflected in the contributions of the Havering Care Association (representing all care providers in the borough) and the individual nursing and residential homes that agreed to contribute to this report. A central aim of social care is to provide residents with a safe, loving home. Effective infection prevention and control (IPC) is difficult in health care settings, but still harder in premises designed to be a long-term home and where many residents have dementia and don’t understand what social distancing is or why they need to do it. IPC has always been an integral part of care home ‘business as usual’. However, the measures required during the pandemic were way beyond what a care home would previously have been expected to adopt. The Council provided workshops at the start of the pandemic and supported with advice but ultimately care providers in the borough had to ensure that their whole workforce was trained and retrained as the guidance repeatedly changed over the course of the pandemic. Providers who pre-pandemic had used easily available Personal Protective Equipment (PPE) in small amounts had to get the PPE specified in the guidance in far greater volumes. Wave 1 of the pandemic disrupted global supply chains and it was difficult and very costly to get any PPE. There was widespread dissatisfaction about PPE preparedness nationally from NHS professionals, which is echoed by local care homes in this report. Pre-pandemic, a handful of outbreaks were reported each year by care homes in Havering. Most homes would not experience an outbreak from one year to the next. When an outbreak did occur, the care home could rely on direct support from the local specialist health protection team (part of PHE at the start of the pandemic, now incorporated into the UK Health Security Agency (UKHSA)). During the pandemic, most homes experienced an outbreak at some point, some several. Local health protection teams were unable to support the dozens of care homes reporting an outbreak each day. As a result, care homes primary source of advice during an outbreak became the Council’s own Public Health team. From the start of the pandemic, there was huge concern about the safety of care home residents due to their high risk of severe illness and the highly infectious nature of SARs-CoV-2. None of the care homes in Havering experienced a huge outbreak causing a very large number of deaths in a short period, as was the experience in some other areas. However, despite our collective best efforts, local care homes did experience the death of residents with Covid-19, with larger homes and those providing ‘designated beds’ (a self-contained unit in which patients testing positive for Covid could be discharged from hospital to, to isolate before moving on to their own care home) experiencing the greatest number. Each death was a personal tragedy for the family concerned also affecting staff who may have known and cared for that resident for many months if not years previously. The decision taken at the start of the first wave to discharge patients from hospital who were medically fit, including into care homes, without prior testing or expectation of isolation has been the subject of considerable criticism and a partly successful legal challenge. An expert review has concluded that Covid-19 was most often introduced unwittingly into care homes by staff and visiting health professionals. Nonetheless, it is likely that some outbreaks were caused by hospital discharges. The fear that outbreaks would result in significant numbers of deaths remained until the summer of 2021 by when it was clear that vaccination of residents greatly reduced their risk of serious illness and vaccination of staff reduced the likelihood that infection would be introduced. Care home management and staff cooperated fully in the vaccination effort which was instrumental in protecting the vulnerable and avoiding the need for the continuation of intrusive and painful social distancing measures.
Protecting the NHS and Social Care As the pandemic continued into a second year, and with the huge majority of residents benefitting from vaccination, concern increasingly focused on whether social distancing and the ban on indoor visiting were doing more harm than good in terms of the general wellbeing and mental health of residents. Care homes demonstrated enormous ingenuity in keeping residents in touch with families and friends, first by telephone, Zoom and window visits and then by offering visiting opportunities outside in purpose-built structures. Always seeking to comply with the national guidance; responding to advice from the Director of Public Health (DPH) about levels of infection locally and in many cases having had direct experience of residents dying with Covid-19, care homes must have felt that they had been placed in an impossible position. Nonetheless, their efforts to strike a balance between safety and maintaining relationships were appreciated by the majority of family and friends of residents. Social care is largely provided by private or charitable organisations, funded by the individual resident or the Council depending on the outcome of means testing. Some providers are part of large national organisations that may be able to provide assistance with workforce shortages or be more resilient to short-term financial problems. But most are local providers reliant on the capacity and capability of a relatively small team. Irrespective of ownership and size, many social care providers struggle financially at the best of times. As the pandemic hit, fewer people chose to live in a care home. As time progressed, occupation levels and income to care homes fell whereas their costs increased, increasing the risk of financial failure. This risk was recognised by the government who made additional money available during the pandemic, to be distributed by councils. However, putting social care on a financially sustainable footing for the long-term, from the perspective of both individual residents and local government remains a challenge that a succession of UK governments have failed to address. The other perennial problem facing social care is workforce shortages. Relatively low pay results in few new entrants being attracted into the social care workforce, leaving providers with vacancies and reliant on more expensive agency staff. Conversely, many staff rely on agency work to top up their wages. Absence rates were abnormally high during the pandemic. To make things more difficult, agency staff were prohibited from working at multiple sites to reduce the spread of infection between homes. The council did all it could to assist care homes providers to maintain safe staff levels but the pressure on staff was incredibly intense for very long periods of time. In addition to excessive workloads, health and social care staff collectively faced many of the same challenges during the pandemic including:• responsibility for the safety of the most vulnerable residents/patients • to this end, having to enforce social distancing and shielding requirements that were at odds with usual practice e.g. the complete prohibition on visiting • the requirement to keep up with constantly changing guidance • anxiety and fear for self and family - like health care workers, social care staff suffered a higher rate of mortality from Covid-19 than the average • initial shortages of Personal Protective Equipment (PPE) and then the need to wear uncomfortable PPE for long periods that made it more difficult to communicate with colleagues and clients • the requirement to test regularly before starting work Colleagues in social care also faced some issues that were uniquely their own: • enforcing social distancing and shielding responsibilities in a home rather than clinical environment • unprecedented scrutiny from regulators, the media and families firstly about outbreaks and associated deaths and later about visiting policy • the legal obligation put on staff working in care homes, later rescinded, to be fully vaccinated
Protecting the NHS and Social Care The mantra ‘protect the NHS’ was simple and readily conveyed the need for action on the part of UK residents. However, it also unwittingly suggested that the health care was more important than social care rather than being equally valuable parts of the same system. Havering Council sought to support social care as best we could through the pandemic, led by our Director of Adult Services - a fact that care providers have recognised in their contribution to this report. The UK Covid-19 Inquiry is tasked with providing clarity as to what could have been done better during the pandemic and thereby improve preparedness for the future. It seems certain that aspects of the pandemic response as it affected social care will be considered including PPE stocks and availability to social care; discharge of residents from hospital into care homes and the balance of benefit and harms resulting from the suspension of visiting. In the meantime, there is learning we can apply now. As we emerge from the pandemic, there are almost daily reports that demonstrate that social care is an essential part of the health and care system without which the NHS cannot work effectively. With this in mind, it is encouraging that representatives of local care home and domiciliary care providers are now members of the Havering Borough Place Based Partnership (HBPBP) where they can help shape local health and care services to the benefit of local residents. The HBPBP must plan for a high quality, financially viable social care sector and any workforce strategy must include the social care workforce. Of more immediate operational benefit, NHS partners are continually looking for opportunities to improve the discharge of medically fit patients back into the community to reduce pressure on A&E. These plans should include ongoing training and direct access to IPC advice for social care providers to minimise the chances that they have to close to admissions as a result of outbreaks of infectious disease.
Protecting the NHS and Social Care Care provider engagement, support and development The Council communicated proactively with all care providers in Havering (and beyond where Havering residents are cared for out of borough) so that they had the information they needed to care for residents during the pandemic and were able to share their concerns seven days a week: • There were regular conference calls for social care providers with the Director of Adult Social Care from the point the first Covid-19 cases were reported in the UK. • Weekly calls were held between the Havering Care Association, representing the interests of care providers in the borough, the Director of Adult Social Care and the commissioning team. The Havering Care Association and the Council developed a strong relationship during the pandemic; working together to find solutions to difficult problems, providing mutual support to keep residents safe and receiving good-quality care. Building on this success, the Havering Care Association became the Care Providers Voice (CPV) representing providers across Havering, Barking & Dagenham and Redbridge. CPV are now expanding their reach to represent providers across North East London. • The Provider Emergency Control Centre (PECC) was set up to respond immediately to concerns and uncertainty e.g. when provider staff had to deal with Covid positive residents for the first time. • Frequently asked questions based on queries received were published online and updated regularly. • Text messaging was introduced to relay messages to personal assistants (PAs) working independently in the community. • Timely advice and guidance was proactively provided on all aspects of the response beginning with IPC and use of PPE, and including testing and vaccination consistent with guidance from the government and Public Health England. • The Council’s Quality Team maintained their existing relationship with providers usually based on regular visits by offering daily support calls. • Public Health colleagues worked with the quality team to: • r esolve provider queries and concerns e.g. regarding isolation periods for individual residents; the appropriate response to outbreaks and how to implement guidance about routine and outbreak testing regimes (with PCR and later LFD tests). • l og every positive case in a care home so that active outbreaks could be identified and managed and there was clarity about which homes were closed to further admissions •U pdate Standard Operating Procedures (SOPs) so the whole system operated in line with constantly evolving national guidance • One way or another, support was available from the Council seven days a week including bank holidays. The Council worked with partners to ensure the wider health and care system continued to function as best it could through the pandemic. • Contingency planning for care homes included exploring mutual aid and personal assistants providing support in care homes to maintain staffing at safe levels. • New services were commissioned to support the discharge of Covid-19 positive patients including step down beds in sheltered accommodation, designated beds in residential and nursing care homes and a dedicated homecare service for people who were discharged to their home. • The Council’s Public Health team, with the support of the Quality Outcomes team, provided advice and guidance to managing outbreaks and worked with other stakeholders such as the Infection Protection Control team and Public Protection to support providers to contain the outbreak, cohort infected cases within self-contained units and wherever safe, continue to remain open to admissions. • The Adult Placement team was expanded to provide a detailed real time understanding about the status and availability of all care homes and PAs in the borough.
Protecting the NHS and Social Care Care provider engagement, support and development • Mental health support was developed in partnership with Havering Care Association and Public Health to support the care workforce. • The Proud to Care initiative launched to promote employment opportunities in adult social care and increase providers’ staff capacity In addition, the Council supported the financial stability of the local care market by:• Making two rounds of additional payments to care home providers in the initial phase of the crisis • Making advance payments when providers were at risk • Providing payments to daycare providers to maintain their financial viability while they were closed and enable the redeployment of staff elsewhere in the system.
Protecting the NHS and Social Care Havering Care Association Havering Care Association (HCA) existed for many years prior to the pandemic to represent the interests of older peoples care homes, 80% of which were members. When the pandemic began, the HCA introduced fortnightly virtual meetings to update all providers on changes of guidance, how to access and use PPE, other IPC requirements and best practice. They also provided a chance to discuss how government payments were able to meet the additional costs incurred during the pandemic could be accessed and spent. The HCA met each Saturday with the Director of Adult Social Services and her team, to update on providers latest position, challenges and potential joint solutions. This led to some great work with the Council around the purchasing of PPE, mutual aid and the development of a wellbeing offer for staff. Cooperation regarding PPE was particularly reassuring as providers were often no more than 24 hours away from running out at the start of the pandemic when prices rose 1500% and stock was almost impossible to come by. Cooperation developed further as the pandemic continued:• Havering Care Association came together with Feebris, NHSX and Havering Health to offer twenty providers access to remote monitoring. An approach which has now been rolled out nationally. • The HCA worked closely with NEL CCG (North East London Clinical Commissioning Group), Havering Council and providers to ensure homes and domiciliary care providers were supported in encouraging staff to take up vaccinations. This led to many providers achieving 90% take up before the government chose to mandate vaccination for care home staff (later rescinded). • The mandation of vaccination, although short lived, caused some staff to leave and made existing staff shortages worse still. The Council and Havering Care Association have undertaken a recruitment campaign supported by Purpletribe – a recruitment agency specialising in social care. Whilst the relationship with the Council was strong throughout the pandemic, the relationship with the NHS was more variable. • The provision of poor or inaccurate information about patient discharges eroded trust with the hospital and on occasion care homes felt railroaded into accepting residents who had tested positive before they had appropriate plans in place. • Conversely, NEL CCG provided technology to enable families to stay in touch with residents. • NEL CCG also made the case that domiciliary care providers should be put on a more equal footing with care homes e.g. so that all providers could get urgent advice from a senior clinician by dialling NHS111 Star*6 when they had concerns about a resident and couldn’t contact their GP. Domiciliary care providers faced particular challenges around families’ non-compliance with the social distancing requirements, which sometimes resulted in verbal abuse. The biggest challenge to providers and the most upsetting was having to close our doors to families, friends and all those within the system that would visit and bring life to the home. It was a period of loneliness, isolation and fear. Providers worked together on solutions to increase access for residents and work with people right across the system on ways to bring loved ones into our homes in a way that minimised risk. Care Providers Voice was created as a mutual support network to tackle the isolation that many providers in North East London have experienced during the pandemic. It is open to all Care Quality Commission (CQC) registered providers across North East London and seeks to make the case for extra resources, support providers with recruitment and to ensure providers are represented within the system to ensure that our residents get the best outcome possible. We in Havering were particularly fortunate as providers were actively supported by the local authority which funded support with recruitment, gave access to training and has sought to build a strong relationship where we work on solutions together. None of this would have been possible without one of our biggest supporters and advocates, the Director for Adult Social Services (DASS) in Havering.
Protecting the NHS and Social Care Covid-19 and how the pandemic impacted our nursing home “When the pandemic started and everything came to a standstill with the first lockdown, many of our residents were overcome with fear and uncertainty. We stepped up in their time of need to be more supportive than ever before. What made it even more difficult was that our residents had to go from seeing their families every few days or in some cases every single day, to not being able to see them at all unless it was through a window, which was never the same experience. This brought a lot of loneliness to many of our residents, feelings of isolation and some were simply not able to grasp why these restrictions were put in place. It affected their mental health and that of the staff as the emotional strain was at times too great. Our staff did a fantastic job being the residents’ only support network for months. My job as a care assistant now meant far more than taking care of someone. It now meant being there for someone when nobody else could be. It meant being a shoulder to cry on for our residents in their time of need. It meant becoming closer and building connections like we had never done before. We would now see our residents as family. Although it was a challenging experience for everyone involved it also brought a lot of good into our lives. It showed how tough we can be. Although we couldn’t see our own relatives for months we had to step up and be the family to the residents when they couldn’t see theirs; couldn’t hold their hand and tell them that they loved them. We did all we could to fill their shoes. The bridges we had formed and connections we had made were something magical. The families’ gave us so much appreciation for the job we were doing, sending cards and bringing us gifts, it really made us all feel like super heroes and it is something which will always stick with me as it had such a positive impact. Working in a nursing home during the pandemic may have been one of the most challenging jobs I have ever experienced but I wouldn’t have changed it for the world. It made me realise this is the industry I want to work in. It helped me develop as a person and find my calling - which has now led to me to train to be a nurse, as I love my job so much I want to make it my career and I can’t wait.” Care Home Manager
Protecting the NHS and Social Care A Havering care home during the pandemic March 2020 marked the beginning of a unique time in history where we faced unprecedented challenges. There were many unknowns and fear amongst the general populous including our staff, residents and their families. We had very serious decisions to make e.g. when to lockdown and subsequently how to safely manage visiting. We felt quite isolated, unsupported and were desperately trying to make the right decisions to keep everyone safe. We took the decision to lockdown a week before the national lockdown which proved somewhat unpopular. Subsequently, there were many challenges including the lack of PPE as all resources were diverted to the NHS. We felt undervalued and very much the Cinderella of the services. We felt marginalised and unsupported particularly when we were reported to CQC for not wearing PPE which was unavailable. We also had to look at innovative ways to maintain contact between residents, families and professionals and become proficient at using virtual means of communication. Then came testing, ensuring all staff were trained on testing, frequency of testing, registration and reporting programmes which resulted in a huge amount of extra work. As guidance emerged, was continually refined and changing, we devised new procedures and trained staff to ensure safe visiting. As time progressed, and vaccines were developed, there were challenges associated with ensuring staff were vaccinated as there was a considerable amount of false information being circulated via social media and people were fearful. From November 2020 to March 2021, we were educating our staff ensuring they had all available information to make an informed decision. We had individual discussions, group meetings and supported staff throughout this period. However, by February 2021, having lost residents to COVID, we decided to issue new staff contracts to include mandatory COVID vaccines for all staff. This was a brave and challenging decision and indeed, most of our staff had the vaccine – only a handful decided against it and left the organisation. Looking back, I remember seeing staff exhausted, sweltering in full PPE and at times, tearful, putting their own lives at risk to protect and keep their residents safe. Care Home Manager
Testing and Tracing Development of test and trace policy over the pandemic Testing and contact tracing were a crucial part of the response to Covid-19. ‘Contain’ was the first stage in the government’s initial coronavirus action plan published at the start of March 2020. The aim being to detect cases entering the country, follow up their close contacts, and prevent the disease taking hold in this country for as long as was reasonably possible. However, both testing and contact tracing capacity was very small at the start of the pandemic. As soon as community transmission began to any extent, there were simply too many cases for PHE to cope with and contact tracing was quickly stopped. Likewise, only about 1000 people nationwide could be tested a day at the start of the pandemic and this capacity was focused on testing people already in the NHS often with serious illness. The huge majority of cases remained untested in the community. However, Government invested massively to expand both testing and contact tracing capacity brought together in a new service named ‘NHS Test and Trace’ (NHST&T) that launched at the end of May 2020. The early symptoms of Covid-19 are not very specific, so telling everyone with symptoms to isolate meant many people with coughs and colds, and their close contacts had to isolate unnecessarily. Testing allowed restrictions to be focused on those with Covid-19. Initially PCR testing was offered to people with symptoms through a network of ‘drive thru’ sites and mobile testing facilities. In time, permanent walk up testing sites were added before finally home testing kits were made available. The Council worked with the DHSC and NHST&T to provide testing as close to communities as possible. PCR tests are very specific and very sensitive. However, they are also relatively expensive and rely on a network of laboratories to process the tests resulting in delay and limiting overall capacity. A quicker and cheaper test was needed to test for the third of infected people who don’t develop symptoms at all. Lateral flow devices (LFDs) met this need. LFDs are less sensitive than a PCR test but don’t involve a laboratory and provide an answer within 30 minutes. Mass asymptomatic community testing with LFD tests was initially introduced in the early winter of 2020 in areas of the country with high infection rates including Havering. In the new year, government announced that regular community testing using lateral flow tests would be rolled out nationwide. Initially residents attended testing sites in the local community, run by local authorities rather than NHST&T, before home testing was introduced. Contact tracing went through a similar process of expansion and development. Tens of thousands of contact tracers were recruited by NHST&T; working to pre-prepared scripts and standard operating protocols (SOPS) under the supervision of health professionals transferred from PHE. Later on, the NHS Covid-19 App provided further capacity to collect information about close contacts and automatically inform them of the need to isolate. NHST&T received a lot of criticism over the pandemic e.g. for delays in processing tests and some people getting multiple calls when others got none at all.
Testing and Tracing Development of test and trace policy over the pandemic The overall effectiveness of the test and trace process is heavily dependent on public compliance but surveys suggested that not everyone with symptoms requested a test, and not everyone who tested positive or who was identified as a close contact, self-isolated in line with requirements. From the start, government was advised that it needed to do more than simply legally require to isolate. People needed: • Financial support: ensuring that those who had to self-isolate didn’t experience financial hardship. • Proactive outreach to identify and resolve any practical needs that people have e.g. access to food, care for elderly relatives. • Information explaining how and when to self-isolate, and why it helps, in addition to more detailed advice for those self-isolating. • Emotional support for those who struggled mentally with isolation. A huge amount of effort went into communications over the pandemic, supported by councils. After sometime, NHST&T invited local authorities to contribute to contact tracing in the hope that local teams might reduce the proportion of cases / contacts who were uncontactable and improve the offer of non-financial and emotional support during isolation. Havering Council responded to the request for assistance with our local contact tracing offer beginning in October 2020. The details of people who couldn’t be contacted quickly were shared by NHST&T for the council to follow up. Staff delivering the Covid hotline, handled the calls and the Outbreak Support Service visited residents who were uncontactable by phone. Our approach developed overtime to proactively support residents who were isolating and we subsequently collaborated with the UKHSA to evaluate the impact of our support offer. It is debatable whether the financial support offer was ever adequately resolved. Unlike furlough that provided people who could not work at all during the pandemic with 80% of their full wage; workers required to isolate due to infection or being a close contact received sick pay, with statutory sick pay less than £100 per week. It is not hard to see that repeated periods of isolation would be unwelcome for anyone who relied on receiving their wage, in full, to meet their day-today costs and thus dis-incentivised their participation in testing and sharing details of their close contacts.
Testing and Tracing Introduction of PCR testing in Havering From March to April 2020 there was very little testing outside of the NHS. Community PCR testing was initially introduced for people with symptoms via large regional drivethrough testing sites. The nearest to Havering were in Greenwich and Stansted. In May 2020, councils were asked if they wanted to host drive through mobile testing sites and Havering Council agreed to host one at the Town Hall in Romford every third day. In August 2020, councils were given the opportunity to request fixed testing sites for people arriving on foot. Havering Council asked for six sites spread evenly across the borough to minimise the distance residents had to travel to get tested. Four were approved, as many as in any other London borough. Once the locations, (Council-owned car parks), were approved by the Council’s Cabinet, the testing sites were built and operational in a few weeks, with Cherry Tree Lane Car Park in South Hornchurch and Central Park Leisure Centre in Harold Hill opening in September, Romford Town Hall in December 2020 and Dorrington Gardens car park in Hornchurch in January 2021. Initially, residents living near testing sites worried that people getting tested were a risk to them. Overtime, as more and more people needed to be tested, the sites came to be seen as an essential community asset until more convenient home testing options became available.
Case Study Central Park Leisure Centre Site The test site in Central Park Leisure Centre was one of the first walk through testing sites in London The manager of the adjacent myspace recalls: ‘The speed it went from a group meeting with lots of different agencies in a car park to a fully functional testing site was remarkable.’ All business, services and residents in the local area were apprehensive about the introduction of a testing site. Covid-19 was national news and there was no vaccine at this point to protect individuals. Despite this, the local community responded with a can-do attitude to make the best of the situation. The General Manager of Central Park Leisure Centre operated by Everyone Active commented: ‘Although we were heavily concerned for our customers, we knew it was the right thing at the time so we wanted to work together to accommodate the site and help keep people safe. ‘We came together with residents, businesses, the school, the Council, NHS T&T and site customers – everyone wanted to make it a success for the local area’. The Head teacher of a nearby school said: ‘I was concerned due to the national messages around coronavirus and the fact the entrance to the site was opposite the entrance to the school. We had introduced staggered start times so we had parents lining up with children opposite a testing site. ‘We helped to embed the site within the local area by doing role play exercises with the children which helped alleviate the fear of getting tested. We also shared positive messages about the benefits of the location to parents. Eventually parents came round to the idea of the testing site, with the location making it easier to get tested. ‘For me it helped sharpen the focus that schools aren’t just for education, they are part of the community and are part of a much bigger picture - working with our community to deliver what’s needed.’
Testing and Tracing Introduction of PCR testing in Havering In the early winter of 2020, as Wave 2 increased, driven by the more transmissible Kent (Alpha) variant, the four permanent PCR testing sites in the borough were more or less at full capacity. To meet demand, the Council requested three more mobile testing units bringing the total to seven between late December until the end of January.
Map of symptomatic testing sites in January 2021 From October 1 to 31 January 2021, nearly 80,000 tests were performed at Havering test sites.
Testing and Tracing Introduction of Lateral Flow Devices (LFD) for rapid community testing Lateral flow devices (LFD) are less sensitive than PCR tests but are cheaper and can provide an answer within 30 mins. LFDs provided a way of extending testing to the whole population to find the 30% of cases that are symptom free. Mass testing with LFDs was piloted in Liverpool with significant military support. In November 2020, government announced the extension of rapid community testing to 50 other local authorities including Havering as rates of infection rose steeply in the SE of England and NE London. Unlike previous testing activity that was managed by NHST&T, councils were expected to run these new testing facilities themselves, charging additional costs against the Coronavirus Outbreak Management Fund (COMF). Small teams of army personnel were available to provide advice rather than deliver testing as had been the case in the Liverpool pilot. NEL London was a particular priority as infection rates here increased rapidly after the country came out of the 2nd ‘circuit breaker’ lockdown and we had to make every effort to avoid London as a whole being moved from tier two into the tighter tier three restrictions. The Chief Executive of Havering Council led the response across NE London, supported by members of the Havering Public Health team. In the run up to Christmas, Council officers worked long days, 7 days per week, to get a range of testing projects up and running. Working with the DHSC, additional mobile PCR testing units were relocated into NE London from other parts of the country. With the Christmas holidays approaching, there was particular concern that long anticipated contact between households over the festive period would put older and more vulnerable people at particular risk. So all secondary school staff, students and families of children who did not have Covid-19 symptoms were asked to get a test over the second weekend of December, by either walking up to one of three mobile PCR testing sites or booking online. The following week, the three mobile testing sites were relocated to secondary schools across the borough in areas with the highest infection rates. Before schools broke up, PCR tests were also distributed to pupils and their families so that they could test over the holidays before returning to school in January. At the same time, rapid asymptomatic community testing was introduced. In Havering, libraries were repurposed as LFD testing centres based on the learning from the Liverpool pilot. This included moving books and shelves and installing testing booths; health and safety assessments of each step in the testing process to ensure robust infection prevention and control measures including use of appropriate PPE; arranging clinical waste disposal, security, extra cleaning, secure IT, and deployment of a new workforce of COVID Marshalls to ensure social distancing outside the venues. Within two weeks, in mid-December, the first rapid community testing site was opened in Elm Park library, initially prioritising residents who were caring for relatives or other loved ones. Over the following weeks, four more libraries were brought on-line making LFD testing widely available for the first time. Throughout this period, frequent communications were sent out to residents and staff to encourage testing and make them aware of the increasing testing options. On 14 December 2020, the government announced that a new more transmissible variant, first identified in Kent (which would later be named ‘Alpha’) was now spreading rapidly in parts of the country. On 19 December, all London boroughs were put under even higher tier four restrictions. As a result, mixing indoors with people from another household was not possible at Christmas after all. Nonetheless, many colleagues worked through the Christmas holidays to make sure that testing centres remained open. Likewise, teachers and volunteers arranged to collect thousands of tests taken by pupils and their families ahead of a planned return to school in January. Despite the best efforts of all involved, a third national lockdown would be introduced on 5 January 2021. Although this intense period of activity failed to avoid the need for a third lockdown in the face of the Alpha variant, it did see the creation of the teams and infrastructure that would allow residents to test regularly for the remainder of the pandemic such that by May 2021, there were 50 places in Havering where people could be tested or pick up tests to use at home.
Testing and Tracing Introduction of Lateral Flow Devices (LFD) for rapid community testing These included six easily accessible assisted testing sites (ATS) run by the Council’s outbreak response team including those at Romford and Rainham where residents could get help to test. Residents could also pick up home testing kits from any of the borough’s libraries and a large number of pharmacies. In addition, the outbreak response team regularly distributed tests from pop-ups in high footfall locations. A range of teams collaborated to make sure that Havering residents had good access to LFD testing: • The outbreak team operated the assisted testing sites. • The Estates Team fitted out sites to become testing centres. • SLM, the borough’s leisure centre operator, set up a storage and distribution hub to hold the supply of tests. • Library staff shifted books to make way for rapid testing centres and then moved them back when libraries reopened and continued to stock home tests for collection by residents. • The waste disposal team put in place arrangements to collect used LFD tests and clinical waste from testing sites. • COVID marshals were on hand to give advice and manage queues at busy periods. • The communications team kept local businesses and residents informed • A working group, led by the Public Health Team, coordinated the overall response to ensure there were testing centres in key locations across the borough.
Testing and Tracing The Outbreak Support Team As the pandemic progressed, and after government had invested huge sums in NHST&T, it recognised the benefit of local services, who knew the community they served. Over time, councils were invited to contribute to contact tracing; support the roll out of rapid community testing and improve compliance with isolation and the uptake of vaccination; charging additional costs incurred to the Contain Outbreak Management Fund (COMF). Contact tracing was taken on by staff supporting the Council’s existing COVID hotline in October 2020. The Council team contacting people who NHST&T were unable to reach, calling when they were most likely to be in and trying the number that the Council held if different to that provided by NHST&T. As more and more staff were able to return to their business as usual duties, Havering Council created a new Outbreak Support Team (OST) to take on additional tasks. The team was largely made up of local residents, some of whom were out of work due to the pandemic. Initially recruited and trained to support rapid community testing, the OST were then trained to offer support to people during isolation and help NHS clinicians to deliver vaccination to create a flexible and multi-skilled team willing and able to support the COVID response in whatever way was required. The OST began running assisted testing sites at fixed locations across the borough including Rainham, Romford, Collier Row, Harold Wood, Harold Hill and Elm Park. A Council bus was adapted to create a mobile testing unit so that testing could be offered on site in the event of distinct outbreak e.g. a work place. As the government worked through its roadmap out of lockdown in the first half of 2021, more and more people began to return to work and the OST offered a Business Collect model allowing small-to-medium-sized businesses to access asymptomatic test kits for their staff. As home tests became available, the national online ordering website was often overwhelmed so the OCS ran pop-ups at locations with high footfall, such as The Liberty Shopping Centre and Romford Station so that people who needed to be out-and-about could get tests and at the same time get advice about the latest Government advice on COVID. The mobile testing unit was later repurposed to help NHS partners run vaccination pop-ups in the community. While health professionals jabbed residents the OST team managed queues and booked people in. Although there was a legal requirement for cases and their close contacts to isolate there was evidence that a proportion didn’t isolate either at all or for a shorter period than required due in part to a combination of practical, psychological and financial problems. We created an isolation support outreach team to see if welfare visits would increase compliance with self-isolation. The new service launched in June 2021, initially as a six-week trial. The initial feedback was positive and the pilot continued, prioritising older residents who were more likely to be very unwell if they caught COVID. The visits provided the opportunity for a face-to-face conversation to understand residents’ situations, and offer immediate support if needed. This included information about the process they could use to claim financial support payments and an offer to people who weren’t fully vaccinated to contact them again in 28 days to help them arrange to get jabbed. The Havering team was asked to share our model with local authorities across the country. In November 2021, we were invited by UKHSA to participate in a randomised controlled trial to prove whether the welfare visits increased compliance with self-isolation or not. The trial ran from early January to March 2022 and we were very pleased to find that the group who received a home visit were 21% more likely to have isolated compared with the group who had no visits. No impact was found on the likelihood of the person taking up isolation support payments or vaccination. The study will be published in a scientific journal in the coming months.
Testing and Tracing The Outbreak Support Team The success of the service reflects the commitment of the staff involved and the care taken in preparing them for their role: -
Case Study - CM - COVID Response Officer ‘I was originally recruited to do testing on the mobile testing unit and pop-ups, which were stations in various public locations where the residents could receive lateral flow tests and advice around the pandemic. Later down the line, I was moved to the isolation outreach team, providing welfare support to those isolating. ‘Transferring between the roles was really easy because the support and advice stayed the same. It was just the implementation of methods that changed and I received the necessary training in order to make the transfer as easy as possible. ‘Before starting a new role, I was showned the correct procedure to carry out the new role and was briefed on scenarios that other colleagues had encountered while doing the role and how to deal with them. ‘I was also monitored on my first shift by colleagues and team leaders to ensure I was completing the procedure correctly.’
Epidemiology wave 1 Spring 2020 - Wave 1 – Wildtype (Wuhan) Variant
Testing outside the NHS was very limited during Wave 1 so there is no meaningful data about the number of new infections in the community. Our best understanding of the pandemic at this time is based on the number of people admitted to hospital or who died following a Covid-19 infection. Data are presented here about the daily count of confirmed COVID-19 patients in hospital reported by Barking, Havering and Redbridge University Hospitals NHS Trust (BHRUHT) that operates Queens and King George Hospitals . Usually about 40% of patients in these two hospitals are Havering residents. The number of beds across the two sites varied at different points in time as the NHS created additional capacity to cope with the pandemic but was generally around 1000 beds. Data is available from 21 March 2020 onwards when 20 beds at BHRUHT were occupied by someone who had tested positive for SARS-CoV-2. Numbers increased and averaged just under 160 during April. Thereafter, the number of inpatients with Covid-19 dropped steadily to about 20 per day at the start of June and under 10 through much of the summer. The mortality data presented here relates to Havering residents who died within 28 days of testing positive. The Government also published information about the number of deaths with Covid-19 on the death certificate. The two definitions give roughly similar estimates of the harm caused over the course of the pandemic - 987 vs 1043 deaths of people resident in Havering from March 2020 to the end of February 2022 . The first deaths in Havering were reported in the 4th week of March. On average just under 5 people died each day during April. Thereafter numbers dropped to below 5 a week through the summer. The first lockdown was announced on 23 March 2020. Hospital admissions peaked a month later and declined steadily afterwards. Deaths followed a similar trajectory. The lockdown measures were sufficient to bring the transmission rate (R) below 1 so that the first wave peaked and then declined relatively quickly. As such, Wave 1 was steep but short lived in comparison with subsequent waves.
Epidemiology wave 2 Winter 2020/21 – Wave 2 – Kent / Alpha Variant
Case numbers began to increase during the early autumn of 2020 with a total of 500 cases in September, 1600 in October and 3600 in November. For a short time, it appeared that the fourweek long ‘circuit breaker’ lockdown in November had checked the rise in infections but they surged again to reach over 500 a day around New Year, with 11600 in December as a whole. The third national lockdown brought infection rates down through the spring of 2021. The number of inpatients at BHRUHT who had tested positive for SARS-CoV-2 mirrored the rise in new cases in the community; averaging 90 per day during October, 200 during November, nearly 300 in December and over 400 in January. In early January, around 500 beds, half of all those available were occupied by someone with Covid-19. Rates dropped steadily in the New Year although never quite as low as achieved the preceding summer. The number of deaths following a positive test tracked a similar course averaging 1 a day during October, 3 a day in November, almost 6 per day during December and over 7 each day during January. Thereafter deaths with COVID-19 dropped quickly and remained very low into the autumn of 2021. Vaccination began at the end of December 2020 with health and social care workers; care home residents and people aged 80 and above. The majority of the vulnerable population were unprotected during Wave 2. Wave 2 was longer and more complex than Wave 1. By this time, Government had invested massively in testing and contact tracing capacity with the intention of breaking chains of transmission. Nonetheless, infection rates began to increase in the autumn of 2020. In response, Government introduced the three-tier coronavirus alert level system on 14th October. Subsequently, a second national lockdown was enforced for 4-weeks beginning 5th November. Lockdown was then replaced with a stricter version of the three-tier system. However, cases rates began to increase quickly; a still stricter Tier 4 was added on 21st December and applied in London and SE England before the whole country entered a third lockdown on the 6th January 2021. This continued until the 8th March when Government began implementation of a 4-step plan to exit lockdown. As these events unfolded, whole genome sequencing demonstrated that a new variant initially identified in Kent – and later named alpha, was becoming predominant. It proved to be more transmissible than the original wuhan variant and as a result, stronger social distancing measures, ultimately a second and third lockdowns, were required to bring Wave 2 under control. Havering was geographically close to the source of the new variant and rates of infection rose very high locally before the third national lockdown was enforced. As a result, and as vaccination had only just started, Havering experienced many more deaths during Wave 2 than Wave 1. During the 6 months October 20 – March 21, 625 Havering residents died following a positive test for SARSCoV-2. Almost 2/3 of all deaths experienced during the two years of the pandemic.
Epidemiology wave 3 Late summer / autumn / winter 2021/22 – Wave 3 – Delta and Omicron variants.
Wave 3 was longer and more complex than previous waves; beginning in the summer of 2021, peaking over the New Year but arguably continuing into the summer of 2022. In the course of the spring of 2021, the more transmissible delta variant replaced the alpha variant. Nonetheless, on July 19th 2021, Government progressed to Step 4 of its roadmap out of lockdown whereby all legal limits on social contact were removed and any remaining sections of the economy were reopened. Rates of infection rose a bit but didn’t spike hugely. Moreover, high rates of vaccination and more effective treatments including antivirals reduced the proportion of cases that resulted in serious illness and death. In September, Government issued England’s COVID19 Response: autumn and winter plan 2021. Vaccination was now the main line of defence, supported by treatment for those who remained vulnerable to serious illness despite vaccination, as well as continued testing and self-isolation to limit transmission. Plan B, should the NHS come under unsustainable pressure would see modest additional controls being reintroduced. As autumn progressed another variant, omicron, which was more transmissible again and able to avoid immunity gained by vaccination or previous infection began to spread rapidly. Although there were reports that omicron was less likely to cause serious illness, there remained the possibility that the NHS might yet be overwhelmed. Government activated Plan B on 8th December and preexisting plans for a vaccine booster programme were massively accelerated. Case numbers did rise hugely, reaching over 1300 in Havering over a single day at the end of December. However, the proportion of people that developed serious illness was much reduced as omicron caused less severe illness and vaccination or prior infection continued to protect against the worst effects of COVID-19. As a result, Government was able to lift the additional measures introduced with Plan B on 27th January 2022 when it was clear that omicron would not overwhelm the NHS. Case numbers remained high into the spring and placed a significant burden on the NHS but deaths remained relatively low. Currently the UK is able to live with the known variants of SARS-CoV-2 in the same way that it can live with seasonal flu. Both can cause unpleasant illness in most people, and severe illness and death in vulnerable groups. Vaccination reduces the risk of severe illness in more vulnerable groups and benefits everyone as it reduces pressure on the health and care services that we all rely on some extent.
Learning from the pandemic A note about inequalities Coronavirus can infect anyone and the NPIs used to control the pandemic affected everyone. To that extent, we were all in the pandemic together. However, the harms caused were not the same for all. The risk of severe disease and death from COVID-19 is higher in people who are older, male, from deprived areas or from certain non-white ethnic backgrounds. Certain underlying health conditions, as well as obesity, also increase risk of severe disease and death in adults. The very high risk faced by the elderly and people with pre-existing health conditions was understood early on and a desire to protect the most vulnerable shaped the UK response to the pandemic. Despite these measures, they nonetheless bore the brunt of the direct harm caused by COVID-19.
The greater risk of death to ethnic minorities and disadvantaged communities became clear as Wave 1 proceeded. These inequalities resulted from differences in both: • the likelihood of acquiring the infection •p eople in these communities are more likely to be key workers who could not work from home; more likely to use public transport thereby raising their risk of exposure getting to work and more likely to be employed in roles that entail close face to face contact thereby increasing their risk of exposure at work. • t hey were also more likely to live in overcrowded households making it more difficult to isolate effectively. In addition, some ethnic minorities are more likely to live in multigenerational households increasing the likelihood of spread from low risk working age adults to high-risk elders. • and the risk of severe illness if infected •d isadvantaged communities have higher rates of pre-existing disease and obesity. •p rior experience of racism and poorer experiences of healthcare mean that individuals from ethnic minority groups may present later with severe COVID-19. Later in the pandemic, these same communities were less likely to be vaccinated; resulting in further inequality. Again, a greater level of suspicion of statutory services, including the NHS, played a part. In addition, the cost to the individual in getting vaccinated e.g. the cost of transport to a remote mass vaccination centre and absence from work dissuaded some who were undecided about the benefits. Overall, the pandemic served to highlight existing health inequalities rather than create new ones. Narrowing such inequalities is a priority for newly created integrated care systems. Learning from the experience of the pandemic, our plans to tackle inequality should: • Place expectations on health and care services to actively engage with and advocate on behalf of historically poorly served communities • Actively seek to address inequalities regarding the wider determinants of health (income, employment, housing) • Include adequately resourced, culturally competent interventions, targeted on specific communities, to raise health literacy and awareness, support behaviour change, as well as deliver effective health care The experience and outcomes achieved by health and care services care should be routinely captured and subject to regular equity audit.
Glossary ALAMA Association of Local Authority Medical Advisers exists to improve the communication, education, consistency and quality of clinical practice of doctors providing occupational health services for the benefit of local authority employees and employers (including those in the police, fire and the National Health Service). ALAMA members put together a risk assessment table to assist occupational health to assess how vulnerable our staff may be if they caught Covid 19 and what precautions were needed to be put in place in order to minimise the risk but still be able to deliver critical services. ASC – Adult Social Care is the support provided to adults with physical or learning disabilities, or physical or mental illnesses. BHRUHT Barking, Havering and Redbridge University Hospitals NHS Trust Bronze/silver/Gold command structure The Gold commander (the Council’s Chief Executive) is in overall control of the organisation’s resources and formulates strategy. Silver (the Director of Public Health) is the tactical commander who manages implementation of the strategy, making it into a set of actions to be delivered by Bronze(s). Bronze directly controls the organisation’s resources. The pandemic plan identified a number of bronze groups, each led by a Director or Assistant Directors, with their own areas of responsibility e.g. support to health and care services; early years and education; council services etc. With some changes, e.g., the addition / deletion of some bronze groups and / or the frequency of meetings and size of supporting team; the GSB command structure would design and oversee delivery of the Council’s response to the pandemic for the next 2 years. CEV – Clinically Extremely Vulnerable Close contact – definitions can vary but in the context of the UK’s track and trace system a ‘close contact’ is defined as 15 or more minutes within 2 metres of distance. CMOs – Chief Medical Officers. There are four CMOs in the United Kingdom who are appointed to advise their respective governments: England, Scotland, Wales and Ireland. Contingent Workers individuals who are not on the payroll, but instead provide independent services to an organisation. Contingent workers include independent contractors, freelancers, consultants, advisors or other outsourced workers hired on a per-job and non-permanent basis. Covid Marshall Provided advice and guidance for citizens to support compliance with covid restrictions. The covid marshals did not have enforcement powers and were employed in a community engagement capacity. CPV – Care Providers Voice is a network connecting care providers across London, with a focus on North East London. The CPV platform is free to access and has been created by providers, for providers, to collate resources, ensure care providers are represented and to support recruitment. CQC The Care Quality Commission is an executive non-departmental public body of the Department of Health and Social Care of the United Kingdom. It was established in 2009 to regulate and inspect health and social care services in England. DASS – Director of Adult Social Services Day centres places for older people, disabled people or people who need extra support to take part in activities, catch up with friends and have lunch or a cup of tea. DHP Discretionary Housing Payment
Glossary Digital Divide the gap between people in society who have full access to digital technologies (such as the internet and computers) and those who do not. Concerns about the digital divide have been particularly acute during the COVID-19 pandemic as the internet and digital devices have played an important role in allowing people to work or study from home, access services, attend medical appointments and stay in touch with friends and family. Domiciliary Care Providers Domiciliary carers, also known as home carers or private carers, are paid professionals that help to keep people living independently in their own homes through daily visits or live-in care DPH – Director of Public Health ELFT – East London NHS Foundation Trust provide a wide range of mental health, community health, primary care, wellbeing and inpatient services to young people, working age adults and older adults across the City of London, Hackney, Newham, Tower Hamlets, Bedfordshire and Luton. Everyone Active Havering has leisure centres which are managed by Everyone Active. Feebris – A company which provides AI-guided tools to support community and family care workers to capture and share precise health measurements enabling more effective care for vulnerable patients. Havering Care Association was a representative group of elderly care homes, with 80% off providers being members which later became the Care Providers Voice (CPV). Havering Health a collaboration of local GP practices (GP Federation) who have agreed to work together to offer a well-resourced, high-quality health service provided by clinicians with expertise, in understanding of, and commitment to their local communities. Havering Health is a Federation of 41 General Practices in the London Borough of Havering caring for more than 270,000 patients, 92% of the Havering population is registered with a GP practice which holds membership of Havering Health. Havering Mind an independent local registered charity, affiliated to the national Mind charity, but raise their own funds separately to provide advice and support to empower anyone experiencing a mental health problem across Barking, Dagenham and Havering. Havering Talking Therapies Provide Talking Therapies e.g. Cognitive Behavioural Therapy (CBT) for people over the age of 18 and registered with a GP in the London Borough of Havering. Havering Talking Therapies can help you with issues around feeling anxious, trouble sleeping, emotional pressures, stress and depression. Havering Volunteer Centre – a charity that acts a central point to source volunteers for local organisations and a place for people to go who want to volunteer. Health Impact Assessment (HIA) a practical approach used to judge the potential health effects of a policy, programme or project on a population, particularly on vulnerable or disadvantaged groups typically used as a tool to identify and optimise the health and wellbeing impacts of planning. Health Inequalities avoidable, unfair and systematic differences in health between different groups of people. Health inequalities can involve differences in health status, for example, life expectancy, access to care, for example, availability of given services, quality and experience of care, for example, levels of patient satisfaction, behavioural risks to health, for example, smoking rates, and wider determinants of health, for example, quality of housing. Healthwatch Healthwatch is your health and social care champion. If you use GPs and hospitals, dentists, pharmacies, care homes or other support services, Healthwatch want to hear about your experiences. As an independent statutory body, they have the power to make sure
Glossary NHS leaders and other decision makers listen to your feedback and improve standards of care. Havering Healthwatch: https://www.healthwatch.co.uk/your-local-healthwatch/ list?title=Healthwatch+Havering&Search=Search HES – Health and Safety Executive HPB Health Protection Board IMT – Incident Management Team IPC Infection Prevention Control is a practical, evidence-based approach preventing people from being harmed by avoidable infections. Infection prevention and control includes hand hygiene, safe cleaning and decontamination, correct use of PPE etc. JCU – Joint Commissioning Unit was established to commission services on behalf of: Adults Social Care; Children’s Social Care and Public Health services in the London Borough of Havering. JCVI Joint Committee on Vaccination and Immunisation advises UK health departments on immunisation. Key Workers A key worker, critical worker or essential worker is a public-sector or private-sector employee who is considered to provide an essential service for example, teachers, nurses, and delivery drivers. LCRC – London Coronavirus Response Cell was the local Public Health England (PHE) Health Protection Team (HPT) for Havering and all other London Boroughs who worked with complex settings including care homes and schools during outbreaks to assess risks and provide help and advice in managing COVID-19 cases. LFD test – Lateral Flow Device test. The test usually involves taking a sample from your throat and nose, or from your nose only, using a swab. You get a result in 10 to 30 minutes. London Resilience Forum Local Resilience Forums were introduced in 2004 in the Civil Contingencies Act to provide the means for those involved in emergency preparedness to collaborate at a local level. The London Resilience Forum ensures London’s preparedness in the event of emergencies and coordinates the activities of a wide range of organisations to achieve this. It also provides a link between emergency preparedness and resilience at the local and national levels. Long Covid the effects of Covid-19 that last for several weeks or months beyond the initial illness. MHRA The Medicines and Healthcare products Regulatory Agency regulates medicines, medical devices and blood components for transfusion in the UK. MVS – Mass Vaccination Site NEL CCG – North-East London Clinical Commissioning Group was created following the Health and Social Care Act in 2012, and replaced primary care trusts on 1 April 2013. They were clinically-led statutory NHS bodies responsible for the planning and commissioning of health care services for their local area. As of 1 April 2021, following a series of mergers, there were 106 CCGs in England. However, they were dissolved in July 2022 and their duties taken on by the new integrated care systems (ICSs). CCG functions were subsumed into integrated care systems, with CCGs ceasing to exist as statutory organisations in July 2022. NELFT – North-East London NHS Foundation Trust provides an extensive range of integrated
Glossary community and mental health services for people living in the London boroughs of Barking & Dagenham, Havering, Redbridge and Waltham Forest and community health services for people living in the south west Essex areas of Basildon, Brentwood and Thurrock. NHS COVID pass (Also known as Vaccine Passport) A way to show your coronavirus (COVID-19) vaccination status or test results if you need to when you travel abroad. NHSX – A new NHS body which was established to drive digital transformation and lead IT policy across the NHS by bringing together teams from the Department of Health and Social Care (DHSC), NHS England and NHS improvement into one central unit. In 2022, NHSX was merged with NHS Digital and incorporated into NHS England and the NHSX brand was retired. NPIs Non-pharmaceutical intervention also known as ‘public health and social measures’, referred in COVID-19 to the measures to reduce transmission that did not depend on drugs, vaccines or other specific medical countermeasures. ONS The Office for National Statistics is the executive office of the UK Statistics Authority, a nonministerial department which reports directly to the UK Parliament. PA – Personal Assistant someone employed by an individual to provide support with things they need for example, help with washing and dressing or making food and eating. PCN – Primary Care Networks where GP practices work together with community, mental health, social care, pharmacy, hospital and voluntary services in their local areas in groups of practices. PCR test Polymerase Chain Reaction tests. The test detects the presence of a virus if you have the virus at the time of the test. The test could also detect fragments of the virus even after you are no longer infected Peabody – a housing association that provide information, advice and guidance to people living in Havering. They provide the ‘Here to help’ service operated in the Harold Hill Community Hub provide support on welfare benefits, debt, disabled transport, housing and they also distribute foodbank vouchers. PECC – Provider Emergency Contact Centre was established to maintain proactive communications with all care providers in Havering (and beyond where Havering residents are cared for out of borough) throughout the COVID crisis, to ensure that they were able to continue to provide care as required to their service users. Personal Covid Risk Assessments – A Personal Covid Risk Assessment is an estimate of how likely you are to contract it in the type of work you do (workplace Risk Assessment) and the likely medical consequences if this happens (personal health Risk Assessment) PHE – Public Health England was an executive agency of the Department of Health and Social Care in England which began operating on 1 April 2013 to protect and improve health and wellbeing and reduce health inequalities. From 1 October 2021, PHE’s health protection functions were formally transferred into the UK Health Security Agency (UKHSA), while its health improvement functions were transferred to the Office for Health Improvement and Disparities (OHID), NHS England, and NHS Digital. PHM Population Health Management focuses on the wider determinants of health and the crucial role of communities and local people. PHM is a partnership approach across the NHS and other public services including councils, the public, schools, fire service, voluntary sector, housing associations, social services and police. All have a role to play in addressing the interdependent issues that affect people’s health and wellbeing.
Glossary Pingdemic The term “pingdemic” was coined from “pings” delivered by the NHS app to notify users when they have come into contact with someone who has tested positive for COVID-19. The NHS COVID app then issues a message urging them to quarantine at home for ten days. PPE – Personal Protective Equipment helps prevent the transmission of infection between staff and patients. PSHE Personal, social, health and economic education. Quality Outcomes Team The means by which providers are monitored by the Council is through the Quality Outcomes team, based within the Joint Commissioning Unit (JCU). This is a team of officers whose job is to liaise with and visit care providers on a regular basis to ensure the quality of services. Safeguarding Safeguarding means protecting a citizen’s health, wellbeing and human rights; enabling them to live free from harm, abuse and neglect. Those most in need of protection include children and young people and adults at risk, such as those receiving care in their own home, people with physical, sensory and mental impairments, and those with learning disabilities. Seconded/secondment an arrangement under which an employee is temporarily assigned to work either for another part of their employer’s organisation or for a different employer within the same group. SLM – Sports and Leisure Management SOPs – Standard Operating Procedures are documents containing step-by-step instructions to guide employees on how to perform a technical, repetitive process within an organization in the example of care homes during the COVID-19 pandemic the SOPs described how to admit new residents, how often to test staff and residents, isolation periods etc. Support Bubbles A support bubble is a support network that links 2 households for people who live alone and/or with very young children. Surge Testing Surge testing is increased testing (including door-to-door testing in some areas) and enhanced contact tracing in specific locations in England that involves testing of people who do not have any symptoms of COVID-19. Tapestry Tapestry is an innovative charity and ‘not for profit’ social business working to provide appropriate, personalised and affordable care and support for adults and older people in the local community including a food delivery service, day care centres, social prescribing and financial advice. The rule of six Apart from a set of limited exemptions including work and education – any social gatherings of more than six people will be against the law TTSP Test & Trace Support Payment Scheme was for people on low incomes who had to self-isolate because they tested positive for COVID-19 or were notified as a close contact of someone who had tested positive for COVID-19. UK Influenza Pandemic Preparedness Strategy provided a UK-wide strategic approach to planning for and responding to the demands of an influenza pandemic. Vaccination UK Commissioned by NHS England since 2015 to provide school aged immunisations, including Influenza, to pupils across numerous counties and boroughs in England, including the Black Country, Hertfordshire, Herefordshire & Worcestershire and 9 Boroughs of North East London
Glossary VOCD – Vaccine as a Condition of Deployment Wellbeing and Social Prescribing Service Social prescribing is a way for local agencies including general practice, pharmacies, multidisciplinary teams, hospital discharge teams, allied health professionals, fire service, police, job centres, social care services, housing associations and voluntary, community and social enterprise (VCSE) organisations to refer people to a link worker. Link workers give people time, focusing on ‘what matters to me’ and taking a holistic approach to people’s health and wellbeing. They connect people to community groups and statutory services for practical and emotional support. WHO – The World Health Organisation is a specialized agency of the United Nations (UN) responsible for international public health. Whole Systems Approach defined as responding to complexity through a dynamic way of working, bringing stakeholders, including communities, together to develop a shared understanding of public health challenges and identify collective actions to bring about sustainable, long-term systems change. Wider Determinants of Health also known as social determinants, are a diverse range of social, economic and environmental factors which impact on people’s health such as their level of education, quality of housing, working conditions & income, access to green space etc.
Acknowledgements Thank you so much to every organisation and individual who has contributed their experiences and other information to this report. We have included as many as we could in no particular order and we decided to acknowledge the names of the teams involved in the response to the pandemic rather than individuals to avoid the risk of offending anyone who might have been missed out but we know that this has only captured a tiny number of the experiences that people in the London Borough of Havering have had in the pandemic. London Borough of Havering Council teams: • Public Health • Communications • Housing • Children and Adult Services • Joint Commissioning Unit • Adult Social Care • Quality Outcomes team • Adult Placement team • Education • Health and Safety team • Estates team • Libraries • Customer Services team • Civil Protection • Births, deaths and Marriages • Bereavement services • Recycling and waste collections Editorial Team: • Mark Ansell (Director of Public Health) • Benjamin Vaughan (Deputy Head of Communications - Media & Campaigns) • Yvonne Lamothe (Senior Communications & Campaigns Officer) • Luke Squires (Public Health Practitioner) Design: • Havering Design Studio And to the following local organisations for your contributions about the Covid-19 pandemic response: • Healthwatch Havering • Peabody • Tapestry • Havering Health GP Federation, • Havering Volunteer Centre (HVC) • Everyone Active and SLM • Care Providers Voice • NELFT • Havering Crest PCN • Care Providers Voice (PCV) • Havering Borough Place Based Partnership (HBPBP) • All educational establishments in the borough • BHRUT • Disablement Association of Barking & Dagenham (DABD(UK) • ELFT