°Ç¸ç³Ô¹Ï

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

Developing terms of reference

Aims

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

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

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

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

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

Meetings

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

Depending on the nature and scale of the outbreak, and the number and level of responders, it may be necessary to establish specific cells (or sub-teams) to support the IMT. Cells may be tasked by the IMT and provide direct reporting to the IMT, in these circumstances, the IMT will always have primacy.

Leadership

The IMT chair is responsible for providing strategic leadership to the IMT meeting, facilitating effective coordination of the management of the outbreak including facilitating shared decision making and learning. In the majority of outbreaks, the IMT meeting will be chaired by a consultant in health protection or a principal or senior health protection practitioner (UKHSA) unless otherwise agreed by members.

Local authority directors of public health (DsPH), or their nominated lead, may wish to chair meetings where there are wider implications for local public health or a the situation requires a major contribution.

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

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

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

Membership and roles

The membership of the IMT will be determined based on:

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

Where possible, a representative of UKHSA will attend all IMT meetings, with a few exceptions (for example, in the instance of a non-complex outbreak confined to a hospital environment).  If not represented as members, then the relevant DsPH and local authority public health team should be informed that an IMT has been established and updated on any key decisions.

Members should be sufficiently senior and empowered to represent their organisation and to support timely decisions on the mobilisation of resources and funding, including having access to appropriate escalation routes. Any conflicts of interest should be declared by members as soon as they become apparent. Whilst decisions made by the IMT should be made collectively, organisations remain accountable for decisions within their own organisation or remit.

Typical membership

The typical membership of an IMT includes:

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

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

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

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

Wider UKHSA representatives:

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

Local partner agencies:

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

Other government departments and agencies:

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

Community representatives:

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

Administration and documentation

Administrative support should be provided by the lead agency for the incident.

Administrative support should include capturing IMT meeting minutes, which should:

• be taken for all IMT meetings
• include a log of attendees and apologies
• provide a summary of outbreak context (that is, situational awareness and risks), considerations (that is, points of consensus and any differing views), decisions and reasoning, and subsequent actions (see template agenda)
• be signed off by the IMT chair prior to circulation
• be circulated using appropriate record classification and secure mechanisms
• be circulated in a timely way as agreed during the meeting
• be stored by the lead agency and in accordance with organisational policies – each organisation should also maintain its own records of related decisions and actions

Data protection

Where artificial intelligence tools are used to support the IMT documentation, these should be used with the agreement of members of the IMT, referenced on any associated minutes, ensure appropriate governance and protection of sensitive information, and align with organisational policies.  

Any use of video, audio or transcript recording for IMT meetings should be agreed with members, and the recording should be stored securely. The recording should be deleted following sign-off of meeting minutes.

Minutes are shared for the purposes of supporting the management of the outbreak and are not for onward sharing without the permission of the chair. Where wider use of the IMT minutes is required, this should be discussed with the appropriate organisation information rights team.

Meetings

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

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

Roles and responsibilities of typical members of the IMT

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

UKHSA consultant in health protection (CHP)

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

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

Environmental health lead/officer

Typical responsibilities are to:

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

Director of public health

Typical responsibilities are to:

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

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

Typical responsibilities are to:

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

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

Typical responsibilities are to:

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

In addition, the consultant in public health infection will:

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

NHS commissioner

Typical responsibilities are to:

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

Relevant service providers

Typical responsibilities are to:

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

Communications lead

Typical responsibilities are to:

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

Other attendees

The IMT chair and members may identify additional specialists, teams or organisations who may contribute to support the IMT.  Where additional members are identified, their roles and responsibilities should be agreed and clearly communicated with them and other members.

Supporting decision making

Where possible, the IMT should seek to reach consensus on decisions made. To support in the development of consensus, the IMT should:

• ensure roles and responsibilities are clearly defined across member organisations
• establish robust communication channels and protocols to ensure all members have access to relevant information and can engage in timely well-informed discussions
• employ structured processes for decision-making

Guiding principles to support decision-making within the IMT

The IMT must seek to make decisions reflective of known system and organisation constraints.

The IMT must consider decisions made, and risks held, by individual organisations contributing to outbreak management, noting organisations remain responsible for their own operational risks through outbreak management.

Consensus should be sought wherever possible relating to IMT decisions.

Where consensus on IMT decisions cannot be reached, issues should be escalated within the respective organisations’ clinical governance structures to support resolution.

Differing views expressed and considered should be documented. Where decisions are within the remit of the IMT, any final decision required should be taken by the IMT chair, ensuring consideration and documentation of any risks and associated mitigations to address areas of concern.

Concerns regarding an organisation’s role within the IMT or response to an outbreak should be discussed with the IMT chair and raised with the relevant organisation. If the issue cannot be resolved by discussion between parties, the issue should be escalated to the UKHSA Regional Deputy Director and/or local DsPH and senior colleagues within the relevant organisation.

Any associated learning should be recorded.

Where an outbreak requires material local authority resource, mutual aid or escalation to multi-agency strategic (Gold) command, this should be escalated to the local authority chief executive as Head of Paid Service, with the section 151 officer engaged on any significant expenditure. The IMT remains the tactical health protection structure and feeds advice into strategic command rather than being subsumed by it.

Template agenda for IMT meeting

(Title of outbreak)

(Date, time and venue)

Information contained within the IMT meeting is shared for the purposes of supporting outbreak investigation and management and must not be shared more widely.

Members should support the IMT through sharing of information where needed and assist in the development of consensus decisions where possible. Members should familiarise themselves with the roles and responsibilities and principles contained in the Communicable Disease Outbreak Management Guidance.

1. Welcome, introductions and apologies

2. Minutes and actions of previous meeting (for subsequent meetings)

3. Purpose of meeting

• agree chair and terms of reference including aims (at first meeting)
• agree roles and responsibilities (at first meeting)
• confirm incident arrangements
• confirm terms of reference remain accurate and valid (in subsequent meetings)

4. Situation update and review of evidence

• epidemiological (including agreeing and review of case definition and international situation if relevant)
• microbiological/phylogenetic
• environmental (and food chain where relevant)
• health equity and safeguarding considerations
• international

5. Risk assessment (See toolkit 3)

6. Control measures

• resources, lead agency and timeframe
• review of control measures, including barriers to implementation and assessment of impact (in subsequent meetings)

7. Next steps, including further investigations and reporting

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

8. Communications

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

9. Legal and other issues

10. Review of agreed actions and decisions recorded

11. Any other business

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

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

Template IMT meeting minutes

(Title of outbreak)

(Date, time and venue)

These minutes are shared for the purposes of supporting the management of the outbreak and must not be shared more widely. In the event that the minutes may be required for other purposes, please inform the IMT chair.

1. Welcome, introductions and apologies

• note attendees, apologies and non-attendance, including representing organisation

2. Minutes and actions of previous meeting

• note if minutes agreed or amends recommended

• update actions

3. Purpose of meeting

• record agreement of collective aims of the group and individual’s roles and responsibilities agreed

• record summary of key points of discussion

4. Situation update and review of evidence

• record summary of key points of discussion, changes to situational awareness and any points of dispute under relevant headings

5. Current risk assessment

• record summary of key points of discussion and any points of dispute
• record risk assessment considerations and score

6. Control measures

• record summary of key points of discussion, including control measures considered, barriers to implementation and any points of dispute

• record decisions, including benefits and harms considered

• record actions, including action owner and timeframe

7. Next steps, including further investigations

• record summary of key points of discussion and any points of dispute 

• record decisions, including benefits and harms considered

• record decisions, actions, action owner and timeframe

8. Communications

• record summary of key points of discussion and any points of dispute

• record decisions including benefits and harms considered

• record actions, including action owner and timeframe

9. Legal and other issues

• record summary of key points of discussion and any points of dispute

• record decisions including benefits and harms considered

• record actions, including action owner and timeframe

10. Review of agreed actions and decisions

11. Any other business

• record summary of key points of discussion

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

• insert date, time and location of next meeting