First Minister’s foreword
Tackling the coronavirus crisis has meant major changes to the lives of every single one of us across Wales. We have had to take difficult decisions in order to save lives and protect our NHS. The actions of every one of us have contributed to falling levels of infection in Wales, but the virus remains a very serious threat to us all and we cannot be complacent in any way.
For that reason, as we consider lifting some of the restrictions, we must do so with great caution and on the basis of the best scientific data and analysis.
We have all played our part in abiding by the restrictions. Looking ahead, I want to be open with the Welsh people as I consider, along with my Cabinet colleagues, how the restrictions might be eased.
I want to use the coming weeks to engage in a conversation with people in Wales, to explain how we will take decisions and weigh up the risks and benefits of moving out of lockdown.
I am mindful of the impact on families, jobs, health and well-being for all of us, but we cannot put at risk the sacrifices we have made. We will not do anything without being as sure as we possibly can be that we do not risk a second significant wave of infection, and therefore have to re-introduce some restrictions.
I recognise that many people will be fearful about stepping back into a form of normal life – so this framework also sets out the evidence, principles, and public health measures that will make sure that everyone can have confidence in the approach to easing the restrictions.
This framework, therefore, is based on 3 pillars:
- Firstly, it sets out the measures and evidence by which we will judge the current infection level and transmission rates for coronavirus in Wales.
- Secondly, it sets out a series of principles by which we will examine proposed measures to ease the current restrictions, grounded in both scientific evidence and wider social and economic impacts.
- Thirdly, it sets out how we will enhance our public health surveillance and response system to enable us to closely track the virus as restrictions are eased, and how this system will protect people’s health. Wales has maintained a National Public Health system, with a strong local presence in every part of Wales, and we will build on these strengths.
This public health response will draw on the international evidence, building on our strong existing networks.
Taken together, these pillars are the basis on which we will lead Wales out of this crisis in a way that keeps everyone safe and revitalises our economy as quickly as possible.
The whole of the UK entered ‘lockdown’ in the same ways and at the same time, and our preference as a government would be that all four nations retain a common approach to lifting the restrictions. However, we have been consistent in making clear that we will take the right decisions in the interests of the people of Wales.
Our approach here is to be open about those decisions, use the time we have to consider and review the restrictions, and to involve and engage people. This document sets out the basis on which we will do this, and contributes to the work underway across the UK to map out the way forward.
Mark Drakeford AM
First Minister of Wales
Pillar 1: Measures and evidence
The most important consideration from a public health point of view is that relaxing from the current lockdown should not cause further harm in terms of the direct effects of the virus. We need to be able to show that the current outbreaks of infection are under control, and ensure that we understand the way the disease travels through our communities in Wales. Over the coming weeks, we are focussed on further understanding and measuring the level of infection that is present in Wales. To achieve this we are stepping up our testing capacity and capability to meet our needs in every part of Wales.
We have substantially increased our health and care capacity and we will put this to good use, deciding how we can best look after people who might have COVID-19 without putting others in danger. We know that people who suffer severely may need to be in hospital for several weeks, whether that is an isolation ward, or a separate hospital like the Dragon’s Heart or other field hospitals across Wales.
Each part of daily life needs to be considered, to see what the risk of infection might be if we go back to it without changes. The recovery plan for Wales will need to address how we can return to work, to education, and meet our families and friends without endangering life or health.
We need to be assured that we can track and treat future outbreaks, both now in the summer, and when the real pressure comes in the winter months. We need to know that we can contain future outbreaks in a robust way, so that we do not have to reinstate restrictions which we decide to lift.
The evidence that we will need to relax the current measures is complex, but it is becoming clearer. With much more population testing we will know that the infection rate is coming down. Some of the factors to consider in lifting restrictions will include:
- evidence of a sustained decrease in key metrics such as COVID-19 hospital admissions for at least 14 days.
- evidence that we can cope with the expected increase in healthcare needs for at least 14 days if the infection rate goes above 1 and the virus is spreading widely once again. This is how long it will take from locking down to stopping the increase again.
- assurance that we have enough PPE to provide for all frontline workers who need it in order to deliver our recovery plan.
- robust international evidence of the impact of lifting the restrictions on the spread of the virus, engaging with countries across the world to learn from their measures, and close engagement with other devolved administrations and the Mayor of London.
Pillar 2: Principles to evaluate changes to the restrictions
Over the coming days and weeks, we will continue to review the current restrictions, and consider options for relaxing them safely. We will evaluate these options against the following principles, in order to test risk and potential benefit.
To what extent would easing a restriction have a negative effect on containing the virus?
- Is the action consistent with assumptions informing the prevailing infection control measures?
- Does the action seek to secure an identifiable public health gain?
- Does the action reflect the evaluations made of similar actions elsewhere?
Is the measure at the low end of risk of further infection?
- Can the scale of the measure be adequately quantified?
- Is the scale of the action proportionate to the scale of the risk of further infection?
- Is the scale of the action communicable in such a way as to avoid confusion about its extent and its limits?
How can it be monitored and enforced?
- How visible is the proposed action?
- Is the action already subject to regulation, inspection or surveillance?
- Can infractions be sufficiently well defined to be subject to enforcement?
Is it capable of being rapidly reversed if it has unintended consequences?
- Are arrangements sufficient to monitor the impact of the action?
- Is the action sufficiently defined to allow rapid communication with those engaged in the action?
- Have the potential consequences of reversing the action been subject to a risk analysis?
Is it a measure of relatively high positive economic benefit?
- Can the economic benefit be readily calculated?
- Is the measure of economic benefit consistent with WG’s commitments to a more prosperous, equal and greener Wales?
- Is the economic benefit sectional and/ or narrow in its scope?
Does it have a high impact on social and psychological well-being?
- Does the measure impact on an identifiable vulnerable or disadvantaged group?
- Can the measure be understood and communicated as having an impact on well-being?
- Is the measure socially divisive/ cohesive?
Does the measure have a high positive equality impact?
- Is the measure consistent with the requirements of the Future Generations Act, and other legislation?
- Does the measure have any biases to the detriment of vulnerable or marginalised groups?
- Does the measure provide any opportunities for widening participation and a more inclusive society?
These principles will form the basis for our approach to easing the current restrictions, and are grounded in distinctively Welsh values.
The broader recovery from the many different ways that the current emergency has impacted on Wales represents the biggest challenge we have faced as a devolved government.
This vital work will impact all areas of Welsh peoples lives; it will be profoundly important for public services, for the economy and society. The Counsel General and Minister for European Transition will oversee the coordination of the work inside the Welsh Government to respond to the crisis, and draw in expertise and experience from outside government to ensure our preparations for future recovery are creative and comprehensive.
This crisis has brought many changes to our daily lives and to the way our public services operate in a very short period. Changes which would have taken months or even years to come about have been delivered in just a few weeks. It is vital that we seize on the changes which can have a positive impact long into the future, for example, greater use of technology for medical consultations, and a re-evaluate where that technology can enable fewer journeys to be made for work, contributing to our long-term climate targets.
Pillar 3: Public health response
COVID-19 related-harm to the people of Wales can occur in 4 key ways:
- firstly, through direct harm to individuals from SARS-CoV2 infection and complications including for those who develop severe disease and in some cases sadly die as a result
- secondly, the harm caused if services including the NHS became overwhelmed due to any sudden large spike in demand from patients with COVID-19 on hospitals, critical care facilities and other key services
- thirdly, harms from non-COVID illness, for example if individuals do not seek medical attention for their illness early and their condition worsens, or more broadly from the necessary changes in NHS service delivery made during the pandemic in Wales to pause non-essential activity
- fourthly, socioeconomic and other societal harms such as the economic impact on certain socioeconomic groups of not being able to work, impacts on businesses of being closed or facing falling customer demand, psychological harms to the public of social distancing and many others.
Measures to ease the restrictions will need to be supported by a comprehensive public health response, to be developed at scale.
The response will require 4 strands:
- improved surveillance
- effective case identification and contact tracing
- learning from international experience
- engaging with the public
Strand 1: Enhancing COVID-19 surveillance
Surveillance will have the primary aim of continuing suppression of infection, with a secondary aim of gathering information on risk groups and outcomes in order to inform vaccination policy (when available). Our COVID-19 surveillance system will monitor transmission in communities, in vulnerable groups and in NHS care settings.
Once a vaccine is available, surveillance will shift to monitoring vaccine impact, uptake, vaccine failures and adverse events, changes in epidemiology and strain variation in the virus, and control of outbreaks. In order to deliver this strand Public Health Wales will lead the design and implementation of a COVID-19 surveillance system.
Strand 2: Case identification and contact management
Surveillance will be supported by a significantly scaled, digitally supported, co-ordinated and locally implemented contact tracing operation across Wales. Coordination during the recovery phase will be undertaken by Public Health Wales, and locally implemented under the leadership of local Directors of Public Health.
Wales has recently enhanced its all-Wales National Health Protection Service. Achieving coordination on the scale needed for our recovery strategy will require a significant upscaling of a much wider public health workforce drawing on existing health protection and environmental health staff, community health staff, the voluntary sector and community groups. To deliver this strand Public Health Wales will develop a standard operating framework for Community Control Teams.
Strand 3: Learning from international experience
Excellent situational awareness and analysis of the effects of international strategies on the lifting of population restrictions is needed; this should include effects on case numbers, deaths, healthcare usage, and acceptability to the public. Various approaches are already being used across different countries, including a gradual stepping down of restrictions in Austria, a more regional approach to measures in the USA and Germany, and more widespread use of technology such as mobile phone contact tracing in Korea and Singapore. Wales will establish a system to monitor, engage with and report on international efforts for recovery. This will allow us to develop a systematic approach to the evaluation of our relaxation of restrictions and to take a public health risk based approach informed by broader social, societal and economic indicators.
Strand 4: Engaging with communities
Throughout the recovery phase, recognising the range of complex interventions and actions that will be put in place, there is a need for strong communication and a conversation with the public at national and local level. As with the behavioural and social controls the recovery plan will require a high level of engagement and buy-in from the public to help mitigate the impact of COVID-19 in the community. The Welsh Government and its partners will continue to give priority to working with the public as we plan together to move into the recovery phase.