Implementation Support Pack

Assurance Strategy and Audit

Implementation Support Pack

6th March 2008

The objective of this pack is to provide a summary of key materials to support SHA Flu Leads, PCT Flu Co-ordinators and key contacts in Acute and Mental Health trusts with Pandemic Flu Preparedness work

Note:Information is correct at the time of publishing. The programme will endeavour to update documentation regularly, however if you have any queries relating to the content of this document please email: [email protected]

This document is not in the public domain. Please restrict circulation to those involved with flu planning.

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An Introduction to Pandemic Flu

• Influenza pandemics are natural phenomena that have occurred three times in the last century.

"Most experts believe that it is not a question of whether there will be another severe influenza pandemic but when” Chief Medical Officer 2002.

• It is recognised that the likelihood of a high pathogenic human influenza virus, capable of causing a pandemic, evolving in the near term is real but unquantifiable.

• This unquantifiable probability must be set against the possible huge impact of a pandemic. In the worst case a pandemic would have a massive impact, with many millions of people worldwide becoming ill and a proportion of these dying. In the UK this could mean up to half the population may become ill and up to 750,000 additional deaths.

• A pandemic will impact on all aspects of UK society. In the worst case scenario, with no interventions taken, the possible cumulative costs of a pandemic to society have been estimated to be up to £1,242 billion.

• The World Health Organization (WHO) currently advise that, out of six levels of alert, we are in the pandemic alert period at phase 3, where there are human infections with a new type of virus, but there is not efficient and sustained transmission from person to person. Phase 6 would be the start of a pandemic.

• As a pandemic flu virus has yet to emerge, we do not know how infectious it will be, or the severity of the illness it will cause. We do know that it is likely to take only a few weeks between a pandemic virus emerging somewhere in the world and it reaching the UK, and that it will spread quickly to all parts of the UK. As it will be too late to secure stocks of countermeasures once the pandemic virus has emerged, we need to allow some time to procure stocks and to ensure a response strategy can be implemented in the NHS. Therefore, decisions need to be taken in the pandemic alert period, before a pandemic emerges. This is supported by the WHO state “in view of the immediacy of the threat, WHO recommends that all countries undertake urgent action to prepare for a pandemic”*.

*Responding to the avian influenza pandemic threat. Recommended strategic actions. WHO. Page 1

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Useful reference documents

There are two useful reference documents that help build an understanding of the subject of pandemic flu.

Pandemic Flu Frequently Asked Questions

To open double click on the icon below

Pandemic Flu Key Facts

To open double click on the box below

FAQs

Key facts

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The programme’s intervention strategy

The programme’s intervention strategy is based on the need for ‘defence in depth’.

This strategy aims to

• Reduce amount of illness caused by pandemic flu

• Reduce number of deaths which result from pandemic flu

• Manage the increased pressure on the NHS and Social Care Services

The programme is building up capability in several areas to deliver to the above programme objectives

• Clinical countermeasure stockpiles are being built up e.g. Antivirals, antibiotics, face masks etc

• Infrastructure to deliver the pandemic response across the NHS and Social care is being built e.g. the national flu line service, surveillance mechanisms

• Processes are being put in place to ensure the right information is available to inform management of a pandemic emergency situation, such as identifying key information required by Ministers

• Public preparation and confidence is being built up through a public health and hygiene campaign

• A programme of public engagement is testing how the public will respond to proposed policy

The programme is also helping the NHS and the Social Care field prepare

• Health and social care service planning and preparation work is underway in the NHS

The programme is also liaising with the wider business continuity work being undertaken by the Department, in the Emergency Preparedness Division


Summary of outputs from the Programme

Guidance

Position on countermeasures

Communications and training materials

Contact details

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Pandemic preparedness health guidance available

Guidance Current status Guidance document Document owner

A national framework for responding to an influenza pandemic Published Department of Health

Guidance for primary care trusts and primary care professionals on the provision of healthcare in a community setting

Published Department of Health

The ethical framework for policy and planning Published Department of Health

+ Cabinet Office

Guidance on preparing acute hospitals in England Published Department of Health

Guidance for ambulance services and their staff in England Published Department of Health

Planning for pandemic influenza in adult social care Published Department of Health

Guidance on the management of death certification and cremation certification

Consultation ends 22/0208

Draft Department of Health

Guidance on preparing mental health services in England



Surge Capacity and prioritisation in health services Provisional UK Guidance



Possible amendments to medicines and associated legislation during an influenza pandemic

Consultation ends 22/02/08

Draft Department of health

Human Resources guidance for the NHS


Draft NHS Employers + Department of Health

To open the document double click on the box below

National framework

Ethical framework

Acute

Primary care

Ambulance

Social care

Death + Cremation

Mental health

Surge capacity

HR

Medicines

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Pandemic preparedness infection control guidance available


Guidance for funeral directors Published HPA + Department of Health

Guidance for cleaning staff and refuse collectors in non-healthcare settings Published HPA + Department of Health

Guidance for fire and rescue service Published HPA + Department of Health

Guidance for the hospitality industry Published HPA + Department of Health

Guidance for infection control for hospitals and primary care settings Published HPA + Department of Health

Guidance for infection control in healthcare setting Published HPA + Department of Health

Guidance for the police service Published NPIA


Funeral directors

Cleaning

Fire and rescue

Hospitality

Police

Primary

Healthcare

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Infection control training materials available

Posters Current status Document Document owner

Poster: Prepare and Protect Published Department of Health

Poster: Hand-washing technique Published Department of Health

Poster: Alcohol hand-rub technique Published Department of Health

For access to the infection control training video go to

http://www.coionline.tv/singleVideo.php?vID=videos/flu.flv

Hand washing

Alcohol hand-rub

Prepare and protect


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Pandemic preparedness non health guidance available


Overarching government strategy to respond to an influenza pandemic – analysis of the scientific evidence base

Published Cabinet Office

Planning for a possible influenza pandemic a framework for planners preparing to manage deaths

Published Home Office

Guidance documents to help schools and other bodies

For further information go to

http://www.teachernet.gov.uk/emergencies/planning/flupandemic/

Published Department for Children, Schools and Families

Introductory material on pandemic influenza for businesses communicating with their staff


Pandemic Flu Checklist for businesses Published Cabinet Office

Preparing for pandemic influenza – guidance to local planners (including check list for Local Resilience Forum plans)


HSE workplace guidance Published Health and Safety Executive

To open the document double click on the icon below

For more information go to

http://www.ukresilience.info/latest/human_pandemic.aspx

Overarching strategy

Planners for death

Schools

Businesses

Planner + check list

Check list

HSE

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Pandemic preparedness health guidance in progress


Further work on surge capacity In progress Not yet issued Scottish government

Contact: Scott Henderson

‘Hard to reach groups’ guidance In progress Not yet issued Department of Health

Contact: Catherine Heffernan

GP practices In progress Not yet issued RCGP, BMA and DH

Contact: Amy McCullough

Dentistry In progress Not yet issued Department of Health

Contact: Tony Jenner

Pharmacy professionals In progress Not yet issued Department of Health

Contact: Gul Root

Guidance for pandemic flu in pregnancy In progress Not yet issued Department of Health Contact: Chloe Sellwood

Infection control for critical care units In progress Not yet issued HPA

Contact: Carole Fry (DH)

Guidance for Faith Communities and Local Influenza Pandemic Committees In progress Not yet issued Communities and local government

Contact: John Perkins

This is information is correct as of February 2008To review latest guidance published, see the DH website

http://www.dh.gov.uk/en/Publichealth/Flu/PandemicFlu/index.htm

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Summary of key sources

• Guidance published by the Department can be found http://www.dh.gov.uk/en/Publichealth/Flu/PandemicFlu/index.htm

• Guidance published by the Cabinet Office can be found http://www.ukresilience.info/latest/human_pandemic.aspx

• Guidance published by HPA can be found http://www.hpa.org.uk/infections/topics_az/influenza/pandemic/default.htm

• Guidance published by HSE can be found http://www.hse.gov.uk/biosafety/diseases/pandemic.htm

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Summary of the programme’s countermeasures strategy

• The programme has devised an intervention strategy, for use in the event of a pandemic, based on the need for ‘Defence in Depth’. This strategy aims to

– Minimise illness and death

– Reduce the burden on the NHS

– Reduce economic impact of a pandemic

• There are four layers to the ‘Defence in Depth’ strategy, these are reflected the portfolio of countermeasures the programme proposes to procure.

Figure 3 - Illustration of the Defence in Depth strategy

Reduce the spread of the virus

• The first line of the ‘defence in depth’ model is to reduce the spread of the virus, this is achieved through good public hygiene habits, social distancing measures and the use of facemasks.

Reduce the number of cases

• The next layer of defence aims to reduce the number of people who get the symptoms of flu. This is achieved through the use of vaccines and antiviral prophylaxis.

Reduce length and severity of symptoms, reduce the risk of complications, hospitalisations and deaths

• The following layers aim to reduce the number of symptomatic people who get complications and reduce the number of people with complications who die or become chronically ill through use of antivirals and antibiotics.

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Summary of countermeasures to be procured by the programme

Countermeasure What is it? Current national stockpile

Capacity in current NHS supply chain

Proposed stockpile Estimated date to start stockpile

Estimated date to complete stockpile

Face masks Protective mask to cover mouth and nose

100,000 FFP3 respirators 250,000 surgical masks

Unknown Facemasks for health and social care workers

Jan 2009 Beginning 2010

Antivirals Treatment that will reduce the duration of the flu for a patient and the risk of complications

14.6m courses of Tamiflu

Limited to seasonal use Enough antivirals to treat 50% of the population

By March 2009 End 2009

Antibiotics Treatment for bacteria complications that arise as the result of the flu

None Limited to normal supply chain –estimated 3 weeks supply

14.7m courses of antibiotics to treat all those with complications

By March 2009 By the end of 2010

Pandemic specific vaccine

A vaccine that will be developed against a specific strain of the virus. It will only be available in subsequent waves of a pandemic

None None Access to supply for 100% of the population, if required (this will not be available immediately, it make take several months)

Advance supply agreement signed in July 2007 for a 4 year period.

Consumables 8 categories of consumables that will enable the above countermeasures to be administered e.g. syringes

None Unknown Required to support delivery of pandemic countermeasures

By March 2009 By the end of 2010

Pre-pandemic vaccine

Vaccine for use against the H5N1virus

Programme is currently reviewing how pre-pandemic vaccine could be used.

Antivirals for household prophylaxis

Household prophylaxis - giving antivirals to all members of a household when one family member is symptomatic

Programme is currently reviewing how antivirals could be used to follow a policy of household prophylaxis

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Template for Consumables

A framework of the consumable items that may be in short supply to trusts / health care providers during an influenza pandemic was drafted in Autumn 2007 and shared with SHA Flu Leads.

The Department of Health is not creating a complete, comprehensive list of items that all trusts / health care providers will need. However the below list is provided as a guide to stimulate local discussion with local experts as to what items are required and in what quantities.

Click the icon below to open up the consumables template

Template for consumables

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Scientific Evidence Papers


Risk of a human influenza pandemic emerging from Avian H5N1 viruses Published Department of Health

The use of face masks during an influenza pandemic Published Department of Health

The use of antibiotics for pandemic influenza Published Department of Health

Use of antiviral drugs in an influenza pandemic Published Department of Health

Pre-pandemic and pandemic influenza vaccines Published Department of Health

Antibiotics

Antivirals

H5N1

Face masks

Vaccines

Tables


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Campaign materials

Posters Current status Document Document owner

CATCH IT, BIN IT, KILL IT

Catch it, Bin it, Kill it poster A3 Published Department of Health

Catch it, Bin it, Kill it poster A4 Published Department of Health

Local action pack Published Department of Health

Summary of regional advertising activity Published Department of Health

Summary of supporting research Published Department of Health

COUGHS AND SNEEZES SPREAD DISEASES

Poster Published Department of Health

Letter from Professor Lindsey Davies Published Department of Health

WET, SOAP, WASH, RINSE, DRY

Poster Published Department of Health

For access to further materials including a screensaver go to - http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_080839


A3

A4

Local action plan

Poster

Letter

Poster

Regional activity

Research


Communications & Stakeholder Management

Communications &StakeholderRelationship

ManagerFiona Carr

Internal CommunicationsBridget Le Good

Respiratory and Hand Hygiene

CampaignsNicola Lewis

CommunicationsFor Vulnerable & Hard To Reach

GroupsAlison Langridge

Communications Support

Sarah Wheller

Clinical Countermeasures & Business Case

Clinical Countermeasures

ManagerDamien Bishop

Business Case Manager

Mark Thomas

Budget ManagerPaul Winslow

Budget SupportAnita Sharma

Healthcare

Primary Care/Community Setting Manager

Amy McCullough

Antiviral Project Office ManagerVasanti Shirodkar

Audit Tool SMERichard Puleston

Distribution arrangements/Audit Tool

Tony McDermott

Stock management ArrangementsUmesh Kumar

Mental Health/Vulnerable

Groups ManagerCatherine Heffernan

Pandemic Flu in Pregnancy Manager

Chole Sellwood

Clinical Advisor/Engagement with the ProfessionalsBarbara Bannister

Healthcare SupportKola Okunola

Legal, International, Cross Government &

Briefing

International & Cross Government Lead

Jo Newstead

Legal, International,Briefing

Neri Ineneji

Cross-Govt, Ethics, UKNIP, Briefing

Greg Hartwell

Briefing/SecretariatLorna Wilkinson

Administrative Support

Samuel Stewart

Science & Surveillance

Science Manager

Sandra Costigan

Surveillance Manager

Arlene Reynolds

Surveillance Clinical

Network DatabaseJane Leese

Scientific Manager

Colin Armstrong

Surveillance/SAG/Secretariat/ Support

Noorie Beeharry

National Director for Pandemic Influenza PreparednessLindsey Davies

Senior PA to National DirectorTanya Nickols

Programme Management OfficeLloyd Thomas (Contractor), Kevyn Austyn

Dan Oligive (Contractor), Anya Tahir

Programme DirectorKaren Fitzgerald

Branch HeadBruce Taylor

Branch HeadHelen Shirley Quirke

Implementation

Social careSimon Cole

Ian Summerscales

NHS ImplementationRuth Whitfield

NHS LiaisonJohn Pullin

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Key programme contacts

Subject area First Surname Telephone no. EmailNational Director Lindsey Davies 020 7210 5753 [email protected]

Programme Director Karen Fitzgerald 020 797 21897 [email protected]

Deputy Director - remit includes Healthcare Bruce Taylor 020 797 25526 [email protected]

Deputy Director - remit includes Social care Helen Shirley-Quirk 020 797 26556 [email protected]

NHS Implementation Ruth Whitfield 020 797 25809 [email protected]

NHS Liaison John Pullin 020 797 25595 [email protected]

NHS Implementation Board (PMO) Kevyn Austyn 020 797 25578 [email protected]

NHS Implementation Board (PMO) Anya Tahir 020 797 25600 [email protected]

Audit tool technology + distribution Tony McDermott 020 797 25619 [email protected]

Primary Care (includes National Flu line) Amy McCullough 020 797 25702 [email protected]

Antiviral project office Vasanti Shirodkar 020 797 25588 [email protected]

Communications Fiona Carr 020 797 25171 [email protected]

Communications Nicola Lewis 020 797 25375 [email protected]

Communications - Flu news Alison Langridge 020 797 25387 [email protected]

Social care Ian Summerscales 020 797 26567 [email protected]

Social care Simon Cole 020 797 25363 [email protected]

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Extended Programme Structure

DMB Programme Representation

(reviews quarterly)

Programme Board(meets six weekly)

NHS Implementation Board

(meets every 4 weeks)

Operational Management Board

(meets fortnightly on informal basis and formally

once every six weeks)

Workstreams

X-DH Reference Groups UKNIP, SAG, EPCLAG

Programme Sponsor

SRO

Programme Director

SHA Flu Teams

MISC 32(meets quarterly)Flu Working Group

MISC 32 provides cross-government strategic direction / issue resolution and ensures strategy is aligned

DMB responds to escalated decisions & issues which affect stated ministerial & departmental positions

Operational Management Board actively coordinates and manages day to day risks, issues, conflicts and priorities of the PIG workstreams. PIG / Project Chairs are represented at formal meetings (together with DA, Finance and HPA representatives). PIG Leads participate in informal meetings.

Pandemic Influenza Groups (PIGS) /Project Boards take place regularly to discuss progress / risks and resolve issues on the day to day running of the workstream (eg: Health Care, Clinical Counter Measures, National Flu Line, Business Case etc).

The structure is designed to provide both strategic and operational direction to the programme. The complexity of the programme means that multiple stakeholders are involved in delivery. The governance process integrates these groups.

• Business Case

• Communications

• Countermeasures

• Healthcare

• Pharmacy

• Research

• Surveillance

• Social Care

• X-Cutting

Programme Board provides leadership, oversees the implementation of strategy and interacts with key stakeholders

NHSIB provides a bridge between the programme & regional operations & is responsible for the local implementation of the preparedness plan.

Programme Manager

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SHA Flu Leads contact details

SHA NAME EMAIL & ADDRESS PHONE

London Jackie SpibyPandemic Flu Lead(& Public Health Consultant)Karen HetheringtonNHS London Pandemic Flu Coordinator (Acting)

[email protected]

[email protected]

020 7732 3865020 7759 281307790 708 559

East of England

Linda SheridanNHS Head of Public Health (Delivery of Health Programmes) David WalkerEmergency Planning & Public Health Manager

[email protected]

[email protected]

01223 597 50707932 306 319 01223 597 583 – 07507 645 981

East Midlands Lindsey BeasleyHead of Emergency Planning

[email protected] 0115 968 4482

North East Eugene MilneDeputy RDPH (Strategy)


North West Kate ArdernAssociate Director of Public HealthFrank WhitefordAssociate Director of Health Service Resilience

[email protected]

[email protected]

0161 625 72500161 625 7275 07825 080 031

South Central Debbie LewisEmergency Planning Manager

[email protected] 01635 275 50507825 448258

South East Coast

Anna TaylorProject Manager Emergency Planning and Resilience

[email protected] 0129 377 882407810 056802

South West Jody JamesAssociate Director of Regional Resilience


West Midlands Gillian SmithRegional Epidemiologist

[email protected] 0121 634 8757 – 07753 904 599

Yorks & Humber

Sally BellEmergency Planning and Resilience Lead


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Healthcare PIG members contact details

Name Organisation Email Address Name Organisation Email Address

Amy McCullough DH [email protected] Linda Bailey RCN [email protected]

Barbara Bannister DH [email protected] Martyn Rees Welsh Assembly [email protected]

Bruce Taylor Intensive Care Society

[email protected] Maureen Baker RCGP [email protected]

Carole Fry DH [email protected] Meena Paterson DH [email protected]

Catherine Heffernan DH [email protected] Margaret Lally Red Cross [email protected]

Claire Crawley DH [email protected] Nick Phin HPA [email protected]

Debbie Mellor DH [email protected] Nigel Edwards NHS Confederation [email protected]

Fiona Carr DH [email protected] Peter Grove DH [email protected]

Gerry McSorley Lincoln College [email protected] Richard Bedford NHS Blood Transfusion Service

[email protected]

Gordon Wall NHSBSA [email protected] Rodney Burnham RCP [email protected]

Helen Shirley Quirk DH [email protected] Russ Mansford DH [email protected]

Janet Meacham DH [email protected] Sally Bell Yorks and Humber SHA

[email protected]

John Pullin DH [email protected] Scott Henderson Scottish Government [email protected]

John Coakley Homerton Hospital [email protected] Sharon Terry DH [email protected]

Judy Wilson Customer Rep [email protected] Steven Weeks NHS employers [email protected]

Keith Young DH [email protected] Steven Wibberley NHS Direct [email protected]

Lindsey Davies DH [email protected] Tanya Nickols DH, DH [email protected]

Lorraine Doherty DHSSPSNI [email protected] Tim Young DH [email protected]

Luke Perera DH [email protected] Tony Jenner DH [email protected]

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Dentistry PIG contact details

Name Email Address Role Contact Number

Tony Jenner (CHAIR) [email protected] Deputy Chief Dental Officer 020 7633 4247

Lindsey Davies [email protected] National Director Pandemic Influenza 020 7210 5753

Amy Mccullough [email protected] Pandemic Flu Primary Care Manager 020 797 25702

Amit Bose [email protected] Policy Manager, Commissioning & System Management Directorate

020 797 25702

Lesley Derry [email protected] Head of Professional Services, British Dental Association N/A

Paul Langmaid [email protected] Chief Dental Officer for Wales N/A

Kate Taylor Weetman [email protected] Consultant in Dental Public Health N/A

Henrik Nielsen [email protected] N/A

Mark Shackell [email protected] Consultant in Dental Public Health, Essex Public Health Resource Unit

01376 302268

Serbjit Kaur [email protected] Head of Quality and Standards, Commissioning & System Management Directorate

0207 633 4252

Richard Emms [email protected] N/A

Nick Phin [email protected] N/A

Susan Bruckel [email protected] N/A

Angie Mcbain [email protected] BADN President 07515 579 320

Chris Audrey [email protected] Head of Primary Dental Services, Dental & Eye Care Services

Directorate of Commissioning & System Management

020 7633 4149

Margie Taylor [email protected] Chief Dental Officer, Scotland N/A

Alan Taylor [email protected] Lead Clinician & Senior Dental Officer, Oxfordshire Salaried Primary Care Dental Service

01869 604052

Carole Fry [email protected] Nursing Officer, Health Improvement and Protection Directorate 020 797 24419


Summary of planning support materials

Implementation timings

Planning assumptions

Exercise feedback

Page │ 24

Feb Apr Jun Aug Oct Dec

A summary of key dates for NHS preparedness planning 2008

Key meetings

31/01Audits

complete

Jan

Current timingsAudit tools for• Acute• Community• Ambulance

Mar May Jul Sept Nov Jan

20/03 SHA confirm results

30/04 Action plans

complete

06/08 Implementation

check point

31/10Implementation

deadline

14/11Re-audit

completed

23/04 NHS Management Board update

tbc/10 NHS Management Board update

tbc/01 NHS Management Board update

= Milestone

= Meeting

Key = Programme activity

10/04 Actions plans

reviewed

10/06SC Audit launched

26/09Audit

completed

23/06 NHS National

Workshop

31/10 Action plans

complete

Proposed audit tool timing for

• SHA

• Mental health

• Social care

Programme work Agree forward look of

programme of exercises required

Agree the measure and target for an acceptable level of preparedness by end 2007

05/12 SHA

confirm results

Update to NHS Man. Board on audit results

Update to NHS Man. Board on audit results

21/03 SHA audit launched

04/04 Audit completed

15/05 mental health audit launched

30/05 audit completed



04/07 Action plans

complete

Programme delivers support to NHS Implementation

Programme offers independent review of plans/flu squad challenge sessions

Indicative timings*

Indicative timings*

Indicative timings*

*Indicative timings will be confirmed as soon as possible

tbc = to be confirmed. These will be confirmed as soon as possible.

Draft

Restricted: Policy

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Pandemic preparedness planning principles

The National Framework articulates the planning principles upon which the health and social care response to a pandemic should be planned

• Response arrangements should be based on strengthening and supplementing normal delivery mechanisms as far as is practicable

• Plans should be developed on an integrated multi-agency basis with risk sharing and cross-cover between all organisations

• Plans should encourage pan-organisational working, seeking to mobilise capacity and skills of all public and private sector healthcare staff, contractors and volunteers

• Response measures should maintain public confidence and ‘feel fair’

Source: National Framework, p94,95

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Plans should account for the following assumptions on how healthcare will be delivered during a pandemic

The National Framework explains that the NHS should plan on the basis that normal patient pathways and service delivery arrangements will need to be adapted. It suggests that plans should assume use of the following

1. From WHO Phase 6, UK Alert Level 2 a National Flu Line Service is activated to enable symptomatic patients rapid access to a assessment, advice and, if appropriate, antiviral medicine treatment and onward referral. This includes triage to another healthcare professional where further advice and care is required. The Flu Line Service is intended to help preserve primary healthcare capacity for seeing those people that most need their services, as well as facilitating rapid access to antiviral treatment

2. Provision of a wider range of treatments by health professionals other than GPs e.g. nurses following agreed guidelines

3. Care of patients, who under normal circumstances would be admitted to hospital, in their own home/residential settings

4. Treatment of severely ill patients in areas of a hospital not normally used for providing acute medical care by medical and nursing teams who do not normally manage such patients

5. Treatment of patients in private healthcare facilities not normally used for acute medical care by healthcare teams that do not normally manage such patients

6. Managing surge demand during the pandemic will require a focus on delivering essential services

Note:

DH is currently consulting on necessary changes to medicines or other legislation that may be required to implement these alternative operational arrangements

Source: National Framework, p97

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Plans must take account of the following surge management assumptions

Introduction

At WHO Phase 6, Alert Level 2 respective health departments will need to make decisions to reduce or change NHS services and, where appropriate, to modify or suspend some normal performance targets.

Health and social care organisations need to ensure their plans include provision for enhancing, scaling down, or ceasing some services at the pandemic threat increases. Their planning should be based on the following surge assumptions

Source: National Framework, p95, 96

• Up to 50% of the population may show clinical symptoms,

up to 25% of those may develop complications

• Up to 2.5% of those who become symptomatic may die

• Up to 22% of cases can be expected in the ‘peak week’ of

a pandemic wave

• Up to 28.5% of symptomatic patients will require

assessment and treatment by a general medical

practitioner or experience nurse

• Up to 4% of those symptomatic may require hospital

admission, average length of stay for those with

complications may be 6 days (10 if in intensive care)

• A short epidemic would be greater strain on services than

a lower-level but more sustained one

• Hospitalisations and deaths are likely to be greatest if the

highest attack rates are in older people, lowest burden if

highest attack rates are in adults aged 15-64

• Total healthcare contacts for influenza –like illness could

be up to 30 million

• Peak demand could last for 1-2 weeks, local epidemic

waves 6-8 weeks

• Most patients will be treated at home with antiviral

medicines initially

Severity of illness assumptions* Health and social care demand assumptions*

* All statistics are based on national planning assumption attack rate of 50%Further information can be found in the Primary care guidance and managing surge guidance

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Planners are asked to plan on the basis of a clinical attack rate of up to 50%

Expected healthcare demand over the course of a pandemic

Per 100,00 people Per GP practice

Clinical cases 50,000 2,900

GP consultations 14,250 2,900

Hospital admissions 2,000 120

Deaths 1,250 80

Expected healthcare demand during the peak of a pandemic

Per 100,00 people Per GP practice

Clinical cases 11,000 640

GP consultations 3,135 185

Hospital admissions 440 30

Deaths 280 20

Planning will assume a clinical attack rate of up to 50%, the table below shows the surge in demand healthcare providers must plan for.

Source: National Framework, p96, 97 * All statistics are based on national planning assumption attack rate of 50%. This is assumed to be a worst case attack rate/

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The following assumptions should underpin Primary Care planning

Source: National Framework, p107-113

Area Category Planners should assume…

Primary care • National Flu Line Service

• From WHO Phase 6, UK Alert Level 2 a 24/7 National Flu Line service will be activated to enable symptomatic patients rapid access to a assessment, advice and, if appropriate, antiviral medicine treatment and onward referral. This includes triage to another healthcare professional where further advice and care is required. The Flu Line Service is intended to help preserve primary healthcare capacity for seeing those people that most need their services, as well as facilitating rapid access to antiviral treatment

• That the National Flu Line service will be in place, with a minimum specification, by Winter 2008

• Automated channels such as the web and non clinical staff with access to clinical supervisions will be used to provide initial assessment for patients and either to authorise collection of antivirals or refer patients to GP as appropriate

• Although the Flu Line is intended to meet the majority of demand for antivirals some will still need to be issued through existing primary care arrangements. General practice for example will need to be able to issue antivirals when on home visits. Other services that are likely to need a local stockpile include hospitals for inpatient use. These antivirals will come from the central stockpile the programme is currently building

• Secure systems will allow for the collection of an antiviral treatment course and self-care leaflet by a friend, from a designated centre

• That Antiviral medicines should initially be available to all patient who have been symptomatic for less than 48 hours (unless clinically contra indicated)

• Primary care services

• That primary care services will need to continue provision of essential primary care

• That arrangements are required to deliver pandemic influenza programmes including targeted vaccination as/when available and antiviral supply and issuing

• Demand for primary care services

• That General practice can expect to see 3,135 influenza patients per 100,000 of population per week at the peak*

• That parents/guardians of symptomatic children weighing 15kg or less will need to contact a GP

• That although visiting all cases will not be possible, primary care plans should be based on influenza patients avoiding leaving home as far as possible

• That plans must recognise the need to respond to psychosocial issues and concerns such as anxiety, grief and distress and for sympathetic arrangements to manage additional fatalities

* All statistics are based on national planning assumption attack rate of 50%. This is assumed to be a worst case attack rate/

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The following assumptions should underpin Primary Care planning



Primary care continued • Prioritising care • That Primary care response strategies should focus the available capacity and clinical skills primarily on treating those suffering with the complications of influenza or requiring other essential clinical care and assessing young children or patients in groups identified at being at particular risk

• That treatment and admission criteria should remain clinically based

Community Pharmacies • Services • Community pharmacies will contribute to support self-care, dispensing/repeat dispensing of routine medicines, signposting other NHS services, supplying regular medicines to vulnerable people, maintaining medicine supplies under contracts with other bodies e.g. mental health trusts etc

• New powers may be given to community pharmacists, to ease burden on GPs, consultation on this is in progress

Dentistry • Services • Emergency care should remain throughout the pandemic

• Skills of local dental practitioners should be used to support wider delivery of healthcare in a pandemic

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The following assumptions should underpin PCT planning



PCT • Role of the PCT That role of the PCT is to

• Act as a focal point to provide a link to and oversight of the local health response, working with the SHA

• Monitor and coordinate the overall health response

• Maintain the continuing provision of primary care services (including GP and Community pharmacy) in/out of hours

• Collect, collate and report information on local health situation

• Link with social care and other agencies to support delivery of care and maintain patients at home

• Provide local link and health input and advice to the wider local coordination arrangements

• Ensure national messages cascaded from SHAs are reinforced

• Ensure the public are well informed and advised on local response arrangements

• Co-ordinate key pandemic influenza programmes including the supply and issuing of antivirals and a programme of specific vaccine, if and when it becomes available

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The following assumptions should underpin planning for acute care



Acute care • Provision of services • That provision for emergency treatment will need to continue

• That that some symptomatic patients will present at accident and emergency departments, GP, pharmacies etc

• That plans should recognise the need to respond to psychosocial issues and concerns such as anxiety, grief and distress and for sympathetic arrangements to manage additional fatalities

• Demand for services • That 2,000 per 100,000 population may need hospital admission for acute respiratory and related conditions

• That demand for hospital admission can be expected to increase up to 440 new cases per 100,000 population per week at the peak

• That demand for critical care beds could rise up to 110 per 100,000 population per week at the peak

• Prioritising care • That agreed and consistently applied clinical criteria and thresholds for hospital admission are required

• That critical care will need to be prioritised

• That treatment and admission criteria should remain clinically based and hospital admission criteria should be applied in a transparent, consistent and equitable way that uses the capacity available for those who are most seriously ill and most likely to benefit

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The following assumptions should underpin Ambulance, Mental health and Social care planning



Ambulance Service • Services • Ambulance services will be expected to maintain capacity to answer all emergency and urgent calls, some prioritisation and reduction in normal response time standards may become unavoidable

• Plans should recognise the need to respond to psychosocial issues and concerns such as anxiety, grief and distress and for sympathetic arrangements to manage additional fatalities

Mental health • Services • It should be assumed that may not be possible to move those with significantly disturbed behaviour to other settings

• Plans should recognise the need to respond to psychosocial issues and concerns such as anxiety, grief and distress and for sympathetic arrangements to manage additional fatalities

• Demand • Mental health trusts may experience increasing demands on services due to the impact of the pandemic on individuals and families

• Infection control • Contingency plans should include infection control measures to minimise spread of influenza in residential establishments

Community Pharmacies • Services • Community pharmacies will contribute to support self-care, dispensing/repeat dispensing of routine medicines, signposting other NHS services, supplying regular medicines to vulnerable people, maintaining medicine supplies under contracts with other bodies e.g. mental health trusts etc

• New powers may be given to community pharmacists, to ease burden on GPs, consultation on this is in progress

Dentistry • Services • Emergency care should remain throughout the pandemic

• Skills of local dental practitioners should be used to support wider delivery of healthcare in a pandemic

Social care • Demand • Must anticipate the need for additional short term and short notice demand from influenza sufferers no longer able to cope independently and others whose normal care arrangements have been disrupted

National Blood Service • Services • Blood, tissue and organ supply will be continued

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Planners may want to review feedback from the following exercises


Phoenix and New Day Published HPA

United Endeavour 2 Published HPA

Exercise programme Published HPA

Phoenix New Day

United Endeavour 2

Exercise Programme


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Disclaimer

In carrying out our work and preparing our report, we have worked solely on the instructions of Department of Health and for Department of Health’s purposes. It should not be provided to any third party without prior written consent. Our report may not have considered issues relevant to any third parties, any use such third parties may choose to make of our report is entirely at their own risk and we shall have no responsibility whatsoever in relation to any such use.

The information in this pack is intended to provide only a general outline of the subjects covered. It should not be regarded as comprehensive or sufficient for making decisions, nor should it be used in place of professional advice. Accordingly, Assurance Strategy and Audit accepts no responsibility for loss arising from any action taken or not taken by anyone using this pack.

The information in this presentation pack will have been supplemented by matters arising from any oral presentation by us, and should be considered in light of this additional information.

Implementation Support Pack

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