Implementation Support Pack

1
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
pandemicflu_at_dh.gsi.gov.uk This document is not
in the public domain. Please restrict circulation
to those involved with flu planning.
2
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

3
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

4
The programmes intervention strategy

• The programmes 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

5
Summary of outputs from the ProgrammeGuidanceP
osition on countermeasuresCommunications and
training materialsContact details
6
Pandemic preparedness health guidance available
To open the document double click on the box below
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 Consultation ends 22/0208 Draft Department of Health
Surge Capacity and prioritisation in health services Provisional UK Guidance Consultation ends 22/0208 Draft Department of Health
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 Consultation ends 22/0208 Draft NHS Employers Department of Health
7
Pandemic preparedness infection control guidance
available
To open the document double click on the box below
Guidance Current status Guidance document Document owner
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
8
Infection control training materials available
To open the document double click on the box below
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.p
hp?vIDvideos/flu.flv
9
Pandemic preparedness non health guidance
available
To open the document double click on the icon
below
Guidance Current status Guidance document Document owner
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 Published Cabinet Office
Pandemic Flu Checklist for businesses Published Cabinet Office
Preparing for pandemic influenza guidance to local planners (including check list for Local Resilience Forum plans) Published Cabinet Office
HSE workplace guidance Published Health and Safety Executive
For more information go to http//www.ukresilienc
e.info/latest/human_pandemic.aspx
10
Pandemic preparedness health guidance in progress
Guidance Current status Guidance document Document owner
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
2008 To review latest guidance published, see the
DH website http//www.dh.gov.uk/en/Publichealth/F
lu/PandemicFlu/index.htm
11
Summary of key sources

• Guidance published by the Department can be found
  http//www.dh.gov.uk/en/Publichealth/Flu/Pandemic
  Flu/index.htm
• Guidance published by the Cabinet Office can be
  found http//www.ukresilience.info/latest/human_pa
  ndemic.aspx
• Guidance published by HPA can be found
  http//www.hpa.org.uk/infections/topics_az/influen
  za/pandemic/default.htm
• Guidance published by HSE can be found
  http//www.hse.gov.uk/biosafety/diseases/pandemic.
  htm

12
Summary of the programmes 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.

13
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. 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. Programme is currently reviewing how pre-pandemic vaccine could be used. Programme is currently reviewing how pre-pandemic vaccine could be used. Programme is currently reviewing how pre-pandemic vaccine could be used. 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 Programme is currently reviewing how antivirals could be used to follow a policy of household prophylaxis Programme is currently reviewing how antivirals could be used to follow a policy of household prophylaxis Programme is currently reviewing how antivirals could be used to follow a policy of household prophylaxis Programme is currently reviewing how antivirals could be used to follow a policy of household prophylaxis
14
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

15
Scientific Evidence Papers
To open the document double click on the box below
Guidance Current status Guidance document Document owner
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
16
Campaign materials
To open the document double click on the icon
below
Posters Current status Document Document owner
CATCH IT, BIN IT, KILL IT CATCH IT, BIN IT, KILL IT CATCH IT, BIN IT, KILL IT 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 COUGHS AND SNEEZES SPREAD DISEASES COUGHS AND SNEEZES SPREAD DISEASES 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/Public
ationsandstatistics/Publications/PublicationsPolic
yAndGuidance/DH_080839
17
National Director for Pandemic Influenza
Preparedness Lindsey Davies Senior PA to
National Director Tanya Nickols
Pandemic Influenza Core Team
Programme Director Karen Fitzgerald
Programme Management Office Lloyd Thomas
(Contractor), Kevyn Austyn Dan Oligive
(Contractor), Anya Tahir
Branch Head Bruce Taylor
Branch Head Helen Shirley Quirke
Communications Stakeholder Management Communi
cations Stakeholder Relationship Manager Fiona
Carr Internal Communications Bridget Le
Good Respiratory and Hand Hygiene
Campaigns Nicola Lewis Communications For
Vulnerable Hard To Reach Groups Alison
Langridge Communications Support Sarah Wheller
Clinical Countermeasures Business
Case Clinical Countermeasures Manager Damien
Bishop Business Case Manager Mark
Thomas Budget Manager Paul Winslow Budget
Support Anita Sharma
Healthcare Primary Care/Community Setting
Manager Amy McCullough Antiviral Project Office
Manager Vasanti Shirodkar Audit Tool SME Richard
Puleston Distribution arrangements/ Audit
Tool Tony McDermott Stock management
Arrangements Umesh Kumar Mental
Health/ Vulnerable Groups Manager Catherine
Heffernan Pandemic Flu in Pregnancy
Manager Chole Sellwood Clinical
Advisor/ Engagement with the Professionals Barbar
a Bannister Healthcare Support Kola Okunola
Legal, International, Cross Government
Briefing International Cross Government
Lead Jo Newstead Legal, International, Briefing N
eri Ineneji Cross-Govt, Ethics, UKNIP,
Briefing Greg Hartwell Briefing/Secretariat Lorna
Wilkinson Administrative Support Samuel
Stewart
Science Surveillance Science Manager Sandra
Costigan Surveillance Manager Arlene
Reynolds Surveillance Clinical Network
Database Jane Leese Scientific Manager Colin
Armstrong Surveillance/SAG/ Secretariat/
Support Noorie Beeharry

Implementation Social care Simon Cole Ian
Summerscales NHS Implementation Ruth
Whitfield NHS Liaison John Pullin
18
Key programme contacts
19
Extended Programme Structure
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.
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
DMB Programme Representation (reviews quarterly)
MISC 32 (meets quarterly)
Flu Working Group
?
Programme Sponsor
Programme Board provides leadership, oversees the
implementation of strategy and interacts with key
stakeholders
Programme Board(meets six weekly)
?
SRO
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.
NHS Implementation Board(meets every 4 weeks)
Operational Management Board(meets fortnightly
on informal basis and formally once every six
weeks)
?
Programme Director
NHSIB provides a bridge between the programme
regional operations is responsible for the
local implementation of the preparedness plan.
?
Programme Manager
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).
Workstreams

• Business Case
• Communications
• Countermeasures
• Healthcare
• Pharmacy

• Research
• Surveillance
• Social Care
• X-Cutting

20
SHA Flu Leads contact details
SHA NAME EMAIL ADDRESS PHONE
London Jackie Spiby Pandemic Flu Lead ( Public Health Consultant) Karen Hetherington NHS London Pandemic Flu Coordinator (Acting) jackie.spiby_at_london.nhs.uk Karen.hetherington_at_hpa.org.uk 020 7732 3865 020 7759 2813 07790 708 559
East of England Linda Sheridan NHS Head of Public Health (Delivery of Health Programmes) David Walker Emergency Planning Public Health Manager Linda.sheridan_at_eoe.nhs.uk David.walker_at_eoe.nhs.uk 01223 597 507 07932 306 319 01223 597 583 07507 645 981
East Midlands Lindsey Beasley Head of Emergency Planning Lindsey.beasley_at_eastmidlands.nhs.uk 0115 968 4482
North East Eugene Milne Deputy RDPH (Strategy) Eugene.milne_at_northeast.nhs.uk 0191 202 3741
North West Kate Ardern Associate Director of Public Health Frank Whiteford Associate Director of Health Service Resilience Kate.ardern_at_northwest.nhs.uk Frank.whiteford_at_northwest.nhs.uk 0161 625 7250 0161 625 7275 07825 080 031
South Central Debbie Lewis Emergency Planning Manager Debbie.lewis_at_southcentral.nhs.uk 01635 275 505 07825 448258
South East Coast Anna Taylor Project Manager Emergency Planning and Resilience Anna.taylor_at_southeastcoast.nhs.uk 0129 377 8824 07810 056802
South West Jody James Associate Director of Regional Resilience Jody.james_at_southwest.nhs.uk 01823 344 303
West Midlands Gillian Smith Regional Epidemiologist Gillian.smith_at_hpa.org.uk 0121 634 8757 07753 904 599
Yorks Humber Sally Bell Emergency Planning and Resilience Lead Sally.bell_at_yorksandhumber.nhs.uk 0113 295 2012
21
Healthcare PIG members contact details
Name Organisation Email Address Name Organisation Email Address
Amy McCullough DH Amy.mccullough_at_dh.gsi.gov.uk Linda Bailey RCN linda.bailey2_at_nhs.net
Barbara Bannister DH Barbara.bannister_at_dh.gsi.gov.uk Martyn Rees Welsh Assembly martyn.rees_at_Wales.GSI.Gov.UK
Bruce Taylor Intensive Care Society bruce.taylor_at_porthosp.nhs.uk Maureen Baker RCGP mbaker_at_rcgp.org.uk
Carole Fry DH Carole.fry_at_dh.gsi.gov.uk Meena Paterson DH Meena.paterson_at_dh.gsi.gov.uk
Catherine Heffernan DH Catherine.heffernan_at_dh.gsi.gov.uk Margaret Lally Red Cross mlally_at_redcross.org.uk
Claire Crawley DH Claire.crawley_at_dh.gsi.gov.uk Nick Phin HPA nick.phin_at_hpa.org.uk
Debbie Mellor DH Debbie.mellor_at_dh.gsi.gov.uk Nigel Edwards NHS Confederation Nigel.edwards_at_nhsconfed.org
Fiona Carr DH Fiona.carr_at_dh.gsi.gov.uk Peter Grove DH Peter.grove_at_dh.gsi.gov.u
Gerry McSorley Lincoln College gmcsorley_at_lincoln.ac.uk Richard Bedford NHS Blood Transfusion Service rbedford_at_btinternet.com
Gordon Wall NHSBSA gordon.wall_at_nhsbsa.nhs.uk Rodney Burnham RCP rodney.burnham_at_rcplondon.ac.uk
Helen Shirley Quirk DH Helen.shirley-quirk_at_dh.gsi.gov.uk Russ Mansford DH Russ.mansford_at_dh.gsi.gov.uk
Janet Meacham DH Janet.meacham_at_dh.gsi.gov.uk Sally Bell Yorks and Humber SHA Sally.Bell_at_yorksandhumber.nhs.uk
John Pullin DH John.pullin_at_dh.gsi.gov.uk Scott Henderson Scottish Government scott.henderson_at_scotland.gsi.gov.uk
John Coakley Homerton Hospital john.coakley_at_homerton.nhs.uk Sharon Terry DH sharon.terry_at_dh.gsi.gov.uk
Judy Wilson Customer Rep judy.wilson3_at_ntlworld.com Steven Weeks NHS employers steven.weeks_at_nhsemployers.org
Keith Young DH Keith.young_at_dh.gsi.gov.uk Steven Wibberley NHS Direct Steven.Wibberley_at_nhsdirect.nhs.uk
Lindsey Davies DH Lindsey.davies_at_dh.gsi.gov.uk Tanya Nickols DH, DH Tanya.nickols_at_dh.gsi.gov.uk
Lorraine Doherty DHSSPSNI Lorraine.Doherty_at_dhsspsni.gsi.gov.uk Tim Young DH Tim.young_at_dh.gsi.gov.uk
Luke Perera DH Luke.perera_at_dh.gsi.gov.uk Tony Jenner DH Tony.jenner_at_dh.gsi.gov.uk
22
Dentistry PIG contact details
Name Email Address Role Contact Number
Tony Jenner (CHAIR) tony.jenner_at_dh.gsi.gov.uk Deputy Chief Dental Officer 020 7633 4247
Lindsey Davies lindsey.davies_at_dh.gsi.gov.uk National Director Pandemic Influenza 020 7210 5753
Amy Mccullough amy.mccullough_at_dh.gsi.gov.uk Pandemic Flu Primary Care Manager 020 797 25702
Amit Bose amit.bose_at_dh.gsi.gov.uk Policy Manager, Commissioning System Management Directorate 020 797 25702
Lesley Derry l.derry_at_bda-dentistry.org.uk Head of Professional Services, British Dental Association N/A
Paul Langmaid Paul.Langmaid_at_Wales.gsi.gov.uk Chief Dental Officer for Wales N/A
Kate Taylor Weetman Kate.Taylor-Weetman_at_northstaffs.nhs.uk Consultant in Dental Public Health N/A
Henrik Nielsen drhnielsen_at_googlemail.com N/A
Mark Shackell Mark.Shackell_at_MidEssexPct.nhs.uk Consultant in Dental Public Health, Essex Public Health Resource Unit 01376 302268
Serbjit Kaur Serbjit.Kaur_at_dh.gsi.gov.uk Head of Quality and Standards, Commissioning System Management Directorate 0207 633 4252
Richard Emms emmsrk_at_supanet.com N/A
Nick Phin Nick.Phin_at_HPA.org.uk N/A
Susan Bruckel Susan.Bruckel_at_glos.nhs.uk N/A
Angie Mcbain a.mcbain_at_ntlworld.com BADN President 07515 579 320
Chris Audrey chris.audrey_at_dh.gsi.gov.uk Head of Primary Dental Services, Dental Eye Care Services Directorate of Commissioning System Management 020 7633 4149
Margie Taylor Margie.Taylor_at_scotland.gsi.gov.uk Chief Dental Officer, Scotland N/A
Alan Taylor alan.taylor_at_oxfordshirepct.nhs.uk Lead Clinician Senior Dental Officer, Oxfordshire Salaried Primary Care Dental Service 01869 604052
Carole Fry carole.fry_at_dh.gsi.gov.uk Nursing Officer, Health Improvement and Protection Directorate 020 797 24419
23
Summary of planning support materials
Implementation timings Planning
assumptionsExercise feedback
24
A summary of key dates for NHS preparedness
planning 2008
Indicative timings will be confirmed as soon as
possible
Feb
Apr
Jun
Aug
Oct
Dec
Jan
Mar
May
Jul
Sept
Nov
Jan

• Current timings
• Audit tools for
• Acute
• Community
• Ambulance

31/10 Implementation deadline
14/11 Re-audit completed
05/12 SHA confirm results
31/01 Audits complete
20/03 SHA confirm results
30/04 Action plans complete
06/08 Implementation check point
10/04 Actions plans reviewed

• Proposed audit tool timing for
• SHA
• Mental health
• Social care

21/03 SHA audit launched
04/04 Audit completed
06/05 SHA confirm results
Indicative timings
15/05 mental health audit launched
30/05 audit completed
10/06 SHA confirm results
04/07 Action plans complete
Indicative timings
10/06 SC Audit launched
26/09 Audit completed
31/10 Action plans complete
Indicative timings
Programme work
Agree forward look of programme of exercises
required
Agree the measure and target for an acceptable
level of preparedness by end 2007
Update to NHS Man. Board on audit results
Update to NHS Man. Board on audit results
Programme delivers support to NHS Implementation
Programme offers independent review of plans/flu
squad challenge sessions
Key meetings
23/06 NHS National Workshop
23/04 NHS Management Board update
tbc/10 NHS Management Board update
tbc/01 NHS Management Board update
Key
tbc to be confirmed. These will be confirmed as
soon as possible.
Draft
Milestone
Programme activity
Meeting
Restricted Policy
25
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
26
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
• 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
• Provision of a wider range of treatments by
  health professionals other than GPs e.g. nurses
  following agreed guidelines
• Care of patients, who under normal circumstances
  would be admitted to hospital, in their own
  home/residential settings
• 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
• Treatment of patients in private healthcare
  facilities not normally used for acute medical
  care by healthcare teams that do not normally
  manage such patients
• 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
27
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
Severity of illness assumptions
Health and social care demand assumptions

• 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

Further information can be found in the Primary
care guidance and managing surge guidance
Source National Framework, p95, 96
All statistics are based on national planning
assumption attack rate of 50
28
Planners are asked to plan on the basis of a
clinical attack rate of up to 50
Planning will assume a clinical attack rate of up
to 50, the table below shows the surge in demand
healthcare providers must plan for.
Expected healthcare demand over the course of a pandemic Expected healthcare demand over the course of a pandemic 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 Expected healthcare demand during the peak of a pandemic 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
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/
29
The following assumptions should underpin Primary
Care planning
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 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
Primary care 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
Source National Framework, p107-113
All statistics are based on national planning
assumption attack rate of 50. This is assumed to
be a worst case attack rate/
30
The following assumptions should underpin Primary
Care planning
Area Category Planners should assume
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
Source National Framework, p107-113
31
The following assumptions should underpin PCT
planning
Area Category Planners should assume
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
Source National Framework, p107-113
32
The following assumptions should underpin
planning for acute care
Area Category Planners should assume
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
Acute care 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
Acute care 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
Source National Framework, p107-113
33
The following assumptions should underpin
Ambulance, Mental health and Social care planning
Area Category Planners should assume
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
Mental health Demand Mental health trusts may experience increasing demands on services due to the impact of the pandemic on individuals and families
Mental health 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
Source National Framework, p107-113
34
Planners may want to review feedback from the
following exercises
To open the document double click on the icon
below
Guidance Current status Guidance document Document owner
Phoenix and New Day Published HPA
United Endeavour 2 Published HPA
Exercise programme Published HPA
35
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