Hot Topic Meeting by:

Royal College of Physicians of Edinburgh &

The Scottish Executive Health Department

Pandemic Flu

Planning Scotland’s Health Response

5th June 2007

Queen Mother Conference Centre

How prepared are we to

manage within the

community?Pandemic Influenza

and Scotland

RCPE SEMINAR

June 2006

Content

What is being prepared to respond

Preparedness Standards for Overall Strategic, Healthcare and Health Protection Services

Conclusions on levels of preparedness in the community

InfluenzaThe Public Health Agenda

AvianAvian

InfluenzaInfluenza

PandemicPandemic

InfluenzaInfluenza

SeasonalSeasonal

InfluenzInfluenzaa

Single wave profile showing proportion of new clinical cases, consultations, hospitalisations or

deaths by week..

0%

5%

10%

15%

20%

25%

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Week

Pro

po

rtio

n o

f to

tal

ca

se

s,

co

ns

ult

ati

on

s,

ho

sp

ita

lis

ati

on

s o

r d

ea

ths

• Cumulative clinical attack rate up to 50% of the population over one or more waves of around 15 weeks each, weeks or months apart.

• ‘Worst case’ of single wave.

• Complication rate of up to 25%

• Overall case fatality rate of up to 2.5%.

• Hospitalisation rate of up to 4%.

Reasonable Worst Case Scenario

Pandemic InfluenzaPlanned Response

Alert Level 1 Alert Level 1 no virus in UKno virus in UK

Alert Level 2 Alert Level 2 new virus in UK new virus in UK Slow spreadSlow spread

Alert Level 3Alert Level 3 -outbreaks in UKoutbreaks in UKAdapt servicesAdapt services

Alert Alert Level 4Level 4 widespread widespread activityactivityMaintain essential Maintain essential servicesservices

End of first End of first pandemic pandemic wavewaveRecoveryRecovery

2- 42- 4

weeksweeks

7-97-9

weeksweeks

6-86-8

WeeksWeeks

Intense Intense pressurepressure

2- 42- 4

weeksweeks

12 -1512 -15

weeksweeks

Pandemic Influenza Preparedness

in the EUIntegrated planning across governments.Integrated planning across governments.

Making plans operational at the local level.Making plans operational at the local level.

Making sure that national plans and actions Making sure that national plans and actions work well together between counties and work well together between counties and within countrieswithin countries

Stepping up prevention efforts against Stepping up prevention efforts against seasonal influenzaseasonal influenza

Extending influenza research from basic Extending influenza research from basic science to include more operational research science to include more operational research

What needs to be done What needs to be done in the communityin the community

Limit Limit transmissiotransmissio

n and n and mitigate mitigate impactimpact

Care and Care and treat sick treat sick

and support and support their familiestheir families

Keep Keep society society goinggoing

Public Health

Civil Contingency

Health and Social Care

Health Protection

Primary Care, Community Care

Strategic Co-ordinating

Groups

  

Pandemic Influenza Preparedness Standards for Overall Strategic,

Healthcare and Health Protection Services

• To develop & pilot methodology in StandardTo develop & pilot methodology in Standard setting, monitoring and reporting for:setting, monitoring and reporting for: Health ProtectionHealth Protection Health Care servicesHealth Care services

• To develop & apply the standards to assessdevelop & apply the standards to assess Boards’ preparednessBoards’ preparedness • To recommend future standard operating QA To recommend future standard operating QA process for Health Protection servicesprocess for Health Protection services

• To give Boards a self-assessment tool forTo give Boards a self-assessment tool for future planningfuture planning

AimsAims

The Areas of Enquiry The Areas of Enquiry - the ‘Standards’- the ‘Standards’

Standard 1 Strategic: Structures and processes in place to ensure

preparedness for managing the local NHS response to a pandemic of influenza

Standard 2 Health protection services: Structures and processes in

place to ensure preparedness for limiting the transmission of pandemic influenza and its impact on the public’s health.

Standard 3   Healthcare services: Structures and processes in place to

ensure preparedness for responding to the direct and indirect health consequences of an influenza pandemic

Acute CarePrimary CarePharmacyMicrobiology

For each Standard:For each Standard:

• Expansion into criteria and lines of enquiryExpansion into criteria and lines of enquiry i.e. specific questionsi.e. specific questions

• Boards self-assess according to standard QIS Boards self-assess according to standard QIS scores in the key areas of: scores in the key areas of:

AccountabilityAccountabilityProcessesProcessesAudit & ReviewAudit & Review

• Consensus scoring workshops (Jan & Mar 2007)Consensus scoring workshops (Jan & Mar 2007)Individual Board & National ScoresIndividual Board & National ScoresEvidence Evidence

Scoring SystemScoring SystemScore Definition

1 Board is still considering how to take forward their responsibilities

2 Board is actively developing the means to take forward their responsibilities

3 Board is actively implementing the means of meeting its responsibilities

4 Board is monitoring the adequacy of how they have implemented its responsibilities

• These are findings from pilot

• The process is intrinsically subjective

• Methodology assessment & validation • A measure of how well Boards are doing what they are expected to rather than how well they will respond to a pandemic

CaveatsCaveats

Health Protection

National Scores for Standard 2:

NHS Boards’ health protection services have structures and processes in place to ensure preparedness for limiting the transmission of pandemic influenza and its impact on the public’s health

PerformanceCriteria

Accountability

Processes Audit and Review

Score 3 Surveillance & 2 Investigation

Risk assessment 3

Control measures 2

Communications 3

3

Key function

QA Areas of impact

Current development

Surveillance and

Investigation

2

IMT capacity to investigate cases clusters and progression of pandemic (First 100)

Capability of monitoring rates of Influenza like illness consultations and monitor vaccine and antiviral effectiveness

Laboratory handling of suspect influenza samples

Field Epidemiology database (FF100)developed

Pandemic flu surveillance system (PIPER ) 1st phase piloted

Communication protocol regarding laboratory arrangements

Health Protection Health Protection PreparednessPreparedness

Key function

QA Areas of impact Current development

Control Measur

es

2

Antiviral treatment

Pandemic vaccine programme

Social distancing, school closure, mass gatherings, travel restrictions, quarantine

Infection control & PPE: masks , respiratory precautions

Rx within 12h of symptoms; logistics of manufacture, distribution and delivery

Pre vs post pandemic vaccine benefits

Further modelling of social distancing measures

National guidance on infection control under development

NHS Scotland NHS Scotland Preparedness for Preparedness for

Pandemic InfluenzaPandemic Influenza Standard 2

Key function

QA Impact areas Current development

Surge Capacity

2Field investigation

Data collection and processing

Communication (media/service / public)

Scottish Health Protection Information System (SHPIMS)

Joint NHS Board agreements

Local authority/NHS Board support

NHS Scotland NHS Scotland Preparedness for Preparedness for

Pandemic InfluenzaPandemic Influenza Standard 2

Primary Care

Operational arrangements

Management of cases of pandemic influenza and curtailing activity to

cope with increased demand

Clinical management

Clinical management protocols covering care at home especially if

quarantine

Staff redeployment & support

Redeploying current staff, identifying back-up staff

CommunicationMechanisms to ensure flow of information to front-line staff

Joint workingLinks with acute and voluntary sector

Pharmacy servicesContinuity plans, distribution of

vaccines and anti-virals

Microbiology servicesTesting and reporting laboratory

results and infection control

National scores for Standard 3:

NHS Boards have structures and processes in place to ensure preparedness for responding to the direct and indirect health consequences of an influenza

pandemicPerformance Criteria: Primary Care

Score

Accountability 3

Processes & Procedures

Operational arrangements 2

Clinical management 1

Staff redeployment & support 1

Communication 3

Joint working 1

Pharmacy services 2

Microbiology services 3

Audit and review 1

Key function QA Areas of impact

Current development

Operational arrangements

2 Contingency plansAntiviral dispensing

RCGP Business Continuity GuidanceNational telephony service

Clinical management

1 Self and voluntary quarantine impact on home care

RCGP Scotland GuidanceBritish Thoracic Society

Staff redeployment & support

1 Smaller delivery units

SEHD Primary Care Planning Workshop

Joint working 1 Community careEngagement with voluntary sector

SEHD Adult Community Care Guidance

Pharmacy 2 Continuity of supply AntibioticsAntiviral indications

Further policy discussionScientific advice

Preparedness for Preparedness for Pandemic InfluenzaPandemic Influenza

Standard 2

• NHS Scotland has made considerable progress in the last 2 years (since the Oct. 2005 National Contingency Plan) in being prepared to manage the community aspects of pandemic influenza

•Progress has been greater in overall strategic decision-making and health protection & acute adult services than in primary care services

• Emphasis should now be placed on developing health protection policy, primary care and tactical & operational planning

•Integration with “routine” surge capacity and business continuity arrangements should be explored

ConclusionsConclusions

• Darren Ross, Ann Smith, Dr Jim McMenamin, Samantha Fleming, HPS

• Jacqueline Campbell, Anne Aitken, Colin Robertson, Scottish Executive

• Jim Miller, Lanarkshire NHS Board• Pandemic Flu QA Steering Group

Acknowledgements

Hot Topic Meeting by:

Royal College of Physicians of Edinburgh &

The Scottish Executive Health Department

Pandemic Flu

Planning Scotland’s Health Response

5th June 2007

Queen Mother Conference Centre