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INFORMATION STANDARDSGOVERNANCE PROCESS

INFORMATION STANDARDFINAL PROPOSAL

FOR NEW OR CHANGED (INCLUDING RETIRED) INFORMATION STANDARD

Pandemic InfluenzaSituation Reports

(SITREPS)

October 2009

Corporate Health Information Programme Pandemic Influenza SITREPS

Document: WIGSB Final Proposal - Pandemic Influenza SITREPS Date Created: 07/10/2009Programme: CHIP Date Printed: 29/10/2009Author: David Hawes Version: 1.0

Status: DraftPage 2 of 20

INFORMATION STANDARD FINAL PROPOSALFOR NEW OR CHANGED (INCLUDING RETIRED) INFORMATION STANDARD

This document should be completed using theGUIDANCE ON COMPLETING THE “INFORMATION STANDARD

FINAL PROPOSAL NOTIFICATION” SUBMISSION TEMPLATE

REVISION HISTORYDate of this revision: 07/10/2009

Versionno.

Revisiondate Summary of Changes Changes

marked1.0 07/10/2009 First draft n/a

SUBMITTED BY:

Document completed by: David Hawes

Role & organisation: Project Manager, Corporate Health Information Programme

FEEDBACK TO BE PROVIDED TO:

Feedback will be provided on the Proposal within 10 days of the WIGSB meeting. If the feedback is to bedirected to another nominee please provide the name and contact details below.

Name: Roger Perks, DHSS Business Unit, Welsh Assembly Government

Email: [email protected]

SUBMISSION PURPOSEProposal submitted for: Formal Approval

If this Proposal submission is not for formal approval then please state the specific aspects on which youwould like more detailed comments.

Specific Areas for WIGSB to comment on when not submitting for formal approval at the Proposalstage




SECTION 1: BACKGROUND

1. Information Standards Reference Number [from Information Services Division]

IGRN 2009 / 011

2. Name of Information Standard

Pandemic Influenza Situation Reports (SITREPS)

3. Type of change

Introduction of a new standard

4. Type of standard [Select all that apply]

Operational

5. Introduction

In June 2009, the World Health Organisation (WHO) declared that the current H1N1 influenza (swine flu)outbreak to have reached the pandemic phase (phase 6) of spread across the globe.

In the UK, there was a surge in the number of cases in relation to swine flu over the course of the summer.As at Friday 11th September 2009, there have been a total of 75 deaths due to swine flu in the UK1. Therehave been 120 laboratory confirmed cases of swine flu in Wales, of which 46 have required admission tohospital.

Due to the significant increase in demand over the summer, GPs are no longer being asked to swab peoplethey suspect may have swine flu. The actual number of people suffering with swine flu is, therefore, likely tobe far greater than these figures suggest. Indeed, Welsh organisations in both primary care and secondarycare experienced significant pressures due to surges in demand during the initial outbreak phase of theillness.

Whilst reported rates of illness are currently falling, it is predicted that a “second wave” of swine flu illness willoccur in the autumn. It can therefore be expected that the NHS could again be placed under significantpressure in some or all areas of Wales. It is therefore essential that adequate planning is undertaken toensure that NHS organisations can continue to function within acceptable and safe levels, with a view tomaintaining provision of current services to as great an extent as possible.

There is a requirement to identify system pressures arising from the swine flu pandemic at both a local andnational level.

Information generated will be used:

To alert Welsh Assembly Government and Health Minister of key service pressures To support Local Health Boards by giving them an organisation-wide and Wales-wide perspective of

pressures To provide data to Department of Health (DoH) for UK monitoring purposes.

The data will be collected for the duration of the swine flu pandemic, with a view to ceasing collection at anappropriate time.

1 Swine influenza daily update – 11th September 2009 http://howis.wales.nhs.uk/NewsDets.cfm?ContentID=20125




6. Sponsor

Roger Perks – Head of Business Unit, Directorate General of Health & Social Care, Welsh AssemblyGovernmentTel: 029 2082 5850Email: [email protected]

A formal letter of support from the sponsor is outlined in Appendix A for information.

7. Developer

David Hawes – Data Quality Improvement Manager, Corporate Health Information Programme, WAGTel: 029 2020 7606Email: [email protected]

8. IImmpplleemmeennttaattiioonn DDaattee

It is proposed that the new data collection will be mandated effective 12th October 2009.

Whilst it is recognised that such an implementation date is not ideal, and will require commencement of thedata collection prior to formal approval from WIGSB, there is a clear urgency to begin collecting data due tothe imminent nature of any potential pandemic situation.

A summary project plan is provided in section 22 for further information.




SECTION 2: BUSINESS JUSTIFICATION

9. Purpose

There is a need to ensure that the NHS has a core set of information available in a timely manner to manageits services through a period of potentially sustained pressure. As a product of this, the Service itself and theWelsh Assembly Government (WAG) will have an accurate set of information that can be used to monitorservice provision, capacity and demand and to use this for communication purposes.

10. Scope

The data will be collated and reported daily from primary and secondary care services at the following levels:

Daily pandemic flu SITREPS reportingo ‘Main’ Acute District General Hospital (DGH)o Community Hospitals / Mental Health Services

FluCon Status Reportingo Primary care

General Practice Out Of Hours (OOH) Community Pharmacy Other

o Secondary care (Acute DGH’s only)

The data will support Local Health Boards (LHBs) by giving them an organisation-wide and Wales-wide viewon current capacity and demand within the LHB DGH, community hospital and primary care settings that willallow aggregation at the organisation or all-Wales level.

Whilst specifically developed for the current pandemic flu outbreak, it is envisaged that the proposed datacollection will be decommissioned outside of periods of pandemic, but will be able to be invoked during otherperiods of pandemic, whether flu-related or not. Irrespective of the cause of any particular pandemic, theimmediate pressures on the Service will need to be understood, and the proposed data collection shouldenable the Service and WAG to quickly initiate data collection as and when such a situation re-occurs.

It should be noted that some primary care data in relation to swine flu is already being collected by PublicHealth Wales using the AUDIT+ system installed in Welsh GP practices. This data is published on the Healthof Wales Internet Service (HOWIS). It is not anticipated that this standard will impact or duplicate anyreporting from this system in any way but consideration has been given as to how the outputs from theprimary care and secondary care could be brought into a single reporting “dashboard” on HOWIS.

11. FFuunnddiinngg

There are not anticipated to be any funding issues associated with this development. The development andreporting will be undertaken by Health Solutions Wales (HSW) under the current SLA held between WAG andHSW.




12. Support

The introduction of this standard will require the support and will be consulted on with the followingorganisations and/or bodies:

Local Health Boards Health Solutions Wales National Public Health Service (NPHS) Welsh Assembly Government (WAG)

Directorate General for Health & Social Care Business Unit Directorate of Operations

Corporate Health Information Programme (CHIP)

A formal letter of support from Roger Perks is outlined in Appendix A.




SECTION 3: HEALTH INFORMATION STRATEGIC AND OPERATIONAL FIT

13. Strategic Fit

At present, NHS Wales does not have a consistent and easily deployable data collection and situationreporting (SITREP) system for outbreaks of pandemic illness. Whilst routine ‘emergency pressures’ reportinghas taken place within Wales for a number of years, the acute and sudden nature of pandemic situationsnecessitates a slightly altered approach so that the Service can adequately monitor capacity and demand inresponse to a rapidly changing environment.

The current swine flu pandemic has presented an opportunity to review the manner in which timely reportingis conducted by affected Welsh organisations. In developing a pandemic flu SITREP, it is anticipated that theproposed data collection will provide a platform from which future pandemics can be monitored andmanaged.

The proposed system will also support a national approach so that impact in one area could be mitigated bysupport from others – i.e. Wales working as a whole, rather than disparate parts.

14. Operational Fit

This standard is unlikely to affect the recording of data in Local Health Board operational IT systems.However, it is recognised that the data collection is likely to, in some cases, require additional effort andresources in terms of the collection of the required data.

HSW (EMERGENCY PRESSURES) REPORTING TOOLS

Health Solutions Wales provides an online data collection and reporting function for Wales in relation toEmergency Pressures SITREPS. This service includes the production and maintenance of a data entryfacility for Welsh organisations to enter data on both a daily and weekly basis. In addition to this, HSWcurrently produce a range of reports in relation to SITREP data. The introduction of this standard willnecessitate an update to the emergency pressures website, both in terms of data entry functionality and anyrequired pandemic flu reports.

15. Known standards in use nationally and internationally

England

In England, the DoH has designed a standard SITREP daily reporting system that Wales needs to havecomparable data on. Whilst Wales has decided to collect much of the same data, there have been somechanges introduced:

The age ranges have been expanded to reconcile with the Primary Care reports; The detailed “at risk” groups have been included to clarify definitions;

Some aspects of critical care have been added to identify impact on these services.

The English pandemic flu SITREP form is outlined in Appendix B for information.




SECTION 4: THE PROPOSAL

16. Proposed Solution

In order to ensure the availability of timely information in relation to Service capacity and demand during theswine flu pandemic, a new pandemic flu daily SITREP and FluCon data collection is proposed.

Data will be collected on a daily basis through an updated web-based SITREP data entry tool, to be madeavailable via the current emergency pressures website on HOWIS2.

DAILY PANDMIC FLU SITREPS FOR SECONDARY CARE

The proposed pandemic flu SITREP is as follows:

ACTIVITY

A&E Departments / MIU

1.1 The number of attendances at an A&E department by patients with flu-like symptoms in the past 24 hours(i.e. 24 hours period, midnight to midnight previous day)

1.2 Please provide any appropriate supporting information relating to A&E pressures (free text box)

Inpatient Activityunder 1’s1 – 5 yrs6 – 15 yrs16 – 44 yrs45 – 64

2.1 The total number of hospital beds occupied by patients with flu-like symptoms as at midday

65+under 1’s1 – 5 yrs6 – 15 yrs16 – 44 yrs45 – 64

2.2 Of the total (2.1), the number of critical care beds occupied by patients with flu-likesymptoms as at midday

65+

under 1’s

1 – 5 yrs

6 – 15 yrs

16 – 44 yrs

45 – 64

2.3

Of the total (2.1), the number of beds occupied by patients with flu-like symptoms whohave underlying health conditions as at midday- Chronic lung disease- Chronic heart disease- Chronic kidney disease- Chronic liver disease- Chronic neurological disease- Immunosuppression (whether caused by disease or treatment)- Diabetes mellitus- Patients who have had drug treatment for their asthma within the past 3 years- Pregnant women- Morbidly obese individuals- Other 65+

under 1’s1 – 5 yrs6 – 15 yrs16 – 44 yrs45 – 64

2.4 The number of new hospital admissions with flu-like symptoms within the past 24 hours(i.e. 24 hours period, midnight to midnight previous day)

65+under 1’s1 – 5 yrs6 – 15 yrs16 – 44 yrs45 – 64

2.5

The number of deaths due to flu-like illness within the past 24 hours (i.e. 24 hours period,midnight to midnight previous day)

Split by the following clinical areas:- Critical Care- Not Critical Care 65+

2 http://howis.wales.nhs.uk/sites3/news.cfm?contentid=2103&orgid=296




2.6 Please provide any appropriate supporting information relating to pressures on emergency admissions and/orthe current levels of occupied beds (free text box)

OPERATIONAL PRESSURES

Impact on Elective WorkloadYes1.1 Has there been, or are there, any planned reductions in elective workload due to pressures

associated with pandemic flu? No1.2 If yes, please provide a description of any planned reductions in elective workload (free text box)

1.3 The number of patients who have had their urgent elective admission cancelled between the reporting dateand Monday 12th October 2009 who have still not had their procedure carried out

Yes1.4 Have there been any unplanned reductions in elective workload due to pressuresassociated with pandemic flu? No

1.5 If yes, please provide a description of any unplanned reductions in elective workload (free text box)

Staff Illness

2.1

Please provide any appropriate information in relation to staff sickness / absence and the impact this ishaving on services in the following clinical areas:

- A&E / MIU- Paediatrics (incl. SCBU / Neonates)- Critical Care- Medical- Surgical- Maternity- Other

Ward / Bed Closures3.1 The number of ward closures due to pressures associated with pandemic flu as at midday3.2 The total number of bed closures due to pressures associated with pandemic flu as at midday

COMMUNITY HOSPITALS / MENTAL HEALTH SERVICES

Impact on Elective WorkloadYes1.1 Has there been any impact on community hospital services due to pressures associated

with flu-like symptoms? No1.2 If yes, please provide a description of the impact on your community hospital services (free text box)1.3 Has there been any impact on mental health services due to pressures associated with flu-like symptoms?

Yes1.4 If yes, please provide a description of the impact on your mental health services (free textbox) No

CONTACT INFORMATION

1.1 General Contact – Name, Telephone Number, Email1.2 Media Contact – Name, Telephone Number, Email1.3 Comments on media interest (free text box)

Please note – for the purposes of reporting, Welsh organisations are required to report activity based on thepresence of “flu-like symptoms”. It is understood that this will also include seasonal flu patients because it isrecognised that without a firm diagnosis it is not possible to be precise. Where laboratory tests confirm that apatient does not have swine flu, such patients are to be excluded from any affected figures above.

Definition of “Flu-Like Symptoms”Source: NHS Direct Wales

The symptoms of swine flu are broadly the same as those of ordinary flu, but may be more severe and causemore serious complications. The typical symptoms are:

Sudden fever (a high body temperature of over 38C or 100.4F) and; Sudden cough.




Other symptoms may include: Headache; Tiredness; Chills; Aching muscles; Limb or joint pain; Diarrhoea or stomach upset; Sore throat; Runny nose; Sneezing and; Loss of appetite.

The inclusion of patients within counts of patients with “flu-like symptoms” should be determined by clinicalstaff based upon the symptoms specified above.

For the purposes of the daily pandemic flu SITREP data collection, the following acute District GeneralHospitals in Wales are required to report:

Local Health Board (LHB) Reporting Site

Abertawe Bro Morgannwg University LHB

Princess of Wales HospitalNeath Port Talbot HospitalMorriston HospitalSingleton Hospital

Aneurin Bevan LHBRoyal Gwent HospitalNevill Hall HospitalCaerphilly Miners Hospital

Betsi Cadwaladr LHBGlan Clwyd HospitalWrexham Maelor HospitalYsbyty Gwynedd

Cardiff & Vale LHB University Hospital of WalesLlandough Hospital

Cwm Taf LHB Prince Charles HospitalRoyal Glamorgan Hospital

Hywel Dda LHB

West Wales General HospitalBronglais General HospitalWithybush HospitalPrince Phillip Hospital

Local Health Boards are not required to supply activity data for individual community hospitals or mentalhealth units. They are instead required to answer two general questions in relation to the impact of thepandemic flu outbreak on those services as a whole.

DAILY FLUCON REPORTING FOR PRIMARY & SECONDARY CARE

This indicator aims to provide a give a summary indication of the impact of pandemic flu on the primary andsecondary health services in each Local Health Board (LHB) across Wales. The FluCon information needs tobe collected on a daily basis and then reported to the Welsh Assembly Government using the online reportingtool, which can be found on the HOWIS ‘Emergency Pressures’ website via the following link:

http://howis.wales.nhs.uk/sites3/page.cfm?orgid=296&pid=5795

The Welsh Assembly Government will then forward the reported data to the Department of Health (DoH) insupport of the national programme of swine flu monitoring and reporting.

Local Health Boards will also be required to report the FluCon status for both the primary and secondary caretheir organisation.




Primary Care FluCon

For primary care, four individual status indicators are required for each of the following primary care areas:

- General Practice- Out Of Hours (OOH)- Community Pharmacy- Other

This is reported by Unitary Authority, whose boundaries are co-terminus with the Welsh Local Health Boardboundaries.

Secondary Care FluCon

For secondary care, a daily FluCon status indicator is required for the acute District General Hospital (DGH)sites only.

The following table summarises the organisations / locations for which a daily pandemic FluCon statusupdate is required:

Local Health Board (LHB) Primary Care FluCon(by Unitary Authority – UA)

Secondary Care FluCon(by Acute DGH)

Abertawe Bro MorgannwgUniversity LHB

Bridgend UANeath Port Talbot UASwansea UA


Aneurin Bevan LHB

Monmouthshire UABlaenau Gwent UACaerphilly Teaching UANewport UATorfaen UA

Royal Gwent HospitalNevill Hall HospitalCaerphilly Miners Hospital

Betsi Cadwaladr LHB

Anglesey UAConwy UADenbighshire UAFlintshire UAWrexham UAGwynedd UA

Glan Clwyd HospitalWrexham Maelor HospitalYsbyty Gwynedd

Cardiff & Vale LHB Cardiff UAValle of Glamorgan UA

University Hospital of WalesLlandough Hospital

Cwm Taf LHB Merthyr Tydfil UARhondda Cynon Taf UA

Prince Charles HospitalRoyal Glamorgan Hospital

Hywel Dda LHBCeredigion UACarmarthenshire UAPembrokeshire UA


Powys LHB Powys UA -

It should be noted that there may not always be a clear correlation between the activity levels reported via thedaily SITREPS and the FluCon status. For example, staffing pressures may place an organisation underextreme pressure during a period where the actual incidence of flu is relatively low.

A copy of the supporting data definitions / guidance document for the daily pandemic flu SITREPSand FluCon reporting is shown in Appendix C for information.

Local Health Boards will be required to report the daily SITREPS by 3pm each day, covering activity for theprevious 24-hour period (i.e. midnight to midnight the previous day).




Local Health Boards are required to ensure both the primary care and secondary care FluCon statusindicators are submitted daily by 1.30pm at the latest. Data must be for the preceding 24 hour period ending0800 on the day of the reporting period.

In the event of a major increase in swine flu activity, it may be necessary to increase the frequency ofreporting. The reporting tool is to take account of this and can provide such flexibility if required.

Health Solutions Wales and the Welsh Assembly Government are in the process of developing a reporting“dashboard” to facilitate the presentation of a range of data to reflect the status of the pandemic and itsimpact on a range of public services, including the NHS, Social and Local Authority Care and Education. Thistool is designed to provide users with an indication of pressures across the public sector with a view toenabling improved decision making based on real-time data.

It should be noted that whilst information in relation to the impact of the pandemic flu outbreak on other publicsector areas is being sought in relation to the reporting “dashboard”, this is mostly high-level and is beingdeveloped to reflect the overall impact on services in relation to the outbreak. Where more detailed activitydata is being requested in relation to specific numbers of patients presenting with flu-like symptoms (e.g. OutOf Hours), the nationally approved definition for “flu-like symptoms” (as outlined in this document) is beingused.

17. Fitness for Purpose

The following will be an indication of a successful implementation;

Full mandation of the daily pandemic flu SITREP and FluCon data collection via Ministerial Letter.

The production of a pandemic flu reporting “dashboard” from which current capacity and demandcan be monitored.

The data being collected and reported in relation to this standard is designed to support the “here andnow” decision making taking place within LHBs during the pandemic flu outbreak. By its very nature, thedata collection is somewhat imperfect and is unlikely to reflect precisely the number of actual flu casespassing through the system during the pandemic. It is therefore recognised that the numbers reportedthrough the pandemic flu SITREPS may not match exactly those reported via any retrospective analysis ofthe outbreak, such as the sort undertaken by national public health organisations (e.g. Public HealthWales), which may be based on data of a higher quality and accuracy (e.g. using clinically coded data).

18. Testing / Pilot

Given the immediacy of implementation of this standard, a full period of testing / pilot has not beenpossible. However, during the development of the pandemic flu SITREP and FluCon data collection tool,some quality assurance testing has been carried out by CHIP, WAG and Abertawe Bro MorgannwgUniversity (ABMU) and Aneurin Bevan Local Health Boards to ensure that the developed tool operates at apractical level for those within the Service who shall be using it. This period of testing took place over thecourse of two weeks commencing Monday 21st September 2009.

Following completion of the development of the tool, it was then put onto the ‘live’ HOWIS domain, atwhich point all Welsh Local Health Boards were given full data entry access. A week-long period of parallelreporting alongside the manual Microsoft Excel return is in the process of being carried out with a view toprogressing to a fully live data collection on XXXXXXXXXXX.

19. Information Governance

As the proposed solution does not necessitate the provision of any patient identifiable information andutilises the existing emergency pressures data reporting infrastructures, there are no new InformationGovernance issues to consider.




20. Commercial Considerations

There are no commercial issues which will impact upon the proposed standard.




SECTION 5: IMPACT ASSESSMENT

21. Impact Assessment

A formal impact assessment has not been undertaken. However, Local Health Boards have been collectingand reporting activity data in relation to pandemic flu to WAG via a daily Microsoft Excel return for a numberof months. WAG has been engaging extensively with the Service to understand the issues around thecollection of this data and this knowledge has been used to ensure the pandemic flu SITREP and FluCondata collection proposed in this document is tailored to suit the needs of both the Service and WAG and doesso in a manner that, where possible, minimises the impact on resources within data provider organisations.

The Service has been actively engaged in the development of the proposed SITREP and FluCon datacollection through a series of meetings involving WAG, CHIP, Local Health Boards (LHBs) and NPHS. Thesemeetings included pandemic flu leads from Welsh LHBs who are already involved in the collection andreporting of data via the mechanism outlined above. They have also ensured the initial proposal has beenrefined down to a manageable level and has ensured that the data required of Health Boards is concise andwell-defined.

However, it is recognised that this proposal will result in an additional burden on certain areas of the service,as the online collection of the data will necessitate a change in practice for certain staff groups – e.g. bedmanagers, information department staff. At all stages of the development of the proposed standard, this hasbeen taken into account with a view to minimising the impact on their ability to go about their usual day-to-dayoperational duties.

As noted in Section 18, a short piloting / testing period has been undertaken involving ABMU and AneurinBevan Local Health Boards to understand the appropriateness of the data being required of the Local HealthBoards and to more fully identify the potential impact on resources required to collect and report the data.Furthermore, following completion of the development of the tool, it was then put onto the ‘live’ HOWISdomain, at which point all Welsh Local Health Boards were given full data entry access. A week-long periodof parallel reporting alongside the manual Microsoft Excel return is in the process of being carried out with aview to progressing to a fully live data collection on XXXXXXXXXXX.




SECTION 6: IMPLEMENTATION PLAN

22. Implementation Plan

A summary project plan is provided below for further information:

Milestone Deadline Status

The development and implementation of a pandemic flu SITREP for NHS WalesAgree draft reporting specification and data definitions 7th September 2009 Completed

Develop draft SITREP data entry tool 14th September 2009 Completed

Submit WIGSB Documentation- Requirement Notification / Development Proposal 17th September 2009 Completed

Test draft SITREP data entry tool 18th September 2009 Completed

Pilot testing of draft SITREP data entry tool 25th September 2009 Completed

Revise data definitions and SITREP reporting tool 30th September 2009 In Progress

Submit WIGSB Documentation- Final Proposals 15th October 2009 In Progress

Mandate daily reporting of pandemic flu SITREPS datavia Ministerial Letter 12th October 2009 In Progress

The development and implementation of pandemic flu SITREP reporting outputsAgree required reporting outputs TBC Completed

Develop required reporting outputs TBC In Progress

Go Live TBC

23. Official Documentation

It will be necessary to formally mandate the standard proposed in this document. This will be undertaken viaMinisterial Letter in October 2009.




SECTION 7: MAINTENANCE AND REVIEW

24. Maintenance Process

In developing the pandemic flu SITREPS and FluCon data collection, it has been recognised that there is aneed for a wider review of the daily ‘emergency pressures’ SITREPS. Furthermore, it is acknowledged thatthe pandemic flu SITREPS and FluCon data collections proposed in this document are designed to supportthe NHS in Wales through the pandemic period. Therefore, when the pandemic outbreak is over it isanticipated that the data collections will cease. The date on which this occurs is unknown, since it will dependon the severity and longevity of the outbreak itself.

However, it can be anticipated that a post-pandemic review of the pandemic and ‘emergency pressures’SITREPS will be undertaken with a view to rationalising them so that the regular daily SITREPS are morefocussed and provide more meaningful data to the Service in support of ‘live’ decision making with regards toservice provision during times of peak activity.

Similarly, the development, content and presentation of the reporting ‘dashboard’ will also be subject toreview once the pandemic is over, again with a view to ensuring it provides a meaningful display to assistNHS staff in the day-to-day management of local NHS services.

25. Planned review dates

As noted above, the dates on which a post-pandemic review of the data collections proposed take place willbe dependant on the longevity of the pandemic outbreak itself. As such, a specific date cannot be stated atthis time.




APPENDIX A – LETTER OF SUPPORT

Tuesday 5th October 2009Dear Pam,

Pandemic H1N1 Influenza (Swine Flu) SITREPS

I am writing to express my support for the introduction of a swine flu SITREP reportingmechanism for NHS Wales. Such a data collection is essential at both a local and nationallevel to ensure there is a timely understanding of capacity and demand pressures on theNHS in Wales during the pandemic.

As the lead on Information Collection in the Directorate General for Health & SocialServices, with the authority of Paul Williams the Director General I fully support the workthat CHIP is undertaking to contribute to this objective.

Yours sincerely,

Roger PerksDirector – Business Unit, Directorate General for Health & Social Care

Pam HallProgramme DirectorCorporate Health Information ProgrammeChurchill HouseCardiffCF10 2HH




APPENDIX B – DAILY SITREPS FORM DESIGNED BY DEPARTMENT OF HEALTH

Daily Swine Flu SITREP – Wales

Organisation:Date of Report:

Contact Details

General contact:Name:Tel:Email Address:Media contact:Name:Tel:Email Address:

Section 1 – Scoping this return

Has the trust had any swine flu inpatients during the past 24 hours (H1N1 swabbedor clinically presumed)?If “YES” please complete Section 2 in fullIf “NO”, then your trust is not required to complete section 2 of this form

Has the trust experienced any of the serious operational problems listed in section3 below during the past 24 hours as a consequence of swine flu?If “YES” please complete Section 3 and 4 in fullIf “NO”, then your trust is not required to complete section 3 and 4 of this form

Your trust may need to complete none of the sections (no swine flu inpatients and o serious opsproblems as a result of swine flu), just section 2 on swine flu (swine flu inpatients but no serious opsproblems as a result of swine flu), or all.

Section 2 – Details of inpatientsPlease complete only where an organisation has inpatients (H1N1) swabbed or clinically presumed

Under5

5-15years

16-64years

65 andover

a) Total in-patients by age group in connection with swine flub) Of the total of (a), numbers of new admissionsc) Of the total of (a), numbers with co-morbidities or underlying conditionsd) Of the totals of (a), numbers in critical caree) Deaths over past 24 hours in connection with swine flu

CommentsPlease add narrative to describe outlook relation to any figures above e.g. Is workload increasing or

decreasing? Are the outlooks of the patients generally good or poor?




Section 3 – Details of Serious Operational Problems

Total numberin reporting

periodA&E closuresA&E DiversionsTrolley-waits of over 12 hoursUrgent operations cancelled for the second or subsequent timeNon medical critical care transfers out of an approved critical care transfer group

Yes/NoAny unplanned reductions in elective workload because of pressures?Any operational problems resulting in difficulties with ambulances queuing?

CommentsPlease comment on the cause and remedial action being taken for each serious operational problem reportedabove.

Section 4 – Other Serious Operational Problems

Total number in reporting periodUrgent operations cancelledNon medical critical care transfers (including thosewithin approved critical care transfer group)

Further CommentsIf there are current issues relating to the issues below, then please write comments in the appropriatebox. A comment is not required if the topic is not currently an issue. Please keep this specific to SwineFlu.

Media interest – please give details of any current media interest

Staffing

Any other issues (this should include any recent /forthcomingpotentially newsworthy issues)

SHA CommentsIf there are current issues relating to the issues below, then pleasewrite comments in the appropriate box. A comment is not required ifthe topic is not currently an issue.

Public Health/Out of Hours Issues




APPENDIX C – DEFINITIONS & GUIDANCE DOCUMENTATION

Page 1 of 12Pandemic Flu Daily SITREPS Indicators

Directorate General of Health & Social Care, Directorate of Operations, Welsh Assembly Government

PPAANNDDEEMMIICC FFLLUU

DDAAIILLYY SSIITTRREEPPSS RREEPPOORRTTIINNGG

INDICATOR DEFINITIONS FORWELSH LOCAL HEALTH BOARDS

Created: 6th October 2009



CCOONNTTEENNTTSS

Page

1. Supporting Information 3

2. Indicators Collected

- Indicators of Demand/Access to Services 4- Operational Pressures 6- Community Hospitals / Mental Health Services 9

3. SITREPS Definitions

- Health Facilities Required to Report Pandemic Flu SITREPS 10

4. FluCon Reporting & Definitions 11

- Organisations Required to Report Pandemic FluCon Status 12



SUPPORTING INFORMATION

There are a number of indicators where data is requested on patients with “flu-likesymptoms” or “flu-like illness”. The symptoms of swine flu are broadly the same as thoseof ordinary flu, but may be more severe and cause more serious complications. Thetypical symptoms are:

Sudden fever (a high body temperature of over 38C or 100.4F) and; Sudden cough.

Other symptoms may include:

Headache; Tiredness; Chills; Aching muscles; Limb or joint pain; Diarrhoea or stomach upset; Sore throat; Runny nose; Sneezing and; Loss of appetite.

The inclusion of patients within counts of patients with “flu-like symptoms” should bedetermined by clinical staff based upon the symptoms specified above.

All specialities must be counted for all indicators.

All indicators are mandatory and must be completed.

To access the Pandemic Flu SITREPS website, users should visit the ‘Emergency Pressures’ pageon HOWIS at:


Each user will be assigned a unique username and password to access the data entry moduleappropriate to their organisation and hospital site.

Unless directed otherwise by theAssembly, all returns should be completed and signed offdaily by 3pm at the latest. Please ensure that reports are complete and have been agreed by anappropriate member of staff (e.g. designated pandemic flu lead) before submitting the return.

If you anticipate a problem with submitting your daily return, please contact ?????.

If you wish to save your return without submitting it, because you will return to the formlater, select the “Save” option on the form.



INDICATORS COLLECTED

A&E Departments

1.1 The number of attendances at an A&E department by patients with flu-like symptoms inthe past 24 hours (i.e. 24 hours period, midnight to midnight previous day)

1.2 Please provide any appropriate supporting information relating to A&E pressures (freetext box)

Inpatient Activity

2.1 The total number of hospital beds occupied by patients with flu-like symptoms as atmidday

Split by the following age bands:- under 1’s- 1 – 5 yrs- 6 – 15 yrs- 16 – 44 yrs- 45 – 64- 65+ yrs

Note: Patients in Assessment Units should be included in all counts.

2.2 Of the total (2.1), the number of critical care beds occupied by patients with flu-likesymptoms as at midday


INDICATOR DEFINITIONS

A&E Departments (1.1 and 1.2)

Exclude the following:

- Follow-up patients- Any patient who may be waiting within theA&E area for a booked

admission/appointment to any department other thanA&E and is not being assessed ortreated by a member of theA&E staff.

- Any patient attending a GP Out Of Hours (OOH) service based within a hospitalA&EDepartment.



2.3 Of the total (2.1), the number of beds occupied by patients with flu-like symptoms whohave underlying health conditions as at midday


… and by the following underlying medical conditions:- Chronic lung disease- Chronic heart disease- Chronic kidney disease- Chronic liver disease- Chronic neurological disease- Immunosuppression (whether caused by disease or treatment)- Diabetes mellitus- Patients who have had drug treatment for their asthma within the past 3 years- Pregnant women- Morbidly obese individuals- Other

2.4 The number of new hospital admissions with flu-like symptoms within the past 24 hours(i.e. 24 hours period, midnight to midnight previous day)


2.5 The number of deaths (in hospital) due to flu-like illness within the past 24 hours (i.e. 24hours period, midnight to midnight previous day)


… and by the following clinical areas:- Critical Care- Not Critical Care

2.6 Please provide any appropriate supporting information relating to pressures onemergency admissions and/or the current levels of occupied beds (free text box)



OPERATIONAL PRESSURES

Impact on Elective Workload

1.1 Has there been, or are there, any planned reduction in elective workload due topressures associated with pandemic flu (Yes / No)

1.2 If yes, please provide a description of any planned reductions in elective workload (freetext box)

1.3 The number of patients who have had their urgent elective admission cancelledbetween Monday 12th October 2009 and the reporting date and who have still not hadtheir procedure carried out

1.4 Has there been any unplanned reduction in elective workload due to pressuresassociated with pandemic flu (Yes / No)

1.5 If yes, please provide a description of any unplanned reductions in elective workload(free text box)


Admissions (2.1, 2.2, 2.3, 2.4, 2.5)

Include the following:- Patients admitted to a MedicalAssessment Unit (who would be recorded on the

Admitted Patient Care (APC) data set in accordance with national data definitions).

Exclude the following:- Patients who, on admission, may have been suspected as having swine flu, but who

have since been confirmed (e.g. following laboratory testing) as negative.

New Hospital Admissions (2.4)

Include the following:- Patients new to the hospital onlyExclude the following:

- On-site ward transfers

Important: 2.1, 2.2, 2.3, 2.4 and 2.5 should not include patients who, on admission, mayhave been suspected as having pandemic flu, but who have since been confirmed (e.g.following lab test) as negative

The values for 2.2 and 2.3 should not exceed the figure entered for 2.1.




Impact on Elective Workload (1.1, 1.2, 1.4, 1.5)

Local Health Boards should provide narrative information in relation to any planned or unplannedchanges to elective capacity and/or workload in relation to the pandemic flu outbreak.

An elective admission is defined as:

“Where the decision to admit could be separated in time from the actual admission - i.e. apatient whose admission date is known in advance thus allowing arrangements to be madebeforehand. Excludes patients transferred from another hospital provider.”

Elective admissions are recorded with a method of admission code of 11, 12 or 13 – i.e.:11 = admissions via a waiting list12 = a booked admission13 = a planned admission

An unplanned reduction in elective workload due to the pandemic flu outbreak can beregarded as any change made either on the day or day before admission of an electivepatient.

A planned reduction in elective workload due to the pandemic flu outbreak can be regardedas any change made 2 or more days before admission of an elective patient.

It is essential that staff provide appropriate narrative to this section of the SITREP datacollection. In particular, it is essential that the Service is able to demonstrate that any plannedreductions in elective capacity or workload are based upon sound data/information.

Impact on Elective Workload (1.3)

This figure should is cumulative and should reflect the total number of patients who havehad their urgent elective admission or procedure (as prioritised by a clinician) cancelledbetween the 12th October 2009 and the reporting date and who are still waiting to have theirprocedure carried out.



Staff Illness

2.1 Please provide any appropriate descriptive information in relation to staff sickness /absence and the impact this is having on services in the following clinical areas:

Split by the following clinical areas (separate free text box for each):- A&E / MAU- Paediatrics (incl. SCBU / Neonates)- Critical Care- Medical- Surgical- Maternity- Other

Ward / Bed Closures

3.1 The number of ward closures due to pressures associated with pandemic flu as atmidday

3.2 The total number of bed closures due to pressures associated with pandemic flu as atmidday


Staff Illness (2.1)

Local Health Boards are required to provide a narrative summarising any impact of staff sickness and/orabsence in relation to the pandemic flu outbreak, outlining the effect this is having on its ability to operateacross the clinical areas specified.

Where there is no impact on a stated clinical area, no feedback is required – the free text boxcan be left black.


Ward / Bed Closures (3.1 and 3.2)

The number of ward/bed closures should reflect the situation as at midday on the day of the reportingperiod.

Any closed beds/wards, including non-acute (e.g. day surgery units) should be reported.



3. COMMUNITY HOSPITALS / MENTAL HEALTH ONLY

The following questions are general and apply to all community hospital and mental healthservices within a Local Health Board.

1.1 Has there been any impact on community hospital services due to pressuresassociated with flu-like symptoms (Yes / No)

1.2 If yes, please provide a description of the impact on your community hospital services(free text box)

1.3 Has there been any impact on mental health services due to pressures associatedwith flu-like symptoms (Yes / No)

1.4 If yes, please provide a description of the impact on your mental health services (freetext box)



HEALTH FACILITIES REQUIRED TO REPORT PANDEMIC FLU SITREPS

There are two categories for the purpose of pandemic flu SITREPS reporting. Data isrequired for each of the following:

Type 1 – Acute District General Hospitals (DGHs)Type 2 – Community Hospitals / Mental Health Services

i. Type 1 – Acute District General Hospitals

For the purposes of Pandemic Flu SITREP data collection, the following major acute DGHsin Wales from whom information is required are:

Local Health Board (LHB) Site

Abertawe Bro Morgannwg University LHB


Aneurin Bevan LHBRoyal Gwent HospitalNevill Hall HospitalCaerphilly Miners Hospital

Betsi Cadwaladr University LHBGlan Clwyd HospitalWrexham Maelor HospitalYsbyty Gwynedd

Cardiff & Vale University LHBUniversity Hospital of WalesLlandough Hospital

Cwm Taf LHB Prince Charles HospitalRoyal Glamorgan Hospital

Hywel Dda LHB


ii. Type 2 – Community Hospital / Mental Health Services

Local Health Boards are not required to supply data for individual community hospitals ormental health units. They are instead required to answer two general questions in relation tothe impact of the pandemic flu outbreak on those services as a whole.



FluCon Reporting & Definitions

FLUCON STATUS LEVELS FOR PRIMARY & SECONDARY CARE

This indicator aims to provide a FluCon picture for primary and secondary health services in eachLocal Health Board (LHB) across Wales. The FluCon information needs to be collected on a dailybasis and then reported to the Welsh Assembly Government using the online reporting tool, which canbe found on the HOWIS ‘Emergency Pressures’ website via the following link:


The Welsh Assembly Government will then forward the reported data to the Department of Health(DoH) in support of the national programme of swine flu monitoring and reporting.

ALL LHBS SHOULD ENSURE BOTH THE PRIMARY CARE AND SECONDARY CARE STATUSINDICATORS ARE SUBMITTED DAILY BY 1.30PM AT THE LATEST.

Data must be for the preceding 24 hour period ending 0800 on the day of the reporting period.

FLUCON REPORTREPORTING SERVICE PRESSURES ACROSS THE NHS

PRIMARY CAREGeneral Practice / Out Of HoursCommunity Pharmacies / Other

SECONDARY CAREAcute DGH sites only

(See list below)STATUS

PANDEMIC NOT YET IN LOCALITY / PREPARATION OR RECOVERED- Current status as ‘normal’ for season- Preparatory work underway- Available appointments at GPs- Increased number of ‘worried well’- Reviewing plans for business

continuity- Returning to normal operations

- Current status as ‘normal’ for season- Preparatory work underway- Discharging non-critical care patients- Increased number of ‘worried well’- Reviewing plans for business

continuity- Returning to normal operation

FLUCON 0

LOW SURGE: SLIGHT EFFECT ON SERVICES- Implementation of business continuity

plans- Planned closures- Reduction in non-critical services- Enhanced co-ordination between

health and social care- Antiviral assessment and collection

points working as planned

- Implementation of business continuityplans

- Planned closures- Reduction in non-critical services- Enhanced co-ordination between

health and social care- Antiviral assessment and collection

points working as planned

FLUCON 1

MEDIUM SURGE: MODERATE EFFECT ON SERVICES- Triage of patients attending service- Implementation of admission and

discharge criteria- Unplanned closures of some critical

services and treatment

- Triage of patients attending service- Implementation of admission and

discharge criteria- Escalation of service reductions and

closures (including reduced treatmentregimes)

- Planned closures

FLUCON 2

HIGH SURGE: MAJOR DISRUPTION TO SERVICES- Critical – services not copying- Demand outstripping supply for critical

services

- Critical – some services not beingdelivered

- Demand outstripping supply for criticalservices

FLUCON 3



ORGANISATIONS REQUIRED TO REPORT PANDEMIC FLUCON STATUS

As noted above, a FluCon status is required for both primary and secondary care.

Primary Care FluCon

For primary care, four individual status indicators are required for each of the followingprimary care areas:

- General Practice- Out Of Hours (OOH)- Community Pharmacy- Other

This is reported by Unitary Authority, whose boundaries are co-terminus with the (previous)Welsh Local Health Board boundaries.

Secondary Care FluCon

For secondary care, a daily FluCon status indicator is required for the acute District GeneralHospital (DGH) sites only.

The following table summarises the organisations / locations for which a daily pandemicFluCon status update is required:

Local Health Board (LHB) Primary Care FluCon(by Unitary Authority – UA)

Secondary Care FluCon(by Acute DGH)

Abertawe Bro MorgannwgUniversity LHB

Bridgend UANeath Port Talbot UASwansea UA


Aneurin Bevan LHB

Monmouthshire UABlaenau Gwent UACaerphilly Teaching UANewport UATorfaen UA

Royal Gwent HospitalNevill Hall HospitalCaerphilly Miners Hospital

Betsi Cadwaladr University LHB

Anglesey UAConwy UADenbighshire UAFlintshire UAWrexham UAGwynedd UA

Glan Clwyd HospitalWrexham Maelor HospitalYsbyty Gwynedd

Cardiff & Vale University LHB Cardiff UAValle of Glamorgan UA

University Hospital of WalesLlandough Hospital

Cwm Taf LHB Merthyr Tydfil UARhondda Cynon Taf UA

Prince Charles HospitalRoyal Glamorgan Hospital

Hywel Dda LHBCeredigion UACarmarthenshire UAPembrokeshire UA


Powys Teaching LHB Powys UA -