Swine Flu Update Swine Flu Update London Borough of Bexley 2/5 th October 2009 Prof Hilary Pickles, External pandemic flu advisor Peter Buck pandemic flu lead Bexley Care Trust

Today’s meeting Brief introduction to swine flu What we think may happen to it in Bexley in the coming months What you could/should be doing right now

Swine Flu: history First UK cases recognised late April 2009 Initial attempts to contain spread with the antiviral drug Tamiflu for contacts WHO declared a pandemic mid June 2009 By end July, Tamiflu only for those who were ill, not their contacts National pandemic flu line operational

The current situation – 5th Oct 09 Experts expect another wave this autumn, and it may have just started Timing of peak uncertain, but could coincide with the ‘winter pressures’ on the NHS Rushing to get vaccine ready and given Swine flu appears not as bad as we thought it could be, but still very serious for some Those worst affected have included the obese, the pregnant, those with underlying conditions and young children

Bexley worst case planning scenario – clinical cases delay starting date given here by 3 weeks?

Bexley worst case planning scenario Bexley worst case planning scenario (September revision) Over the 15 weeks of the next wave: clinical cases, in peak week GP consultations, 2177 in peak week 674 hospital admissions, 145 in peak week 168 ITU admissions, 36 in peak week 67 deaths, 15 in peak week

Swine flu : age profile GP consultations for flu-like-illness to end Sept Under 5s also have more hospital admissions

Bexley : public sector response Joint work, led by Bexley Care Trust Tamiflu for those passing the flu line test Public information: catch it, bin it, kill it Planning for restricting services if need be Planning for vaccination (?end October) Personal protective equipment (PPE) stocks Preparing staff, and for staff vacancies

Issues for the Council Increased demands from some clients and/or some services Partners under severe pressure too Tensions around closure of schools and nurseries Potential supply chain difficulties Increased use of the phone and remote working Staff sickness and other staff absences Business continuity at risk

Increased demands for services Most people ill with flu will be expected to stay at home, and that includes vulnerable clients The hospital will be clearing beds for flu cases, so sicker people will need supporting at home Care staff will need to take infection-control precautions – and that’s time consuming Some routine NHS services may stop or be done differently, and the vulnerable will need help Expected to support any failing private care sector Not just social services, and not just the elderly!

Effect on staffing levels? Plan for 12% sickness rate in the peak week (most will take 7-10 days to recover, but some longer), on top of the standard leave But maybe another 15% if schools close More if staff are scared to work (eg if pregnant) or to look after relatives other than children Absences higher with a largely female workforce Suggest involve staff side esp in decisions about leave, or redeployment, or use of volunteers

What are the risks? [Top of national risk register: where’s it on yours?] The greatest risk to the Council is probably business continuity in the face of staff shortages Risks from consequences of third party failures and supply chain disruptions For vulnerable people managed in residential settings, the clients are more at risk from the staff Those most at flu risk will be offered vaccination, but it may be too late Swine flu is mild for almost everyone anyway School closures: high profile dilemma

Closure of schools Expected to be a local decision, taking advice from the Health Protection Agency and Care Trust Not now needed to prevent spread, but question of whether too many staff off sick to be safe Need to consider impact on working parents, and knock on impact on statutory services Risks of alternative child supervision or lack of it Parents are likely to challenge it either way! Lots of specific national advice for the sector

Prevention better than cure Keep away staff and visitors who are ill Be extra careful with hygiene Increase cleaning – the flu virus can last for hours on hard surfaces In residential settings, ‘social distancing’ of the ill and well, and it’s best if staff don’t mix either Wash hands again and again, with hand gel an alternative to soap and water Vaccination available soon for those eligible Make it easy for people to ‘catch it, bin it, kill it’

Vaccination First vaccine available by late October, need 2 jabs Priority for: –those at high personal risk because of pre-existing illness or pregnancy: from GP –Those at occupational risk, eg ‘social care staff who … provide personal care to children and adults, both in care homes and the community’: from occupational health Not for managers, housing staff, social workers, etc

Guidance available Lots available through NHS Choices website, with lots of links too, on: flu/Pages/Introduction.aspx Specific advice for various services from appropriate government department The local HPA has advice packs for schools and care homes, and the Care Trust can help source leaflets, posters etc

Immediate priorities Read the guidance relevant to your service and ensure any specifics are covered Refresh business continuity plans Discuss within the team and work out how you’d manage if you had fewer present, and consider leave and domestic commitments Expectations for your team: critical service to be keep going, or helping others out if need be? See if local hygiene arrangements can be improved (wash basins, gel dispensers, bins)

Finally Just because it’s quiet now, doesn’t mean it’s over The flu could change: in 1918/1919 it became more severe for the second wave Good news – we have Tamiflu and vaccine coming. The bad news is that the virus could become resistant to Tamiflu, and staff might refuse vaccine At least it isn’t bird flu (much nastier) Any questions?