Hot Topic Meeting by: Royal College of Physicians of Edinburgh & The Scottish Executive Health Department Pandemic Flu Planning Scotland’s Health Response 5 th 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

Influenza The Public Health Agenda AvianInfluenza PandemicInfluenza SeasonalInfluenza

. Single wave profile showing proportion of new clinical cases, consultations, hospitalisations or deaths by week. 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 Influenza Planned Response Alert Level 1 no virus in UK Alert Level 2 new virus in UK Slow spread Alert Level 3 -outbreaks in UK Adapt services Alert Level 4 Alert Level 4 widespread activity widespread activity Maintain essential services End of first pandemic wave Recovery 2- 4 weeks 7-9weeks 6-8Weeks Intense pressure 2- 4 weeks weeks

Pandemic Influenza Preparedness in the EU Integrated planning across governments. Making plans operational at the local level. Making sure that national plans and actions work well together between counties and within countries Stepping up prevention efforts against seasonal influenza Extending influenza research from basic science to include more operational research

What needs to be done in the community Limit transmission and mitigate impact Care and treat sick and support their families Keep society going 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 Standard To develop & pilot methodology in Standard setting, monitoring and reporting for: setting, monitoring and reporting for: Health Protection Health Protection Health Care services Health Care services develop & apply the standards to assess To develop & apply the standards to assess Boards’ preparedness Boards’ preparedness To recommend future standard operating QA To recommend future standard operating QA process for Health Protection services process for Health Protection services To give Boards a self-assessment tool for To give Boards a self-assessment tool for future planning future planning Aims

The Areas of Enquiry - 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 Care Primary Care Pharmacy Microbiology

For each Standard: Expansion into criteria and lines of enquiryExpansion into criteria and lines of enquiry i.e. specific questions i.e. specific questions Boards self-assess according to standard QIS scores in the key areas of:Boards self-assess according to standard QIS scores in the key areas of:AccountabilityProcesses Audit & Review Consensus scoring workshops (Jan & Mar 2007)Consensus scoring workshops (Jan & Mar 2007) Individual Board & National Scores Evidence

Scoring System ScoreDefinition 1Board is still considering how to take forward their responsibilities 2Board is actively developing the means to take forward their responsibilities 3Board is actively implementing the means of meeting its responsibilities 4Board 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 Caveats

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 Performance Criteria Accountability ProcessesAudit and Review Score 3 Surveillance & 2 Investigation Risk assessment 3 Control measures 2 Communications 3 3

Key function QAAreas 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 ) 1 st phase piloted Communication protocol regarding laboratory arrangements Health Protection Preparedness

Key function QA Areas of impact Current development Control Measures 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 Preparedness for Pandemic Influenza NHS Scotland Preparedness for Pandemic Influenza Standard 2

Key function QAImpact areas Current development Surge Capacity 2 Field 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 Preparedness for Pandemic Influenza NHS Scotland Preparedness for Pandemic 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 Communication Mechanisms to ensure flow of information to front-line staff Joint working Links with acute and voluntary sector Pharmacy services Continuity plans, distribution of vaccines and anti-virals Microbiology services Testing 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 pandemic Performance Criteria: Primary Care Score Accountability3 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 review1

Key functionQAAreas of impact Current development Operational arrangements 2Contingency plans Antiviral dispensing RCGP Business Continuity Guidance National telephony service Clinical management 1Self and voluntary quarantine impact on home care RCGP Scotland Guidance British Thoracic Society Staff redeployment & support 1Smaller delivery unitsSEHD Primary Care Planning Workshop Joint working 1Community care Engagement with voluntary sector SEHD Adult Community Care Guidance Pharmacy 2Continuity of supply Antibiotics Antiviral indications Further policy discussion Scientific advice Preparedness for Pandemic Influenza Preparedness for Pandemic Influenza Standard 2

NHS Scotland has made considerable progress in the last 2 years (since the Oct 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 exploredConclusions

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 5 th June 2007 Queen Mother Conference Centre