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

Pandemic Flu – Operational Management The Hospital Response Dr R G Masterton NHS Ayrshire & Arran

Pandemic Influenza WILL HAPPEN! WHEN?? “The pandemic influenza clock is ticking. We just don’t know what time it is” Ed Marcuse (CDC)

Pandemic Influenza 1918 Influenza hospital

Planning Assumptions Flu Pandemics l They are unpredictable l Occur at any time of the year l 3 months to spread to UK l Disease will spread rapidly l > 25% of population will be affected l Higher hospitalisation rate l Higher mortality rate l May be 2 -3 waves over 1-2 years

l Increased GP referral - l 18,400 during pandemic l Increased Hospitalisation l 750 additional l Increased Death rate l 400 deaths l Staff Absence > 25% l Disruption to NHS care, social services etc l Problems with supplies, utilities etc l Schools may close l MAJOR SOCIETAL DISRUPTION EFFECTS 92,000 people ill in Ayrshire (25% of pop) CONTINGENCY PLANNING IS THEREFORE ESSENTIAL Planning assumptions Flu Pandemics - Ayrshire

Effects on Workforce l Increased workload Schools close  child care? Travel disruption  get to work? Sick family members  exacerbate absenteeism Increase in deaths  anxiety and bereavement l Public, political and media concern

Effects on Services l Depletion of workforce l Interruption of supplies (of ‘just in time’ delivery and storage policies of major companies) including blood, medicines and other essentials l Disruption to utilities and transport l Delays in dealing with other medical conditions l Pressure on mortuary facilities

Pandemic Influenza Contingency Plan Aims to :- l Provide effective health response l Safeguard and maintain health & other essential services l Minimise social & economic disruption l Allow flexibility whilst ensuring a consistent national approach

Contingency Planning - Staffing Identify Essential Staff - numbers & names (vaccination?) Identify Essential NHS work -what routine work can be suspended or modified and trigger for doing so? What are minimum staffing levels (in a crisis!!) ? Allocate to pandemic/non-pandemic areas Possible use of family members or volunteers Staff working outwith normal sphere of practice e.g. out- patients staff in wards Education and training Communication

How will you deal with Staff sickness/absence? re-deployment, use of volunteers, cessation of services Staff Training requirements? treatment, infection control measures, adaptability Occupational Health requirements? vaccination, use of anti-virals (PEP?), bereavement, etc Arrangements for supplies, pharmaceuticals etc. Contingency Planning - Staffing

Occupational Health Assess staff with Respiratory symptoms Monitor staff deployment Document staff sickness absence Psychological support Administer anti-virals as instructed Vaccinate staff as instructed Contingency Planning - Staffing

Contingency Planning - Patients Arrangements for care of affected patients Who will be admitted to hospital? Where? Arrangements for care of non-affected patients Who will be admitted to hospital? Where? How will patients be supported in the community? Infection Control measures

Bed Management Admission criteria - Primary Care arrangements Discharge arrangement - Primary Care arrangements Transportation (Flu v’s non-Flu) Tracking bed occupancy - flexible use of beds Cancellations - elective admissions, non-urgent procedures Arrangement for re-designating wards e.g. surgical to Pandemic Flu ward, increasing ICU and HDU beds Contingency Planning - Patients

Identification and separation of patients with Influenza Identify suitable areas for cohorting (ventilation!!) Communication - ensure staff are aware of procedures Visiting – risk management Infection Control - routine measures Mortuary facilities – ensure enough and transportation Contingency Planning - Patients

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