NHS Enfield CCG s Influenza Pandemic Plan

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1 NHS Enfield CCG s Influenza Pandemic Plan 1 SUMMARY Flu Pandemic Plan 2 RESPONSIBLE PERSON: Director of Performance and Corporate Services 3 ACCOUNTABLE DIRECTOR: Chief Officer 4 APPLIES TO: All employees 5 GROUPS/ INDIVIDUALS WHO HAVE OVERSEEN THE DEVELOPMENT OF THIS POLICY: London Borough of Enfield, Public Health Directorate, Public Health Consultant & Public Health Strategist 6 GROUPS WHICH WERE CONSULTED AND HAVE GIVEN APPROVAL: London Borough of Enfield Resilience Forum, 24 March EQUALITY IMPACT ANALYSIS COMPLETED: 8 Policy Screened Yes Template completed RATIFYING COMMITTEE(S) & DATE OF FINAL APPROVAL: Executive Team 19 April 2017 Yes 9 VERSION: 1 Intranet Yes Website Yes 10 AVAILABLE ON: RELATED DOCUMENTS: NHS Enfield CCG 11 EPRR Policy & Procedure DISSEMINATED TO: All employees DATE OF IMPLEMENTATION: May DATE OF NEXT FORMAL REVIEW: Every year or earlier should there be national or local changes at Borough or NHSE Level Page 1

2 Contents 1. INTRODUCTION BACKGROUND Avian and Swine Influenza Pandemic influenza planning assumptions Mortality information PANDEMIC RESPONSE PHASES The UK Pandemic Preparedness Strategy UK response phases (DATER) Detection Assessment Treatment... 7 Escalation... 7 Recovery ROLES AND RESPONSIBLITIES Enfield CCG s Responsibilities Local Self-Care Information Death Certification After a pandemic, Enfield CCG will; Debrief Incident recovery PERSONNEL MANAGEMENT AND STAFF WELFARE Impact on workforce Staff welfare team (Workforce management) Failure to attend work COMMAND, CONTROL AND CO-ORDINATION ARRANGEMENTS Pandemic command and control Co-ordination and liaison with NHS England Co-ordination and liaison with other partner agencies REVIEW FOLLOWING THE BCCG PANDEMIC FLU RESPONSE Related Documents Dissemination Advice & Guidance Review, Reporting and Monitoring Training References..20 Page 2

3 1.0 INTRODUCTION 1.1 This Influenza (Flu) Pandemic plan provides the framework for co-ordinating Enfield Clinical Commissioning Group [ECCG] response to an influenza pandemic. It is not a standalone document and supplements ECCG s existing Business Continuity Policy by providing additional information and guidance specific to mitigating, minimising and responding to an influenza pandemic. As a Category Two responder under the Civil Contingencies Act (2004), NHS organisations, including Clinical Commissioning Groups (CCGs) have a role in supporting NHS England London in planning for and responding to an influenza pandemic. 1.2 The potential for a new influenza pandemic remains unchanged although the timing and severity of a future pandemic remains unpredictable. The threat and potential impact of the pandemic influenza (Flu) is such that it remains the top risk on the UK Cabinet Office National Risk Register. 1.3 In line with national guidance, ECCG s Flu Pandemic Plan is: flexibly constructed to deal with a wide range of possibilities; based around an integrated, multi-sector approach; built on effective business continuity arrangements; responsive to local challenges and needs; and supported by strong local, regional and national leadership measures 1.4 When activated this plan contains procedures that allow the organisation to: receive notifications of pandemic influenza levels; comply with pandemic influenza reporting; reduce spread of influenza; ensure that critical outputs are maintained; provide timely, authoritative and up-to-date information for staff and partner organisations; and return to normal working after an outbreak as rapidly and efficiently as possible. 1.5 This Flu Pandemic Plan like all ECCG s emergency plans will be updated as new guidance is made available and following recommendations from internal (or external) incidents and exercises; the plan will also be updated following any changes to our organisational structure. 2.0 BACKGROUND 2.1 If a virus or disease occurs more than expected, then it is known as an epidemic or pandemic. Epidemic: The occurrence of more cases of a disease than would be expected in a community or region during a given time period; Pandemic: occurring over a wide geographic area and affecting an exceptionally high proportion of the population. 2.2 A pandemic may occur if an influenza virus undergoes major change ( antigenic shift ), and a new virus emerges, which is markedly different to recently circulating strains, and to which humans are not immune. A pandemic may occur if the new virus can: Page 3

4 infect people (rather than, or in addition to, animals or birds); spread from person to person; cause illness in a high proportion of the people infected; and spread widely, because most people will have little or no immunity to the new virus and will be susceptible to infection. 2.3 Pandemics have occurred throughout history when a new subtype of influenza develops the ability to spread rapidly through a global human population with little or no immunity to it. 2.4 Three pandemics occurred in the 20th century (in 1918, 1957 and 1968), with the first pandemic of the 21st century that started in April The twentieth century pandemics ranged in severity from something resembling a severe outbreak of seasonal influenza to a major event where millions of people became ill and died. They also varied with respect to numbers of waves of disease, age groups affected and symptoms caused. Planning at the start of the twenty-first century was based on these events. The 2009 pandemic did not occur as expected, demonstrating the uncertainty around pandemic preparedness. 2.6 Avian and Swine Influenza Avian influenza ( bird flu ) is an infectious disease of birds caused by influenza A viruses that spread mainly through contact with contaminated faeces (droppings) but also via respiratory secretions. Although they do not readily infect species other than birds and pigs, scientists believe that human-adapted avian viruses were the most likely origin of the last three human influenza pandemics. The highly pathogenic A/H5N1 avian influenza virus which is extremely contagious and rapidly fatal in domestic poultry species has prompted particular concerns in recent years. To date there has only been limited evidence of person-to-person transmission and, even where that has occurred; it has been with difficulty and has not been sustained The 2009 A/H1N1 virus was linked to outbreaks of influenza in pigs; and hence termed Swine Flu when it spread to humans; although it was not widely reported in pigs outside the initial outbreak in Mexico. A/H1N1 was not shown to be transmissible to people through eating properly handled and prepared pork (pig meat) or other products derived from pigs. The influenza A/H1N1 virus is killed by cooking temperatures of 160 F/70 C, corresponding to the general guidance for the preparation of pork and other meat. 2.7 Pandemic influenza planning assumptions A pandemic is most likely to be caused by a new subtype of the Influenza A virus, however an influenza pandemic could emerge at anytime, anywhere in the world, including the UK, and could emerge at any time of the year. Regardless of where or when it emerges, it is likely to reach the UK very quickly. From arrival in the UK, it will probably be a further one to two weeks until sporadic cases and small clusters of disease are occurring across the country. Initially, pandemic influenza activity in the UK may last for three to five months, depending on the season. There may be subsequent substantial activity weeks or months apart, even after the WHO has declared the pandemic to be over. Although it is not possible to predict in advance what proportion of the population will become infected with the new virus, previous studies suggest that roughly one half of all people will display symptoms of some kind (ranging from mild to severe). Page 4

5 2.7.2 The Department of Health s UK Influenza Pandemic Preparedness Strategy 2011 states that health services should continue to prepare for: up to 30% of symptomatic patients requiring assessment and treatment in usual pathways of primary care; between 1% and 4% of symptomatic patients will require hospital care, depending on how severe the illness caused by the virus is; up to 50% of the workforce, between 15% and 20% of staff may be absent on any given day, may require time off at some stage over the entire period of the pandemic; and In a widespread and severe pandemic, affecting 35% - 50% of the population, this could be even higher as some with caring responsibilities will require additional time off. 2.8 Mortality Information It is impossible to predict the number of deaths that can be expected. Nevertheless it is the responsibility of Local Authorities in conjunction with NHS providers to have a robust surge plan in place to cope with additional burials and cremations. Locally we should prepare to cope with up to 200,000 additional deaths across the UK over a 15 week period. In less widespread and lower impact influenza pandemic the number of additional deaths would be lower. 3.0 PANDEMIC RESPONSE PHASES 3.1 The UK Pandemic Preparedness Strategy The 2011 UK Influenza Pandemic Preparedness Strategy recognises that the World Health Organization (WHO) pandemic alert phases are not ideally suited as a response framework within individual countries. In 2009, the UK was well into its first wave of infection by the time WHO declared the official start of the pandemic. The use of WHO phases as a trigger for the different stages of local response, as detailed in the 2007 National Framework, proved to be confusing and unhelpful, as did categorisation of UK Alert Levels which were not used. The 2011 UK Strategy recognised that a more flexible approach is required for pandemic preparedness and response The overall objectives of the UK s approach to preparing for an influenza pandemic are to: minimise the potential health impact of a future influenza pandemic; minimise the potential impact of a pandemic on society and the economy; and instil and maintain trust and confidence Towards this, the strategy identifies a series of non-linear phases: Detection, Assessment, Treatment, Escalation and Recovery (DATER) with indicators for moving between them. The phases are not numbered as they are non-linear and may not follow in strict order; it is also possible to move back and forth or jump phases. It should also be recognised that there may not be clear delineation between phases, particularly when considering regional variation and comparisons Given the uncertainty about the scale, severity and pattern of development of any future pandemic, three key principles should underpin all pandemic preparedness and response activity: Page 5

6 Precautionary: the response to any new virus should take into account the risk that it could be severe in nature; Proportionality: the response to a pandemic should be no more and no less than that necessary in relation to the known risks; and Flexibility: there should be a consistent, UK-wide approach to the response to a new pandemic but with local flexibility and agility in the timing of transition from one phase of response to another to take account of local patterns of spread of infection and the different healthcare systems in the four countries The strategy further elaborates on the proportionate aspect of the response by describing the nature and scale of illness in low, moderate and high impact scenarios, and further attributes potential healthcare and wider societal actions as well as key public messages. 3.2 UK s Response Phases (Detection Assessment Treatment Escalation & Recovery (DATER) Pandemic influenza response plans should be based on existing systems and processes wherever possible, however in the 2009/10 pandemic, several extraordinary systems were introduced at short notice including the distribution of antiviral medication and vaccinations outwith normal pharmacy and GP arrangements. Following the 2009/10 A/H1N1 pandemic, the Department of Health withdrew the UK Alert Levels and FluCon levels previously used in healthcare plans. New terminology was introduced in 2011 to categorise the various phases of the response to a pandemic namely: Detection, Assessment, Treatment, Escalation and Recovery and incorporates indicators for moving from one phase to another although they are not linear and can occur in any order. Public Health England (PHE) is the lead agency for the first aspects of the DATER process, and coordinates the surveillance and investigation of new cases of influenza, providing public health advice. 3.3 Detection This phase would commence on either the declaration of the current World Health Organisation (WHO) phase 4 or earlier on the basis of reliable intelligence or if an influenza-related Public Health Emergency of International Concern (a PHEIC ) is declared by the WHO. The focus in this stage would be: intelligence gathering from countries already affected enhanced surveillance within the UK the development of diagnostics specific to the new virus information and communications to the public and professionals The indicator for moving to the next stage would be the identification of the novel influenza virus in patients in the UK. 3.4 Assessment Page 6

7 3.4.1 The focus in this stage would be: the collection and analysis of detailed clinical and epidemiological information on early cases, on which to base early estimates of impact and severity in the UK. reducing the risk of transmission and infection with the virus within the local community by: actively finding cases; self-isolation of cases and suspected cases; and treatment of cases / suspected cases and use of antiviral prophylaxis for close / vulnerable contacts, based on a risk assessment of the possible impact of the disease The indicator for moving from this stage would be evidence of sustained community transmission of the virus, i.e. cases not linked to any known or previously identified cases. These two stages Detection and Assessment - together form the initial response. This may be relatively short and the phases may be combined depending on the speed with which the virus spreads, or the severity with which individuals and communities are affected. It will not be possible to halt the spread of a new pandemic influenza virus, and it would be a waste of public health resources and capacity to attempt to do so NHS England (London) is the lead agency for the final three phases of the DATER process, and coordinates both the strategic and operational NHS response to pandemic influenza within London. NHS England (London) roles and responsibilities during a future influenza pandemic as summarised below, are available in more detail in the national NHS England Pandemic Influenza Operating Framework (October 2013) and the NHS England (London) Pandemic Influenza Operating Arrangements (June 2014) Treatment The focus in this stage would be: treatment of individual cases and population treatment via the National Pandemic Flu Service, if necessary. enhancement of the health response to deal with increasing numbers of cases. consider enhancing public health measures to disrupt local transmission of the virus as appropriate, such as localised school closures based on public health risk assessment. depending upon the development of the pandemic, to prepare for targeted vaccinations as the vaccine becomes available Arrangements will be activated to ensure that necessary detailed surveillance activity continues in relation to samples of community cases, hospitalised cases and deaths. When demands for services start to exceed the available capacity, additional measures will need to be taken. This decision is likely to be made at a regional or local level as not all parts of the UK will be affected at the same time or to the same degree of intensity. Escalation Page 7

8 The focus in this stage would be: escalation of surge management arrangements in health and other sectors; prioritisation and triage of service delivery with aim to maintain essential services; resiliency measures, encompassing robust contingency plans; and consideration of de-escalation of response if the situation is judged to have improved sufficiently These two stages (Treatment and Escalation) form the main response phase of the pandemic. Whilst escalation measures may not be needed in mild pandemics, it would be prudent to prepare for the implementation of the Escalation phase at an early stage of the Treatment phase, if not before. Recovery The focus in this stage would be: normalisation of services, perhaps to a new definition of what constitutes normal service; restoration of business as usual services, including an element of catching-up with activity that may have been scaled-down as part of the pandemic response e.g. reschedule routine operations; post-incident review of response, and sharing information on what went well, what could be improved, and lessons learnt; taking steps to address staff exhaustion; planning and preparation for a resurgence of influenza, including activities carried out in the Detection phase; continuing to consider targeted vaccination, when available; and preparing for post-pandemic seasonal influenza The indicator for this phase would be when influenza activity is either significantly reduced compared to the peak or when the activity is considered to be within acceptable parameters. An overview of how services capacities are able to meet demand will also inform this decision. 4.0 ROLES AND RESPONSIBLITIES 4.1 The aim of this Plan is to outline the roles and responsibilities of ECCG during a pandemic and provide operational guidance to staff in relation to how to respond in accordance with the CCG s responsibilities. 4.2 The Health and Social Care Act 2012 created a new set of responsibilities for the delivery of public health services in England. Although the local leadership for improving and protecting the public s health sits with local government, the reforms provided specific roles across the system. Each of the partners has its own responsibilities for which it is accountable. 4.3 During a pandemic, the NHS and local government commissioning and provider organisations will maintain their existing roles and responsibilities for the management of the local health and social care system. However, some pandemic specific activities will also be required by specific organisations. 4.2 Department of Health (DH) is responsible for: Page 8

9 4.2.1 policy decisions on the response to the flu season holding NHS England and PHE to account through their respective frameworks agreements, the Mandate and the Section 7A agreements oversight of the supply of antiviral medicines and authorisation of their use authorising campaigns such as Catch it, Kill it, Bin it 4.3 NHS England is responsible for: commissioning the flu vaccination programme under the terms of the Section 7A agreements; assuring that the NHS is prepared for the forthcoming flu season; monitoring the services that GP practices and community pharmacies provide for flu vaccination to ensure that services comply with the specifications; building close working relationships with Directors of Public Health (DsPH) to ensure that local population needs are understood and addressed by providers of flu vaccination services 4.4 Public Health England is responsible for: planning and implementation of the national approach; monitoring and reporting of key indicators related to flu, including flu activity and vaccine uptake procurement and distribution of flu vaccine for children oversight of central vaccine supply advising NHS England on the commissioning of the flu vaccination programme managing and co-ordinating the response to local incidents and outbreaks of flu public communications to promote uptake of flu vaccination and other aspects of combating flu such as hand hygiene supporting DsPH in local authorities in their role as local leaders of health and ensuring that they have all relevant expert input, surveillance and population data needed to carry out this role effectively. 4.5 Local authorities, through their DsPH, have responsibility for: providing appropriate advocacy with key stakeholders and challenge to local arrangements to ensure access to flu vaccination and to improve its uptake by eligible populations; and providing leadership, together with local resilience partners to respond appropriately to local incidents and outbreaks of flu infection 4.6 Local authorities can also assist by: promoting uptake of flu vaccination among eligible groups, for example older people in residential or nursing care, either directly or through local providers; promoting uptake of flu vaccination among those staff providing care for people in residential or nursing care, either directly or through local providers 4.7 Clinical Commissioning Groups (CCGs) are responsible for: quality assurance and improvement which extends to primary medical care services delivered by GP practices including flu vaccination and antiviral medicines; Enfield CCG commissions a local chemist (Simmons Pharmacy, 111 Cockfosters Page 9

10 Road, EN4 0DA) to provide flu vaccines for its staff during the winter period. The vaccination data is monitored and reported to NHS England by the CCG at its Assurance meeting; The primary role of CCGs is to manage local pressures in provider organisations during a pandemic and may need to represent NHS England at the Local Influenza Pandemic Co-ordination Group. NHS England may not have sufficient resources to attend every group meeting and therefore, the local CCGs will be involved to provide support; London CCGs are responsible for reporting the local issues to the NHS England London Pandemic Influenza Incident Response Team (PI-IRT) and for distributing NHS messages/information to the local public as directed by the PI- IRT; Enfield CCG s GP members practices will also be responsible to work collaboratively with the Acute and Community Health providers to co-ordinate patients flow during an outbreak. The diagram below provides an overview of London Pandemic Response Structure 4.8 GP practices, community pharmacists and other providers are responsible for: Page 10

11 educating patients, particularly those in at-risk groups, about the appropriate response to the occurrence of flu-like illness and other illness that might be precipitated by flu; ordering the correct amount and type of vaccine for their eligible patients, taking into account new groups identified for vaccination and the ambition for uptake; ordering vaccine for children from PHE central supplies through the ImmForm website and ensuring that vaccine wastage is minimised; storing vaccines in accordance with national guidance; ensuring that all those eligible for the flu vaccine are invited personally to receive their vaccines; ensuring vaccination is delivered by suitably trained, competent healthcare professionals who participate in recognised on-going training and development in line with national standards; maintaining regular and accurate data collection using appropriate returns encouraging and facilitating flu vaccination of their own staff; and ensuring that antiviral medicines are prescribed for appropriate patients, once the CMO/CPhO letter has been distributed alerting them that antiviral medicines can be prescribed. 4.9 All employers of individuals working as providers of NHS services are responsible for: management and oversight of the flu vaccination campaign or alternative infection control measures for their frontline staff; and support to providers to ensure access to flu vaccination and to maximise uptake among those eligible to receive it. 5.0 Enfield CCG s Responsibilities 5.1 NHS England has produced a guidance relating to the role of CCGs in the event of an influenza pandemic. Please refer to NHS England Gateway: December The following has been adapted from the original document to reflect ECCG s responsibilities as a Category Two Responder under the Civil Contingencies Act 2004 and our limited capabilities and resources. 5.3 ECCG will follow its business continuity procedures in pandemic with low and moderate impacts. However, in a high impact event, ECCG is likely to activate its Major Incident Procedures. Before a pandemic, ECCG will: Undertake business continuity and resilience planning for pandemic flu, identifying key issues within the CCGs, including the identification of which normal business functions are essential and which can be suspended or postponed Communicate any plans with key internal and external stakeholders Call a meeting of the Systems Resilience Group which will include the Director of Commissioning, Head of Primary Care Commissioning, the Page 11

12 Business Continuity Lead, the Resilience and Urgent Care Programme Manager and the Communications and Engagement Lead Participate in relevant planning groups such Enfield Borough Resilience Forum, Health Protection Forums and Local Health Resilience Partnerships in supporting and ensuring local health pandemic preparedness to discuss strategy in the event of a pandemic Ensure early engagement of communications professionals to devise, deliver and maintain communication plan in the event of an influenza pandemic, particularly with General Practitioners and Community Health providers. During a pandemic, ECCG will: Ensure the 24/7 on-call arrangements across ECCG are robust and maintained, particularly with respect to surge and responding to major incidents Lead the management of pressure surge arrangements with our commissioned services. In the event of a major incident being declared NHS, England assumes strategic control. Support NHS England London in the local coordination of the response. Participate in a multi-agency communication strategy to ensure consistent, clear and timely dissemination of information and guidance. Participate in the multi-agency response as agreed with NHS England London. Activate business continuity arrangements to ensure critical activities can be maintained. Ensure that the ECCG Systems Resilience Group meets regularly to inform the incident commander and formulate strategy about incident management. Maintain local data collection processes to support the overall response to the pandemic i.e. sitreps for NHS England London. Review normal and acceptable minimum staffing levels of core functions and services and address any potential changes to working practices that may be needed to facilitate this. The GP practice and/or CCG will collaborate with other providers such as community or health and social care trusts to identify and offer flu vaccination to residents in care homes, nursing homes and housebound patients 5.4 Local Self-Care Information Page 12

13 5.4.1 A local communications campaign will be co-ordinated through NHS England that will inform residents of local services and promoting community responsibility as well as self-care Voluntary organisations will also be essential when reaching vulnerable and seldom heard groups The public often prefer to follow media advice than government issued guidelines and therefore the Communications strategy will take into consideration the response of the public to pre-pandemic and government communication strategies Information for symptomatic individuals will also be essential in reducing the impact on healthcare services which will include information to support people recognise and monitor their own or another s symptoms take infection control measures know when, where and how to get further help and advice (including knowing how to access information and antiviral medicines via the National Pandemic Flu Service) identify friends, relatives or helpers who may be able to provide assistance and support during the pandemic in particular, a friend or relative ( flu friend ) who is able to collect their antiviral medicines (and other medicines) for them when they are symptomatic helping neighbours and vulnerable individuals in the community know what is normal during an influenza illness understand why it is important that they take their medicines and how to do so use of non-prescription flu medicines 5.5 Death Certification During a pandemic, changes to the current death certification legislation may be implemented for individuals dying from influenza or complications of influenza. However, deaths of patients may still need to be referred to the Coroner for investigation. There may be a delay in organising funerals and during the peak of a pandemic; funerals may not be allowed to reduce the risk of infection. Families or support groups may consider holding a small memorial service at home and arrange something more formal for after the pandemic wave has passed In a period of high mortality, there may be a shortage of storage facilities to house the bodies of deceased patients. There will need to be local meetings of the Systems Resilience Team, Enfield Borough Resilience Teams and NHSEL to identify solutions for this issue. 5.6 After a pandemic, ECCG will: Debrief A debrief should be held after every Low, Moderate and High Impact Pandemic response (the full process can be found in the ECCG s Business Continuity Policy). In addition to this, a multi-agency debrief will be facilitated by a partner agency. Incident recovery Page 13

14 5.6.2 The Business Continuity Lead will be responsible for collating and storing all the records, logs and reports associated with the incident. All documents associated with any pandemic period are to be sent to the Business Continuity Lead as soon as possible after stand-down or at the declared end of the pandemic After a pandemic, an assessment will be completed to review the disruption to ECCG s functions caused by the incident this should include: effects on staffing (e.g. loss of staff through injury or sickness, impact of overtime worked by staff during the incident on staffing levels); support needs of staff affected by the incident (including trauma support); disruption caused to services; financial losses; future provision of services in the short-,medium- and long-term; Contribute to any London Enfield Borough, Regional and National post-pandemic debriefs as required and consider the implementations of recommendations from any subsequent reports Acknowledge staff contributions Assess the impact of the pandemic on the provision of commissioned services by ECCG and ensure that ongoing service levels are sufficient to meet the demands of the system in the local health economy Ensure the recovery of services to business as usual as soon as appropriate Review responses and update the CCG Pan-Flu Plan, contracts (patient commissioned and CSU commissioned) and other arrangements to reflect lessons learnt from the pandemic - particularly where services have been commissioned locally Collect financial and contractual impact information for commissioned providers During the recovery process, the Staff Welfare Team will focus on enabling staff to take appropriate leave, enabling staff to return to work and reviewing vacancies and prioritising recruitment. The Team will also play an essential part in planning for the next pandemic wave and recording lessons learnt. 6.0 Personnel Management and Staff Welfare Impact on workforce 6.1 It is estimated in a worst case scenario that up to 50% of the workforce may require time off at some stage over the entire period of the pandemic, with infected individuals likely to be absent for a period of seven to ten working days. Absenteeism should follow the pandemic profile, with an expectation that it will build to a peak lasting for two to three weeks, when between 15% and 20% of staff from the workforce may be absent, and then decline. In a UK study of 1,034 Health Care Workers in 2009 pandemic flu, only 13% said they would continue to work if their children were ill, 23% would work if their partner was ill, 60% would work even if they had to work more hours than normal and 63% would be willing to work if they had to work with untrained volunteers. Only 14% said they would be likely to work under all these circumstances. Page 14

15 6.2 Additional staff absences are likely to result from other illnesses, taking time off to provide care for dependants (e.g. children), family bereavement, other psychosocial impacts, fear of infection or practical difficulties in getting to work. 6.3 The Government may advise schools and early years/childcare settings to close in order to reduce the spread of infection amongst children. This advice will be provided only if closure is anticipated to produce significant health benefits. Closures will be area-specific (if the virus is circulating in the locality) and are likely to be for two to three weeks, although they may be extended if the pandemic remains in the area. 6.4 A further 5 6% of CCG staff could be absent as a result of school closures, though this is based on an analysis of informal childcare being available for parents. This policy may change over the course of a pandemic wave. Staff welfare team (Workforce management) 6.6 People will be the most valuable resource and the most vulnerable during a pandemic. In order to effectively manage this essential resource, a staff welfare team may be formed, led by the Director of Performance and Corporate Services, supported by the CCG s Human Resources business partner from NEL CSU. The staff welfare team s main purpose will be to assist staff during the pandemic, from recording absences to enabling staff to return to work. The team will provide a focal point for staff during the pandemic and its duties will include: monitoring and reporting real-time absence rates ensure that contact details and characteristics of the available workforce are captured enabling staff to work by agreeing alternative duties or directing them to support services (e.g. transport or childcare) managing the redeployment of staff, including voluntary and recently retired providing general advice on self-care and infection control confirming leave and special leave arrangements providing or directing staff to appropriate psychological support services enabling staff to resolve concerns or disputes involving working requirements review locations of staff at home and at work and implement a travel assistance policy in the event that normal transport services are unavailable develop arrangements for staff to access counselling and support services review local human resources policies and procedures to maximise flexibility for staff to be able to work and accommodate caring obligations, annual leave and special leave (carer s leave, bereavement leave, etc ) identify if a specific workforce or team has a high proportion of people with young children and other personal caring responsibilities that may impact upon their ability to attend work during normal hours, develop plans to support them with childcare or alternative work options 7.0 Failure to attend work 7.1 Enfield CCGs expects that unless members of staff are unwell themselves, it will be exceptional for the member of staff to not be able to attend work in some capacity. Staff who do not attend work because they are unwell should follow the locally agreed sickness absence policy outlined to them at the beginning of an influenza pandemic. Staff who display symptoms should be sent home and advised not to work until fully Page 15

16 recovered. Staff should also be informed in an appropriate way of the risks associated with pandemic influenza and what action they can take to protect themselves and others, and instructing them not to attend work when they are symptomatic but to attend work when they are well. 7.2 Staff with caring responsibilities should be dealt with on a sympathetic basis but at the same time, Enfield CCG and staff should be working together to try and agree attendance at work in some capacity. Home working may be a feasible option for some staff. The nature of the support could vary, for example mixes of paid and unpaid leave, building on existing carers leave provisions. Some staff may be reluctant to come to work due to fear of infection. Initially, efforts should be made to convince staff to attend work by direct approaches from clinical colleagues and Occupational Health. 7.3 The level of anxiety that an influenza pandemic is likely to generate should be acknowledged and ECCG should seek to persuade rather than penalise. However, ECCG should not rule out the possibility of having to apply disciplinary action, subject to disciplinary policies and procedures for unauthorised absence or failure to follow a reasonable management instruction. ECCG will need to recognise that some individuals may be deemed at higher risk than others due to health conditions and special consideration may need to be given to these staff, including Occupational Health advice and support. For further advice, please contact the HR business partner at NEL CSU. 7.4 Every NHS organisation is required to have a Pandemic Influenza Lead to drive local pandemic influenza planning. The ultimate responsibility for pandemic preparedness and planning resides with Chief Executives as described in the Civil Contingencies Act COMMAND, CONTROL AND CO-ORDINATION Pandemic command and control 8.1 NHS England London (NHSEL) is responsible for the command, control, coordination, communication and governance of the health response in London. These arrangements do not alter during or after a pandemic. Upon initiation of a pandemic response in the UK, NHS England Incident Management Teams (IMTs) will convene and meet as appropriate to the level of response to coordinate and support the response of NHS organisations. 8.2 NHS England National, Regional and Area Teams will ensure that capacity to respond to a concurrent major incident or emergency is maintained; in terms of personnel, facilities and capacity. 8.3 The NHSEL IMT will regularly disseminate scientific, epidemiological and operational guidance and direction to NHS organisations in London. This will be through electronic means (such as and a web-based portal) and through teleconferences. 8.4 The response to a pandemic will be localised in the initial phase and in low impact pandemics and as such for as long as possible should be coordinated through business as usual arrangements and business continuity managements. In a moderate to high impact pandemic it is expected to become a DECLARED major incident then the usual procedures as contained in ECCGs Business Continuity Plan will apply alongside all dedicated pandemic response arrangements as detailed in section four of this plan. Page 16

17 Co-ordination and liaison with NHS England 8.5 The ECCG Incident Team will remain in contact with the NHSEL throughout the pandemic period and provide them with SitReps through the usual channels on request. The daily rhythm will be defined as the acute phase of the pandemic is approached, but will vary as the impact wanes. 8.6 NHSEL will also receive information direct from the DH and disseminate all relevant information to all nominated NHS emergency preparedness officers throughout their regional area. At a moderate to high impact, pandemic regional major incident rooms may be opened to coordinate requests for mutual aid and monitor service delivery across the area. Co-ordination and liaison with other partner agencies 8.7 Every NHS organisation is required to have a Pandemic Influenza Lead to drive local pandemic influenza planning. The ultimate responsibility for pandemic preparedness and planning resides with Chief Executives as described in the Civil Contingencies Act It is recommended by NHSEL that local planning and response mechanisms are coordinated on a borough-basis where local health organisations collaborate with multiagency partners. It is suggested that influenza pandemic planning meetings are held before an influenza pandemic, response meetings during and then after a pandemic. Following the changes to the NHS and local authority landscape, it is suggested that a Borough Health Resilience Partnership or similar forum that reports into the statutory Health & Well Being Board performs the multi-agency influenza pandemic planning functions. The forum must have adequate and appropriate representation from all organisations required to prepare for and respond to pandemic influenza. 8.9 The Department of Health and NHS England will be co-ordinating the national communications strategy during a pandemic. Locally communication material should focus on information for residents on how to access assessment services and antiviral collection points, changes to regular health services, and alterations to general practices. Information may also need to be distributed through voluntary, community and faith groups, especially in areas where language and literacy may make it difficult to understand national media messages ECCG s Communications Team will be in charge of pandemic communications internally and externally. The objectives of pandemic communications are: For staff to be aware of the predictability of a flu pandemic and be able to identify the symptoms of flu; For staff to be aware of hygiene practices which can reduce the spread of infection and practice these; For the public to know who to contact and how to access support in the event of a flu pandemic; For staff to get clear messages from the Executive Management team at each phase of the pandemic about a range of issues temporary policy changes, revisions of policies, access to petrol, agreed essential and non-essential services, taking sick leave and/or carers leave, signing off and signing on, supply lines, etc; Convey key messages from Department of Health/NHS England Page 17

18 London to staff; Communicate key Situation Reports (Sit Reps) to NHS England London; Monitor internal and external developments; Liaise with relevant stakeholders; and Communications will be planned with the Systems Resilience Team 8.11 Local Co-ordination 8.12 An Enfield-wide Local Influenza Pandemic Co-ordination Group will be convened by the Director of Public Health with the following core members: Director of Public Health (Chair) NHS England (London) representative and/or CCG Pandemic Lead Local Authority Directors of Adult s Services Local Authority Directors of Children s Services Public Health England (PHE) including a Comms Lead from LBE Local Authority Emergency Planning Leads Chief Pharmacists Acute Trust Leads (NMH) Mental Health Leads Community Health Services Leads 8.13 The Group will be able to call on other multi-agency members if necessary, for example: Metropolitan Police Service; London Ambulance Service; Transport for London; London Fire Brigade; Barnet, Enfield & Haringey Mental Health NHS Trust; North Middlesex Hospital NHS Trust; Royal Free Foundation NHS Trust; Environment Agency; Chamber of Commerce Rep; Enfield Voluntary Services Council; London Buses Representative; and Any other Group s representative that the Enfield Borough of London deem appropriate to call upon. This Multi-Agency Group is updated by LBE Public Health on behalf of the Enfield Borough Resilience Forum (EBRF) This group will be Chaired by the local Enfield Public Health team based at Enfield Council and will coordinate and lead the local response - requesting information and assurance around systems and processes and issues arising during the response. It will provide leadership, rather than a command role and will consider the following areas: Cases of flu locally; Local organisational pressures (staff absence, current demand for services, supply issues); Management of deaths locally; Antiviral and vaccination situation; Page 18

19 Performance issues; Incidents relating to flu; and Communications ECCG Pandemic Response Team ECCG will identify a team to lead their response to the pandemic. This will include the following individuals: Pandemic Flu Lead (Director of Performance & Corporate Services); Head of Medicines Management; Director of Acute Commissioning ( Or representative from Acute Commissioning) Director of Primary Care Commissioning (Or representative from Primary Care) Urgent Care Lead; Communications and Engagement Lead; 8.16 This team will have the responsibility for ensuring all actions relating to the pandemic are carried out: reporting to senior CCG staff and attending the Local Influenza Pandemic Coordination Group and participating in teleconferences as necessary. ECGG on-call Arrangements 8.17 There are shared on-call arrangements in place for all NCL CCGs. At any time, there are members of staff on call: the Director on call and second Director on call for NCL CCGs (NELCSU). They both hold a pager which is part of the PageOne Network: Surge Management Team Surgemanagement@nelcsu.nhs.uk or REVIEW OF ENFIELD CCG s PANDEMIC FLU PLAN 9.1 ECCG s Pandemic Influenza Plan will be regularly reviewed by the EPLO and Business Continuity Lead with support and guidance from NHS England; Enfield Borough Resilience Forum in the local health economy and in discussion with the Commissioning Support Unit who provide ECCG with surge management on an outsourced basis. This Plan will be reviewed annually in line with Enfield Multi-agency Pandemic Flu Plan RELATED DOCUMENTS 10.1 The following documents contain information that relates to this Plan: ECCG s Business Continuity Policy; and Public Health England- Flu Plan Winter 2016/17: May DISSEMINATION 11.1 ECCG s Corporate Affairs Department has the responsibility to ensure that all employees within their departments have access to the CCG s Corporate Policies and Procedures It is the responsibility of the relevant line manager and Head of Department to ensure that all staff are comply with ECCG s policy and procedures by providing both access and related training commensurate with the staff job role. Page 19

20 11.3 This policy will be published on ECCG s website and also onto the intranet for access by all CCG employees, GP members and other relevant individuals ADVICE & GUIDANCE 12.1 Advice and guidance on Flu Pandemic Planning can be sought from the following people: ECCG s Director of Performance & Corporate Services ( EPLO); ECCG s Head of Corporate Services; and London Borough of Enfield s Public Health Team REVIEW, REPORTING AND MONITORING Review 13.1 An annual review of this policy will be undertaken by the Executive Committee. The Executive Committee will require provide assurance to NHS England as required. Reporting 13.2 If the pandemic reaches across the UK and the number of cases increases, guidance will be provided by NHSE Public Health Directorate as there will be a requirement to monitor the outbreak through regular reports (SitReps) from all organisations including ECCG TRAINING 14.1 This plan will be circulated to all senior staff once approved. Training will be provided on request from the Public Health Directorate. The last training update was provided on 18 February REFERENCES This document supports the: London Resilience Partnership Pandemic Influenza Framework v 6 (2014) Cabinet office guidance on Pandemic flu Department of Health The UK Influenza Preparedness Strategy (2011) h_ pdf NHS England Operating Framework for Pandemic Influenza (2013) Page 20