DERBYSHIRE LOCAL RESILIENCE FORUM DERBYSHIRE STRATEGIC PLAN FOR PANDEMIC INFLUENZA

Transcription

1 DERBYSHIRE LOCAL RESILIENCE FORUM DERBYSHIRE STRATEGIC PLAN FOR PANDEMIC INFLUENZA JANUARY 2012

2 Derbyshire Strategic Plan for Pandemic Influenza CIRCULATION LIST Amber Valley Borough Council Bolsover District Council Chesterfield Borough Council Chesterfield Royal Hospital NHS Foundation Trust Derby City Council Derbyshire Cluster PCT (NHS Derby City and NHS Derbyshire County) Derby Hospitals NHS Foundation Trust Derbyshire Constabulary Derbyshire County Council Emergency Planning Division Derbyshire Community Health Services NHS Trust Derbyshire Dales District Council Derbyshire Fire and Rescue Service Derbyshire Healthcare NHS Foundation Trust East Midlands Ambulance Service NHS Trust Environment Agency Erewash Borough Council High Peak Borough Council Health Protection Agency East Midlands Maritime and Coastguard Agency North East Derbyshire District Council South Derbyshire District Council NHS Tameside and Glossop January 2012

3 Derbyshire Strategic Plan for Pandemic Influenza CONTENTS Page OVERVIEW 1 AIM 1 OBJECTIVES 1 CONTEXT 2 PLANNING ASSUMPTIONS 3 OPERATING PRINCIPLES 4 ACTIVATION OF PLAN 8 SUB-GROUPS 9 IMPACT ON DERBYSHIRE 10 STRATEGIC CO-ORDINATING GROUP 22 MEETING FREQUENCY 22 REMIT OF THE STRATEGIC CO-ORDINATING GROUP 22 STRATEGIC CO-ORDINATING GROUP - STRATEGIES 22 MEMBERSHIP - STRATEGIC CO-ORDINATING GROUP 23 COUNTY HEALTH GROUP 24 MEETING FREQUENCY 24 REMIT OF THE COUNTY HEALTH GROUP 24 SUGGESTED FIRST AGENDA 24 MEMBERSHIP - COUNTY HEALTH GROUP 25 WARNING AND INFORMING GROUP 26 REMIT OF THE WARNING AND INFORMING GROUP 26 MEMBERSHIP - WARNING AND INFORMING GROUP 26 OPERATIONAL LEVEL GROUPS 27 DERBYSHIRE INFLUENZA PANDEMIC PLANS 28 DERBYSHIRE SUPPORT PLANS 29 LRF MASS FATALITIES AND EXCESS DEATHS PLAN 29 LRF WARNING AND INFORMING PLAN 29 LRF HUMANITARIAN ASSISTANCE PLAN 29 LRF STRATEGIC RECOVERY PLAN 29 LRF FUEL SHORTAGE RESPONSE PLAN 29 LRF COMMAND AND CONTROL PLAN 30 RESILIENT COMMUNICATIONS PLAN 30 LOCAL AUTHORITY EMERGENCY PLANS 30 CATEGORY 1 RESPONDERS BUSINESS CONTINUITY PLANS 30 January 2012

4 Derbyshire Strategic Plan for Pandemic Influenza Page APPENDIX A - SITUATION REPORTING INFORMATION FLOWS APPENDIX B - SITUATION REPORT APPENDIX C - LOCAL AUTHORITY DAILY REPORT - INFLUENZA PANDEMIC APPENDIX D - STRATEGIC CO-ORDINATING GROUP - OUTLINE STRATEGIES AT THE COMMENCEMENT OF AND DURING THE PANDEMIC POST PEAK OF PANDEMIC CASES AND INTER WAVE PERIOD APPENDIX E - PANDEMIC INFLUENZA GUIDANCE CABINET OFFICE COMMUNITIES AND LOCAL GOVERNMENT DEPARTMENT FOR EDUCATION AND SKILLS DEPARTMENT OF HEALTH GENERAL REGISTER OFFICE HEALTH AND SAFETY EXECUTIVE HOME OFFICE NATIONAL POLICING IMPROVEMENT AGENCY MINISTRY OF JUSTICE PHARMACUETICAL SERVICES NEGOTIATING COMMITTEE ROYAL COLLEGE OF GENERAL PRACTITIONERS WORLD HEALTH ORGANISATION (WHO) INFECTION CONTROL GUIDANCE DEPARTMENT FOR EDUCATION AND SKILLS DEPARTMENT OF HEALTH GENERAL REGISTER OFFICE NATIONAL POLICING IMPROVEMENT AGENCY A1 A1 B1 C1 D1 D1 D3 E1 E1 E1 E1 E1 E2 E2 E2 E2 E2 E3 E3 E3 E3 E3 E3 E3 E3 January 2012

5 Derbyshire Strategic Plan for Pandemic Influenza OVERVIEW The Derbyshire Strategic Plan for Pandemic Influenza has been prepared on behalf of the Local Resilience Forum (LRF). The Plan will formalise and clarify the procedures and structure for co-ordination of the response to pandemic influenza in Derbyshire. In responding to an influenza pandemic this Plan will be utilised in conjunction with other relevant LRF plans eg Mass Fatalities and Excess Deaths and Warning and Informing Plans. AIM To enable the response to pandemic influenza to be co-ordinated within the Derbyshire LRF and to be consistent with the Pandemic Flu East Midlands Regional Concept of Operations (CONOPS). OBJECTIVES To ensure an effective, multi-agency strategic tier can be established to co-ordinate activity across the LRF area and act as a link to the regional structure. To develop a structure which effectively co-ordinates the overall health response across the NHS Trusts in the LRF area. To ensure individual Trusts are supported appropriately. To ensure effective communications throughout the structure, including dissemination of information to the public. To ensure the resources of the voluntary sector can be used effectively and co-ordinated across the LRF area. To ensure social care needs are considered. To manage excess deaths expected during an influenza pandemic. To assess the need for and to co-ordinate mutual aid. To determine the interdependencies between the emergency services and partner agencies. January

6 Derbyshire Strategic Plan for Pandemic Influenza CONTEXT The Government judges that one of the highest current risks to the UK is the possible emergency of an influenza pandemic, where there is the rapid worldwide spread of influenza caused by a novel virus strain to which people have no immunity, resulting in more serious illness than caused by seasonal influenza. The Derbyshire Community Risk Register identifies Influenza Pandemic as a Very High risk (as of January 2012) (see below). SUB CATEGORY OF HAZARD OR THREAT GUIDELINE SCALE AND DESCRIPTION OF EVENT LIKELIHOOD IMPACT(S) OVERALL RISK DESCRIPTION CONTROLS CURRENTLY IN PLACE Communicable disease outbreak (influenza pandemic) Pandemic Influenza involving new virus, with no immediately available vaccine. A significant proportion of the population are likely to be infected, of which a proportion (unknown at this stage but predicted to be 1-3% of the total number infected) may be fatal cases. Further significant impacts on essential services, particularly the NHS Medium High Significant Very High Specific Dept of Health and HPA national plans; Specific HPA East Midlands framework plan; Specific health trust escalation plans (responding to demand increase); Generic major incident plans (eg local authorities, health trusts) A pandemic occurs when a new type of influenza virus emerges. This means that almost all the population are potentially susceptible and the new virus may be more virulent than other flu viruses in circulation. Past pandemics have varied in scale, severity and consequences, although in general their impact has been much greater than that of even the most severe winter epidemic. There have also been material differences in the age groups most affected, the time of year they occurred and the speed of spread, all of which influenced their overall impact. Although little information is available on earlier pandemics, the three that occurred in the 20 th century are well documented. The worst (often referred to as Spanish Flu ) occurred in 1918/19. It caused serious illness, an estimated million deaths worldwide (with peak mortality rates in people aged years) and major disruption. Some residual health problems attributed to it lasted for many years thereafter. Whilst the pandemics in 1957 and 1968 (often referred to as Asian and Hong Kong Flu respectively) were much less severe, they also caused significant illness levels - mainly in the young and the elderly - and an estimated 1-4 million deaths between them. January

7 Derbyshire Strategic Plan for Pandemic Influenza During 2009/10 a new influenza virus Pandemic (A) H1N1 influenza virus 2009 (commonly referred to as Swine Flu) caused the first influenza pandemic since the 1968/69 pandemic. The virus first emerged in Mexico in late April and then spread across the world. Although most people experienced relatively mild illness, some younger adults and children, particularly those with underlying health conditions and some pregnant women, experienced severe or even fatal illness and NHS services came under pressure. Therefore, there are no grounds for complacency and no presumption should be made that the relatively mild Swine Flu pandemic is representative of future pandemics. PLANNING ASSUMPTIONS It is impossible to forecast the precise characteristics, spread and impact of a new influenza virus strain. An influenza pandemic could emerge at any time, anywhere in the world, including in the UK. It could emerge at any time of the year. Regardless of where or when it emerges, it is likely to reach the UK very quickly. It will not be possible to stop the spread of, or to eradicate the pandemic influenza virus, either in the country of origin or in the UK, as it will spread too rapidly and too widely. 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. Following an influenza pandemic, the new virus is likely to re-emerge as one of a number of seasonal influenza viruses and based on observations of previous pandemics, subsequent winters are likely to see a different level of seasonal flu activity compared to pre-pandemic winters. 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 may display symptoms of some kind (ranging from mild to severe). The transmission rate of the pandemic virus and the proportion of people in which severe symptoms are produced will not be known in advance. Regardless of the nature of the virus, it is likely that members of the population will exhibit a wide spectrum of illness, ranging from minor symptoms to pneumonia and death. Most people will return to normal activity within seven to ten days. All ages are likely to be affected but those with certain underlying medical conditions, pregnant women, children and otherwise fit younger adults could be at relatively greater risk as older people may have some residual immunity from previous exposure to a similar virus earlier in their lifetime, the exact pattern will only become apparent as the pandemic progresses. Health services should continue to prepare for up to 30% of symptomatic patients requiring assessment and treatment in usual pathways of primary care, assuming the majority of symptomatic cases do not require assistance from a healthcare professional. Between 1% and 4% of symptomatic patients will require hospital care, depending on how severe the illness caused by the virus is. January

8 Derbyshire Strategic Plan for Pandemic Influenza For deaths the analysis is that up to 2.5% of those with symptoms would die as a result of influenza if no treatment proved effective. These figures might be expected to be reduced by the impact of countermeasures but the effectiveness of such mitigation is not certain. Taking account of this, and the practicality of different levels of response, local planners are asked to prepare to extend capacity on a precautionary but reasonably practicable basis, and aim to cope with a population mortality rate of up 210, ,000 additional deaths (across the UK), possibly over as little as a 15 week period and perhaps half of these over three weeks at the height of the outbreak. Pandemic Influenza Scenarios for Additional Deaths in the UK Overall Case Fatality Rate Clinical Attack Rate 10% 25% 50% 0.37% 21,500 53, , % 56, , , % 85, , , % 141, , ,300 OPERATING PRINCIPLES Local planning and response should allow for flexibility at operational level and should be the mainstay during a pandemic influenza. The local and sub-national response roles must dovetail with the detailed Department of Health and Health Protection Agency contingency and operational plans, allowing flexibility while ensuring a consistent national approach. The regional and sub-regional response roles must fulfil the requirements of the Civil Contingencies Act There should be clarity and consistency of health advice at all levels and throughout all agencies involved. Communication within the health sector and across all other sectors must be effective and streamlined. Arrangements for regional co-ordination must be practical, appropriate and not interfere with operation of local response/co-ordination mechanisms. Mechanisms at the local level must be sustainable for at least five months, as after the first pandemic wave subsequent waves are likely to occur and may be as intense as or more intense than the first. Communications with the public is vital to ensure that they are aware of the public health messages, and know the effect on service provision from the local responders. January

9 Derbyshire Strategic Plan for Pandemic Influenza The World Health Organisation (WHO) in partnership with national departments of health maintains a surveillance of new and emerging infectious diseases. The WHO has published phase levels, which alert national Governments to any changes in the ability of any new influenza virus to potentially cause a pandemic: World Health Organisation - Pandemic Alert Periods WHO Phases Definition Inter-pandemic Period 1 No animal influenza virus circulating among animals has been reported to cause infection in humans. 2 An animal influenza virus circulating in domesticated or wild animals is known to have caused infection in humans and is therefore considered a specific potential pandemic threat. Pandemic Alert Period 3 An animal or human-animal influenza virus has caused sporadic cases or small clusters of disease in people, but has not resulted in human-to-human transmission sufficient to sustain community-level outbreaks. 4 Human-to-human transmission of an animal or human-animal influenza virus able to sustain community-level outbreaks has been verified. 5 The same identified virus has caused sustained community level outbreaks in two or more countries in one World Health Organisation region. Pandemic Period 6 In addition to the criteria defined in Phase 5, the same virus has caused sustained community level outbreaks in at least one other country in another World Health Organisation region. Post Pandemic Period Levels of influenza activity have returned to the levels seen for seasonal influenza in most countries with adequate surveillance. January

10 Derbyshire Strategic Plan for Pandemic Influenza UK Response The experiences of the Swine Flu pandemic showed that a response based on the WHO six phases approach was too inflexible. While the UK will follow the status of the WHO phases as an indication of the current risk of a pandemic, the UK preparedness and response will now follow a new structure which takes the form of a series of phases. The phases are not numbered as they are not linear, may not follow in strict order, and it is possible to move back and forth or jump phases. There may not be clear delineation between phases, particularly with considering regional variations and comparisons. While the UK Government will adopt a consistent overall approach to ensure an effective clinical and operational approach, it became apparent from the Swine Flu pandemic that the timing of the introduction of cessation of response measures needs to be determined flexibly in the light of local indicators. Furthermore, the UK s response to a future pandemic will be more proportionate to the severity and impact of the virus. Pandemic Response - UK Phases UK Phases Detection Outline of Activities During This Phase This phase would commence on either the declaration of the WHO Phase 4 or earlier if WHO declares a Public Health Emergency of International Concern. 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 phase would be the identification of the novel influenza virus in the UK Assessment 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. - Treatment of cases/suspected cases and use of anti-viral prophylaxis for close/ vulnerable contacts, based on a risk assessment of the possible impact of the disease. The indicator for moving from this phase would be evidence of sustained community transmission of the virus, ie cases not linked to any known or previously identified cases. Treatment The focus in this stage would be: Treatment of individual cases and population treatment via the National Pandemic Flu Services, 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. January

11 Derbyshire Strategic Plan for Pandemic Influenza 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 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. Resilience measures, encompassing robust contingency plans. Consideration of de-escalation of response if the situation is judged to have improved sufficiently. The indicator for moving into the Recovery Phase would be when influenza activity is either significantly reduced compared to the peak or when activity is considered to be within acceptable parameters. An overview of how services capacities are able to meet demand will also inform this decision. 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 eg 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. Preparing for post-pandemic seasonal influenza. January

12 Derbyshire Strategic Plan for Pandemic Influenza ACTIVATION OF PLAN In line with the LRF Command and Control Plan, the activation of the Derbyshire Strategic Plan for Pandemic Influenza will be through the Chair of the LRF and through discussion/ agreement with other relevant agencies. The current status of the WHO phase level will be used in preparing for a pandemic and potentially in activating the plan. However, the primary lead in the decision to activate the Derbyshire Strategic Plan for Pandemic Influenza will depend on the UK level of response. WHO Phase Level UK Response Phases Actions Phases Annual review of the Plan. Periodic testing of the Plan through multi-agency exercises. Phase 4 Detection Review Strategic Plan to ensure that structures and processes are in place across the county to deal effectively with an influenza pandemic including. Derbyshire County Council Emergency Planning Division in liaison with Emergency Planning and Pandemic Flu Leads from the health trusts consider convening County Health Group (commonly referred to as the Derbyshire Flu Exec) to consider the situation and review preparedness in health and social care. County Health Group will meet regularly (at a frequency to be decided at the time). Implementation of this Plan to co-ordinate the local multi-agency response to during the early stages of the pandemic to: Provide an effective health and multi-agency response to an influenza pandemic; Maintain health and other essential services; Minimise social and economic disruption; and Ensure the provision of timely accurate information for professionals, public and the media. Derbyshire County Council Emergency Planning Division to consider in liaison with Police and health trusts the need for a Strategic Co-ordinating Group (SCG). Phases 4-6 Assessment Treatment Escalation County Health Group will meet regularly (at a frequency to be decided at the time) to review the situation and coordinate the overall health and social care response to the pandemic. Derbyshire County Council Emergency Planning Division to consider in liaison with Police and health trusts the need for a Strategic Co-ordinating Group (SCG). January

13 Derbyshire Strategic Plan for Pandemic Influenza Post Peak of Pandemic and inter-wave period Recovery SCG and the County Health Group to lead planning for recovery of services and a return to normality. Review of Derbyshire Strategic Plan for Pandemic Influenza and overall response to the pandemic in preparation for possible further wave of cases. SUB-GROUPS In line with the LRF Command and Control Plan, a number of sub-groups may be established to support the SCG and the County Health Group. These could include: Warning and Informing. Category 2 Responders. Recovery. Humanitarian Assistance. Logistics. Mass Fatalities and Excess Deaths. Category 1 responders and other agencies may be required to provide representatives to any of these groups. January

14 Derbyshire Strategic Plan for Pandemic Influenza IMPACT ON DERBYSHIRE Based on planning assumptions outlined in the national framework the impact on Derbyshire 1 of an influenza pandemic would be: Range of possible excess deaths 2 Overall Case fatality rate (%) Clinical Attack Rates (%) Number of Pandemic Influenza Cases , ,006 1,509 2, , ,516 3,773 6, ,172 1,303 3,522 5,283 8, ,103 1, ,547 12,578 Number of Cases by age group over one wave with 10% clinical attack rate Week 5-15 yrs Working Age 16-59F/64M Retirement Age 60+F/65+M No of Cases , , ,962 6,522 2,171 10, ,998 13,290 4,424 21, ,924 13,044 4,342 21, ,647 8,799 2,929 14, ,795 5,968 1,987 9, ,388 4,615 1,536 7, ,200 1,065 5, , , , Total 18,529 61,592 20, ,621 1 Population of Derbyshire (including Derby) of 1,005,200 from 2008 population estimates 2 On average the annual number of deaths in Derbyshire is 10,000 January

15 Derbyshire Strategic Plan for Pandemic Influenza Number of Cases over one wave with 10% clinical attack rate and 2.5% fatality rate Week Cases Requiring Assessment by GP Requiring Admission to Hospital Bed Requiring Critical Care No of Dead , ,655 3, ,712 6, ,310 6, ,374 4, ,750 3, ,539 2, ,227 1, , , Total 100,621 32,198 4,025 1,006 2,516 January

16 Derbyshire Strategic Plan for Pandemic Influenza Number of Cases by age group over one wave with 25% clinical attack rate Week 5-15 yrs Working Age 16-59F/64M Retirement Age 60+F/65+M No of Cases , , ,435 4,769 1,587 7, ,905 16,305 5,427 26, ,995 33,226 11,059 54, ,810 32,611 10,854 53, ,617 21,997 7,322 35, ,489 14,921 4,966 24, ,471 11,537 3,840 18, ,406 7,999 2,662 13, ,203 3,999 1,331 6, , , , , ,759 Total 46, ,979 51, ,551 January

17 Derbyshire Strategic Plan for Pandemic Influenza Number of Cases over one wave with 25% clinical attack rate and 2.5% fatality rate Week Cases Requiring Assessment by GP Requiring Admission to Hospital Bed Requiring Critical Care No of Dead , ,790 2, ,638 8,524 1, ,281 17,370 2, , ,276 17,048 2, , ,936 11,500 1, ,376 7, ,848 6, ,068 4, ,534 2, ,021 1, , , Total 251,551 80,497 10,062 2,516 6,289 January

18 Derbyshire Strategic Plan for Pandemic Influenza Number of Cases by age group over one wave with 35% clinical attack rate Week 5-15 yrs Working Age 16-59F/64M Retirement Age 60+F/65+M No of Cases , , ,008 6,676 2,222 10, ,867 22,828 7,598 37, ,994 46,517 15,483 75, ,734 45,655 15,196 74, ,264 30,796 10,250 50, ,284 20,889 6,953 34, ,859 16,152 5,376 26, ,369 11,198 3,727 18, ,684 5,599 1,864 9, ,037 3,446 1,147 5, , , , ,463 Total 64, ,570 71, ,172 January

19 Derbyshire Strategic Plan for Pandemic Influenza Number of Cases over one wave with 35% clinical attack rate and 2.5% fatality rate Week Cases Requiring Assessment by GP Requiring Admission to Hospital Bed Requiring Critical Care No of Dead , ,906 3, ,293 11,934 1, ,993 24,318 3, , ,586 23,868 2, , ,310 16,099 2, , ,127 10,921 1, ,387 8,444 1, ,295 5, ,147 2, ,629 1, ,166 1, , Total 352, ,695 14,087 3,522 8,804 January

20 Derbyshire Strategic Plan for Pandemic Influenza Number of Cases by age group over one wave with 50% clinical attack rate Week 5-15 yrs Working Age 16-59F/64M Retirement Age 60+F/65+M No of Cases , , , ,869 9,537 3,174 15, ,810 32,611 10,854 53, ,991 66,452 22, , ,621 65,222 21, , ,235 43,994 14,643 71, ,977 29,842 9,933 48, ,941 23,074 7,680 37, ,813 15,998 5,325 26, ,406 7,999 2,662 13, ,481 4,922 1,638 8, , , , ,518 Total 92, , , ,103 January

21 Derbyshire Strategic Plan for Pandemic Influenza Number of Cases over one wave with 50% clinical attack rate and 2.5% fatality rate Week Cases Requiring Assessment by GP Requiring Admission to Hospital Bed Requiring Critical Care No of Dead , ,021 1, ,581 4, ,276 17,048 2, , ,562 34,740 4,342 1,086 2, ,551 34,096 4,262 1,066 2, ,872 22,999 2, , ,752 15,601 1, , ,695 12,062 1, ,135 8,363 1, ,068 4, ,042 2, ,523 1, ,518 1, Total 503, ,993 20,124 5,031 12,578 January

22 Derbyshire Strategic Plan for Pandemic Influenza Number of Cases in Vulnerable Groups over one wave with 10% clinical attack rate Week People Providing Unpaid Care to Others Lone Parents Single Person Households Single Pensioner Households , , ,257 1, , ,233 1, , , Totals 11,545 3,666 5,824 6,173 January

23 Derbyshire Strategic Plan for Pandemic Influenza Number of Cases in Vulnerable Groups over one wave with 25% clinical attack rate Week People Providing Unpaid Care to Others Lone Parents Single Person Households Single Pensioner Households , ,542 1, ,227 1,977 3,141 3, ,112 1,941 3,083 3, ,123 1,309 2,080 2, , ,411 1, , ,091 1, , Totals 28,860 9,162 14,559 15,432 January

24 Derbyshire Strategic Plan for Pandemic Influenza Number of Cases in Vulnerable Groups over one wave with 35% clinical attack rate Week People Providing Unpaid Care to Others Lone Parents Single Person Households Single Pensioner Households , ,279 1,358 2,158 2, ,718 2,768 4,398 4, ,557 2,717 4,317 4, ,772 1,833 2,912 3, ,915 1,243 1,975 2, , ,527 1, , ,058 1, , Totals 40,381 12,828 20,383 21,605 January

25 Derbyshire Strategic Plan for Pandemic Influenza Number of Cases in Vulnerable Groups over one wave with 50% clinical attack rate Week People Providing Unpaid Care to Others Lone Parents Single Person Households Single Pensioner Households , ,113 1,941 3,083 3, ,455 3,955 6,282 6, ,224 3,881 6,166 6, ,245 2,618 4,159 4, ,593 1,776 2,822 2, ,325 1,373 2,182 2, , ,513 1, , , Totals 57,719 18,327 29,117 30,866 January

26 STRATEGIC CO-ORDINATING GROUP Derbyshire Strategic Plan for Pandemic Influenza At the LRF level of the Concept of Operations, the senior group would be the Strategic Co-ordinating Group (SCG). This Group would be Derbyshire s Gold during a pandemic. The Strategic Co-ordinating Group would meet regularly during the pandemic at Police Headquarters, Ripley or County Hall, Matlock as agreed by the Chief Emergency Planning Officer and Assistant Chief Constable. MEETING FREQUENCY Once the SCG has been convened, the meeting frequency is at the discretion of the SCG members. REMIT OF THE STRATEGIC CO-ORDINATING GROUP Determine the overall strategy for responding to a pandemic. Co-ordinate and deliver the local multi-agency response to a pandemic, through the network of Category 1 responders who operate within the LRF. Determine resources required to ensure that the health and social care organisations are adequately supported in their response to a pandemic. Maintenance of critical services provided by Category 1 and 2 responders. Provision of situation reports sub-national and national agencies. Receive public health advice and public health messages from the Regional Science and Technical Advice Cell or Regional Director of Public Health. To monitor the delivery of essential support services by the voluntary sector and ensure additional voluntary agency support is co-ordinated and effective. Co-ordinate the multi-agency planning and delivery of response for handling excess deaths during a pandemic. Liaise with sub-national agencies, Regional Science and Technical Advice Cell, Category 1 responders and other agencies with regards to the County s response and to the dissemination of public health and other public messages with the aim of keeping the community of Derbyshire informed during the pandemic. STRATEGIC CO-ORDINATING GROUP - STRATEGIES To assist the Chair of the SCG, a number of outline SCG strategies are included in Appendix D. Furthermore an outline agenda is included the LRF Command and Control Plan. January

27 Derbyshire Strategic Plan for Pandemic Influenza MEMBERSHIP 3 - STRATEGIC CO-ORDINATING GROUP Strategic Co-ordinating Group Chair Primary Care Trust Chief Executive/Assistant Chief Constable; or other appropriately trained representative 4. Fire and Rescue Service Chief Fire Officer or deputy. Police Assistant Chief Constable or deputy. Ambulance Senior representative. Derbyshire County Council PCT (To provide NHS strategic management command) Public Health Adviser (May be part of the Regional Science and Technical Advice Cell) Communication Representative Derby City Council District/Borough Councils Hospitals Health Group Others Chief Executive or deputy. Chief Emergency Planning Officer. Primary Care Trust director (or deputy) from: Derbyshire Cluster PCT NHS Tameside and Glossop Primary Care Trust Public Health Professional; or Health Protection Agency Consultant in Communicable Disease Control. Representative drawn from local authorities, health trusts or emergency services. Chief Executive or deputy. A Chief Executive to represent all eight district/borough councils. Chief Executive or a senior representative to represent each Acute Hospital. Chair of the County Health Group. There may also be the need for senior representatives from the Department for Communities and Local Government Resilience (DCLG) from local Government and other essential services to attend the Strategic Co-ordinating Group as required. 3 Membership as suggested by the Regional Concept of Operations in Pandemic Influenza: The Chair will be decided locally, and in the first instance may be a Chief Executive or deputy from a Primary Care Trust. January

28 COUNTY HEALTH GROUP Derbyshire Strategic Plan for Pandemic Influenza The role of the County Health Group (commonly referred to as the Derbyshire Flu Exec) is to ensure that there is a co-ordinated health and social care response and to advise the Strategic Co-ordinating Group on the situation regarding the health and social care sectors response to the pandemic. This would include detailing any response shortfalls and requests for resources and advice. The Primary Care Trust (PCT) Chief Executive (or deputy) will also keep the Strategic Health Authority Incident Team informed. The County Health Group would meet at the Emergency Centre, County Hall, Matlock. MEETING FREQUENCY Once the County Health Group has been convened, the meeting frequency is at the discretion of the Group s members. REMIT OF THE COUNTY HEALTH GROUP Ensure a co-ordinated and mutually supportive response by the health and social care sector within Derbyshire. Provide information and direct requests for assistance to the Strategic Co-ordinating Group. Interpreting national and regional guidance, particularly public health advice from the Department of Health and the Health Protection Agency and implement it at the local level. Liaise with the NHS East Midlands (Strategic Health Authority) Incident Team. Identify resourcing shortfalls where it may be practical for voluntary sector support to be utilised. Ensure that transportation resources are co-ordinated in support of the Health and Social Care Section. Consider private sector issues: - Communications. - Capacity. - Need. SUGGESTED FIRST AGENDA Confirm Chair. Review Emergency Plans. Briefing of the current situation regarding the novel pandemic influenza virus and the position of the UK response - so that all have a common understanding of the situation. Briefing from all organisations on their current state of readiness. Need and planning for a local Flu Line. Availability of anti-virals. Need and planning for anti-viral Collection Points. Availability of Personal Protective Equipment. Messages to the public. Agree what needs to be done and who is leading on the actions. Agree frequency of meetings and date of next meeting. January

29 MEMBERSHIP 5 - COUNTY HEALTH GROUP Derbyshire Strategic Plan for Pandemic Influenza County Health Group Chair Senior representatives from each of the NHS Trusts Local Public Health PCT Pandemic Flu Lead or deputy. For example the Emergency Planning Leads/Pandemic Flu Leads, etc from: Derbyshire Cluster PCT. Clinical Commissioning Groups. Derbyshire Community Heath Services NHS Trust. Derby Hospitals NHS Foundation Trust. Chesterfield Royal Hospital NHS Foundation Trust. Derbyshire Healthcare NHS Foundation Trust. NHS Tameside and Glossop. Primary Care Trust Director of Public Health/Primary Care Trust Public Health Professional from NHS Derby City and NHS Derbyshire County. The health community in Derbyshire will need to ensure that local public health representation can be provided both to the Strategic Co-ordinating Group and the County Health Group. Primary Care Emergency Planning Division Social Care Communication HPA may be asked to attend dependent on staff availability during a pandemic. Representatives from: Derbyshire Health United (Out of Hours primary care provider). Local Medical Committee (LMC). Local Pharmaceutical Committees (LPC). Chief Emergency Planning Officer or deputy. Emergency Planning Officer (Health). Drawn from a senior officer, with representation from: Derbyshire County Council Adult Social Services and Children and Younger Adults; and Derby City Council Adult Social Services and Children and Young People. Representative drawn from all health trusts. Other Health Representation Emergency Services Other personnel from health trusts will be called upon to attend the group as and when required. As deemed necessary at the time: East Midlands Ambulance Service NHS Trust. Police. Fire and Rescue Service. Voluntary Groups St John Ambulance. British Red Cross. WRVS. Others as appropriate. 5 Membership as suggested by the Regional Concept of Operations in Pandemic Influenza: 2007 January

30 WARNING AND INFORMING GROUP Derbyshire Strategic Plan for Pandemic Influenza In the event of Pandemic Influenza a Warning and Informing Group will be established to formulate and advise Strategic Co-ordinating Group and County Health Group on the joint media strategy. A senior communications officer should liaise with and brief Strategic Co-ordinating Group on the communications strategy. REMIT OF THE WARNING AND INFORMING GROUP Ensure effective dissemination of information direct to the public. To reinforce Department of Health messages to the public on self care and the correct routes to follow to access health services. Disseminate information and produce regular briefings for partner responders in Derbyshire. Act as a central source of pandemic information and main point of contact for the media on enquiries related to Derbyshire. Co-ordinate communications activity between the county and regional agencies. Ensure effective sharing of information between the Derbyshire Strategic Co-ordinating Group and the Regional co-ordination tier. MEMBERSHIP - WARNING AND INFORMING GROUP Warning and Informing Group Chair To be decided at the time. Wider NHS Trust Representation Police Local Authority Other organisations as appropriate All trusts that have a communications/public relations capability (potentially Primary/Acute/Ambulance/Mental Health) as appropriate. Police Public Relations Officer. County and City Council's Press and Public Relations Officers. To be decided at the time. January

31 OPERATIONAL LEVEL GROUPS Derbyshire Strategic Plan for Pandemic Influenza Feeding into the County Health Group would be health trust operational groups which would co-ordinate the individual trust s responses to a pandemic. It is anticipated that these groups would be formed by senior trust managers, plus other staff as required. In the event of a pandemic, trusts would implement Pandemic Influenza Contingency Plans, which have been developed in line with NHS Influenza Pandemic Planning Guidance. A list of organisation specific Pandemic Influenza Contingency Plans are outlined in the next section. In addition to health trusts, Category 1 responders would need to respond to the impact of a pandemic on their own services. Under the Civil Contingencies Act 2004, all Category 1 responders have been required to prepare Business Continuity Plans. It is anticipated that Category 1 responders would manage the response to a pandemic through the implementation of the Business Continuity Plan, including the convening of Business Continuity Management Teams. Category 1 responders would need to liaise with the Strategic Co-ordinating Group to ensure that the Group has a complete overview of the ongoing delivery of critical services in Derbyshire. It is anticipated that the local authority response will be co-ordinated by regular liaison. This will ensure some consistency across the LRF area in the closure/re-opening of services, and could provide pooling of resources or mutual aid for critical services. January

32 Derbyshire Strategic Plan for Pandemic Influenza DERBYSHIRE PANDEMIC INFLUENZA PLANS The following key organisations will have in place Pandemic Influenza Contingency Plans which detail their specific actions in responding to an influenza pandemic: Derbyshire Cluster PCT. NHS Tameside and Glossop. Primary Care Trust Anti-viral Collection Point and Vaccination Plans. Derbyshire Community Health Services NHS Trust. Derbyshire Healthcare NHS Foundation Trust. Derby Hospitals NHS Foundation Trust. Chesterfield Royal Hospital NHS Foundation Trust. Derbyshire Fire and Rescue Service. East Midlands Ambulance Service. Derbyshire County Council (Adult and Children s and Younger Adults Social Services). Derby City Council (Adult and Children s and Younger Adults Social Services). HM Prison Foston Hall. HM Prison Sudbury. January

33 DERBYSHIRE SUPPORT PLANS Derbyshire Strategic Plan for Pandemic Influenza In addition to pandemic influenza specific plans, a number of emergency plans will be utilised to support the LRF s response to a pandemic. LRF MASS FATALITIES AND EXCESS DEATHS EMERGENCY PLAN The aim of this Plan is to provide a range of emergency mortuary options suitable for every mass fatality eventuality, supporting the roles of the pathologist and coroner in establishing identification of the dead and cause of death. The options available incorporate a procedure for enhancing storage capacity at acute hospital mortuaries where practicable; maximising the body storage capacity with funeral directors and identifying alternative body holding facilities if required. LRF WARNING AND INFORMING PLAN The Warning and Informing Plan sets out the principles that Category 1 responders will follow in communicating with stakeholders and the public. It details how Category 1 responders will work together to maintain arrangements to warn and inform the public before, during and after emergencies. These arrangements are flexible and would be adopted as appropriate for the circumstances. LRF HUMANITARIAN ASSISTANCE PLAN Delivered by a jointly managed Crisis Support Team consisting of staff drawn from the County and City Councils Social Care departments and other organisations. The Team will work closely with and support the Police Family Liaison Officers. LRF STRATEGIC RECOVERY PLAN The Plan provides a framework to enable the Local Resilience Forum (LRF) to put in the appropriate structures and mechanisms for strategic leadership during the recovery phase of an emergency. LRF FUEL SHORTAGE RESPONSE PLAN The Plan outlines the procedures to be adopted by the Derbyshire Local Resilience Forum in the event of a national or regional fuel shortage resulting from international or internal disruption to the UK fuel supply. January

34 LRF COMMAND AND CONTROL PLAN Derbyshire Strategic Plan for Pandemic Influenza This document sets out the strategic response of the agencies that make up the Derbyshire Local Resilience Forum in response to incidents requiring multi-agency co-ordination. RESILENT COMMUNICATIONS PLAN This Plan captures local knowledge about arrangements for communications of local responders and their resilience partners and identifies how the resilience of these arrangements is to be improved to ensure that local responders and their resilience partners are able to communicate effectively even when faced with the most challenging circumstances. This Plan is to be used as a means for co-ordinating the approach taken to enhance resilience and to ensure that arrangements are complementary and consistent. LOCAL AUTHORITY EMERGENCY PLANS These plans provide a framework to enable the councils to provide a quick and effective response to mitigate the effects of any emergency on the public and/or the environment in Derbyshire. CATEGORY 1 RESPONDER BUSINESS CONTINUITY PLANS These plans support the Category 1 responders in anticipating risks for the purpose of reducing them and having flexible, tested plans in place to minimise disruption when unplanned events significantly interrupt normal business. January

35 SITUATION REPORTING Derbyshire Strategic Plan for Pandemic Influenza - Appendix A The Cabinet Office s Civil Contingencies Secretariat guidance 6 outlines how situation reports will be provided by the regions to central Government. The Strategic Co-ordinating Group will provide information to the Department for Communities and Local Government Resilience (DCLG) for inclusion in the region s situation report. This section summarises the likely reporting frequency (termed Battle Rhythm in Civil Contingencies Secretariat guidance) during an influenza pandemic. This is subject to change by Ministers during a pandemic depending on severity of the pandemic and arising issues. At the height of the pandemic the likely reporting frequency will be: 1. The Civil Contingencies Committee (CCC) is likely to meet mid-morning (most likely at around 1100 hours). The Civil Contingencies Committee (Officials) CCC(O) will meet prior to meetings of CCC (most likely at around 0900 hours) to prepare the ground, to consider papers for Ministers or to consider other issues as directed by CCC. The Cabinet Office will draw up the agenda and circulate a situation report in advance of each meeting of CCC and CCC (O). After each meeting, the Cabinet Office will prepare a note summarising the key points to emerge, work commissioned and decisions taken, and, for CCC, any issues on which Ministerial guidance is sought. Papers will be commissioned as necessary from Departments. 2. Departments will be operating on a 24/7 basis, particularly those engaged in the operational response, or in management of Parliamentary, media and public issues, at least during the first weeks of the emergence of a pandemic in the UK. Where pressures are less, some Departments will be working extended days. Pressures for all Departments may reduce towards the end of each wave. To take into account staffing requirements during a pandemic, Departments have designated alternates to staff in key leadership or other roles in case they themselves suffer sickness. INFORMATION FLOWS Required activity to meet battle rhythm SCG meeting/gathering of intelligence for report SCG Report submitted to GOEM DCLG report to CCC of situation at 1700 hours DoH/HPA report to CCC of situation at 1500 hours day before CCC (O) meeting CCC meeting SCG meeting/gathering of intelligence for report SCG Report submitted to DCLG DCLG report to CCC of situation at 1700 hours Deadline (each day) By 1500 hours By 1700 hours By 1900 hours By 0700 hours At 0900 hours At 1100 hours By 1500 hours By 1700 hours By 1900 hours Local/individual agency activity to inform LRF reporting requirements Report back from SCG representative to agency to inform future activity. Internal business continuity measures; assessment of service availability/planning and information gathering for next SCG meeting. Sharing intelligence across sectors/ borders. Report back from SCG to agency to inform future activity. Note: Timings are approximate and may be amended as requested. 6 Cabinet Office (2008) Preparing for Pandemic Influenza - Supplementary Guidance for Local Resilience Forum Planners. January 2012 A1

36 Derbyshire Strategic Plan for Pandemic Influenza - Appendix A Those agencies contributing to meetings of the SCG; and in cases where the SCG identifies that it requires status reports from Category 2 responders or other organisations; will need to gather information to meet the 1500 hours SCG meeting. In this case, each organisation will be required to establish its own internal arrangements to ensure it gathers accurate information in a timely manner and has time to analyse this data to present a report following the SCG s agreed reporting model/template. The data set that the SCG will gather from local responders will be based on the Regional Sitrep reporting format shown in Appendix B. However, a new situation report form may be issued at the time. A model for data gathering in a local authority is shown as Appendix C. However, a new situation report form may be issued at the time. Health Community Situation Reporting During the Swine Flu Pandemic of , a health only situation reporting system (called Flucon) was established. On a daily basis, trusts were required to inform NHS East Midlands (Strategic Health Authority) of the level of impact the pandemic was having on services. Similarly, local authority social care was required to provide a daily situation report (called Soccon) to the NHS East Midlands (Strategic Health Authority). It is envisaged that similar situation reporting structures would be established in any future pandemic. January 2012 A2

37 SITUATION REPORT Derbyshire Strategic Plan for Pandemic Influenza - Appendix B SITREP Number: XX DD-MM-YY HH-MM Lead Official: Alternate Contact: This situation report provides key information and data on the present situation it has been validated by the relevant department/agency officials. The information contained herein can be disseminated to other agencies as necessary - where clarification is required the lead official should, in the first instance, be contacted, 1. Department/Government Office Key Issues January 2012 B1