CWP Pandemic Influenza Plan

Transcription

1 CWP Pandemic Influenza Plan Document level: Trustwide (TW) Code: EP8 Issue number: 2 Lead executive Author and contact number Type of document Target audience Document purpose Director of Operations Deputy Director of Nursing and Therapies and Director of Infection Prevention and Control Emergency Planning and Business Continuity Coordinator Guidance All CWP staff To provide a framework for response and recovery to influenza pandemic; Ensuring that Cheshire and Wirral Partnership NHS Foundation Trust are prepared and coordinated to respond to increased needs and service demand throughoutan infleunza pandemic period. Document consultation Emergency Planning Sub Committee Members, and Health and Social Care Partners Approving meeting Emergency Planning Sub Committee 19-Sep-12 Ratification Document Quality Group (DQG) 16-Oct-12 Original issue date Nov-11 Implementation date Oct-12 Review date Oct-17 CWP documents to be read in conjunction with GR7 EP1 IC9 Major Incident Plan Business continuity management system policy and procedures Strategic Business Continuity Plan Infection Control Policy Pandemic Influenza Training requirements Financial resource implications There are no specific training requirements for this document. No Equality Impact Assessment (EIA) Initial assessment Yes/No Comments Does this document affect one group less or more favourably than another on the basis of: Race No Ethnic origins (including gypsies and travellers) No Nationality No Gender No Culture No Religion or belief No Sexual orientation including lesbian, gay and bisexual people No Age No Disability - learning disabilities, physical disability, sensory impairment and mental health problems No Is there any evidence that some groups are affected differently? No Page 1 of 49

2 If you have identified potential discrimination, are there any exceptions valid, legal and / or justifiable? N/A Is the impact of the document likely to be negative? No If so can the impact be avoided? N/A What alternatives are there to achieving the document without N/A the impact? Can we reduce the impact by taking different action? N/A Where an adverse or negative impact on equality group(s) has been identified during the initial screening process a full EIA assessment should be conducted. If you have identified a potential discriminatory impact of this procedural document, please refer it to the human resource department together with any suggestions as to the action required to avoid / reduce this impact. For advice in respect of answering the above questions, please contact the human resource department. Was a full impact assessment required? What is the level of impact? No Low Document change history Changes made with rationale and impact on practice 1. Policy includes references to Community Care Western Cheshire. 2. Policy has withdrawn references to Leighton in-patient facilities. 3. CWP Infection control policy pandemic influenza has been updated. 4. New outlying services in learning disability, ADHD, eating disorder service, learning disability and drug service have been added to the policy. 5. Configuration of the PCTs has resulted in the formation of NHS Cheshire, Warrington and Wirral cluster PCT references have been updated. 6. Arrangements updated in line with Health and Social Care Influenza Pandemic Preparedness and Response (2012), and UK Influenza Pandemic Preparedness Strategy Change of document title to CWP Influenza Pandemic Plan. External references References 1. Guidance for Pandemic Influenza: Infection Control in Hospitals and Primary Care Services 2. (2005) DH and HPA 3. Pandemic Flu, UK Influenza Pandemic Contingency Plan (2005) DH 4. Influenza Pandemic Contingency Plan Version 7 (2005) Health Protection Agency 5. St Helens and Knowsley PCT Pandemic Plan 6. Boroughs Partnership NHS Trust Pandemic Plan 7. DH (2008) Pandemic Influenza Guidance for Mental Health Trusts 8. Health and Social Care Influenza Pandemic Preparedness and Response (2012) 9. UK Influenza Pandemic Preparedness Strategy (2011) Monitoring compliance with the processes outlined within this document Please state how this document will be monitored. If the document is linked to the NHSLA accreditation process, please complete the monitoring section below. Page 2 of 49

3 Content 1. Introduction Background Aims and objectives Scope Mutual aid Working with joint health and social care partners Support vulnerable people Plan review Testing and validation Ethical considerations Context Key Assumptions Pandemic planning assumptions Health and Social Care planning assumptions Essential Services identified in CWP in the event of an Influenza Pandemic Essential external support services identified in CWP Avian Influenza Definitions Procedure Health and Social Care Structures; Pandemic preparedness and response Reporting Core principles Preparing to respond Leadership CWP Influenza Pandemic Lead Infection Control Business Continuity Human Resources Health and Social Care Response; Detection and Assessment Phase Public Health Services School closures Primary and Community Care Social Care Secondary Care, including Mental Health Health and Social Care Response; Treatment and Escalation Primary and community care Mental Health Services Human Resource policies Social Care Community Care Carers Secondary Care Potential for legislative changes Vaccination Health and Social Care Response; Recovery Phase Duties and responsibilities Local Duties and Responsibilities Wider duties and responsibilities Communications Local Communications Wider communications Command and Control Internal Command and Control External command and control Technical Advisory Section Page 3 of 49

4 8.1 Advances in the management of severe respiratory failure Specialist respiratory support Facemasks and respirators Consumables Antiviral Strategy National Pandemic Flu Service Antiviral Collection points Associated IT systems Conclusion Appendix 1 - Action Cards Appendix 2 - Influenza Pandemic Templates...42 Appendix 3 - Vaccination delivery plan for seasonal flu to be modified for influenza pandemic vaccination Appendix 4 - Antiviral collection point checklist Appendix 5 - Pandemic Influenza Business Continuity Plan Page 4 of 49

5 1. Introduction It is now generally accepted that it is not a case of if there will be another pandemic but when. The Department of Health is the lead UK agency for the national response to pandemic flu. The Health and Social Care Influenza Preparedness and Response (2012) guidance is intended to support preparedness and response planning in the transition period through to 2013.This guidance advises health and social care organisations to revise plans to reflect the learning from the pandemic in 2009 and the latest scientific evidence. The potential for a new influenza remains unchanged although the timing and severity of future pandemic remain unpredictable. All Public Health, NHS and social care organisations, including Mental Health Trusts are required to have plans detailing their contingency arrangements for pandemic flu. Furthermore, it is essential that the Trust feeds into the local Health and Social Care economy plans; work is ongoing with partner organisations. This plan is a framework which will evolve as internal and external intelligence becomes available and the plan has been exercised and tested. The following planning arrangements take into account lessons identified by CWP in the 2010 debrief report of the Influenza Pandemic outbreak as declared in May Background Pandemic flu differs from major incidents in that there is likely to be a 2-4 week warning and the longevity of the incident. The UK Influenza Pandemic Preparedness Strategy (2011) sets out the key changes to the previous approach, reflecting the lessons learnt from the H1N1 (2009) influenza pandemic. These are to: Develop better plans for the initial response to a new virus, when the focus should be on rapid and accurate assessment of the nature of the pandemic virus and its effects, both clinically and epidemiologically; Put plans in place to ensure a response that is proportionate to a range of scenarios reflecting pandemic viruses of low, moderate and high impact, rather than focusing on the worst case planning assumptions; Take greater account of age specific, geographic and other differences in the rate and pattern of spread of the disease across the country and internationally; Further explore statistical population-based surveillance, such as serology, to measure the severity of a pandemic in its early stages; Take better account of information from behavioural scientists about how people are likely to think, feel and behave during an influenza pandemic; Develop better plans for managing the end of an influenza pandemic the recovery phase and preparation for subsequent seasonal influenza outbreaks. It is uncertain when a new pandemic virus might appear. Until it emerges and affects a significant number of people, it will not be possible to identify the key features of the disease, such as any pre existing immunity, the groups most affected, and the effectiveness of clinical countermeasures. Given this, there are three main principles that must underpin planning and response; Precautionary plan for an initial response that reflects the level of risk, based on information available at the time, accepting the uncertainty that will initially exist; Proportionality plan to be able to scale up or down in response to the emerging epidemiological, clinical and virological characteristics of the virus and its impact at the time; Flexibility plan for the capacity to adapt to local circumstances that may be different from the overall UK picture for instance in hotspot areas. The impact a pandemic has on the population and wider society will be determined by three interdependent factors: Page 5 of 49

6 Disease characteristics - the number of cases and deaths, the proportion of severe disease in the population, the clinical groups most affected and the rate of onward transmission. This will only become possible to assess once sufficient data are available; Service capacity - the number of patients presenting at primary care services and / or admitted to hospital and intensive care and specialist treatment (e.g. extracorporeal membrane oxygenation (ECMO)), and the capacity of public services, utilities and businesses to cope with increased demands and staff absence; Behavioural response - the levels of concern experienced by the population, positive reactions to good respiratory and hand hygiene campaigns, the likely uptake of antiviral medicines and vaccination and the way health services are accessed and used. 1.2 Aims and objectives The CWP Pandemic Influenza Business Continuity Plan aims to describe proposals for an updated strategic approach to planning for and responding to the demands of an influenza pandemic. The objectives of the CWP Business Continuity Pandemic Influenza Business Continuity Plan are; Save lives and alleviate illness; Cope with large numbers of people ill, at home and in the hospital; Ensure business continuity for CWP, so that essential health and social services are maintained; Work in partnership with the health and social care economy partners to provide timely, authoritative and up-to-date information for professionals, the public and the media at all stages. 1.3 Scope This approved plan sets out the overall plans for services directly managed by the Trust. As a number of services to the Trust are provided by partner Trusts it is essential that the Trust links with these organisations. 1.4 Mutual aid While it is anticipated that this principle will be difficult to fulfil during an influenza pandemic, it must be acknowledged that some expertises and mental health resources are distributed across Cheshire, Merseyside and Greater Manchester health and social care economies. All health and social care partners will be required to work closely together and coordinate their activities in order to support essential care provision. 1.5 Working with joint health and social care partners A number of our services are jointly managed and staffed. In the event of a pandemic situation it is the expectation of the Trust that joint health and social care staff follow CWP s influenza pandemic planning arrangements unless informed otherwise by a health or social care senior officer. 1.6 Support vulnerable people Whilst the Trust service users may be considered vulnerable, this plan supports their continued care. 1.7 Plan review This plan will be the responsibility of the Trust Emergency Planning Sub Committee; this sub committee will revise this plan in light of new guidance and services line reporting. During an influenza pandemic this plan will remain a working document and will be reviewed regularly. This plan will be reviewed in light of learning from incidents, exercises and comments received. This plan may require a review in April 2013 following the implementation of new health and social care structures nationally and locally. Further guidance on how the emergency preparedness and response arrangements post transition will be issued as structures and relationships develop. Page 6 of 49

7 1.8 Testing and validation This plan will be tested and validated through exercises developed as part of CWP s annual emergency planning training and exercise programme, the responsibility for which lies with the emergency planning sub committee. 1.9 Ethical considerations Ethical considerations are important in determining how to make the fairest use of resources and capacity. The routine use of the principles outlined by The Committee on Ethical Aspects of Pandemic Influenza (CEAPI) can act as a checklist to ensure all ethical considerations have been considered. 2. Context 2.1 Key Assumptions During this unpredictability, there are some key assumptions that will help to inform planning; A pandemic is most likely to be caused by a new subtype of the Influenza A virus but plans could be appropriately adapted and deployed for any epidemic infectious disease; An influenza pandemic could emerge at any time of the year anywhere in the world, including in the UK. Regardless of where or when it emerges, it is likely to reach the UK very rapidly and, from arrival, it will probably be a further one to two weeks until sporadic cases and small clusters of cases are occurring across the country; The potential scale of impact, risk and severity from related secondary bacterial infection and clinical risk groups affected by the pandemic virus will not be known in advance; It will not be possible to completely stop the spread of the pandemic influenza virus in the country of origin or in the UK, as it will spread too rapidly and too widely; Initially, pandemic influenza activity in the UK may last for up to three to five months, depending on the season. There may be subsequent waves of activity of the pandemic virus 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 persist as one of a number of seasonal influenza viruses. Based on observations of previous pandemics, subsequent winters are likely to see increased seasonal flu activity compared to pre-pandemic winters. 2.2 Pandemic planning assumptions Influenza pandemic planning in the UK has been based on an assessment of the reasonable worst case, derived from experience and scientific analysis of influenza pandemics and seasonal influenza in the 20th Century. These considerations suggest that, in a worst case scenario, up to 50% of the population could experience symptoms of pandemic influenza spread over one or more pandemic waves each lasting 15 weeks, although the nature and severity of the symptoms would vary from person to person. For deaths, the analysis suggests that up to 2.5% of those with symptoms could die as a result of influenza if no treatment proved effective. CWP Pandemic Influenza Business Continuity Plans within local services and departments will be written with the planning assumption of 50% of staff experiencing symptoms. Additional staff absence are likely to result from other illness, taking time off to care from dependants, to look after children in the event of school closures. 2.3 Health and Social Care planning assumptions Staff absence is likely to follow the wider community profile. In a wide spread and severe influenza pandemic affecting 50% of the population, between 15-20% of all staff might be absent on any given day during peak weeks, with smaller teams potentially experiencing increased absence percentages. These figures may be reduced by the impact of antiviral and antibiotic countermeasures depending on the effectiveness of these measures. Page 7 of 49

8 2.4 Essential Services identified in CWP in the event of an Influenza Pandemic The Trust has identified essential services both clinical and non-clinical (please refer to CWP strategic business continuity plan). The essential services identified in the event of influenza pandemic have been agreed by members of the Emergency Planning Sub Committee and are detailed below. In the event of an influenza pandemic all CWP services users are deemed as vulnerable for the purpose of Pandemic Flu. Clinical In-patient Units; Liaison Psychiatry; Home Treatment Teams; Early Interventions Teams; Occupational Health (supported by Human Resources); Infection Prevention & Control Team; Mental Health Act Teams; Pharmacy; Bed Management team; Temporary Staffing Team; GP Out of Hours; Community Care Western Cheshire Palliative Care; Prioritised staff in Community Care Western Cheshire District Nursing Teams; Community Care Western Cheshire Crisis and Re-ablement Teams; Community Matrons carrying out crisis work. Non- Clinical Cleaning, transport and waste management; Emergency maintenance; Catering for service users & staff; Major Incident & Flu Pandemic Teams; Security coordinated by LSMS; Supplies; Communications; Informatics / Data Analysis; Payroll (contracted Wirral University Teaching Hospital). Wherever possible clinical and non-clinical staff will be redeployed to support the above areas in the event of influenza pandemic, however this will be done without disproportionately increasing risk of patients within other services. 2.5 Essential external support services identified in CWP It is important for all services to identify, ahead of influenza pandemic, those externally contracted support services that enable them to provide a service. The Trust will maintain relationships with these external contractors in all phases of influenza pandemic. All external support services are to provide details of pandemic influenza business continuity plans making local plans to maintain supplies. These suppliers may include but are not limited to; Lloyds Pharmacy; Aramark; Cheshire ICT service; Countess of Chester Hospital; Pennine Acute Hospitals; Mediwell. Page 8 of 49

9 2.6 Avian Influenza Avian influenza is still considered a threat, particularly H5N1 and algorithms outlined by the HPA (as per below) have been developed to reflect this. However, they are flexible enough to be used should another event capable of causing human disease be identified. Link HPA Avian Influenza Guidance and Algorithms; 3. Definitions Pandemic - a pandemic is a global outbreak requiring coordination at national level with close working between the NHS, public health and social care services. Mental Health Act - The Mental Health Act 1983 and code of practice will need to be followed during the period of an influenza pandemic. The Trust will also take into account any modification to the Act by the department of Health (consultation amended 10th September 2009). Business Continuity - Business Continuity Management (BCM) is an essential tool to enhance the Trust s ability to withstand the effects of potential widespread disruption as a result of a flu pandemic. BCM embraces all parts of the organisation and is underpinned by services specific plans to respond to the impact of the pandemic. Recovery - The process of rebuilding, restoring and rehabilitating the community following an emergency. 4. Procedure A new UK approach to the indicators for action in a future pandemic response has been developed, taking into account a series of phases moving from one phase to another: Detection; Assessment; Treatment; Escalation; Recovery. Detection 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. 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 antiviral prophylaxis for close / vulnerable contacts, based on a risk assessment of the possible impact of the disease. Treatment The focus in this stage would be: Treatment of individual cases and population treatment via the NPFS, if necessary; Enhancement of the health response to deal with increasing numbers of cases; Page 9 of 49

10 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. 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; Resiliency measures, encompassing robust contingency plans; Consideration of de-escalation of response if the situation is judged to have improved sufficiently. 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; 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. 4.1 Health and Social Care Structures; Pandemic preparedness and response At the start of the pandemic there will be a transition from business as usual, where operational decisions are devolved at the local level, to a command and control system led at a national level that is able to coordinate the response. It is the responsibility of each local area to ensure that preparedness plans are drawn up and tested. Local planning and health and social care level will incorporate; Communications plans integrated with the national communications strategy; Individual school closures, within the guidelines specified in the UK Influenza Pandemic Preparedness Strategy 2011; Receipt, storage and onward distribution of national countermeasure stockpiles across each local area; Location and operation of ACPs; Movement from initial response phases of Detect and Assess to Treatment and Escalation in hotspot areas with advice from local and national public health services; Escalation and de-escalation of response in local service areas within the context of national arrangements; Mutual aid arrangements across local and sub-national organisations; Flexibility in commissioning plans to enable money to follow appropriate interventions in different settings, e.g. the vaccination of at risk groups; Vaccination implementation plans, including those for health and social care staff; Recovery, audit and return of unused national countermeasures, and Real-time feedback on coverage across local areas Reporting In the response phase of influenza pandemic, there will be a requirement for the Trust to submit situation reports to commissioners providing an update on the Trust current position and any operational areas experiencing significant pressures. Page 10 of 49

11 These requests for information will be coordinated by the major incident team and made available to the business continuity leads for completion at a local level. The influenza pandemic lead will liaise with business continuity leads ahead of any submission to ensure that information is collected in the most effective and efficient way Core principles The key must do s in influenza pandemic planning, as directed by the health and social care influenza pandemic preparedness and response guidance are; A future influenza pandemic remains a threat and may have a more severe impact than in 2009; Joint planning between all organisations, together with a cohesive approach for every response phase is essential; Exercises and testing are still needed on an ongoing basis within individual organisations and with partner organisations to test assumptions and interrelated aspects of plans; Coordination of a pandemic response is key to ensure best use of resources and to achieve the best outcome for the local area; Continuity plans are needed to underpin pandemic influenza response, in common with many other emergency response plans. 4.2 Preparing to respond People infected with the virus are likely to experience typical influenza symptoms of varying severity. Pivotal to all local plans are; A sustainable community-based response -with effective arrangements for providing initial assessment, access to antiviral medicines (and vaccines, when available), treatment of complications, home care and access to hospital care; An integrated approach to planning and response that effectively employs all of the health and social care services in a local area, using flexible working across all agencies and making best use of potentially scarce facilities and resources, including the skills of volunteers; Clear and comprehensive arrangements for admission, discharge and transfer between appropriate levels of health and social care based on established ethical and equalities frameworks to assist in managing local demand; Effective monitoring and communications systems and dialogue to permit: (i) timely exchange of essential information needed for management of the influenza pandemic and; (ii) local messaging to the public and staff; Effective management of the increases in demand resulting from the pandemic including: o A graded approach to configuring services, (i.e. identifying non-essential activity that can be reduced or ceased to increase capacity, and indicating when these changes will need to take place) allowing the local response to be proportionate to the severity of the pandemic and be escalated and de-escalated as needed; o Continuation of essential care including mechanisms for recognition and management of patients with urgent non-flu medical conditions, other emergencies and individuals with long-term conditions requiring regular intervention; o Psychosocial support for staff and patients / clients when needed including plans to afford necessary rest time for hard-pressed staff Leadership In influenza pandemic, leadership challenges may include high levels of uncertainty during the initial response phase requiring flexibility and rapid adaptability of plans, and increased demand on services, which may be exacerbated by staff absence CWP Influenza Pandemic Lead The Deputy Director of Nursing and Therapies, and Director of Infection Prevention and Control / Emergency Planning Officer will be the Influenza Pandemic Lead. Page 11 of 49

12 The CWP Influenza Pandemic Lead will be supported by the Emergency Planning Sub Committee, Influenza Pandemic Group and Emergency Planning Team to provide leadership, direction and ownership of the CWP Influenza Pandemic Plan and local Influenza Pandemic Business Continuity Plans Infection Control The incubation period can range from one to four days. People are most infectious soon after they develop symptoms, though they can continue to shed the virus, for example in coughs and colds for up to five days (longer in children). Once the symptoms are gone, people can be considered as no longer infectious to others. The meticulous use of infection control procedures such as segregation, isolation and cohort nursing are fundamental in limiting the transmission of the virus. Local risk assessments for required levels of infection control should be performed. Stringent attention to hand and respiratory hygiene should also be observed. Staff can refer to the infection control policy pandemic influenza policy for further information and guidance. Vaccination of frontline health and social care workers should be carried out as soon as pandemic influenza vaccine becomes available Business Continuity Business continuity planning for all aspects of the Trusts operational activity will be important in underpinning the influenza pandemic plans. Assurance of sufficient supplies requires a detailed understanding of the potential impact of a pandemic on the supply of consumables, medicines and other services that are critical to maintaining essential services Human Resources Pandemic influenza planning should cover training, appropriate health protection and welfare for staff and volunteers, and should take into account the specific needs of those who are pregnant or who are in risk groups. It is essential that the Trust ensures that staff are prepared, trained and available to be deployed within the Trust to maintain essential services. An influenza pandemic will affect NHS Staffing in four ways: NHS staff may themselves become infected, which is likely to lead to an unprecedented level of sickness absence during a pandemic; Some staff may have fears of being infected while at work and, in particular, of passing on the infection to their families and friends; Stress levels will be high because of pressures on staffing; Staff with caring responsibilities may be adversely affected. As a result these staff may wish to stay at home to care for dependent children and, in other cases, staff may be caring for partners or other dependents, such as older relatives. In order to maintain the delivery of essential services during pandemic influenza, it is essential that: The pool of available staff is as large as possible; Staff are deployed as flexibly as possible; Infrastructure and support mechanisms are in place to ensure that staff who are fit to work are able to come to work; Systems are in place to enable effective and timely information on the Trusts staffing levels / status to be supplied to the command and control structure as required; All existing staff and additional staffing are trained and inducted as appropriate. Staff can refer to the flexible working and special leave policy for further information and guidance. Page 12 of 49

13 Skills questionnaire In order to make the most effective use of the skills of its available staff, the trust will seek to collect additional information on staff before the pandemic has a significant impact on staffing levels. The trust will collect further information in relation to skills, willingness to work in other locations, car share; for use only in the event of a flu pandemic impacting on staffing levels. Internal temporary redeployment The main method of responding to absence will be internal temporary redeployment; provided that it does not compromise infection control, where necessary, staff will be asked to change their normal place of work. Some managerial, administrative and clinical staff, especially those with clinical skills, may also be redeployed if normal duties / activities deemed not to be essential during the pandemic are suspended. Pharmacist and nurse prescribers could play an important role in prescribing medicines for those people who cannot access their usual prescriber where required. In all such instances, the employee s personal circumstances will be considered: however, the exigencies of continuous service delivery may have to supersede the need to be in the normal work location. As far as practicable, redeployment will be voluntary: however, that may not be possible and, if absolutely necessary, an instruction may be issued. In all cases where staff are temporarily redeployed, redeployed staff will: Be given appropriate line management support; Only be asked to take on tasks within their competence; Have any reasonable additional costs reimbursed by the trust (in accordance with normal policy provisions). Increasing the pool of staff: Recently retired staff - will be contacted to ask if they will be willing to work for the trust in an emergency. Issues regarding refreshing skills and restoring staff to professional registers on a temporary basis, etc will need to be addressed, as will consideration given to assisting with registration fees; Secondments - although there is a working assumption that there will be little scope for reciprocity between organisations during the major impact of a pandemic, the option for staff to work for other NHS Trusts which are located nearer to their home is being discussed regionally and will be considered on a case by case basis; Bank staff - may be asked to work additional hours and travel to priority areas. Travelling expenses will be reimbursed for bank staff travelling to areas outside of their usual work areas. Wherever possible the Trust will provide support for those bank staff travelling outside their usual work areas; Student nurses links with the University will be made to ensure that students and / or teaching staff may be contacted as required; Commercial agencies those, with which we already have contracts, may also be used; Independent providers - services with links to independent providers should also be contacted to see if they have staff who could work for the trust if their normal work is suspended; Existing volunteers - will be asked if they are willing to help out but ensuring that their remit is clear and that they are covered by an honorary contract as necessary; Trainees - it is likely that in a pandemic there would be embargo on rotational moves for trainees (junior doctors). Initial discussions have taken place with the Deanery, who will need to work with the trust in line with respective business continuity plans. The usual pre employment check processes will be carried out on all staff asked to work with vulnerable adults or children in line with the trust s current procedures. Page 13 of 49

14 Training Priority will be given to ensuring that induction and mandatory training needs are covered for all staff moving temporarily into new areas of work. Induction for newly appointed staff will also continue to be given priority. Ongoing staff training throughout the pandemic is an important part of routine contingency plans. Where there may be a need for staff to work outside their normal role or in unfamiliar situations, it is important that this work remains within the scope of their competence. 4.3 Health and Social Care Response; Detection and Assessment Phase The detection and assessment start when human to human transmission of a novel influenza virus with pandemic potential which poses a substantial risk to human health is detected in the UK. During these initial phases the main requirement is to identify the virus and to gain an understanding of its clinical, epidemiological and virological characteristics, such as risk groups for severe disease. This phase therefore focuses on intelligence gathering, enhanced clinical surveillance, the development of laboratory diagnostic tests, swab testing by GPs and testing in hospitals of suspect cases, presumptive treatment for affected individuals, possible prophylaxis of contacts, and good communication. As data becomes available, scientific advice and modelling at a national level will help inform the response. At the outset, the eventual severity of the pandemic will not be clear, nor will its impact on health systems. Initial response plans should therefore adopt a risk based approach but remain flexible and capable of proportionate scaling up or down Public Health Services The initial response will be resource intensive for public health and primary care services, GP s, public health and local NHS providers will need locally agreed mechanisms to share tasks and collaborate, to minimise the risk of individual service failure and to sustain response School closures It is unlikely that widespread school closures will be required, except in a very high impact pandemic. Locally school closures may be advised in specific circumstances to reduce the initial spread of infection whist awaiting more information about the spread of the virus. Head teachers and the Board of governors will take the ultimate decision on school closures Primary and Community Care Whereas this initial response will be limited, primary and community care services may still come under pressure, and may be required to implement escalation plans. Facemasks and Antiviral medicines Although there are central stockpiles, it could take 7-10 days for UK wide distribution; organisations should prepare to rely initially on local stocks and continuity. Access to antiviral medicines in the first days will be via local health protection units. Antiviral medicines (oseltamivir and zanamivir) from the national stockpile will be free for those who have a clinical need. It is unlikely that the National Pandemic Flu Service (NPFS) will be activated until there is a wider geographical pressure on primary care services from high numbers of patients with flu like symptoms Social Care Social care services could experience little pressure in the initial phases of a low impact pandemic Secondary Care, including Mental Health Secondary care services, including mental health, are less likely to be under pressure during the initial phase of a low impact pandemic. Page 14 of 49

15 4.4 Health and Social Care Response; Treatment and Escalation Once there is evidence of sustained transmission of the virus in the community, the focus will be moved to treatment. The decision to move to treatment and escalation will be taken nationally, although some areas may have already moved to this phase following consultation with local NHS and public health services, and those at national level. Diagnosis will be based on clinical assessment, with antiviral treatment of clinical at risk groups and those who may be at risk of serious complications. A possible treat all strategy may be adopted depending on the behaviour of the virus. At this phase, all health and social care services should be undertaking vaccination planning although initial vaccine supplies may be unavailable for four to six months from the emergence of the new virus. Public health services will continue to gather data and monitor the virus through the pandemic. During the treatment and escalation phase, in particular within a moderate to high impact pandemic, service activity may need to be prioritised and flexible as part of business continuity planning. The following arrangements may be considered; Prioritisation of referrals for assessment (according to urgency); The use of telephone assessment; consider only doing home assessments where absolutely necessary; Greater use of self-assessment (e.g. Internet); A one-stage referral and assessment model; Deferral of non-urgent referrals until after the pandemic; Redeploying staff from other tasks to delivery of actual support / care; Temporarily reallocating support from those with lower levels of need to those in higher levels. CWP services and departments may be required to activate local pandemic influenza business continuity plans at this stage. The Pandemic Influenza Business Continuity Plan template can be found in appendix 5. If pressure on services reduces available capacity to the extent that only the needs of those assessed as having a critical need can be met, prioritisation criteria will include where: Life is or will be threatened; Significant health problems have developed or will develop; There is little or no control over vital aspects of the immediate environment; Serious abuse or neglect has occurred or will occur; There is or will be an inability to carry out vital personal care or domestic routines Primary and community care In a pandemic of moderate severity there may be a requirement for primary and community care services to suspend non urgent clinical care and non urgent clinical activities to free up additional capacity. This is to be done so in conjunction with existing business continuity arrangements. In a high impact pandemic, primary care and out of hours services (for example, Community Care Western Cheshire out of hours service) may be relying on telephone advice systems such as NHS Direct or NHS 111, where and when operational, to support urgent and emergency calls. Clear arrangements for admission and discharge to various levels of the health and social care system will be critical in managing local demand. It is intended that service users will be supported to continue receiving primary and community care services where required. Page 15 of 49

16 Where patients have physical health complications as a result of the influenza pandemic these will be assessed and the appropriate referral to other health and social care services will be made. There may also be a requirement to provide additional support for end of life care. Antiviral medicines Influenza antiviral medicines are likely to be the first line of defence until a pandemic specific vaccine becomes available Mental Health Services It is important to have plans in place to enable mental health services to deal with increased staff shortages during a pandemic; in particular plans need to ensure the continued ability to safeguard patients in accordance with the Mental Health Act Acute illness, such as influenza, can worsen depression, which can complicate risk assessment, treatment and recovery for some service users. In a moderate impact pandemic, pressures on local acute services may mean that mental health units cannot transfer service users who develop increased physical health needs to acute hospitals as regular practice would require. CWP staff training will continue to have education and training in relation to improving their skills in physical health as part of an ongoing programme Trust wide. This will include Infection Prevention & Control training, basic life support, physical health skills (such as Venepuncture), which are appropriate for Mental Health Services. Discharging service users from general inpatient wards into the community may be difficult during a pandemic. Forensic services pose an additional challenge in that some service users are on restriction orders imposed under mental health legislation (administered by Ministry of Justice); court appearances may be affected. Inpatients that contract the flu will be supported and treatment will be given in accordance with the Trust s Infection Prevention & Control Policies. When service users, who may not have capacity to consent to treatment, need influenza-related medicines, usual consent procedures should be followed as set out in the Mental Capacity Act 2005 and its Code of Practice. Should a service user have made a Lasting Powers of Attorney (LPA) for welfare matters under the act, the attorney would need to be consulted about the person s treatment. This consultation may be affected if the LPA is affected by flu. Contingency plans will need to be in place locally within services to meet this. There are certain drug treatments that may require additional contingency planning. For example, Clozapine, which is used to treat schizophrenia, may reduce the white blood cell count, so clients require regular monitoring. The Medicines and healthcare Products Regulatory Agency (MHRA) have stated that this requirement will not change. CWP will be required to maintain monitoring requirements based on their own resources Human Resource policies Absence management and monitoring In order that employees continue to be paid accurately, ESR must be up dated in the usual way. Normal sickness absence reporting routines should be observed for any employee unable to attend work owing to illness; including where that illness is understood to be flu related. However, in giving priority to service continuity, it is acknowledged that some time may elapse before managers are able to carry out trigger interviews with employees. All staff are required to adhere to the Trust Managing attendance policy and procedures during a pandemic. Page 16 of 49

17 Prior to staff returning to work having declared that they ve had influenza or suspected influenza it will be necessary for managers to complete an Influenza Return to Work Form within appendix 2. In these circumstances staff will be considered immune and may be asked to work in infected areas. Staff who fail to attend work because of fear of infection should be properly advised that they have no right to refuse to attend work during a pandemic unless there is a clear health and safety risk. If necessary, managers will need to ensure that individual employees understand that to refuse to come into work could mean that the employee is in breach of contract and that professional staff may be in breach of their professional codes of practice in which they have an obligation to provide care to those in need. Generally, the trust s managers will seek to persuade staff to attend work rather than penalise them. However, the ability of managers to maintain service delivery is dependent upon having staff that are not ill at work and all employees are expected to take reasonable steps to make themselves available for work. Whilst it is unlikely that disciplinary action will be taken, it will be considered on a case by case basis; for example, where an employee has been offered immunisation against flu has chosen not to take it and subsequently becomes unable to work owing to illness with flu. Staff with school age children or other dependents (leave of absence) The trust acknowledges that staff may be affected should their children become infected or the schools and / or child care facilities close. However staff must ensure in advance that they have contingency plans in place for child care. Where staff have to stay at home to look after dependants, the trust the flexible working and special leave should be applied in the normal way. As usual, other options such as annual leave or unpaid leave may be considered, decisions being dependent on the manager s assessment of the staffing situation. Working flexibly Where staff temporarily take on different roles or work in unfamiliar situations, the following guiding principles should be observed; Non registered staff who temporarily take on new or additional tasks should receive appropriate training and receive appropriate supervision. These tasks do not set a precedent for longer-term role changes, as issues that staff face during a pandemic are very different from the usual ones; Registered staff who temporarily take on different roles should refer to their existing codes of practice. The NMC has developed the following statement - Registrants will not be professionally compromised provided they are competent (and have been assessed as such), to carry out any practice being requested of them. They remain answerable at all times for their actions or omissions. Staff can refuse to undertake duties if they reasonably consider them to be outside their competence; During a pandemic itself, emergency situations may arise which need to be dealt with on a case-by-case basis, balancing the needs of patients against any risks in asking staff to take on unfamiliar roles; No permanent changes will be made to staff working patterns or other arrangements during a pandemic. Any requests by staff for flexible working on an indefinite basis will be considered on a case by case basis after the main impact pandemic period and in the light of normal (i.e. non pandemic) operational and service needs. Working flexibly does not mean that managers should be requiring staff to regularly work in excess of their contracted weekly hours during a flu pandemic. Where additional hours are worked, the provisions of the European Working Time Directive (EWTD) should be borne in mind and normal provisions for remuneration of additional hours applied. Managers are advised to seek further guidance from Human Resources where required. Page 17 of 49