Pandemic Influenza Coordinating Committee. Pandemic response plan NHS Greater Glasgow and Clyde

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1 Pandemic Influenza Coordinating Committee Pandemic response plan NHS Greater Glasgow and Clyde

2 Version History Version No Date Comments/Pages Amended Amended by Plan issued Dr Oliver Blatchford 2 April 2009 Plan re-issued Dr Eleanor Anderson & Dr Tasmin Sommerfield 3 28 April 2009 Minor amendments across whole document Dr Eleanor Anderson & Dr Tasmin Sommerfield 4 4 June 2009 Phase 5 revision Dr Eleanor Anderson 5 August 2009 Minor amendments across whole document, plus new planning assumptions Dr Tasmin Sommerfield 6 September 2009 New planning assumptions Dr Jessica Smith 7 January 2010 Updated to reflect comments from Dr Anderson 8 January 2010 Updated to reflect comments from Dr Anderson Darren Links Darren Links NHS GGC Pandemic Response Plan Page 1 of 36

3 TABLE OF CONTENTS 1. Introduction Scope Aim and objectives Pandemic Influenza Planning and Response Structure National Regional Local Background Planning Assumptions The Phases of an Influenza Pandemic International phases Declaration and Activation of Plans International Declaration of Pandemic Activation of UK Plans Activation of Plans: Scotland Activation of Plans: Greater Glasgow and Clyde Actions during the post pandemic period Debrief Recovery and Rehabilitation Final Report Interim Report Surveillance Communications Information for the Public Communication with the media Information for NHS and other key professionals Patient pathway Antiviral Distribution Hospital Admission Criteria Managing demands on services General principles NHS Performance Targets Measures to maintain service delivery Primary and Community Care Services Acute Services Care Support Services and Business Continuity Staffing Human resources Appendices...30 Appendix 1.a: Membership of PICC-P (Planning)...30 Appendix 1.b: Membership of Executive PICC...31 Appendix 2: Planning structures...32 Appendix 3.a: Example Draft PICC-P (Planning) agenda...33 Appendix 3.b: Example Draft Executive PICC agenda...34 Appendix 4: The role of the LRMT...35 NHS GGC Pandemic Response Plan Page 2 of 36

4 1. Introduction 1.1 Scope This plan describes the overall strategic responses to an influenza pandemic by NHS Greater Glasgow and Clyde (GGC). The plan is owned by the Board s Chief Executive and was written by the Director of Public Health and the Board s Pandemic Influenza Coordinator. It has been reviewed by the pre-pandemic subcommittee of the Board s Pandemic Influenza Coordinating Committee (PICC-p). This plan does not include plans of partner organisations; however, it is recognised that the response to a pandemic is multi-agency; accordingly, plans have been developed in collaboration with partner agencies. 1.2 Aim and objectives This plan aims to describe the procedures and arrangements that will be implemented in GGC to manage the strategic response to an influenza pandemic. The specific objectives of the plan are to: describe the arrangements for the management of an influenza pandemic across the NHS Board area ensure that national arrangements for pandemic influenza management are consistently implemented in NHS GGC indicate the relationship of the strategic and operational NHS GGC Pandemic Influenza plans and the wider planning arrangements of the Strathclyde Emergencies Coordination Group (SECG) ensure that lessons learned during any activation or exercise of the plan are incorporated into future planning arrangements. NHS GGC Pandemic Response Plan Page 3 of 36

5 1.3 Pandemic Influenza Planning and Response Structure Figure 1 shows the relationship between local and national structures. Figure 1 NHS GGC Pandemic Response Plan Page 4 of 36

6 1.3.1 National At a UK level the Department of Health (DOH) will be the lead UK Government Department in the event of a pandemic. The Scottish Civil Contingencies Unit leads the pandemic planning process in Scotland, with health input being provided by the Scottish Government s Health Department, Public Health and Well-being Directorate, which will work with the support of the Scottish Government s Emergency Action Team (EAT) to provide health input for the Cabinet Sub-Committee-SGoRR (CSC- SGoRR). It will also liaise with local health services. To help achieve this it has developed the Health and Community Care Pandemic Influenza Steering Group, which also includes membership from NHS Boards, Health Protection Scotland (HPS), COSLA and Social Work Regional Strathclyde Emergencies Co-ordination Group (SECG) This group exists to co-ordinate the responses of all Category 1 and 2 responders, as well as the private and voluntary sectors within Strathclyde, with respect to preparing for and responding to civil contingencies. During a pandemic the group will be responsible for dealing with the consequences of an outbreak and rather than the clinical aspects. In the emergency phase it will be chaired by Strathclyde Police s Chief Constable. Scientific and Technical Advice Cell (STAC) This is a joint group consisting of Directors of Public Health from Strathclyde s NHS Boards, in addition to staff from Health Protection Scotland (HPS) and other specialist advisors. It will be responsible for considering advice and guidance issued by national bodies, the strategy of a regional response with respect to clinical issues, and advising the SECG group Local Executive Pandemic Influenza Coordinating Committee (PICC) This is the management group that will be established by NHS GGC in the event of a pandemic to provide an area-wide approach to managing the situation. Membership of the Pre-pandemic planning sub-group of the PICC (the PICC-p) is shown in Appendix 1. Appendix 2 contains the planning structure for pandemic influenza within NHS GGC, along with planning groups of partner agencies. NHS GGC s pandemic influenza NHS GGC Pandemic Response Plan Page 5 of 36

7 sub-plans reflect this planning structure. Figure 3 shows the response structure within NHS GGC and with regional and national agencies. Figure 3: NHS GGC Executive PICC* Structure *(Partner agencies included in various groups as appropriate) SGORRS (See Figure 1) SECG Strategic Group DPH/CEO members STAC Chair DPH NHS GGC Executive PICC Chair CEO 10 CH(C)P LRMTs Chaired CHP Director Acute Division PICT Chair Medical Director Acute site or function HPICT Chair Hospital Manager NHS GGC Pandemic Response Plan Page 6 of 36

8 Acute Division The Acute Division plan includes operational details for pandemic responses in the acute hospitals and cross cutting functions. It includes detailed plans for responses in a range of specialist settings, including critical care, accident and emergency, women s & children s services and mortuary services. The Acute Division plans will also include specific plans for each acute hospital site. In the event of a pandemic an Acute Division pandemic influenza management team will be formed. In addition, each hospital will also have its own Hospital Pandemic Influenza Control Team (HPICT). Partnerships A partnership planning group coordinates pandemic influenza planning across the ten CH(C)Ps. Each CH(C)P has a pandemic influenza plan which follows an agreed template. Each CH(C)P also has a Local Response Management Team (LRMT) which will be convened upon the declaration by the WHO of Phase 5 pandemic and will meet more regularly at WHO Phase 6 UK Alert Level 1. At this point the LRMT will assume responsibility for co-ordinating implementation of the local response. The full role of the LRMTs is described in Appendix 4. In addition, CH(C)P directors will have regular teleconferences throughout the pandemic. NHS GGC Board-wide sub-plans There is a range of sub-plans which relate to issues requiring management in corporate, acute and partnerships settings during a pandemic. These sub-plans are listed below and are described in the relevant sections of this plan, and are available on request from the Public Health Protection Unit (PHPU). Information management Infection Control Pharmacy and antiviral distribution GP Out of Hours Human resources Communications Pandemic influenza vaccination Care Homes Supplies NHS GGC Pandemic Response Plan Page 7 of 36

9 2. Background Detailed background information about pandemic influenza can be found in the Scottish Government s framework for responding to an influenza pandemic ( 2.1 Planning Assumptions Infectivity and mode of spread Influenza spreads through the respiratory route by droplets of infected respiratory secretions produced when an infected person talks, coughs or sneezes It may also spread by hand/face contact (nose, mouth or eyes) after touching a person or surface contaminated with infectious respiratory droplets Finer respiratory aerosols (which stay in the air for longer and are therefore more effective at spreading infection) may occur in some circumstances such as during the use of nebulisers and some dental procedures etc Incubation period 1-4 days (typically 2-3) ( maximum of 7 days used for Public Health purposes) People may be infectious for four to five days from the onset of symptoms (longer in children and those who are immunocompromised). A period of 7 days is used for Public Health purposes. Children may also be infectious up to up to 12 hours prior to symptom onset. Children have been shown to secrete the virus for longer and at higher levels than adults It has been estimated that with the current Influenza A H1N1 strain, one person infects about 1.4 other people on average. This may be higher in closed communities such as prisons, residential homes or boarding schools. The severity (clinical attack rate) of illness and deaths The Department of Health released new planning assumptions for the swine flu pandemic in October They are to be used to inform planning, but it should be noted that they represent a reasonable worst case scenario rather than a prediction of events. The timing of the start of the pandemic cannot be predicted. NHS GGC Pandemic Response Plan Page 8 of 36

10 Department of Health planning assumptions The Department of Health has produced updated planning assumptions for the H1N1 pandemic (dated 22/10/09). The new assumptions represent a downwards revision of the previous planning assumptions indicating that the 2 nd peak may be lower than originally thought. These are to be used to inform planning but represent a reasonable worst case scenario rather than a prediction of events. The timing of the start of the pandemic cannot be predicted. Planning assumptions to mid-may 2010 Clinical attack rate Up to 12% of population Peak clinical attack rate Up to 2.5% of the population Up to 0.5% of clinical cases Hospital admissions ITU required for up to 15% of patients admitted Case fatality Up to 0.014% of clinical cases Notes for these figures Clinical attack rate may be higher amongst children under 16 years old (up to 30%) compared to over 65 year olds. The GG&C population estimate is based on the 2008 mid-year estimate from the Scottish Public Health Observatory. The CH(C)P population estimates are 2007 mid-year population estimates from the Scottish Public Health Observatory. Table 1 and figure 1 illustrate the impact of these predictions on the NHS Greater Glasgow and Clyde population. NHS GGC Pandemic Response Plan Page 9 of 36

11 Table 1: Illustration of numbers of H1N1 cases, complications, admissions and deaths in NHS GG&C Weekly % of cases in pandemic wave New clinical cases Complications Admissions Deaths Week 1 0.1% Week 2 0.2% Week 3 0.8% 1, Week 4 3.1% 4, Week % 15, Week % 30, Week % 30, Week % 20, Week 9 9.7% 13, Week % 10, Week % 7, Week % 3, Week % 2, Week % 1, Week % 1, Total 143, Note: based on a total population of 1,194,675 (2008 mid-year population estimate from Scottish Public Health Observatory) Figure 1 Predicted number of new clinical cases per week in NHS GGC based on current planning assumptions Number of New Clinical cases Week of Pandemic NHS GGC Pandemic Response Plan Page 10 of 36

12 3. The Phases of an Influenza Pandemic 3.1 International phases For international planning purposes, the World Health Organization (WHO) has defined six phases in the progression of an influenza pandemic from the first emergence of a novel influenza virus to wide international spread (see Figure 3). These phases allow a stepwise escalating approach to preparedness planning. Figure 3 Influenza viruses circulate continuously among animals, especially birds; in Phase 1 no viruses circulating among animals have been reported to cause infections in humans. In Phase 2 an animal influenza virus circulating among domesticated or wild animals is known to have caused infection in humans, and is therefore considered a potential pandemic threat. In Phase 3, an animal or human-animal influenza re-assortment virus has caused sporadic cases or small clusters of disease in people, but has not resulted in humanto-human transmission sufficient to sustain community-level outbreaks. Limited human-to-human transmission may occur under some circumstances, for example, when there is close contact between an infected person and an unprotected caregiver. Limited transmission under such specific circumstances does not indicate NHS GGC Pandemic Response Plan Page 11 of 36

13 that the virus has gained the level of transmissibility among humans necessary to cause a pandemic. Phase 4 is characterized by verified human-to-human transmission of an animal or human-animal influenza re-assortment virus able to cause community-level outbreaks. The ability to cause sustained disease outbreaks in a community marks a significant upwards shift in the risk for a pandemic. Any country that suspects or has verified such an event should urgently consult with WHO so that the situation can be jointly assessed and a decision made by the affected country if implementation of a rapid pandemic containment operation is warranted. Phase 4 indicates a significant increase in risk of a pandemic but does not necessarily mean that a pandemic is a forgone conclusion. Phase 5 is characterized by human-to-human spread of the virus into at least two countries in one WHO region. While most countries will not be affected at this stage, the declaration of Phase 5 is a strong signal that a pandemic is imminent and that the time to finalize the organization, communication, and implementation of the planned mitigation measures is short. Phase 6, the pandemic phase, is characterized by community level outbreaks in at least one other country in a different WHO region in addition to the criteria defined in Phase 5. Designation of this phase will indicate that a global pandemic is under way. During the post-peak period, pandemic disease levels in most countries with adequate surveillance will have dropped below peak observed levels. The post-peak period signifies that pandemic activity appears to be decreasing; however, it is uncertain if additional waves will occur and countries will need to be prepared for a second wave. Previous pandemics have been characterized by waves of activity spread over months The second wave may be as, or more, intense than the first. Once the level of disease activity drops, a critical communications task will be to balance this information with the possibility of another wave. Pandemic waves can be separated by months and an immediate at-ease signal may be premature. In the post-pandemic period, influenza disease activity will have returned to levels normally seen for seasonal influenza. It is expected that the pandemic virus will behave as a seasonal influenza A virus. At this stage, it is important to maintain surveillance and update pandemic preparedness and response plans accordingly. An intensive phase of recovery and evaluation may be required. NHS GGC Pandemic Response Plan Page 12 of 36

14 UK alert levels In addition to the above phases, a 4-point UK specific alert mechanism has been developed, consistent with the alert levels in other UK infectious disease response plans. Scotland participates in this UK-wide alert mechanism. 1 Virus / cases only outside the UK 2 Virus isolated in the UK 3 Outbreak(s) in the UK 4 Widespread activity across UK NHS GGC Pandemic Response Plan Page 13 of 36

15 4. Declaration and Activation of Plans The development, maintenance and implementation of this plan will closely follow the WHO phases (section 3). Actions are required at a national, regional, health board and local area at each phase of the pandemic (Appendix 5). 4.1 International Declaration of Pandemic The WHO will announce the various phases as soon as they are confirmed, indicating the level of preparedness expected of the WHO and its individual member states. National Authorities (the UK government) are expected to be prepared to activate their national contingency plans following announcement of Phase Activation of UK Plans On being informed by the WHO that Phase 5 has been announced the UK Government will undertake the following actions: Convene the UK National Influenza Pandemic Committee (UKNIPC) which will advise all UK Health Departments Department of Health will inform all devolved administrations and the Civil Contingencies Secretariat The Civil Contingencies Secretariat will inform other government departments The Civil Contingencies Committee will review preparedness across all sectors and make appropriate strategic decisions A Civil Contingencies Sub Group may be established at this stage. On being informed by the WHO that Phase 6 has been announced the UK Government will undertake the following actions: Pass on the information to all the relevant organisations including the devolved administrations which will inform the NHS in their areas. 4.3 Activation of Plans: Scotland On being advised by the Department of Health or Scottish Resilience that the WHO has announced phase 5 the Scottish Minister for Health and Community Care will undertake the following actions:- NHS GGC Pandemic Response Plan Page 14 of 36

16 The Scottish Government Health Directorate will inform the NHS and the Civil Contingencies Division of the Scottish Government Justice Department The Civil Contingencies Division will inform other Scottish Government Departments and may convene the Ministerial Group on Civil Contingencies and the Scottish Emergencies Co-ordinating Committee (SECC) The Scottish Government s Resilience Room (SGoRR) formerly known as the Scottish Executive s Emergency Room (SEER) may also be activated at this stage. 4.4 Activation of Plans: Greater Glasgow and Clyde Actions at WHO phase 4 When WHO phase 4 is declared, the main activity should be to review pandemic plans including business continuity arrangements. At this stage the PICC planning group (see Appendix 1 and Appendix 3a.) should be convened to: review the NHS GGC PICC-P pandemic response plan and related sub plans, and plans from the Acute Division PICC and Partnerships Local response Management Teams (LRMTs) to ensure their operational readiness identify planning gaps and institute actions to remedy deficiencies ensure that plans have been tested and continue testing liaise with HR Director on issues including staff numbers, recently retired staff and staff training (including rapid refresher courses) identify and implement training needs, through the LRMTs in Partnerships and the Acute Division, in conjunction with NHS GGC Human Resources ensure that national systems including the national flu line, and national flu surveillance mechanisms are established locally as required ensure adequate supplies and transportation of necessary drugs and equipment are available. Actions at WHO phase 5 At the declaration of WHO phase 5, the PICC planning group should be ensuring all pandemic preparedness and operational response arrangements are on standby for implementation. To achieve this, the actions in WHO phase 4 should be revisited by the PICC planning group. NHS GGC Pandemic Response Plan Page 15 of 36

17 Actions at WHO phase 6 The WHO will declare pandemic phase 6. The Scottish Government will notify NHS GGC of this and the full Scottish pandemic plan will be activated. At this point, the CEO will initiate the weekly executive PICC meetings (membership is included in Appendix 1b) The priorities for the PICC at alert levels 1 and 2 are: Surveillance Ensuring preparedness for alert levels 3 and 4. Management of the first few hundred cases in GGC may require: Adequate surveillance (through an adapted version of the Avian Flu Database) Containment (identifying, diagnosing, and giving prophylaxis and infection control advice to suspected cases and their close contacts). At alert levels 3 and 4, the executive PICC (E-PICC) should review: continuity of health and other relevant essential services delivery of health care and social care responses for treatment and care take strategic decisions about prioritisation of services oversee and coordinate operational responses of NHS GGC flu groups coordinate service prioritisation responses of LRMTs give advice to the SECG (as part of the Scientific and Technical Advisory Cell), to minimise social disruption and ensure coordination of responses of different agencies flow of information on the impact of the pandemic and responses of services, internally in NHS GGC, and with the Scottish Government and HPS implementation of Scottish Government advice and direction on countermeasures implementation of appropriate infection control measures throughout NHS GGC continuity of antiviral distribution in the community feedback on emerging problems. All members of the E-PICC should identify alternates to deputise for them, should they become ill or otherwise be unable to attend. For most members of the E-PICC, NHS GGC Pandemic Response Plan Page 16 of 36

18 their alternates should have already been identified through their organisations local business continuity arrangements. Executive PICC agenda The draft agenda (Appendix 3b) provides a list of the items which may require discussion by the E-PICC. Reports from the Scottish Government Health Department and/or HPS should include (where relevant): information on current WHO pandemic phase / UK alert level current / recent epidemiological data derived from the national flu line, PIPER and other relevant data sets projections of likely impact of pandemic advice received on suspension of targets, if appropriate guidance on social distancing measures being implemented, if any information on civil contingencies issues where appropriate. Internal reports Reports from services should include (where relevant): pressure on services staff absence levels HR issues including redeployment epidemiological intelligence on disease patterns if available. External agencies (e.g. SGHD, HPS, NHS24, Scottish Ambulance Service (SAS)) are not represented on the E-PICC as a matter of course. It is suggested that they may submit written updates to the E-PICC, or the E-PICC chair may co-opt representatives of these and other partner agencies as appropriate. Decision making levels It is expected that, generally, the CHCP of acute LRMT / HPICT will make local operational decisions regarding services and will report these to the PICC. In addition, it will inform the E-PICC of pressure which require a E-PICC decision- these include those issues which would lead to service provision inequity across NHS GGC if sharing of services, for example, across two CHCPs, is not feasible. Some of these decisions may relate to non NHS services: these should be reported to the E-PICC. NHS GGC Pandemic Response Plan Page 17 of 36

19 In turn, the PICC chair will bring such issues to the SECG if not appropriate for local resolution. NHS GGC Pandemic Response Plan Page 18 of 36

20 5 Actions during the post pandemic period 5.1 Debrief When the pandemic has been declared to have ended, (i.e. at the end of the first pandemic wave and at the end of UK alert level 4) the E-PICC will need to meet to: reviews the effectiveness of NHS GGC pandemic responses and the plans, to amend these plans in the light of experience take measures to allow the resumption of normal NHS services review stock levels of antivirals and other pharmaceuticals and supplies prepare for a possible future wave of pandemic influenza prepare to implement vaccination programme if appropriate. Second (and subsequent) pandemic waves may be more or less severe than their precursors. UK alert levels 1 to 4 would apply as before, and the revised plans should be in place for re-implementation. Finally, after pandemic waves have ended, there will be a recovery period during which actions will be needed to return services to normal operation. In particular, there may be a backlog of postponed elective work which will require to be addressed. It is important that the findings of the debriefing process are recorded and that any actions identified are completed as soon as possible following debriefing, and certainly in advance of a second wave of the pandemic. Further debriefing and review of arrangements should be undertaken at the end of each subsequent wave of the pandemic. 5.2 Recovery and Rehabilitation As the pandemic recedes the E-PICC will continue in its co-ordination role to ensure that the short, medium and longer term recovery and rehabilitation issues are identified and addressed. 5.3 Final Report Due to the significance of the pandemic event and the importance of ensuring that the scale of the pandemic and the response made by the health board and others is documented, it will be the responsibility of the E-PICC to prepare a final report on the NHS GGC Pandemic Response Plan Page 19 of 36

21 response to the emergency and to present this to the main agencies involved, HPS, and to the Scottish Government Health Directorate. 5.4 Interim Report Due to the nature of pandemics and the potential for a series of pandemic waves over a timescale that could last up to two years, the E-PICC will prepare an interim report at the end of each pandemic wave culminating in a final report, once world influenza infections have reduced to base levels. NHS GGC Pandemic Response Plan Page 20 of 36

22 6 Surveillance Information will be collated from General Practices using the PIPeR system (developed by HPS), augmented with information from NHS 24, and other local and/or national datasets to provide surveillance on levels of disease in the population. In addition, it is proposed that the normal winter pressures reporting mechanisms should be used to provide information on service delivery and service pressures, to enable the E-PICC to give appropriate guidance to service providers, and to feed information to HPS and the Scottish Government. Activity data, death rates, admission rates and infectious disease notifications will be analysed. The structures and processes required to enable these information outputs are detailed in the information management plan, available from the PHPU. NHS GGC Pandemic Response Plan Page 21 of 36

23 7. Communications NHS GGC s communications plan describes how communication with NHS staff, the media and the public will be undertaken during a pandemic (Annexe 2). The national information campaign which will be implemented at WHO international phase 5 will advise the public about the National Flu Line (described below). There will be a national strategy to follow but individual health boards will engage with their local media proactively as the situation develops. There will also be close liaison with partner agencies such as Scottish Government, local authorities, emergency services and voluntary bodies. 7.1 Information for the Public Information will need to be widely distributed to the public via leaflets, help-lines and national and local links with the media (radio, television and press). This will also be undertaken on a national basis. Basic advice via the media to the public should be easily understood, encouraging non attendance at enclosed crowded areas. The public will be advised to stay at home if symptomatic until recovered and to obtain advice, and symptomatic relief using over the counter medicines from community pharmacists. In addition, the public will need to be educated about the reasons for vaccine not being immediately available and will require reassurance. This will involve distributing information leaflets for the public that will include basic advice about self-treatment in mild infection and advice about avoiding crowded enclosed areas, if appropriate. 7.2 Communication with the media The Communications Officer will also be responsible for preparing press releases daily as appropriate, possibly after each meeting of the E-PICC. They will be required to liaise regularly with other press officers and equivalent officers at the SECG and Scottish Government Health Department. Co-ordination of press releases via the NHS Board s Communications Officer is essential to ensure consistency of information. 7.3 Information for NHS and other key professionals Communication links will be essential at both national and local level. Regular information will be cascaded to doctors via Surefax, s, fax and/or by post. NHS GGC Pandemic Response Plan Page 22 of 36

24 8. Patient pathway 8.1 Antiviral Distribution Flu Line and the mechanism for antiviral distribution is described in the NHS GGC antiviral distribution (AVD) plan (see Annexe 3). AVD is likely to be via community pharmacies with back-up from antiviral distribution centres if required. The plan encompasses arrangements for storage, security, distribution, IT, out of hours provision, business continuity, Patient Group Directive (PGD) and staffing. There is a separate pharmacy and medicines plan which will describe arrangements for the continuity of supply of drugs and other supplies during a pandemic (part of the CHPs plans). NHS GGC Pandemic Response Plan Page 23 of 36

25 8.2 Hospital Admission Criteria NHS GGC Pandemic Response Plan Page 24 of 36

26 9. Managing demands on services 9.1 General principles NHS GGC s prioritisation plan describes the measures necessary to maintain services. Applying the planning assumptions in the UK Plan, NHS GGC and local partners will have to manage increased demand for services over several weeks (around 15) with a marked peak in influenza related demand in the 5th to 9th weeks. This could coincide with significant and to an extent unpredictable staff shortages through illness and care commitments. Ethical processes for decision making during a pandemic In general, ethical decisions will be made locally by the doctor caring for the patient in consultation his or her colleagues as is normally the case. During a pandemic, where ethical issues may come to the fore more regularly, there should be a demonstrable process to follow for individual patients. The preference is for the clinician concerned to take the issue to his or her Clinical Director, and if a decision cannot be made, the Medical Director. There may also be ethical elements to the prioritisation of services. These decisions should come to the E-PICC. The E-PICC will act in accordance with the Scottish Government s flu pandemic surge capacity and prioritisation in health services and other flu guidance, and available ethical guidance including the flu ethical framework, BMA and GMC guidance. Prioritisation of services The peak demand may require that the NHS temporarily withdraws a substantial proportion of service in some areas of care to better concentrate on core services with the aim of: Minimising ill health Minimising short-term demand for further NHS or Local Authority social care services. An NHS service or treatment will be regarded as core if its withdrawal would result in or fail to alleviate: 1. Life threatening condition, serious injury or serious harm to others (e.g. child protection services or severe mental illness) 2. Severe pain or distress NHS GGC Pandemic Response Plan Page 25 of 36

27 3. Disability requiring further support during pandemic wave. These are in priority order; therefore, if all 3 categories were maintained but the demand/resource situation worsened then category 3 services/procedures may temporarily be withdrawn. 9.2 NHS Performance Targets It is possible that elective targets and the A&E target will be suspended during a pandemic, with the ongoing monitoring of hot spots by the Scottish Government. However, certain HEAT targets will remain in place: access to cancer diagnosis and treatment following urgent referral access to specialist hip surgery following fracture access to cardiac intervention. Target suspension will be triggered at WHO Phase 6 Alert level 2. When this point is reached NHS Board Chief Executives would be notified by the Scottish Government Health Division that specific targets were being temporarily suspended. 9.3 Measures to maintain service delivery Prioritisation Redeployment of staff, clinical areas and equipment, and staff training Maximising staff availability, e.g. the suspension of the European Working Time Directive, annual leave etc, using retired staff and students Amalgamation of services Primary and Community Care Services The CH(C)P plans include details of service prioritisation and business continuity. The LRMTs will be responsible for these decisions during the pandemic. Level 1 Within each GP Surgery Each practice will seek to cope with core duties as far as practicable. This may result in the cancellation of routine clinics, home visits or appointments on a temporary basis. The practice s contingency plan will be activated to cope with increasing demand. Level 2 Within each locality As individual practices come under growing pressure and are unable to cope services will be provided on a locality basis for a group of surgeries using designated NHS GGC Pandemic Response Plan Page 26 of 36

28 health centres as the main provider of health care. Routine services provided on a locality basis will be suspended temporarily Acute Services Care Admission to acute hospitals in times of severe demand (probably around the peak of the pandemic) may require to be prioritised in accordance with the criteria set out as above and, in relation to flu cases, using the agreed admission criteria. The Acute plan and individual site plans describe measures to: 1) Manage the cases 2) Deal with increased demand in the context of reduced supply of services. The Acute Division s Pandemic Influenza Control Team and each Hospital Pandemic Influenza Control Team (HPICT) will be responsible for these decisions. Measures which will progressively be put in place include: Curtailment/cancellation of non-urgent out-patient clinics (return and new patients) Curtailment/cancellation of out-reach clinics Curtailment/cancellation of elective non-urgent surgery Methods to facilitate rapid discharge Step down arrangements Alternative care sites should be considered Measures for the clinical management and, if required isolation and cohorting for; Non pandemic influenza emergencies Suspected or proven pandemic influenza patients Patents at special risk e.g. immunocompromised patients and those with chronic diseases. The resources (staff, equipment, clinical areas) made available by the above measures should be used to provide care for influenza cases, for example paediatric critical care. Redeployment and training of staff would be necessary, eg refresher courses in paediatric emergency care. NHS GGC Pandemic Response Plan Page 27 of 36

29 9.3.3 Support Services and Business Continuity While the focus of this plan is the direct clinical care of people affected by pandemic flu, it is recognised that the NHS relies on a wide range of support services to ensure appropriate standards in the delivery of health care. Executive Directors and Heads of Departments have the lead responsibility for ensuring that contingency plans to deal with peak demands are in place for the core aspects of all support services including the following disciplines/functions: Estates Heat Power Lighting Water Drainage Systems Ventilation Systems Medical Gases Laundry Services Fire detection and Automatic Fire Fighting Other Support Services Management Services Secretarial Support Medical Records Procurement/Supplies IT Management and Support Catering Cleaning Portering Transport. NHS GGC Pandemic Response Plan Page 28 of 36

30 11. Staffing 11.1 Human resources NHS GGC s Human Resources (HR) Pandemic Influenza plan is being described and describes staff management issues and HR responses before and during a pandemic. This covers issues including identifying staff resources, redeployment of staff, management of staff absence and discipline, legal issues including indemnity, Disclosure Scotland and the working time directive. NHS GGC Pandemic Response Plan Page 29 of 36

31 13. Appendices Appendix 1.a: Membership of PICC-P (Planning) DPH (chair) Pandemic influenza coordinator Acute lead for pandemic planning Lead partnership director for pandemic planning Pharmacy lead for pandemic planning Infection Control Nurse Consultant IM&T Manager/Director HR Director or representative Communications Director or representative Estates & supplies lead for pandemic planning Representative of Occupational Health (if appropriate) GGC Civil Contingencies Planning Officer (Emergency Planning Officer) Clinicians, virologists, microbiologists or others to be co-opted for relevant expertise when indicated Administrative support NHS GGC Pandemic Response Plan Page 30 of 36

32 Appendix 1.b: Membership of Executive PICC Chief Executive Director, Public Health Director, Mental Health Partnership Clinical Director, Public Health Protection Consultant, Public Health Medicine (Pandemic Flu coordinator) Clinical Director, Out of Hours Medical Director, Acute Services Chief Operating Officer, Acute Services Director, Emergency Care & Medical Specialities Director, Rehabilitation & Assessment Director, Human Resources Director, Communications Director, Health Information & Technology Administrative support from secretariat NHS GGC Pandemic Response Plan Page 31 of 36

33 Appendix 2: Planning structures DPH NHS GGC Lead: Linda de Caestecker Eleanor Anderson Pandemic Inflenza Coordinating Committee (PICC) NHS GGC-wide planning group Acute Division planning Lead Sharon Adamson Specialist subgroups as needed Board-wide topics Link: Eleanor Anderson Partnerships planning Lead: David Walker Specialist subgroups as needed Partner agencies Link: Eleanor anderson Contingency planning: Alan Dorn Critical Care Lead: Sarah Ramsay Pharmacy Lead: Liz McGovern CH(C)Ps Leads: in each CH(C)P Police / SECG Mortuary services Lead: Robert McNeill Occupational health Lead: Rona Wall Social Services (inc. care homes) Universities & Colleges Medicine Lead: David Stewart Communications Lead: Sandra Bustillo Local authorities Golden Jubilee Surgery Lead: Infection control Lead: Pamela Joannidis Private Sector hospitals A & E Lead: Grant Archibald Estates, supplies Lead: Alex McIntyre Mental Health Lead: Anne Hawkins NHS 24 Hospitals Leads: per each hospital IM & T Lead: Richard Copeland Out of hours services Lead: Norrie Gaw Immunisation Lead: Syed Ahmed NHS GGC Pandemic Response Plan Page 32 of 36

34 Appendix 3.a: Example Draft PICC-P (Planning) agenda 1. Welcome, introduction, apologies 2. Minutes of previous meeting (if applicable) 3. Matters arising from the minutes including review of actions 4. Planning Reports a. Board Plan b. Sub Plans c. Infection Control Plan d. Anti viral distribution Plan e. Human Resource Plan f. Communications Plan g. Health Information & Technology Plan h. Vaccination Plan i. CHP Plans j. Mental Health Plans k. Acute Plans 5. Any other pandemic influenza related business 6. Agreed action points 7. Date, time and venue of next meeting NHS GGC Pandemic Response Plan

35 Appendix 3.b: Example Draft Executive PICC agenda 1. Introduction and apologies 2. Minutes of the last meeting 3. Review of project action log 4. Flu surveillance report 5. Partnership report 6. Acute report 7. Flu planning report 8. General Plans Review 9. Vaccination planning 10. Report from teleconferences: a. Scottish Government b. HPS general H1N1 c. Vaccination 11. Other issues 12. Any other business NHS GGC Pandemic Response Plan

36 Appendix 4: The role of the LRMT Act as a focal point, providing a link to and oversight of the local health response Maintain the continuing provision of general practice and primary care services both in and out of hours o o o o o o receive information which allows general medical practices and pharmacies to be monitored with regard to the adequacy of their business continuity arrangements make operational decisions eg stopping non-essential services and the need for consolidation of services and other business continuity measures communicate to practices and pharmacies when non essential services may be suspended (and when they are re-commissioned) coordinate any consolidation that may be required among general practices and pharmacies if business continuity fails, including the redeployment of both staff and stock resources coordinate cooperative arrangements, such as staff redeployment or changed opening hours specified in business continuity plans co-ordinate regional implementation of measures such as Patient Group Directions Collect, collate and report information on the local health situation. Ensure that national messages are cascaded, reinforced and that the public are well informed and advised of local response arrangements Link with local authority services, particularly community care services but potentially also including transport, housing and others. NHS GGC Pandemic Response Plan