Sets out clearly the DoH s expectations of the NHS and the roles and responsibilities of each part of the system over the coming months.

Transcription

1 NORTH EAST AMBULANCE SERVICE NHS TRUST UPDATE AND RESILIENCE ACTIONS FOR NHS BOARDS REPORT BY : Director of Ambulance Operations INTRODUCTION As Board members are aware, the World Health Organisation (WHO) raised its alert level to 6 recognising that A(H1N1) swine flu has spread to pandemic levels. The virus is increasingly widespread within the UK and it is expected to continue to spread rapidly. BACKGROUND The initial containment strategy has bought some time in the early stages of this pandemic to better understand the virus and we have now moved to a treatment strategy focussing the NHS efforts on treating those who have the virus and its complications. We have been given clear expectations by the Department of Health (DoH) as a Board concerning preparedness prior to any subsequent attack wave. The pandemic swine flu virus is a novel strain and its potential impact on the NHS capacity and operations could be significant. Whilst the scientists cannot yet predict the future spread of the virus with any precision, past pandemics of and can help to plan for what may lie ahead. NEAS should therefore work on the assumption that we need to be at peak preparedness by September GUIDANCE AND ACTIONS We need to ensure the focus and resources devoted to this work are sufficient in the context of the WHO declaration of a global pandemic and the prospect of a sustained second wave of up to five months duration using guidance Pandemic Influenza - Human Resources Guidance for the NHS (DoH document Gateway reference 10280) and Managing Demand and Capacity in health Care Organisations (Surge) (DoH document Gateway Reference 11697). This guidance seeks to: Provide the NHS with a clear explanation of the rationale for the decision taken on 2 nd July 2009 by Health Ministers across the UK to move from containment to treatment nationally. Sets out clearly the DoH s expectations of the NHS and the roles and responsibilities of each part of the system over the coming months. Explain the support being made available to the NHS and front line staff to ensure the Service is as prepared and resilience as possible in advance of a potentially more severe autumn or winter attack of the swine flu virus. It is in this context that all NHS Organisations need to ensure that: Each NHS Board appoints a full time director level lead dedicated to flu preparedness and resilience with immediate effect. This can be a single individual or shared between directors but must provide visible, full-time, senior leadership and ensure a well-resourced team on this issue through the months ahead The lead director role will be undertaken by Paul Liversidge and Colin Cessford. Initial thoughts are that two dedicated full-time positions working on Pandemic/Winter preparedness will be Graham Robinson and Jim Broad assisted by Phil Bain, NEAS Pandemic Lead, who will provide the logistical and technical support. Page 1 of 5

2 A number of other staff from various departments will be involved. Pandemic preparedness plans are stress tested to ensure that the provision of high quality care to flu and non-flu patients now and during a second, sustained wave of up to five months can be sustained NEAS has undertaken exercises already and has completed a table top exercise on the 17 th July. This is an in-house test of the Flu Plan, BCP arrangements and functionality of the Pandemic Management Team. Further exercising will be planned. It is also expected that we take part on 8 th September in a nationally devised and SHA and HPA organised resilience testing and exercise programmes to validate plans. Board level attendance, including CEO, is expected. Each NHS Board is requested to take reports on progress towards their readiness assessment against the Department s HR and Surge guidance to their July and August meetings We will need to assess our plans against this guidance. The HR guidance is being reviewed by the HR department and an action plan is being compiled. Surge Management events have been attended by NEAS and we are awaiting feedback and action plans. They understand and test capacity constraints that may be caused through increased demand and workforce sickness absence. This includes but is not limited to those clinical areas that are likely to face most flu-related pressures. Recent Pandemic Flu: Managing Demand and Capacity in Health Care Organisations (surge) guidance and the NHS Employers/ Department of Health document Pandemic Influenza Human Resources Guidance for the NHS will help with this work; REAP will be instigated along with our R.A.G. plan Major Incident plan (M.I.P.) REAP levels from 1 5+ will be introduced resulting in specific organisational actions. We can use the MIP to further curtail services to protect A/E delivery. A level of daily surge demand can be managed by our traffic light escalation system. Their organisation takes part in the September nationally devised and SHA and HPAorganised resilience testing and exercise programmes to validate Pandemic Flu Plans and Winter Readiness Plans. Board level attendance, including from NHS CEs, is expected at these events; The 8th September has been set by the SHA/HPA and the Executive Team and Peter Wood (NED) have been advised of this date. NEAS is fully involved in developing a national winter pressures plan with colleagues from throughout the UK. This will be ready by the end of September deadline. Work is also ongoing on the preparation of an internal winter plan. Extract from the Surge Capacity guidance - Overview of Ambulance Services NHS Ambulance services are expected to see significant rises in demand for the 999 Emergency service, coupled with additional requests for transportation from Health professionals such as General Practitioners (to potentially more distant locations) alongside increases in transportation and discharge requests from the health community. Page 2 of 5

3 Ambulance services will need to build on their pivotal role as one of the main gateways into Healthcare. They will need to ensure enhanced triaging arrangements and strong partnership links with local PCTs, GPs, out-of-hours services, NHS Direct, A&E Departments, minor injury units, walk - in centres, social services, mental health agencies and others that provide access to NHS services; including the devolved administrations where appropriate. Ambulance Trusts will need to ensure their essential role in telephone call handling, (particularly in the 999 scenario) triaging and inter health agency coordination is robust and able to manage limited resources against acute need; in an environment of significant increase in activity over weeks and possibly months during an Influenza Pandemic. Trusts will play a key link in the chain of effective communication both inward and outward facing, and will need to ensure robust arrangements are in place to manage raised public expectations at a time of limit resources in conjunction with other health bodies; in particular NHS Direct. Ambulance Trusts will be key in assisting the wider health system with Strategic command and control arrangements; and provide a key link between Healthcare and the resilience community including supporting PCTs at LRFs and in the response phase, Strategic Coordination Groups. All NHS Employees should respond positively to the professionalism of NHS staff shown since April in managing the Pandemic. This should include: Ensuring that appropriate HR policies and procedures are in place to support staff and maintain their well being in line with the national Pandemic Flu HR guidance Is part of the action plan being developed to meet the Pandemic Flu HR guidance and will be cross referenced against the Pandemic Flu plan Delivering staff training as required to support service provision and high quality patient care Plans to be reviewed to identify any training implications Effective communications and consultation with staff and their Representatives on the support needed Regular meetings to be arranged with staff side and agreed communication plan to be introduced Ensuring that staff have access to timely and accurate information about the progress of the Pandemic and the practical steps they can take to protect themselves, including clear advice about the importance of infection control procedures and routine respiratory and hand hygiene practices one of the very best ways people can protect themselves, their families and their parents from the virus Communication plan to be introduced with clear guidance on infection control and hygiene for staff and their dependents Ensuring that staff in close and regular contact with patients with Pandemic Swine Flu have access to appropriate personal protective equipment, such as face masks Face masks available, in storage Page 3 of 5

4 Ensuring that the case is being made to NHS staff and their Representatives for the importance of getting vaccinated against seasonal flu and Swine Flu as the vaccines become available to protect staff, their families and patients Will be part of the communication plan and the HR action plan NHS Trusts and NHS Foundation Trusts NHS trusts, including NHS foundation trusts, including acute, specialist, mental health and ambulance service trusts are required to: Take full account of national pandemic Swine Flu policy and SHAs system management responsibilities; Accepted Ensure that there are robust systems in place to provide antivirals to patients requiring admission where clinical judgement indicates Swine Flu has been contracted. (Clinicians may wish to follow the RCP guidance in identifying priority patients in advance (using yellow and blue cards) so that priority patients can be identified for follow up) Ensure that all those people with suspected Swine Flu in the higher risk groups get antivirals and start using them as soon as possible within 48 hours of the onset of symptoms Appropriate pathway chosen for patients accessing support through the 999 system. Card 36 pathway equivalent yet to be implemented Ensure that local hospitals - and where appropriate walk in centres - have arrangements in place in case patients without normal access to GPs may attend and may need access to antiviral medication Ensure that the case is being made to NHS staff and their Representatives for the importance of getting vaccinated against seasonal flu and Swine Flu as the vaccines become available to protect staff, their families and patients The Occupational Health department have gone out to stations each year to provide vaccinations and have stressed the importance of the vaccination however take up is poor. A different approach may have to be undertaken when the vaccination is ready for A(H1N1) Swine Flu NEAS to consider making vaccination compulsory Page 4 of 5

5 Participate fully in discussions and joint working about local pandemic Swine Flu preparedness with local partners, especially GPs, other NHS organisations, Local Authority children s services, adult social care services and with the voluntary sector NEAS involved in virtually every Flu group that has been established throughout the region. Undertake and provide assurance to the SHA on the resilience testing and exercising of the organisation s Pandemic Flu Plans and Winter Plans NEAS Flu exercise 17 th July SHA/HPA exercise 8 th September Currently working nationally and locally on Winter plans Support the sentinel surveillance system on patients hospitalised with Swine Flu which will be used to provide advice on clinical management; Ensure robust arrangements are in place to provide accurate and timely situation reporting mechanisms to SHAs and the Department of Health; Sitreps have been provided in the past by Emergency Planning Department when required. Involved in the regional conference call facility Ensure continuity of essential supplies and services. Supply chain resilience is being reviewed by Procurement CONCLUSION This is the first report bringing together the guidance available and summarising the actions required of NEAS to ensure that we are prepared and resilient to manage increased activity with reduced resources. The roles and responsibilities for NEAS over coming months have been set out in this document alongside the support being made available to front line staff. The table has identified key points expected and relevant to NEAS and informs on progress to date. RECOMMENDATION The Board is asked to receive this report for information. Paul Liversidge DIRECTOR OF AMBULANCE OPERATIONS 20 th July 2009 Page 5 of 5