NHS PREPAREDNESS FOR A MAJOR INCIDENT

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1 NHS PREPAREDNESS FOR A MAJOR INCIDENT In light of the recent tragic events in Paris, NHS England has asked that the Trust reviews the following, and that assurance is provided in the form of a Statement of Readiness at a Public Board meeting as part of the normal assurance process: You have reviewed and tested your cascade systems to ensure that they can activate support from all staff groups, including doctors in training posts, in a timely manner including in the event of a loss of the primary communication systems The Trust communication systems are practiced every six months through a pre-notified major incident communications exercise organised by NHS England. Contact details of key staff are available 24/7 through ESR. In the event of the loss of primary communications systems the Trust s Emergency Communications Policy details alternate means of communication such as the use of radio and social media to contact staff as appropriate You have arrangements in place to ensure that staff can still gain access to sites in circumstances where there may be disruption to the transport infrastructure, including public transport where appropriate, in an emergency The Trust has a Fuel Shortage Resilience Plan which has been tested. The Trust is also represented on the Local Resilience Forum Fuel Supply Group to ensure that any new advice and guidance made available regarding fuel shortages is incorporated into plans. This plans also details the availability of Trust mini buses and drivers that can be utilised to transport staff to work bases and is cross referenced in Trust Business Continuity Plans Plans are in place to significantly increase critical care capacity and capability over a protected period of time in response to an incident, including where patients may need to be supported for a period of time prior to transfer for definitive care Whilst we are not an acute hospital Trust, staff drawn from our Community Health Nursing Teams would be made available to provide additional support where practical to colleagues in the acute hospital environment. This may be as part of a direct care team for those with key skills or backfilling for acute hospital colleagues. Escalation Plans will be implanted to support the early discharge of patients to free up hospital capacity. Business Continuity Plans would be activated to ensure that the Trust would still be able to deliver its essential services during this period You have given due consideration as to how the Trust can gain specialists advice in relation to the management of a significant number of patients with traumatic blast and ballistic injuries Whilst we are not an acute hospital Trust, staff drawn from our Community Health Nursing Teams would be made available to provide additional support where practical to colleagues in the acute hospital environment. This may be as part of a direct care team for those with key skills or backfilling for acute hospital colleagues whose specialist skills will be needed to manage traumatic blast and ballistic injuries. Business Continuity Plans would be activated to ensure that the Trust would still be able to deliver its essential services during this period Caroline Brookes Head of EPRR 6 January 2015

2 NOTTINGHAMSHIRE HEALTHCARE NHS FOUNDATION TRUST STATEMENT OF READINESS Nottinghamshire Healthcare NHS Foundation Trust is able to provide assurance that: Cascade systems to ensure that support from all staff groups can be activated, including doctors in training posts, in a timely manner including in the event of a loss of the primary communication system have been reviewed and tested Arrangements are in place to ensure that staff can still gain access to sites in circumstances where there may be disruption to the transport infrastructure, including public transport where appropriate, in an emergency Plans are in place to significantly increase critical care capacity and capability over a protected period of time in response to an incident, including where patients may need to be supported for a period of time prior to transfer for definitive care, and Due consideration has been given as to how the Trust can gain specialists advice in relation to the management of a significant number of patients with traumatic blast and ballistic injuries Julie Hall Chief Executive Dean Howells Executive Director, Nursing Quality and Patient Experience / Accountable Emergency Officer 6 January January 2016

3 NOTTINGHAMSHIRE HEALTHCARE NHS TRUST A (H1N1) SWINE FLU INFLUENZA STATEMENT OF READINESS Introduction On 11 June 2009, the World Health Organisation raised its alert level to 6, recognising that A (H1N1) swine flu had spread to pandemic levels. Nottinghamshire Healthcare NHS Trust (the Trust) has been planning for such an event and is well prepared to deal with a flu pandemic. The Trust has a specific Pandemic Influenza Plan which was ratified by the Trust Risk Management Committee in December Each Directorate has also prepared individual Influenza Plans which were also ratified in December 2008 by the Chief Executive. All Influenza plans are reviewed regularly to reflect new Department of Health policy and guidance as well as lessons learned from testing the plans. Preparedness The Trust has put full measures in place to ensure preparedness for every event It has reviewed Department of Health guidance Pandemic Flu: Managing Demand and Capacity in Health Care Organisations (Surge) and the NHS Employers/Department of Health document Pandemic Influenza Human Resources Guidance for the NHS, to understand potential capacity constraints that may be caused through increased demand and workforce sickness absence. The Trust s response to the specifics of Ian Dalton s letter of 2 July 2009 is detailed below: CONSIDERATION 1 Appoint a full time Director 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 ASSURANCE The Lead Executive is Rachel Munton Executive Director of Nursing and AHP with Emergency Planning in her Portfolio. Dr Mike Harris, Executive Director of Forensic Services, and Simon P Smith, Executive Director of Local Services, have the Executive Responsibility for deployment within the two operational Divisions of the Trust. All Executives have a key leadership role and responsibility in this area. We employ a Head of Emergency Planning who reports direct to the Executive Director of Nursing

4 CONSIDERATION 2 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 5 months can be sustained 3 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 4 They fully 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 5 The organisation takes part in the September nationally devised and SHA/HPA organised resilience testing/exercise programmes to validate pandemic flu and Winter Readiness Plans. Board level attendance, including NHS CEs, is expected at these events 6 Take full account of national pandemic Swine Flu policy and SHAs system management responsibilities 7 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) ASSURANCE The Trust has fully tested the level of preparedness and resilience of the organisation s Pandemic Flu Plans by carrying out a self assessment using the DH toolkit. This self-assessment identified areas of good practice and organisational strength plus areas that need further development. All Directorates have run, or are in the process of running, the Camden PCT Flu Game or Exercise Cold Play II within their teams. The Trust Flu Plans together with Directorate Flu Plans have been reviewed in response to the first wave of Swine Flu and the Trust is confident that its business continuity plans are sufficiently robust to cope with a sustained wave of up to 5 months Trustwide Pandemic Influenza Updates were tabled at the Boards in July and August with a Local Services Specific Report tabled at the July meeting This is part of lessons learned from the exercises undertaken. A system has now been put in place to monitor staff sickness so that capacity constraints can be rapidly identified and managed across Divisions and Corporate Depts The Chief Executive and Executive Director of Nursing and Allied Health Professionals will be attending Exercise Peak Practice on behalf of the Trust The Trust is compliant with these. All new Swine Flu policy, advice and guidance is shared across the Trust as it is made available for immediate action or reflection in the planning processes Robust systems have been established for this purpose. The Trust Pharmacy serving in patient wards situated in the City and South of the County have stocks of antivirals for dispensing on request. Rampton Hospital s Pharmacy hold stock of antivirals. Other in patient wards have arrangements with the PCTs or Acute Hospital Pharmacies for accessing antivirals as required. The latest HPA WHO Phase 6: Algorithm for the management of patients with a flu like illness has been issued to medics across the Trust

5 8 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 9 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 Processes are in place; please see above. Staff in Trust clinics, day centres and outpatient departments are aware of the actions to take should a patient present with Flu like symptoms 10 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 11 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 12 Undertake and provide assurance to the SHA on the resilience testing and exercise of the organisation s Pandemic Flu Plans and Winter Plans 13 Support the sentinel surveillance system on patients hospitalised with Swine Flu which will be used to provide advice on clinical management 14 Ensure robust arrangements are in place to provide accurate and timely situation reporting mechanisms to SHAs and the Department of Health The Trust Communications Team is working with the Head of Emergency Planning to prepare a Trust campaign to encourage this including letters to all staff. This will also be reflected in the Trust HR Guidance when available This is co-ordinated by the Local Resilience Forum Gold Strategic Coordinating Group which is chaired by the Assistant Chief Constable on behalf of all partners across the county. The Trust is represented by NHS Nottinghamshire County. The Trust Head of Emergency Planning also attends the Countywide Health & Social Care Group, the Regional Resilience Forum Health Group and various Task and Finish groups as required. Also the SHA Trust Flu Leads Groups and the SHA Mental Health Trust Flu Leads Group Assurance is provided through completion of Self Assessments as issued by the SHA The Trust does not subscribe to the sentinel surveillance system. However, it has developed its own reporting system which has been shared with the SHA. However, regular reporting has not as yet been requested formally by the SHA Please see 8 above 15 Ensured continuity of essential supplies and services This is part of business continuity planning; currently this is only having a minor effect on routine services but over the coming weeks and months this may change depending on the number of cases and how this will be kept under constant review by the Pandemic Outbreak Command Teams. Supplies Department have also sought assurances from key suppliers as to the robustness of their Pandemic Plans. A flu focussed list of consumables has bee crated for easiness of ordering and

6 16 Ensure that appropriate HR policies and procedures are in place to support staff and maintain their wellbeing in line with the national Pandemic Flu HR Guidance 17 Deliver staff training as required to support services provision and high quality patient care 18 Ensure effective communications and consultation with staff and their Representatives on the support needed 19 Ensure 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 20 Ensure that staff in close and regular contact with patients with pandemic Swine Flu have access to appropriate personal protective equipment such as face masks is available on the Supplies Intranet page Trustwide Guidance is still awaited from HR Department. Discussions are on going with regards to providing robust occupational health, counselling and bereavement counselling services during the pandemic Physical healthcare skills and infection control training is being delivered to nursing and non nursing staff. Staffside attend the Pandemic Flu Leads Group. HR are also engaging Staffside in preparing the HR guidance Trust Swine Flu Situation reports are issued to Managers as appropriate. Briefings containing key messages from the Chief Executive are issued to all staff. Infection control advice and information is available on the Trust intranet, as well as in a CD and information leaflets which are available to all staff. This has been made available to all Directorates. Health & Safety staff are being trained to help staff fit test FFP3 masks for use when carrying out aerosol generating procedures with infected patients Conclusion Having considered all these points, this Statement of readiness demonstrates that Nottinghamshire Healthcare NHS Trust has robust arrangements in place for subsequent influenza pandemic waves. Clair Chilvers Chair Nottinghamshire Healthcare NHS Trust Mike Cooke Chief Executive Nottinghamshire Healthcare NHS Trust 24 September 2009