NHS Herefordshire Seasonal Flu Plan 2011/12

Transcription

1 NHS Herefordshire Seasonal Flu Plan 2011/12 Authors Version Dr Arif Mahmood/Ms Catherine Floyd Final Date Created July 2011 Approved by The Herefordshire PCT Board Date approved 24 th November 2011 Review date July 2012

2 Table of Contents 1. PURPOSE SEASONAL FLU PLANNING FOR SEASONAL FLU PREPARING FOR UNCERTAINTY AIM AND OBJECTIVES SEASONAL FLU VACCINATION PROGRAMME SEASONAL FLU VACCINATION PROGRAMME SEASONAL FLU VACCINE UPTAKE 2010/ NATIONAL TARGET FOR 2011/ SEASONAL FLU VACCINATION IMPLEMENTATION PLAN Commissioning and providing responsibilities Procuring sufficient vaccine Identifying all eligible individuals Ensuring a high uptake Flu vaccine uptake data submission MONITORING THE FLU ACTIVITY TREATMENT FOR FLU CASES TREATMENT AT HOME ANTIVIRAL MEDICINE TREATMENT IN SECONDARY CARE COMMUNICATION PLAN ESCALATION OF FLU ACTIVITY A STAGED FLU RESPONSE Table 1. Seasonal flu vaccine uptake in Herefordshire 2010/ Table 2. Commissioning and provider responsibilities... 7 Table 3. Responsibility of procuring vaccine... 8 Table 4. Responsibility of identifying all eligible individuals... 8 Table 5. Arrangements to achieve high uptake... 9 Table 6. Staged Flu Response Annex A - Groups eligible for the seasonal flu vaccine for 2011/ Annex B - Good Practice Guide Annex C - Seasonal Flu Vaccine Communications Plan 2011/ Annex D Wye Valley NHS Trust Flu Vaccination plan for Healthcare workers 2011/12.24 Page 2 of 26

3 RECORD OF AMENDMENTS Amendments should be made immediately they are received and recorded below. The Immunisation and Screening Manager will retain a record of amendments. Amendments to a PDF will be recorded electronically on this page. Hard copy amendments will be in the form of complete new sections. The person incorporating the amendment should sign as having incorporating the amendment and name clearly written in block capitals. Version. No. Date Issued. Change(s) Date Actioned Name & Initials INTENTIONS FOR DOCUMENT MANAGEMENT AND DISTRIBUTION A PDF copy will be issued to selected Herefordshire NHS/Council appointments by the Immunisation and Screening Manager and also Herefordshire Pandemic Influenza Planning Committee (PIPC), Herefordshire Immunisation review Group and Strategic Health Authority (SHA). A PDF copy will also be available on the intranet for staff and primary care contractors to access. Permission is granted to copy/print the PDF. A hard copy will be printed off and held in the Major Incident Box. The table below shows the distribution arrangements for the plan. Requests for further copies of the plan should be made via the Immunisation and Screening Manager. Organisation Designation Hard Copy PDF Herefordshire NHS/Council Chief Exec Director of Public Health Major Incident Box EPO (Resilience Team) Comms Lead Intranet Herefordshire PIPC Herefordshire Immunisation Review Group External Partners SHA Page 3 of 26

4 1. Purpose This plan sets out NHS Herefordshire strategic approach to responding to the demands of the seasonal flu during , and escalating healthcare service response in case of surge in demand. This plan is not intended to replace Herefordshire Influenza Pandemic Plan. In fact, it should be read in conjunction with that plan. This plan does not constitute guidance on seasonal flu vaccine. Therefore, Green Book and CMO letter should be consulted for clinical guidance on seasonal flu vaccine. 2. Seasonal flu Influenza (commonly known as flu) is an acute viral infection of the respiratory tract. There are three types of flu virus; A, B and C. Influenza virus A and B are responsible for most clinical illness. Flu infection is characterised by the sudden onset of fever, chills, headache, muscle pains, severe prostration and usually cough, with or without a sore throat or other respiratory symptoms. The acute symptoms last for about a week, although full recovery may take longer. Flu is passed from person to person through droplets created when someone with the infection sneezes or coughs. Infection can also be spread by contact with surfaces on which the virus has become deposited. Flu can spread rapidly. In most years, flu occurs predominantly during a six to eight week period during the winter. The timing, extent and severity of this seasonal flu can all vary and are unpredictable. For most people, this 'seasonal' flu is an unpleasant but self-limiting and not life endangering illness, but in some people it may be more severe, or complicated by secondary bacterial infections such as bronchitis and pneumonia. The very young, older people and those with underlying diseases such as cardiovascular disease and pulmonary disorders are particularly at risk of serious illness from influenza. Without interventions such as annual influenza immunisation, older people and those of all ages in disease-based risk groups suffer significant morbidity and mortality even in a non-epidemic year. An estimated 12,000, mainly older people, die each year from seasonal influenza in England and Wales Planning for seasonal flu Preparing for uncertainty The impact of flu virus on the population varies each year: it is influenced by changes that may have taken place in the virus, the number of people susceptible to infection and the severity of the illness caused by a particular strain. These factors 1 Review of the arrangements for the Seasonal Influenza Programme in England Report of an independent panel. Department of Health, March 2007 Page 4 of 26

5 may vary between regions and local areas, requiring different approaches in different places. Therefore, local plans need to be flexible to adapt as the flu season progresses. Given the local experience of sudden rise in the flu activity in December 2010 with a subsequent surge in demand for flu vaccine, this plan ensures that NHS Herefordshire is well prepared for a range of possibilities including need to respond quickly to modify the plan. 4. Aim and objectives The overarching aim of this plan is to minimise the health impact of the seasonal flu through effective monitoring, prevention and treatment. The Key strategic objectives of the seasonal flu plan include: vaccinating at least 75% of those at greatest risk with the seasonal flu vaccine before the virus starts to circulate monitoring flu activity, severity of the disease in risk groups, vaccine uptake and impact on the NHS offering antiviral medicines to patients in at-risk groups for the treatment of flu in line with NICE guidance 2 ensuring the NHS Herefordshire is well prepared. 5. Seasonal flu vaccination programme 5.1 Seasonal flu vaccination programme is the key strand of the seasonal flu plan. The Joint Committee on Vaccination and Immunisation (JCVI) recommends the use of flu vaccine for specific population groups. It keeps the available evidence under review and modifies its advice should evidence suggest that the programme could be more effective. Current evidence does not support vaccination of the whole population as being cost effective. 5.2 Seasonal flu vaccine uptake 2010/11 3 In 2010/11 flu uptake in individuals aged 65 and over was 70.9% in Herefordshire. That was slightly lower than the national (72.8%) and regional (71.3%) averages (Table 1) Page 5 of 26

6 Table 1. Seasonal flu vaccine uptake in Herefordshire 2010/11 % vaccine uptake >65 years % vaccine uptake in those aged over 6 months at risk % vaccine uptake - pregnant and NOT IN a clinical risk group % vaccine uptake - pregnant and IN a clinical risk group England West Midlands Herefordshire % vaccine uptake Frontline Health & Social Care Workers PCT HHT National Target for 2011/12 The Chief Medical Officer (CMO) letter (2011) 4 set out targets for which are to: reach or exceed 75% uptake for people aged 65 years and over; and reach or exceed 60% uptake for people under age 65 with clinical conditions, which put them more at risk from the effects of flu; and pregnant women 5.4 Seasonal flu vaccination implementation plan Commissioning and providing responsibilities Herefordshire PCT has the responsibility to commission services for delivering flu vaccine to the individuals aged 65 and over and in at-risk groups including pregnant women. For frontline health and social care workers, it is the responsibility of the employer to make arrangements for provision of flu vaccine to the eligible staff. Table 2 broadly sets out the commissioning and provider arrangements across the health economy for year Seasonal Flu Immunisation Programme 2011/12 PL/CMO/2011/01, PL/CNO/2011/01, PL/CPHO/2011/01 Page 6 of 26

7 Table 2. Commissioning and provider responsibilities Eligible cohort Responsible commissioner Provider Age 65 and over HPCT GP surgery Aged 6 months-64 years with clinical conditions HPCT GP surgery Pregnant women HPCT GP surgery Nursing and residential care home residents HPCT GP surgery Carers 5 HPCT GP surgery Wye Valley NHS Trust staff (Frontline Health Care Workers directly involved in delivering care for adults or children, including seconded Social Care staff) Herefordshire Council staff (Frontline Social Care Workers directly involved in delivering care for children) Wye Valley NHS Trust (Annex D) Herefordshire Council Occupational Health Wye Valley NHS Trust Occupational Health Hereford Council 2gether NHS Trust staff (Frontline Health Care Workers directly involved in delivering care for adults or children) 2gether NHS Trust Occupational Health 2gether NHS Trust Poultry workers have been excluded from the seasonal flu programme 2011/ Procuring sufficient vaccine The providers will have the responsibility to put in orders for flu vaccine with the manufactures (Table 3). The Hereford PCT will seek assurance from each provider that enough vaccine is ordered to be able to offer vaccine to all eligible individuals. 5 Those who are in receipt of a carer s allowance, or those who are the main carer, or the carer of an elderly or disabled person whose welfare may be at risk if the carer falls ill. Page 7 of 26

8 Table 3. Responsibility of procuring vaccine Task Responsibility Timing Categories i vii above As above February/March Identifying all eligible individuals The providers will have the responsibility to identify individuals in eligible cohorts (Table 4). Table 4. Responsibility of identifying all eligible individuals Task Responsibility Timing i. Aged 65 and over GP Surgeries July 2011 ii. Aged over 6 months with clinical conditions 6 : Chronic respiratory disease Chronic heart disease Chronic kidney disease Chronic liver disease Chronic neurological disease Diabetes Immunosuppression GP Surgeries July 2011 iii. People living in long-stay residential care homes or other long stay care facilities GP Surgeries July 2011 iv. Pregnant women v. Carers: those who are in receipt of a carer s allowance, or those who are the main carer, or the carer of an elderly or disabled person whose welfare may be at risk if the carer falls ill. Community Midwifes and GP Surgeries GP Surgeries July/August 2011 July 2011 vi. Frontline health and social care workers (FHSCW): those directly involved in delivering care Wye Valley NHS Trust Herefordshire Council 2gether NHS Trust July See Annexe A for further detail this list is not exhaustive Page 8 of 26

9 Ensuring a high uptake The providers will have the responsibility to invite individuals in eligible cohorts ensuring they meet the national targets (table 5). In order to achieve high uptake rates the has set out a Good Practice Guide for GP practices (Annexe B). Table 5. Arrangements to achieve high uptake Task Responsibility Timing i. Establish robust call and recall system for all eligible individuals registered with GP Practice GP Surgeries August 2011 ii. Identify process to carry out home visit GP Surgeries August 2011 iii. Identify process to vaccinate those living in long term care GP Surgeries August 2011 iv. Establish process to vaccinate health and social care workers through occupational health departments Occupational Health Departments August 2011 v. Establish reporting mechanism and give feedback to GP Practices HPCT August Flu vaccine uptake data submission The providers will have responsibility to submit uptake data on a weekly/monthly basis from the beginning of October via the web-based ImmForm system. The uptake data will show the coverage for the following groups People aged 65 and over People aged under 65 with a clinical condition All pregnant women Frontline healthcare workers PCT will feedback the monthly uptake data by GP practice to all practices as soon as it is published on the ImmForm system. Page 9 of 26

10 PCT will monitor the monthly uptake rate in frontline healthcare workers across the health economy. PCT will provide support to the providers with low monthly uptake rates in understanding the issues and resolving them in order to improve the uptake. 6. Monitoring the flu activity Flu activity is monitored via a combination of clinical surveillance for influenza like illness (ILI) and laboratory data. From week 40 (early October) the HPA will publish weekly reports (on its website) covering the followings: a narrative summary of the current situation weekly consultation rates (ILI) in national sentinel schemes community surveillance (e.g. calls to NHS Direct) microbiological surveillance disease severity vaccination uptake the international situation. The PCT will keep an eye on the local weekly GP consultation rates (ILI) and will make it available to GP practices in Herefordshire as soon as the flu activity escalates. 7. Treatment for flu cases 7.1 Treatment at Home For most people, this 'seasonal' flu is an unpleasant but self-limiting and not life endangering illness. guidance states that people with suspected flu who are not in the at-risks groups should: stay at home rest drink plenty of fluids while they are recovering, and consider taking paracetamol/ibuprofen-based painkillers or cold remedies to lower their temperature and relieve their symptoms The use of antivirals in the treatment and prophylaxis of influenza will be guided by the latest HPA advice Antiviral medicine 7 HPA guidance on use of antiviral agents for the treatment and prophylaxis of influenza, (November 2011 V1.1) Page 10 of 26

11 Antiviral medicines prevent the influenza virus from replicating inside the body. They can lessen symptoms by a couple of days and reduce their severity, and help to reduce the likelihood of complications. The Chief Pharmaceutical Officer (CPhO) issues advice on the use of antiviral medicines, based on advice from the HPA in light of flu surveillance data. Following NICE guidance, antiviral medicines should only be prescribed once has notified general medical practitioners and other prescribers that it is clinically appropriate to do so. The government holds large stocks of antiviral medicines in case of a flu pandemic. In the event of the commercial sector supply chain for antiviral medicines running low, anti-virals from the national pandemic flu stockpile may be made available to suppliers as a contingency subject to arrangements about replenishment. In this system, government stocks of antiviral medicines would be supplied to the manufacturers who would distribute to community and hospital pharmacies using their normal supply chain mechanisms. Government stocks would be replaced like for like by suppliers at the end of the flu season. This system would only be activated if there was overwhelming demonstrable public health need. Locally, the Medicine management Team of the PCT will support the availability of antvirals in the community and hospital pharmacies. 7.3 Treatment in secondary care In certain groups and individuals, flu can progress from mild flu like illness to one which is serious, like pneumonia. Such patients will usually assessment and treatment in hospital. The treatment will include intravenous antibiotics and some form of ventilation in a level 2 or level 3 critical care facility. For some critically ill patients, a more invasive and complex intervention called Extra- Corporeal Membrane Oxygenation (ECMO) is required. This is a complex procedure which is only carried in certain specialist centres using highly trained specialist teams. The PCT Commissioners will ensure that commissioning arrangements are in place for the provision of such services with providers as appropriate. 8. Communication plan Clear and timely communication is vital to ensure that all parties involved in managing flu understand their roles and are equipped with the necessary information. The has designed a national communication plan and the PCT has developed a local plan complementing it (Annexe C). It sets out roles and responsibilities of various stakeholders with regards to communicating the key messages to the eligible cohorts and wider public throughout the flu season Page 11 of 26

12 9. Escalation of flu activity a staged flu response The flu virus activity is largely unpredictable. Nevertheless, it is anticipated that at some point during the autumn or winter, the levels of flu circulating in the community will rise, the incidence of flu-like illnesses will increase and GP practices and hospital services may come under increased pressure. Through a robust surveillance system will monitor the flu activity and assess the overall impact of flu on the population and on health services. It will initiate a national strategic public health response to address the situation if needed. Given the variability in the flu activity across regions and localities, this local plan has been developed with a degree of flexibility to mount a local healthcare response addressing the local flu situation. The flu response is set out in stages of activity that would take place depending on various factors, including the levels of flu that are circulating, pressure on NHS services, and epidemiological evidence on the nature and severity of illness the virus is causing, and among whom. Page 12 of 26

13 Table 6. Staged Flu Response Stage Levels of flu like illness 1 Community and primary care indicators starting to show that flu and flu-like illness are being detected Description of flu season Beginning of the flu season low levels of flu and/or low severity of illness associated with the virus National &Local activity Data on ILIs, virological surveillance, vaccine uptake and NHS operational data published on Winterwatch. HPA publishes weekly reports on flu incidence, vaccine uptake, morbidity and mortality. Responsibility HPA Director of Immunisation writes to the NHS if vaccine uptake is low. in contact with vaccine manufacturers on production and delivery schedules. in contact with antiviral medicine manufacturers on their preparedness plans. GPs actively invite their eligible patients to be vaccinated, using call and reminder systems. GP Surgeries Data on flu incidence and vaccine uptake rates in England issued at a national and, if available, regional/local levels. Monitor for local impact. HPCT 2 Flu indicators starting to show that activity is rising (e.g. GP consultation rates for flu like illness) Normal levels of seasonal flu and/or normal to high severity of illness associated with the virus GPs will be alerted to start prescribing antiviral medicines in line with the National Institute for Health and Clinical Excellence (NICE) guidance and following expert advice that the flu virus is circulating. /HPCT

14 The respiratory and hand hygiene campaign launched as necessary. If evidence emerges that a particular age group or people with a certain clinical conditions are being disproportionately affected by the flu virus, the CMO may issue specific advice to both the public and health professionals to increase efforts to vaccinate that particular group, if practicable and seeking expert advice from JCVI if necessary Local NHS responds to local circumstances according to local plans and needs Review daily NHS operational data, eg critical care CMO may provide a media briefing to provide clear, factual information on flu. This may include information for the public about what to do if they become unwell and advice on accessing services. If vaccine shortages are considered likely across the country, will alert GPs to the availability of the central strategic reserve and set out how they should access this stock. It is likely this will be through the on-line Immform system. Depending on the level of shortages, restrictions may be placed on the number of doses a GP can order. /HPCT HPCT Wye Valley NHS Trust /HPCT (DPH) /HPCT Vaccine manufacturers contacted regarding the availability of additional supplies if needed. /GP Practices Page 14 of 26

15 In the event of shortages of antiviral medicines, and an evident public health need, would take steps to support arrangements for supplies by using its pandemic flu stocks as buffers in the supply chain. In this system, government stocks of antiviral medicines would be supplied to the manufacturers who would distribute to community and hospital pharmacies using their normal supply chain mechanisms. will work closely with antiviral medicines manufacturers, wholesalers and pharmacies to minimise disruptions of supply to patients. will work closely with antibiotic manufacturers, wholesalers and pharmacies to minimise disruptions of supply to patients. 3 Flu indicators exceeding historical norms (e.g. GP consultation rates for flu like illness) Epidemic levels of flu rare for a flu season A national flu epidemic is declared GPs alerted that a late surge in demand for the vaccine may occur. Vaccine manufacturers contacted regarding availability of additional supplies. /HPCT JCVI will review the available data and amend guidance on vaccination if necessary and if sufficient supplies of vaccine are available and can be delivered and administered in time. Weekly CMO press briefings will be considered. Page 15 of 26

16 Maintain or boost the respiratory and hand hygiene campaign Proactive work with media to allay any public concerns. Reiterate advice on signs and symptoms, and treatment at home. Communicate regularly with clinical and professional networks, and stakeholder groups for patients at risk of severe illness. Continue to review daily NHS operational data, eg critical care. Alert the NHS when the flu season has peaked, to aid local planning. Assessment of local flu situation and activation of Herefordshire Pandemic Flu Plan Convening Pre-ERMA or ERMA OR multiagency Silver meetings Activation of local Flu Helpline (if need be) Activation of Antiviral Collection Point (ACP) Plan (if need be) Communicating with the professionals and wider public /HPCT /HPCT /HPCT (DPH) /HPCT /WVNHST HPCT (DPH) HPCT (DPH) HPCT (DPH) HPCT (DPH) HPCT (DPH) Page 16 of 26

17 Annex A - Groups eligible for the seasonal flu vaccine for 2011/12 8 The list of eligible patients who should be offered the seasonal flu vaccine has not changed since the 2010/11 season. The seasonal flu vaccine should be offered to the eligible groups set out in the table below, and overleaf. Eligible groups Further detail All patients aged 65 years and over Chronic respiratory disease aged six months or older Chronic heart disease aged six months or older Chronic kidney disease aged six months or older Chronic liver disease aged six months or older Chronic neurological disease aged six months or older Diabetes aged six months or older Immunosuppression aged six months or older Asthma that requires continuous or repeated use of inhaled or systemic steroids or with previous exacerbations requiring hospital admission. Chronic obstructive pulmonary disease (COPD) including chronic bronchitis and emphysema; bronchiectasis, cystic fibrosis, interstitial lung fibrosis, pneumoconiosis and bronchopulmonary dysplasia (BPD). Children who have previously been admitted to hospital for lower respiratory tract disease. Congenital heart disease, hypertension with cardiac complications, chronic heart failure, individuals requiring regular medication and/or follow-up for ischaemic heart disease. Chronic kidney disease at stage 3, 4 or 5, chronic kidney failure, nephrotic syndrome, kidney transplantation. Cirrhosis, biliary artesia, chronic hepatitis Stroke, transient ischaemic attack (TIA). Conditions in which respiratory function may be compromised (e.g. polio syndrome sufferers). Clinicians should consider on an individual basis the clinical needs of patients including individuals with cerebral palsy, multiple sclerosis and related or similar conditions; or hereditary and degenerative disease of the nervous system or muscles; or severe neurological disability. Type 1 diabetes, type 2 diabetes requiring insulin or oral hypoglycaemic drugs, diet controlled diabetes. Immunosuppression due to disease or treatment. Patients undergoing chemotherapy leading to immunosuppression. Asplenia or splenic dysfunction, HIV infection at all stages. Individuals treated with or likely to be treated with systemic steroids for more than a month at a dose equivalent to prednisolone at 20mg or more per day (any age) or for children under 20kg a dose of 1mg or more per kg per day. It is difficult to define at what level of immune- suppression a patient could be considered to be at greater risk of the serious consequences of flu and should be offered flu vaccination. This decision is best made on an individual basis and left to the patient s clinician. Some immunological patients may have sub optimal immunological response to the action. Consideration should also be given to the vaccination of household contacts of immunocompromised individuals, i.e. individuals who expect to share living accommodation on most days over the winter and therefore for whom continuing close contact is unavoidable. This may include carers (see below) Pregnant women Pregnant women at any stage of pregnancy (first, second or third trimesters) 8

18 Eligible groups Further detail People living in long-stay residential care homes or other long-stay care facilities where rapid spread is likely to follow introduction of infection and cause high morbidity and mortality. This does not include, for instance, prisons, young offender institutions, or university halls of residence. Vaccination is recommended Carers Those who are in receipt of a carer s allowance, or those who are the main carer, or the carer of an elderly or disabled person whose welfare may be at risk if the carer falls ill. (Please note this category refers to individual carers entitled to a free flu vaccine on the NHS, not professional health and social care workers who should be vaccinated by their employer as part of an occupational health programme.) The list above is not exhaustive, and the medical practitioner should apply clinical judgement to take into account the risk of flu exacerbating any underlying disease that a patient may have, as well as the risk of serious illness from flu itself. Trivalent seasonal flu vaccine should be offered in such cases even if the individual is not in the clinical risk groups specified above. Further guidance on the list of eligible groups and guidance on administering the seasonal flu vaccine, can be found in the updated influenza chapter of the Green Book: Immunisation against infectious disease Page 18 of 26

19 Annex B Good Practice Guide 9 The following arrangements may enable GPs to increase the uptake of seasonal flu vaccine among their patients in clinical risk groups. Ensure all practice staff are fully informed of the arrangements for the campaign as set out in the annual CMO letter sent in the spring. Identify a named influenza champion in each practice to co-ordinate the programme, link with the PCT influenza co-ordinator and respond to patient queries. Share best practice with the PCT so that it can be disseminated to practices with lower uptake. Be able to identify the patients who fall into a clinical risk group. Have robust call and reminder systems in place. Have sufficient vaccine stock and appointment slots available to ensure all those eligible have the opportunity to receive the vaccine. Chase up patients who don t respond to invitations to attend for vaccination, ideally by phone (some practices also now have texting systems in place and this could also be used). Consider a domiciliary visit to the home of patients who do not respond to letters or phone calls or who are unable to get to the practice. Ensure that patients have up to date, accurate information available, e.g. attach a copy of the 'is your child at risk' leaflet to repeat prescriptions for at-risk children or attach other relevant leaflets to repeat prescriptions for other groups, for example, pregnant women; some practices also have a stamp that they use on repeat prescriptions reminding patients to have their seasonal flu vaccine. Respond to any objections the patient may have to receiving the vaccine and point out the increased risk that seasonal flu poses to them and the benefits of having the vaccine. Make sure that systems are in place to ensure the GP practice receives and records details of anyone who receives the vaccine outside the practice (individuals in risk groups, pregnant women and others may get the vaccine from their employer, at-risk children/adults/pregnant women may be offered it in hospital/special school, community paediatrician clinic, secure children's units etc) Consider increasing access arrangements at the surgery, e.g. evening and Saturday morning clinics for seasonal flu vaccine in addition to routine clinics and appointment availability for the vaccine outside of these clinics. Put an alert on the computer records of those eligible to receive the vaccine and provide it opportunistically to those presenting at the surgery for other reasons when appropriate to do so. Regularly review those on the flu vaccine list who have not yet received the vaccine. Doing well Could do better 9 Page 19 of 26

20 Annex C Seasonal Flu Vaccine Communications Plan 2011/12 Aim The national strategic objectives of the seasonal flu plan for winter 2011/12 include vaccinating at least 75% of those at greatest risk, with the seasonal flu vaccine before the virus starts to circulate. Objectives To reach or exceed 75% uptake for people aged 65 years and over To reach or exceed 60% uptake for people under the age of 65 with clinical conditions which put them more at risk from the effects of flu. This includes pregnant women. Background The H1N1 virus has caused respiratory problems in young healthy adults. In the case of pregnant women, those who contract the virus are likely to suffer complications and as a result, last year the Department of Health extended the list of people at risk and eligible for the vaccine to pregnant women. Last year s uptake by pregnant women in a clinical risk group in Herefordshire was 55.7% which was just below the English average (56.6%). For pregnant women, not in a clinical risk group, the take up was even less at 36%. Other target groups include frontline health and social care workers: last year only 23.2% of NHS Herefordshire staff took up the vaccine and 49% from the Hereford Hospital Trust. This year the figures will be combined due to formation of the Wye Valley NHS Trust. This campaign aims to increase vaccine take-up in line with the objectives for the following groups: o o o o Clinical risk group Pregnant women Carers Frontline health and social care workers, as well those aged 65 years and above.

21 Communications campaign updated September 2011 Department of Health is not re-producing generic posters and leaflets which can be used locally, merely making the at risk groups leaflet available electronically. The West Mercia SHA has worked up leaflets produced by the East Midlands and these will be available locally National Timing Message Target Medium Cost Responsibility Flu Season HPA Weekly Influenza Report on flu incidence, vaccine uptake, morbidity and mortality Flu Season CMO Press Briefings: Issuing specific public health message and, allowing media to obtain more detailed information to inform their reporting. Flu Season Winter Watch providing information on the following: vaccination uptake weekly consultation rates (ILI) from RCGP data data showing the impact of flu on the NHS, e.g. number of critical care beds in use, and a weekly message from the CMO. Flu Season Respiratory and hand hygiene campaign - Catch it, Bin it, Kill it Professionals, public and media Professionals, Public and media Professionals, Public Professionals and Public Internet, Press Statement Press statement, Internet, Radio/Television HPA Internet ( Website) Internet, Radio/Television, Press, Leaflets/Posters /HPCT Page 21 of 26

22 Local Timing Message Target Medium Cost Responsibility Sept Nearly ready Expect plans are ready clarify targets (with actual numbers estimates) Training of immunisers offered Materials/copy of this comms plan GP practices & primecare Occupational Health/Comms teams/executive leads: Wye Valley NHS Trust HPS 2gether NH Trust Long stay care homes Sept At risk groups get ready, Members of public: At risk groups Carers Pregnant women >65 years of age Sept Why pregnant women are being Pregnant women offered vaccine At risk groups At risk groups Page 22 of 26 Distribution of Seasonal Flu Plan Press Release/ radio interviews A4 poster doubling as A5 flier/poster (based upon Buckinghamshire one) and East Midlands leaflets for GP hospitals children centres HV clinics Midwife booking clinic Libraries etc - Health and Well being Services - HPS Comms Team About 450 HPS Comms Team funding from Health and Well being Services

23 Sept/Oct Working with vulnerable groups - be responsible HPS FHSC Workers First press - HPS Comms Team Why important Ask your manager where to get vaccinated Wye Valley FHSC Workers Team Brief and Trust Talk; info with payslips, posters, through Senior Managers - Wye Valley NHS Trust 2gether FHSC Workers As above, using internal communications mechanisms - 2gether NHS Trust Nov Dec11/Jan 12 Have you have your vaccine yet? -Special emphasis on carers How are we doing/good news/could do better? tbc Members of public: At risk groups Carers Pregnant women >65 years of age Members of public: At risk groups Carers Pregnant women >65 years of age Advert /Editorial in Herefordshire Matters PR 600 HPS Comms Team PR - HPS Comms Team Page 23 of 26

24 Annexe D Wye Valley NHS Trust Seasonal Flu Vaccination plan for Healthcare workers 2011/12 ITEM ACTION DEADLINE Communication 2011 flu vaccination programme will be communicated to all wards and departments by the way of flyers. This will also be advertised in Team Brief and Trust Talk. Alongside this we will educate staff by sending out information regarding Flu Myths, leaflets on flu and importance of vaccination. OH Manager will speak with Community Hospital Sisters to discuss best way of delivering programme. Dates for vaccination will be attached to payslips + Flu facts Posters will be displayed in the Health@Work Department reception informing all new staff they will require vaccination. July & August 2011 July 2011 September 2011 July/August/September 2011 Education Director of Nursing to be contacted to discuss senior members of staff setting good example as nurses are one of lowest groups for uptake of the vaccination. The Health@Work Department will attend business unit meetings to educate managers. Contact Medical Director to do the same for Consultants as although last years uptake was better than previous years the majority did not attend for vaccination until January when Swine Flu was more prolific. August 2011 July/August 2011 August 2011 Page 24 of 26

25 Below is a breakdown of senior clinical staff who received the vaccine last year: o Ward Sisters - 7 o Matrons - 1 o Clinical Site Managers - 3 o NNP s - 3 o CNS s 13 out of 55 Health@Work Department will meet with managers from other areas where uptake is low such as: o Physiotherapy o Charles Renton Unit o Paediatrics o Maternity o Leadon ward August/September 2011 Delivery Initial vaccination programme will be delivered directly to clinical areas. Managers asked to identify staff groups who want vaccination and liaise with the Health@Work Department regarding suitable time to visit for vaccination, thereby utilising better use of OH time and capturing more staff. Clinics will also be held in the Health@Work Department. Full programme issued on payslips and through Trust Talk and Team Brief. Week commencing Week commencing September 2011 (Extra support will need to be identified due to amount of staff now employed in WYNHST) Page 25 of 26

26 Night floor walking will be undertaken on three separate occasions. Satellite Clinics will be held in all Community Hospitals and outlying areas e.g. Gaol Street. Hillside. Once organised clinics are completed the OH team will continue to floor walk to mop up. Staff can continue to book a vaccination through the department. All new staff at commencement of employment will be vaccinated. October 2011 October 2011 November 2011 November-January 2012 October-January 2012 Page 26 of 26