JOINT TRUST BOARD AND MEMBERSHIP COUNCIL MEETING TITLE Wednesday 29 July 2009 Management of Pandemic Flu PURPOSE To provide a briefing and assurance to the Trust Board and Governors on the actions taken to mitigate against the impact of Pandemic Flu on service delivery at The University Hospitals Bristol NHS Foundation Trust and to highlight the challenges and risks. 1. Operational framework in place to manage pandemic flu on a day to day basis 2. Business continuity plans in place to mitigate increasing staff sickness rising up to potential 40% sickness/absence 3. Risks to delivery of performance targets 4. Delivery of training 5. Management of appropriate equipment and availability FORMAT THE BOARD and GOVERNORS ARE ASKED TO: One-off report The Trust Board and Governors are asked to note the actions taken to date, the plans developed and the potential impact on performance standards. Prepared by: Irene Scott, Chief Operating Officer and Pat Fields, Interim Chief Nurse Presented by: Irene Scott, Chief Operating Officer 20 July 200
Management of Pandemic Flu 1. Purpose 1.1 To provide a briefing and assurance to the Trust Board on the actions taken to mitigate against the impact of Pandemic Flu on service delivery at The University Hospitals Bristol NHS Foundation Trust 2. Introduction 2.1 It is well know that the introduction of Swine Flu to the human population has escalated to Pandemic Status and therefore, the Trust is required to work closely with key partners across the South West to ensure all necessary action is taken to minimise the impact of this illness both in the community and on the provision of a continued health service. A Pandemic Flu has been predicted for some time and therefore the local health community already has well developed plans to mitigate against impact and to manage services in a collective manner. 2.2 The Avon Health Emergency Resilience Group which represents both acute and primary care settings is responsible for all emergency planning. This trust is represented on this group by the Emergency Planning and Liaison Officer. The main role of this group is to develop plans to manage any major incident, e.g. biological and or chemical incident, major rail, road or air incident and pandemic flu. These plans are co-ordinated across all health agencies and the police to ensure effective implementation can be achieved. The plans, or elements of the plans are tested on a routine basis. 2.3 University Hospitals Bristol NHS Foundation Trust, has a Pandemic Flu plan which was signed off by the Trust Board in January 2009, and this plan is now being executed and used as a framework for managing and planning on a day to day basis. 2.4 Due to the current escalation status and the anticipated trajectory of the current Pandemic Flu, each NHS Trust has been required to identify a full time executive lead to undertake all aspects of pandemic flu planning and management. University Hospitals Bristol NHS Foundation Trust has appointed Mrs Pat Fields into this position. 3. Aetiology 3.1 This current phase of Swine Flu has presented generally in a mild form, with few deaths, although there are identified high risk groups, including pregnant women and those with long term underlying conditions. It has to date been prevalent in the younger population with predicted final attack rates on children as high as 50%. It is predicted that there will be two phases of this pandemic, the first reaching its peak at the end of August, beginning of September and the second during or around December when it is anticipate that the virus will have mutated and therefore the strain may be stronger. The Trust has considered the implications of both peaks in activity and the impact on services. Clearly the first peak, interacts with the holiday high season, i.e. staff away, plus increased tourism around the coast line. The second peak will potentially interact with the normal activity challenges
seen at this time of the year. As the number of cases has escalated nationally, the approach to managing this illness has moved from containment to. It is also recognised that significant mitigation plans are required for the management of children and the impact on these services. See paragraph 5.3. Working to common assumptions (DH 16 th July) the August peak may result in a 9% absence rate rising to 12% in the assumed major pandemic. These figures are based on a reasonable worst case prediction. It is predicted in both waves that 2% will require hospital admission. 4. Health Economy Co-ordination 4.1 NHS Bristol are responsible for co-ordinating all pandemic flue activities across the health economy and for liaising closely with the Health Protection Agency, the Department of Health and the Strategic Health Authority. Regular, routine meetings are held with all stakeholders (currently twice a week) to ensure all plans are progressing and to co-ordinate activities such as antiviral collection points and management of communications etc. The actions from these meetings are reported to the Trust Pandemic Flu Operational Committee, which currently meets two to three times per week (determined by agenda items). 5. Business Continuity 5.1 Each division and specialist service such as I.T and finance, have reviewed and revised their internal business continuity plans. In line with the health economy approach, each area have identified what services will be delivered in the event of escalation and a reduction in staff. At the peak of the pandemic it is estimated that there will be a potential loss of up to 40% of staff, 30% with flu symptoms and 10% as carers. Appendix 1. Is an example of the approach taken. 5.2 In the event of the need to implement these plans, the Trust will hold meetings as a minimum on a daily basis to agree levels of service provision and redeployment of staff. Daily liaison will continue with the PCT. 5.3 The children services are currently undertaking scenario planning and revising staffing deployment to manage children presenting in the Emergency Department. The division are also actively leading a pan South West group to determine how paediatric intensive care beds will be managed and co-ordinated. 6. Workforce 6.1 The trust has detailed workforce plans in place to support the management of peak absence. Plans include identifying and writing to all staff recently retired to determine how many would be available at short notice to strengthen workforce numbers. All clinically trained staff in non clinical posts have been identified to assist with essential redeployment to clinical duties and all other non clinical staff groups have been identified for redeployment to essential service delivery functional roles such as portering duties.
7. Education and Training 7.1 A formal education and training pack is now being delivered to all staff groups. 73 training events have been scheduled and are now underway. Training is aimed at educating staff on the sign and symptoms, what to do if they believe they are infected or been in contact with an infected person/s and the care and management of patients who may present with symptoms. Each member of staff attending the training will sign to identify they have attended and understood the training. 8. Communications 8.1 A communications working group has established a trust web page with links to key for all staff. Posters and letters are agreed and now distributed to divert patients and staff to appropriate. 9. Risks Risk 1 Increased numbers of patients attending emergency department with flu symptoms and disrupting normal activity flow 2 Failure of 98% 4 hour target due to reduced staffing and reduced capacity. 3 Failure to meet cancer targets. Advice from the national cancer action team is that if patients cancel due to flu symptoms it will count as a breach 4 Failure to meet the cancelled operations target due to staff availability and capacity Mitigation Posters on all access doors advising patients not to attend and contact NHS Direct Identification of a separate triage facility to advise patients where to get Business continuity plans to be implemented in a timely fashion Separate triage area for patients presenting with flu symptoms Divisions to closely monitor activity and ensure appointments are sent out in a timely manner and to offer early second appointment (within reason) if first is cancelled. Revise elective admissions daily and target for admission those who fall into the cancer pathway.
10. Conclusion and Recommendation 10.1 University Hospitals Bristol NHS Foundation Trust is working collaboratively to manage and mitigate against the impact of Pandemic Flu. Plans have been modelled against national assumptions regarding absence and hospitalisation rate. 10.2 The Trust Board are asked to note the actions taken to date, the plans developed and the potential impact on performance standards. Authors: Irene Scott; Chief Operating Officer. Pandemic Flu Pat Fields; Executive Lead for
APPENDIX 1. SPECIALISED SERVICES BUSINESS CONTINUITY HIERARCHY OF SERVICES Division-Wide Key 1 Cannot stop - maintain General division wide Teaching 3 3 3 Research 3 3 3 Non-essential meetings 3 3 3 Training 3 3 3 Appraisal 3 3 3 Adverse incident reporting 1 1 1
Bristol Heart Institute Key 1 Cannot stop - maintain 20% 30% 40% Cardiac Surgery Emergency 1 1 1 None Wound clinic 3 3 3 Elective 3 3 3 Rehab 3 3 3 Outpatients/ preassessment 2 3 3 Electives 2 3 3 Cardiology Primary PCI 1 1 1 Device implant non elective Emergency pacing 1 1 1 2 2 2 One Physiologist RACPC 2 2 2 ETT 2 2 2 To maintain patient flow Echo service 2 2 2 Outpatients Inpatient only To maintain patient flow Diagnostic tests 3 3 3 EP & GUCH 3 3 3 Emergencies
Key 1 Cannot stop - maintain 20% 30% 40% interventions On-call 1 1 1 Pacing clinic 2 3 3 Urgent inpatient cases 2 2 2 Electives 2 3 3 Outpatients 2 3 3 Bristol Haematology & Oncology Centre Key 1 Cannot stop - maintain Radiotherapy Physics planning 1 1 1 Linac maintenance & calibration 1 1 1 Routine maintenance Stereotactic 2 3 3 HDR 2 3 3 IMRT 2 3 3 External 1 1 1
Key 1 Cannot stop - maintain beam CAT A External beam CATB 2 2 2 Palliatives 2 2 2 Depending on capacity Isotopes 2 3 3 General Oncology/ Emergencies 1 1 1 Haematology Curative s Adjuvant therapies Outpatient follow-up New outpatients Chemotherapy Ongoing s 1 2 2 2 2 2 3 3 3 Phone line for queries 2 2 3 1 1 2 Patient safety Line care 2 2 2 Pamidronate 3 3 3 Palliative care Ward rounds 2 2 2 Clinical Trials Non-elective 1 1 1
Recruitment 3 3 3 See above for elective chemotherapy Ongoing and new study set-up 3 3 3 Haemophilila Emergencies 1 1 1 Other 3 3 3 Bristol Homeopathic Hospital Key 1 Cannot stop - maintain Homeopathy New outpatients 2 3 3 Follow up outpatients 2 3 3