Trust Board Meeting Agenda Item 7 Date: 30 September 2009 Title of Report Recommendations (please outline the purpose of the report and the key issues for consideration/decision) Progress with Pandemic Flu planning. This paper sets out the progress that has been made since late April 2009 in taking forward planning for a potential second or subsequent wave of H1N1 Influenza (Swine Flu) during the autumn or winter months of 2009/10. Actions Required Which Corporate Objective(s) are supported by this paper Is this on the Trust s risk register? If yes please give details. If not, why not? Eg. Risk Score is below 15 Which healthcare commission standard does this report provide evidence for? The Board is asked to receive the report and agree a statement of readiness. Section 6. To produce a comprehensive civil contingencies plan to meet national requirements including a pandemic flu plan approved and understood across the Trust No. To be reviewed following participation at local and regional pandemic flu exercises Core Standard 24 Financial Implications Revenue Yet to be determined Capital 700,000 Funded by Bristol Primary Care Trust Prepared by: Name & Title Presented by: Name & Title Cass Sandmann Emergency Planning Officer Pat Fields Executive Director for Pandemic Flu Planning
Previous Meetings Please insert the date the paper was presented next to the relevant group Exec Team Audit & Assurance Committee Governance Risk and Risk Management Finance Committee Trust Executive Group Other Meeting Please state 23/09/09
1.0 - Introduction All National Health Service Boards are required formally to publish a statement of readiness against key elements of the Pandemic Flu Framework 2007 and associated guidance including Pandemic Flu: Managing Demand and Capacity in Healthcare Organisations (Surge) 1 May 2009. This paper sets out the progress that has been made since late April 2009 in taking forward planning for a potential second or subsequent wave of H1N1 Influenza (Swine Flu) during the autumn or winter months of 2009/10. Following Ian Dalton s letter dated 2/7/09 (Gateway ref. 12125), the Trust is obligated to ensuring that sufficient organisational focus and resources are devoted to this work in the context of a global pandemic and the prospect of a sustained second wave of up to five months duration. 2.0 Requirements All National Health Service Boards are further charged with: Appointing a full-time director-level lead dedicated to flu preparedness and resilience with immediate effect. Stress testing of pandemic flu plans 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. Understand and test capacity constraints caused on rough increased demand and workforce sickness absence. Engage in discussions with Trade Unions about a staff vaccination programme and wider communications to staff, and support for staff. Build an existing relationship with local partner agencies to ensure that their role, Channels of Communication and ways of working are clear during sustained second wave. In addition, All Acute National Health Service Trusts must: Support the Sentinel Surveillance Systems on patients hospitalised with Swine Flu. (A system that enables daily situation reporting of pandemic flu activity across the Avon Health Community feeding into the wider health community). 3.0 Pandemic Flu Plan A plan detailing the Trust s response to a pandemic influenza outbreak was ratified by the Trust Board in April 2009
The document outlines the Trust s role within local and national health community planning strategies before, during and after a Pandemic Flu event. The plan sets out both the management considerations and operational activities that will be necessary during a Pandemic Flu event and is available on the Trust intranet Swine Flu and Emergency Planning pages. 4.0 Pandemic Flu Preparedness 4.1 Command and Control The Trust s arrangements for Command and Control have been revised in respect of the World Health Organisation s pandemic flu declaration. In accordance with the pandemic flu plan the Pandemic Flu Management Group is established to manage the pandemic incident on a day by day basis. This group currently meets once a week but has the capacity to increase the frequency of meetings as required as the situation evolves. The Group has a fixed agenda and keeps minutes of all meetings. The Group consists of representatives from all divisions as well as other relevant departments e.g. Occupational Health. The meetings are chaired by the Executive lead for Pandemic Flu planning supported by the Emergency Planning Officer. Information from the Avon Health Emergency Resilience Group is disseminated via this group. 4.2 Avon Health Emergency Resilience Group As part of developing resilience in respect of Emergency Planning and Preparedness, the local National Health Service organisations established an overarching Executives Group chaired by the Director of Strategic Development of the Primary Care Trust. This Group was responsible for ensuring that different components of Pandemic Flu plans developed in 2008 were consistent across the health community. ( Avon and Somerset Local Resilience Forum Multi-Agency Pandemic Flu Plan 11/08) This Group established teleconferences to coordinate the health communities response to individual cases occurring throughout the health community and to provide assistance where required. Teleconferences are currently held twice weekly. The Executive Lead for Pandemic Flu Planning supported by the Emergency Planning Officer, represent the Trust at these teleconferences. 4.3 Ongoing health community-based work streams A formal programme of work has been agreed through the Avon Health Emergency Resilience Group to take forward the latest national guidance and inform revisions to pandemic flu plans. There are nine work streams. 1. Antiviral medicinal distribution. University Hospitals Bristol maintains Bristol Primary Care Trusts antiviral medicine stock in the Trust pharmacy. The Trust pharmacy holds ample supplies of all antiviral medicines with emergency stock available at appropriate locations across the Trust.
2. Pandemic-specific vaccinations. Additional staff have been identified to receive training in the administration of swine flu vaccine to Trust front line staff. Front line staffhave been identified following Department of Health guidelines. 3. Surge Capacity planning. Significant surge capacity modelling has been undertaken in the Trust. Additional critical care beds have been identified for use in the event of second or subsequent pandemic flu waves. Adult intensive and high dependency care beds can be increased from 15-50 beds and paediatric intensive and high dependency care beds from 15 to 27 beds. Finance received from Bristol Primary Care trust has enabled the purchase of intensive care equipment to be purchased to help to create this additional capacity. 4. Human Resources and training. The Human Resources Department has run a programme contacting all recently retired staff asking if they would be prepared to return to work during peak pandemic flu activity periods. Responses to date have been low. Contact has also been made with existing staff with clinical backgrounds currently employed in non clinical roles to identify training and support needs required to enable them to return to temporary clinical practice. 5. Communications. Trust Heads of Communication have met with regional media to discuss terms of engagement during the pandemic. The communications team has used internal channels such as Newsbeat, the intranet, poster campaigns to keep staff informed of all pandemic flu developments and, has used the external website to inform visitors of key messages. The team have also helped to compile and distribute advice leaflets to patients about hospital attendances during a pandemic. The team works collaboratively with communications teams from the Primary Care Trusts and Strategic Health Authority 6. Multi-agency arrangements. The Trust has recently taken part in two exercises aimed at testing Primary Care Trust pandemic flu plans with multi agency partners. The trust will also take part in a pan Avon exercise and a regional exercise. Lessons learned from these exercises will be reviewed and incorporated into the Trust plan as they are identified. 7. Mutual aid assumptions. The Avon Health Emergency Resilience Group has published a draft Mutual Aid Plan that is currently at the consultation process. Whilst this plan allows for National Health Service Organisations to support other organisations during the pandemic period, staff will not be released to work in other organisations without ensuring continued provision of core services at the Trust. 8. Local Authority partnerships. This work is Primary Care Trust led and forms part of the overarching Pan Avon Pandemic Flu Plan. This work is in early stages and relevant updates will be provided in future board reports. 9. Logistics. The Trusts holds and maintains a sufficient stock of personal protective equipment. Resilient communication lines are established to ensure timely replenishment of used stock. The Trust has access to further stocks of personal
protective equipment held by Bristol Primary Care Trust should demand exceed stocks held within in Trust. Representatives from the Trust are actively engaged in all workstreams and report back via the Pandemic Flu Management Group. 5.0 Board Assurance The Trust Board is required to provide a statement of readiness by the South West Strategic Health Authority. To assist the Board in making this statement, the table below sets out the level of assurance against the key elements of pandemic preparedness and management. Full details of actions and assurance in each section are provided in appendix I. Assurance Area Current status Full-time director dedicated to flu preparedness and resilience as part of a well resourced team Clear accountability and governance framework across University Hospitals Bristol Surge Capacity Amber o Demand and Capacity plans to ensure business continuity o Trusts have stress tested pandemic flu preparedness plans to ensure high quality care to both flu and non flu patients o Tested capacity constraints that could be caused through increased demand and workforce sickness Seasonal flu vaccination programme for staff Pandemic flu vaccination programme (swine Flu) Communications Surge capacity is currently graded as amber for the following reasons: o Surge capacity plans have not as yet been stressed tested o A triage area for pandemic flu cases has yet to been finalised Surge capacity plans will be stress tested the week commencing 4 th October. An area for triage has been identified and enabling works are being progressed urgently.
Appendix One Assurance Area What s currently in place Further actions being taken Full-time director dedicated to flu preparedness and resilience as part of a well resourced team Clear accountability and governance framework across University Hospitals Bristol Surge capacity Demand and Capacity plans to ensure business continuity Trusts have stress tested pandemic flu preparedness plans to ensure high quality care to both flu and non flu patients Pat Fields (Deputy Chief Nurse) Director lead, supported by: Full time Emergency Planning Officer Identified Human Resource lead Identified Occupational Health Lead Terms of reference are available for the Trust Pandemic Flu Management Group and the Pandemic Flu Planning group. The Trust Intranet has a Pandemic Flu workspace that contains all the minutes of the swine flu meetings, currently held weekly Service Level plan for the redeployment of staff and various modelling exercises around various levels of staff sickness. Weekly Trust-wide pandemic flu meetings with representation from the PCT. Divisional operational management structures in place for sickness reporting/management tested at divisional level Further designated, named person to be seconded for collation of surge capacity management plans for all trust Divisions The Pandemic Flu Management Group continue to meet weekly with full representation from the divisions and other interested parties including Trade Union representation The Trust has participated in two exercises in September 2009 in conjunction with North Bristol trust, Bristol Primary Care Trust and South Gloucestershire Primary Care Trust. The Trust will also participate in Pan-Avon
Surge service prioritisation tool populated and regional exercises in September 2009 The Trust will stress test the plan following the local and regional events and will review any actions highlighted. Planned for week commencing 4 th October 2009 Regional event to be held on 29 th September 2009 Tested capacity constraints that could be caused through increased demand and workforce sickness Seasonal flu vaccination programme for staff Demand Management for swine flu- Emergency department Swine Flu designated triage area staffed from the Emergency department The Occupational Health Department has developed plans for the provision and administration of the seasonal flu vaccinations for all staff. Additional supplies of seasonal flu vaccine are available to meet projected increases in demand Since the onset of the current pandemic flu outbreak the Trust s pandemic flu plan has been reviewed and amended to allow for the continual updating of available information and to incorporate lessons learned A working group has identified suitable areas for the management of the triage of patients presenting with potential swine flu during second or subsequent waves. Enabling works are in progress This plan will potentially run in conjunction with the Trust s plans for the provision and administration of the swine flu vaccination. The programme will commence at the end of September 2009
Pandemic flu vaccination programme (swine Flu) Communications The Occupational Health Department has plans for the provision and administration of swine flu vaccinations in line with Department of Health guidance. The plans have been developed with full involvement of the Trade Unions Over 5000 staff have received training on swine flu awareness and clinical management of swine flu The role out of this programme is dependent on the availability of the swine flu vaccine Indicative date for availability is currently early October 2009 Additional staff have been identified to administer vaccinations to front line staff. Training will commence end of September 2009 Formal communications plan being finalised. This programme is led by the Strategic Health Authority and anticipated completion is September 2009 Press office representation at weekly pandemic flu management meetings Intranet home page has details of current swine flu guidance. Specific swine flu web page is available to all staff These sites are updated and reviewed daily or as new information becomes available