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Health and Social Care Influenza
Pandemic Preparedness and
Health and Social Care pandemic preparedness and response
DH INFORMATION READER BOX
Policy Clinical Estates
HR / Workforce Commissioner Development IM & T
Management Provider Development Finance
Planning / Performance Improvement and Efficiency Social Care / Partnership Working Best Practice Guidance Document Purpose 17092 Gateway Reference Title Health and Social Care Influenza Pandemic and Response DH / HIP/ PIP Author April 2012 Publication Date Target Audience PCT Cluster CEs, NHS Trust CEs, SHA Cluster CEs, Care Trust CEs, Foundation Trust CEs, Directors of PH, Local Authority CEs, Directors of Adult SSs, Special HA CEs, GPs, Emergency Care Leads, Directors of Children's SSs #VALUE!
Circulation List Description This document provides guidance on operational aspects of pandemic response in the health and social care sectors. It should be read in conjunction with the UK Influenza Pandemic Preparedness Strategy
2011. It reflects key changes set out in the strategy, incorporating lessons identified from the H1N1 (2009) influenza pandemic.
Cross Ref UK Influenza Pandemic Preparedness Strategy 2011 Superseded Docs 0 Action Required N/A N/A Timing Pandemic Influenza Preparedness Team Contact Details 451c Skipton House 80 London Road SE1 6LH 0 0 0 For Recipient's Use © Crown copyright 2012 First published April 2012 Published to DH website, in electronic PDF format only.
Contents Executive Summary
Guiding Points from the Strategy
The planning context
3. Health and social care structures – pandemic preparedness and response............ 12 Core Principles
Responsibilities for pandemic preparedness and response from April 2013
4. Preparing to respond
Ensuring an effective response
5. Health and social care response – Detection and Assessment phases
Public Health services
Primary and Community Care
6. Health and social care response – Treatment and Escalation phases
Public Health services
Primary and Community Care
Mental Health services
Closed communities including Prison Health
Potential for legislative changes
7. Health and social care response – Recovery phase
Return to Winter Planning
8. Technical advisory section
Advances in the management of severe respiratory failure
Specialist respiratory support
Facemasks and respirators
National Pandemic Flu Service (NPFS)
Antiviral Collection Points (ACPs)
Associated IT Systems
Annex A – Summary of NHS roles and responsibilities during a pandemic
Annex B – Summary of social care roles and responsibilities during a pandemic................ 68 Annex C – Summary of HPA roles and responsibilities during a pandemic
Executive Summary This document focuses predominantly on the operational aspects of pandemic response in the health and social care sectors, incorporating the lessons identified from the H1N1 (2009) influenza pandemic. It supports, and should be read in conjunction with, the UK Influenza Pandemic Preparedness Strategy 20111 and reflects the key changes set out in the strategy,
namely the need to:
• develop improved plans for the initial response to a new pandemic;
• ensure a response that is proportionate to a range of scenarios;
• allow for differences in the rate and pattern of spread of the disease across the country and internationally;
• further explore statistical population-based surveillance, such as serology to measure the severity of a pandemic in its early stages;
• take better account of information from behavioural scientists about how people are likely to think, feel and behave during an influenza pandemic, and • develop improved plans for managing the end of an influenza pandemic – the recovery phase.
The document outlines the key areas where public, independent and voluntary sector health and social care organisations should work together to maintain and improve integrated operational arrangements for planning and response in order to deliver the best outcomes possible during an influenza pandemic. It reflects the structures and roles of the NHS and public health organisations in England during the transition period and will need updating to reflect the new structures post 2013.
Multi-agency plans, covering NHS, public health and social care, need to be in place in each
local health economy to provide for:
• a clear definition of responsibilities;
• reporting and collation of surveillance data, in line with national requirements;
• contact tracing, swabbing and testing of samples, and issue of antivirals before Antiviral Collection Points (ACPs) are set up;
• surge plans for primary, secondary and critical care;
• establishment and operation of ACPs in line with the national specification;
• implementation of the National Pandemic Flu Service (NPFS), in line with national requirements;
• implementation of a pandemic-specific vaccination programme, and • recovery and return to business as usual.
All plans need to be tested and exercised at regular intervals. Further details are set out in this document.
A key theme is the unpredictability of any pandemic virus and the uncertainty that this presents in quantifying the response required. Given this, there are three key principles that underpin
both planning and response:
' Precautionary ' Proportionality ' Flexibility The indicators for action in the UK in a future pandemic response have been revised and decoupled from those used by the World Health Organisation (WHO) to describe the global pandemic. These UK indicators are described as phases named: Detection, Assessment, Treatment, Escalation and Recovery. The document outlines the key objectives for the phases together with actions that will be required by organisations to respond to the capacity and capability challenges of pandemic scenarios which may range in impact on services from low to moderate or high.
The technical advisory section of this guidance provides a summary of advice on management of respiratory failure, facemasks and respirators, and antiviral distribution. Annexes A, B and C provide a summary of roles and responsibilities during a pandemic for NHS and social care commissioners and providers and the Health Protection Agency (HPA).
1. Introduction This guidance is intended to support local preparedness and response planning 1.1 in the transition period through to 2013, in England. The Devolved Administrations are producing their own guidance. It will be updated to reflect preparedness and response structures for the longer-term as they develop. This guidance should be read together with the UK Influenza Pandemic Preparedness Strategy 2011.
Local leadership and accountability are a key plank of the health and social care reforms in England. The responsibility during 2012/13 for ensuring that pandemic preparedness and response plans are drawn up and tested at the appropriate subnational levels rests with the Clustered Primary Care Trusts (PCTs) and Strategic Health Authorities (SHAs). Local plans should align with the guidance in this document, as well as the UK Influenza Pandemic Preparedness Strategy 2011. Plans will need to allow for the balance between national decisions and priorities, and local operational flexibility during the pandemic response.
1.2 The UK Influenza Pandemic Preparedness Strategy sets the strategic context for planning for an influenza pandemic across wider society. In response to the consultation on the Strategy, people in many areas of care delivery raised questions on operational issues. Where possible we have addressed these in this document. This guidance is therefore relevant to all local and national commissioners and providers of health and social care services including acute, community and mental health providers, ambulance services, local authorities, voluntary and independent sector providers and clinicians, all of whom are central to the successful planning and delivery of the response and recovery.
1.3 The potential for a new influenza pandemic remains unchanged although the timing and severity of a future pandemic remains unpredictable. Public health, NHS and social care organisations have already undertaken considerable planning for a pandemic event and, although the H1N1 (2009) influenza pandemic proved to be relatively mild for the majority of people, it was a helpful initial test of plans. However, plans now need to be revised to reflect the learning from the pandemic in 2009 and the latest scientific evidence. Public health services, NHS providers, Local Authorities and other partner agencies need to collaborate closely in revising and testing these plans.
2. Context Guiding Points from the Strategy 2.1 Paragraph 1.10 of the UK Influenza Pandemic Preparedness Strategy 2011 sets out the key changes to the previous approach, reflecting the lessons learnt from the H1N1 (2009) influenza pandemic. These are to:
• develop better plans for the initial response to a new virus, when the focus should be on rapid and accurate assessment of the nature of the pandemic virus and its effects, both clinically and epidemiologically;
• put plans in place to ensure a response that is proportionate to a range of scenarios reflecting pandemic viruses of low, moderate and high impact, rather than focusing on the “worst case” planning assumptions;
• take greater account of age specific, geographic and other differences in the rate and pattern of spread of the disease across the country and internationally;
• further explore statistical population-based surveillance, such as serology, to measure the severity of a pandemic in its early stages;
• take better account of information from behavioural scientists about how people are likely to think, feel and behave during an influenza pandemic, and • develop better plans for managing the end of an influenza pandemic – the recovery phase and preparation for subsequent seasonal influenza outbreaks.
2.2 It is uncertain when a new pandemic virus might appear. Until it emerges and affects a significant number of people, it will not be possible to identify the key features of the disease, such as any pre–existing immunity, the groups most affected, and the effectiveness of clinical countermeasures. Given this, there are three main principles that must underpin planning and response.
Precautionary – plan for an initial response that reflects the level of risk, based on • information available at the time, accepting the uncertainty that will initially exist about the scale, severity or level of impact of the virus.
• Proportionality – plan to be able to scale up or down in response to the emerging epidemiological, clinical and virological characteristics of the virus and its impact at the time.
• Flexibility – plan for the capacity to adapt to local circumstances that may be different from the overall UK picture – for instance in hotspot areas.
These principles are set out in more detail in Chapter 3 of the Strategy.
2.3 Chapter 4 of the Strategy sets out the key elements of the UK’s ‘Defence in Depth’ approach, which are also reflected in the actions required during each phase of the pandemic response. The primary objective of the Strategy is to protect health, with the aim of reducing the proportion of the population that may develop influenza or become
critically ill. This will be achieved by:
• maintaining surveillance to detect the emergence of a novel virus strain or any illness attributable to it, monitoring its spread, assessing the impact of the virus and identifying the groups most at risk of severe illness and death and monitoring the uptake, effectiveness and safety of the various clinical counter-measures including vaccination;
• reducing risk of transmission and infection by applying individual and community infection control measures and assisting self support by providing public advice and information and promoting messages of good respiratory and hand hygiene;
• reducing illness and complications and minimising deaths of symptomatic individuals by rapid access to health assessment, providing antiviral medicines promptly where they are needed and providing other effective treatment including antibiotics for those suffering from secondary bacterial infections;
• protecting the public through preventing the disease when possible and appropriate, through pandemic specific vaccination, and • promoting work during the inter-pandemic period to increase capacity and resilience in the UK.
2.4 A summary of the scientific evidence which supports this approach was published alongside the Strategy2.
Pandemic phases 2.5 The WHO adopts a series of phases to describe and monitor the progress of a pandemic at a global level. Whilst useful for planning and monitoring the worldwide pandemic, this is not sensitive enough to direct the pace and scope of the response within individual countries. The H1N1 (2009) influenza pandemic virus affected the UK prior to WHO declaring a global pandemic.
2.6 The UK Influenza Pandemic Preparedness Strategy 2011 outlines a new approach to the indicators for action in the UK in a future pandemic response that is no longer linked
to the WHO global phases. This takes the form of a number of phases named:
Detection, Assessment, Treatment, Escalation and Recovery. A pre-pandemic planning and preparation period precedes these.