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02 Integration of Specific Planning for Pandemic Influenza
This chapter to be reviewed by April 2008
Introduction
2.1 This Chapter outlines how specific preparation for response to pandemic influenza relates to Scotland's generic arrangements for any emergency. It provides guidance on integrating the UK Health Departments' UK Influenza Pandemic Contingency Plan and Scottish plans ( http://www.scotland.gov.uk/Publications/2005/06/16105916/59200). It summarises considerations for local preparation and assumes that the reader is aware of Section 1 of Preparing Scotland ( http://www.scotland.gov.uk/Publications/2006/02/27140215/0).
2.2 The World Health Organization ( WHO) describes six Phases for the progression of an influenza pandemic. This guidance deals only with Phases 5 and 6.
Influenza pandemic
2.3 Influenza pandemics have swept the world from time to time throughout history with devastating effect, far in excess of that resulting from the seasonal influenza which occurs in most winters. Pandemics arise when a new influenza virus emerges that is markedly different from recently circulating strains and it is able to spread readily from person to person, cause illness in a high proportion of the people infected and spread widely because people have little or no immunity.
Preparation
2.4 As part of their risk assessment all Category 1 and 2 responders must consider all of the impacts, on their functions, of an influenza pandemic in their area. They must review their organisations' business continuity arrangements and measured their generic emergency plans ability to deal with assessed impacts, modifying them as necessary. In addition they should ensure that they will be able to perform their functions in response to a pandemic.
2.5 In broad terms the impacts of pandemic influenza will require:
- activity related to the prevention and treatment of the disease - referred to below as the "health response";
- activity to bolster those services that support daily life and to mitigate the effects on public health as part of a multi-agency response - referred to herein as the "civil contingencies response"; and
- activity related to warning and informing the public of the actions they should take prior to, and during, an outbreak of pandemic 'flu.
Management/Leadership Specific to Pandemic Influenza
2.6 A managed and co-ordinated response will be as described in Section 1 of Preparing Scotland. Generic arrangements will be complemented by the arrangements defined in the UK Health Departments' Influenza Pandemic Contingency plan. Multi-agency planning will be of benefit for each Strategic Co-ordinating Group's ( SCG) both for the health and civil contingencies responses to a 'flu pandemic.
2.7 The Department of Health ( DH) is the Lead Government Department and works closely with the Scottish Executive Health Department ( SEHD) to ensure consistency in their plans for the health response. Those plans deal with activity to minimise the impact on the health of the UK population (vaccine, vaccination, antiviral procurement and distribution, recovery and support) and ensuring that the health services are prepared. DH will provide health input for the UK civil contingencies response through the Cabinet Office Briefing Room ( COBR).
2.8 In Scotland SEHD is responsible for leading, planning, initiating, directing and central co-ordination of the health response. It will provide health input for the Scottish civil contingencies response and will work with the support of the Scottish Executive's Emergency Action Team ( EAT). SEHD will provide health input for the Ministerial Group on Civil Contingencies. It will initiate liaison arrangements with local health services built upon generic outbreak plans.
2.9 There are other groups of health specialists with a specific role in an influenza pandemic:
UK National Influenza Pandemic Committee ( UKNIPC)
2.9.1UKNIPC is the main forum providing specialist advice to inform UK Health Departments in their response to an influenza pandemic. It reports to the Department of Health. Scottish health services are represented on the Committee.
Scientific Advisory Group ( SAG)
2.9.2SAG will provide advice on the scientific evidence base for health related influenza pandemic policies. It advises UKNIPC.
Scottish Pandemic Influenza Co-ordinating Group ( SPICG)
2.9.3SPICG provides strategic advice on the implementation and co-ordination of the health response in Scotland, working within the overall framework set by UKNIPC. SPICG advises the Scottish Executive Health Department.
NHS Board Pandemic Influenza Management Teams ( PIMT)
2.9.4NHS Boards prepare for response to any incident or outbreak by an Incident Management/ Control Team which comprises of professionals from a range of relevant organisations (health, local authority, scientific advisors and others). In the event of an influenza pandemic such a Team (designated in this Chapter as a Pandemic Influenza Management Team) will meet to ensure a co-ordinated response. The work of the Team will be an integral part of Strategic Co-ordinating Group activity at Strategic and Tactical levels and local reporting lines should be clearly stated. The NHS Board is responsible for PIMT's reporting on pandemic 'flu to SEHD, giving PIMT's advice to the Strategic Group and ensuring PIMT's close integration with the Tactical Group's activities through nominated individuals.
Co-ordinating Management Structures
2.10 The co-ordinating management structure for response to an influenza pandemic is shown at Figure 1. It builds upon the generic structures described in Section 1 of Preparing Scotland.
2.11 The sections below should be read with reference to Figure 1.
Actions when an influenza pandemic is imminent
2.12 When there is a substantial pandemic risk ( WHO Phase 5) the Department of Health will initiate arrangements that include convening the UKNIPC which has representatives from the Scottish Executive Health Department ( SEHD) and Health Protection Scotland ( HPS). The Cabinet Office Briefing Rooms ( COBR) will be opened and the Civil Contingencies Committee ( CCC) is likely to meet to review preparations and take strategic decisions, it will have Scottish representation.
2.13 In Scotland SEHD will initiate the SPICG to provide strategic advice on the health response in Scotland. The Scottish Executive's co-ordinated response mechanisms will be activated at this stage. The Scottish Executive Emergency Room ( SEER) will be activated to brief Ministers and co-ordinate action by its Departments. Its Emergency Support Team ( EST) and Emergency Action Team ( EAT) will be alerted. The EST will inform SCGs of SEER's opening through its generic arrangements. SEHD will inform the NHS. The Ministerial Group on Civil Contingencies ( MGCC) and the Scottish Emergencies Co-ordinating Committee ( SECC) will be alerted and may convene.
Actions when an influenza pandemic is confirmed
2.14 When the onset of a pandemic is confirmed ( WHO Phase 6) SEHD will inform SE Departments, agencies and the NHS. EST will inform SCG Chairs. Arrangements established at WHO Phase 5 will intensify.
2.15MGCC will meet and set parameters for the overall response. MGCC will take the Ministerial lead for Scotland and may elect to appoint a Minister with a particular portfolio to lead the SE response. MGCC will contribute to CCC discussions.
2.16SECC will meet, advise Ministers, determine the strategic direction of SE's response, set overall priorities and take ownership of long-term recovery issues at the Scottish level. It will disseminate the agreed strategy amongst its constituent bodies.
2.17MGCC and SECC will be advised by SEHD on health matters and EAT on civil contingency impacts. They will implement decisions and ensure co-ordination of SE activity. EAT will co-ordinate SE's input to the health and civil contingencies responses.
2.18 The EST will support the EAT and will liaise with the Cabinet Office Civil Contingencies Secretariat which supports the Civil Contingencies Committee. It will ensure effective communication and information flows with SCGs and the Scottish Police Information and Co-ordination Centre (S- PICC).
2.19EST will provide situation reports for EAT, CCS and Scottish Ministers regarding the consequences of the pandemic in Scotland. SEHD will gather information on health matters from Health Boards. EST will gather information from SCGs on civil contingencies matters. Both SEHD and EST will issue templates for producing situation reports.
2.20SCGs will meet to examine the impact of the pandemic at local level and co-ordinate their partners' activity to mitigate its impacts on the community. They should consider arrangements for chairing their meetings and how they may change as a pandemic develops. They should be clear about who will provide advice on public health and the health response locally and recognise the role of the PIMT in the local response.
Figure1 National Structures for Response to Pandemic Influenza
Specific issues for consideration in local preparations
2.21 The following is a simple list of issues to inform responders planning. It is not comprehensive.
Business continuity management
- Short, medium and long-term planning for the impacts of a pandemic;
- Identify critical services;
- Identify essential personnel, skills and staffing levels;
- Identify essential supplies and distribution arrangements;
- Steps to reduce service disruption:
- Advice and guidance for staff before, during and after a pandemic;
- Consider staff rostering;
- Consider alternative working patterns;
- Public information on continuity planning as it may affect services for the public;
- Promote business continuity planning for business and voluntary organisations.
Leadership and communications
- Chairmanship of SCG considering health and civil contingencies aspects;
- Integration of specific roles and responsibilities for influenza pandemic;
- Integration of the Pandemic Influenza Management Team ( PIMT) and SCG generic management framework;
- Communication with vulnerable individuals and groups;
- Arrangements for situation reporting on the spread and impact of pandemic;
- Mutual aid/support within and outside SCG area;
- Emergency vaccination arrangements;
- Community care;
- Stand-down from first wave and preparation for later waves of pandemic;
- Dealing with fatalities.
Public information and media
- Identify lead responder(s) for warning and informing;
- Prepare information on the nature of pandemic 'flu compared with seasonal 'flu;
- Information for services, staff, the vulnerable and the community;
- Websites and links;
- Helpline management;
- Local media support;
- Train spokespersons.
Situation reporting
- NHS Board arrangements to gather, collate and disseminate information on pandemic 'flu and health services;
- SCG arrangements to gather, collate and disseminate information for other local responders' services and consequences of the pandemic.
Measures to reduce health impact
- Public health measures;
- Social distancing - mass gatherings - closure of premises;
- Services for vulnerable individuals and groups.
USEFUL LINKS
UK Health Departments' Influenza Pandemic Contingency Plan: Scottish Executive Health Department Influenza Pandemic Contingency Plan - http://www.scotland.gov.uk/Publications/2005/06/16105916/59200.
Draft advice for staff - http://www.ukresilience.info/publications/intro_staffadvice_flu_planning.pdf.
HSE Guidance to employers, available via the HSE website - http://www.hse.gov.uk/biosafety/diseases/influenza.htm.
Scottish Executive Guidance to Schools and Child Care Settings in Scotland (July 2006) - http://www.scotland.gov.uk/Publications/2006/07/05121311/0.
UK Resilience web-site general and specific advice - http://www.ukresilience.info/latest/human_pandemic.shtm.
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