Exercise Winter Willow Scotland

Contents

• Background
• Aims
• Objectives
• Execution
• Scenario
• Conduct of the Exercise
• Lessons identified
• Conclusion

Introduction

1. Background

1.1 Exercise Winter Willow was the largest of a number of exercises undertaken in the UK aimed at testing and strengthening planning for the response to an influenza pandemic. The Exercise built on exercises held in previous years, especially Exercise Shared Goal in June 2006 which tested response plans at World Health Organisation (WHO) Pandemic Phases 4 and 5. Exercise Winter Willow thus focused on WHO Phase 6, covering the period from the first case in the UK through the development of the pandemic.

1.2 It was designed to exercise structures, plans and procedures across the whole UK and at all levels of emergency response. In Scotland this included the Ministerial Group on Civil Contingencies, the Strategic Coordinating Groups (SCGs) of Lothian and Borders, Strathclyde, Central Scotland, Highlands and Islands, and Fife. The following NHS Boards participated in the exercise within their SCG - NHS Lothian; NHS Borders; NHS Ayrshire and Arran; NHS Lanarkshire; NHS Greater Glasgow and Clyde; NHS Forth Valley; NHS Fife and NHS Orkney. The event also exercised arrangements within the Scottish Executive and national co-ordination arrangements within Scotland and the UK.

2. Aim

2.1 The aim of the exercise was to enhance the UK's ability to manage the effects of an influenza pandemic by practicing and validating response policies and the decision-making process at national, regional and local levels.

3. Objectives

3.1 The UK objectives for the exercise were:

a) To familiarise Ministers and officials involved in the central response with the policy and response issues (including public information) that would arise at UK Alert Levels 2 - 4 of a pandemic at World Health Organisation (WHO) Phase 6.

b) To familiarise key players throughout the UK with the level of interaction between different tiers of government in such circumstances, at both national, regional and local levels.

c) To simulate and analyse the impact upon the Critical National Infrastructure and other relevant sectors such as medicine distribution, and their influence on the delivery of the UK national response.

d) To test information flows, real-time modelling and access to timely expert advice during a pandemic.

e) To identify gaps in our response arrangements and preparedness in order to inform the future development of policy, plans and procedures.

f) To inform the development of future exercise activity, both within the UK Government and more widely.

4. Execution

4.1 A core planning team was established in the Cabinet Office and from that a UK National Planning Team was formed from all Westminster Government Departments including the English Regions, and also the Devolved Administrations of Scotland, Wales and Northern Ireland. This group set the scenario for the exercise as well as the policy for executing the exercise process.

4.2 In Scotland a National Scottish Planning Team was established, chaired by the National Emergencies Planning Officer for NHSScotland, to include all Scottish Executive (SE) Departments as well as representatives from the SCGs mentioned in paragraph 1.2 above. This group set the exercise policy for Scotland as well as developing the exercise injects which would be fed to the Scottish players.

5. Scenario

5.1 The scenario was one involving an outbreak of Pandemic Influenza in the UK. Stage 1 of the exercise on 30 January 2007 was set at WHO Alert Level 6 (increased and sustained transmission in general population) - UK Level 2 (virus isolated in the UK).

5.2 Stage 2 of the exercise, held on 16 to 20 February 2007, was set at WHO Alert Level 6 - UK Level 4 (widespread activity across the UK). Some late changes were made, but the scenario for the exercise was realistic.

6. Conduct of the Exercise

6.1 The exercise was initiated by 'soft start' material being issued to planners and players. This comprised of simulated minutes of meetings, briefing notes, situation reports and a video of a news broadcast, all designed to set the scene for the exercise.

6.2 The conduct of the exercise was coordinated at UK level from an exercise control room (EXCON) based in the Cabinet Office in London. The Scottish element of the exercise was coordinated from an exercise control room in St Andrew's House, Edinburgh. Regular telephone contact was maintained between exercise directing staff in London, Edinburgh and the Scottish Strategic Coordinating Groups to ensure that the exercise flow was maintained, there was no overloading on the players and to keep up the momentum of the exercise.

7. Lessons identified

7.1 The lessons identified below do not, by and large, repeat the more detailed UK report on Exercise Winter Willow. The Scottish Executive was fully involved in both the planning beforehand and debriefing after the exercise, and shared lessons will have been reflected in the UK report. Instead, with some exceptions (where UK lessons are notable and should be repeated to maximise awareness), the lessons identified in this report are those which are Scottish-specific.

7.2 Feedback suggested that the objectives of the Exercise were largely achieved. It was particularly valuable in demonstrating levels of levels of interaction between different local and national levels and in highlighting key areas of the response arrangements, for further policy and planning work to take place. It was recognised that the degree of artificiality in the timing and scenario of such an exercise placed limits on the testing of information flows, real-time modelling and access to timely advice during a flu pandemic. And testing of the Critical National Infrastructure occurred largely at UK rather than a Scottish level.

7.3 There were a number of lessons identified from the exercise falling within some distinct themes.

Communication between different bodies

7.4 Communication was a key aspect of exercise play and the scenario provided an important opportunity to test communication between the different bodies involved in the response.

• A daily teleconference between Health Protection Scotland and the NHS Boards was found to be very useful and should be adopted as good practice.
• A daily briefing from SE to SCGs via video or teleconferencing would have been of benefit.
• The need for close liaison between Health Protection Scotland and the Health Protection Agency was demonstrated and the four countries Health Protection teleconferences were extremely useful.
• Given the importance of the liaison between the Scottish Executive and Health Protection Scotland, there should be at least two Health Protection Scotland staff based in Edinburgh to work with the Scottish Executive, with a clear role in relation to other Scottish Executive Medical staff.
• It would be beneficial for the NHS to have a clearer understanding of the role of other authorities involved in the response.

Next steps

• The Scottish Executive will consider providing SCG chairs with a daily briefing via video or teleconferencing.
• Each Strategic Coordinating Group should consider the way it would use audio and video conference arrangements in a crisis.
• Health Protection Scotland will discuss with the Health Protection Agency how best to ensure close liaison in the event of a pandemic flu outbreak and identify suitable staff to be sent to the Scottish Executive as advisers, with a clear role.
• The Scottish Executive National Emergencies Planning Officer will discuss with Health Emergency Planning Officers how NHS staff should develop a greater understanding of the role of other authorities.

Information management

7.5 The Exercise provided an opportunity to test how the large amount of information being sent around the responders was managed.

• A message action system was established in Scottish Exercise Control to monitor the progress of actions which had been placed on players. This was recognised as good practice and a useful tool in keeping the exercise on track.
• Certain organisations became overloaded with information sent by email, some of which they did not require to see.
• Organisations and individuals need to be pro-active about seeking information from the Scottish Executive or any other agency/organisation.

Next steps

• Individuals and organisations should consider carefully who needs to be copied into emails, so that only those who have to know, and who will benefit from the information receive them.

Further policy development

7.6 The Exercise was helpful in testing some of the practical implication of national policies and identified a number of areas where policy issues require further clarification and development, in particular the demand for medical countermeasures to respond to an outbreak. The exercise scenario - which used a high clinical attack rate - put pressure on stocks of antiviral drugs and antibiotics. Similarly, other medical supplies such as masks were subjected to a high surge in demand. There was concern about the level of the current stockpile of antiviral drugs if the attack rate was at the higher end of the planning assumptions.

Next Steps

• Discussions are continuing about these issues including the practical aspects of continuity of pharmaceutical provision and the costs and benefits of a stockpiling medical countermeasures.
• UK consideration of prioritisation of antivirals and vaccines in the event of that that they are in short supply is underway.
• To ensure a consistent approach to the prioritisation of services, a workstream has been established to consider patient and service prioritisation and provide guidance to the health sector. The guidance will be issued by June 2008.

Business Continuity

7.7 The Exercise showed that maintaining business continuity will be a significant challenge to all organisations during a flu pandemic. Specific business continuity issues identified included:

• The consequences of staffing shortages at major fuel depot such as Grangemouth.

• The importance of contingency planning for staff losses within schools, particularly for a scenario in which schools closed for a number of weeks.
• The exercise highlighted the need for all organisations to have in place business continuity plans for staff absence and succession planning, and also a recovery plan for managing the backlog of routine work which could build up during the emergency phase.
• The importance of the Scottish Parliament's operational arrangements during a flu pandemic.

Next steps

• All organisations should revisit their business continuity plans with a view to maintaining their vital services as far as possible through staff redeployment or other suitable measures.
• Officials from the Scottish Executive and the Scottish Parliament are working together to consider how parliamentary business might best be managed in the event of a flu pandemic or any other similar emergency.

8.

8.1 A Pandemic Flu outbreak would pose a significant challenge to Scotland. Exercise Winter Willow was extremely valuable in testing the robustness of planning at national and local level and identified a number of learning points which will be taken on board in our ongoing planning.