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1 Introduction
1.1 Purpose
The purpose of this guidance is to assist NHS Boards and community health providers in developing their plans for responding to an influenza pandemic by providing a framework for the provision of healthcare in a community setting. Local contingency plans should fit within the broad framework articulated in this guidance. The intention is to ensure a degree of consistency and equity in response to a pandemic, while allowing local flexibility in order to cope with variations in both the progression of the pandemic, and in local resources and health service configuration.
The approach taken here seeks to build upon existing plans and arrangements where possible and to augment normal delivery mechanisms in order to cope with increased demand. Working jointly across agencies and sectors will produce the best possible result from the capacity and skills available. The main part of this document sets out the operational planning elements that NHS Boards and community health providers should be considering. It sets out a model for access to care within which the delivery of healthcare services in Scotland should be framed.
1.2 Development
This guidance has been informed by a report and recommendations produced by a RCGP Scotland led group at the invitation of the Minister for Health and Community Care. The report drew on the expertise of an advisory group which included representation from the British Medical Association, Scottish General Practitioners Council, Association of Directors of Social Work, NHS24, Scottish Ambulance Service, Scottish Pharmacists General Council and Health Protection Scotland. A draft report was also shared with and commented upon by wider stakeholder organisations.
1.3 Related guidance
This guidance is related to a number of other pieces of work. It is supplementary to the revised Scottish framework for responding to an influenza pandemic, which can be found at http://www.scotland.gov.uk/Pandemicflu
1.4 Audience
This guidance is intended for NHS Boards, Community Health Partnerships and front line health care providers including general practice, community pharmacy and ambulance services. While there will be separate guidance for other components of the health sector, elements of this framework are likely to be widely relevant to organisations involved in health and community care.
1.5 Aim
The overall aim of this guidance is to support those involved in the organisation and delivery of community based healthcare in the development of their operational plans for the provision of care in a community setting during a pandemic. The provision of care involves both the direct response to patients who suffer from influenza, and the maintenance of services for people who require care for non influenza related conditions.
The aims of the health and community care response to an influenza pandemic are to reduce mortality and morbidity by:
- maintaining surveillance to detect the emergence of a novel virus strain or any illness attributable to it
- providing prompt access to rapid and reliable diagnostic tests
- reducing the severity of illness and incidence of complications in infected individuals
- reducing disease transmission and rates of illness by applying individual and community infection control measures
- adjusting responses to reflect emerging epidemiological data
- developing surge capacity to meet expected demand, recognising that this will require the reactive redefinition of boundaries between primary and secondary care
- making targeted and effective use of potentially scarce healthcare skills, facilities and resources
- reducing/ceasing non-essential activity as demand increases but maintaining essential care for emergencies or patients with chronic or other illness
- assessing all symptomatic patients rapidly and treating them promptly with antiviral and other medicines if indicated
- providing effective treatment for those suffering complications
- educating the community and providing public advice and information
- providing vaccination, if and when suitable vaccines are available
- providing data to monitor the impact and effectiveness of interventions.
1.6 How this guidance is intended to be used
This guidance is intended to cover healthcare in a community setting, which includes primary care provision in the context of the community or home.
This guidance seeks to provide framework for planning, rather than to be a detailed and prescriptive operational plan itself. Good reason may exist in local circumstances for divergence from the framework (for example, remote and rural areas may choose to configure services differently, or a particular local authority may have different emergency mechanisms in place which have implications for local health services). It is essential that NHS Boards work with local stakeholders to develop robust plans in their area which take account of local needs and local resources.
The timing and impact of an influenza pandemic is uncertain. Planners and health care providers should acknowledge the possibility that a pandemic may occur before further guidance is developed. Regular assessment, updating and testing of response plans and business continuity arrangements are therefore necessary in order to prepare for a pandemic at any time.
1.7 Relationship to other administrations
This guidance has been developed for the community healthcare sector in Scotland and reflects the structure, organisation and delivery of services in Scotland. Where appropriate, this guidance is also compatible with planning guidance across the rest of the UK.
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