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7 Other Planning Elements
7.1 Vulnerable or hard-to-reach groups
The impact of a pandemic may mean that there are more individuals and groups who become temporarily vulnerable or hard to reach, for example, those within closed communities whose location puts them at risk.
NHS Boards should work with other agencies, including community care services and voluntary organisations, to identify those known to be at risk, and to identify those groups at risk who may be unknown to health and community care providers. These may be groups who are at risk due to underlying health or social conditions, or because of their hard-to-reach status (those with difficulties in understanding English, those who are not registered with a GP, etc).
These groups should be identified so that their needs can be taken into account when developing local arrangements for the provision of healthcare in the community setting, in particular the assessment and treatment (and management) of influenza patients and, if applicable, distribution of antivirals.
The following list identifies a number of individuals and groups who could be classified as vulnerable or hard to reach (permanently or temporarily). This list is not exhaustive, and some individuals may fit into more than one category:
- those with a mobility impairment
- those with a sensory impairment
- those with a mental/cognitive impairment
- non-English speakers
- children
- those living alone
- older people
- those who are clinically at risk
- those with ill health and taking regular medicines
- those with ill health and using medical support equipment (oxygen, etc)
- the homeless
- travellers
- those in residential institutions (residential homes, prisons, nursing homes, sheltered accommodation, half-way houses, boarding schools, colleges, etc).
7.2 Infection control
Guidance on infection control for hospital, primary care and some other settings is available. The advice and principles within this guidance should be applied across all local plans to assist in limiting and preventing the spread of infection.
The guidance is available from the Scottish Government website at: http://www.scotland.gov.uk/Pandemicflu
Some professional bodies have also developed infection control guidance. Guidance from RCGP/ BMA for general practice can be found at: http://www.rcgp.org.uk/default.aspx?page=3908
Primary care organisations such as GP practices and pharmacies will wish to think about the potential of their staff to act as role models for good practice in infection control, and to take action to minimise the potential for their premises to spread the virus. They may also wish to consider the following:
- how they will reduce the risks of droplet spread in seated areas, such as waiting areas in GP practices, and in collection areas, such as pharmacies
- the availability and adequacy of hand washing facilities. Adequate hand washing practice and facilities are fundamental to good infection control. As part of their general response to infection control, primary care organisations should review the availability of hand washing facilities and hand washing procedures/practices. They should also be providing guidance to patients and relatives on hand washing (using national guidance where possible)
- the availability and adequacy of other facilities that help minimise virus spread, eg tissues and tissue disposal facilities for those people coughing and sneezing in areas of close human-to-human contact
- the most appropriate management of areas of close human-to-human contact in all areas of the site. Primary care organisations will wish to plan for how they will minimise mixing in areas of high contact, such as reception areas, waiting rooms and triage stations
- the standards set for cleaning premises and facilities before and after use. Infection control standards are important at all times regardless of the presence of an influenza pandemic. However, primary care organisations will need to ensure that high-quality cleaning standards are maintained during a pandemic, with particular attention given to places affected by droplet spread
- Primary care organisations will wish to consider and plan for their own duty of care to their staff so that they can continue to provide their services whilst minimising exposure to the infection where possible, for example by using screens between reception staff and patients, or making use of telephone interaction systems.
7.3 Promotion of self-care
Promotion of self-care will be crucial in encouraging the community at large to look after its health. Encouraging those who are symptomatic with influenza to care for themselves at home if they are able to do so will enable healthcare professionals to concentrate on helping those with greater clinical needs.
Messages on self-care with regards to influenza will be included in the national public communications campaign, but benefits can also be realised through local targeting of specific groups, such as those with long-term chronic diseases. NHS Board plans should specify how self care will be encouraged locally.
7.4 Communications
Any emergency of this scale needs strong national direction from the outset. Timely, accurate and consistent advice will help prepare the population for the potential impact of a pandemic and will be critical to its subsequent management.
The Scottish Government's communication plan supports the UK Framework and recognises that the Department of Health has the overall UK lead and will be the primary source of health information. However, all four health departments/directorates, the Cabinet Office, other government departments/directorates, the Health Protection Agency and Health Protection Scotland are working together to deliver a nationally co-ordinated communications strategy. (Please refer to section 11 of A Scottish framework for responding to an influenza pandemic for full details of the strategy.)
Health Boards and primary health care providers should work with the Scottish Government and other national bodies to both, support the national communications plan and to communicate to the public on local operational issues.
Where possible, all material should use nationally available resources contextually applied to local circumstances and should be available in suitable languages for the local population.
7.5 Surveillance, reporting and data collection
A common theme across all local planning is the need to gather information. This will be used to monitor the behaviour of the virus, response to the pandemic and the availability of resources (beds and staffing levels). It will help to evaluate the efficacy of antivirals and other interventions such as vaccinations, antibiotics, social distancing etc.
Health Protection Scotland will work with NHS Boards and primary health care providers to ensure that systems for epidemiological monitoring are in place. NHS Boards will have requirements to provide regular situation reports for decision making at Scottish and UK levels.
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