« Previous | Contents | Next »
Listen
2. Context
2.1. It is impossible to forecast the precise characteristics, spread and impact of a new influenza virus strain. Modelling suggests that from the time it begins in the country of origin it may take as little as two to four weeks to build from a few to around a thousand cases and could reach the UK within another two to four weeks.
2.2. Once in the UK, it is likely to spread to all major population centres within one to two weeks, with its peak some 50 days from initial entry. An influenza pandemic can occur either in one wave or in a series of waves, weeks to months apart.
2.3. Current UK planning assumptions are based on 3 attack rates: 25%, 35% and 50%. It is important to emphasise that planning should take place across the range of possible attack rates, including the upper end of the scale.
2.4. To inform planning, we have considered the potential impact of fatality rates of 0.4%, 1%, 1.5% and 2.5%. At a 25% attack rate we could expect between 5,100 and 31,700 additional deaths in Scotland. At a 50% attack rate this could rise to between 10,200 and 63,700 additional deaths.
2.5. Separate guidance is being produced addressing the workforce and human resource issues that may arise in a pandemic. The guidance will appear on the following site: www.scotland.gov.uk/pandemicflu
2.6. The guidance will cover NHS services and their links to community care. In this regard up to 50% of the workforce may require time off at some stage over the entire period of the pandemic. This absence may includes time off to care for family members and bereavement leave as well as sickness absence. Individuals could be absent for a period of seven to ten working days. Absence should follow the pandemic profile with an expectation that it will build to a peak lasting for 2-3 weeks when between 15% and 20% of staff may be absent and then decline
2.7. Demand on mental health and other services may become stretched due to:
- an additional burden on health and mental health caused by anxiety and bereavement;
- staff absence and illness;
- illness of informal carers (e.g. family, friends and neighbours);
- pressure on social services, primary care and the interface with mental health services;
- pressures on secondary care in coping with increased demand for acute care;
- logistical problems due to disruption of supplies, utilities and transport;
- delays in dealing with other essential healthcare needs; and
- pressure on mortuary facilities, delays in death registration and funerals etc.
2.8. To respond to the increased demand for services while operating with reduced staff numbers, will require mental health services to adopt flexible approaches for assessing needs, sourcing and deploying staff and delivering care. Consideration must also be given as to whether some services should be scaled back or stopped to free up capacity. It is crucial that mental health services plan with all relevant partners so that responses are safe, co-ordinated and effective.
2.9. There is an important distinction between the preparation of general contingency plans and the preparation of emergency plans for an influenza pandemic, in that there will be a sustained impact on demand, affecting most areas simultaneously. Additionally, the pandemic may occur over more than one wave and response plans will need to cover this eventuality. While the immediate priority at the end of the first wave will be to develop recovery plans and gradually restore supplies, services and activities depleted or curtailed during the pandemic, plans must assume that some regrouping may be necessary in anticipation of a future wave.
2.10. Additional demand for healthcare and other support will mean that most influenza patients will require an initial assessment, and the majority of their subsequent care and support, outside of hospital healthcare settings. Service users will need to access care (including self care) from their own home or residential settings as far as possible to help reduce and limit the spread of infection.
2.11. This will increase pressure and demand on community care providers including General Practitioners, District Nurses and community pharmacists , and on their role in the care of mental health service users. Plans for mental health services will need to have regard to this pressure and should be consistent with the contingency plans for primary care and community care.
2.12. Community based mental health service users presenting symptoms of pandemic influenza should be advised to approach health services in the same way as the rest of the general population.
2.13. It is important that mental health services and partners plan to the same planning principles which address:
- joint working, integrated planning and delivery;
- flexible planning to deal with a range of possible scenarios and clinical attack rates;
- flexible thinking on staff capacity issues;
- public/patient information strategies;
- enabling influenza patients to remain at home;
- facilitating rapid access to antiviral medicines;
- continuity of core essential care; and
- potentially scaling back/stopping some services to free up capacity to meet other pressing demands
2.14. Planning for an influenza pandemic should reflect the needs of the local population, including the population demographics, ethnic structure and geographic dispersion of residents. This will be particularly important for communications and access to services and treatment.
2.15. Joint response plans for mental health services should adopt measures that maintain public confidence and balance individual care with the priority to reduce illness and save most lives. The following issues should be taken into account in the preparation of plans:
- given the expected increased demand, staff and supply shortages there will be capacity and priority setting issues for staff and services; and
- people with mental health problems should receive the same degree of support and protection whether at home, as residents in care homes or as in-patients.
« Previous | Contents | Next »