flu pandemic contingency plan · c outline of lincolnshire health community command and control...

FLU PANDEMIC CONTINGENCY PLAN

A FRAMEWORK FOR THE

LINCOLNSHIRE HEALTH

AND SOCIAL CARE COMMUNITY

Framework March 2006

FLU PANDEMIC CONTINGENCY PLAN

A FRAMEWORK FOR THE LINCOLNSHIRE HEALTH AND SOCIAL CARE COMMUNITY

DOCUMENT CONTROL

VERSION – FRAMEWORK MARCH 2006 DATE RATIFIED: DATE FOR REVIEW: Produced for the Health Subgroup, of the Lincolnshire Resilience Forum, serving as the Flu Pandemic Planning Committee for the Lincolnshire Health Community, the ‘lead’ Director of Public Health (East Lincolnshire PCT) acting as the Flu Pandemic Coordinator Complemented and supplemented by the Plan for Mass Vaccination/Prophylaxis Centres and by the Plans and Procedures developed by the Flu Pandemic Committees of the constituent Primary Care Trusts (PCTs), NHS Trusts and Lincolnshire County Council: East Lincolnshire PC T West Lincolnshire PCT Lincolnshire South West PCT United Lincolnshire Hospitals Trust (ULHT) Lincolnshire Ambulance Trust (LAS) Lincolnshire Partnership Trust (LPT) Lincolnshire County Council

- Social Services - Emergency Planning Unit (previously

Civil Protection Unit) (Plans and Procedures to be developed by Primary Care Services) Supported by, and in support of, the Plans and Procedures produced by the: Member agencies of the Lincolnshire Resilience Forum (LRF) HM Prisons in Lincolnshire RAF Bases in Lincolnshire Trent Strategic Health Authority ((TSHA) Regional Public Health Group (RPHG) – East Midlands Regional Resilience Forum (RRF) – East Midlands Health Protection Agency (HPA) Department of Health (DH) Cabinet Office

FLU PANDEMIC CONTINGENCY PLAN - Framework March 20061 2

Distribution:

Emergency Planning “Leads” - East Lincolnshire PCT (ELPCT) - West Lincolnshire PCT (WLPCT) - Lincolnshire South West PCT (LSWPCT) - United Lincolnshire Hospitals Trust (ULHT) - Lincolnshire Ambulance Service (LAS) - Lincolnshire Shared Services (LSS) - Lincolnshire Partnership Trust (LPT) - Lincolnshire County Council - Social Services - Emergency Planning Unit (previously CPU)

- HMP - Lincoln Morton Hall North Sea Camp

Chair Lincolnshire Resilience Forum Chairs Lincolnshire - Local Medical Committee (LMC)

- Local Pharmaceutical Committee (LPC) - Local Dental Committee (LDC)

Senior Medical Officers, Lincolnshire RAF bases DPH - SHA

- Government Office East Midlands

Regional Health Emergency Planning Adviser (HPA) Lincolnshire Health Protection Team (HPA)


AMENDMENT SHEET

Amendment No.

Section/Para/ Annex

Description of Amendments

Date Amended by (Name)

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21


FLU PANDEMIC CONTINGENCY PLAN A FRAMEWORK FOR THE LINCOLNSHIRE HEALTH AND

SOCIAL CARE COMMUNITY

CONTENTS

Page PART I CONTEXT

1 INTRODUCTION

8

2 BACKGROUND: PANDEMIC FLU - Risk 10 - Nature and Scale 10 - Other Planning Assumptions 12 - Alert Levels 13 PART II LINCOLNSHIRE RESPONSE

3 CO-ORDINATION, COMMAND AND CONTROL

15

4 COMMUNICATION AND ACTIVATION - Initial Response (Alert Level 2) 16 - Media and Helpline(s) 16 - Caseloads 17 5 HEALTH AND SOCIAL CARE (Alert Levels 3 and 4) - General Practice 19 - Other Primary Care Contractor Services 19 - Triage Systems 20 - Community Nursing 20 - Social Services 20 - Hospitals 21 - Prisons 22 - RAF bases 22 - Further/Higher Education Institutions 22 6 INFECTION CONTROL - Core Principles of Containment and Infection Control 23 - Staff Deployment 23 - Infection Control Precautions 24 - Environmental Infection Control 26 7 PUBLIC HEALTH - Antiviral Agents 28 - Immunisation 29


8

OTHER ISSUES AND ACTIONS

Page

- Registers and Databases 30 - Training and Exercises 30 - Supplies 30 - Prioritisation of Staff 30 - Childcare 31 - Other Multi-agency Support 31 9 END OF FIRST WAVE - Restoration of Normality 32 - Planning for Second/Later Wave 32 Appendices A Internal Phases of an Influenza Pandemic B Estimated “Additional Burden” C Outline of Lincolnshire Health Community Command and Control Infrastructure for Major/Mass Casualty Incidents D Patients at High Risk of Influenza – Related Respiratory Complications


PART I

CONTEXT


1. INTRODUCTION 1.1 This Plan is based on the UK Health Departments “UK Influenza

Pandemic Contingency Plan” (October 2005) and “Influenza Pandemic Contingency Planning Guidance for Health Service Planners in England” (March 2005), the Department of Health’s “UK Operational Framework for Stockpiling, Distributing and Using Antiviral Medicines in the event of Pandemic Influenza” (August 2005) and “Guidance for Pandemic Influenza: Infection Control in Hospitals and Primary Care Settings” (October 2005), and related Health and Safety Executive (HSE) legislation and guidance, and on the local Framework produced by the Health Protection Agency (HPA) – East Midlands (May 2005).

1.2 It has to be read in conjunction with the Major Incident/Mass Casualty

Plan for the Lincolnshire Health Community, and the constituent organisations’ Plans and Procedures for Major Incidents/Business Continuity.

1.3 These define the planning and the command and control arrangements

implemented for any major incident but, as identified in these Plans, some incidents, because of their nature and/or impact, require specific consideration.

1.4 A flu pandemic is one such type of incident, in “best case” scenario being

equivalent to a Level II Mass Casualty incident and in “worst case” to a Level III incident. [Levels as defined in “Beyond a Major Incident (Dept. of Health 2004) – Level I : large, but not unusual incident; Level II “exceptional” response to very large incidents with most of the health communities over the Region involved; Level III : “extraordinary” response to potentially catastrophic incidents requiring every possible resource to be utilised over an extensive area]

1.5 This Plan has been produced from discussions of the Health Subgroup

of the Lincolnshire Resilience Forum. It provides an overarching unifying framework for the response by the local Health and Social Care Community, the detail of the contingencies defined in each PCT’s/Trust’s Flu Pandemic Plans and Procedures. (Similar to be developed by Primary Care Services and Local Authorities). In so doing, the need to support RAF bases, Prisons and Higher/Further Education Institutions in the County has been taken into account.

1.6 Arrangements for the setting up and operation of

Vaccination/Prophylaxis Centres are also detailed separately in the Mass Vaccination/Prophylaxis Centres: Integrated Framework for Lincolnshire.

1.7 This Plan supports the principle underpinning the national guidance in

that the priority in an influenza pandemic is to reduce the impact on public health ie reduce illness and save lives. Interventions will, therefore, be applied where they will achieve maximum health benefit. However, they may also be needed to help maintain essential services.


1.8 In keeping with the national guidance, the focus of this Plan is to reduce,

as much as possible, unnecessary demands on General Practice and the emergency Ambulance and Hospital services.

1.9 The Plan is also based on the premise that, in a flu pandemic scenario,

mutual aid is unlikely to be available and, consequently, the Lincolnshire Health and Social Care Community needs to be self sufficient.

1.10 All the plans and procedures will be kept under review and updated as

new guidance becomes available and/or lessons are learned from exercises and incidents.


2. BACKGROUND: PANDEMIC FLU Risk 2.1 Influenza pandemics have occurred at irregular intervals throughout

history, in the last century in 1918 (”Spanish Flu”), 1957 (“Asian Flu”) and 1968 (“Hong Kong Flu”) They are associated with illness, deaths and general societal disruption far in excess of that experienced in even the most severe “seasonal “ epidemic.

2.2 An influenza pandemic can occur at any time of the year. No country is

exempt from the risk. A further pandemic is thought to be inevitable. Nature and Scale 2.3 An influenza pandemic arises when an entirely new strain of influenza

virus emerges to which most people are susceptible. A new virus may be a re-emerging previously known human virus subtype which has not recently been in circulation, or a virus of avian origin, emerging either through stepwise ‘adaptation’ conferring greater affinity for people or through a process of genetic ‘re-assortment’ between the genes of an avian and a human virus. A new strain is likely to transmit more easily to people if it contains genetic material from a human influenza virus.

2.4 Important features of influenza pandemics include:

• ability to spread widely • unpredictability • likelihood of arising outside the UK and spread to the UK within 3

months • likelihood of spreading rapidly once established in the UK, rapidly

over 2-3 weeks and gradual decline over next 4 – 6 weeks. • possibility of subsequent waves of illness weeks or months apart

2.5 The two pandemics which are within living memory behaved very differently.

The “Asian Flu” hit the UK population quickly and explosively in

September 1957 having arisen in the Far East in May 1957. This epidemic predominantly affected school children and families (adults under 50 years) with school children. Older people were hit in a second wave in December 1957 and January 1958 when higher levels of mortality were seen.

“Hong Kong Flu” emerged in July 1968 causing epidemics in various parts of SE Asia, Australia and India. A major epidemic hit the USA in the winter 1968/69. The “Hong Kong” virus was not isolated in the UK until August 1968 with outbreaks through the winter months before peaking and tailing off in April 1969. However, in the winter of 1969/70


there was an explosive outbreak in the UK, cases of illness and death falling off rapidly by the end of January 1970.

2.6 Influenza is spread mainly by the respiratory route, through droplets of

infected respiratory secretions produced when an infected person coughs or sneezes. It may also be spread by hand/face contact after touching a person or surface contaminated with infectious respiratory droplets.

2.7 People are highly infectious from the onset of symptoms for 4-5 days

(longer in children, 7 days or more, and people who are immunocompromised). People are likely to be infectious just before the onset of symptoms. Children have been shown to shed the virus for longer (several days before their illness onset and at higher levels) than adults. The incubation period is 1-3 days with historical evidence suggesting that 1 person infects on average 1.4 – 1.8 people.

2.8 The UK Plan assumes 25% of the population will develop clinical

influenza over one or more waves, of around 17 weeks each, weeks or months apart. (Compared with “seasonal” flu attack rate of 5-10%). Attack rates could be higher, the “reasonable worst case” scenario specified as a cumulative attack rate of 50% of the population, again spread over one or more waves. (NB: The “reasonable worst case” scenario is specified as a case fatality rate of 2.5%). An equal number of people may have asymptomatic infection. The second wave may be the more severe.

2.9 Attack rates, and severity of illness, are likely to vary between age

groups but, as neither children nor most adults are likely to have immunity to the new virus, a uniform attack rate, serious illness and mortality is to be assumed, for planning purposes, across all age groups.

2.10 Additional burdens on health service activity over the entire pandemic

(based on 25% clinical attack rate, 0.55% case hospitalisation rate and 0.37% overall case fatality rate) is as estimated in table below. Healthcare contacts represent the equivalent of GP consultations outside the pandemic period. It is envisaged that individuals experiencing symptoms will be diverted away from GPs in a pandemic. GP consultations represent the remaining contact required to deal with complications and with young children.

Population

ave

People with clinical symptoms/healthcare

contacts

GP Consultations

A&E Presentations

Hospitalisation Excess Deaths

1,000 250 25 13 1 1 100,000 25,000 2,500 1,250 140 90

Lincolnshire 175,610 18,065 9204 995 628


The additional burden distributed across 17 weeks of a pandemic is illustrated (in Appendix B) for the Lincolnshire population of 708,152

2.11 The UK Plan also assumes that a cumulative total of 25% of the

workforce will take 5-8 working days off over a 3-4 month period, absenteeism modelled to peak at 5-7%. This equates to about double the normal average absenteeism in the public sector, and about three times that in a private sector company. In the worst case of a 50% attack rate the figures rise to 10-15%. NB: Small organisations, and small teams within larger organisations, may experience higher rates of absence – 14 and 30% where 25% and 50% attack rates respectively).

2.12 In the absence of vaccinations, those occupations with particularly high

exposure, such as health care workers, wiIl have higher absenteeism (has been as high as 30% absenteeism at the peak). Influenza spread will be accelerated in schools and other closed communities. There will also be constraints on movement, widespread disruption and high levels of public, political and media concern.

2.13 For planning workforce availability it has been agreed to adopt the following absenteeism rates, a “worst case scenario”, across the Lincolnshire Health and Social Care Community:

Week 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

% 0 0 0.5 1.5 6 11 11 7 6 3 2 1 0.5 0.5 0 0 Other Planning Assumptions 2.14 Vaccination with a vaccine specifically formulated against the pandemic virus

strain can be expected to achieve the greatest reduction in illness – vaccine reduces infection by around 70-80%, hospitalisations in high risk individuals by around 60% and deaths by around 40%. However, vaccine will not be available in the early stages as its development cannot start until the virus strain is known. It is likely to take several months for a vaccine to be produced.

2.15 As vaccine becomes available it will be given according to nationally agreed

priorities, starting with healthcare and other essential workers. When supplies are more widely available vaccination will be offered to the general public.

2.16 Antiviral drugs are being stockpiled nationally but there will not be an unlimited

supply. They may be used initially to try to contain small outbreaks and later to treat certain narrowly defined priority groups. Early treatment (within 48 hours of onset of illness) should shorten illness by around 1 day, reduce the severity of symptoms and reduce the need for hospitalisation.


Alert Levels 2.17 A four step alert mechanism has been developed for the UK (to complement

WHO/International Inter-Pandemic and Pandemic period phases). Should the UK have cases during the pre pandemic phase, the international phases apply (See Appendix A).

UK Alert Level Definition 0 No cases anywhere in the world 1 Cases only outside UK (in a country or countries with or without

extensive UK travel/trade links) 2 New Virus isolated in UK 3 Outbreak(s) in UK 4 Widespread activity across UK A move to a higher alert level may be triggered if, assessing the risk, influenza

due to a pandemic strain is affecting another country geographically close to the UK, although technically it is still ‘outside the UK’.

2.18 On being alerted to the isolation of a new influenza virus with pandemic

potential the Department of Health will warn other Government Departments, the HPA and, as necessary, other health organisations, in order to review national preparedness. On confirmation of the onset of a pandemic the Department of Health will alert the NHS, and others, of the need to be prepared to activate plans.


PART II

LINCOLNSHIRE RESPONSE


3. COORDINATION, COMMAND AND CONTROL 3.1 The Health Subgroup of the Lincolnshire Resilience Forum will continue to

serve as the Pandemic Influenza Planning Committee for the Lincolnshire Health and Social Care Community.

- Supporting the coordinated development, maintenance and testing of

local contingency arrangements - The ‘lead’ Director of Public Health (DPH ELPCT) acting as countywide

Influenza Pandemic Coordinator. 3.2 Each of the constituent PCTs and Trusts will have their own Committees and

Coordinators with responsibility for developing the detail of the organisation’s contribution to the Health Community response and of its own business continuity arrangements.

3.3 PCTs are also responsible for involving and mobilising General Practice and

other Primary Care and Independent Sector services and resources. 3.4 In the pre pandemic phases activities will be directed towards:

• maintaining the annual influenza immunisation programmes for identified ‘at risk’ groups

• ensuring local plans are kept up to date • raising awareness/understanding of the plans through the media and

education/training events for staff • testing the plans • contributing to local and UK surveillance

3.5 Suspected cases will be managed in accordance with the algorithm produced

by the HPA (latest version on www.hpa.org.uk), with consideration given to the appropriateness of antiviral treatment for the case(s) and prophylaxis for close contacts and necessary infection control measures.

3.6 When the NHS is alerted by the Department of Health to the onset of a

pandemic, the Health Subgroup will assume the role of Health Community Coordination Group (HCCG), in accordance with the agreed generic Major Incident/Mass Casualty response infrastructure (Appendix C).

3.7 Other organisations will be alerted through the auspices of the Lincolnshire

Resilience Forum (LRF) in anticipation of the likely need to declare a Major Incident and seek the establishment of a multi-agency Gold Command. NB: In a Flu Pandemic situation the NHS will be expected to be the lead ‘Agency’.


http://www.hpa.org.uk/

4. COMMUNICATION AND ACTIVATION Initial Response 4.1 At level 2 (New virus isolated in UK) the initial response will be to: • Communicate with Managers, Staff and Practitioners to keep them informed

and to be informed of state of preparedness and ability to respond. (HCCG/All organisations)

• Establish ‘baselines’ of workforce and capacity across the Health Care, Social Care and Independent Sector Services. (HCCG/All organisations)

• Review work schedules/rotas and receive plans for reducing activity and redeployment of staff to key areas for business continuity and in support of the pandemic response. (HCCG/All organisations)

• Keep the general public informed, liaising with the local media and NHS Direct in disseminating national guidance with details of the local arrangements being established. (HCCG)

• Prepare for the setting up of the local help-line to supplement, as necessary, NHS Direct, in providing information and advice to concerned public and patients. (HCCG)

• It will also be necessary to establish within each NHS and SS organisation reporting channels via line managers to enable staff to seek support in advance of care/services being unable to be provided and to enable SITREP reports to be relayed to local Gold Command and to the Strategic Health Authority (SHA). (All organisations/HCCG)

• Review and prioritise, as appropriate, registers of vulnerable patients/clients and caseloads. (All organisations)

• Identify and address training needs of staff likely to be redeployed and/or to have to undertake other duties. (HCCG/All Organisations)

NB: Staff may be required to work outside their job specification but they should not be required to work outside their level of competency. 4.2 As identified, an aim throughout is to keep as much pressure as possible off the

services of General Practice, of Ambulance Control (re triage and emergency transport), and of the Hospitals so that they can continue to provide for those with illnesses unrelated to the pandemic as well as those acutely ill with the influenza.

Media and Helpline(s) 4.3 This will be achieved by continuing to educate and inform the general public

through published materials and use of the media and by establishing a local helpline, as needed, to supplement the resources of NHS Direct.

4.4 Media messages and relationships will be managed via the National, Regional

and multiagency Lincolnshire Communications Networks in accordance with agreed policies and procedures.

4.5 In the first 2-3 weeks most calls from the public will be the “worried well”. They

will be guided to contact NHS Direct, in the first instance, for basic information and advice. The local helpline will also be established utilising the facilities of Lincolnshire County Council’s Customer Services Centre, staffed by PCT and non Acute Trust staff.


4.6 People suffering flu like symptoms who are otherwise well will be advised through the media, NHS Direct and the local helpline, to take over the counter medicines and to stay at home until recovered.

4.7 If such patients’ symptoms worsen they will be advised to contact the nearest

‘Flu Centre’ (see below). They will be ‘triaged’ over the phone by a Nurse (with GP back up) using an agreed ‘Flu’ algorithm to determine if a visit to the Centre or home visit is necessary.

4.8 It is proposed that a Health Centre or larger Practice premises will be identified

in 8 localities across the County (to accord with the 8 ‘cluster’ areas being established to implement Practice Based Commissioning) to serve as designated ‘Flu Centres’. They will be staffed primarily by Community Nurses with PCT/non Acute Trust administrative support and on site clinical advice provided by General Practitioners.

4.9 Those patients with acute illness or long term illnesses with or without flu like

symptoms, and parents of young children, will be advised to contact their GP surgery to facilitate their acute or continuing care and/or their particular needs to be appropriately met.

4.10 Emergency cases will be advised to contact the Ambulance ‘triage’, in and, as

the outbreak develops, out of hours, where ‘Flu’ cases will again be assessed in accordance with agreed algorithms.

4.11 The above approach is, therefore, intended not only to minimise the impact of

overall caseload on General Practice but also to reduce the problems of infection control (See Section 6). Staff will be provided with, and trained in the use of, agreed protocols, algorithms and related procedures.

Caseloads 4.12 The aim of reducing the pressure on the services (and of minimising the spread

of infection, see 6) will also be achieved by people being cared for/treated in their normal place of residence, ie own home, Residential or Nursing Home.

4.13 Health Visitors and District Nurses will ensure that the vulnerable

children/young people, adults and elderly can be identified and can continue to be provided for (including provision of medicines, Home Oxygen supplies and maintenance of water supplies for those on dialysis). Health and Social Services staff will share their respective Registers of Vulnerable Patients/Clients. Patients living in their own homes will be given priority, as those in Residential and Nursing Homes have other support mechanisms available.

4.14 As identified above, reporting channels will also be established for carers and

staff working in the community to enable support needs to be identified before the care system/service breaks down, with other staff deployed if necessary, and as appropriate to the needs of the individual(s). The Health Community Co-ordination Group will establish a ‘Staff Bureau’ operations function utilising the facilities of the Lincolnshire Partnership Trust Incident Room at Gervas House, Lincoln. Regular, at peak of pandemic at least daily, reports will thus be received on the availability of personnel from across Health and Social Care Services and the relevant voluntary and private sectors.


4.15 Information on skills and experience, and also on the flu and vaccination status of staff, will also be provided via these reporting channels to the ‘Staff Bureau’ to aid in their appropriate deployment, social support, clinical and geographical (see later re Infection Control - Section 6). This information, with that from the Emergency Care Capacity Management and triage systems will enable the Health Community Co-ordination Group to effectively fulfil its role.


5. NEXT STAGES 5.1 At alert Level 3 (Outbreak(s) in the UK) the Lincolnshire PCTs, Trusts, Primary

Care and Social Services will fully activate their Escalation/Major Incident/Business Continuity Plans across commissioning, provider and support functions (as detailed in separate Plans and Procedures documents).

General Practice 5.2 As identified, use will be made of the media, NHS Direct and the local helpline

to inform and advise patients and public and reduce the pressure across the Health Services. However, there will undoubtedly still be additional calls made to General Practices with staff redeployed to provide additional reception/administrative capacity required. Where possible, PCT/non Acute Trust staff will provide support to the Practices.

5.3 General Practice Contingency Plans will include not only arrangements for

business continuity within the Practice but also, if/as necessary/appropriate, those with other Practices in the locality for staff cover and/or for shared use of premises if staffing levels became insufficient to keep all practices open.

5.4 As also identified, designated ‘Flu Centres’ will be established in localities

across the County to provide for adult patients with ‘flu like symptoms’/the flu who are otherwise well ie do not suffer from long term conditions or have other special need. Operational procedures will be developed and agreed with the local GPs and Community Nurses, the GPs to provide the clinical support to the nursing, and other, staff manning the ‘Centre’.

5.5 These General Practice Plans and Procedures will address the increased

demand and requirement for home visits (patients ill, lack of transport) and the need to minimise transmission of infections (See 6). Their implementation will be initiated and monitored by the Health Community Coordination Group via the PCTs’ Flu Pandemic/Major Incident response infrastructure and the SITREP mechanisms.

5.6 The aim, therefore, is to keep as many General Practices open for as long as

possible. The desirability of practitioners having access to clinical systems from different practices/other facilities will be pursued with the Informatics Service. Out of hours arrangements will be incorporated with the Ambulance triage system if/when deemed necessary to ensure 24 hour access.

Other Primary Care Contractor Services 5.7 Pharmacy, Dental and Ophthalmic Services will also have Business

Contingency Plans to address the issues of staffing, supplies and maintaining essential services. The particular demands on, and implications for, pharmacies will require similar responses as in General Practice, with the businesses expected initially to pool resources (stock and staff) and share facilities as required. Arrangements and procedures for the centralised acquisition, delivery, storage and onward distribution of supplies will be developed to be implemented if required.


Triage Systems 5.8 As identified, as the outbreaks become more widespread (into Alert Level 4)

and cases increase in the County, the Health Community Coordination Group will instigate and oversee implementation of the triage systems operating in General practices and the designated ‘Flu Centre’ (as described previously) and in the Lincolnshire Ambulance Control Centre.

5.9 The existing 13 Nurses in Ambulance Control who normally provide the triage

(protocol driven, to be adapted as necessary to accord with national/locally agreed criteria) will be supplemented by at least an additional 20 nurses (estimated number needed to provide for the additional demand and cover for anticipated staff absence) from a pool of First Contact Nurses and others identified and trained for this role from across the PCTs/Trusts.

5.10 The Ambulance triage system will continue to operate 24 hours/day and, as

identified above, will incorporate the normal PCT/GP out of hours arrangements when, and for as long as, determined by the Health Community Co-ordination Group.

5.11 The Ambulance Service triage process will also continue to be supported by the

Capacity Management System which is being developed to hold up to date information on Hospital bed capacity across the County thus enabling patients to be directed to the most appropriate provision. Referral and admission protocols will be developed in accordance with National/Regional guidance and/or local circumstances. As identified previously, the information from the Capacity Management System along with that from the ‘Staff Bureau’ operations function will enable the Health Community Co-ordination Group to make the most effective and efficient use of the resources available.

Community Nursing 5.12 As also identified previously, Health Visitors and District Nurses will ensure that

their vulnerable patients are provided for in order to avoid unnecessary admissions to hospital

5.13 Provision will also be made to care for the additional numbers of patients whose

admissions have been cancelled and for those who have been discharged earlier than would be usual.

5.14 Community Hospital and Primary Care beds will be used as “step up”/”step

down” provision for patients with the more significant health care needs. 5.15 Community Nursing capacity will be enhanced by (re)deployment of other

Primary Care Nursing staff eg Bank/Agency Nurses, School Nurses, Specialist Nurses and by Nurses from Lincolnshire Partnership Trust.

Social Services 5.16 As also identified previously, Community Nurses will prioritise patients on their

caseloads who are living at home over those in Residential and Nursing Homes, the latter having support not available to those in their own home.


5.17 The Free Nursing Care (FNC) Nurse Assessors and other NHS Nurses (as above) will, where possible, provide back-up with support from the Voluntary Sector. Professional registration, training and associated Criminal Records Bureau (CRB) legal and indemnity issues for Voluntary Sector and other recruited/redeployed staff will have to be addressed.

5.18 It is the County Council’s responsibility to ensure that the Social Services’ own

Business Continuity Plans, and those of their Home owners, are adequate and appropriate. Such contingencies should include, in the first instance, staff rostering, shared rotas, short term transfers/residential care, then with multi-agency support, use of schools/University accommodation, hotels and holiday centres, ie facilities where there is an existing infrastructure and available staff can be concentrated in fewer locations.

5.19 Such arrangements will also be necessary to provide for the large numbers of

vulnerable people being provided with Home Care, much of this work also contracted out. If the contingency arrangements are not adequate then, by default, those people are likely to put additional pressure on the already pressured NHS.

Hospitals 5.20 All the acute hospital sites will have implemented their routine Escalation Plans

and Procedures, from Alert Level 2 stage at the latest, ‘up-sizing ‘ and ‘down-sizing’ re Out Patient and elective services.

5.21 Patients self-presenting at Accident and Emergency Departments will be

triaged as quickly as possible when identifying themselves at reception. Where influenza is suspected they will be directed immediately into the ‘Flu’ designated area of the Department for assessment.

5.22 Patients referred to hospital will be admitted via a designated Flu Entrance.

They too will be assessed for admission in accordance with Nationally/Regionally and/or locally agreed criteria.

5.23 Patients admitted with influenza, and those in hospital with other conditions who

then develop the infection, will be cared for within designated ‘Flu’ wards. Patient, visitor and staff movement will be controlled as much as possible.

5.24 Loss of capacity at each of the ULHT sites has been estimated at the peak of

the Pandemic to be equivalent to: - 3 wards Pilgrim Hospital - 4 wards Lincoln Hospital - 1-2 Wards Grantham Hospital - 1 ward Louth Hospital 5.25 The Trust’s Contingency Plan includes redeployment of medical and nursing

staff from non-essential areas and managers with the requisite medical or nursing skills. The Health Community Coordination Group will also facilitate support from Primary Care and the Lincolnshire Partnership Trust services. Support will also be sought, via the SHA, from neighbouring health communities but, as highlighted in the Introduction, the Plans assume that mutual aid is unlikely to be available in a Flu Pandemic situation.


5.26 Other key capacity issues for the acute hospitals will be in relation to artificial ventilation and mortuary facilities (see later).

5.27 The Community Hospital/Intermediate Care beds will serve as step up/down

facilities for those with medical/needs that do not require care in an acute hospital setting but which cannot be provided for in the Community. Facilities of Independent Treatment Centres/Hospitals could similarly be utilised to provide such additional capacity.

5.28 Those beds will not provide ‘back up’ for breakdown in Social Care or

Community Nursing care. If necessary, in such circumstances, closed wards in the acute hospital(s) and/or Independent Sector will be required to provide the facility and infrastructure as long as staff (Social Services, Nursing, Voluntary) can be relocated to provide the patient/client care.

Prisons 5.29 The three HM Prisons in the County, Lincoln, North Sea Camp and Morton Hall,

have each developed their own Major Incident Plans and have addressed the response needed to a Flu Pandemic.

5.30 The populations of the three Prisons are very different. However, as ‘closed

communities’ (noting that North Sea Camp is an Open Prison) spread of infection is likely to be accelerated. The flu ‘wave’ potentially starting sooner and finishing earlier than in the general population with a higher peak.

5.31 Prison staff are likely to be similarly affected, necessitating not only

arrangements for mutual aid from other Prisons but also support from Primary Care and Community Healthcare staff. PCTs also have responsibility to ensure antivirals and vaccines when available, are made available to Prisons, and other closed communities (See Section 7).

5.32 Once the waves in the Prisons have reached their peak, Prison healthcare staff

will be able to reciprocate support to colleagues in the Primary Care and Community Health Services.

RAF Bases 5.33 There are five RAF bases in Lincolnshire, Waddington, Coningsby, Cranwell,

Digby and Scampton with a total of in excess of 6000 military personnel and of 5000 dependents, many of whom no longer live in married quarters but in the local community. Some families may live many miles away.

5.34 As for Prisons, the PCTs have responsibility to make, when available, antivirals

and vaccines (See Section 7) available to RAF bases. Specific Plans and Procedures will be developed and agreed with the relevant RAF Medical Officers (if necessary also to address mutual aid issues).

Further/Higher Education Institutions 5.35 The implications in relation to the colleges and the University in the County will

depend on the nature of the pandemic, the time of year and on any additional guidance forthcoming on the matter of closures. Again specific Plans and Procedures will be developed and agreed with the local Further/Higher Education Institutions to cover the various potential scenarios.


6. INFECTION CONTROL NB: Guidance detailed in “Guidance for Pandemic Influenza : Infection Control

in Hospitals and Primary Care Settings” (DH/HPA Oct 2005) is also relevant to other community settings eg Residential Care and Nursing Homes and Prisons, Military and Educational Institutions healthcare facilities.

Core Principles of Containment and Infection Control 6.1 Details of modes of transmission of influenza viruses has been outlined in the

Background (See Section 2). Experimental studies of virus survival suggest that it can:

• Survive for limited periods of time in the environment • Be transferred from contaminated surfaces onto hands • Be easily inactivated by commercially available alcohol hand disinfectant

Thus, contact spread is likely to be important unless controlled by careful and

frequent hand washing and environmental cleaning. 6.2 During a pandemic Health and Social workers (ie all workers employed in

health and social care settings) can be exposed to persons with influenza through their normal daily lives both inside and outside of work.

6.3 Limiting transmission of pandemic influenza requires application of tried and

tested principles including:

• Timely recognition of cases • Standard Infection Control and Droplet Precautions • Administrative controls, such as the segregating or cohorting of patients,

restricting ill workers and visitors • Education of staff, patients/clients and visitors • Treatment of patients/clients and staff with antivirals • Vaccination

6.4 However, in a pandemic:

• Workers who may be unfamiliar with standard Infection Control policies and procedures may be asked to look after patients/clients with influenza

• Services do not normally operate in facilities or in a manner allowing for segregation

• There may be limited supplies of antivirals and vaccines in the early stages/first wave

• Personal Protective Equipment (PPE) may be in short supply. Staff Deployment 6.5 Before commencing duty all staff will be required to report any flu like

symptoms to their line manager (or equivalent) who will advise accordingly. Similarly, if a member of staff develops such symptoms whilst on duty s/he must report to their line manager immediately.


6.6 As a general principle, all Health and Social Care workers who have symptoms

of pandemic influenza should be excluded from work to avoid infecting patients/clients, colleagues and others. However, where staff shortages are extreme, line managers may allow symptomatic staff to work provided they work in parts of the facility segregated for the care of influenza patients/clients and avoid contact with non influenza patients/clients and staff who remain well.

6.7 All workers who have recovered from pandemic influenza will have to report to

their line manager before commencing duties to allow their illness to be recorded. This group of workers can care for people with influenza.

6.8 Health and Social Care workers assigned to care for patients/clients with

pandemic influenza or who work in areas segregated for such patients should not be assigned to care for those who do not have influenza or to work in non influenza areas. Exceptions include: • In hospitals where disciplines have limited number of staff, eg medical,

allied health professionals, although segregation of staff needs to be maintained as much as practically possible.

• In situations where care and management of the individual would be compromised.

6.9 In some Primary Care and Community settings such deployment/segregation

may not be feasible, but alternative mechanisms such as designating particular staff to see all patients with flu symptoms in am/pm surgeries, home visits etc can be introduced.

6.10 The arrangements for the acute hospital sites have been outlined in the

preceding sections. As highlighted previously, by aiming to divert all but young children and patients with long term conditions or with other special needs away from General Practice it is hoped that the numbers of patients with flu like symptoms/the flu needing to be seen by/in General Practice will be kept to a minimum and thus make the implementation of infection control arrangements in these settings easier.

6.11 Health and Social care workers who have recovered from pandemic flu or have

received a full course of vaccination across the pandemic strain will be prioritised for the care of patients/clients with pandemic influenza.

6.12 Workers who are at high risk for complications from pandemic influenza (eg

pregnant women, immunocompromised) will be assigned work away from direct patient/client care for the duration of the pandemic or until vaccinated if appropriate. The Occupational Health Department will advise such NHS staff.

Infection Control Precautions 6.13 “Hand Hygiene” for staff, patients/clients and visitors is the single most

important practice. Hands will be washed, with soap and water, before and after all contact with an infected patient/client or their care area, removal of protective clothing and cleaning of equipment and where hands are visibly contaminated. Hands are then to be dried thoroughly using paper towels that are discarded in waste bins (preferably with foot operated lids).


6.14 As part of good practice, hand decontamination will also be undertaken using

alcohol hand rub. The solutions must be used, on hands that are free of dirt, where patient contact has taken place.

6.15 Appropriate Personal Protective Equipment (PPE) for care of patients/clients

with pandemic influenza is summarised in the table below. Care in the correct donning and removal of PPE is essential to avoid inadvertent contamination.

ENTRY TO

COHORTED AREA BUT NO PATIENT

CONTACTa

CLOSE PATIENT CONTACT (<3

FEET)

AEROSOL GENERATING

PROCEDURESbc

Hand Hygiene Gloves Xd e Plastic Apron Xd X Gown X Xfg g

Surgical Mask X FFP 3 respirator X X Eye protection X Risk Assessment a Standard Infection Control Principles apply at all timesb Examples of aerosol-generating procedures include intubation, nasopharyngeal

aspiration, tracheotomy care, chest physiotherapy, bronchoscopy, nebuliser therapy and autopsy of lung tissue

c Wherever possible, aerosol-generating procedures should be performed in side rooms or other closed single-patient areas with minimal staff present

d Gloves and apron should be worn during certain cleaning procedures

e Gloves should be worn in accordance with Standard Infection Control Principles. If glove supplies become limited or pressurised, this recommendation may need to be relaxed. Glove use should be prioritised always for contact with blood and body fluids, invasive procedures, and contact with sterile sites

f Consider in place of apron if extensive soiling of clothing or contact of skin with blood and other body fluids is anticipated (eg during intubation or caring for babies)

g If non-fluid repellent gowns are used a plastic apron should be worn underneath 6.16 A surgical mask should be worn by healthcare workers for close patient

contact (eg within 3 feet), where the patient is symptomatic. This will provide a physical barrier and minimise contamination of facial mucosa by large particle droplets, one of the principal ways influenza is transmitted.

6.17 Staff involved in the care of patients in a cohorted area/multiple patient area eg flu clinic, will wear a single surgical mask upon entry to the area and to keep it on for the duration of the activity or until the surgical mask requires replacement.

6.18 A disposable respirator providing the highest possible protection factor available (ie an EN149:2001 FFP3 disposable respirator) should be worn by health care workers when performing procedures which have the potential to general aerosols (Aerosol-generating procedures: include intubation, nasopharyngeal aspiration, tracheostony care, chest physiotherapy, bronchoscopy, nebuliser therapy).


6.19 In maintaining respiratory etiquette, the nose and mouth should be covered with disposable single use tissues when sneezing, coughing, wiping and blowing noses. The tissue to be disposed of in the nearest bin (as above) and hands washed.

6.20 In common waiting areas, or during transport, patients/clients who are coughing/sneezing will wear surgical masks (where tolerated) to assist in the containment of respiratory secretions and to reduce environmental contamination.

6.21 The purchase, delivery, storage and distribution of PPE will be co-ordinated by

the Health Community Co-ordination Group. If/as required, given limitations of storage capacity and/or concerns re security, Lincoln Prison will serve as a central site for delivery and storage. Transport for onward distribution will be provided by Lincolnshire Shared Services (thus conserving Ambulance/Patient Transport Services for the transfer of patients).

Environmental Infection Control

6.22 No special handling procedures for linen, laundry, crockery, utensils, waste beyond those principles/arrangements routinely applied.

6.23 The appropriate use of PPE will protect uniforms from contamination in most circumstances. During a pandemic Health and Social Care workers should not travel to and from work in uniform.

6.24 Patient cohorted areas and clinical rooms, including hospitals, General Practice, Nursing Homes, Prison medical units, should be cleaned daily at a minimum. Frequently touched surfaces should be cleaned at least twice daily and when known to be contaminated.

6.25 Domestic staff should be allocated to specific areas and not moved between influenza and non influenza areas.

6.26 No special handling procedures beyond those for Standard Infection Control Principles are recommended for clinical and non-clinical waste that may be contaminated with influenza virus. Waste will be collected in accordance with the latest guidance (ref Countywide Waste Policy 2004).

Category Bag Description

Domestic waste (non clinical)

Medium black bag Household waste

Infectious diseases waste (clinical)

Medium yellow bag inside medium yellow bag

“Any waste which consists wholly or partly of human or animal tissue, blood or other body fluid excretions, drugs or other pharmaceutical products, swabs, dressings or syringes, needles or other sharp instruments being waste which unless rendered safe may prove hazardous to any person coming into contact with it”


6.27 The PCT contractor company has contingency plans in place taking on board additional incineration capacity, refrigerated trailers, and increase in transport fleet. The point of contact for initiation and stand down will be Operations Manager at Lincolnshire Shared Services.


7. PUBLIC HEALTH 7.1 Local Public Health control measures are broadly “medical” ie use of antivirals

and immunisation, or “social”, ie personal hygiene and segregation (as addressed in Section 6).

Antivirals 7.2 Antivirals are to be used primarily for patient treatment once a pandemic is

established in the absence of, or as an adjunct to, vaccination. Although the stockpiles being built up nationally are intended to provide treatment for all influenza patients who might benefit, small amounts may be devolved to controlling and limiting the spread of a pandemic in the initial stages.

7.3 National decisions on treatment priorities will be taken if demands threaten to

exceed available supplies. Treatment will be offered in, provisional, order of priority to healthcare workers, if/when they develop fever/flu like symptoms, the high risk group of patients, ie those considered most at clinical risk from influenza related respiratory complications in seasonal outbreaks (See Appendix D), other unimmunised people.

7.4 The overall aim is to ensure that antiviral medicines are available to treat

patients suffering from influenza within 24-48 hours of the onset of symptoms. 7.5 Supplies to Lincolnshire will initially be delivered to Lincoln Prison for storage

and then distributed to the hospital pharmacy Lincoln County Hospital, and if necessary/appropriate, to the 3 other hospitals (Pilgrim Hospital, Boston, Grantham and Louth Hospitals) for onward supply.

7.6 The Pharmacist(s) will monitor availability/supply/use and provide the

information required for the Health Community Co-ordination Group and the Strategic Health Authority (SHA).

7.7 The Health Community Co-ordination Group will determine the appropriate

distribution of antiviral medication. This will be to the Hospitals and/or General Practices and/or the designated ‘Flu Centres’ (and/or Prisons/RAF bases/Further Education/Higher Education establishments) depending on the amounts made available and the groups prioritised.

7.8 It is proposed that if the numbers to be provided for cannot be coped with via

the 8 designated ‘Flu Centres’ some or all of the facilities (schools) identified as Mass Vaccination Centres should be used. They will have been assessed for accessibility, security, patient flow etc and operational policy and procedures, including those for patient identification and record keeping, can be readily adapted to serve as Mass Prophylaxis Centres. If necessary, existing mobile medical units (eg Breast Screening, Diabetic Retinopathy) can also be redeployed to provide appropriate facilities.

7.9 The Lincolnshire Shared Services (LSS) will have responsibility for securing

transport of the antivirals to the hospital pharmacies and thence to the designated Access Points/Centres/other establishments/facilities identified.


7.10 Pharmacists and other health professionals will be able to supply antivirals following a clinical protocol and authorised by a Patient Group Direction (PGD) or Patient Specific Directives (PSD) thereby allowing hospital doctors and General Practitioners to focus on patients with the greatest clinical need.

7.11 As indicated previously, the Occupational Health Service will provide advice in

relation to NHS staff for whom tamiflu and/or vaccination is contraindicated. Immunisation 7.12 As identified, a specific vaccine is unlikely to be available in any quantity at

least in the early stages of a pandemic. There will therefore be 3 stages:

• No vaccine available • Vaccine in limited supply • Vaccine widely available

The lead time before a new vaccine becomes available in quantity is likely to be at least 4 months.

7.13 Nationally, a tiered approach to immunisation is planned, immunising tranches of the population according to availability of vaccine. If vaccine supplies are limited healthcare workers, and possibly some other essential service key workers, may need to take precedence over some of the risk groups prioritised for vaccine in inter pandemic years.

7.14 The Health Community Co-ordination Group will agree in advance the lists of

prioritised staff and allocate vaccine according to availability. Immunisation of staff will be carried out in designated workplace sites across the health community.

7.15 The Health Community Co-ordination Group will also oversee the mass

vaccination programme for the Lincolnshire population. The detail of arrangements are defined in the ‘Mass Vaccination/Prophylaxis Centres: Integrated Framework for Lincolnshire’. The Centres are to be based in 18 designated Secondary Schools and a further 18 Primary Schools as back up. If additional facilities are needed existing Rest Centres will be able to be brought into operation.


8. OTHER ISSUES AND ACTIONS Registers and Databases 8.1 As identified, Registers of vulnerable children/young people, adults and elderly

will need to be established and maintained. Health and Social Services practitioners will share the information on these patients/clients and keep one another updated on any changes in their circumstances.

8.2 As also identified previously, ‘databases’ will similarly be established and

maintained with details of the experience and skills of staff, of their flu/vaccination status and of contraindications to antivirals and/or vaccination. Appropriate governance arrangements will be put in place in relation to the redeployment of staff and the active involvement of people from the voluntary sector and volunteers.

Training and Exercises 8.3 Specific training programmes will be developed and delivered for administrative

and clinical staff, in addition to general awareness sessions and exercise/scenarios for all.

8.4 Where appropriate, these programmes and exercises will be undertaken on a

multi-agency basis. By identifying the specific staff groups who will be redeployed to other service areas/functions much of the training will be able to be provided in advance of the pandemic. However, it will also be necessary to provide for some “just in time” appropriate/according to circumstances at the time.

8.5 This training will, as relevant, incorporate adherence to nationally and/or locally

produced protocols for giving advice, triage, referral, assessment, admission, treatment, infection and environmental controls.

Supplies 8.6 General supplies, as well as those specifically related to the pandemic ie, anti-

virals and vaccine, are likely to be affected by loss of workforce and by disruption to fuel supplies and to the transport infrastructure. Medicinal supplies requiring refrigeration will be delivered to the Pharmacy at Lincoln County Hospital (and as necessary the other hospitals’ pharmacies) for appropriate storage and/or distribution. As identified, medical supplies not requiring refrigeration and other supplies, as necessary, will initially be delivered to, and stored on, the Lincoln Prison site, facilitating security.

8.7 As identified previously, the Lincolnshire Shared Services (LSS) will have

responsibility for securing the transport of medical supplies, (protecting transport services for patients), the Emergency Planning Unit (formerly Civil Protection Unit) having responsibility for that of non medical supplies.

Prioritisation of Staff 8.8 As also indicated, prioritised lists of staff will be produced and agreed to support

decisions re antivirals and vaccinations, and other relevant situations arising eg fuel supply disruption.


Childcare 8.9 Contingency arrangements will be agreed with existing crèche/childcare

providers, Social Services and the Education Authority in order to minimise the need for staff to care for their child/ren if their own childcare arrangements break down.

Other Multi-agency support 8.10 The Emergency Planning Unit will assist with mobilisation of the resources of

the voluntary sector and with securing additional mortuary capacity. 8.11 The Police will provide support to enhance security where there is a risk of

public disorder, though the ability to respond will depend on staff availability and the need to prioritise protection of major facilities.

8.12 Anglian Water will prioritise supply to the hospitals and other agreed healthcare

facilities and to identified vulnerable patients in the community. 8.13 The other Utility organisations will, similarly, agree priorities for maintenance

and/or resumption of their services.


9. END OF FIRST WAVE Restoration of Normality 9.1 As the first wave of the pandemic starts to decline the focus of the response will

shift to restoration of normality and preparation for a second/later wave. This will continue to be overseen by the Health Community Coordination Group.

9.2 This phase will include counselling and bereavement support to patients and

staff who have suffered loss of relative(s) or close friends from the influenza. Occupational Health and Lincolnshire Partnership Trust staff will liaise with hospital pastoral staff and voluntary services in the coordination and provision of the necessary support.

9.3 It will also include internal organisational, cross Health and Social Care

Community and multi-agency, debrief of the response to the first phase to learn lessons and make any required changes to Plans and Procedures in anticipation of a second/later wave of the pandemic.

Planning for a second/later wave 9.4 The planning for a second/later wave will not only have to address lessons from

the response to the first wave but will also have to remodel the “additional burden” and capacity profiles from the epidemiological evidence and plan for the establishment and operation of Mass Vaccination Centres.

9.5 As identified, the plans for the Mass Vaccination/Prophylaxis Centres are

detailed separately.


APPENDICES

Appendix A INTERNATIONAL PHASES OF AN INFLUENZA PANDEMIC INTER-PANDEMIC PERIOD Phase 1 No new influenza virus subtypes have been detected in humans. An

influenza virus subtype that has caused human infection may be present in animals. If present in animals, the risk of human infection or disease is considered to be low.

Phase 2 No new influenza virus subtypes have been detected in humans.

However, a circulating animal influenza virus subtype poses a substantial risk of human disease.

PANDEMIC ALERT PERIOD Phase 3 Human infection(s) with a new subtype, but no new human-to-human

spread, or at most rare instances of spread to a close contact. Phase 4 Small cluster(s) with limited human-to-human transmission but spread

is highly localised, suggesting that the virus is not well adapted to humans.

Phase 5 Large cluster(s) but human-to-human spread still localised, suggesting

that the virus is becoming increasingly better adapted to humans, but may not yet be fully transmissible (substantial pandemic risk).

PANDEMIC PERIOD Phase 6 Pandemic phase: increased and sustained transmission in the general

population Past experience suggests that a second, and possibly further, waves

of illness caused by the new virus are likely 3-9 months after the first wave has subsided. The second wave may be as, or more, intense than the first.

POST PANDEMIC PERIOD Return to inter-pandemic period

Appendix B ESTIMATED ADDITONAL BURDEN CALCULATED FOR LINCOLNSHIRE POPULATION OF 708,152 Estimated clinical cases, excess GP consultations, excess hospitalisations required, beds occupied and excess deaths for a Lincolnshire population of 708,152 during an influenza pandemic, distributed by week of pandemic activity

Week

Clinical Cases

GP

Consultations

Minimum total excess

hospitalisations required

Bed Occupancy (end of wk)

Excess deaths

1 252 26 1 12 357 37 2 13 1435 147 8 64 5460 562 31 215 18466 1899 105 706 37716 3880 213 1447 37030 3809 210 1418 24976 2569 141 959 16996 1749 96 65

10 13202 1358 75 5011 9156 942 52 3512 4557 469 26 1713 2744 282 16 1014 1512 155 9 615 1148 118 7 416 351 37 2 117 252 26 1 1

OUTLINE OF LINCOLNSHIRE HEALTH COMMUNITY COMMAND AND CONTROINFRASTRUCTURE FOR MAJOR/MASS CASUALTY INCIDENTS

INCIDENT(S)

- Convened by ‘Lead’ DPH - Emergency Planning ‘Leads’, as/when appropriate, from Lincs PCTs, Trusts and LA and H

responsibilities for: - ensuring tactical decisions co-ordinated/not conflict - ensuring required mutual aid secured - supporting ‘NHS Gold Commander’, if multi-agency Gold Command established, advisin

- immediate/short term mutual aid requirements - potential short term recovery phase needs - longer term ‘return to normality’ needs

- To meet in an appropriate Control Centre - Can continue to meet when multi-agency incident ‘stood down’ to co-ordinate ongoing NHS

- instigate, as approp, ORGANISATION MAJOR INCIDENT/BUSINESS CONTINUITY PROCEDURES including:

- reporting as SUI to Trent SHA - advising ‘lead PCT’

+ -

- ‘Silver’ managers/officers from Ambulance, ULHT and relevant PCT(s), (incluHealth rep) and Police and/or Fire Services

- meet together as team(s) or ‘virtual’ with responsibilities for: - tactical decision support to ‘Bronze(s)’ - informing ‘Lead PCT’ (DPH or Director on call if out of hours) of incident (a

for updates, if approp) - advising ‘Lead PCT’ (as above) if potential/likely to affect other PCT(s) pop- advising ‘Lead PCT’ (as above) if require/likely to require mutual aid from o

the Lincs/other Health Community(ies) - advising ‘Lead PCT’ (as above) if require/likely to require establishment of

MULTI-AGENCY TACTICAL (SILVER) COMMAND(s)

’

- DPH to ensure, in liaison with SHA, relevant PCT(s) informed/involved, as approp - DPH to co-ordinate, with support of the SHA as required, securement of the mutual aid req

- by ‘virtual’ means via relevant Lincs PCT/Trust/LA Emergency Planning leads [Director(shours]

OR - establishing a ‘Health Community Co-ordination Group’ with Lincs PCTs/Trusts/LA EP ‘le

HPA - DPH to establish PHAG/JHAC if required - DPH to establish Co-ordination Group (as above) if more than 1 Silver command set up

P

PCT(s)/TRUST(s)

EMERGENCY ESCALATION PLANS

MULTI-AGENCY STRATEGIC CO-ORDINATING GROUP (GOLD)

COMMAND

- Away from the site(s) - ‘Lead’ PCT DPH or Chief Executive as ‘NHS Gold Commander’ with responsibilities for:

- strategic decisions on behalf of the Trent SHA/Lincs Health Community - communicating with Strategic Health Authority +/- Regional Director of Public Health on the

situation/mutual aid requirements - establishing a PHAG/JHAC if/as necessary

Appendix C

L

OPERATIONAL (BRONZE)COMMAND(s)

- at the site(s) - ‘Bronze’ managers/officers of

PCT(s)/Trusts +/- Emergency Services, with responsibility for:

- co-ordinating “doing” - advising Silver Command(s)

(Organisation and/or multi-agency) of the situation and requirements

ding Public

greeing timescale

ulation(s) ther services in

PHAG/JHAC

‘LEAD PCT

uested ) on call if out of

ads’ and reps

HEALTH COMMUNITY CO-ORDINATION GROU

+ -

PA reps, with

g on

response
NB: To be revised in light of PCTreconfiguration and most recent National Guidance

Appendix D

PATIENTS AT HIGH RISK OF INFLUENZA – RELATED RESPIRATORY COMPLICATIONS Clinical risk category

Examples

Chronic respiratory disease, including asthma

This includes chronic obstructive pulmonary disease (COPD) including chronic bronchitis and emphysema, and such conditions as bronchiectasis, cystic fibrosis, interstitial lung fibrosis, pneumoconiosis and bronchopulmonary dysplasia (BPD). Asthma requiring continuous or repeated use of inhaled or systematic steroids or with previous exacerbations requiring hospital admission. Children who have previously been admitted to hospital for lower respiratory tract disease.

Chronic heart disease This includes congenital heart disease, hypertension with cardiac complications, chronic heart failure and individuals requiring regular medication and/or follow-up for ischaemic heart disease.

Chronic renal disease Including nephritic syndrome, chronic renal failure, renal transplantation.

Chronic liver disease Including cirrhosis

Diabetes Diabetes mellitus requiring insulin or oral hypoglycaemic drugs

Immunosuppression Due to disease or treatment. Including asplenia or splenic dysfunction, HIV infection at all stages. Patients undergoing chemotherapy leading to immunosuppression. Individuals on or likely to be on systemic steroids for more than a month at a dose equivalent to prednisolone at 20mg or more per day (any age) or for children under 20kg a dose of 1mg or more per kg per day. However, some immunocompromised patients may have a suboptimal immunological response to the vaccine.

Long stay residential care homes residents

This does not include prisons, young offender institutions, university halls of residence.

Aged 65 years or older

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