How prepared are we to manage within the community?

2. How prepared are we to manage within the community? Pandemic Influenza and Scotland RCPE SEMINAR June 2006

3. What is being prepared to respond Preparedness Standards for Overall Strategic, Healthcare and Health Protection Services Conclusions on levels of preparedness in the community Content

4. InfluenzaThe Public Health Agenda Avian Influenza Seasonal Influenza Pandemic Influenza

5. Reasonable Worst Case Scenario Single wave profile showing proportion of new clinical cases, consultations, hospitalisations or deaths by week. • Cumulative clinical attack rate up to 50% of the population over one or more waves of around 15 weeks each, weeks or months apart. • ‘Worst case’ of single wave. • Complication rate of up to 25% • Overall case fatality rate of up to 2.5%. • Hospitalisation rate of up to 4%.

6. Pandemic InfluenzaPlanned Response End of first pandemic wave Recovery Alert Level 4 widespread activity Maintain essential services 6-8 Weeks Intense pressure 12 -15 weeks • Alert Level 3 • outbreaks in UK • Adapt services 7-9 weeks 2- 4 weeks Alert Level 2 new virus in UK Slow spread Alert Level 1 no virus in UK 2- 4 weeks

7. Integrated planning across governments. Making plans operational at the local level. Making sure that national plans and actions work well together between counties and within countries Stepping up prevention efforts against seasonal influenza Extending influenza research from basic science to include more operational research Pandemic Influenza Preparedness in the EU

8. What needs to be done in the community Limit transmission and mitigate impact Keep society going Civil Contingency Public Health Strategic Co-ordinating Groups Health Protection Care and treat sick and support their families Health and Social Care Primary Care, Community Care

9. Pandemic Influenza Preparedness Standards for Overall Strategic, Healthcare and Health Protection Services

10. Aims • To develop & pilot methodology in Standard • setting, monitoring and reporting for: • Health Protection • Health Care services • To develop & apply the standards to assess • Boards’ preparedness • To recommend future standard operating QA • process for Health Protection services • To give Boards a self-assessment tool for • future planning

11. The Areas of Enquiry - the ‘Standards’ Standard 1 Strategic: Structures and processes in place to ensure preparedness for managing the local NHS response to a pandemic of influenza Standard 2 Health protection services: Structures and processes in place to ensure preparedness for limiting the transmission of pandemic influenza and its impact on the public’s health. Standard 3 Healthcare services: Structures and processes in place to ensure preparedness for responding to the direct and indirect health consequences of an influenza pandemic Acute Care Primary Care Pharmacy Microbiology

12. For each Standard: • Expansion into criteria and lines of enquiry i.e. specific questions • Boards self-assess according to standard QIS scores in the key areas of: Accountability Processes Audit & Review • Consensus scoring workshops (Jan & Mar 2007) Individual Board & National Scores Evidence

13. Scoring System Score Definition 1 Board is still considering how to take forward their responsibilities 2 Board is actively developing the means to take forward their responsibilities 3 Board is actively implementing the means of meeting its responsibilities 4 Board is monitoring the adequacy of how they have implemented its responsibilities

14. Caveats • These are findings from pilot • The process is intrinsically subjective • Methodology assessment & validation • A measure of how well Boards are doing what they are expected to rather than how well they will respond to a pandemic

15. Surveillance Health Protection Investigation Risk Assessment Coordination Communication Risk management

16. National Scores for Standard 2: • NHS Boards’ health protection services have structures and processes in place to ensure preparedness for limiting the transmission of pandemic influenza and its impact on the public’s health

17. Health Protection Preparedness

18. NHS Scotland Preparedness for Pandemic InfluenzaStandard 2

19. NHS Scotland Preparedness for Pandemic InfluenzaStandard 2

20. Primary Care

21. National scores for Standard 3: NHS Boards have structures and processes in place to ensure preparedness for responding to the direct and indirect health consequences of an influenza pandemic

22. Preparedness for Pandemic InfluenzaStandard 2

23. Conclusions • NHS Scotland has made considerable progress in the last 2 years (since the Oct. 2005 National Contingency Plan) in being prepared to manage the community aspects of pandemic influenza • Progress has been greater in overall strategic decision-making and health protection & acute adult services than in primary care services • Emphasis should now be placed on developing health protection policy, primary care and tactical & operational planning • Integration with “routine” surge capacity and business continuity arrangements should be explored

24. Acknowledgements • Darren Ross, Ann Smith, Dr Jim McMenamin, Samantha Fleming, HPS • Jacqueline Campbell, Anne Aitken, Colin Robertson, Scottish Executive • Jim Miller, Lanarkshire NHS Board • Pandemic Flu QA Steering Group