Swine Flu Pandemic Response Lessons learned

1. Swine Flu Pandemic Response Lessons learned Professor Lindsey Davies RCGP Conference Pandemic Summit Thursday 18thMarch 2010

3. Potential impact 25 - 50% people with symptoms 50,000 - 750,000 deaths 80,000 � 1,115,000 needing hospital care 15-20% absent from work at the peak �1,242bn cost to society 1242 is at 50% attack rate with no mitigation, total costs including estimates of lost lifetime earnings etc1242 is at 50% attack rate with no mitigation, total costs including estimates of lost lifetime earnings etc

4. Defence in depth

5. UK pandemic preparedness in April 2009 Cross-government framework and guidance Local multi-agency plans Catch It, Bin It, Kill It NHS operating framework NHS plans and self assessment Countermeasures Communications plan and materials CAMDEN PCT posters on the underground CAMDEN PCT posters on the underground

6. UK countermeasures in April 2009 Antivirals to cover 50% of the population A small national reserve supply of surgical face masks and respirators Pre-completed contracts with suppliers for the supply of vaccine Flu Line in development Business cases prepared for HMT for antibiotics, masks, respirators, consumables

7.  UK preparation and response Planning and preparation 1997- Slowing the spread April-June 2009 Managing outbreaks June 2009 Focus on rapid treatment July 2009-

8. Slowing the spread Laboratory confirmation of cases Treating all suspected and confirmed cases Collecting detailed case data Tracing close contacts and offering prophylaxis Closing schools Public health campaign Leaflet to all households Swine Flu Information Line HPA/NHS Flu Response Centres Building resilience � countermeasures, health and social care preparations Surpirses- didn�t get everywhere quickly and did affect well- off areas initially Surpirses- didn�t get everywhere quickly and did affect well- off areas initially

9. Focus on treatment Initially in �hotspots� only, later UK-wide Antiviral treatment for people with symptoms. Limited prophylaxis National Pandemic Flu Service July 2009 � February 2010 Local risk assessment Immunisation from October 2009

11. The pandemic in numbers

12. The NHS response 4.7 million vaccinations given to priority groups so far 1.2 million courses of antivirals dispensed through the NPFS and primary care Clinically led surge plans including the doubling of critical care capacity and available ECMO beds All NHS Boards published statements of readiness, demonstrating board level engagement and accountability in preparedness Robust and tested command and control arrangements including organising mutual aid

13. Primary Care � an excellent response Huge pressure in some areas, particularly on out of hours services; tremendous response from staff Patience with rapidly evolving national advice Tested flu pandemic plans in Primary Care against best practice (eg: DH SURGE, DH/NHS Employers HR Guidance and Critical Care Checklist) Provided guidance � Pandemic Flu: Planning & Responding to Primary Care Capacity Challenges, September 2009 PCT Boards published Statements of Readiness and took an active part in Exercise Peak Practice in their regions

14. Primary Care � an excellent response Response to swine flu critically dependent on stakeholder engagement and partnership working � close relationships with clinical leaders vitally important Design of the National Pandemic Flu Service and the clinical algorithm was supported by the Royal Colleges, RCN and BMA. In addition, a team of clinicians from the RCGP supported the operation of the NPFS, by providing clinical advice Many practices put in good models of buddying and mutual aid for business continuity Vaccination programme undertaken by over 8000 GP practices, delivering essential vaccinations to patients at-risk, health and social care workers and children under 5

15. The impact of swine flu �implications for resilience Speed: in many local areas, the number of cases and demand for services developed with great pace, requiring an agile yet coordinated response Profile: the media pressure and public thirst for information was intense, requiring frequent and consistent communications Cross-sector: the response spanned different sectors and organisations, requiring close working and mutual support Local hotspots: the demands of the pandemic were not uniform, with different areas under pressure at different times (and some not at all), requiring understanding and flexibility Duration was different. Particular applicability for other periods of sustained increases in pressure, such as winter

16. NHS emerging lessons An opportunity to test preparedness plans The scale of what has been achieved is significant We can be even better prepared for the future Public health and emergency planning in the spotlight Preparedness and resilience are generic concepts that now need to be incorporated into the NHS mainstream Maximise knock-on benefits of swine flu for resilience Act now before skills and experience ebb away

17. NHS next steps NHS Boards to take improving resilience seriously SHAs to oversee, and ensure that resilience covers the whole health economy in an integrated way. The Operating Framework requirement provides a vehicle to prioritise action Strengthen resilience for pandemic flu, other national emergencies and the management of operational pressures.

18. UK Pandemic Preparedness March 2010 Antivirals for 80% of the population 227 million surgical face masks and 34 million respirators for NHS and social care staff Antibiotics for 30% of the population National Pandemic Flu Service Business continuity plans and awareness Experienced responders in all sectors

19. Emerging lessons The importance of planning and preparation The need to plan for a range of scenarios The impact of strong leadership Reliable and appropriate surveillance is essential Regular, proactive, timely communication is vital Pre-existing relationships make a real difference Containmnet Mutual aid Containmnet Mutual aid

20. And finally� A huge thank you to all of you as both strategic and local leaders, to local GPs and clinicians who have supported all staff across the system The response from the NHS has been excellent And you have minimised the number of unnecessary deaths or harm to patients and retained confidence in the NHS amongst the public, patients and politicians We need to capture the skills and experience gained from managing swine flu to maximise our ability to respond to emergencies and provide a first-class service to the public and taxpayer