Report to the Meeting of the Oxfordshire and Buckinghamshire
Mental Health NHS Foundation Trust
Board of Directors
30 September 2009
TRUST STATEMENT OF PREPARDENESS FOR PANDEMIC
INFLUENZA A (H1N1)
This report briefs the Board on the developments of the Trust’s preparedness for
an influenza pandemic.
This report has been written at the request of the Department of Health (see
attached letter) and is based on the template being used by South Central SHA.
The Board is requested to:
1. Note the work undertaken to develop resilient plans to respond to
pandemic influenza and, specifically, a second wave of Influenza A
2. Approve the report for submission to the South Central SHA (the SHA will
include this report in its ‘statement of readiness’).
Author and Title: Mike Foster, Associate Director of Risk Management
and Pandemic Influenza Planning Lead
Justinian Habner, Trust Secretary and Trust
Emergency Planning Officer
Lead Executive Director: Caroline Birch, A/Director of Nursing and Clinical
1. A risk assessment has been undertaken around the legal issues that this paper presents
and there are no issues that need to be referred to the Trust Solicitors.
2. This paper provides assurance and evidence against the following Better Healthcare
1. Context and Background
1.1 On 26th April 2009 the first case of ‘swine flu’ (Influenza A [H1N1]) was
confirmed in the UK and the World Health Organisation (WHO) declared a
pandemic on 11th June 2009. There has been a first peak of the
pandemic which has now resolved but it is anticipated that there will be a
second, more serious, peak over the current autumn/winter period.
1.2 The Trust has been preparing for an influenza pandemic for a number of
years, working closely with the Oxfordshire and Buckinghamshire PCTs,
other health providers, and social and health care. In March 2009, the
Board of Directors approved the Trust plan for responding to a pandemic.
The Trust’s plan was reviewed by the SHA and Thames Valley Emergency
Planning Leads in July 2009 and they confirmed the Trust’s self
assessment score of 89%; the highest of any of the mental health trusts in
the SHA area.
2.1 The Trust has an overall, general plan that was approved by the Broad of
Directors in March 2009. Each directorate and department of the Trust
has a plan that is based on the general plan and their local needs. The
plans have continued to be developed in response to national guidance
and local experience of the first peak of the pandemic.
2.2 The directorate and department planning leads met with the Trust planning
leads to review their plans on an individual basis during August 2009. All
directorates and departments were asked to identify which services would
be closed and which would remain open at the very peak of a wave and
based on the Department of Health ‘planning assumptions’. The
Executive Team reviewed this list of services on 8th September 2009.
2.3 At the reviews, a number of actions were agreed to be implemented during
September 2009. The reviews identified the following significant issues:
• Staff response to the HR questionnaire is low. The information
from the questionnaire is needed to assist in workforce planning.
Directorates have been tasked to increase the response rate with
individual managers being contacted if their area has a low return
• The Trust’s business continuity plan remains in draft form but will
be approved by the Executive Team before the end of September
• Further work on the ‘recovery phase’ of plans needs to occur.
2.4 The service directorates presented their updated plans (taking into
account the points above and any other areas identified) to the Executive
Team on 29th September 2009. The outcomes of those presentations
were reported to the Board of Directors at its meeting on 30th September
2009. The Executive Team rigorously tested the directorate plans and
assumptions, and recommended some further areas for improvement.
Overall, the Executive Team were satisfied that robust plans were in
place. Non-service directorates (such Estates and Facilities,
Communications, Finance, Pharmacy) will present their plans to the
Executive Team on 6th October 2009.
2.5 The plan includes command and control arrangements (based on the
Trust’s Major Incident Plan) that are to be implemented at the different
stages of a pandemic wave. It is planned to undertake a table top
exercise to test these arrangements further in October 2009.
2.6 Caroline Birch, Acting Director of Nursing and Clinical Governance, is the
Executive Director for pandemic influenza planning. Mike Foster,
Associate Director of Risk Management, has that responsibility on a day to
day basis, coordinates the corporate planning, and links regularly with
directorate and department planning leads.
2.7 Each directorate and department has identified flu planning leads. The
leads meet regularly to monitor the spread / retraction of the virus and
discuss the impact on the Trust. Mike Foster leads these meetings.
2.8 The Occupational Health Department has developed a plan to vaccinate
frontline staff with seasonal and swine flu vaccines. The priority will be
inpatient staff, particularly the forensic service, and key support services,
such as the coordination centres (receptions / switch-board at Tindal and
Warneford). Staff who can administer the vaccines are being identified
and will receive training. A plan for administering vaccines to vulnerable
patients, particularly inpatients, is being developed. It is not clear, at the
time of writing this report, when vaccine supplies will be delivered and in
3.1 In line with the request from the National Director of Flu Resilience, the
assessment of the readiness of the Trust pandemic influenza plan will be
agreed at the Board of Director’s meeting on 30th September (based on
the information contained in this report).
3.2 Since the emergence of the virus in April 2009, the Trust has participated
in the Health Emergency Planning Groups of both Oxfordshire and
Buckinghamshire PCTs. These are currently being held on a fortnightly
basis. In addition, the Trust has liaised with the PCTs in other areas
where it provides services. Oxfordshire PCT is the Lead PCT for
pandemic influenza planning in the Thames Valley and represents the
health economy at regional health and resilience meetings. The Trust
regularly reports on its flu planning and progress to the Oxfordshire PCT.
3.3 The communications to the public concerning the pandemic have been
coordinated by the Lead PCT. Regular communications have been
provided to the Trust’s staff through the Trust’s communications team
using information made available by the Lead PCT. Information leaflets
are available for service users and carers.
3.4 Records have been kept of planning meetings. Should the Trust Major
Incident Plan be invoked during the pandemic wave, Health Protection
Agency-trained loggists will record decisions made by the ‘central control
4.1 The Trust has participated in all the exercises to test the resilience of
planning that it has been invited to attend. Most recently, the Trust
participated in Exercise Cold Play II (16th September 2009) with the
Oxfordshire PCT Health Emergency Planning Group, Patient Pathways
Workshop (23rd September 2009) with Buckinghamshire PCT and the
South Central SHA strategic Exercise Peak Practice on 28th September
2009. The Trust has completed the Department of Health Pandemic
Preparedness Toolkit. Trust-wide internal table-top exercises to test plans
have been held, the last in January 2009. Finally, individual directorates
and departments have held table-top exercises to test aspects of their
local resilience plans.
4.2 Trust plans are constantly evaluated against emerging intelligence and
advice, and are shared with partner organisations.
4.3 Planning by the Human Resources Department has included regular
liaison with the staff side. Policies and procedures are in place to enable
flexible but safe working practices during a pandemic.
4.4 The planning for staff to receive seasonal and swine flu vaccines is
4.5 Each directorate and department has identified how it will maintain
services to its priority groups or maintain its essential services (such as
urgent estates maintenance). Vulnerable patients are being identified and
staff are working with them to prepare for the spread of the virus. For
example, vulnerable patients are being helped to identify ‘flu friends’
(people who could collect anti-virals on behalf of a sick patient).
Directorate and department plans set out the services that will be
suspended or reduced, if necessary, during a pandemic. Directorates and
departments have been identifying staff that can be redeployed internally
or to support other parts of the health economy as a result of these
4.6 The Trust has participated in planning with the Local Authorities, other
health care providers and other groups, such as voluntary groups, through
the planning forums with the Buckinghamshire and Oxfordshire PCTs.
5. Service Specific
5.1 A consultation document on the operation of the Mental Health Act during
a pandemic has been issued. The Mental Health Act Office is
coordinating the Trust’s response to this document. The consultation
period ends on 7th October 2009.
5.2 The Trust will need to support its patients, both in hospital and in the
community, that contract swine flu. Staff are being prepared on the care of
patients suffering from swine flu and the use of personal protective
equipment (PPE) when providing such care. This will include training on
the use of respirator (FFP3) masks for inpatient staff. Whilst the Trust will
be able to care for patients in hospital that have swine flu and mild
complications, it does not have the facilities or staff with the necessary
skills to care for patients that have more serious complications, such as
pneumonia. Patients with serious complications will require transfer to the
acute general hospitals.
6.1 There has been extensive planning, both internally and with other local
health and social care organisations, and these plans have been updated
in line with national guidance and local experience. The Trust has plans in
place for all its services, which include detail on how they will respond to
the different stages of a pandemic and during the recovery period. The
plans will need to continue to develop, and further work is being
undertaken to confirm the resilience of the service directorate plans and
the effectiveness of the command and control structure of the Trust and its
key services. A business continuity plan for the Trust is in the process of
being approved, plans are being developed and implemented to ensure
frontline staff and vulnerable patients can be vaccinated and staff continue
to be encouraged to complete the human resources workforce
Mike Foster, Associate Director of Risk Management and Pandemic
Influenza Planning Lead
Justinian Habner, Trust Secretary and Emergency Planning Officer
18th September 2009 – Updated at Board on 30 September 2009
PANDEMIC FLU SHA BOARD ASSURANCE TEMPLATE.
All SHA Boards are required to publish a ‘statement of readiness’ against key
elements of the Demand and Capacity Guidance, HR Guidance and Critical Care
In order to promote consistency of reporting and presentation of information that will
go into the public domain, the following template of headings and discussion areas
has been developed to support SHA Flu Lead Directors and Directors of
Communications in formulating their statement for presentation to their September
SHA Board meeting.
There is a robust plan in place to support delivery of a coordinated response to
flu pandemic across the region
each NHS organisation has the equivalent of a full-time Director dedicated to
flu preparedness and resilience, and internal structures which enable that
Director to discharge her/his responsibilities effectively
There is a Director-level led vaccination programme in place to ensure the
maximum possible uptake of both the swine flu and seasonal flu vaccines
among priority public groups and frontline staff.
All NHS Trust Boards have agreed and signed off their assessment of
There is a robust governance accountability framework in place from NHS
organisations through to SHAs and on to the NHS Flu Resilience Directorate.
There are effective reporting mechanisms in place to support the regional
response and to participate in national reporting.
There is a communications strategy in place to convey consistent and timely
messages to staff, the public, the media and which addresses engagement
with key external stakeholders.
Maintenance of accurate records of decisions, patient care, vaccination uptake
rates and requested epidemiology.
Each NHS organisation has reviewed the HPA resilience checklist and
attended the “Peak Practice” exercise during September 2009 with at least
Pandemic plans have been stress tested to ensure high-level delivery of care
to swine flu, seasonal flu and non-flu patients.
Effective HR policies and practices are in place to support resilience, as
evidenced by the August workforce assurance return
Arrangements are in place for staff to receive seasonal and H1N1 vaccines, as
evidenced by the August workforce assurance return.
A service priority assessment tool, as evidence by the August workforce
assurance, has been completed to include:
o the potential gain by the deferral of non-essential services;
o staff training plans and staff deployment plans are in place to support
prioritised services (e.g. critical care);
o the impact of service prioritisation has been considered;
o optimal utilisation of health and social care resources.
There are mechanisms in place to support the Local Authority with their
planning for frontline Adult and Children’s Services social care staff.
To include areas of service where extra resilience work has been undertaken
across the region, for example:
o PCTs - to have in place a robust network of ACPs and other critical
services to support delivery of the NPFS and the medicines and supply
o Acute Services - critical care capacity and other essential services to
ensure business continuity (e.g. paediatrics, A&E, acute medicine etc)
o Mental Health – to have systems in place to enable the delivery of physical
health care and resilient HR plans.
o Ambulance Services - plans to support 999 resilience and critical care
A clear summary of the SHA Board’s assessment of the ‘state of readiness’ of
the NHS for a potential second wave swine flu outbreak over the coming
Gateway Ref: 12593
TO: SHA Flu Lead Directors London
020 7210 3832
COPY: SHA Chief Executives email@example.com
SHA Flu Leads
SHA Director of Communications
11th September 2009
A (H1N1) SWINE INFLUENZA: SHA BOARD ASSURANCE TEMPLATE
On the 2nd July, Ian Dalton wrote to all Chief Executives across the NHS detailing
what they and their boards needed to do to ensure that all organisations had
appropriate plans in place to respond to the swine flu pandemic.
The NHS has done an excellent job in preparing itself to date and we believe the
strategy of preparing for a second wave in the autumn is the right one. Preparing for
every eventuality is a key governance issue for all NHS Boards (including NHS
Foundation Trusts), and something that the public will be expecting of the NHS at this
Having considered all of the points outlined in the letter of 2nd July, Ian asked all NHS
Boards (including NHS Foundation Trusts) to publish a statement of readiness
against the DH Surge and HR guidance at its September meeting.
To support the work required to make that public statement, the NHS Flu Pandemic
Implementation Team and NHS Flu Resilience Team have liaised with a small group
of Flu Lead Directors and SHA communications teams to produce a template with the
aim of ensuring consistency of reporting and presentation of SHA reports. I am
pleased to be able to enclose that template to this letter.
The template has been designed for use at the SHA level, as we have committed to
making these reports available on the DH website and placing copies in the House of
Commons’ Library. But you may wish to consider working with NHS organisations
across your region to develop a similar tool, possibly based on the attached template
or a local variation, to maintain a reasonably consistent approach across the Service.
If you have any questions on how to use the template then please contact Jeanette
Hall, NHS Implementation Manager on firstname.lastname@example.org or myself.
National Chief Operating Officer, NHS Flu Resilience
Department of Health