NHS Rotherham Summary of action taken and underway to prepare for pandemic flu 1. Introduction As a pandemic enters the phase of rapid spread in the community, we are likely to experience a surge in patient numbers. This is likely to put extreme pressure on Primary care and Hospitals for a period of up to 10 weeks. Other services in the community will also be affected by staff absences and stresses that may occur due to disruption of supply chains. For the current H1N1 strain the suggestion from the experience in the Australian winter is that there was a great increase in the number of people seeking treatment for mild to moderate symptoms who would be fine with minimal intervention, but also there was a significant increase in the number of seriously unwell people requiring hospitalisation. We should be expecting at least a 20% increase in the total number of A&E attendances, and a similar increase in the number of admissions to adults and children‟s services. Intensive care services will also be under extreme pressure particularly at the peak of a pandemic. Primary care will need to be able to triage patients effectively, and also to restrict referrals where possible to those in most urgent need to ensure resources are appropriately assigned to minimise loss of life and serious morbidity. All services will have a role to play. The primary aim will be to help relieve pressure on hospitals but at the same time essential services must be maintained, particularly those which have a role in keeping people out of tertiary services. Services will need to consider how they will need to redistribute staff and other resources in the event of a pandemic to ensure that the most essential services are maintained, and also how they can contribute to relieving pressure on primary care and the hospitals. This overview attempts to summarise the business continuity plans and pandemic flu plans we have received from organisations. Actions the services have planned in the event of a pandemic are divided into three sections; 1. those directly related to business continuity in the event of a pandemic 2. those which highlight their own command and control structures and how they will interface with the overall command and control structure 3. any additional resources they may have available after ceasing non-essential services which could be redeployed in the event of a severe pandemic 2. Services affected General Medical Services Business Continuity o All GP practices have been asked to produce business continuity plans o All GP practices have been asked to “stress test” their business continuity plans o GP practices have their own “Buddying” arrangements in place with similar sized practices / IT operating systems.
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Command and Control o NHS Rotherham will operate a command and control system, which will include the relocation and redeployment of available GPs as necessary o The Local Medical Committee fully support the command and control mechanism o Daily Flucon reporting arrangements are in place with GP practices. This captures planned and unplanned staff absences and workload status. The Flucon escalation process works on a traffic light system (ie Green, Amber, Red). Additional resources o 5 locum GPs have confirmed their availability to provide sessions in the event of Pandemic Flu General Pharmaceutical Services Business Continuity o All Pharmacies have been asked to produce their own Business continuity plans. These should consider team working with neighbourhood pharmacies, identifying recently retired, pre-registration and non-practicing colleagues who might be able to support community services, as well as security. o Details of Locum pharmacies will be held by each pharmacy as part of their own business continuity plan o Pharmacy chains / multiples will have their own contingency plan via their head office. o Command and Control o Daily Flucon reporting arrangements are in place with Pharmacies. This captures planned and unplanned staff absences and workload status. The Flucon escalation process works on a traffic light system (ie Green, Amber, Red). o Additional Resources – Premises o Local Antiviral Collection Points (ACPs) – There are currently 10 ACPs in the NHS Rotherham area. If required this number could be increased to 22. The location and opening times of the ACPs have been published. Additional Resources – Staff o Rapid response teams – NHS Rotherham staff will provide administration support to struggling pharmacies on red alert. These duties will include helping with IT input in pharmacies and helping check peoples ID and unique reference number General Dental Services Business Continuity o All practices have been asked to produce business continuity plans. o Every NHS general Dental practice has been paired up with another dental practice which is referred to as their “sister practice”. In the event of closure of a dental practice due to pandemic influenza patients who do not have symptoms of influenza but require urgent dental treatment may be redirected to the “sister practice”. Command and Control
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Daily Flucon reporting arrangements will be instigated with Dental practices. This captures planned and unplanned staff absences and workload status. The Flucon escalation process works on a traffic light system (ie Green, Amber, Red). Urgent care patients with suspected flu will be asked to attend a designated pandemic flu dental clinic.
Additional Resources o 6 practices have already been commissioned to provide additional in hours emergency care services. o The Dental Access Centre will provide urgent care General Ophthalmic Services Business continuity o All practices will be asked to produce business continuity plans o Practices will be sign posted to the College of Optometrists Infection Control policy National Pandemic Flu Services The national Pandemic Flu line has been set up and run nationally. If people believe they have swine flu, instead of calling their GP, they should call the new NPFS line which will provide pandemic related advice and information. GP practices have already seen a dramatic decrease in their telephone calls for help and advice. Out of Hours GP Services Business Continuity o Care UK have submitted their surge plan. This outlines their plans for managing a surge in calls, which has already been tested in July this year when additional call handlers were necessary. In this case the PCT helped provide an additional 36 nursing staff from within the PCTs staffing pool, who answered calls specifically related to suspected H1N1 Flu. o An unexpected increase in call volumes can be responded to by one or all of the following o Calling in the on call duty GPs o Calling in additional call handlers o Deploying home triaging GPs o Additional GP registrars have started in August and Care UK will be able to make use of them from October 2009 for sessional work. Command and Control o Care UK report daily on their Flucon status to the PCT. o A plan of escalation exists to ensure that in the event of unusual demand the Care UK Operations Manager and Local Medical Director are alerted.
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Recovery phase All primary care practices have been asked to plan for a gradual return to “business as usual” as the pandemic comes to an end and communities regain confidence. The pace of recovery will depend on the residual impact of the pandemic, ongoing demands, backlogs, staff recovery and continuing supply difficulties. The rate of recovery may differ from provider to provider. Suppliers will take time to return to normal so shortages and delivery delay can be expected. The Rotherham NHS Foundation Trust Business Continuity o The Trust has produced its Pandemic Influenza Plan which identifies plans for o A stepped increase in bed numbers for adult patients, with appropriate triggers. Patients with pandemic flu will be cohorted together. o Infection control processes to minimise the risk of transmission of influenza to staff, visitors and patients. o Restricting visitor numbers. o Communicating with the public – all communications will be made in conjunction with the PCT, and with staff. o Expediting discharge processes by working in collaboration with the Local Authority and NHS Rotherham Community Services. o Identifying staff at highest risk of contracting pandemic flu for purposes of vaccination and risk assessment by occupational health services. o Managing staff absences and leave to maximise the available number of staff through the pandemic period. o This sits on top of the Trust‟s operating framework which is currently being updated so that all areas of the Trust map out their resources in terms of staff (through a matrix capturing transferable skills and training needs, as well as emergency contact details), equipment and premises, as well as any potential weakness in their supply chains. o As part of the Trust‟s Pandemic Influenza Plan, plans for a stepped increase in bed numbers for paediatric patients, with appropriate triggers are outlined. Patients with pandemic flu will be cohorted together. o As part of the Trusts Pandemic Influenza Plan, they outline measures to double the capacity of their current intensive care unit by using a range of equipment normally dedicated to elective surgery, which would be suspended for the duration of the pandemic. It also identifies the triggers that would instigate this. The Trust currently does not have any paediatric intensive care service, however in the event of a severe pandemic they recognise that if the regional network is overwhelmed they may have to manage paediatric patients in adult ITU spaces with clinical support from the paediatricians. Command and Control o The Trust Pandemic Influenza Plan outlines their internal command and control systems including triggers for instigation and how this will be implemented in the event of a pandemic. It also outlines how the Trust will contribute to the Rotherham-wide command and control structure headed by NHS Rotherham. o Daily Flucon reporting arrangements will be instigated throughout the hospital and communicated to the Trusts Command and Control team. o Once a Flucon alert level above 2-3 has been declared within the organisation, then a process of „Force Majeure‟ would apply. Routine elective contracts would be suspended during the emergency period, and discussions and agreement
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would be sought for the re-commencement of procedures following a period of recovery and dependant on the severity of the pandemic. Rotherham Doncaster and South Humber Mental Health services Business Continuity o RDASH have submitted their Pandemic Influenza Plan which highlights the actions already taken which include having; o Reviewed and stress tested Business Continuity Plans (BCPs) o Ensured that individual service BCPs complement each other and do not have conflicting actions o Identified staff who have additional skills or training and collated this data in staff skills matrices o Identified staff who have health vulnerabilities or who have dependants o Mapped where staff reside in the event of needing them to support services within their home locality o Identified critical inpatient and supported living services which would need to be sustained in the event of an escalating pandemic o Identified vulnerable individuals residing within the community o Undertaken simulation exercises involving the managers of all clinical and non-clinical services o Multi-agency planning to prepare for a community wide approach o Identified and contacted recent leavers and retirees in the event of needing to request their support o Provided e-training for staff on the care of someone with pandemic flu within the context of mental health service provision o Provided e-training on the use of PPE for staff o Summary information presented to staff at Induction Training o Trust‟s Pandemic Influenza Communications Plan reviewed in light of new guidance o Followed recent guidance and developed HR major incident protocols in liaison with partners across the region o In the event of a surge in the number of flu cases they have a stepped plan for the redistribution of staff to maintain essential services, as well as plans to close non-essential services. o The Trust have an infection control team who would have responsibility for the prevention and management of transmission between infected patients and other patients and staff. Command and Control o RDASH will attend and contribute to the Command and Control meetings held by NHS Rotherham. o They will also convene the RDASH Emergency Planning Panel on announcement of a Level 3 alert in the UK. This group will co-ordinate with colleagues in all the South Yorkshire PCTs during a pandemic. o Daily reporting of Flucon levels to NHS Rotherham Rotherham Community Health Services Business Continuity o Have produced a plan for the entire organisation which covers planning for staff shortages, and a staged approach to suspension of services based on rates of staff absence.
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Command and Control o Sick leave will be reported centrally to the Business Development Administration Team allowing production of a report on each day‟s staffing situation which will be available for the Core management Team by 10.00am daily. Additional Resources – Staff o Have asked these teams to provide lists of their nursing staff who fall into the following three categories: o Qualified nurses who have up to date vaccination and immunisation training. o Qualified nurses who have previously been trained, but whose competency/training has since lapsed. o Qualified nurses who have never been trained in vaccination and immunisation but could be trained to undertake this task in the event of a mass vaccination programme. Adult Services Business Continuity o Have provided business continuity plans that identify and consider staffing for essential services in the event of a pandemic. o Have also provided plans for access to fuel in the event of fuel shortages. o Each directorate has a Business Continuity Group which will convene in the event of a disruption or potential disruption to services. Command and Control The RMBC will be represented at Rotherham Strategic Pandemic Flu group meetings Residential Care Homes Business Continuity o All independent homes have been provided with information on pandemic flu and asked to produce Business Continuity plans. o Homes have been asked to provide a list of staff for administration of vaccination once vaccine is available. Command and Control o An up to date list of managers and their contact details is being compiled o Procedures for identifying vacancies at homes are being streamlined to ensure that these are identified rapidly. Local Recovery Phase o NHS Rotherham will contribute to a recovery phase working group as required and will continue to co-ordinate Command and Control throughout the recovery period. NHS Rotherham will stand-down their emergency operations as appropriate and will be advised by the Lead PCT and SHA and feedback from local organisations.
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