Hot Topic Meeting by: Royal College of Physicians of Edinburgh & The Scottish Executive Health...
Transcript of Hot Topic Meeting by: Royal College of Physicians of Edinburgh & The Scottish Executive Health...
Hot Topic Meeting by:
Royal College of Physicians of Edinburgh &
The Scottish Executive Health Department
Pandemic Flu
Planning Scotland’s Health Response
5th June 2007
Queen Mother Conference Centre
How prepared are we to
manage within the
community?Pandemic Influenza
and Scotland
RCPE SEMINAR
June 2006
Content
What is being prepared to respond
Preparedness Standards for Overall Strategic, Healthcare and Health Protection Services
Conclusions on levels of preparedness in the community
InfluenzaThe Public Health Agenda
AvianAvian
InfluenzaInfluenza
PandemicPandemic
InfluenzaInfluenza
SeasonalSeasonal
InfluenzInfluenzaa
Single wave profile showing proportion of new clinical cases, consultations, hospitalisations or
deaths by week..
0%
5%
10%
15%
20%
25%
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Week
Pro
po
rtio
n o
f to
tal
ca
se
s,
co
ns
ult
ati
on
s,
ho
sp
ita
lis
ati
on
s o
r d
ea
ths
• 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%.
Reasonable Worst Case Scenario
Pandemic InfluenzaPlanned Response
Alert Level 1 Alert Level 1 no virus in UKno virus in UK
Alert Level 2 Alert Level 2 new virus in UK new virus in UK Slow spreadSlow spread
Alert Level 3Alert Level 3 -outbreaks in UKoutbreaks in UKAdapt servicesAdapt services
Alert Alert Level 4Level 4 widespread widespread activityactivityMaintain essential Maintain essential servicesservices
End of first End of first pandemic pandemic wavewaveRecoveryRecovery
2- 42- 4
weeksweeks
7-97-9
weeksweeks
6-86-8
WeeksWeeks
Intense Intense pressurepressure
2- 42- 4
weeksweeks
12 -1512 -15
weeksweeks
Pandemic Influenza Preparedness
in the EUIntegrated planning across governments.Integrated planning across governments.
Making plans operational at the local level.Making plans operational at the local level.
Making sure that national plans and actions Making sure that national plans and actions work well together between counties and work well together between counties and within countrieswithin countries
Stepping up prevention efforts against Stepping up prevention efforts against seasonal influenzaseasonal influenza
Extending influenza research from basic Extending influenza research from basic science to include more operational research science to include more operational research
What needs to be done What needs to be done in the communityin the community
Limit Limit transmissiotransmissio
n and n and mitigate mitigate impactimpact
Care and Care and treat sick treat sick
and support and support their familiestheir families
Keep Keep society society goinggoing
Public Health
Civil Contingency
Health and Social Care
Health Protection
Primary Care, Community Care
Strategic Co-ordinating
Groups
Pandemic Influenza Preparedness Standards for Overall Strategic,
Healthcare and Health Protection Services
• To develop & pilot methodology in StandardTo develop & pilot methodology in Standard setting, monitoring and reporting for:setting, monitoring and reporting for: Health ProtectionHealth Protection Health Care servicesHealth Care services
• To develop & apply the standards to assessdevelop & apply the standards to assess Boards’ preparednessBoards’ preparedness • To recommend future standard operating QA To recommend future standard operating QA process for Health Protection servicesprocess for Health Protection services
• To give Boards a self-assessment tool forTo give Boards a self-assessment tool for future planningfuture planning
AimsAims
The Areas of Enquiry The Areas of Enquiry - the ‘Standards’- 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 CarePrimary CarePharmacyMicrobiology
For each Standard:For each Standard:
• Expansion into criteria and lines of enquiryExpansion into criteria and lines of enquiry i.e. specific questionsi.e. specific questions
• Boards self-assess according to standard QIS Boards self-assess according to standard QIS scores in the key areas of: scores in the key areas of:
AccountabilityAccountabilityProcessesProcessesAudit & ReviewAudit & Review
• Consensus scoring workshops (Jan & Mar 2007)Consensus scoring workshops (Jan & Mar 2007)Individual Board & National ScoresIndividual Board & National ScoresEvidence Evidence
Scoring SystemScoring SystemScore 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
• 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
CaveatsCaveats
Health Protection
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
PerformanceCriteria
Accountability
Processes Audit and Review
Score 3 Surveillance & 2 Investigation
Risk assessment 3
Control measures 2
Communications 3
3
Key function
QA Areas of impact
Current development
Surveillance and
Investigation
2
IMT capacity to investigate cases clusters and progression of pandemic (First 100)
Capability of monitoring rates of Influenza like illness consultations and monitor vaccine and antiviral effectiveness
Laboratory handling of suspect influenza samples
Field Epidemiology database (FF100)developed
Pandemic flu surveillance system (PIPER ) 1st phase piloted
Communication protocol regarding laboratory arrangements
Health Protection Health Protection PreparednessPreparedness
Key function
QA Areas of impact Current development
Control Measur
es
2
Antiviral treatment
Pandemic vaccine programme
Social distancing, school closure, mass gatherings, travel restrictions, quarantine
Infection control & PPE: masks , respiratory precautions
Rx within 12h of symptoms; logistics of manufacture, distribution and delivery
Pre vs post pandemic vaccine benefits
Further modelling of social distancing measures
National guidance on infection control under development
NHS Scotland NHS Scotland Preparedness for Preparedness for
Pandemic InfluenzaPandemic Influenza Standard 2
Key function
QA Impact areas Current development
Surge Capacity
2Field investigation
Data collection and processing
Communication (media/service / public)
Scottish Health Protection Information System (SHPIMS)
Joint NHS Board agreements
Local authority/NHS Board support
NHS Scotland NHS Scotland Preparedness for Preparedness for
Pandemic InfluenzaPandemic Influenza Standard 2
Primary Care
Operational arrangements
Management of cases of pandemic influenza and curtailing activity to
cope with increased demand
Clinical management
Clinical management protocols covering care at home especially if
quarantine
Staff redeployment & support
Redeploying current staff, identifying back-up staff
CommunicationMechanisms to ensure flow of information to front-line staff
Joint workingLinks with acute and voluntary sector
Pharmacy servicesContinuity plans, distribution of
vaccines and anti-virals
Microbiology servicesTesting and reporting laboratory
results and infection control
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
pandemicPerformance Criteria: Primary Care
Score
Accountability 3
Processes & Procedures
Operational arrangements 2
Clinical management 1
Staff redeployment & support 1
Communication 3
Joint working 1
Pharmacy services 2
Microbiology services 3
Audit and review 1
Key function QA Areas of impact
Current development
Operational arrangements
2 Contingency plansAntiviral dispensing
RCGP Business Continuity GuidanceNational telephony service
Clinical management
1 Self and voluntary quarantine impact on home care
RCGP Scotland GuidanceBritish Thoracic Society
Staff redeployment & support
1 Smaller delivery units
SEHD Primary Care Planning Workshop
Joint working 1 Community careEngagement with voluntary sector
SEHD Adult Community Care Guidance
Pharmacy 2 Continuity of supply AntibioticsAntiviral indications
Further policy discussionScientific advice
Preparedness for Preparedness for Pandemic InfluenzaPandemic Influenza
Standard 2
• 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
ConclusionsConclusions
• 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
Acknowledgements
Hot Topic Meeting by:
Royal College of Physicians of Edinburgh &
The Scottish Executive Health Department
Pandemic Flu
Planning Scotland’s Health Response
5th June 2007
Queen Mother Conference Centre