Greenwich CCG Pandemic Flu Plan
Equality and diversity are at the heart of the NHS strategy. Throughout the
production of this document, due regard has been given to eliminate discrimination, harassment and victimisation, to advance equality of opportunity, and to foster good relations between people who share a relevant protected characteristic (as cited in under the Equality Act 2010) and those who do not share it. This document therefore abides by the Equality and Diversity Act 2010.
Author(s)
Interim Governance Consultant
Version
1.0
Version Date
September 2015
Approval Date
September 2015
Review Date
September 2016
Review Body
Greenwich Executive Group
Version Control
Version Author Date Reason for review
0.1 Interim Governance Consultant
September 2015
New Plan. Statutory EPRR Requirement 1.0 Interim Governance Consultant September 2015 Approved Policy 1.1 Interim Governance Consultant September 2015
Updated with comments from NHS England
Staff or Groups Consulted
This is optional.Name Job Title
Kerry Cleaver Communications and Engagement Manager Greenwich CCG
Ian Cheshire Emergency Planning & Resilience Officer (RBG) Lynette Russell Head of EPRR (RBG)
David Wernick EPRR Engagement Officer (NHS England) Jacqueline Lo EPRR Officer (Oxleas NHS Foundation Trust) Samantha Bennett PHE Consultant (RBG)
Sarah Bryan Surge and Resilience Manager (SEL)
Langley Gifford Associate Director of Integrated Commissioning Alison Edgington Resilience Planning Greenwich CCG
Judy Durrant Interim Designated Nurse for Children and Adults Gemma Battrum Care Home Support Team
Contents Page
1. Contents
2. Summary ... 4
3. Introduction ... 4
4. Aims and Objectives ... 4
5. Planning assumptions ... 4
5.1 At Risk groups ... 5
6. Associated Documents ... 5
7. Declaration of Pandemic Influenza- DATER ... 5
7.1 DATER Phases (UK Strategy) ... 6
7.2 Triggers for DATER Phases ... 7
8. CCG Roles and Responsibilities ... 8
8.1 Before a pandemic ... 8
8.2 During a pandemic ... 8
8.3 After a pandemic ... 9
9. Business Continuity ... 10
10. NHS England ... 10
Fig 1: London Pandemic Response Structure ... 12
11. National Pandemic Flu Service ... 12
12. Communications ... 13
Table 2: Key agency messages ... 14
13. Reporting ... 14
14. Recovery ... 15
15. Training and Exercises ... 15
16. Review ... 15
17. Sources of Evidence... 16
Appendix 1: Pandemic Flu Notification/ Alerting Process ... 17
Appendix 2: Pandemic Flu Communications checklist ... 18
Appendix 3: Pandemic Flu Group (PFG) Meeting Agenda ... 19
Appendix 4: Pandemic Flu Lead Action Card ... 20
Appendix 5: Communications Action Card ... 21
Appendix 6: Directorate Leads Action Cards ... 22
Appendix 7: Finance Officer Action Card ... 23
Appendix 8: Loggist Action Card ... 24
2. Summary
As Category 2 responders under the CCA (2004) and in line with arrangements for other major incidents and emergencies, Clinical Commissioning Groups (CCGs) have a role in supporting NHS England and providers of NHS funded care in planning for and responding to an influenza pandemic. The threat and potential impact of a pandemic influenza is such that it remains the top risk of the UK Cabinet Office National Risk Register of civil emergencies and continues to direct significant amount of emergency preparedness activity on a global basis. Lessons identified during the response to the 2009/10 pandemic caused by the A (H1N1) pdm09 virus and subsequent 2010/11 winter seasonal influenza outbreaks have informed on-going preparedness activity.
3. Introduction
Pandemic influenza emerges as a result of a new flu virus which is markedly
different from recently circulating strains. Few - if any - people will have any immunity to this new virus thus allowing it to spread easily and to cause more serious illness. With unpredictable frequency, novel influenza viruses emerge or re-emerge to cause an influenza pandemic. When this happens, it is likely that global spread will ensue rapidly, affecting large numbers of the population because there will be little or no immunity to this strain. Preparing successfully and responding effectively to a pandemic requires collaborative working between the NHS and other partner agencies.
4. Aims and Objectives
The overall aims and objectives of this plan are:
To outline Greenwich CCG‟s roles and responsibilities during pandemic influenza outbreak
To assist Greenwich CCG in minimising the potential health impacts caused by a future influenza pandemic on society and economy by:
a) Supporting the continuity of essential services
b) Supporting the continuation of everyday activities as far as is practicable c) Promoting a return to normality and the restoration of disrupted services at the
earliest opportunity
Instil and maintain trust and confidence by ensuring that other health partners, the public and the media are engaged and well informed in advance of and throughout the pandemic period and that health and other professionals receive information and guidance in a timely way so that they can respond to the public appropriately
5. Planning assumptions
Due to the uncertainty about the scale, severity and pattern of development of any future flu pandemic, the following 3 key principles underpin Greenwich CCG‟s plan
Precautionary: This plan takes into account that a new virus may carry the risk of being severe in nature. This plan therefore takes into account that the pandemic will have potential to cause severe symptoms in individuals and widespread disruption to the society
Proportionality: Greenwich CCG Plan will be applicable for both high impact pandemics and milder scenarios with the ability to adapt as new evidence emerges
Flexibility: This plan will take into account local patterns of spread of infection and be flexible and agile as required/ dictated by the pandemic
5.1 At Risk groups
The following groups have been identified as at increased risk of developing complications during a pandemic
Older people over 65 years old Pregnant women
Children under the age of 5
People who have relevant pre-existing medical conditions, e.g. neurological condition such as multiple sclerosis or cerebral palsy
People with underlying chronic medical conditions especially renal and respiratory problems
6. Associated Documents
Greenwich CCG Business Continuity Policy and Plan Greenwich CCG EPRR Policy
SE London Director‟s on call handbook SE London Daily Surge process
Royal Borough Greenwich (RBG) Pandemic Flu Plan
7. Declaration of Pandemic Influenza- DATER
Although the World Health Organization (WHO) is responsible for identifying and declaring influenza pandemics, the UK was well into the first wave of infection when WHO declared a pandemic in 2009.
The use of WHO phases to trigger different stages of the local response were considered confusing and inflexible and it was decided to develop a more flexible approach, not driven by the WHO phases and determined nationally was needed for the UK. The UK approach uses a series of phases: detection, assessment,
treatment, escalation and recovery (DATER). It also incorporates indicators for moving from one phase to another. The rationale for this is described in detail in the UK Influenza Pandemic Preparedness Strategy 2011.
The phases are not numbered as they are not linear, may not follow in strict order, and it is possible to move back and forth or jump phases. There will also be variation in the status of different parts of the country reflecting local attack rates,
7.1 DATER Phases (UK Strategy)
Detection
Led by PHE
The focus at this stage will be:
intelligence gathering from countries already affected
enhanced surveillance within the UK
the development of diagnostics specific to the new virus
information, specific advice, and communications to the public and professional
the indicator for moving to the next stage would be the identification of the novel influenza virus in patients in the UK
Assessment
Led by PHE
The focus at this stage will be:
The collection and analysis of detailed clinical and epidemiological information on early cases on which to base early estimates of impact and severity in the UK (First Few Hundred (FF100)
reducing the risk of transmission and infection with the virus within the local community by:
actively finding case
advising community voluntary self-isolation of cases and suspected cases advising on the treatment of cases/suspected cases and use of antiviral
prophylaxis for close/vulnerable contacts, based on a risk assessment of the possible impact of the disease
Treatment
Led by NHS England
The focus at this stage will be:
Advising on the treatment of individual cases and population treatment, if necessary, using the National Pandemic Flu Service (NPFS)
to consider enhancing public health measures to disrupt local transmission of the virus as appropriate, such as localised school closures based on public health risk assessment
Depending upon the development of the pandemic, to prepare for targeted vaccinations with NHS as the vaccine becomes available (NB the vaccine will not be available for 5-6 months after the decision to order vaccine is given). Arrangements will be activated to ensure that necessary detailed surveillance activity continues in relation to samples of community cases, hospitalised cases and deaths. When demands for services start to exceed the available capacity, additional measures will need to be taken. This decision may be made at a regional or local level as not all parts of the UK will be affected at the same time or to the same degree of intensity
Escalation
Led by NHS England
The focus at this stage will be:
The escalation of surge management arrangements in health and other sectors
Prioritisation and triage of service delivery
Resiliency measures
This phase would not necessarily be activated in a mild to moderate pandemic such as that experienced in 2009. Recovery Led by Local Authority. Membership from other agencies
The normalisation of services, perhaps to a new definition of what constitutes normal service restoration of business as usual services, including an element of catching-up with activity that may have been scaled-down as part of the pandemic response eg reschedule routine operations
post-incident review of response, and sharing information on what went well, what could be improved, and lessons learnt
taking steps to address staff exhaustion
planning and preparation for resurgence of influenza, including activities carried out in the detection phase
7.2 Triggers for DATER Phases
Phase General Nature and Scale of Illness Potential impact to healthcare Delivery Detection Reports of sporadic influenza cases in
the local community. And/or
Limited influenza local outbreaks in schools, care homes, prisons etc.
None – business as usual
Assessment As above As above
Treatment Low impact event
Similar numbers to moderate or severe seasonal influenza outbreaks. AND In the vast majority of cases – mild to moderate clinical features
Notable increase in pressures on services associated with respiratory illness with maximum effort. No significant deferral of usual activities Escalation (often happens simultaneously with Treatment Phase)
Moderate Impact event
Higher number of cases than large seasonal epidemic
Young healthy people and those in at-risk groups severely affected AND/OR More severe illness
High Impact Event
Widespread disease in the UK Most age groups affected
Severe debilitating illness with or without severe or frequent complications
Health services no longer able to continuity all activity Local and regional decisions to cease some health care activity (Trust Essential/Non Essential Services List) Community Health staff fully stretched trying to support essential care within the community
Consequential pressure on secondary care
Recovery Once the number of cases of influenza infections have been confirmed as reducing on a weekly basis, it will be important to manage the
reimplementation of services based on the availability of staff and resources and the impact the pandemic has had on the local population who may access these services. Recovery measures, including the provision of psychological counselling for both staff and the public may also be required.
Potential backlog of routine services – e.g. visits
8. CCG Roles and Responsibilities
As Category 2 responders (as defined by the CCA (2004)), the roles and
responsibilities of CCGs are to support the NHS and other Category 1 responders in preparing for and responding to pandemic influenza. The CCG Accountable
Emergency Officer (AEO) is responsible for „ensuring that the organisation is properly prepared and resourced for dealing with a major incident or civil
contingency event‟ (Emergency Officers‟ for Emergency Preparedness, Resilience and Response (EPRR) 2012). The following actions / activities will be undertaken by Greenwich CCG in response to Pandemic Flu.
8.1 Before a pandemic
Greenwich CCG will:
Identify a Pandemic Influenza Executive Lead (likely to be the AEO) to lead internal organisational pandemic planning activities in light of national and international developments, advice and guidance
Undertake internal business continuity planning in the context of pandemic influenza
Communicate plans with employees, contractors, and affiliated organisations Participate in relevant planning groups to discuss, plan, exercise and share
best practice
Ensure early engagement of communications professionals to devise, deliver and maintain internal, external and stakeholder/ cross-partnership
communications before, during and after a pandemic
Work with commissioned service providers, in planning for surge in relation to elective work and the possible financial implications if there is on-going
disruption to normal service levels over the period of a pandemic and its recovery phase
Participate in appropriate assurance processes regarding their arrangements and be assured that their commissioned services have adequate provisions in place for managing a pandemic
Work with NHS England who will commission community pharmacies as anti-viral collection points.
8.2 During a pandemic
Greenwich CCG will be notified as detailed in Appendix 1 and complete the following actions:
Support the national pandemic response arrangements as laid out in
Department of Health and NHS England guidance issued prior to or during a pandemic occurring
In line with other guidance, ensure 24/7 on-call arrangements remain robust and maintained, particularly with respect to surge and responding to major incidents. This will be done in line with the SEL Director on Call arrangements
Lead the management of pressure surge arrangements with their
commissioned services as a result of increased activity as part of the overall response
Closely monitor the on-going ability of commissioned services to assess and accept referrals. Information on levels of infection, staffing status and other emerging issues will be regularly reviewed
Support NHS England in the local coordination of the response, e.g. through tried and tested surge capacity arrangements, appropriate mutual aid of staff and facilities, and provision of support to the management of clinical queries As necessary share communications with locally commissioned healthcare
providers through established routes
Participate in the multi-agency response as appropriate and agreed with NHS England to ensure a comprehensive local response
Maintain close liaison with local NHS England colleagues, particularly when considering changes to delivery levels of NHS commissioned services Enact business continuity arrangements as appropriate to the developing
situation to ensure critical activities can be maintained
Maintain local data collection processes to support the overall response to the pandemic, including completion and submission of relevant situation reports and participation in coordination teleconferences
Throughout the pandemic, undertake and contribute to appropriate, timely and proportionate debriefs to ensure best practice is adopted through the
response
In particular, Greenwich CCG Medicines Management Team will:
Provide telephone advice and answer any technical questions that GPs and pharmacies may have
Cascade prescribing guidance to GPs within the Borough as per national guidance
Cascade prescribing guidance for antivirals to pharmacies as per national guidance
Maintain a stock pile of antivirals. The CCG will liaise with selected
pharmacies in the locality to store these and will directly receive the anti-virals from NHS England on behalf of the CCG
Deliver with partners, training to GPs, nursing homes and pharmacies on how to control the spread of pandemic flu
8.3 After a pandemic
Greenwich CCG will:
Contribute to local, regional and national health post-pandemic debriefs and consider the implementation of recommendations from any subsequent reports
Acknowledge staff contributions
Assess the impact of the pandemic on the provision of commissioned services and ensure that the ongoing service level is sufficient to meet the demands of the system
Ensure the recovery of services to business-as-usual as soon as appropriate Review response update plans, contracts and other arrangements to reflect
Collect financial and contractual impact information from commissioned providers
9. Business Continuity
Business Continuity Management is a holistic process that identifies potential threats to an organisation and the impacts to the business operations that those threats, if realized, may cause. Greenwich CCG must be able to continue its critical services as identified through the Business Impact Analysis. The level of staff absenteeism will depend significantly on the nature of the pandemic virus when it emerges and Greenwich CCG is prepared to this end for such an eventuality. When normal service is compromised at 30 %, the CCG will invoke its Business Continuity plan whilst implementing its contingency plans across all directorates. This may be invoked if the main supporting directorates such as Transformation and Service Delivery and Medicines Management are affected by staff absenteeism.
10. NHS England
NHS England is responsible for leading the mobilisation of the NHS in the event of an emergency or incident and for ensuring it has the capability for NHS command, control, communication and coordination and leadership of all providers of NHS funded care.
The Health and Social Care Act (2012) created a new set of responsibilities for the delivery of public health services. The department of Health is the lead government department for the pandemic preparedness and response. All other health partners will be directly or indirectly involved in the preparing and play an active role in informing and supporting contingency planning in their areas of responsibility. During a pandemic, it is likely that the Cabinet Office Briefing Room (COBR) will activate a Scientific Advisory Group of Emergencies (SAGE) to coordinate strategic scientific and technical advice to support UK cross government decision making. NHS England will monitor, manage and support the health community during a pandemic. Where possible and appropriate, existing arrangements and procedures will be used, underpinned by major incident coordination processes.
NHS England London will establish a dedicated Pandemic Influenza Incident Response Team (PI-IRT) that will operate out of a dedicated Pandemic Influenza Incident Coordination Centre. In line with the national strategy, these will be flexed to meet demands, and some may not be relevant to all DATER (Detection;
Assessment; Treatment; Escalation and Recovery) stages. These include (but not limited to):
Overseeing and coordinating the response of the NHS England in London appropriate to the current and predicted impact
Ensuring that the NHS and partners are kept appraised of the evolving situation
Overseeing the most effective deployment of available resources through adapting the response according to capacity
Ensuring that NHS England London Directorates and Teams enact their business continuity plans and mobilise resources appropriately as necessary
Ensuring prompt and timely establishment of a Pandemic Influenza Recovery Working Group (PI- RWG) to run in parallel with the response
Setting strategy for the PI-RWG
Providing progress updates and assurance regarding the NHS response in London to the NHS England London Delivery Group
Liaising with NHS England National, to support the local response, securing mutual aid if required
Acting as a central point of contact for stakeholders and partners (e.g.
London NHS provider and CCGs, NHS England National, the Department of Health, Public Health England (PHE), and wider multi-agency partnership through the London Resilience Team (LRT)
Ensuring appropriate escalation and two way communication of relevant issues and decisions
Overseeing the delivery of pandemic-specific aspects of the response; this includes, but is not limited to, antiviral distribution, pandemic specific
vaccination campaign and Personal Protective Equipment (PPE) distribution Managing the NHS response to pandemic –related surge; ensuring the
commissioning of additional NHS capacity where required (e.g. intensive care capacity (through Clinical Commissioning Groups (CCGs) and extra corporeal membrane oxygenation (ECMO) capacity (through NHS England Specialised Commissioning)
Overseeing the management of London-wide critical care resources and surge capacity demands through appropriate discussion, escalation and resource allocation
With communication colleagues, coordinating London-wide NHS messages to ensure consistent , clear and timely dissemination of information and guidance to the NHS, partners, the public and media
Collating information for submission to NHS England (National) and other bodies as appropriate related to pressures and capacity within the NHS in London
Fig 1: London Pandemic Response Structure
11. National Pandemic Flu Service
The Pandemic Flu service will be commissioned by NHS England. The purpose of the National Pandemic Flu Service (NPFS) is to enable antivirals to be distributed in a controlled and consistent manner to symptomatic individuals during an influenza pandemic. Anti-virals will come from national stock piles and distributed directly to antiviral collection points. NPFS would only be used at a time when the pressures in primary care have reached the point that a supplementary service is required for the assessment of symptomatic individuals and where appropriate, the authorisation and issuing of antivirals. There will be close monitoring of the number of consultations with GPs during a pandemic to inform this.
The key aims of the service are to:
Provide antiviral treatment promptly to those who need it
Reduce the demands on front-line health services by providing a separate route to access and collect antivirals
The NPFS involves an on line and telephony self-assessment service where individuals are not assessed by a clinician but follow a process of answering
questions which determine whether the person who is ill is eligible for an antiviral or not.
Accountability/ coordination &reporting Specialist advice/ information exchnage/ liasion Wider impact reporting
NHS England (London) Public Health England (National) NHS England National Department of Health Clinical Commissioning Groups, London Ambulance
Service, NHS Provider Organisations All BRF based organisations coordinated
information sharing for local situational awareness.
Formal reporting conducted intra-agency to the SCG London Local Authority Gold (LLAG) London Local Authority Control Centre (LLACC) London Borough Emergency Control Centre x33 (BECC)
Strategic Coordination Group (Multi-Agency LFB, LAS, MPS, ColP, BTP,
NHS, PHE and sectors) Public Health England (London ) DCLG Resilience & Emergencies Division (RED) COBR Other Govt Departments
As part of the NPFS, antiviral collection points are required locally when the NPFS is operating so that friends or relatives (flu friends) can collect the antivirals on behalf of the person with flu, enabling them to stay at home and mitigate the risk of spreading infection.
It takes at least three weeks for the necessary arrangements to be made for the NPFS to be able to operate. This includes the time required for the systems to be mobilised and for call centre staff to be identified and trained to deal with calls.
Therefore, the NPFS would not be operating in the initial stages of the pandemic, but this is in line with the plan that it should only be considered as pressures increase.
12. Communications
A robust communication strategy is an important part of a response to a pandemic. As a result, information relating to pandemic flu will be coordinated centrally by NHS England for consistency. The CCG will communicate with its commissioned
providers, partners, stakeholders and the public during a pandemic and build on existing mechanisms and good practice (see appendix 2 for communications checklist). The CCG will maintain robust communication lines with the Local Authority as they deliver social services to the Greenwich population. The RBG Pandemic Flu plan details how they will support the wider population during Pandemic Flu and management of excess deaths.
The CCG recognises that an effective 2 way communications strategy that positively engages the key groups, before and during a pandemic is essential. Nationally, this is outlined in the UK Pandemic Influenza Communications Strategy 2012. This communications strategy considers health-related communication in the UK in the stages leading up to a pandemic, during a pandemic, and during the recovery phase. The CCG has suitably qualified communications staff who will be responsible for cascading information out via the intranet/ internet between the hours of 9am to 5pm, in a timely manner. Other media channels such as social media including twitter will be utilised to reach out to the public. South East Commissioning Support Unit (SECSU) provides out of hours communication on behalf of the CCG from 5pm to 9am Monday to Friday and all weekend.
Additionally, communications cascades will be used to ensure information reaches target audiences. Where appropriate, messages will be developed and delivered in partnership with other organisations, including PHE and the LHRP and LRF partners. Greenwich CCG Communications team will ensure that information will aim to:
Explain the outbreak
Establish confidence by reassuring the public
Minimise the risk of infection by advising people how to protect themselves Advise the public on how to prepare in advance
During a pandemic, each organisation will be required to supply situation reports to their host Government Department which will be fed to COBR. Additionally, each organisation will provide reports to LRT, as secretariat to the London Partnership Meeting, to produce an overall London picture. The London Common Recognised Information Picture (CRIP) will provide key information and data on the present situation in London.
The Pandemic Flu Framework sets out examples of reportable intelligence as detailed below:
Table 1: Key agency messages
Agency Examples of possible reporting lines
PHE Enhanced surveillance and epidemiology
Transmission and spread, e.g. circulating strain and severity
NHS surge, including primary care impacts on elective work critical care capacity
mortality and morbidity data Local Authorities impacts on local critical services
social care provision;
impacts on cremation and burial services; community concerns;
business issues;
local support to the health service/voluntary and
community inputs and mutual aid issues and solutions; public communication activity and media coverage; and
requests for assistance. Other Agencies impacts on service delivery
staff absenteeism
public communication and media coverage requests for assistance
13. Reporting
Incident reporting is fundamental to the identification of risk and response management and all staff are encouraged to use the CCG‟s existing incident reporting mechanisms. As the pandemic reaches the UK and number of cases increases, there will be a requirement for regular situation reports (SitReps) from all organisations including CCGs. The frequency of the Situation reports will be defined by the severity of the pandemic.
Greenwich CCG will maintain the usual incident reporting mechanisms for non-flu related incidents to ensure these continue to be managed during a pandemic. Flu related incidents will report into the CCG Pandemic Response Team consisting of Senior Management Team, led by the CCG Pandemic Flu Lead.
The CCG Pandemic Response Team will ensure that there are robust processes in place to document and record decisions and actions made during the pandemic. A decision log will be used to record all communications and activities, including time the decision was made, who made it and the rationale behind the action or decision.
14. Recovery
The Recovery phase in the Department of Health (DH) Strategy encompasses
normalisation of services; restoration of business as usual services, evaluation of the pandemic, planning and preparation for a resurge in activity, and targeted
vaccination, when available. The Department of Health will issue information to inform plans following a review of the first wave and the availability of
countermeasures.
Health and social care services may experience persistent secondary effects for some time, with increased demand for continuing care from:
Patients whose existing illnesses have been exacerbated by influenza. Those who may continue to suffer potential medium or long term health
complications.
A backlog of work resulting from the postponement of treatment for less urgent conditions.
The pace of recovery will depend on the residual impact of the pandemic, on-going demands, backlogs, staff and organisational fatigue and continuing supply difficulties in most organisations. The CCG will continue to support its commissioned providers during the recovery stage to restore services and to phase the return to „new-normal‟ in a managed and sustained way.
15. Training and Exercises
This plan will be available on the CCG intranet for all staff to access. All directors receive training through the Director on call training and relevant training identified by NHS England. Greenwich CCG will work closely with the Borough Resilience Forum and participate in multiagency Pandemic Flu exercises. A Pandemic flu exercise or test informed by this plan will be conducted within the next 6 months (by end of March 2016) as required by NHS England EPRR Assurance Framework.
16. Review
This plan will be reviewed annually as a statutory requirement or earlier should new information/ regulation come to light or as indicated by an incident.
17. Sources of Evidence
Civil Contingencies Act (2004)
https://www.london.gov.uk/sites/default/files/LRF_PanFlu_Framework_6.0.pdf https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/21567 9/dh_125338.pdf https://www.gov.uk/pandemic-flu#guidance-for-local-planners https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/21567 8/dh_125431.pdf https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/22586 9/Pandemic_Influenza_LRF_Guidance.pdf http://www.who.int/influenza/preparedness/pandemic/GIP_PandemicInfluenzaRiskM anagementInterimGuidance_Jun2013.pdf https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/21326 8/UK-Pandemic-Influenza-Communications-Strategy-2012.pdf http://www.england.nhs.uk/commissioning/wp-content/uploads/sites/12/2015/03/ccg-assurance-framework.pdf http://www.england.nhs.uk/wp-content/uploads/2013/12/roles-resps-panflu-ccgs.pdf http://www.england.nhs.uk/nhs-standard-contract/15-16/ http://www.england.nhs.uk/wp-content/uploads/2015/06/core-standards-eprr.xlsx
Appendix 1: Pandemic Flu Notification/ Alerting Process
NHS Trusts and CCGs WHO declares Pandemic
Department of Health
Cabinet Office
Public Health England & NHS England
Appendix 2: Pandemic Flu Communications checklist
The following will be considered by Greenwich CCG during a pandemic to ensure that information cascaded from NHS England is shared in a timely and consistent manner to partners and members of the public.
1 Methods of communicating with the public have been identified and are appropriate for individuals with hearing, visual and other disabilities or limited English speaking.
2 The message has been tailored for different audiences (internal or external audiences, stakeholders, public, the media, business, and the vulnerable). 3 Local media have been engaged, and the channels of communication have
been considered (web, social media, in-house productions, local newsletters).
4 A list has been created of health care entities, including points of contact, within the LRF locality (e.g. hospitals, long-term care and residential facilities, clinics, GPs) with which it could be necessary to maintain
communication and be able to report information in a timely and accurate manner during a pandemic.
(The Medicines Management Team have the list of all GPs and Clinics and the Care Home Support Team have a list of the long term care and residential facilities)
5 Local arrangements to support central and devolved Government in communicating advice to the local population and public messages have been established.
6 Individuals have been identified within organisations with responsibility for coordinating the information.
Appendix 3: Pandemic Flu Group (PFG) Meeting Agenda
The following draft agenda topics have been outlined as a guide for potential PFG meetings during a pandemic. A series of action cards have also been produced to guide the PFG through various alert levels. This meeting will be chaired by the AEO or designated deputy.
Meeting agenda for PFG in response to a Pandemic or Outbreak
Item
Number Topic 1 Introduction 2 Matters arising
3 Reports from borough level or information received from NHS England or PHE
4 Issues from providers eg surge 5 Staff welfare
6 CCG Situation Report (SitRep) 7 Financial arrangements
8 Issues that require escalating to other stakeholders e.g. NHS England /PHE
9 Communications
10 Any Other Business (AOB)
Appendix 4: Pandemic Flu Lead Action Card
CCG Pandemic Flu Lead (AEO or delegated officer) Role:
Cascade information from NHS England
Coordinate planning efforts across the CCG
Represent the CCG in multi-agency pandemic flu meetings across boroughs
Detection and Assessment Phase
Cascade all information about Pandemic Flu to other Directorate Leads
Ensure Greenwich CCG is represented at local Borough Pandemic Flu Response meetings.
Treatment phase
Continued monitoring of the pandemic and brief senior staff with most up to date information
Ensure Greenwich CCG is represented at local Borough Pandemic Flu Response Groups
Liaise with the Medicines Management Team to ensure that there are adequate stock piles for local supplies
Escalation phase Provide NHS England with regular updates
Ensure Greenwich CCG is represented at local Borough Pandemic Flu Response Groups
Recovery Phase Attend debrief when requested
Post pandemic actions Review CCG Pandemic Flu Plan post pandemic
Review Business Continuity plans with services following the pandemic to ensure lessons learnt are incorporated into future plans
Appendix 5: Communications Action Card
CCG Associate Director of Communications Role:
Coordinate internal and external communication activity
Put in place communication arrangements to make information available to the public about civil protection matters and maintain arrangements to warn, inform, advise the public throughout the course of the pandemic
Liaise with other partners and link in with LON01 to ensure there is a controlled and consistent message for staff, members of the public visitors within the CCG and any communications are made in a timely manner
Engage with local media where necessary
Detection and Assessment Phase Link in with LON01 if necessary
Liaise with the CCG Pandemic Flu Lead at the early stages of a pandemic to ensure consistent messages are delivered to staff and the public
Warn and inform the public of the potential of a pandemic
Treatment phase Handle any media enquiries
Maintain updates on the pandemic on Greenwich CCG website for staff and the public
Escalation phase Engage with the media as appropriate
Recovery Phase Attend debrief when requested
Post pandemic actions
Appendix 6: Directorate Leads Action Cards Directorate Leads Role:
Lead any response to pandemic as directed by Senior Management
Ensure Directorate Business Continuity arrangements are implemented
Ensure adequate staffing resources
Ensure relevant information is cascaded to staff
Ensure continuation of all essential services as dictated in Business Continuity Plans
Detection and Assessment Phase Ensure all staff are aware of any new guidance as required
Treatment phase Keep staff updated with new information
Monitor staff absence/ sickness and report for PFG SitRep
Escalation phase Maintain communications with staff
Monitor and report issues in staff sickness and absence (capacity)
Recovery Phase Attend debrief when requested
Acknowledge staff efforts
Post pandemic actions
Review Business Continuity plans with services following the pandemic to ensure lessons learnt are incorporated into future plans
Appendix 7: Finance Officer Action Card
Finance Officer Role:
Ensure funding is available to cover additional costs incurred during a pandemic
Ensure arrangements are in place to minimise problems to the supply chain during the pandemic
Detection and Assessment Phase
Ensure sufficient funding is available to cover any additional costs incurred during a pandemic
Ensure there is a clear audit trail of all costs associated with the pandemic for record following pandemic, should the DoH request for information
Ensure the continued provision of key services such as Payroll throughout pandemic
Treatment phase
Ensure the continued provision of key services such as Payroll throughout pandemic
Escalation phase
Ensure funding is available to cover additional costs as required
Recovery Phase Attend debrief when requested
Post pandemic actions
Review Business Continuity Plan following pandemic to ensure lessons learnt are incorporated
Appendix 8: Loggist Action Card Your role Loggist
Your Base 31-37 Greenwich Park Street, SE10 9LR
Your
responsibility
You support the Incident Control Team (Pandemic Flu) and ensure a record or log of the incident is maintained
Your immediate actions
1. Proceed to the Incident Control Room as directed 2. Report to the Incident Manager - Pandemic Flu Lead for
briefing
3. Maintain a log of decisions taken, communications and actions taken by the Incident Control Team
NB: The record must be in permanent black ink, clearly written, dated and initialled by the loggist at the start of the shift.
All persons in attendance to be recorded in the log.
The log must be a complete and continuous (chronological record of all issues/ options considered/ decisions along with the reasoning behind those decisions/ actions.
Timings have to be accurate and recorded each time information is received or transmitted.
If individuals are tasked with a function or role, this must be documented and when the task is completed this must also be documented.
On-going management
All documentation is to be kept safe and retained for evidence for any future proceedings.
Stand down Participate in a “hot” debrief immediately after the incident and any
subsequent structured debrief.
Following stand down evaluate admin effectiveness and any lessons learned and report these to the Incident Manager for inclusion in the report to the Chief Officer.
Appendix 10 - Equality & Equity Impact Assessment & EDS2 Checklist
This is a checklist to ensure relevant equality and equity aspects of proposals have been addressed either in the main body of the document or in a separate equality & equity impact assessment (EEIA)/ equality analysis. It is not a substitute for an EEIA which is required unless it can be shown that a proposal has no capacity to influence equality. The checklist is to enable the policy lead and the relevant committee to see whether an EEIA is required and to give assurance that the proposals will be legal, fair and equitable.
The word proposal is a generic term for any policy, procedure or strategy that requires assessment.
Challenge questions Yes/No What positive or negative impact do you assess there may be?
1. Does the proposal affect one group more or less favorably than another on the basis of:
Race No
Pregnancy and Maternity Yes Identified as vulnerable group
Sex No
Gender and Gender Re-Assignment No
Marriage or Civil Partnership No
Religion or belief No
Sexual orientation (including lesbian, gay bisexual and transgender people)
No
Age Yes Identified as vulnerable group
Disability (including learning disabilities, physical disability, sensory impairment and mental health problems)
Yes
2. Will the proposal have an impact on lifestyle? (e.g. diet and nutrition, exercise, physical activity, substance use, risk taking behaviour, education and learning)
No
3. Will the proposal have an impact on social environment?
(e.g. social status, employment (whether paid or not), social/family support, stress, income)
No
4. Will the proposal have an impact on physical environment?
(e.g. living conditions, working conditions, pollution or climate change, accidental injury, public safety, transmission of infectious disease)
Yes Limitation of pandemic influenza spread in work and public areas
5. Will the proposal affect access to or experience of services?
(e.g. Health Care, Transport, Social Services, Housing Services, Education)
Yes Identified vulnerable population during access to health. Possible disruption to education centres during influenza pandemic
By using evidence and insight to assess and grade our equality performance, NHS Greenwich can generate much of the information we will require to demonstrate compliance with the PSED. The checklist is to enable the policy lead and the relevant committee to see if a particular policy or project will provide the relevant evidence to assist NHS Greenwich CCG meet the set out EDS goals to achieve better outcomes for patients and staff. Please assess your policy, project or service against the following:
The goals and outcomes of EDS2
Description of outcome Yes/
No Better health outcomes 1.1 Services are commissioned, procured, designed and delivered to meet the health
needs of local communities
YES
1.2 Individual people‟s health needs are assessed and met in appropriate and effective ways
YES
1.3 Transitions from one service to another, for people on care pathways, are made smoothly with everyone well-informed
YES
1.4 When people use NHS services their safety is prioritised and they are free from mistakes, mistreatment and abuse
YES
1.5 Screening, vaccination and other health promotion services reach and benefit all local communities
YES
Improved patient access and experience
2.1 People, carers and communities can readily access hospital, community health or primary care services and should not be denied access on unreasonable grounds
No
2.2 People are informed and supported to be as involved as they wish to be in decisions about their care
No
2.3 People report positive experiences of the NHS No
2.4 People‟s complaints about services are handled respectfully and efficiently No A representative and
supported workforce
3.1 Fair NHS recruitment and selection processes lead to a more representative workforce at all levels
No
3.2 The NHS is committed to equal pay for work of equal value and expects employers to use equal pay audits to help fulfil their legal obligations
No
3.3 Training and development opportunities are taken up and positively evaluated by all staff
No
3.4 When at work, staff are free from abuse, harassment, bullying and violence from any source
No
3.5 Flexible working options are available to all staff consistent with the needs of the service and the way people lead their lives
No
3.6 Staff report positive experiences of their membership of the workforce No Inclusive leadership 4.1 Boards and senior leaders routinely demonstrate their commitment to promoting
equality within and beyond their organisations
No
4.2 Papers that come before the Board and other major Committees identify equality-related impacts including risks, and say how these risks are to be managed
No
4.3 Middle managers and other line managers support their staff to work in culturally competent ways within a work environment free from discrimination
No
Policy Author Signature: H MAKAMURE Date: 25/08/2015 Equalities Lead
