Kent Resilience Forum Pandemic Influenza Contingency Plan. March 2009 (Version 3.9) Image here

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1 Kent Resilience Forum Pandemic Influenza Contingency Plan March 2009 (Version 3.9) Image here

2 Version control summary sheet Updates Version Date produced Description, comments and changes since previous version Jun 2005 First meeting of Kent Pandemic Flu Contingency Meeting (28 Jun 2005). Health Protection Unit identified as lead organisation to draft Kent Pandemic Flu Plan. First draft based on UK Health Departments UK Influenza Pandemic Contingency Plan (March 2005) published 1 March 2005 (Gateway ref 4614) UK Health Departments UK Influenza Pandemic Contingency Planning: Operational Guidance for Health Service Planners in England (March 2005) published 12 May 2005, and Health Protection Agency Influenza Pandemic Contingency Plan (version 7.0) published February Drew heavily on plan produced by Surrey/Sussex Health Protection Unit Jul 2005 Internal Health Protection Unit consideration and revisions Aug 2005 Internal Health Protection Unit consideration and revisions Sep 2005 Further revised version produced for second Kent Pandemic Flu Contingency Meeting (16 Sep 2005) Dec 2005 Comments received from: Kent Pandemic Flu Contingency Planning Group Amendments/additions: Relationships in Kent during the pandemic period (Section 8.4) Revised PCT section Health impact spreadsheet Supplements to plan (eg, antiviral, vaccination and infection control guidance) produced Revised version for exercise (18 Jan 2006) Jul 2006 Working draft not published Feb 2008 New draft plan based on Civil Contingencies Secretariat. Preparing for pandemic influenza: Guidance to local planners. London: Cabinet Office, Department of Health, Cabinet Office. Pandemic flu: A national framework for responding to an influenza pandemic. London: DH, Health Protection Agency. Pandemic influenza contingency plan. London: HPA, Aim to be formally adopted by the Kent Resilience Forum Feb 2008 Comments on version 3.0 received from: Eastern & Coastal Kent PCT KM Kent County Council (KASS only) UC Kent Fire & Rescue Service MT Kent Health Protection Unit JS, AT Tonbridge & Malling Borough Council (on behalf of District Councils) MO Medway Council RF The Medway NHS Trust FS, MS Amendments/additions: Cover Some logos removed 1.1 Clarification of aims 1.1 Addition of reference to National Framework 1.2 Clarification of objectives 2.2 Addition of reference to Community Risk Register 2.3 Absenteeism amended to staff absences 2.3 Addition of reporting, recording, cover and support to staff 3.2 Addition of identification of priority staff for vaccination 4.1 Clarification re SCG and STAC 4.2 Clarification re local authorities 4.6 Clarification re surveillance 4.6 Clarification re NHS (acute trust or PCT) 4.6 Clarification of mental health trust role in infection control 5. New section re declaring a pandemic 5.1 Additions re UK alerting 5.2 Additions re alerting in Kent 6.2 Additions re communications within Kent inc SCG and STAC 6.3 Additions re communications within NHS inc Strategic Command 7.1 Clarification re local authorities 10.1 Addition of training in death certification Appendix 1 Amended Appendix 6 Amended 2

3 Mar 2008 Comments on version 3.1 received from: Army Primary Health Care Services SR Medway PCT (partial) DS West Kent PCT MV South East Coast Ambulance Trust JW Kent Police DW Amendments/additions: Revised wording for responsibilities of SEC Ambulance 7.1 Clarification re schools and childcare settings closure 8.4 Clarification re pre-pandemic vaccine May 2008 Appendix 4 ERMT rota updated Oct 2008 In response to supplementary CO guidance and checklist. 3.3 Referred to HSE guidance 4.2 Typos addressed, Table 2 updated 4.5 Reference to September 2008 exercise 5.2 Further detail on triggers for establishing SCG 6 Re-titled communication and coordination, content amended accordingly Reporting to RCCC and CCC made explicit New section SCG subgroups Clarification and further detail on NHS command and control 6.5 New section Battle rhythm 6.6 (prev 6.5) Further detail on allied communications plans 7.4 Minor wording change 8.1 Reference to September 2008 exercise 8.4.1, Refer to revised vaccination strategy (version 2.2) 10.1 Identification of KCC lead 11 Updated and enhanced to include local documents and allied plans Appendix 2 Revised population and GP consultation rate, reference to working document held by HPU Appendix 5 NHS traffic light alert system added Appendix 6 Draft communications plan added, other appendices renumbered Nov Typo addressed 1.2 Objectives amended 1.4 New section Relationship to other plans Typo addressed 6.2 Typo addressed Possibility of regional STAC detailed 6.4 New section Communication in social care Refers to intelligence cell, ongoing work and CO guidance Appendix 6 Local, regional, nationals agencies relationships diagram added, other appendices renumbered Dec 2008 Amended version produced following meeting with and consideration by Government Office of the South East (via AT, DC, MD) Outstanding issues Expected dates of resolution added, review date added 1.4 Reference to Pan-Kent Strategic Emergency Framework 4.7 Mutual aid arrangements clarified Reference to health removed 6.7 New section Voluntary sector involvement 7.1 Clarification and additions re schools closure policy, communication and remote learning 7.2 Voluntary quarantine of contacts added 7.5 New section Social distancing measures (inc public gatherings) 9 Animal welfare piece added 10.1 Reference to KRF draft Managing excess deaths plan 10.2 Reference to KRF draft Identifying vulnerable people in an emergency plan Dec 2008 Amended version produced for Cabinet Office Outstanding issues updated following 10 December meeting 4.2 Table 3 Amended Chair of MFWG to Medway Council 6.2.1, Appendix 6 SCG Chair amended to Police Gold Commander 6.5, Further detail on a possible intelligence cell and linking with RRF work 8.3 Further clarification re PCT responsibility for closed communities 8.5, Appendix 8 New section Dental services 11.2 Typos addressed Appendix 4 Revised ERMT rota/flyer inserted Appendix 10 Updated Feb 2009 Amended version produced for KRF Executive Group following KRF consultation Outstanding issues Excess deaths plan signoff delay reflected 1.3 NHS organisations evolving name changes reflected Reference to Medway Council s plans for supporting learning Mar 2009 Amended version produced for GOSE Outstanding issues Excess deaths plan progress reflected Appendix 7 removed pending updated and approved version 3

4 Outstanding issues Date first apparent Issue Resolution Expected date of resolution 28 Feb 2008 Mass Fatalities Working Group to produce plan for excess deaths in flu pandemic. 7 Mar 2008 Provision of antivirals to closed communities (eg, prisons, military establishments) need further assurance all PCTs have agreed plans in place. 10 Sep 2008 Data collection and reporting to SCG (inc. battle rhythms) needs further work. 20 Oct 2008 Revised communications strategy, including a Pandemic Flu Appendix to form Appendix 7 of this plan, to be incorporated when agreed. 20 Oct 2008 Output of Humanitarian Welfare subgroup on identifying vulnerable persons to be incorporated. Draft plan produced. Out for consultation prior to going to Executive and Policy Groups. PCTs taking this work forward and will report back again at March 2009 meeting. Group to consider being formed Jan Added to KRF business plan Awaiting RRF work. Warning & Informing subgroup to approve Appendix and Strategy. Draft plan in progress. Humanitarian Welfare subgroup to approve plan. This is a dynamic document, which will be updated in line with national and regional policy developments and revisions to local responders plans as necessary. Next review due 30 June Comments on this document should be ed to [email protected]. KRF Policy Group Apr Mar

5 Table of contents 1. INTRODUCTION Aims Objectives Status and scope Relationship to other plans 9 2. LIKELY IMPACT OF PANDEMIC INFLUENZA Duration and timing of a pandemic Attack and death rates Staff absences from work BUSINESS CONTINUITY PLANNING Action Contents of CCA category 1 responders business continuity plans Reducing transmission in the work place ROLES AND RESPONSIBILITIES Role of the Kent Resilience Forum, Strategic Coordinating Group and Science and Technical Advice Cell Coordination of multi-agency planning in Kent Individual agency planning Training Testing the Plan Roles of individual agencies Mutual aid DECLARING A PANDEMIC (INTERNATIONAL AND UK) UK alerting Alerting in Kent Alerting in the NHS in Kent 21 5

6 6. COMMUNICATION AND COORDINATION Communication upwards Communication and coordination within the KRF area Communication and coordination within the NHS Communication and coordination in social care Data capture and reporting Battle rhythm Communication and coordination with the voluntary sector Communication with the public SOCIAL MEASURES Schools and childcare settings closure Voluntary home isolation and quarantine Public order Ports Social distancing measures HEALTH MEASURES Health service Supporting self care Antivirals Vaccines Dental services WIDER IMPACTS OTHER ISSUES Management of excess deaths Identification of, and provision for, vulnerable and seldom heard groups BIBLIOGRAPHY Local documents 32 6

7 11.2 National and international documents 32 APPENDIX 1 34 APPENDIX 2 36 APPENDIX 3 37 APPENDIX 4 38 APPENDIX 5 39 APPENDIX 6 40 APPENDIX 7 41 APPENDIX 8 42 APPENDIX 9 43 APPENDIX

8 1. Introduction 1.1 Aims This document aims to provide the backbone for influenza (flu) pandemic preparedness and response in Kent. It does NOT replace existing Kent emergency plans. It is a supplement, providing additional information and guidance specific to a flu pandemic. It aims to be consistent with national policy as outlined by the Department of Health (DH) in A national framework for responding to an influenza pandemic, published November 2007, and associated documents. 1.2 Objectives 1. Act as a reference document by providing: a. a summary of some key aspects of pandemic flu and b. guidance on pandemic flu planning c. a signpost to other key documents 2. Describe arrangements for pandemic flu response in Kent 1.3 Status and scope This document describes arrangements for pandemic flu response in Kent. Its production has involved consultation with the following agencies (principally those identified as category 1 responders under the Civil Contingencies Act (CCA) 2004): Kent Police Kent Fire and Rescue Service South East Coast Ambulance NHS Trust Ashford Borough Council Canterbury City Council Dartford Borough Council Dover District Council Gravesham Borough Council Maidstone Borough Council Medway Council (Unitary Authority) Sevenoaks District Council Shepway District Council Swale Borough Council Thanet District Council Tonbridge and Malling Borough Council Tunbridge Wells Borough Council Kent County Council NHS Eastern and Coastal Kent (Primary Care Trust) NHS Medway (Primary Care Trust) NHS West Kent (Primary Care Trust) Kent and Medway NHS and Social Care Partnership Trust Dartford and Gravesham NHS Trust East Kent Hospitals NHS Trust Maidstone and Tunbridge Wells NHS Trust The Medway NHS Foundation Trust Kent Health Protection Unit The following CCA Category 1 responders have not (thus far) been involved in Kentwide pandemic flu planning: British Transport Police Maritime and Coastguard Agency Environment Agency In addition, the document has been shared with representatives of the following local organisations: Army Primary Health Care Services Prisons Independent Schools 8

9 The document represents the Pandemic Influenza Contingency Plan of the KRF covering the county of Kent including Medway. Membership of the KRF is shown in Appendix Relationship to other plans Whilst this plan is the primary pandemic flu plan for Kent, a coordinated response to a flu pandemic will necessitate the use of other plans: Kent Resilience Forum Pan-Kent Strategic Emergency Framework Kent Resilience Forum Warning and Informing Plan Kent Resilience Forum Influenza Pandemic Managing Excess Deaths Plan Individual agencies business continuity, major incident, pandemic flu and communications plans Kent Pandemic Flu Vaccination Strategy 9

10 2. Likely impact of pandemic influenza The Government judges that one of the highest current risks to the UK is the possible emergence of an influenza pandemic that is, the rapid worldwide spread of flu caused by a novel strain to which people have no immunity, resulting in more serious illness than that caused by seasonal flu. 2.1 Duration and timing of a pandemic A flu pandemic could occur at any time (not only during winter). The pandemic virus is almost certain to arise outside the UK. Cases could begin to occur in the UK within one month of the start of the pandemic. Once in the UK, the pandemic is likely to spread to most major population centres within two weeks. Flu pandemics typically tend to occur in waves. The second wave may be larger than the first. The Cabinet Office advises local planners to assume each wave will last 12 to 15 weeks. 2.2 Attack and death rates The Cabinet Office advises local planners to assume: a 50% clinical attack rate, 10 to 12% of the population will become ill, per week, during peak weeks, up to 4% of those symptomatic will require hospital admission, and up to 2.5% of those symptomatic will die Impact in Kent The KRF Community Risk Register has recorded pandemic flu as having a risk rating of very high, a likelihood of possible (> 1 in 20 chance) and an impact of catastrophic. Table 1 shows the expected impact at different clinical attack and case fatality rates for a population of 1.6 million (ie, Kent). Table 1: Range of possible excess deaths for various permutations of case fatality and clinical attack rates, based on Kent population Clinical attack rate Case fatality rate 25% 35% 50% 0.4% 1,600 2,240 3, % 4,000 5,600 8, % 6,000 8,400 12, % 10,000 14,000 20,000 Appendix 2 shows further detail ie, predicted GP consultations, A&E presentations, hospital admissions and deaths at different clinical attack and case fatality rates by week of a 15-week wave. A working spreadsheet is available from Kent Health Protection Unit (HPU). 2.3 Staff absences from work Staff will be absent from work for a variety of reasons: 1. if they are ill with flu - staff with flu can be expected to be absent from work for about a week the numbers affected depend upon the clinical attack rate 2. if they are ill with other medical problems 10

11 3. to care for children or other family members who are ill 4. to care for (well) children because of the closure of schools and group early years and childcare settings 5. if their employers have advised them to work from home Organisations employing large numbers of people, with flexibility of staff redeployment, should ensure that their plans are capable of handling staff absence rates of up to 15-20% (in addition to usual staff absence levels) at peak. Small businesses, or larger organisations with small critical teams, should plan for level of absence of up to 30-35% at peak (may be higher for very small businesses with only a handful of employees). Organisations will need to have in place clear reporting, recording and cover mechanisms. In addition there will need to be provision for support to staff before, during and after the event. 11

12 3. Business continuity planning 3.1 Action Action points (business continuity planning) All agencies/organisations of the KRF should: have business continuity plans in place which cover arrangements for dealing with pandemic influenza encourage organisations on which they will rely during a pandemic do the same (ie, have business continuity plans in place which cover arrangements for dealing with pandemic influenza) o guidance for business continuity planning (including a pandemic influenza checklist for businesses) can be found on the UK Resilience website at ensure that their business continuity plans have the flexibility to accommodate the range of predicted staff absences. 3.2 Contents of CCA category 1 responders business continuity plans KRF members business continuity plans should cover the following generic issues in addition to those which are agency/organisation specific: 1. Measures to maintain core business activities for several weeks at high levels of staff absence, including options for remote working and expanding selfservice and on-line options for customers and business partners 2. Identification of those essential functions and posts, and perhaps individuals, whose absence would place business continuity at particular risk. 3. Identification of services which could be curtailed or closed down during all, or the most intense period, of the pandemic. 4. Measures to ensure that health and safety responsibilities to employees continue to be fully discharged. 5. Identification of inter-dependencies between organisations, and ensuring they are resilient, for example by ensuring that supplier organisations delivering services under contract have appropriate arrangements in place themselves to sustain their service provision. See also pandemic influenza checklist for businesses on the UK Resilience website at Medical counter-measures will not solve business continuity requirements because antiviral drugs for treatment will only lessen the severity of the illness. They will neither cure it nor significantly reduce staff absence. Pandemic specific vaccines will not be available during the first wave. KRF members should identify priority staff for vaccination with pandemic-specific and/or pre-pandemic vaccine when this becomes available. These vaccines will be administered according to published DH priorities at the time. See also Section Reducing transmission in the work place As a part of business continuity planning all agencies/organisations of the KRF should support efforts to reduce the impact of the pandemic by: 12

13 Taking all reasonable steps to ensure that employees who are ill or think they are ill during a pandemic are positively encouraged not to come into work. Personnel policies may need to be reviewed to achieve this aim. Ensuring that employers and employees are made aware of Government advice on how to reduce the risk of infection during a pandemic. Ensuring that adequate hygiene (eg, hand-washing) facilities are routinely available. Infection control guidance in the event of a flu pandemic is now available for some non-nhs sectors (funeral directors, the hospitality industry, fire and rescue services, cleaning and refuse staff and the police). Each document explains what pandemic flu is, how it is spread and how you can protect yourself and others from it. It also addresses issues relevant to the particular sector. This guidance is in addition to that published for the NHS: Guidance for infection control in hospitals and primary care settings. All these guidance documents can be found at The Health and Safety Executive (HSE) has published Pandemic Flu Workplace Guidance available at 13

14 4. Roles and responsibilities 4.1 Role of the Kent Resilience Forum, Strategic Coordinating Group and Science and Technical Advice Cell The primary responsibility for developing preparedness plans for pandemic flu rests with local organisations (as it does for other major emergencies). The Kent Resilience Forum is the principal mechanism for the coordination of multi-agency planning in Kent. In the event of a flu pandemic a Strategic Coordinating Group (SCG) for Kent is likely to be formed (with members including CCA category 1 responders) which will coordinate the multi-agency response. A Science and Technical Advice Cell (STAC) will advise the SCG via the STAC Lead. See also Section Coordination of multi-agency planning in Kent KRF pandemic flu planning is coordinated by the Kent Pandemic Influenza Contingency Planning Group. The Group has, since 2007, been recognised as a working group of the Health Subgroup of the KRF (see Appendix 3 for KRF structure). Membership of the Group is shown in Table 2. Table 2: Kent Pandemic Influenza Contingency Planning Group organisational membership Agency / Organisation Health Protection Agency Kent Resilience Forum Primary Care Trusts Acute Hospital Trusts Mental Health Trust Ambulance Trust Police Fire & Rescue Service Prisons Local Authorities: - County Council - Unitary Authority - District Councils Port Health Armed Forces Independent Schools Comments Kent Health Protection Unit Chair (HPU Director or Deputy) Business Management Support Unit All All Also represented at Surrey and Sussex LRFs Single representative and via PCTs District Councils represented by Tonbridge & Malling Borough Council Kent Health Protection Unit Army Primary Health Care Services representative Single Representative Table 3 shows how other agencies/organisations are involved in or informed about local multi-agency pandemic planning. Table 3: Other agencies/organisations Agency / Organisation Strategic Health Authority Coroners Funeral Services Neighbouring LRFs Government Office Court Service Voluntary Sector Other Category 2 responders Comments South East Coast SHA PIPP via PCTs head of emergency planning Via Police Via Medway Council chaired Mass Fatalities Working Group Via RRF Health Subgroup Via RRF Via KRF and Police Via KRF Group Invited to comment on plan and attend one-off meeting 14

15 Organisations/agencies which have agreed the KRF Plan are detailed in Section Individual agency planning Individual agencies/organisations are responsible for their own pandemic flu planning. Individual agency/organisation plans should be consistent with the KRF Plan. The plans of Category 1 responders should be shared with other Category 1 responders via the Kent Pandemic Influenza Contingency Planning Group. 4.4 Training Pandemic response training The responsibility for ensuring that individual staff are familiar with the multi-agency plan and appropriately trained rests with individual agencies/organisations. This provision should include personnel who will serve as deputies in the event of staff shortages. These individuals should be identified in individual agencies business continuity plans Infection control training Infection control training material for healthcare staff is available at Infection control guidance for some non-nhs sectors is also available at In the event of a flu pandemic, training will be coordinated by the SCG. It is likely that this will involve training of trainers under the advice of Kent HPU who will then roll out training within their own agencies/organisations. 4.5 Testing the Plan Previous versions of this plan have been tested through multi-agency exercises most recently in September Roles of individual agencies Roles in planning The primary responsibilities of individual agencies/organisations are summarised in Table 4. Table 4: Primary responsibilities of individual agencies/organisations relevant to pandemic flu planning Agency / Organisation Responsibilities Kent Police Reducing crime Maintaining public order Chairing and hosting SCG Chairing and administrating KRF Kent Fire & Rescue Service Delivering fire and rescue services South East Coast Ambulance Trust Responding to accident and emergency calls from the public and from health professionals Providing a service which preserves life and promotes recovery Provision of contracted non-emergency 'Patient Transport Services' (ie, pre-booked patient journeys to healthcare facilities) 15

16 Local authorities Providing a wide range of services including education, environment, social care, housing, planning and business services Primary care trusts Assessing local risk and for commissioning, supporting and monitoring the development of integrated health response plans. Developing arrangements to maintain and support patients in the community. Ensuring that health plans take account of the needs of military bases, prisons or other establishments that may require specific planning In the event of a pandemic coordinating and overseeing the local health response and mobilising general practice and primary care resources. Providing advice and public information Collating and reporting operational information to the SHA Acting as the health link in the SCG Making contingency arrangements for the distribution or collection of antiviral medicines and delivering population wide vaccinations if required Kent and Medway NHS and Social Care Partnership Trust Providing mental health services Providing other services including forensic mental health, learning disability, substance misuse and a range of specialist services Maintaining infection control within trust premises Acute hospital trusts Providing acute hospital inpatient and outpatient services Maintaining infection control within the hospital environment Minimising disruption to health and other essential services during a pandemic Developing arrangements to treat affected patients in hospital during a pandemic Kent Health Protection Unit Chairing Kent Pandemic Influenza Contingency Planning Group Supporting NHS pandemic flu planning Coordination of and advice on the investigation and management of early cases and contacts Supporting the public health response Roles in response The primary responsibilities of individual agencies/organisations at different stages of the pandemic are shown in Table Mutual aid Each of the responding organisations maintains arrangements to draw additional support and resources from its neighbours. In a pandemic, the Regional Civil Contingencies Committee (RCCC) may need to determine priorities for mutual aid and support. Mutual aid may be possible between responding organisations, however in a pandemic all organisations and all areas of the country will be affected. The SCG will provide the forum for this type of mutual aid to be considered and arranged. 16

17 Table 5: Pandemic flu phases and recommended KRF actions WHO International phases Interpandemic period Phase 4 Local Actions National Actions Phase 5 Local Actions National Actions UK Alert Levels Small cluster(s) with limited human-to-human transmission but spread is highly localised, suggesting virus is not well adapted to humans Alert level 0 Review and test local surveillance arrangements and reporting mechanisms (KHPU, PCTs) Advertise the arrangements for investigating and managing any suspected local cases (KHPU) Provide local guidance about use of antivirals for early cases and cases (KHPU) Review/test plans for supply and distribution of essential medicines/supplies (PCTs, acute trusts) Ensure local pandemic plans are up-to-date (KRF, all agencies) Activate COBR (CCC) Monitor international developments (CCC and DH) Revise risk and impact assessment (CCC) Instigate heightened internal surveillance/review reporting and investigation arrangements (DH) Review arrangements for investigating and managing any suspected cases in the UK (DH and OGD) Review travel links and advice/information for travellers (FCO) Review all planning assumptions/presumptions including case for travel/entry restrictions (CC and DH) Review implications/advice for farming/poultry industries (OGD) Confirm/test data collection and coordination arrangements (CCC and DH) Review options for use of pre-pandemic vaccine stock (DH and HPA) Review progress on developing a pandemic specific vaccine (DH and HPA) Review arrangements for additional deaths (CCC) Large clusters but human-to-human spread still localised, suggesting virus is becoming increasingly better adapted to humans, but may not yet be fully transmissible Alert level 0 Reconvene Kent Pandemic Influenza Contingency Planning Group (KHPU, KRF) Consider convening SCG (Police with KHPU/NHS advice) Advise port health authorities based on national advice for incoming and outgoing travellers (KHPU) Alert and advise emergency departments, ITUs, GPs and other front-line services that may see first imported cases (PCTs, acute trusts with KHPU advice) Ensure infection control teams are trained (PCTs, acute trusts with KHPU advice) Place all agencies on standby for pandemic Revise risk and impact assessments and arrangements for international coordination (CCC) Place cross-government emergency management structures/procedures on standby (CCC and DH) Review UK assumptions and intervention strategies (CCC) Revise advice and information for travellers and UK nationals abroad and consider repatriation arrangements (FCO) Review need for border controls/screening or restrictions (CCC) Alert health service and professionals (DH) Place all response and coordination arrangements on standby (CCC) Place arrangements for dealing with additional deaths on standby (CCC) Test response communication and coordination links and instigate daily reporting (CCC) Implement arrangements for pre pandemic vaccination (DH) Activate national flu line service, national door drop leaflet and other arrangements to inform and prepare the population (CCC and DH) Review arrangements for supplementing essential health supplies and prioritisation should it be required (CC and DH) 17

18 Pandemic period Phase 6 Local Actions National Actions Phase 6 Local Actions National Actions Increased and sustained transmission in the general population Alert level 1 No cases in the UK Convene SCG (Police, KRF) Alert all health services professionals and other partners in Kent (SCG and PCTs, acute trusts) Contact all GPs and emergency departments to ensure surveillance guidance is in place (PCTs, acute trusts with KHPU advice) Update staff contact information to facilitate rapid communication (All agencies) Make arrangements to provide pre-pandemic vaccination to front line staff as per national policy (PCTs, acute trusts with KHPU advice) Undertake local media campaign in line with national policy (SCG) Review local reporting arrangements and place on immediate alert (PCTs, acute trusts, KHPU) Ensure all NHS professionals are aware of up to date guidance including patient management protocols, local admission criteria and clinical guidance (PCTs, acute trusts with KHPU advice) Review arrangements for local antiviral distribution/patient assessment (PCTs) Provide training for identified staff (KHPU and PCTs, acute trusts) Recommend proportionate response strategies (CCC) Revise information for travellers and advice for UK nationals abroad (FCO) Review travel links and any case for boarder controls, screening or travel restrictions (CCC) Place response and reporting arrangements on immediate alert (CCC and DH) Activate NCC and step up public information and health advice campaign (CCC, DH and HPA) Review patient management protocols, admission criteria and clinical guidelines (DH) Prepare to extend national flu line service capability to assess patients (DH) Alert level 2 Virus isolated in the UK Continue work through SCG Alert and provide information to NHS, social care and other local partners (SCG) Implement local initial cases surveillance arrangements and local contact/reporting mechanisms (KHPU) Support PCTs in compiling registers of at-risk or high priority groups (KRF) Activate antiviral distribution arrangements (PCTs) Remind health professionals about the arrangements for investigating and managing any suspected cases locally (KHPU) Revise threat assessment and implement appropriate wider response measures (CCC) Alert NHS, social care and all key stakeholders (CCC and HPA) Implement heightened surveillance/virological testing/reporting arrangements (DH and HPA) Activate patient assessment/antiviral capability of national flu line service and local coordination links (DH) Alert primary care and all professional groups (DH) Authorise SHAs to move NHS to essential care only when required (DH) Distribute initial antiviral stocks to PCTs (DH) Update public advice and information (CCC) Monitor/review effectiveness of initial case management/investigation (DH and HPA) 18

19 Phase 6 Local Actions National Actions Phase 6 Local Actions National Actions Alert level 3 Outbreak(s) in the UK Continue work through SCG Implement pandemic flu / business continuity plans where not already initiated (All organisations) Monitor local health and social care response (SCG, NHS, LAs) Monitor critical infrastructure, essential services and business continuity (SCG) Monitor and support local reporting networks (SCG, All organisations) Review local vaccination action plan based on national guidance including identifying vaccination teams and delivery points (PCTs with KHPU advice) Revise threat assessment and review planning assumptions (CCC) Develop/implement/monitor national response strategy (CC) Monitor/support local health and social care response (DH) Authorise use of antiviral stockpile protocols for empirical patient treatment and agreed derogations from regulations/standards (DH) Review and issue guidance on association risk to children when schools closed (DCSF) Monitor critical infrastructure, essential services and business continuity (CCC) Review emerging clinical management and mortality/morbidity data and provide clinical advice (DH) Alert level 4 Widespread activity across the UK Continue work through SCG Monitor and maintain public advice and information (SCG) Explore options for giving and receiving mutual support as pandemic develops affecting different areas (SCG, All organisations) Monitor staffing, antiviral consumption and essential supplies (SCG and NHS) Revise threat assessment, monitor impact and spread, review all planning assumptions (CCC) Monitor mitigation, critical infrastructure and business continuity measures supplementing/ relaxing as required (CCC) Review need for any additional legislative or regulatory powers (CCC) Monitor and maintain public advice, information and engagement (CCC) Monitor/support health and social care response and staffing arrangements (DH) Monitor staffing, antiviral consumption/essential supplies and logistics (DH) Explore options for mutual support as pandemic develops Explore opportunities for gradual resumption of non-emergency care as appropriate 19

20 5. Declaring a pandemic (International and UK) The WHO will announce the phases when they are confirmed, indicating the level of preparedness expected. National authorities are expected to activate their contingency plans immediately following announcement of WHO Phase UK alerting WHO Phase 5 (New flu virus with pandemic potential) The Secretary of State for Health, on the advice of the Chief Medical Officer for England, will convene the UK National Influenza Pandemic Committee (UKNIPC), when informed by the WHO of the isolation of a new flu virus with pandemic potential. This is expected when person-to-person spread has been confirmed in large clusters (WHO Phase 5). UKNIPC will advise the Department of Health (DH). DH will inform the Civil Contingencies Secretariat (CCS). The CCS will inform other Government Departments. DH will advise the NHS. The Civil Contingencies Committee (CCC) is likely to meet to review preparedness across all sectors and take appropriate strategic decisions. A CCC subgroup may be established WHO Phase 6 (Onset of likely pandemic) When WHO confirms the onset of a likely pandemic (WHO Phase 6), DH will cascade this information to the: HPA Civil Contingencies Secretariat Other Government Departments and Agencies NHS Other relevant services and agencies The CCC will be convened (if not done already) National interest In exceptional circumstances, the UK may convene the UKNIPC on the strength of advice from the HPA or the National Expert Panel on New and Emerging Infections (NEPNEI). The UK may also implement its pandemic plans in the absence of a WHO declaration, on the advice of the UKNIPC, after consultation with other European Member States through the European Communicable Diseases Network. Should a potential pandemic subsequently fail to evolve, UKNIPC will be stood down. 5.2 Alerting in Kent At WHO Phase 5, and later at WHO Phase 6, the HPA Centre for Infections will alert Kent Health Protection Unit via the Local and Regional Services Division. In addition, the NHS in Kent will be alerted through normal NHS communication channels. At WHO Phase 5 the Kent Pandemic Influenza Contingency Planning Group will be reconvened. An SCG may be established at this point. The decision will be made by Kent Police advised by the Chair of the Kent Pandemic Influenza Contingency Planning Group (or their deputy) and the Head of Emergency Planning for Kent NHS (or their deputy). At WHO Phase 6 UK Alert Level 1, the SCG will be established if not already in place. 20

21 At WHO Phase 6 UK Alert Level 2 a major incident will be declared. Kent HPU will alert the On Call Emergency Response Management Team (ERMT) for Kent and Medway NHS Primary Care via Kent Ambulance control. Details of the alerting mechanism for the NHS/HPA in Kent are shown in Appendix 4. The Kent Fire and Rescue Service, Kent Police, local authorities and other partner organisations will be alerted by the ERMT On-call Manager both during and out of hours. 5.3 Alerting in the NHS in Kent The NHS in Kent has designed local alert levels and triggers (see Appendix 5). 21

22 6. Communication and coordination 6.1 Communication upwards Reporting to the Regional Civil Contingencies Committee and nationally Kent-wide reporting regionally and nationally during a pandemic will by coordinated by the SCG in the same way as in other major incidents. The SCG will report to the RCCC who in turn report to the (national) Civil Contingencies Committee (CCC) Reporting of individual agencies In addition to reporting by the SCG, some agencies/organisations will be required to report through their own chain of command. The mechanisms for this should be included within individual agencies pandemic flu contingency plans. 6.2 Communication and coordination within the KRF area Communication between agencies within Kent during a pandemic will be coordinated by the SCG in the same way as in other major incidents. A diagram showing relationships between local, regional and national agencies is included at Appendix The SCG The SCG will be chaired by the Police Gold Commander and will be based at Police Headquarters in Maidstone (this is the Strategic Coordinating Centre (SCC)). If, at a meeting of the SCG, a request is made for another agency (eg, NHS or HPA) to take over the chair of the SCG, this request will be considered by a group comprising the Director of the Health Protection Unit, a Director of Public Health and a member of the Kent ERMT Public health advice to the SCG (STAC) Initially, public health advice to the SCG will be provided by the Kent Pandemic Influenza Contingency Planning Group, via the Chair, supported by others nominated by the Group (where necessary). These individuals may attend the SCC or provide advice remotely (eg, via video- or tele-conferencing). The Chair of the Kent Pandemic Influenza Contingency Planning Group may nominate a deputy (senior member of the Health Protection Unit) to attend the SCC and sit on the SCG (and provide public health advice) in their place. Ultimately, the Kent Pandemic Influenza Contingency Planning Group will be replaced by the Science and Technical Advice Cell and provide advice to the SCG via the STAC Lead (eg, the Health Protection Unit Director, or their deputy). The membership of the STAC will be decided upon by the STAC Lead and is likely to be similar to the Planning Group. In the event that a regional STAC is established, public health advice will continue to be provided to the SCG by the Health Protection Unit Director, or their deputy. The HPU Director will liaise directly with the regional STAC to ensure consistency of advice. The regional STAC will report up to a National Scientific Advisory Group for Emergencies (SAGE). 22

23 6.2.3 SCG subgroups The SCG may decide to establish subgroups (in addition to, or instead of, the STAC). Subgroups which will be considered include: communications, data capture and reporting (intelligence cell), excess deaths, social care and vulnerable people. These subgroups will undertake work on the complex response requirements in that particular area and report directly to the SCG via the Subgroup Chair. 6.3 Communication and coordination within the NHS General arrangements Communication with and within the NHS during a pandemic will occur in the same way as in other major incidents. This approach will be consistent with the NHS Emergency Planning Guidance (2005) and the Strategic Command Arrangements for the NHS During a Major Incident (2007) NHS Strategic Command (NHS Gold) The 2007 guidance states that: NHS Strategic Command [NHS Gold ] directs and commands the response of all NHS resources. It is focused on strategic management of the NHS ensuring NHS service delivery for both the incident and normal services. A chief executive or their nominated deputy would usually lead the NHS response and represent the service at the SCG. Within a health community, the Chief Executive of a Lead PCT, with the prior agreement of the SHA, may deliver this function at a LRF level. NHS Strategic Command (NHS Gold) will be formed by the Lead PCT (Eastern & Coastal Kent) and will direct and command the response of the NHS. All NHS organisations will report directly to NHS Strategic Command which will communicate directly with them. A nominated PCT Director (likely from West Kent PCT) will represent the NHS at the SCG. The Chair of NHS Strategic Command (or nominated representative) will liaise with the Kent Pandemic Influenza Contingency Planning Group or STAC Chair and agree representation at each other s meetings. NHS Strategic Command will report to the Department of Health via the Strategic Health Authority (SHA) (NHS South East Coast) Ambulance Strategic Command Ambulance Strategic Command will be formed and will direct the response of the South East Coast Ambulance NHS Trust and voluntary and private ambulance services. Members of the ambulance executive management team will represent the ambulance service at the SCG and the RCCC Planning NHS communications Primary Care Trusts are responsible for producing and maintaining a list of health care entities (eg, hospitals, long-term care and residential facilities, clinics, GPs) within their area. Entities to be included are all those with which it will be necessary to maintain communication, during a pandemic, either to give or receive information. This list should be either contained within or referred to in each PCT pandemic flu contingency plan. 23

24 6.4 Communication and coordination in social care General arrangements Communication with social care providers is the responsibility of local authorities (Kent County Council, Medway Council). They are responsible for producing and maintaining lists of social care entities within their area. Coordination and integration of health and social care communications will be facilitated by NHS and local authority representation on the SCG and by social services representation in PCT 6.5 Data capture and reporting Kent-wide information provision (eg, for regional resilience fora (RRFs) and national organisations) during a pandemic will by coordinated by the SCG in the same way as in other major incidents. An intelligence cell may be established by the SCG. This cell would operate as a subgroup of and report to the SCG, it would receive and process information received from responders represented at SCG. Information received will include but not be restricted to impact on coroners and funeral services, emergency services, essential services (eg, utilities, fuel industry, food industry), schools and services for children and other local issues (eg, channel tunnel, road network). The Cell will be in a position to provide authenticated information direct to local, regional and national stakeholders as well as being a key provider and receiver of information to and from other elements of the response. KRF planning in this area is underway. This planning will link with associated work at the RRF level. Specific guidance including a SitRep template is contained in Annex C of the Cabinet Office s supplementary LRF guidance document (available at regional_local.aspx). South East Coast SHA has a subgroup to work on this area. NHS organisations in Kent should link in with the work of this group Workforce issues Individual agencies/organisations are responsible for making arrangements for monitoring staff illness and attendance (and other workforce issues) through their business continuity planning. They will report to the SCG (or intelligence cell if in place). Some organisations (eg, those in the NHS) will have additional reporting requirements (eg, to the SHA) (see Section 6.3) Cases surveillance The HPA will maintain a detailed database of the first few hundred cases of pandemic flu in the UK. Kent HPU will coordinate local data collection where appropriate Antiviral provision PCTs will be responsible for monitoring stock levels of antivirals during a pandemic and re-ordering from the national coordination centre. They will also be responsible for providing details of antiviral collection points and their opening hours to the National Flu Line. Further detail on antiviral provision is contained in Section

25 6.6 Battle rhythm Table 6 shows the daily reporting schedule from UK Alert Level 2. This schedule may be subject to local, regional and/or national amendment at the time of a pandemic. Before cases are detected in the UK, and during recovery, meetings and reporting are likely to be less frequent. Table 6: Daily reporting and meetings schedule Time Organisation(s) Action(s) (Day 1) DH HPA Situation report covering health impacts to be submitted to Cabinet Office Other Government Departments Situation reports (correct at previous day) to be submitted to Cabinet Office CCC(O) Meeting to consider papers for Ministers or other issues directed by CCC Kent SCG Meeting Previous day s local (and regional) situation report presented by Intelligence Cell Chair CCC Meeting Kent STAC Meeting Other Kent SCG subgroups NHS Gold Meeting Kent NHS organisations Organisational situation reports to be submitted to SHA and SCG Intelligence Cell Kent Cat 1 responders Organisational situation reports to be submitted to SCG Intelligence Cell Kent SCG Intelligence Cell Local situation report (correct at 1700 hrs) to be submitted to GOSE GOSE (RRD) Regional situation report (correct at 1700 hrs) to be submitted to Cabinet Office 0700 (Day 2) DH HPA Situation report covering health impacts to be submitted to Cabinet Office etc 6.7 Communication and coordination with the voluntary sector Voluntary agency support will be used in two ways; by a statutory body calling on specific support and by the agencies providing a general network of support to all those involved. When a voluntary agency acts on behalf of a single statutory organisation, they will liaise directly. When the involvement of voluntary agencies is in support of several organisations, or when several voluntary agencies are involved in one area of work, their involvement will be co-ordinated by Kent County Council (KCC) or Medway Council, as appropriate. 6.8 Communication with the public Communication with the public in Kent during a pandemic will by coordinated by the SCG in the same way as in other major incidents. It will be undertaken in a manor consistent with the generic Kent Resilience Forum Warning and Informing Plan (see Section 11.1) developed by the KRF Public Warning and Informing Subgroup, chaired by Kent Police. This plan, although generic, will include specific details covering pandemic flu. The latest version of this pandemic flu specific supplement is included as Appendix 7. The communications strategy will build on the Catch It, Bin It, Kill It campaign which is already underway. 25

26 South East Coast SHA has produced a pandemic flu specific communications plan. NHS organisations in Kent should ensure their plans are consistent with both the KRF and SHA plans and link in with the work of the SHA communications group. 26

27 7. Social measures 7.1 Schools and childcare settings closure Closure policy Schools and childcare settings closure may be necessary, during a pandemic, either because of inadequate staffing levels or in order to reduce the spread of infection. Detailed information is contained in the published Department for Education and Skills guidance ( School managers (normally the head teacher if the governing body delegates this to the head) are responsible for making the final decision on whether to close a school during a pandemic. However, the Government may advise schools and childcare settings to close during a pandemic. Any such advice would affect each area only when the pandemic reached it. The SCG will follow national guidance during a pandemic under the advice of the STAC. Communication with schools (including independent schools) will be via KCC and Medway Council for their respective areas Communication with schools and settings Kent County and Medway Councils hold contact details for school, early years and childcare settings. The information is available in the event of an emergency. A robust and tested communication system is in place to pass information to schools and settings. Schools have established processes for informing parents on receipt of a notice from the Director Operations. These processes are augmented by local authority communication systems including local and regional radio, TV, newspapers and appropriate media internet sites Remote learning KCC and Medway Council s policies are to keep schools open unless it is absolutely unavoidable. Although KCC has considered plans to set up remote learning, there are several other more effective methods which would be introduced first. Medway is developing a learning platform with phases 1 and 2 complete, and phase 3 underway, with completion due in March This will provide an electronic means of supporting learning if Medway schools close for extended periods. 7.2 Voluntary home isolation and quarantine Symptomatic persons will be asked to stay at home or in their place of residence whilst ill. Voluntary quarantine of contacts of known cases will also be encouraged. National messages for the public will be communicated in Kent during a pandemic, coordinated by the SCG in the same way as in other major incidents. Kent Health Protection Unit will provide advice either directly to the SCG or via the STAC Support to prisoner handling and the judicial process Prison health care is the responsibility of primary care trusts. Kent HPU will advise the PCTs about infection control procedures appropriate for prisoner handling. 7.3 Public order Maintenance of public order is, and will remain during a pandemic, the responsibility of the Police. It is recognised that any request to the Police for support (eg, to respond to civil disorder surrounding the distribution of antivirals) is likely to be made 27

28 in the context of reduced staff resources. Communication between the Police and other agencies/organisations during a pandemic will be via the SCG. 7.4 Ports The current view is that in WHO Pandemic Phase 6, additional measures at ports of entry are likely to be ineffective in controlling the potential impact of the pandemic. However, according to IATA guidelines, airlines/transportation providers should only convey fit and healthy passengers and staff. During a pandemic, the Foreign and Commonwealth Office and DH will provide advice to travellers departing the UK. Once the UK is affected this may include exit screening under recommendation of the HPA Centre for Infections. In addition, Kent HPU will provide advice either directly to the SCG, or via the STAC, and to the port health authorities. 7.5 Social distancing measures National guidance will be issued on public health and social distancing measures to reduce the spread of flu during a pandemic. Hand washing and respiratory hygiene will be particularly important. The national guidance will also include advice on: local restrictions on movement and public gatherings, and reducing unnecessary international or long distance travel. Kent Health Protection Unit will provide advice on this issue either directly to the SCG or via the STAC. The implications of these measures should be taken into account when undertaking business continuity planning. 28

29 8. Health measures 8.1 Health service All NHS organisations in Kent have developed pandemic flu plans. Some are currently under revision following NHS reorganisations. These plans were most recently exercised in September It is essential that the plans of the NHS organisations (including the Ambulance Trust) are mutually compatible. For example, admission criteria for hospitals should be agreed between all NHS organisations. 8.2 Supporting self care PCTs are responsible for the provision of health care in a community setting. Plans in Kent will be consistent with the DH document: Guidance for primary care trusts and primary care professionals on the provision of healthcare in a community setting in England. PCTs will be advised by the HPU. See also sections 6.7, 7.2, 10.2 and Appendix Antivirals PCTs are responsible for the distribution of antivirals during a pandemic and linking with the National Flu Line service. This includes mechanisms for provision in closed communities (eg, prisons, military establishments). Plans in Kent are consistent with the DH document: Guidance for primary care trusts and primary care professionals on the provision of healthcare in a community setting in England. PCTs will be advised by the HPU where necessary. 8.4 Vaccines PCTs are responsible for the provision of vaccine during a pandemic. Plans in Kent will be consistent with the DH document: Guidance for primary care trusts and primary care professionals on the provision of healthcare in a community setting in England. They will include the mechanisms for provision in closed communities. PCTs will be advised by the HPU Pandemic-specific vaccine A pandemic flu vaccination strategy for the KRF area has been developed and is available from Kent HPU. This strategy is an extension of the arrangements for provision of seasonal flu vaccine which is undertaken annually. A revised version (v2.2) of the Strategy was produced in July Pre-pandemic vaccine Pre-pandemic (H5N1) vaccine for health care workers will be prioritised according to DH guidance at the time and delivered through local NHS occupational health services. Were this vaccine to be recommended for other groups, national policy would be followed. The Kent Pandemic Flu Vaccination Strategy (see Section 8.4.1) covers arrangements for pre-pandemic vaccine. 8.5 Dental services The PCTs, Salaried Service and Local Dental Committee have agreed outline plans (see Appendix 8). 29

30 9. Wider impacts The wider impacts of pandemic flu (eg, fuel shortages) are difficult to determine in advance as they depend to a large extent on the epidemiology and consequences of the strain of the influenza virus which emerges. Consideration of these issues will be included in the Plan as they arise through the work of individual agencies/organisations, the Kent Pandemic Influenza Contingency Planning Group, the KRF and in pandemic flu and other relevant exercises. Animal health and welfare during a pandemic are the responsibility of the Department for Environment, Food and Rural Affairs (Defra) and Animal Health. Whilst animal welfare is likely to be a comparatively low priority during a pandemic, issues that do arise will be responded to appropriately, given the current circumstances, through Defra / Animal Health representation at SCG. Those wider impacts which are unforeseen will be dealt with by the SCG in the same way as in other major incidents. 30

31 10. Other issues 10.1 Management of excess deaths Responsibility for planning for the management of excess deaths lies with the KRF Mass Fatalities Group. A draft KRF Pandemic influenza: Managing excess deaths plan has been developed. As this work (lead by Kent County Council) develops, any outputs will be linked with or incorporated into this KRF Pandemic Influenza Contingency Plan. However, individual agencies/organisations likely to be impacted by excess deaths should consider this within their own pandemic flu contingency or business continuity plans. Should the pool of those who are able to complete a Medical Certificate of Cause of Death (MCCD) be widened, beyond registered doctors who have attended the patient, under emergency regulations, the training implications will need to be considered Identification of, and provision for, vulnerable and seldom heard groups The mechanisms for identification of vulnerable individuals during a pandemic are being investigated by the Humanitarian Welfare Working Group reporting to the Capabilities Subgroup of the KRF. A draft Identifying vulnerable people in an emergency plan has been produced. As the work of this group develops, any further outputs will be linked with or incorporated into this KRF Pandemic Influenza Contingency Plan. During a pandemic, the provision of services for vulnerable groups will be considered alongside all other issues by the SCG with appropriate input from relevant agencies. PCTs should work with other agencies to identify those patients and groups who are potentially at risk, and ensure that services will be accessible to them. Kent Adult Social Services will continue to provide social services to those eligible for them during a pandemic including frail/elderly, young adults, physically disabled or people with learning difficulties. Some voluntary organisations can provide information and advice, but also act as a support network. PCTs should seek to engage the voluntary sector and promote opportunities for a joint approach to self care and supporting vulnerable individuals to remain in their own homes (or other community/residential setting) during a pandemic. This should be demonstrated in their self care project plans. See also section 5.5 of DH publication: Guidance for primary care trusts and primary care professionals on the provision of healthcare in a community setting in England. Appendix 9 shows an age-sex profile for the population of the KRF area by primary care trust. 31

32 11. Bibliography 11.1 Local documents Kent Health Protection Unit. Kent pandemic flu vaccination strategy (version 2.2). Maidstone: Kent HPU, Kent Health Protection Unit. Pandemic flu health impact calculator (Excel spreadsheet) (version 5). Maidstone: Kent HPU, Kent Resilience Forum. Pan-Kent Strategic Emergency Framework (version 1.0). Maidstone: KRF, Kent Resilience Forum. Warning and informing plan: Communicating with the public how we will warn and inform people in Kent before, during and after an emergency (version 4). Maidstone: KRF, South East Coast Strategic Health Authority. Major incident plan. Horley: SECSHA, South East Coast Strategic Health Authority. Pandemic flu communications plan. Horley: SECSHA, South East Coast Strategic Health Authority. Pandemic flu contingency plan. Horley: SECSHA, National and international documents Civil Contingencies Secretariat. Civil Contingencies Act 2004: a short guide (revised). London: Cabinet Office, (Accessed January 2008) Civil Contingencies Secretariat. Preparing for pandemic influenza: Guidance to local planners. London: Cabinet Office, (Accessed January 2008) Cabinet Office. Provision of scientific and technical advice in the strategic co-ordination centre: Guidance to local responders. London: CO, (Accessed October 2008) Department for Education and Skills. Planning for a human influenza pandemic: Guidance to schools and children s services. London: DfES, (Accessed February 2006) Department of Health. Pandemic influenza: Guidance for infection control in hospitals and primary care settings. London: DH, (Accessed February 2008) Department of Health. Pandemic influenza: Guidance for primary care trusts and primary care professionals on the provision of healthcare in a community setting in England. London: DH, (Accessed February 2008) 32

33 Department of Health, Cabinet Office. Pandemic flu: A national framework for responding to an influenza pandemic. London: DH, (Accessed January 2008) Department of Health Emergency Preparedness Division. Strategic command arrangements for the NHS during a major incident. London: DH, (Accessed February 2008) Department of Health Emergency Preparedness Division. The NHS emergency planning guidance London: DH, (Accessed November 2005) Health and Safety Executive. Pandemic flu workplace guidance. London: HSE, (Accessed October 2008) Health Protection Agency. Pandemic influenza contingency plan. London: HPA, (Accessed January 2008) World Health Organization. WHO global influenza preparedness plan, (Accessed January 2008) 33

34 Appendix 1 Version 3.9 Appendix 1 Kent Resilience Forum Membership Schedule 1 of the Civil Contingencies Act 2004 lists the responders subject to its provisions. The Act splits local responders into two categories and imposes a different set of requirements on each category. Category 1 and 2 responders are listed below. Category 1 responders ( core responders ) Emergencies services Kent Police British Transport Police Kent Fire & Rescue Service South East Coast Ambulance NHS Trust Maritime and Coastguard Agency Local authorities Ashford Borough Council Canterbury City Council Dartford Borough Council Dover District Council Gravesham Borough Council Kent County Council Maidstone Borough Council Medway Council (Unitary Authority) Sevenoaks District Council Shepway District Council Swale Borough Council Thanet District Council Tonbridge and Malling Borough Council Tunbridge Wells Borough Council London Port Health Authority (On behalf of all Kent Port Health Authorities) Health bodies Primary Care Trusts Eastern and Coastal Kent Teaching Primary Care Trust Medway Teaching Primary Care Trust West Kent Primary Care Trust Acute Trusts Dartford and Gravesham NHS Trust East Kent Hospitals NHS Trust Maidstone and Tunbridge Wells NHS Trust The Medway NHS Trust Health Protection Agency Kent Health Protection Unit Government agencies Environment Agency 34

35 Appendix 1 Version 3.9 Category 2 responders ( co-operating responders ) Utilities EDF Energy Transco Mid Kent Water Southern Water Services Folkestone and Dover Water Services South East Water Sutton and East Surrey Water Thames Water British Telecom Vodafone Transport Network Rail Southeastern Trains Highways Agency Health bodies South East Coast Strategic Health Authority Others Government Office of the South East Military Voluntary Sector 35

36 Appendix 2 Version 3.9 Appendix 2 Predicted GP consultations, A&E presentations, hospital admissions and deaths at different clinical attack and case fatality rates by week of a 15-week wave (Kent: population 1,634,700). Week % of cases Clinical 25% Clinical 50% GP GP consultations 28.5% of 28.5% of 50% A&E 5% of 25% A&E 5% of 50% Hospital 0.55% of 25% Hospital 3.72% of 50% 0.37% of 25% 2.5% of 50% , ,635 1,022 2, ,269 6,539 4,087 8, , ,669 25,338 15,836 31,672 3,611 7, ,320 86,639 54, ,299 12,346 24, , , , , , ,685 25,158 50, , , , , , ,598 24,692 49, , , , ,881 73, ,101 16,656 33, , , ,641 79,283 49,552 99,104 11,298 22, , , ,651 61,301 38,313 76,627 8,735 17, , , ,251 42,502 26,564 53,128 6,057 12, , , ,626 21,251 13,282 26,564 3,028 6, ,539 13,078 8,174 16,347 1,864 3, ,678 7,356 4,598 9,195 1,048 2, ,861 5,721 3,576 7, , Total , , ,844 1,021, , ,945 2,248 30,374 1,512 20,434 Assumptions distribution of cases over time period of pandemic as shown in HPA Plan version 8.0 clinical attack rate 25 or 50% case fatality rate 0.37 or 2.5% GP consultations are all those with complications (25%) and all under 3s (DH guidance) (3.5%) ie, Flu Line in place if case fatality rate 2.5%, hospital admissions higher by same proportion (ie, 3.7 times) JS (Kent HPU) assumption nb - if clinical cases 50% and case fatality 2.5%, estimated UK deaths are three times as high as in 1918/19 (Source of assumptions: UK Influenza Pandemic Contingency Plan, Oct 2005: Chapter 4, p24 Tables 2 & 3, p28 Table 4 and p29 Table 5) Further detail and working spreadsheet available from Kent HPU. 36

37 Appendix 3 Version 3.9 Appendix 3 Kent Resilience Forum structure 37

38 Appendix 4 Version 3.9 Appendix 4 On Call Emergency Response Management Team Kent and Medway NHS Primary Care 38

39 Appendix 5 Version 3.9 Appendix 5 Kent and Medway NHS pandemic influenza traffic light alert system 39

40 Appendix 6 Version 3.9 Appendix 6 Relationship of local, regional and national agencies during a flu pandemic Civil Contingencies Committee (CCC) Civil Contingencies Committee Officials (CCC(O)) Location Cabinet Office Briefing Room (COBR), London Scientific Advisory Group for Emergencies Department of Health Location London Other Government Departments Location London Regional Civil Contingencies Committee (RCCC) Chair???? Location Government Office of the South East (GOSE), Guildford Strategic Coordinating Group (SCG) ( Gold Command ) Chair Police Gold Commander Location Police Headquarters, Maidstone (SCC) Health Protection Agency (National) Location Holborn Gate, London Health Protection Agency (Regional) Location Holborn Gate, London Regional Science & Technical Advice Cell (STAC) Chair???? Location???? Ambulance Strategic Command (Gold) (SECAmb) Chair Ambulance Director Location Coxheath Strategic Health Authority (NHS South East Coast) Location Horley NHS Strategic Command (NHS Gold) Chair Eastern & Coastal Kent PCT Director Location???? Category 1 & 2 Responders (inc local authorities, emergency services) Locations EOCs Kent Health Protection Unit Chair Director or deputy Location Aylesford NHS Trusts (Primary Care, Hospital, Mental Health, inc Foundation) Locations EOCs NHS HPA Direct accountability Impact reporting Advice/information exchange 40

41 Appendix 8 Version 3.9 Appendix 7 <<To follow once approved>> Kent Resilience Forum Pandemic Flu Communications Plan An Appendix to the KRF Strategy for Warning and Informing the Public in an Emergency. This strategy has been drafted by the KRF Warning and Informing Workstream and includes a specific Appendix relating to pandemic influenza communication. The document is being finalised and once approved the Appendix will be included in this plan. 41

42 Appendix 8 Version 3.9 Appendix 8 Dental services during a flu pandemic Primary care Dental Services The issues for primary care dentistry revolve around: PCTs' management of dental contracts during a flu pandemic practice guidelines for treating patients the involvement of dental professionals in managing pandemic flu across the local health economy. PCTs' management of dental contracts during a flu pandemic Guidance from the Department of Heath to Primary Care Trusts is available on both on the Department web site and the Primary Care Contracting web site. The guidance provides specific advice to the NHS on the delivery and contract arrangements for primary care dentistry in the event of a Pandemic. Department of Health. Guidance on the delivery of and contract arrangements for primary care dentistry (Accessed December 2008) Practice guidelines for treating patients Guidance from the Department of Heath to Dental Practitioners is available on both on the Department web site and the Primary Care Contracting web site. This guidance provides a brief overview of pandemic flu, how it is transmitted and the recommendations for containing its transmission with reference to a dental setting. Department of health Guidance for dental practices (Accessed December 2008) Involvement of dental professionals in managing pandemic flu across the local health economy It is anticipated that Dental practices may be forced to close or reduce their services during a flu pandemic due to staff shortages, and PCT salaried services may similarly be affected. In order to prevent spread of infection, Flu Patients will be advised to wait until they have recovered before accessing dental treatment. Non-flu patients will be advised either to wait until their own practice is open again, or to use an alternative practice. There may be a buddying arrangement between practices to facilitate this. Provision will be made however for those requiring emergency treatment *, defined as - Bleeding heavily (haemorrhaging) from the mouth Suffering from a trauma injury to their teeth or mouth Suffering from severe facial swelling In acute pain of sudden onset not helped by pain killers [Reference : *Dentaline] A triage system for non-emergency but urgent treatments e.g. crowns fallen off, fillings fallen out or just advice, possibly using the existing Dentaline service is also proposed. The PCT is likely to receive queries from patients trying to access dental services, and will need to maintain awareness of closures, buddying arrangements, and emergency provision (including when this could be affected due to staff shortages). Non-flu patients Any patient requiring emergency treatment or unable to see their own dentist will be directed to their local Dental Access Centre (DAC). The referral and flow of patients will be monitored through the telephone triage system. The DACs are normally run by dental staff from the Salaried Dental Service, however, a register of volunteers drawn from dental practices in the PCT area could be used to support the DACs, should staffing become critical. Temporary contracts and suitable indemnity cover would need to be put in place. Pan-flu patients For flu patients requiring emergency treatment, domiciliary visits are proposed, with the main advantage being that the infected individual remains in their own home. Dentists making these visits will require access to Personal Protective Equipment (PPE) and will need to have been trained to obtain optimum benefit from this Domiciliary visits Guidelines and training to provide this service will need to be in place ahead of the Pandemic, with regular updates forming part of usual Continuing Professional Development. Responsibility There is a need for adding detail to these plans in regard to telephone access, triage, training and volunteer register. An identified person within the PCT would have to write to General Dental Practitioners at the time detailing the local plan as well as the national guidance. The Primary Care Trusts, Salaried Service and Local Dental Committee have agreed these outline plans. 42

43 Appendix 9 Version 3.9 Appendix 9 Age-sex profile of Kent and Medway population by primary care trust Males Females All persons West Kent and West Kent and E&C Kent Medway Kent Medway E&C Kent Medway Kent Medway E&C Kent Medway West Kent Kent and Medway Under 1 4,200 1,600 4,100 9,900 3,800 1,600 3,900 9,300 8,000 3,200 8,000 19, ,100 6,200 16,100 38,400 15,200 6,200 15,300 36,700 31,300 12,400 31,400 75, ,300 8,300 20,900 50,500 20,500 7,600 19,800 47,900 41,800 15,900 40,700 98, ,400 8,900 22,400 55,700 22,800 8,600 21,800 53,200 47,200 17,500 44, , ,600 9,400 22,200 56,200 24,300 8,700 20,900 53,900 48,900 18,100 43, , ,400 8,100 16,400 46,900 22,200 8,000 16,200 46,400 44,600 16,100 32,600 93, ,800 7,700 18,100 44,600 19,400 8,300 18,500 46,200 38,200 16,000 36,600 90, ,900 8,200 20,500 47,600 21,000 8,600 21,800 51,400 39,900 16,800 42,300 99, ,900 9,600 24,600 58,100 25,800 10,100 26,400 62,300 49,700 19,700 51, , ,900 10,200 26,800 62,900 27,000 10,200 27,600 64,800 52,900 20,400 54, , ,600 8,800 23,700 56,100 24,000 9,000 23,400 56,400 47,600 17,800 47, , ,100 7,800 20,300 49,200 22,700 7,700 21,000 51,400 43,800 15,500 41, , ,600 8,000 22,600 55,200 26,100 8,300 23,200 57,600 50,700 16,300 45, , ,300 6,400 18,300 46,000 22,500 6,400 19,100 48,000 43,800 12,800 37,400 94, ,300 5,000 14,400 36,700 18,400 5,200 15,600 39,200 35,700 10,200 30,000 75, ,300 3,900 12,300 30,500 16,300 4,400 13,900 34,600 30,600 8,300 26,200 65, ,400 2,800 9,500 23,700 15,200 3,700 12,100 31,000 26,600 6,500 21,600 54, ,900 1,700 5,800 15,400 12,700 2,900 9,400 25,000 20,600 4,600 15,200 40, ,800 1,100 4,200 11,100 12,700 2,700 9,500 24,900 18,500 3,800 13,700 36,000 All Ages 348, , , , , , , , , , ,500 1,634,700 Source: ONS mid-2006 population estimates 43

44 Appendix 10 Version 3.9 Appendix 10 Glossary CCA CCC CCC(O) CCS DA DAC Defra DH DPH ERMT GOSE HSE HPA HPA-CfI HPU IATA KRF LA LRF NEPNEI OGD PCT PIPP PPE RCCC RDPH RRD RRF SAGE SCC SCG SHA STAC UKNIPC WHO Civil Contingencies Act Civil Contingencies Committee Civil Contingencies Committee (Officials) Civil Contingencies Secretariat Devolved Administration Dental Access Centre Department for Environment Food and Rural Affairs Department of Health (England) Director of Public Health Emergency Response Management Team for Kent and Medway NHS Government Office of the South East Health and Safety Executive Health Protection Agency Health Protection Agency Centre for Infections Health Protection Unit International Air Transport Association Kent Resilience Forum Local Authority Local Resilience Forum National Expert Panel on New and Emerging Infections Other Government Departments Primary Care Trust Pandemic Influenza Preparedness Programme Personal Protective Equipment Regional Civil Contingencies Committee Regional Director of Public Health Regional Resilience Director Regional Resilience Forum Scientific Advisory Group for Emergencies Strategic Coordinating Centre Strategic Coordinating Group Strategic Health Authority Science and Technical Advice Cell UK National Influenza Pandemic Committee World Health Organization 44 JS/AJ for KHPU for KRF