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Pandemic Influenza Policy Version 2.0 July 2018 Target Audience Who Should Read This Policy Pandemic Influenza Management Plan
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Page 1: Pandemic Influenza Management Plan

Pandemic Influenza Policy

Version 2.0 July 2018

Target Audience

Who Should Read This Policy

Pandemic Influenza Management Plan

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Pandemic Influenza Management Plan

Version 2.0 July 2018 2

STOP

IF A MAJOR INCIDENT HAS BEEN DECLARED DUE TO PANDEMIC INFLUENZA AND YOU ARE RESPONDING AND READING THIS PLAN FOR THE FIRST TIME, DO NOT CONTINUE – FIRST:

MAKE SURE YOU HAVE YOUR ON CALL PACK & A COPY OF THE

TRUSTS MAJOR INCIDENT AND BUSINESS CONTINUITY PLAN TO HAND, THEN ASSESS SITUATION, BACKGROUND AND ACTION

GO DIRECTLY TO THE ACTION CARD SECTION OF THE PANDEMIC INLUENZA PLAN (See Appendix 3)

SEEK OUT YOUR ACTION CARD AND FOLLOW IT

IF YOU DO NOT HAVE AN ACTION CARD THEN AWAIT FURTHER INSTRUCTIONS FROM YOUR MANAGER/ON CALL MANAGER

ENSURE THAT YOUR MANAGER AND WORK COLLEAGUES HAVE A CONTACT NUMBER FOR YOU AND THAT YOU ARE ABLE TO CONTACT THEM

DO NOT GO TO THE INCIDENT CONTROL CENTRE UNLESS YOU HAVE BEEN INFORMED TO DO SO BY THE ON CALL MANAGER

KEEP YOUR ID CARD ON YOU AT ALL TIMES

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Ref. Contents Page

1.0 Introduction 5

1.1 Pandemic influenza background 5

2.0 Purpose 7

3.0 Objectives 7

4.0 Process – UK Pandemic response phases - DATER 8

4.1 Pandemic phases and national focus/activities 8

4.2 BCPFT response to Pandemic Influenza 11

4.2.1 Pandemic Flu Management Team 11

4.2.2 Trust actions required during the phases of the pandemic – DATER (Detect, Assess, Treat, Escalate, Recover)

13

4.3 Managing workforce issues 26

4.3.1 Impact on workforce 27

4.3.2 Workforce profile 27

4.3.3 Staff welfare planning 28

4.4 Business continuity management 28

4.5 Situation reporting -SITREP 29

4.6 Recovery phase 29

4.7 Financial arrangements 30

4.8 Communication 30

5.0 Procedures connected to this policy 30

6.0 Links to relevant legislation 30

6.1 Links to relevant National Standards 31

6.2 Links to other key policies 32

6.3 Reference documents 32

7.0 Roles and responsibilities for this policy 34

8.0 Training 38

9.0 Equality impact assessment 38

10.0 Data protection and Freedom of information 38

11.0 Monitoring this policy is working in practice 39

Appendices

1 Inpatient/Residential Unit- Situation Report template 40

1a Non-Inpatient Services- Situation Report template 41

1b BCPFT Situation Report SITREP template 42

2 How to putt on and remove PPE safely 43

3 Pandemic Influenza Action Cards 44

AC 1 Director for Infection Prevention & Control 45

AC 2 Emergency Planning Officer 46

AC 3 Group Directors 47

AC 4 Infection Prevention & Control Team 48

AC 5 Lead Nurses/Service Managers & Matrons 49

AC 6 Estates, Facilities & Procurement Managers 50

AC 7 Chief Pharmacist 51

AC 8 Communications Manager 52

AC 9 Incident Loggists 53

AC 10 Admin Staff 54

AC 11 Human resources & workforce 55

AC 12 Chaplaincy Team 56

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Explanation of terms used in this policy

Action Cards Action cards are physical documents containing easy-to-follow instructions on how to

execute a key activity (as used in Appendix 3)

Aerosol Generating

Procedures (AGP)

A procedure which stimulates coughing and promotes the generation of aerosols e.g.

intubation, manual ventilation, CPR, collection of specimens (bronchial and tracheal

aspirates), respiratory and airway suctioning (including tracheostomy care)

Business Continuity The creation and validation of a practiced logistical plan for how an organisation will

resume and continue delivery (partially or completely) of interrupted critical functions within a predetermined time after a disaster or extended disruption

Category 1 Responders

A term defined under the UK’s Civil Contingencies Act (CCA) 2004 as a person or body listed in Part 1 of Schedule 1 to the CCA which is required to prepare for

emergencies in line with its responsibilities under the Act, which includes assessing

local risks, implementing emergency plans and co-operating with other local responders to enhance co-ordination and efficiency. Core responders include:

Emergency Services (fire, ambulance, police)

Local Authorities

Government Agencies (Environment Agency)

Health bodies (PCT’s, Acute Trusts, Foundation Trusts, Local Health Boards

(Wales), Health Protection Agency

Category 2

Responders

A term defined under the UK’s Civil Contingencies Act (CCA) 2004 as a person or

body which has a role in supporting Category 1 responders. Co-operating responders

include:

Utilities (Gas, water, electric, telephone)

Health Bodies (Strategic Health Authorities)

Government Agencies (Health and Safety Executive)

Transport (network rail, train operating companies, London underground,

airport operators, harbour authorities, highways agency)

Command and

Control

The exercise of authority and direction by a properly trained designated Leader over

an assigned and attached team in order to efficiently manage an organisations response to a major incident or emergency.

Command and control functions are performed through an arrangement of

personnel, equipment, communications, facilities and procedures. They are employed by the Team Leader in planning, directing, co-ordinating and controlling. They are

designed to continue delivery of critical services at acceptable levels and affect an orderly return to ‘business as usual’ operations

Epidemic The occurrence of more cases of a disease than would be expected in a community

or region during a given period of time within the country of origin

Pandemic The occurrence of a disease occurring over a wide geographic area affecting an

exceptionally high proportion of the population, spreading between countries

Personal Protective

Equipment (PPE)

Specialized clothing or equipment worn by employees for protection against health

and safety hazards. Personal protective equipment is designed to protect many parts

of the body, i.e. eyes, head, face, hands, feet, and ears

Surge A transient increase in demand for care or services above usual capacity

World Health

Organisation (WHO)

Part of the United Nations that is focused on global health issues. The organisation

has been working for over sixty years on such issues as smallpox eradication, family

planning, childhood immunisations, maternal morbidity rates, polio eradication, and

AIDS

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1.0 Introduction

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 influenza caused by a novel virus strain to which people would have no immunity, resulting in more serious illness than caused by seasonal influenza. As such it remains at the top of the UK Government National Risk Register. Lessons identified during the response to the 2009/10 influenza pandemic and the subsequent 2010/11 winter seasonal influenza outbreak has informed ongoing preparedness. The NHS England Operating Framework for Managing the Response to Pandemic Influenza (December 2017), sets out the roles, responsibilities and functions of NHS England in preparing for and responding to an influenza pandemic. NHS England is responsible for the command, control, communication, coordination and leadership of the NHS in the event of a major incident or emergency. An influenza pandemic is a rare occurrence and occurs one to three times each century, but could start at any time of the year. Historically, pandemics have had a higher clinical attack rate than seasonal influenza (10% - 50% of the population) and higher morbidity rate (0.34% to 2.5%). Previous pandemic virus strains have also targeted the 20 – 45 year age range (not usually considered a vulnerable group in terms of seasonal influenza or general physical health). The world’s most recent pandemic – the 2009 A (H1N1) pdm09 influenza pandemic was characterized as being highly transmissible with rapid spread. This swiftly led to sustained human-to-human transmission worldwide, but resulted in a lower mortality than for previous known pandemics, with between 123,000 and 203,000 deaths attributed to the A (H1N1) pdm09 virus. In contrast, the infamous 1918 “Spanish influenza” pandemic spread more slowly but caused an estimated 20-40 million deaths. The differences in the severity of these two pandemics emphasizes that pandemics are unpredictable events. It is not easy to make assumptions about where the next influenza virus with pandemic potential will emerge, or what its characteristics will be, including its severity. No country can expect to escape the impact of a pandemic entirely and when it arrives, most people are likely to be exposed to an increased risk of catching the virus at some point. Influenza pandemics therefore pose a unique international and national challenge. As well as their potential to cause serious harm to human health, they threaten wider social and economic damage and disruption. The most significant risk for this organisation is the dependence on a small pool of staff and the specialist skills and knowledge required to undertake the day-to-day business of the organisation.

1.1. Pandemic Influenza Background A pandemic may occur if an influenza virus undergoes major change (antigenic shift), and a new virus emerges, which is markedly different to recently circulating strains, and to which humans are not immune. A pandemic may occur if the new virus can:

Infect people (rather than, or in addition to, animals or birds)

Spread from person-to-person

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Cause illness in a high proportion of the people infected

Spread widely, because most people will have little or no immunity to the new virus and will be susceptible to infection

Such an influenza virus can spread rapidly, causing an epidemic within the country of origin and becoming a pandemic when it spreads between countries. A pandemic is a natural phenomenon that has occurred from time to time throughout history. The World Health Organisation (WHO) continues to monitor influenza viruses on a global scale. The conditions that allow a new virus to develop and spread continue to exist and some features of modern society, such as air travel, could accelerate the rate of spread. Experts agree that there is a high probability of another pandemic occurring, although timing and impact are impossible to predict. The National Risk Register of Civil Emergencies (2017 edition) highlights pandemic influenza as the highest risk to the UK:

5 Larger-scale chemical, biological, radiological or nuclear attacks

Smaller-scale chemical, biological or radiological attacks

Pandemic

Influenza

4 Natural hazards e.g. river or coastal flooding

Cold & snow

3 Industrial / urban accidents

Transport accidents

Attacks on infrastructure

Natural hazards e.g. surface water flooding

Cyber-attacks on infra-structure

Smaller-scale chemical, biological or radiological attacks

Emerging infectious disease

Space weather

Heatwave Poor air

quality

Attacks on crowded places

2 Wildfires Emerging infectious disease

Industrial action

Drought

System failures

Storm/gales Public

disorder Volcanic

eruptions

Cyber-attacks on services

1 Earthquakes

* 1 Low

2 Medium-Low

3 Medium

4 Medium-High

5 High

* Likelihood of occurring in the next five years Key Hazards, diseases, accidents, and societal risks Malicious attacks

Overa

ll r

ela

tive i

mp

ac

t sc

ore

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The worst recorded pandemic was in 1918/9, this is also known as the Spanish Flu, as Spain was the first country to report openly about the illness affecting its people. The scientific research into the causes of the 1918/19 pandemic has led to the development of antiviral medication and the typing of virus strains. The interval between influenza pandemics is variable, ranging from 11 to 39 years during the last century. Although it is highly likely that another influenza pandemic will occur at some time it is impossible to forecast the exact timing or precise nature of its impact. Even if the pandemic originates in Asia, as it seems likely, it will probably reach the UK within 2 to 4 weeks of becoming epidemic in the country of origin and would then only take 1 to 2 weeks to spread to all major population centres here. The severity of a pandemic varies but in the last century, there were four pandemics and the most recent one occurred in 2009. 20th Century Pandemics:

Pandemic Year Deaths worldwide Age Groups

most affected Sub type

Spanish Influenza 1918 2-3%

(20-50 million) Young adults H1N1

Asian Influenza 1957 0.1-0.2%

(1-4 million) Children H2N2

Hong Kong Influenza

1968 0.2-0.4%

(1-4 million) All age groups H3N2

Swine Flu 2009-10 203,000

(more than originally estimated)

Children 5-14 young adults and pregnant

women

H1N1

2.0 Purpose

The impact of pandemic influenza outbreaks on individuals and societies can be reduced by being well prepared. All NHS Trusts are required to have a comprehensive Board approved plan to respond to an outbreak of pandemic influenza. This plan details the infection prevention and control measures that must be implemented and complied with in the event of a pandemic affecting the Black Country Partnership NHS Foundation Trust (BCPFT). This plan is to be used to assist in the continuity and recovery of BCPFT services that are commissioned by the CCGs, in the event of an outbreak of pandemic influenza. This plan is not intended to replicate or replace national strategy and guidance and should be read in conjunction with national guidance documents. 3.0 Objectives

This document provides a framework for BCPFT on managing their response to pandemic influenza and will:

Set out the roles and responsibilities before, during and after a pandemic.

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Identify command and control arrangements for BCPFT (Note: it should be read in conjunction with the Trust’s Major Incident and Business Continuity Plan and the Local Resilience Forum requirements).

Ensure that the Trust is prepared, has governance processes in place and can continue to function during pandemic influenza outbreaks.

Ensure that the core services are maintained and provided at safe levels.

Minimise the impact of pandemic influenza on our local services.

Set out procedures for handling infected patients and protecting staff, other patients and visitors.

Identify arrangements for effective communication for patients, staff and visitors.

Set out the process for recovery from an influenza pandemic in line with the Trust’s Major Incident and Business Continuity Plan.

4.0 Process

UK response phases (DATER)

Although the WHO is responsible for identifying and declaring influenza pandemics, the UK was well into the first wave of infection when the WHO declared a pandemic in 2009. Therefore it was decided to develop a more flexible approach, not driven by the WHO phases but determined nationally by the UK. The UK approach uses a series of phases: detection, assessment, treatment, escalation and recovery (DATER), as described 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, circumstances and resources. Each phase sets out the actions and priorities for the response, reflecting the situation as it affects the UK. The initial overall health response consists of two distinct phases - detection and assessment (these may be relatively short depending on the speed of spread or the impact on individuals and communities). It is within these phases that Public Health England (PHE) will take the lead. In the subsequent treatment, escalation and recovery phases PHE will have a more supportive role. 4.1 Pandemic Phases and activities

Phase National focus in this phase would be:

Detection

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 professionals

The indicator for moving to the next stage would be the identification of the novel influenza virus in patients in the UK

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Phase National focus in this phase would be:

Assessment

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)

Reducing the spread of transmission and infection with the virus within the local community by:

- actively finding cases

- 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 risk assessment of the possible impact of the disease.

The indicator for moving from this stage would be evidence of sustained community transmission of the virus, i.e. cases not linked to any known or previously identified cases.

Phase National focus in this phase would be:

Treatment

Advising of the treatment of individual cases and population treatment, if necessary, using the National Pandemic Flu Service (NPFS).

Enhancement of the health response to deal with increasing numbers of cases

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.

Arrangements will be activated to ensure that necessary detailed surveillance activity continues in relation to samples of community cases, hospitalised cases and deaths

The indicator to move to the next stage would be when demands for services start to exceed the available capacity and additional measures will need to be taken. This decision is likely to 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.

Phase National focus in this phase would be:

Escalation

Escalation of surge management arrangements - PHE to advise the NHS

Prioritisation and triage of service delivery with aim to maintain essential services

Resiliency measures, encompassing robust contingency plans.

Consideration of de-escalation of PHE response if the situation is judged to have improved sufficiently.

While escalation measures may not be needed in mild pandemics, it would be prudent to prepare for the implementation of the escalation phase at an early stage, if not before.

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Phase National focus in this phase would be:

Recovery

Normalisation of services – perhaps a new definition of what constitutes normal service.

Restoration of business as usual services, including an element of catch up with activity that may have been scaled down as part of the pandemic response e.g. reschedule routine appointments.

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.

Continuing to consider targeted vaccination when available.

Preparing for post-pandemic seasonal influenza.

The indicator for this phase would be when influenza activity is either significantly reduced compared to the peak or when the activity is considered to be within acceptable parameters. An overview of how service capacities are able to meet demand will also inform this decision.

In the absence of early or effective intervention there could be widespread social and economic disruption including: Threats to the continuity of essential services (including fuel) Lower production levels of essential goods (including pharmaceuticals) Travel disruptions causing shortages and distribution difficulties of essential

supplies All of the above can be mitigated or the effects minimised with good business continuity management practices. Since the potential impact of a pandemic is determined by many factors leading to uncertainties surrounding the potential severity of any future pandemic, the UK has the following preparedness arrangements:

UK wide stockpiles and distribution arrangements of antiviral medicines and antibiotics sufficient for a widespread severe pandemic

Health service preparation for up to 30% of symptomatic patients requiring assessment and treatment in usual primary care pathways through surge planning

Health service preparation for between 1 and 4% of symptomatic patients requiring hospital care through surge planning

Multi-agency planning to cope locally with up to 200,000 additional deaths across the UK over a 15 week period through excess death planning, (this is a precautionary measure as less widespread and lower impact pandemic the deaths would be lower)

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4.2 BCPFT response to an Influenza Pandemic

Following evidence of sustained community transmission of the virus, the WHO may make declarations of a pandemic, national authorities are then expected to activate their contingency plans immediately following the announcement. The Trust’s Emergency Planning Officer with the co-operation and advice from the Infection Prevention and Control Team will advise the Trust Board when it is necessary to activate the Pandemic Influenza Plan and the Major Incident and Business Continuity Plan in order to ensure the Trust is prepared to respond to the potential pandemic. 4.2.1 Pandemic Flu Management Team

During this phase the Trust will ensure its Business Continuity plans are reviewed and updated and the Pandemic Flu Management Team will be mobilised. The Pandemic Flu Management Team (PFMT) will manage the Trust’s response to the pandemic influenza. The PFM Teams core membership will comprise of: Director of Operations Emergency Planning Lead Director for Infection Prevention & Control Director/Deputy Director of Nursing Chief Pharmacist Lead for Estates, Facilities & Procurement Consultant Microbiologist Lead Nurse - Infection Prevention & Control Lead – Communications Lead – Human Resources Nominated Lead from each division (Children’s, Corporate, Learning Disabilities

and Mental Health). Loggist Admin support

Between pandemics the Pandemic Flu Management Team should meet routinely up to 2-3 times per year in order to review this plan and undertake any exercises to test the Trusts emergency response. Terms of reference of this group are:

1. To provide leadership and co-ordination in planning and dealing with the potential implications of an Influenza pandemic (or similar highly infectious disease)

2. To monitor identified actions and report progress at each meeting

3. To co-ordinate the work of subgroups

4. To discuss and agree the decision making process for the deployment of local resources, including restricting, withdrawal and cancellation of services

5. To identify and develop strategies for the maintenance of essential services

6. To interpret and implement local, national and international guidance on potential pandemics

7. To develop communication material for service users in line with national guidance and local responding organisations

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8. To develop business continuity strategies and co-ordinate post-pandemic return to normality

9. To prepare reports on progress or planning issues

10. To work with the Infection Prevention and Control Team to effectively manage pandemic influenza outbreaks

11. To co-ordinate bed management including ward/departmental closures

12. To review effectiveness of this plan in light of lessons learnt from exercises or incidents.

13. To utilize the Action Cards found in Appendix 3 of this plan

14. To ensure the incident log is maintained.

The PFMT will develop an action list to progress the planning process; this includes roles and responsibilities for areas including:

Infection prevention and control

Specific training e.g. FIT Testing/use of PPE etc.

Clinical services

Securing essential supplies (clinical & non-clinical)

Provision of essential medicines

Antiviral distribution/collection points & use of PGDs

Situation reporting (SITREP)

Staff skill mix, availability and staff welfare

Staff vaccination (once new vaccine becomes available)

Record keeping - use of trained Loggist

Finance In developing this plan, the group will consult widely with subcontracted services and neighbouring organisations on specific issues. In the event of a pandemic the PFMT will meet at least once each day to review developing and predicted contingencies and to ensure plans are in place to respond to them. Affected areas will submit their Situation Reports (Appendix 1, 1a & 1b) to the PFMT chair at least one hour before each meeting commences. From these reports the Emergency Planning Lead (EPL) or nominated Director will summarise the information provided (see Appendix 1b) and chair the PFMT with the support of the Senior Manager on-call, to ensure that all relevant actions on the Influenza Pandemic Action Cards are undertaken (Appendix 3). The EPL or nominated Director is responsible for briefing the Executive Team and Board, and for communicating any updates with staff. BCPFT will also contribute, as appropriate, to the multi-agency partnership working with the Local Resilience Forums response to the influenza pandemic.

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4.2.2 Trust Actions Required During the Phases of the Pandemic

1. DETECT

Named Phase PHASE INDICATOR - DETECT

DETECT

Locally, this phase would start if the World Health Organisation phase 4 was declared or if there was reliable intelligence or if an influenza-related ‘Public Health Emergency of International Concern’ was declared by the WHO.

Department / Function Actions / Focus for BCPFT

Executive Team

PFMT to be made operational, working arrangements to be clarified

Monitoring and awareness of strategic issues of pandemic flu

Engage with CCGs about possible contract disruption & ensure Trust representation at relevant local committees as part of the joint management approach.

Liaise with local acute Trusts regarding any changes to admission/discharge criteria

Emergency Planning

Research, awareness and planning in consultation with key BCPFT staff and other NHS partners

Regular PFMT meetings – information/invites circulated, rooms booked etc.

Establish the reporting mechanisms for monitoring the impact of pandemic flu on the local population – set up the Situation (SITREP) reports (Appendix 1, 1a & 1b) to enhance surveillance.

Initiate urgent review of Trust current response plans, business continuity arrangements and surge arrangements and any findings from the Local Resilience Forum

Accelerate, consolidate and test all Trust wide and local pandemic preparedness efforts

Ensure subcontractors and commissioned services have adequate response plans in place

Review current response strategies in respect of any past experiences

Pandemic Flu Management Team

Research, awareness and planning in consultation with the Emergency Planning Officer, providing advice and support as required.

To plan a schedule of meetings and actions to deliver the pandemic flu plan

Ensure staff are supported and informed in pandemic influenza preparedness and response plans

Liaise with Public Health Teams locally regarding access to national flu equipment stockpile & how to access when required.

Infection Prevention & Control Team

IPC Lead Nurse will be ‘training the trainers’ re Pandemic Flu management for cascade to all staff

The IPCT will review IPC plans and advise procurement around procurement of essential PPE & consumables

Liaise with Learning & Development Team to source Fit Testing FFP3 masks – ‘train the trainer’ approach

Review use of infection control procedures and use of personal protective equipment within services.

Implement record keeping and surveillance measures for suspected or confirmed cases of Pandemic influenza

Review local teams supply of PPE Trust representation at relevant local committees as part

of the joint management approach Oversee the flu vaccination programme

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DETECT

Communications

Monitoring WHO, DH, PHE and other relevant websites and update the PFMT daily

Promotion of latest flu campaign (national/regional/local) Work with HR to ensure updated lists of services/sites Increase awareness of the signs, symptoms and

epidemiology of pandemic influenza as well as infection control measures, including using posters, intranet and newsletter messages

Human Resources & Workforce

Review staff sickness levels and implement Business Continuity measures if required, communicating any changes to services to staff and patients.

Ensure promotion of annual flu vaccination programme to all BCPFT staff ensuring sufficient vaccine supply

Maintain up-to-date competencies for vaccinators – check training records

Assist in producing records of staff with transferable skill, ready to redeploy in times of need.

Review staff skills, and volunteers including recently retired staff

Monitor news of pandemic and engage with staff side representatives in relation to future potential of staff redeployment requirements

Work with communications to provide staff information and ensure all teams staff contact details are up-to-date

Monitor attendance data and provide information to the PFMT as required.

Estates & Facilities Review estates strategy in readiness to support clinical

need and ability to maintain estates & facilities operations throughout the pandemic.

Procurement Check stock availability of PPE, antiviral medication,

antibiotics etc. and introduce stringent stock control measures

Finance Identify a specific budget code with Director of Finance

and resupply of PPE, clinical consumables etc. Work with the IPCT around procurement of PPE

Learning & Development

Prepare for the provision of accelerated training programmes

Identify staff who will require FIT testing prior to use of FFP3 respirator masks

Implement any Pandemic Influenza awareness training e.g. basic nursing/medical care, use of FFP3 respirator masks, infection prevention & control precautions.

Local Service Managers & Matrons & Medics

Identify staffing resources needed for the future deployment between critical services

All services to review business continuity and escalation plans

Act as a recipient for SITREP reports (Appendix 1, 1a & 1b) and summarise findings for the Nominated Director

Chief Pharmacist

Review of business continuity plan Increase stock of relevant medicines and vaccines Monitor for relevant Patient Group Directions (PGDs)

requirements and develop & approve as necessary Identification of potential additional storage for vaccines

and medicines e.g. antivirals, antibiotics etc.

Performance and Intelligence

Establish the reporting mechanisms for monitoring the impact of pandemic flu on services and staff

Establish recording database for vaccination of staff

Loggist’s

To ensure essential office supplies including a Personal Log books are available to the PFMT

Take official notes at all PFMT meetings Circulate meeting times to PFMT members Book rooms as/when required

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All Staff

To respond to advice and information given in relation to pandemic influenza, ensuring personal contact details updated

Practice good infection prevention & control to reduce risk of transmission of virus

Report symptoms (patient and or staff) promptly taking appropriate containment measures.

Continue business as normal – prepare to activate Pandemic Flu Plan

Summary of key national healthcare response

The focus at this stage is led by DH/PHE

Public Health England response supported by primary care

Detection and diagnosis of early cases through testing and contact tracing on which to base early estimates of impact and severity in the UK

Local areas to start initial preparations for activation of Antiviral Collection Points (ACPs)

Preparations to use the National Pandemic Flu Service (NPFS) when required

Antiviral collection points established in ‘hotspots’.

The length of this phase will depend on the severity and speed by which the virus spreads.

If there was identification of the novel influenza virus in patients in the UK - then this would be an indicator to move to the next stage. These two initial stages may be combined.

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2. ASSESS

Named Phase PHASE INDICATOR - ASSESS

ASSESS

Detection and assessment collectively form the initial response. The length of this phrase will depend on the severity and speed by which the virus spreads. These two initial stages may be combined.

Department / Function Actions / Focus for BCPFT

Executive Team

Monitoring and awareness of strategic issues of pandemic influenza

Negotiate relevant emergency contractual arrangements with commissioners

Emergency Planning

Research, awareness and planning in consultation and cooperation with trust key staff, the wider NHS and other category 1 and 2 responders, suppliers and Third Sector partners.

Ensure all decisions made/meetings held are recorded by the loggist.

Pandemic Flu Management Team

Meet daily and gather information from service leads across the Trust regarding impact, number of reported cases, supply & staffing issues etc.

Report findings to the Executive Team and NHS England/ PHE as required

Review and update business continuity as required in order to provide essential services

Ensure all decisions made/meetings held are recorded by the loggist

Infection Prevention & Control Team

Promotion and advice to staff re nursing and special infection prevention and control measures for symptomatic patients via IPC Champions & Matrons

Daily situation reporting of access to PPE and supporting Procurement on acquisition of suitable equipment

Ensure symptomatic patients and staff have appropriate tests e.g. viral swabs to identify pathogen (first 50-100 cases)

Communications

Work with Emergency Planning to develop key messages and ensure staffs are kept informed as the situation evolves.

Publish FAQs on the intranet, website, posters, other internal communications and social media.

Issue advice trust wide based on guidance from PHE Disseminate approved regional campaigns via established

communication routes

Human Resources & Workforce

Daily situation reporting on staff absences due to flu like illness to NHS England

Review of Service Business Continuity plans Promotion of advice to staff on revised sickness policies &

procedures, childcare issues due to school closures etc. Promoting staff vaccination

Estates & Facilities Review strategies in readiness to support clinical need

and ability to maintain estates and facilities operations throughout the pandemic period

Procurement

Ensure adequate supplies of PPE secured and stored at all in-patient locations

Resilience of obtaining all required supplies

Learning & Development

Escalation of pandemic flu awareness training Escalation of Fit testing for FFP3 respirator face mask –

maintaining records of staff assessed Escalation of pandemic flu training to all staff

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AS

SE

SS

Finance

Ensure resilience of PPE funding to meet anticipated demand

Review payroll arrangements for peak of pandemic activity Review payment of invoices etc. to ensure all future orders

for essential supplies are not affected by non-payment of invoices.

Local Service Managers, Matrons & Medics

Review staffing of critical services and identify staffing resources to support other services as/when required

Implement business continuity plans Reduce risk of transmission and infection by actively

finding cases and by self isolation of cases and suspected cases

Treatment of cases/suspected cases and use of any available anti-viral prophylaxis for close/vulnerable contacts based on risk assessment of the possible impact of disease as advised by local PHE Team

Chief Pharmacist

Research & monitoring of the situation Provision of advice and work in close consultation with

clinical staff re anti-viral and other medicines for different patient groups

Obtaining appropriate PGDs and licences required in advance of later stages

Store, stock and distribute antiviral’s across the trust Provide daily situation reports to PFMT on any medicines

supply issues Order pandemic flu vaccines as advised by PHE/DH

Performance and Intelligence

Facilitation and maintenance of monitoring impact Recording of staff immunisations on data base

Loggist’s

To ensure PFMT have essential office supplies including a Personal Log book

Take official notes at all PFMT meetings Circulate minutes, meeting times to PFMT members Book rooms as/when required

All Staff

To respond to advice and information given in relation to pandemic influenza, ensuring contact details updated

Report illness/symptoms promptly & refrain from duty when symptomatic as advised to reduce risk of transmission

Endeavour to maintain essential services Ensure staff have adequate stocks of PPE & know

how/when to use (Appendix 2)

Continue business as normal for as long as possible

Ensure Pandemic Flu Plan has been activated

Summary of key national healthcare response

The focus at this stage is led by DH/PHE

Public Health England response supported by primary care

Detection and diagnosis of early cases through testing and contact tracing on which to base early estimates of impact and severity in the UK

Local areas to start initial preparations for activation of Antiviral Collection Points (ACPs)

Influenza information line may be activated

Preparations to use the National Pandemic Flu Service (NPFS) when required

If there was identification of the novel influenza virus in patients in the UK with sustained community transmission of the virus of a case not linked to any known or previously identified cases - then this would be an indicator to move to the next stage

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3. TREAT

Named Phase PHASE INDICATOR - TREAT

TREAT

TREAT

The focus on this stage: Treatment of individual cases and population through routine NHS Services

which includes using the National Pandemic Flu Services (NPFS) if necessary. Enhancement of the health response to deal with increasing number of cases

Consider enhancing public health measures to disrupt local transmission of the virus as appropriate e.g. localised school closures based on public health risk assessment.

Department / Function Actions / Focus for BCPFT

Executive Team

Monitoring and awareness Provide leadership and direction for the organisation Host weekly teleconferences with key managers and

partners to manage the response on a local health economy basis

Situation reporting to regional and national command and control structures

Ensure all decisions made/meetings held are recorded by the loggist.

Monitor the provision of services and implement Business Continuity measures if trigger points are reached, communicating any changes to service delivery to patients and staff.

Emergency Planning

Research, awareness and planning in consultation and cooperation with key trust staff, the wider NHS and other partners.

Attendance at trust and partner agency response meetings/ teleconferences

Dissemination of DH demands and situation reporting Ensure all decisions made/meetings held are recorded by

the loggist. Review SITREP reports including number of infected

patients and workforce – management measures as required.

Work in conjunction with the CCGs to agree establishment of any additional services i.e. antiviral distribution points or vaccination centres.

Pandemic Flu Management Team

Meet daily and gather information from service leads across the Trust regarding impact, number of reported cases, supply & staffing issues etc.

Report findings to the Executive Team and NHS England/ PHE as required

Review and update business continuity as required in order to provide essential services

Ensure all decisions made/meetings held are recorded by the loggist

Infection Prevention & Control Team

Daily surveillance & SITREP reporting Provide IPC advice on individual case management Monitor & ensure in-patient units have adequate stocks of

PPE & know how/when to use (Appendix 3) & obtain supplies

Participate in daily PFMT meetings Complete pre-pandemic or seasonal flu vaccination of staff if

available and advised by PHE

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Communications

Work with Emergency Planning & IPCT to develop key messages and ensure staffs are kept informed as the situation evolves.

Continually update FAQs on the intranet, website, posters, other internal communications and social media.

Issue advice trust wide based on guidance from PHE Disseminate approved regional campaigns via established

communication routes

Human Resources & Workforce

Daily situation reporting on staff absences due to flu like illness to PFMT & NHS England (as requested)

Operation of the Service Business Continuity plans Promotion of advice to staff on revised sickness policies &

procedures, childcare issues due to school closures etc. Promoting staff vaccination with any newly developed flu

vaccine Ensure Payroll will run using default information from

previous month if necessary Set up a staff welfare team and agree any measures which

may be introduced to assist staff i.e. provision of transport.

TREAT

TT

Estates & Facilities Implement any relevant estate measures across the trust

sites Support Local Authority in establishing anti-viral centres

Procurement To ensure adequate supplies of PPE, consumables and all

essential supplies Inform the PFMT of any areas for concern immediately

Finance As before plus: Promote use of National Emergency Purchasing Scheme as

appropriate

Learning & Development

Continue to provide essential flu management training as required

Follow advice from the PFMT

Local Service Managers, Matrons & Medics

Operation of the Service Business Continuity plans Ensure the IPCT are updated on any new suspected cases Ensure safe staffing levels for all essential services Actions as requested by the PFMT/Emergency Planning

Officer

Chief Pharmacist

Ensure adequate supplies of all essential medicines Advice on prescribing anti-viral flu treatments Monitor information on development of new flu vaccines and

obtain supplies at the earliest opportunity

Performance and Intelligence

Facilitation and maintenance of monitoring impact Recording of staff immunisations on data base

All Staff

To respond to advice and information given in relation to pandemic influenza, ensuring personal contact details updated

Report illness/symptoms promptly & refrain from duty when symptomatic as advised to reduce risk of transmission.

Comply with management requests in relation to re-deployment requirements

Endeavour to maintain essential services

Loggist’s

To ensure PFMT have essential office supplies including a Personal Log books

Take official notes at all PFMT meetings Circulate minutes, meeting times to PFMT members Book rooms as/when required

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Continue business as normal for as long as possible – this may only be possible in some and not all areas of the Trust

Be prepared to work in other Trust areas/sites as requested by PFMT/and your line manager

Summary of key national healthcare response

Arrangement will be activated nationally 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 available capacity, additional measures will need to be taken.

On-going monitoring of the nature and scale of illness locally and nationally and its effect on healthcare delivery.

This decision is likely to 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.

These two phases’ treatment and escalation form the treatment component of the pandemic. Whilst escalation measures may not be needed in mild pandemics, it would be prudent to prepare for the implementation of the escalation phase at an early stage.

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4. ESCALATE

Named Phase

PHASE INDICATOR - ESCALATE

ESCALATE

The focus on this stage:

Escalation of surge management arrangements in health and other sectors

It would be prudent to prepare for the escalation phase at an early stage and also be mindful or a repeated pandemic wave in the near future

Department / Function Actions / Focus for BCPFT

Executive Team

As in TREAT plus the following: Negotiating with commissioners re suspending non-

essential services and prioritising others Attend trust emergency meetings as necessary Suspend all non-essential meetings Ensure all decisions made/meetings held are recorded by

the loggist.

Emergency Planning

As in TREAT plus the following: Ensure deputies are appointed to all key roles in case of

illness or absence. Determine level of care to be provided in the community

for service users in relation to staffing and resource availability.

Agree admission and discharge protocols for local hospitals during peak weeks.

Attend PFMT meetings Prepare for any de-escalation of response if the situation

is judged to have improved sufficiently. Implement alternative mortality arrangements (if

necessary). Review policy on visitors to in-patient facilities during peak

of pandemic Prepare for any further pandemic waves & re-escalation

Loggist’s

To ensure PFMT have essential office supplies including a Personal Log books

Take official notes at all PFMT meetings Circulate minutes, meeting times to PFMT members Book rooms as/when required

Pandemic Flu MT

As in TREAT plus the following: Continue to hold daily meetings – may need to reconvene

twice daily dependant on situation/demands on services Communicate with Local Resilience Forum to ensure

support/provision across the wider health care economy as required.

Establish daily briefing bulletin including number of cases and mortality rate

Infection Prevention & Control Team

As in TREAT plus the following: Twice daily surveillance & SITREP reporting to ensure

PFMT are updated on evolving situation Ensure staff compliant with IP&C precautions and staff

have access to adequate supplies of PPE (Appendix 3)

Estates & Facilities

Implement any relevant estate measures across trust sites

Support Local Authority with any on-going anti-viral centre premises issues

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ESCALATE

Communications

As in TREAT plus the following:

Liaison with Local Healthcare Economy comm’s teams to ensure consistence in messages.

Communicate latest medical and self-care information for patients and staff.

Ensure regular communication updates are issued and Trust messages are being added to local communication bulletins

Human Resources & Workforce

Daily situation reporting on staffing absences due to flu like illness to PFMT/ NHS England

Operation of business continuity plans

Promotion of advice to staff on revised sickness policies & procedures, childcare issues due to school closures etc.

Vaccination of staff with any newly developed flu vaccine

Keep update on use of support services for staff i.e. occupational health and staff support.

Review staff welfare arrangements and enable well staff to work

Ensure payroll arrangements function for salary provision

Review implications of change in duties for redeployed staff.

Procurement

Review use of PPE (if available) and stock control provisions. Record level of use during peak weeks for use during next wave.

Assess availability of essential resources

Implement any reduced service policies agreed with sub-contractors.

Finance

Use the specific budget code and resupply of PPE, clinical consumables etc.

Work with the IPCT around continued procurement & provision of PPE

Learning & Development

Suspension of training except for that directly required for redeployed clinical (and admin) staff in support of key departments

Local Service Managers, Matrons

& Medics

Ensure business continuity plans are operational and maintained/updated as necessary

Manage demands and resources & close non-essential services

Chief Pharmacist

Assess availability and ensure adequate supplies of all essential medicines

Advice on prescribing anti-viral flu treatments

Review anti-viral medication stocks and availability for re-ordering

Monitor information on development of new flu vaccines and obtain supplies at the earliest opportunity

Performance and Intelligence

Facilitation and maintenance of monitoring impact

Recording of staff immunisations on data base

All Staff

To respond to advice and information given in relation to pandemic influenza, ensuring contact details are updated

Report illness/symptoms promptly & refrain from duty when symptomatic as advised to reduce risk of transmission.

Comply with management requests in relation to re-deployment requirements

Endeavour to maintain essential services

Ensure correct use of PPE (Appendix 3) & know how/ when to use and how to obtain additional supplies

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Continue to provide essential services as far as possible

All staff to be prepared to work in other Trust areas/sites as requested by PFMT/line manager in order to provide essential services. During this time staff may also be required to work additional hours in order to maintain key services.

Summary of key national healthcare response

Prioritisation and triage of service delivery with aim to maintain core essential services, supplies and staffing.

Resiliency measures encompassing robust contingency plans.

Possible implementation of national legislative changes to facilitate changes in working practice (e.g. death certification, drivers hours, sickness self-certification requirements, Mental Health Act, benefits payments etc.)

On-going monitoring of the nature and scale of illness locally and nationally and its effect on healthcare delivery.

Consideration of de-escalation of response if the situation is judged to have improved significantly.

Review lessons learnt and prepare for any future pandemic waves which are likely to occur in the coming weeks/months.

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5. RECOVER

Named Phase PHASE INDICATOR - RECOVER

RECOVER

The focus on this stage:

Treatment of individual cases and population through routine NHS Services which includes using the National Pandemic Flu Services (NPFS) if necessary.

Enhancement of the health response to deal with increasing number of cases

Consider enhancing public health measures to disrupt local transmission of the virus as appropriate e.g. localised school closures based on public health risk assessment

Phased return to normal services as staff & resources allow. Department / Function Actions / Focus for BCPFT

Executive Team

Chief Exec will thank the staff and declare stand down Emergency Planning Officer/Director of IPC to host: 1. A trust and partner agency recorded formal debrief and

ensure that an action plan is drawn up and flu are plans reviewed – good practice examples are incorporated into normal operations as appropriate

2. A joint local health, provider, commissioner and partner agency Recovery Team is set up to meet as frequently as required to plan a phased integrated coordinated recovery

3. Attend a trust debrief Ensure all decisions made/meetings held are recorded by

the loggist.

Emergency Planning

Attendance at formal debriefs for the Trust and Local Health Resilience groups, prepare report for the Trust Board

Identify lessons to date to inform future planning. Implement recovery strategy with aim to return to business

as usual & catch up on scaled down activities. Prepare for second wave of influenza pandemic, including

activities carried out in the DETECT phase Agree stand down of PFMT as/when deemed necessary

Infection Prevention & Control Team

Update Pandemic Flu Plan based on debrief and review findings

Monitoring and replacement of stocks of PPE with the procurement team

Review & continue baseline surveillance – early warning of further pandemic waves

Ensure PPE (if available) is used to minimise the risk of infection (virus will still be circulating although number of cases reducing)

Attendance at the Trust debrief sessions.

Communications

Cascade of stand down regarding changes to services, vaccination availability etc.

Reduce frequency of briefing bulletins until resurgence Review of pandemic flu plans Reinstatement of normal operations Attendance at Trust debrief sessions

Human Resources & Workforce

Review of pandemic flu plans Activation of HR recovery plans and payroll issues due to

leave cancelled/not taken/extra hours worked etc. Work with payroll to correct pay budget/salaries Address issues relating to staff fatigue, review absence

levels and allocate additional or compassionate leave where appropriate.

Reduce rotas and duties (where necessary) for seconded or volunteer staff.

Preparation of staffing FAQs for the intranet and promotion of staff welfare measures with communications team.

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RECOVER

Pandemic Flu MT

Attendance at Trust debrief

Prepare for any future pandemic waves and allocate resources

Prepare post pandemic vaccination strategy and allocate resources

Prepare for post pandemic seasonal influenza.

Restore business as usual, rescheduling cancelled or reduced work streams and reinstating targets

Recovery of any building/service movement or closures Estates & Facilities

Procurement

As in ASSESS and TREAT & prepare for any future pandemic waves

Review availability of subcontracted services and suppliers.

Reinstate normal functions as far as possible

Finance As in ASSESS and TREAT & prepare for any future

pandemic waves

Reinstate normal functions as far as possible

Learning & Development

Reinstatement of training and scheduling of extra sessions to ensure maintenance of clinical registration and other issues

Planned extra activity for care of staff referred due to issues caused by the pandemic and the response

Reinstate normal functions as far as possible

Local Service Managers, Matrons

& Medics

Restore business as usual, rescheduling cancelled or reduced work streams and reinstating targets

Identify and return consumables and healthcare equipment stocks to baseline levels

Review impact on local services – assess caseloads and redeploy staff and resources where necessary to relieve short-term pressures

Review of pandemic influenza plans & mortality arrangements

Review outstanding HR issues e.g. holidays, training, overtime hours worked etc.

Review level of care provided in the community and transfer individuals to appropriate in-patient care as required and where available.

Reinstate normal functions as far as possible

Chief Pharmacist

Review of stocks and supplies – in particular antiviral medication

Return stocks to national stockpile as required and replenish internal supplies

Review of influenza plans

Attend Trust debrief session

Reinstate normal functions as far as possible

Performance and Intelligence

Review of pandemic influenza plans

Reinstatement of planned upgrades and projects

Acceleration of activity to address any backlog

Provide summary of performance targets to enable contractual negotiations to take place

Reinstate normal functions as far as possible

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RECOVER

Loggist

Collect all personal log books from key personal e.g. PFMT members, emergency planning and exec team etc. and store securely in preparation for collating the end of outbreak reports.

Assist the Emergency Planning Office to prepare reports as required.

All Staff

Comply with management requests in relation to re-deployment requirements

Endeavour to maintain essential services and move to resume ‘normal services’ as directed.

Personal uptake of pandemic flu vaccine as soon as it becomes available.

Summary of key national healthcare response

Emphasis on maintaining supplies and staffing

Continue to provide essential services as far as possible and work to get back ‘to normal’.

Provision of psychological counselling for both staff and public will be required.

Preparation for second and subsequent pandemic waves over the coming weeks and months.

4.3 Managing Workforce Issues From experience and analysis, the pandemic influenza could result in up to 50% of the population experiencing symptoms of pandemic influenza during one or more of the pandemic waves - this may result in a potential absence of up to 50% of the workforce. The normal sickness reporting systems and process will be used across the Trust. Human Resources will provide information, advice and support to the PFMT, when established, to enable the management of workforce resource to support critical functions and core service continuity. The difficulties in maintaining essential services could be exacerbated within the Trust further by high levels of staff absence with over 50% of all staff possibly requiring time off at some stage over the pandemic period through:

Sickness or fear of infection

Care providing responsibilities (especially if schools are closed)

Stress

Bereavement (or other psychological impacts)

Transport disruptions It is likely that staff absences will be higher and more pronounced in the Trust’s smaller teams and where staff work in close proximity. The Department of Health and NHS Employers published guidance on the key human resources issues that could arise in the event of an outbreak of pandemic flu including:

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How staff can be redeployed and how organisations can work together to sustain services.

How the NHS should deal with the likely impact of the pandemic on staffing levels, e.g. by seeking to build up a reserve pool.

How to manage staff absence, in particular dealing with staffs that have caring responsibilities, especially school age children.

Ensuring staff are used most effectively and reassuring staff around issues such as discipline.

Impact on terms and conditions of employment How to comply with working time regulations Providing support to staff during the pandemic and the recovery phase.

In consultation with the Director of Human Resources and the Director of Operations, the nominated Executive Director/Emergency Planning Officer will determine whether business continuity plans, the prioritization of services, and the Major Incident and Business Continuity Plan should be invoked. Staff will follow the business continuity procedures in a pandemic with low and moderate impacts. However in a high impact event the Trust is likely to activate its major incident procedures.

4.3.1 Impact on Workforce It is estimated that up to 50% of the workforce may require time off at some stage over the entire period of the pandemic, with individuals likely to be absent for a period of seven to ten working days. Absenteeism should follow the pandemic profile, with an expectation that it will build to a peak lasting for two to three weeks, when between 15% and 20% of staff from the workforce may be absent, and then decline. However as the rate of infection in in-patient facilities may be higher over a short period, higher levels of absence must be planned for. Additional staff absences are likely to result from other illnesses, taking time off to provide care for dependants, family bereavement, other psychosocial impacts, fear of infection or practical difficulties in getting to work. The Government may advise schools and early years/childcare settings to close in order to reduce the spread of infection amongst children. This advice will be provided only if closure is anticipated to produce significant health benefits. Closures will be area specific (whilst the virus is circulating in the locality) and are likely to be for two to three weeks, although they may be extended if the pandemic remains in the area. A further 5–6% of staff could be absent as a result of school closures, though this is based on an analysis of informal childcare being available for parents. Estimates and proportionality of the impact can be found in the Operating framework for managing the response to Pandemic Influenza (NHS England October 2013). 4.3.2 Workforce Profile The workforce profile for the Trust is very diverse in terms of ethnicity. The majority age group is 41-45 which may increase the risk of absence and severe illness in staff during a pandemic.

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The majority of mental health nursing staff will not have any clinical qualification and will require training in basic health needs, influenza assessment and treatment, for use during a pandemic. The Trust sub-contracts some of its services including maintenance and security. Staff absences in support services will have a direct impact on the Trust’s ability to provide safe working environments for its own staff during a pandemic. 4.3.3 Staff Welfare Planning People are the most valuable resource and the most vulnerable during a pandemic. As part of the planning process, the Human Resources Department will develop plans to:

Ensure contact details and skills of the available workforce are captured so that they can be easily contacted in the event of a pandemic

Work with the Group Directors to identify possible risk in service delivery and find solutions where possible

Identify staff with personal caring responsibilities that may impact upon their ability to attend work during ‘normal hours’ and develop plans to support them with alternative work options

Liaise with the Learning and Development team to develop education and training that builds capacity into the existing workforce through teaching new skills, updating existing skills. This may allow staff to take on additional duties as required

Facilitate arrangements for joint working and ‘buddying up’ of community teams or specialist services to provide cross boundary cover within the Trust

4.4 Business Continuity Management For guidance on business continuity management please refer to the detailed plans described in the Business Continuity Management Plan. Business Continuity Management (BCM) is a process that helps manage risks to the smooth running of our organisation or delivery of our services, ensuring continuity of critical functions in the event of a disruption, and effective recovery afterwards.

Business Continuity Management (BCM) is facilitated through the production of Business Continuity Plans (BCPs) which, as well describing the steps that need to be followed to maintain or recover the delivery of services, will also cover incident management such as the initial impact of an event e.g. evacuation of patients and staff, media response, etc.

Each major site of the Black Country Partnership NHS Foundation Trust will have a Business Continuity Plan (BCP) that is specific to that site/service. The major site plan may well be made up of individual unit/service plans dependant on the sites requirements

Unit/service BCPs will be available from the service manager in each building whereas the overall site plan may only be available on the intranet or in a senior manager’s office.

Business Continuity Plans cover all elements of our services and in addition this Pandemic Flu Plan contains information specific to BCM during a flu pandemic. The Civil Contingencies Act requires that all Black Country Partnership NHS Foundation Trust services:

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Have robust and tested business continuity plans in place which cover arrangements for dealing with pandemic influenza (see Business Continuity Management Plan)

Encourage organizations on which they will rely during a pandemic do the same (i.e., have business continuity plans in place which cover arrangements for dealing with pandemic influenza)

Guidance for business continuity planning (including a pandemic influenza checklist for businesses) can be found on the GOV.UK emergency planning website at: https://www.gov.uk/government/policies/emergency-planning

Ensure that their business continuity plans have the flexibility to accommodate the range of predicted staff absences.

4.5 Situation Reporting As the acute phase of the pandemic approaches, NHS England/Public Health England will require the Trust will be required to collect daily situation reports (SITREPs). As an example it is likely that the following information will be reported through the command and control structures:

Staff availability – including sickness rates in staff and volunteers

Number and rates of patient admissions and discharges & cases of influenza

Case demographics and other underlying disease profiles

Assessment level of admitted patients

Bed capacity and occupancy

General responses to treatment of pandemic influenza cases

Deaths

Status of core facilities and utilities

Financial impact Each unit/department will be required to provide a situation report identifying the current situation and measuring the impact of the pandemic against a number of identified standards. The frequency of reporting will be determined by the PFMT. It is anticipated that as a minimum such reports will need to be produced and submitted on a daily basis to the Emergency Planning Officer who will collate the figures and send to the identified point. (See Appendices 1, 1a and 1b).

4.6 Recovery Phase

UK will move into recovery phase as the pandemic phase subsides and there is no threat of further waves occurring in the UK. The phase will follow guidance in the recovery phase of a major incident as per emergency planning. The Black Country Partnership NHS Foundation Trust will need to:

Consider available workforce, both clinical and non-clinical

Consider provision of psychological support to staff (this needs to be in operation during pandemic as well as recovery stages)

Refer staff to the staff support service and bereavement services as required, the Spiritual Care Team may be able to offer help and support

Ensure that buildings are adequately cleaned sanitised and otherwise made ready for resumption of normal service

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4.7 Financial Arrangements

The financial arrangements for pandemic influenza planning including stockpiling of PPE, training and development costs etc., will be agreed with the Director of Finance and reported to the Board through the Chief Operating Officer. Funding for the response to a potential pandemic has been agreed at Board level including provision of PPE stockpiling, antiviral medication and workforce requirements including volunteer expenses etc. It is envisaged that the CCG’s will suspend most targets and regulatory requirements once a pandemic has been declared, however the Trust will need to maintain services under the Mental Health legislation which may incur costs including the employment of private professional staff. 4.8 Communication

All official communications within the organisation will be cascaded through formal senior management structures. The PFMT will oversee the co-ordination and dissemination of all information released to staff throughout the Trust.

All Service and Team Managers/Leaders are kept fully informed and briefed at all times. It is the responsibility of all Group Heads and all Service/Team Managers/Leaders to ensure all their staff receive and have timely access to all appropriate information.

The communication team will publish articles and information for staff and service users in all phases of the pandemic to maintain staff awareness of the pandemic threat and the plans developed by the trust. 5.0 Procedures connected to this Policy

IPC SOP 01: Standard infection prevention & control precautions

IPC SOP 02: Transmission based precautions

IPC SOP 03: Surveillance of infection and data collection

IPC SOP 04: Reporting incidents of infection to PHE or the Local Authority

IPC SOP 05: Management & recognition of outbreaks of communicable infection

IPC SOP 06: Isolation - care of patients in isolation due to infection or disease

IPC SOP 13: Closure of wards due to an infection control issue

IPC SOP 16: Sharing information with other health & social care providers

IPC SOP 24: Alert organisms – respiratory viruses 6.0 Links to Relevant Legislation

6.0.1 Civil Contingencies Act 2004 The Civil Contingencies Act delivers a single framework for civil protection in the UK. The Act is separated into 2 substantive parts: local arrangements for civil protection (Part 1); and emergency powers (Part 2).

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Part 1 of the Act and supporting Regulations and statutory guidance ‘Emergency preparedness’ establish a clear set of roles and responsibilities for those involved in emergency preparation and response at the local level. The Act divides local responders into 2 categories, imposing a different set of duties on each.

Those in Category 1 are organisations at the core of the response to most emergencies (the emergency services, local authorities, NHS bodies). Category 1 responders are subject to the full set of civil protection duties. They will be required to:

Assess the risk of emergencies occurring and use this to inform contingency planning

Put in place emergency plans

Put in place business continuity management arrangements

Put in place arrangements to make information available to the public about civil protection matters and maintain arrangements to warn, inform and advise the public in the event of an emergency

Share information with other local responders to enhance co-ordination

Co-operate with other local responders to enhance co-ordination and efficiency

Provide advice and assistance to businesses and voluntary organisations about business continuity management (local authorities only)

6.0.2 Health and Social Care Act 2008 (updated July 2015) The Health and Social Care Act 2008 sets out the code of practice for the prevention and control of infections. Good Infection prevention, cleanliness and prudent antimicrobial is essential to ensure that people who use health and social care services receive safe and effective care. Effective prevention of infection and cleanliness must be part of everyday practice and be applied consistently by everyone. Good management and organisational processes are crucial to make sure that high standards of infection prevention and cleanliness are set up and maintained. As the regulator of health and adult social care in England, the Care Quality Commission (CQC) will provide assurance that the care people receive, meets the fundamental standards of quality and safety. This Act outlines what registered providers in England, should do to ensure compliance with registration requirement 12(2) (h) – providers must assess the risk of, and prevent, detect and control the spread of, infections, including those that are health care associated. It also sets out the10 compliance criteria against which registered providers will be judged. 6.1 Links to Relevant National Standards

6.1.1 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 12 CQC Fundamental Standards- Regulation 12: Safe Care and Treatment – The intention of this regulation is to prevent people from receiving unsafe care and treatment, and prevent avoidable harm or risk of harm. Providers must assess the risks to people's health and safety during any care or treatment and make sure that staffs have the qualifications, competence, skills and experience to keep people safe. Providers must prevent and control the spread of infection. Where the responsibility

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for care and treatment is shared, care planning must be timely to maintain people's health, safety and welfare. 6.2 Links to other key policies

6.2.1 Major Incident & Business Continuity Plan Although the Trust is classed as a ‘category 1’ responder under the Civil Contingencies Act 2004, this is by definition due to its attainment of Foundation Trust status. Thus, within major incident planning and response arrangements the Trust is not expected to play a major role within a traditional ‘major incident’ scenario. The focus for the Trust should therefore be on developing and embedding appropriate business continuity arrangements to ensure it can effectively meet the challenges of incidents that can disrupt the continuity of its critical and essential services under the NHS England Emergency Preparedness Framework 2013. The aim of this policy is to provide an effective business continuity framework which will allow the Trust to meet its regulatory obligations. 6.2.2 Infection, Prevention and Control Assurance Policy The aim of the policy is to:

Ensure that robust arrangements for the prevention and control of infection are in place within the Trust.

Ensure that infection prevention and control is embedded at all levels of the organisation ‘from the Board to the Ward’

To provide Standard operating procedures for effective infection prevention and control.

6.2.3 Seasonal Influenza policy This policy is also significant in the management of influenza. 6.3 Reference documents

NHS England (December 2017) Operating Framework for Managing the Response to Pandemic Influenza

World Health Organization (November 2017) Guidance for surveillance during an influenza pandemic, Pandemic Influenza Risk Management

European Centre for Disease Prevention & Control and the World Health Organization (November 2017) Guide to revision of national pandemic influenza preparedness plans. Lessons learned from the 2009 A(H1N1) pandemic

Cabinet Office (September 2017) National Risk Register of Civil Emergencies 2017 Edition

Public Health England (October 2016) Infection control precautions to minimise transmission of acute respiratory tract Infections in healthcare settings: (Version 2)

Public Health England (August 2014) Pandemic Influenza Response Plan

Cabinet Office (July 2013) Preparing for Pandemic Influenza – Guidance for Local Planners

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Department of Health (April 2012) Health and Social Care Influenza Pandemic Preparedness and Response

Department of Health (November 2011) UK Influenza Pandemic Preparedness Strategy

Department of Health (May 2011) Pandemic Influenza and the Mental Health Act 1983

General Medical Council (October 2009) Pandemic Influenza Good Medical Practice, Responsibilities of doctors in a national pandemic

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7.0 Roles and Responsibilities for this Policy

Title Role Responsibilities

Chief Executive Accountable Overall responsibility for all matters relating to Pandemic Influenza

Executive Director of

Nursing, AHPs and Governance

Executive Lead

Responsible for ensuring this plan is updated by the IPCT, that it represents best practice and includes current evidence based information and national guidance

Ensure that the daily SITREP response is collated and information is shared with other local, regional and national

agencies as required (see Appendix 1, 1a and 1b) Ensure at least two other appropriate individuals are familiar with their action card responsibilities (Appendix3) and

understand they may need to take up this role in the event of a pandemic. In turn these managers/clinicians should ensure that at least two others are familiar with their action cards and so on

Trust Board Strategic

Strategic overview and final responsibility for setting the direction for Pandemic Influenza within the Trust

Oversee the pandemic influenza planning process Ensure they are represented at the Trust’s Business Continuity and Emergency Preparedness Group at Director level by the

Associate Chief Operating Officer

Quality and Safety

Committee Monitoring Monitor and review performance in connection with this plan and receive exception and progress reports

Quality and Safety

Steering Group

Scrutiny and

Performance

Scrutinise the implementation of a systematic and consistent approach to Pandemic Influenza and provide exception and

progress reports to the Quality and Safety Committee

Infection Prevention

and Control Committee Responsible

Oversee the implementation of a systematic and consistent approach to this plan Approve all policies and procedures that relate to their subject matter or area of practice Provide exception and progress reports to the Trust Board Members of the committee are responsible for ensuring this plan is accurate and up to date

Major Incident

Management Group

(MIMG) or

Pandemic Flu Management Team

(PFMT)

Co-Ordinate Response

Coordinate the Trusts response to an influenza pandemic Identify critical services and resources Arrange meetings of the Pandemic Flu Management Team and notify members of date/time and venue for meetings Meet regularly from the onset of an influenza pandemic to oversee the Trusts preparedness, response and business

continuity arrangements Make arrangements for taking minutes of meetings, log decisions taken Arrange internal debrief sessions Co-ordinate external debrief attendances as required Produce hand-outs as required Ensure the Trusts emergency preparedness is regularly reviewed through regular training, testing and exercises Make arrangements to develop appropriate tests/exercises with the support of the Emergency Planning and Business

Continuity Officer

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Title Role Responsibilities

Human Resources

Management and

Redeployment of Staff

Assist with roster management and redeployment of staff with essential skills to maintain core services Support the segregation of staff so that healthcare staff who are assigned to care for patients with influenza or work in an

area that has been segregated to care for patients with influenza are not assigned to care for non-influenza patients or work in non-affected areas. For example one Doctor and Senior Nurse and HCSW could be designated to see all the patients with symptoms of influenza per shift

Prioritise staff who have recovered from influenza or have received a full course of vaccination against the pandemic strain to care for patients with influenza as they are considered unlikely to develop of transmit influenza

Ensure staff welfare throughout the pandemic is considered and support is provided Ensure daily SITREP report is maintained (Appendix 1, 1a and 1b)

Infection Prevention and Control Team

(IPCT)

Expert advice and

support

Escalate the notification of the threat of an emerging Pandemic to the DIPC and EPO in order to initiate the Trusts preparedness response and activation of this plan

Ensure at least two other appropriate individuals are familiar with their action card responsibilities (Appendix 3) and understand they may need to take up this role in the event of a pandemic. In turn these managers/clinicians should ensure that at least two others are familiar with their action cards and so on

Assist with ensuring this plan is updated in line with any new legislation or best practice guidance Provide expert advice in the planning for and in dealing with an influenza pandemic with the aim to prevent and control

infection particularly within the in-patient service areas Declare an outbreak and inform the Major Incident Management Group (MIMG) and Chief Executive Attend MIMG/PFMT meetings as required Head and co-ordinate the epidemiological investigation Collate infection control surveillance data Provide infection prevention and control advice to other healthcare professionals in the organisation Provide resources e.g. patient information leaflets and posters Brief Lead Nurses and Matrons who will cascade information to clinical services Provide information leaflets for patients, staff and visitors Be a member of local health economy pandemic flu planning groups Provide training on infection prevention and control precautions in relation to pandemic influenza

Chief Pharmacist/ Pharmacy Team

Expert advice and Support

Advise on use of antiviral medication in line with national guidance Secure supplies of antivirals, vaccines and antibiotics and other medicines and ensure distribution to wards and

departments as required Liaise with suppliers to ensure adequate and timely supplies Prepare information on indications, contraindications and adverse reactions of drugs to be used Ensure administration of pharmaceutical preparations is undertaken in accordance with group directives Ensure group directives are updated and approved by the Medicines Management Committee Ensure at least two other appropriate individuals are familiar with their action card responsibilities (Appendix 3) and

understand they may need to take up this role in the event of a pandemic. In turn these managers/clinicians should ensure that at least two others are familiar with their action cards and so on

Learning and Development Team

Training

Facilitate training requirements at the earliest opportunity when the possibility of a pandemic is predicted, in liaison with the Director of Nursing, Medical Director and the Infection Prevention and Control Team to identify the key training requirements

Ensure infection control and basic physical care skills training is provided

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Title Role Responsibilities

Communications Team Communication

Implement the communications strategy, specifically for patients, staff, visitors and contractors Issue internal media bulletins Deal with press enquiries and produce media statements based on the advice of the BCEP Assist with coordination of internal debrief Meet all the communication requirements detailed in the Major Incident and Business Continuity Plan

Occupational Health Provider

Advice

Prompt recognition of cases of influenza among healthcare workers is essential to limit the spread of the pandemic Advise managers on safe return to work of healthcare workers who have been affected Advise managers if a healthcare worker is at high risk of complications from influenza to ensure vulnerable staff do not

provide direct care to symptomatic patients Facilitate staff access to antiviral treatment where necessary and implement the vaccination of the healthcare workforce

when required Attend influenza pandemic planning meetings as required

Directors Implementation

Ensure they are familiar with this document and the Major Incident and Business Continuity Plan and have alerted staff of their role in planning for and managing an influenza pandemic

Ensure at least two other appropriate individuals are familiar with their action card (Appendix 3) and understand they may need to take up this role in the event of a pandemic. In turn these managers/clinicians should ensure that at least two others are familiar with their action cards and so on

Emergency Planning Officer (EPO)

Operational Lead

Responsible for preparing, maintaining, and testing the Trust’s Business Continuity Management Policy including Pandemic Influenza and associated training

In the event of the major incident plan being implemented the EPO will also be responsible for undertaking a formal review of the effectiveness of the plan and implementing any need for improvement/amendment identified

Ensure at least two other appropriate individuals are familiar with their action card responsibilities (Appendix 3) and understand they may need to take up this role in the event of a pandemic. In turn these managers/clinicians should ensure that at least two others are familiar with their action cards and so on

Keep a list of completed exercises and lessons learned from the exercises Make the plan available on the Trusts intranet for use by all staff following approval from the CEO Nominate key personnel to collate the SITREP data (see Appendix 1, 1a and 1b)

Managers (including those with on-call)

Operational

Ensure they are familiar with this document and the Major Incident and Business Continuity Plan and have alerted staff of their role in planning for and managing an influenza pandemic

Ensure at least two other appropriate individuals are familiar with their action card (Appendix 3) and understand they may need to take up this role in the event of a pandemic. In turn these managers/clinicians should ensure that at least two others are familiar with their action cards and so on

Ensure daily SITREP report is maintained for the wards/departments for which they are responsible (Appendix 1 and 1a) Ensure that staff attend infection control training as/when required Ensure an adequate number of staff receive training on administration of vaccines in liaison with Learning and Development

Team Ensure access to training and ‘Fit-Testing’ for any staff who are required to wear respirator FFP3 face masks in liaison with

the IPCT Ensure contact details and skills of the available workforce are captured so that they can be easily contacted in the event of

a pandemic Ensure healthcare workers who are at high risk of complications of influenza (e.g. pregnant women and immune-

compromised workers) are considered for alternative work assignments. Away from the direct care of patients, for the duration of the pandemic or until they have been vaccinated (if it is clinically appropriate)

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Title Role Responsibilities

All Employees Adherence

Adhere to the principles detailed within this document Comply with infection prevention and control procedures detailed within this document to protect themselves and others

from the risks of infection Report promptly to the Infection Prevention and Control Team all cases (patients or staff) suspected to have the illness Attend Pandemic Influenza training sessions as requested Refrain from work if symptomatic with the virus Assist the Trust as far as possible to maintain essential services as requested by the HR Department

Bank and Agency Staff Adherence Ensure they do not work across different clinical environments which may increase the risks of transmission Follow the same deployment advice as permanent staff

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8.0 Training

What aspect(s)

of this policy will require staff

training?

Which staff groups require this

training?

Is this training covered in the Trust’s Mandatory and Risk

Management Training Needs Analysis document?

If no, how will the training be delivered?

Who will deliver the training?

How often will staff require

training

Who will ensure and monitor that staff have

this training?

Specific training based on

updated national guidelines which

will be made

widely available by the DH

All clinical staff No Internally Infection Prevention and Control Team

Only during planning phase

of any future pandemics

Learning and Development Team

9.0 Equality Impact Assessment

Black Country Partnership NHS Foundation Trust is committed to ensuring that the way we provide services and the way we recruit and treat staff reflects individual needs, promotes equality and does not discriminate unfairly against any particular individual or group. The Equality Impact Assessment for this policy has been completed and is readily available on the Intranet. If you require this in a different format e.g. larger print, Braille, different languages or audio tape, please contact the Equality & Diversity Team on Ext. 8067 or email [email protected]

10.0 Data Protection and Freedom of Information

Data Protection Act provides controls for the way information is handled and to gives legal rights to individuals in relation to the use of their data. It sets out strict rules for people who use or store data about individuals and gives rights to those people whose data has been collected. The law applies to all personal data held including electronic and manual records. The Information Commissioner’s Office has powers to enforce the Data Protection Act and can do this through the use of compulsory audits, warrants, notices and monetary penalties which can be up to €20million or 4% of the Trusts annual turnover for serious breaches of the Data Protection Act. In addition to this the Information Commissioner can limit or stop data processing activities where there has been a serious breach of the Act and there remains a risk to the data.

The Freedom of Information Act provides public access to information held by public authorities. The main principle behind freedom of information legislation is that people have a right to know about the activities of public authorities, unless there is a good reason for them not to. The Freedom of Information Act applies to corporate data and personal data generally cannot be released under this Act.

All staffs have a responsibility to ensure that they do not disclose information about the Trust’s activities; this includes information about service users in its care, staff members and corporate documentation to unauthorised individuals. This responsibility applies whether you are currently employed or after your employment ends and in certain aspects of your personal life e.g. use of social networking sites etc. The Trust seeks to

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ensure a high level of transparency in all its business activities but reserves the right not to disclose information where relevant legislation applies. The Information Governance Team provides a central point for release of information under Data Protection and Freedom of Information following formal requests for information; any queries about the disclosure of information can be forwarded to the Information Governance Team.

11.0 Monitoring this Policy is working in Practice

As this policy will not be regularly required as influenza pandemics occur infrequently, compliance will be monitored as part of the planning exercises undertaken and post pandemic de-brief.

What key elements will be monitored?

(measurable policy objectives)

Where described in

policy?

How will they be monitored?

(method + sample size)

Who will undertake this

monitoring?

How Frequently?

Group/Committee that will receive and

review results

Group/Committee to ensure actions

are completed

Evidence this has

happened

Business Continuity Plans 4.2.1 Pandemic Influenza

Planning Team 4.2 Business

Continuity

Management

Each group to provide assurance that plans

have been reviewed and updated

Groups Annually Pandemic Flu Management Team

Major Incident Management Group

(MIMG)

Completed action plan

signed off / minutes of

meeting

Workforce and staffing to

take into account reduced

staffing levels and the need to redeploy to other areas

4.3.3 Staff

Welfare

Planning 7.0 Roles and

Responsibilities for this Policy

Staff data base

including skills

regularly updated

Human Resources As and when

required

Pandemic Flu

Management Team

Pandemic Flu

Management Team

Completed

action plan

signed off / minutes of

meeting

Communications with all

staff throughout all phases of preparation and planning

for pandemic influenza management

4.8 Trust

Actions Required During

the Phases of the Pandemic

Core briefings to be

produced by the communications teams

based on the advice provided by the

Infection Prevention

and Control team

Communications

Teams

As and when

required

Pandemic Flu

Management Team

Pandemic Flu

Management Team

Completed

action plan signed off /

minutes of meeting

Availability of personal

protective equipment

4.2.2 Trust

Actions Required During

the Phases of

the Pandemic

Each group to assess

their requirements and procure sufficient

supplies. Availability of

suitable equipment will be reviewed as

part of the annual PPE infection control audits

Groups As and when

required (otherwise

annually)

Infection Prevention

and Control Committee

Pandemic Flu

Management Team

Completed

action plan signed off /

minutes of

meeting

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Inpatient/Residential Unit - Situation Report

UNIT NAME:

Main contact details:

Tel: E-mail:

Today’s Date:

Time (hr/min): Use 24 hour clock

No. of beds:

No of beds in use:

No. of flu cases:

No. of recovered flu cases:

No. of flu related deaths:

No. of non-infected:

No. of staff symptomatic off sick

No. staff recovered & returned to work

Number of staff absent due to flu related issues e.g. childcare, bereavement etc.

No. & type of beds available for new admissions

Daily Situation Report

Minimum No. of staff required (grade/roles)

Staff available for re-deployment (grade/role or

duties)

Estates issues of concern – give details

Essential resources required e.g. Masks, aprons,

etc.

Communication messages

Information required

Other

Signed (print name)

E-mail DAILY as instructed (no later than 10 a.m.)

Appendix 1

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Non-Inpatient services - Situation Report

UNIT/DEPARTMENT NAME:

Main contact details:

Tel: E-mail:

Date:

Time:

No. of staff symptomatic off sick

No. staff recovered & returned to work

Number of staff absent due to flu related issues e.g. childcare, bereavement etc.

Changes to services:

Daily Situation Report

Minimum No. of staff required (grade/roles)

Staff available for re-deployment (grade/role or duties)

Estates issues of concern – give details

Essential resources required e.g. Masks,

aprons, etc.

Communication messages

Information required

Other

Signed (print name)

E-mail DAILY as instructed (no later than 10 a.m.)

Appendix 1a

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Black Country Partnership NHS Foundation Trust Situation Report (SITREP)

The situation report will provide the Black Country Partnership and other providers of Health and Social Care, both locally and wider through effective links with Public Health England, with a robust reporting pathway to provide decision makers with the information they need to perform their roles effectively. Here is the overall Daily Situation Report from the Black Country Partnership NHS Foundation Trust

Date:

Male Female Time: Male Female

No. of beds:

PICU No of beds in use:

PICU

Older adult Older adult

Adult Adult

Learning Disabilities

Learning Disabilities

No. of flu cases:

No. of recovered flu cases:

No. of flu related deaths:

No. of non-infected:

No. of staff symptomatic currently off sick with flu

No. staff recovered & returned to work

Number of staff absent due to flu related issues e.g. childcare, bereavement etc.

No. & type of beds available for new admissions:

Male Female

PICU

Older adult

Adult

Learning Disabilities

Detail re staffing or resource issues:

N.B. Information to be collated by 12 noon daily

Appendix 1a Appendix 1b

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Appendix 2

How to put on and remove PPE Safely to minimise risk of cross infection

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Appendix 3

Pandemic Influenza Action Cards

The enclosed action cards are to be used as directed in the event of an influenza pandemic.

ACTION CARD

1 Director for Infection Prevention & Control

2 Emergency Planning Officer

3 Service Directors

4 Infection Prevention and Control Team

5 Lead Nurses/Service Managers

6 Estates & Facilities Manager

7 Chief Pharmacist

8 Communications Manager

9 Incident Loggist

10 Admin Support - General

11 Human Resources

12 Chaplaincy Team

Appendix 4

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ACTION CARD 1: Director of Infection Prevention & Control

Your role To act as the first point of contact in the event of any potential influenza pandemic. STRATEGIC/TACTICAL

Your location Trust HQ Delta House - ICR

Incident progress is reported to you by Staff dealing with the incident as appropriate – likely to be the IPCT as determined by circumstances

You report on incident progress to and take direction from

Chief Executive or nominated deputy

Actions and Responsibilities Considered

(Yes/No) a) Respond throughout in accordance with the relevant Trust policy or policies

wherever applicable.

b) Log incident by completing the Initial Incident Report Form (see Major Incident and Business Continuity Plan). Each risk identified should be fully recorded and evaluated using the Risk Assessment Template. Complete Follow-up Incident Report Form(s) if further updates required, ensuring that revised/updated/additional Risk Assessment Templates are completed to ensure that the pattern of risk and mitigating measures are fully catalogued for the duration of the incident. Ensure a loggist is available to record decisions made.

c) Establish as comprehensive an initial incident brief as possible and continue to liaise as necessary.

d) Determine and review Incident Level or Standby Incident Level using Trust Incident Assessment Guidelines & declare a Pandemic Outbreak / Outbreak/ Standby as necessary.

e) Decide whether to escalate to the on-call Manager

f) Convene and chair Pandemic Influenza Management Team (PFMT), co-opting further members onto the team as required, ensuring all members have access to the Pandemic Influenza Management Plan and the Major Incident & Business Continuity Plan

g) Commence a Personal Log & Decision & General log using the approved templates (see Major Incident and Business Continuity Plan - Section 8) - Continue to log as appropriate - Close logging when requested to do so or when the incident is stood down

h) Issue the enclosed action cards to appropriate persons

i) Health and Safety

Assess the likelihood of the incident requiring you to continue responsibility for longer than 6 hours. If this is the case contact another Manager to take over responsibilities at an agreed time

Ensure Health and Safety regulations are adhered to by all staff dealing with the incident, including regular breaks and hand over to another member of staff

j) Ensure that staff working as part of the Pandemic Influenza Management Team, have cover for their normal roles

k) Provide regular feedback to CEO & Non-Executive Directors on management of the incident

l) Hand over as required to the next Manager, providing as comprehensive a handover as possible, including outstanding and discharged actions/issues

m) Authorise the stand down from major incident (pandemic influenza) status when considered safe to do so.

n) Ensure debrief meetings are arranged once 1st wave of the pandemic is over.

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ACTION CARD 2: Emergency Planning Officer - TACTICAL

Your role To ensure the Major Incident & Business Continuity Plan & the Infection Control Pandemic Influenza Management Plans are followed

Your location Trust HQ Delta House - ICR

Incident progress is reported to you by Staff dealing with the incident as appropriate – likely to be the IPCT

You report on incident progress to and take direction from

Chief Executive or nominated deputy

Actions and Responsibilities Considered

(Yes/No)

a) Ensure availability & set up of the Incident Control Room (ICR)

b) Commence a Personal Log using the approved template (see Major Incident and Business Continuity Plan - Section 8)

c) Respond throughout in accordance with the relevant Trust policy or policies where applicable.

d) Mobilise sufficient Decision Loggists, minute takers and administrative support officers on specific requirements regarding their roles, including cross referencing requirements for decision, general and personal logs.

e) Brief Decision Loggists, General Loggists, minute takers and administrative support officers to allow sufficient running of centre

f) Ensure ALL logs (general & personal) are commenced and maintained by ALL involved in the incident management. REMEMBER these are LEGAL DOCUMENTS.

g) Ensure this plan is regularly reviewed and tested.

h) Ensure the daily SITREP data is collated, nominating key personnel

i) Ensure a formal review of the incident management is undertaken at the end of the incident in order to advise on any amendments to the plan and include lessons learnt.

j) Maintain a register of test exercises undertaken & lessons learnt.

k) Hand over as required to the next Manager, providing as comprehensive a handover as possible, including outstanding and discharged actions/issues

l) Collect ALL DECISION LOGS, GENERAL LOGS & PERSONAL LOGS from EVERYONE involved in the Pandemic Flu management response and ensure these are handed to the Chair of the Trust’s Senior Management Group to be retained as per the Major Incident policy requirements.

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ACTION CARD 3: Group Directors - STRATEGIC/TACTICAL

To implement the groups business continuity plans as directed

Your location Trust HQ Delta House - ICR

Incident progress is reported to you by Staff dealing with the incident as appropriate – likely to be the IPCT

You report on incident progress to and take direction from

Emergency Planning Officer or nominated deputy

Actions and Responsibilities Considered

(Yes/No)

a) Respond throughout in accordance with the relevant Trust policy or policies where applicable

b) Commence a Personal Log using the approved template (see Major Incident and Business Continuity Plan - Section 8)

c) Find out your immediate and potential future roles in managing the incident i.e. as a member of the MIMG or as Incident Director and attend as appropriate

d) Implement group contingency plan to mitigate staff `absenteeism and increasing numbers of sick patients

e) Daily or as instructed, report on staff availability throughout each group and effectiveness of group flu contingency plans

f) Instruct your Group Management representative within the Incident Control Room to obtain the ‘Group Management Representative Action Card’ from the Major Incident and Business Continuity Plan.

g) Keep Records

h) Post pandemic review staff welfare issues – flexitime, leave, time in lieu

i) Ensure staff have real-time access to psychological support and supervision as required

j) Provide regular feedback to CEO & Non-Executive Directors on management of the incident

k) Hand over as required to the next Manager, providing as comprehensive a handover as possible, including outstanding and discharged actions/issues

l) Stand down from a major incident when instructed to do so by the Incident Director

m) Close Personal Log stand down, returning your log to the ICR manager

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ACTION CARD 4: Infection Prevention & Control Team - TACTICAL

Your role To collate surveillance data and provide specialist infection control advice

Your location Trust HQ Delta House - ICR

Incident progress is reported to you by Staff dealing with the incident as appropriate

You report on incident progress to and take direction from

Director for Infection Prevention & Control or nominated deputy

Actions and Responsibilities Considered

(Yes/No)

a) Respond throughout in accordance with the relevant Trust policy or policies where applicable

b) Commence a Personal Log using the approved template (see Major Incident and Business Continuity Plan - Section 8)

c) Risk Register – consider and advise on the potential impact of infection prevention and control measures taken and undertake a Risk Assessment to include the degree of infectivity, routes of transmission, and degree of susceptibility of patients, staff, volunteers and visitors

d) Gather data on patient/staff affected – update at least 1-2 x daily

e) Assist L&D to co-ordinate training for Lead Nurses/Service Managers/Matrons in Fit Testing and mask fitting so they can disseminate training to all areas of responsibility e.g. use of FFP3 respirator masks & PPE

f) Attend Pandemic Flu Management Team meetings as required

g) Communicate – assist the Incident Director in preparing statements as required.

h) Review, develop and issue infection control guidance in accordance with national recommendations for all local health and social care establishments.

i) Address the education & training needs of the Trust health care workers in measures to reduce person-to-person spread of the influenza virus

j) Act as a resource for advice and information to primary healthcare workers on related infection control issues.

k) Verify & gather information internal & external

l) Communicate with other agencies e.g. CCG, HPA, Acute Trust & Local Authority Public Health

m) Handover as required to the next Manager, providing as comprehensive a handover as possible, including outstanding and discharged actions/issues

n) Stand down from a major incident when instructed to do so by the Incident Director

o) Close Personal Log stand down, returning your log to the ICR manager

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ACTION CARD 5: Lead Nurses/Service Managers/Matrons – TACTICAL/OPERATIONAL

Your role To ensure business continuity within clinical teams

Your location Trust HQ Delta House

Incident progress is reported to you by Staff dealing with the incident as appropriate

You report on incident progress to and take direction from

Director for Infection Prevention & Control or nominated deputy

Actions and Responsibilities Considered

(Yes/No)

a) Respond throughout in accordance with the relevant Trust policy or policies where applicable

b) Commence a Personal Log using the approved template (see Major Incident and Business Continuity Plan - Section 8)

c) Organise basic infection control measures within their areas when instructed by the Pandemic Flu Management Team

d) Support the ward managers in preparing the information from Pandemic Flu Management Team to give to visitors and patients

e) Receive ‘Train the Trainer’ in FFP3 mask fitting organised by the Infection Control Team to cascade training to staff in all your areas of responsibility

f) Support the in-patient units managers in preparing and maintaining isolation zones of those patients infected with flu

g) Offer support, guidance and advice to members of the team, patients and carers throughout the pandemic

h) Provide a role model of quiet, confident management

i) Review daily the available staffing/skill mix & report to the Pandemic Flu Management Team

j) Redeploy staff as advised by the Pandemic Flu Management Team

k) Make arrangements for maintaining adequate infection control supplies i.e. soap, alcohol based hand rub etc. to all healthcare establishments and healthcare workers

l) Review patients currently on caseloads for appropriateness

m) Provide communication link from the Pandemic Flu Management Team to all areas within the Group

n) Report significant issues to the Pandemic Flu Management Team

o) Identify medical equipment available and any shortfalls / concerns

p) Identify consumable equipment levels and any concerns re supplies

q) Identify services which may be postponed during the peak of the pandemic

r) Consider security issues for both staff, clients & premises

s) Identify timescales for services that have been postponed to be reintroduced, taking into consideration decontamination of facilities and staff counselling & support

t) Keep a log of all actions & decisions taken – hand over all Log documents as directed when stood down

u) Hand over as required to the next Manager, providing as comprehensive a handover as possible, including outstanding and discharged actions/issues

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ACTION CARD 6: Estates, Facilities & Procurement Manager(s) – TACTICAL/OPERATIONAL

Your role To ensure all supplies & services are maintained

Your location Trust HQ Delta House

Incident progress is reported to you by Staff dealing with the incident as appropriate

You report on incident progress to and take direction from

Director for Infection Prevention & Control or nominated deputy

Actions and Responsibilities Considered (Yes/No)

a) Respond throughout in accordance with the relevant Trust policy or policies where applicable.

b) Commence a Personal Log using the approved template (see Major Incident and Business Continuity Plan - Section 8)

c) Attend Pandemic Flu Management Team meetings as required

d) Take a lead on ensuring the availability of all consumables etc.

e) Ensure cleanliness & decontamination of facilities is maintained

f) Liaise with wards/departments daily to identify requirements

g) Monitor stock levels of equipment, consumables, food etc. on a day-by-day week-by-week basis as required

h) Liaise with suppliers on a weekly to daily basis as required to ensure new stock delivered on time

i) Provide advice & guidance on the use of medicines as required

j) Provide information to the Pandemic Flu Management Team on any difficulties obtaining supplies

k) Consider security issues of both equipment & premises

l) Keep a log of all actions & decisions taken - hand over all Log documents as directed when stood down

m) Provide information to the Pandemic Flu Management Team on any difficulties obtaining supplies

n) Hand over as required to the next Manager, providing as comprehensive a handover as possible, including outstanding and discharged actions/issues

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ACTION CARD 7: Chief Pharmacist – TACTICAL/OPERATIONAL

Your role To ensure all medicine supplies & pharmacy services are maintained

Your location Trust HQ Delta House

Incident progress is reported to you by Staff dealing with the incident as appropriate

You report on incident progress to and take direction from

Director for Infection Prevention & Control or nominated deputy

Actions and Responsibilities Considered (Yes/No)

a) Respond throughout in accordance with the relevant Trust policy or policies where applicable.

b) Commence a Personal Log using the approved template (see Major Incident and Business Continuity Plan - Section 8)

c) Attend Pandemic Flu Management Team meetings as required

d) Take a lead on ensuring the availability of all medicines including antivirals and vaccines etc.

e) Oversee antiviral collection points within the Trust

f) Monitor use of antibiotics to ensure compliance with the antibiotic prescribing policy

g) Ensure systems in place for patients requiring Clozapine treatment

h) Liaise with wards/departments to identify pharmaceutical needs

i) Contact suppliers to secure supplies of all essential medicines

j) Provide advice & guidance on the use of medicines as required

k) Provide information to the Pandemic Flu Management Team on any difficulties obtaining supplies

l) Consider security issues of both medication & premises

m) Ensure the administration of pharmaceutical preparations is undertaken in accordance with group directives

n) Monitor stock levels of equipment, consumables, food etc. on a week to daily basis as required

o) Liaise with suppliers on a weekly to daily basis as required to ensure new stock delivered on time

p) Keep a log of all actions & decisions taken - hand over all Log documents as directed when stood down

q) Hand over as required to the next Manager, providing as comprehensive a handover as possible, including outstanding and discharged actions/issues

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ACTION CARD 8: Communications Manager – TACTICAL/OPERATIONAL

Your role To provide senior level communication co-ordination, advice & support

Your location Trust HQ Delta House

Incident progress is reported to you by Staff dealing with the incident as appropriate

You report on incident progress to and take direction from

Director for Infection Prevention & Control or nominated deputy

Actions and Responsibilities Considered

(Yes/No)

a) Respond throughout in accordance with the relevant Trust policy or policies where applicable.

b) Commence a Personal Log using the approved template (see Major Incident and Business Continuity Plan - Section 8)

c) Attend Pandemic Flu Management Team meetings as required

d) Communicate - take a lead on the communication plan for the Trust both internal & external communications

e) Deal with all media/press enquiries

f) Prepare press statements - ensure consistent messages are given to the public

g) Liaise with CEO, DIPC, CCG & HPA & Local Authority regarding press release to ensure consistent messages

h) Assist the Pandemic Flu Management Team to prepare internal staff & client briefings as required

i) Ensure all briefings/press releases are signed off by the Pandemic Flu Management Team prior to circulation

j) Ensure stand down message is communicated promptly

k) Keep a log of all actions & decisions taken - hand over all Log documents as directed when stood down

l) Hand over as required to the next Manager, providing as comprehensive a handover as possible, including outstanding and discharged actions/issues

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ACTION CARD 9: Incident Loggist - TACTICAL

Your role To carefully capture all of the decisions as instructed and agree them in full with the DIPC as a factual account of what has happened

Your location Trust HQ Delta House

Incident progress is reported to you by Staff dealing with the incident as appropriate

You report on incident progress to and take direction from

Director for Infection Prevention & Control (DIPC) or nominated deputy

Actions and Responsibilities Considered

(Yes/No)

a) Respond throughout in accordance with the relevant Trust policy or policies where applicable

b) Commence a Personal Log using the approved template (see Major Incident and Business Continuity Plan - Section 8)

c) Attend Pandemic Flu Management Team meetings as required

d) Use the standard documentation log book provided to record information

e) Capture all decisions made and the reasons for them

f) Ensure that all decisions taken have a supporting justification/rationale

g) Shadow the DIPC or incident director for the shift ensuring that all breaks are covered by another loggist

h) Stand down from the pandemic influenza incident when instructed to do so

i) Hand over as required to the next loggist, providing as comprehensive a handover as possible, including outstanding and discharged actions/issues

j) Close log at stand down, returning your log to the incident control room manager

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ACTION CARD 10: Admin Staff (General) - TACTICAL

Your role To provide administrative support and secretarial support within the Incident Control Room as directed

Your location Trust HQ Delta House

Incident progress is reported to you by Staff dealing with the incident as appropriate

You report on incident progress to and take direction from

Director for Infection Prevention & Control (DIPC) or nominated deputy

Actions and Responsibilities Considered

(Yes/No)

a) Respond throughout in accordance with the relevant Trust policy or policies where applicable.

b) Commence a Personal Log using the approved template (see Major Incident and Business Continuity Plan - Section 8)

c) Attend Pandemic Flu Management Team meetings as required

d) Reschedule diaries of key members of the Pandemic Flu Management Team members as required

e) Arrange venues/refreshments for meetings as instructed

f) Ensure an attendance register is taken at all meetings including the names of those present & the roles they are undertaking

g) Continually capture details for chronological log

h) Take and transcribe minutes of all Pandemic Flu Management Team Meetings and teleconferences

i) Produce & circulate agendas for each meeting

j) Provide routine call handling

k) Assist in preparation of time critical documents

l) If you have used shorthand ensure your notes are transcribed before you leave

m) Stand down from the pandemic influenza incident when instructed to do so

n) Ensure sufficient breaks & cover for your break times

o) Hand over as required to the next loggist, providing as comprehensive a handover as possible, including outstanding and discharged actions/issues

p) Close log at stand down, returning your log to the incident control room manager

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ACTION CARD 11: Human Resources & Workforce Advisor -TACTICAL

Your role To provide advice & support to the DIPC which is informed by established Trust policies and procedures in respect of the Trust’s human resources & workforce

Your location Trust HQ Delta House

Incident progress is reported to you by Staff dealing with the incident as appropriate

You report on incident progress to and take direction from

Director for Infection Prevention & Control (DIPC) or nominated deputy

Actions and Responsibilities Considered

(Yes/No)

a) Respond throughout in accordance with the relevant Trust policy or policies where applicable.

b) Commence a Personal Log using the approved template (see Major Incident and Business Continuity Plan - Section 8)

c) Attend Pandemic Flu Management Team meetings as required

d) Risk Register – consider and advise on the potential impact of the incident on the Trust’s human resources and workforce

e) Assist in the development and implementation of strategies to achieve sufficient services and efficient recovery as required.

f) Ensure an up-to-date record is maintained of staff emergency contact details, work skills & qualifications is maintained

g) Assist with re-deployment of staff resources as required

h) Advise staff on access to Occupational Health & Psychological support as required

i) Hand over as required to the next HR Advisor, providing as comprehensive a handover as possible, including outstanding and discharged actions/ issues

j) Close log at stand down, returning your log to the incident control room manager

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ACTION CARD 12: Chaplaincy Team – TACTICAL/OPERATIONAL

Your role To provide support & advice to patients and staff as required

Your location Trust HQ Delta House

Incident progress is reported to you by Staff dealing with the incident as appropriate

You report on incident progress to and take direction from

Director for Infection Prevention & Control (DIPC) or nominated deputy

Actions and Responsibilities Considered

(Yes/No)

a) Respond throughout in accordance with the relevant Trust policy or policies where applicable.

b) Commence a Personal Log using the approved template (see Major Incident and Business Continuity Plan - Section 8)

c) Ensure safe practices implemented when assisting patients & staff in aspects of faith & worship e.g. communion

d) Informal listening & support to staff as they cope with increasingly stressful situations

e) Act as a resource in relation to spiritual & religious needs

f) Ensure consistent messages are given to staff and patients to minimise risks of cross infection/transmission of virus

g) Liaise with faith communities as required in assisting patients, staff & relatives dealing with a bereavement

h) Close log at stand down, returning your log to the incident control room manager

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Policy Details

* For more information on the consultation process, implementation plan, equality impact assessment, or archiving arrangements, please contact Corporate Governance

Review and Amendment History

Title of Policy Pandemic Influenza Policy

Unique Identifier for this policy BCPFT-COI-POL-02

State if policy is New or Revised Revised

Previous Policy Title where applicable Infection Prevention and Control Policy for Pandemic Influenza

Policy Category Clinical, HR, H&S, Infection Control etc.

Infection Prevention and Control

Executive Director whose portfolio this policy comes under

Executive Director of Nursing, AHPs and Governance

Policy Lead/Author Job titles only

Infection Prevention & Control Lead Nurse

Committee/Group responsible for the approval of this policy

Infection Prevention and Control Committee

Month/year consultation process completed *

N/A

Month/year policy approved July 2018

Month/year policy ratified and issued July 2018

Next review date August 2021

Implementation Plan completed * Yes

Equality Impact Assessment completed * Yes

Previous version(s) archived * Yes

Disclosure status ‘B’ can be disclosed to patients and the public

Key Words for this policy

Flu, Incubation, Situation report, STIREP, Personal protective equipment, World health organisation, FluCon, Immunisation, Catch it, bin it, kill it, Business continuity management

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Version Date Details of Change

V2.0 July 2018

Full policy review and all reference documents updated. Policy now referred to as the Pandemic Influenza Management Plan Change all reference to the Pandemic Influenza Planning Group to

Pandemic Flu Management Team Review and update of action cards in Appendix 3

V1.1 Aug 2015 New policy format and minor amendments – National Risk Register table

updated, tables from Green Book updated and patient placement now incorporates service users in the community

V1.0 Nov 2013 New policy for BCPFT


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