Pandemic Flu: A Scottish framework for responding to an influenza pandemic

1 INTRODUCTION

Influenza pandemics are natural phenomena which have occurred three times in the last century. Their severity has ranged from something similar to seasonal influenza to a major threat, with many millions of people worldwide becoming ill and a proportion of these dying. 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. Managing the impact of an influenza pandemic therefore presents us with unique and difficult challenges if we are to save lives and keep our society running. Planning to deal with the consequences of a pandemic is critical and this framework sets out the Scottish Government's approach.

1.1 Why do we need a framework?

The UK Health Departments' Pandemic Influenza Contingency Plan was last updated in October 2005. There have been a number of advances since then including -

• developments in scientific advice;
• developments in our national and local planning;
• developments in our communications plans;
• experience gained from UK and Scottish wide pandemic influenza exercises, including a major exercise "Winter Willow" held in February 2007.

It makes sense to reflect these developments and our collective knowledge in our strategic planning framework.

However, this framework is primarily about saving lives and reducing the impact on individuals, communities and our society that a pandemic will have. It is about ensuring that, when (not if) a pandemic arrives we have planned to meet the consequences together and can therefore respond effectively together. Those consequences may be severe but, as this framework shows, working together, making the most of our available resources and responding in a flexible way to the pandemic will help us to reduce its impact with benefits for all of us.

All of our planning effort is about keeping our services running in a sustainable way for as long as it is safe to do so. However, we must be realistic - if a pandemic is particularly severe, some services may find it very difficult to cope.

1.2 Who is this framework for?

This framework is intended primarily for those responsible for developing policies and strategies or coordinating, managing, maintaining or testing contingency arrangements for responding to an influenza pandemic. This covers, for example, local and national government, the NHS and community care services, transport providers, financial institutions and many other private and public bodies.

When pandemic influenza arrives in this country, we will be calling upon a wide range of individuals to help us to cope effectively. There will be expectations placed on frontline staff to continue to contribute their skills and knowledge during a pandemic at a time when resources are severely depleted and when everyone has to balance their responsibilities at work against their responsibilities at home. Frontline staff, in the NHS, for example, may also be asked to work flexibly and to undertake new roles for the duration of the pandemic.

There will also be expectations placed on members of the public, whose support and confidence will be crucial if we are to respond effectively. This will include: helping to tackle the pandemic by using infection control measures such as hand washing; helping to ease the strain on the NHS and community care services by caring for ill relatives at home; collecting drugs and prescriptions for ill friends and family; behaving responsibly to maintain public order; and listening to and acting on Government advice and announcements.

If we want to place expectations on others then we also need to be prepared to offer support.

For frontline staff such as NHS and Local Authority staff, we need to ensure that arrangements are in place to cover alternative workforce arrangements, that pay agreements are in place, that appropriate protective equipment is provided, that counselling services are available and that relevant training is made available. It should be our aim to ensure that staff are, in every way, supported to continue to come to work.

Members of the public must be given clear, consistent and regular information about the pandemic and the actions they should take. We must ensure that individuals and families are confident about the actions we will be taking across the country to enable us to continue to provide key services as far as we can. Our aim is to be as open as possible about the wide extent of planning that is taking place and about the measures we have available to use to deal with the impact. This framework sets out how information will be provided to the public during a pandemic and also provides information about infection control and policy on the use of masks, vaccines and antivirals.

1.3 The UK approach

This Scottish Framework is based on the published UK National Framework for Responding to an Influenza Pandemic.

That framework sets out the strategic approach to dealing with an influenza pandemic, provides information on the impact of the pandemic, sets out key planning assumptions and proposes a planning framework.

For the first time, planning has been developed on a cross-government basis that illustrates the breadth of planning across many different sectors.

The Devolved Administrations work closely with the UK Government across the broad spectrum of planning activities. This includes attendance at all UK level planning groups and committees covering policy, operational planning, communications, ethics and scientific advice. We all recognise very clearly that, since an influenza pandemic knows no boundaries, we must also work effectively across administrative boundaries to ensure that our planning works in practice and that the strategic aims and fundamental principles of how we will respond to a pandemic apply equally across the UK.

The strategic aims, scientific advice and key planning assumptions for the Scottish Framework are therefore the same as those which appear in the UK Framework. In addition, fundamental planning principles apply equally across the UK, for example the key principles underlying the approach to care.

In this framework, our planning assumptions are based on 3 attack rates: 25%, 35% and 50%. It is important to emphasise that planning should take place across the range of possible attack rates, including the upper end of the scale. To inform planning, we have considered the potential impact of fatality rates of 0.4%,1%,1.5% and 2.5%. At a 25% attack rate we could expect between 5,100 and 31,700 additional deaths in Scotland. At a 50% attack rate this could rise to between 10,200 and 63,700 additional deaths.

1.3.1 Key Changes

Since the publication of the 2005 contingency plan, there have been a number of UK policy developments which are reflected in this revised Scottish Framework.

The estimates given for GP consultations and hospitalisations have increased from the 2005 plan. This is consistent with feedback we have received over the last 12 months from the NHS and has been taken into account, for example, in the approach to a primary care model.

The requirement for all symptomatic children under the age of seven to be assessed by a GP has changed. A GP assessment is now only required for children under the age of three.

1.4 The Scottish Framework

A draft version of the Scottish Framework was issued for comment in March 2007. This version has been revised in response to comments received during that time and in line with policy changes which have been agreed at a UK level.

The Scottish Framework, whilst based on strategic aims and principles agreed across the UK, applies those aims and principles more specifically to Scotland - our population, our geography and the structure of our services. It sets out the conclusions of some of the national planning work which is taking place across all sectors.

The majority of emergency preparedness work in Scotland is conducted at a local level, and carried forward by Strategic Co-ordinating Groups which comprise key local responders in each of Scotland's eight police force areas. There is also a range of work underway at a national level to support these local planning arrangements. This includes work within key areas such as energy & utilities, transport, telecommunications, education and community care sectors.

The health and community care response is central to this planning work and within health and community care services, the framework sets out the range of planning activities which the Scottish Government is taking forward in partnership with the NHS and others. Those planning activities are based on a programme of work led by the Scottish Government Health Directorates which seeks to provide assurance of our preparedness in two key areas - within the Health Directorates themselves and also within health and community care services. Additionally, good communications are required to promote confidence in government and NHS Scotland both during preparations for and during an outbreak so the framework also seeks to ensure that our communication arrangements promote stakeholder and public confidence.

This is achieved through national work on certain key policy areas such as the national influenza line and public communications and by providing specific guidance to support local planning where appropriate. Current workstreams include service and patient prioritisation, healthcare in a community setting, human resources and vaccination. Whilst the conclusions of some of these areas of work are reflected in the framework, others are ongoing and more information will be available in due course.

Further details about the Scottish Government's pandemic influenza planning activities can be found at: www.scotland.gov.uk/pandemicflu