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

2 STRATEGIC APPROACH

2.1 Aim

This framework sets out the strategic approach of the Scottish Government to planning for and dealing with an influenza pandemic. It proposes a framework for local decision making which should ensure the appropriate levels of national consistency and local flexibility. This includes a framework for the model of care which should be provided during a pandemic.

The primary aim of this framework is to guide and support those organisations and agencies who are involved in planning for an influenza pandemic or who will be involved in delivering our response during a pandemic. It also provides information and key planning assumptions which will assist contingency planning and preparations for pandemic influenza across government and public and private sector organisations who will be dealing with its wider social and economic impact. The framework provides guidance both for those working at a policy or management level and those working at operational level on the frontline. Fundamentally, it should also help organisations to work together across boundaries to ensure that our response is workable and effective in practice.

The response is based on the phases defined by the World Health Organisation ( WHO) in 2005 which trigger an escalation in the actions that need to be taken in the pre-pandemic, pandemic and post-pandemic phases.

2.1.1 Scope

This framework relates specifically to preparations for dealing with an influenza pandemic. It does not deal with avian influenza. Section 3.3, which looks at the background to pandemic influenza, explains the links between the two.

2.2 Strategic objectives

The overarching objectives in planning and preparing for an influenza pandemic must be to reduce illness and save lives. However, the Government's strategic objectives also recognise the need to prepare in accordance with the risk and resources available and to support the continuation of normal life as far as we realistically can.

In planning and preparing for an influenza pandemic, the Government's key overarching strategic objectives are to:

• protect UK citizens and visitors against the health and wider consequences as far as possible
• prepare proportionately to the risk
• support international efforts to prevent and detect its emergence and prevent, slow or limit its spread
• minimise the potential health, social and economic impact
• organise and adapt the health and community care systems to provide treatment and support for the large numbers likely to suffer from influenza or its complications whilst maintaining other essential care
• cope with the possibility of significant numbers of additional deaths
• support the continuity of essential services and protect critical national infrastructure as far as possible
• support the continuation of everyday activities as far as practicable
• uphold the rule of law and the democratic process
• instil and maintain trust and confidence by ensuring that the public and media are engaged and well informed in advance of and throughout the pandemic period
• promote a return to normality and the restoration of disrupted services at the earliest opportunity

Achieving these strategic objectives will require the development, maintenance, testing and, when necessary, implementation of operational response arrangements.

For those planning their operational response to a pandemic, your aims should be to have response arrangements that are:

• able to respond promptly to any changes in alert levels
• developed on an integrated basis, combining local flexibility with national consistency and equity
• capable of implementation in a flexible, phased and proportionate way based on the best available scientific evidence
• based on existing services, systems and processes wherever possible, augmenting and complementing them as necessary to meet the unique challenges of a pandemic
• understood by and acceptable to service providers and the general public
• adaptable to the threats, to the extent that this is practicable, without compromising their effectiveness for pandemic influenza
• implemented in advance of a pandemic, if this action has significant potential to mitigate the effects of a pandemic and, where possible, other threats or hazards
• designed to promote the earliest possible return to normality

Although the intention will be to maintain normal services for as long as, and as far as, that is possible, the unique nature of the challenges presented by a pandemic and their likely duration will inevitably require the curtailment of some services and activities to limit the spread of infection, allow the diversion of resources or protect those who are particularly vulnerable.

Minimising the impact and securing the gradual resumption of services at the earliest possible opportunity are key planning aims. However, it is recognised that the impact on the provision of healthcare in particular is likely to last well beyond the pandemic itself.

2.3 Scientific advice to underpin policy and operational plans

2.3.1 Scientific Advisory Group

To ensure that the best scientific advice is fed into policy and the development of operational plans the Department of Health ( DH), the Scottish Government Health Directorates and other UK Health Departments are advised by the Pandemic Influenza Scientific Advisory Group ( SAG). The SAG meeting minutes are published on the DH website.

Continued improvement in the scientific evidence base, and applying the result of ongoing research and modelling to the development of policy and operational plans, is of critical importance to the UK's strategic and operational response and that of Scotland working within a UK context. As scientific knowledge and information are constantly advancing, regular revision and review of the Scottish Framework and plans at all levels is essential.

2.3.2 UK National Influenza Pandemic Committee

The Chief Medical Officers of all 4 UK Health Departments/Directorates receive specialist advice on the health response from the UK National Influenza Pandemic Committee ( UKNIPC). UKNIPC consists of clinical, scientific and other experts drawn from a range of relevant organisations and agencies. The SAG and other UK expert advisory committees, such as the Advisory Committee on Dangerous Pathogens, National Expert Panel on New and Emerging Infections and Joint Committee on Vaccination and Immunisation, also inform and support the work of UKNIPC.

2.4 Legal framework

2.4.1 International

WHO adopted new International Health Regulations ( IHRs) in 2005. These place a duty on states that are parties to the IHRs to notify WHO of any event - irrespective of cause - occurring in their territory that may constitute a public health emergency of international concern. Annex 2 of the IHRs is designed to assist states in deciding whether to notify WHO of an event and makes clear that any case of 'human influenza caused by a new subtype' must be notified. The IHRs also set out core requirements for surveillance and response.

The IHRs came into force on 15 June 2007 and the World Health Assembly passed a resolution in May 2006 urging states to implement those provisions deemed relevant to pandemic influenza early. The goal is to create a framework within which WHO and others can actively assist states in responding to international public health risks by directly linking the regulations to WHO's alert and response activities.

Article 4 of Decision 2119/98/ EC of the European Parliament requires member states to inform the European Commission and each other via the Communicable Diseases Early Warning and Response System of any relevant infectious disease threats with public health implications for other member states and the control measures applied. The decision also requires member states and the Commission to collaborate in the control of communicable disease threats.

2.4.2 National

Public health powers in Scotland are provided by the Public Health (Scotland) Acts of 1897 (c.38), 1945 and Health Services and Public Health Act 1968 (c.46). Powers generally rest with the Local Authority, on advice from the local NHS Board's designated medical officer.

Key provisions include:

• powers to seek orders from a sheriff requiring a person to be medically examined or to be removed to and detained in hospital
• powers for a sheriff to request a person not to work with a view to preventing the spread of infection, to require a child who has been exposed to infection not to attend school
• the creation of criminal offences where people expose others to the risk of infection
• powers available at ports to require actions to be taken by, and impose obligations on masters, pilots and other persons on board vessels and aircraft on arrival to Scotland in order to help control the spread of disease.

In Scotland, those powers are available for infectious diseases generally.

Part 2 of the Civil Contingencies Act 2004 established a new generic emergency powers framework. Emergency powers allow the Government to make special temporary legislation (emergency regulations) as a last resort in the most serious of emergencies where existing legislation is insufficient to respond in the most effective way. Emergency regulations may make provision of any kind that could be made by an Act of Parliament or by exercise of the Royal Prerogative, so long as such action is needed urgently and is both necessary and proportionate in the circumstances. Further information about the powers and safeguards in Part 2 of the Civil Contingencies Act please consult Chapter 13 of Emergency Response and Recovery or the Short Guide to the Civil Contingencies Act which can both be found on www.ukresilience.info/

For planning purposes, the presumption should be that the Government will rely on voluntary compliance with national advice and is unlikely to invoke emergency or compulsory powers unless they become necessary, in which case the least restrictive measures will be applied first.

2.5 Ethical considerations

In preparing for and responding to an influenza pandemic, people working at all levels, from government to those on the front line, will face difficult decisions and choices. These will impact on the freedom, health and, in some cases, survival prospects of individuals. Many people are also likely to face individual dilemmas and tensions between their personal, professional and work obligations. Given expected levels of additional demand, capacity limitations, staffing constraints and potential shortages of medical supplies, hard choices and compromises are likely to be particularly necessary in the fields of health and community care.

People are more likely to accept the need for and the consequences of difficult decisions if those have been made in an open, transparent and inclusive way. National and local preparations for an influenza pandemic should therefore be based on widely held ethical values, with the choices that may become necessary discussed openly as plans are developed so that they reflect what most people will accept as proportionate and fair.

The UK Committee on Ethical Aspects of Pandemic Influenza was set up to advise on the ethical issues in health and community care and in public health arising from an influenza pandemic, and has developed an ethical framework to inform the development and implementation of health and community care and public health response policy. The systematic use of the principles it contains can act as a checklist to ensure that all the ethical aspects have been considered.

Further details of the ethical framework are available on the Scottish Government website: www.scotland.gov.uk/pandemicflu