North East ambulance Service NHS Trust A (H1N1) Swine Flu Pandemic Assurance Report By: Director of Ambulance Operations and Flu

North East ambulance Service NHS Trust
A (H1N1) Swine Flu Pandemic Assurance

Report By: Director of Ambulance Operations and Flu

1.   Purpose of the Report
     This report provides assurance to the North East Ambulance Service
     (NEAS) Trust Board on the state of readiness, preparedness and resilience
     to respond to a second and subsequent escalation of the A (H1N1) swine
     flu pandemic. Hereafter in this document this escalation is referred to as
     ‘Pandemic surge’.

2.   Introduction
     All NHS organisations have been advised by the Department of Health
     (DH) to prepare for a second and potentially more severe wave of the A
     (H1N1) virus from Autumn 2009 up to five months duration, and to be at
     peak preparedness.

     All NHS Boards have been asked by Ian Dalton, National Director of NHS
     Flu Resilience, to publish a statement of flu readiness at their September
     2009 Board meetings. This report sets out the steps that have been, and
     are being taken, to provide assurance to the NEAS Trust Board.
     Arrangements are in place to display copies of our Board’s assurance
     statement on the NHS North East website.

     Later this month, individual review meetings are being held between the
     North East Director of NHS Flu Resilience and the NEAS Flu Director, to
     receive and review the September Board flu assurance statement being
     made by the NEAS Board.

3.   Leadership
     The Ambulance Service Chief Executive Group (ACEG) decided on an
     enhanced strategic national approach to Winter and Flu planning for
     2009/10; designed to ensure that all scenarios are adequately addressed in
     a collaborative manner, which affords a consistent national approach to
     rising pressure.

     A programme of activity has therefore, been put in place, led by the
     National Ambulance Director (DH) Peter Bradley which has produced a
     national planning framework for ambulance trusts across the UK, which has
     been used to inform NEAS local planning.

     At its meeting in July, the Board endorsed the proposal that the Lead
     Director role for Flu would be undertaken by Paul Liversidge and Colin
     Cessford based at Ambulance Headquarters. There are three staff working
     full time within the Winter Planning and Flu Team and a number of other

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personnel on a part-time basis in a number of roles including emergency
      preparedness, communications, Human Resource and Operations. The
      Trust has a Pandemic Management Team made up of identified
      departmental leads responsible for Business Continuity Planning. Periodic
      Pandemic Management Team meetings have taken place together with
      regular meetings with the flu team involving staff representatives.

4.    Governance
      There is a governance accountability framework in place between NEAS
      and the North East Strategic Health Authority which feeds into the NHS Flu
      Resilience Directorate at the Department of Health. The arrangements that
      fall into this framework, have been successfully tested as recently as this
      month through a regional ‘Peak Practice’ stress test exercise.

      The diagram below shows the command and control arrangements across
      the North East, which underpin the governance accountability framework.

Figure 1. NHS North East command and control arrangements for flu

      NEAS has also undertaken an in house exercise to test its planning
      arrangements and has been involved in a number of events throughout the
      region, including participation in all the Acute Hospitals stress testing of
      their respective flu plans.

      The Winter Planning and Flu Team continues to receive a considerable
      amount of information and guidance on Pandemic Flu and Winter Planning
      for information and determines the action required. For ease of reference
      and review, the Team has consolidated the information and guidance into
      an action plan which is attached as appendix one.

      There are effective reporting mechanisms in place to support the regional
      response and to participate in national reporting. A communication

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strategy exists to convey   consistent and timely messages to staff, public
     and the media.

     The NEAS Winter Planning and Flu Team ‘Command Centre’ which is
     centrally housed currently deals with all issues related to flu and winter
     planning and is currently the receptacle of all flu/winter related information.
     It has proved to be very valuable for NEAS linking with all PCTs and Acute
     Trusts. It will be the single point of contact providing a Flu/winter
     Command and Control centre receiving timely pre-arranged reporting
     information, maintaining accurate records of decisions and completing
     situation reporting. At this stage in the flu pandemic, the proportionate
     response to the level of pressure experienced, has meant that it has not
     been necessary to invoke full command and control arrangements.

     If and when there is a further and more significant pandemic flu surge,
     command and control is likely to be invoked across all NHS operations and
     services. At that time the gold, silver and bronze terminology for strategic,
     tactical and operational command levels will be introduced.

5.   Resilience
     Assuring the resilience of the Organisation to respond effectively to a flu
     pandemic and Winter surge is a key challenge. The Trust has positive
     evidence of flu/winter resilience of NEAS in a number of ways including:

        •   NEAS has been actively engaged in developing the Ambulance
            Service national planning framework to inform its own local planning
            arrangements.

        •   A Pandemic/Winter plan exists consisting of six levels with each
            level having specific triggers and actions for Ambulance Control and
            Field Operations, (CD to be distributed).

        •   An SHA led review of NEAS Pandemic Influenza Plans in 2008/9
            found that good progress had been made over the previous 12
            months. Since this time the SHA has continued to review such plans
            as they have been updated and submitted to the SHA.

        •   NEAS has received positive feedback from a recent DOH audit by a
            member of the National Flu Resilience team.

        •   NEAS has reviewed the Health Protection Agency (HPA) resilience
            checklist and had Board-level representation at the regional “Peak
            Practice” exercise held on 8th September 2009 to test strategic
            pandemic flu preparedness across the North East. This successful
            exercise was jointly facilitated by the SHA and the HPA.

        •   Pandemic/Winter plans have been stress tested (17th July) to ensure
            high-level delivery of care to patients. The letter from the SHA Head
            of Emergency Preparedness attached as appendix 2, gives
            assurance that we have robust arrangements in place for the
            management of a Pandemic Influenza Outbreak.

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•   NEAS has confirmed through workforce assurance returns to the
           SHA that it has effective human resources policies and practices in
           place to support resilience.

       •   Arrangements are in place for maximum possible staff uptake of the
           seasonal and H1N1 vaccines through the regional approach
           supported by all local NHS organisations.

       •   NEAS has used a service priority assessment tool, as evidence by
           the August workforce assurance, to include:

           - the potential gain by the deferral of non-essential services;
           - staff training plans and staff deployment plans are in place to
              support staff
           - prioritised services (e.g. critical care);
           - the impact of service prioritisation has been considered

6.   Service Specific Issues

       •   Work is ongoing Regionally with all NHS Organisations to fully
           understand each other plans and how they impact on one another

       •   Continue to use the tried and tested Flu pandemic protocol within
           the NHS Pathways system.

       •   The national planning framework and winter plan needs to
           continually develop in light of further information, guidance and
           feedback

       •   Further work needs to continue to align the Resource Escalation
           Action Plan (REAP) and the triggers, levels and actions that are
           included in each individual organisation’s plans so that there is a
           common understanding of pressures and an agreed escalation plan.

       •   The staff vaccination plan needs to be reviewed in light of recent
           guidance and feedback as the number of vaccines dedicated to the
           NEAS is insufficient for all frontline A&E and PTS staff. Further
           consideration needs to be given to the voluntary agencies and
           community responders.

       •   Specific planning arrangements with Acute Trusts needs to continue
           to support planned discharge and transfer

       •   Continue to work with Acute Trust on ensuring timely turnarounds at
           Hospitals

       •   To build resilience in the Ambulance Control room, recruit an extra
           5% of staff above existing establishment

       •   To facilitate the introduction of a dynamic resource to target areas
           when under pressures recruit an extra 48 Emergency Care Support
           Workers

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7.   Summary
     The statement of NEAS readiness to respond to a second and subsequent
     pandemic flu surge set out in this report is positive and recognises the
     tremendous dedication and hard work of colleagues within NEAS along
     with other stakeholders.

     That being said, the significant focus must continue to ensure that NEAS is
     optimally prepared to deal with a pandemic flu surge in the weeks or
     months to come. There is still much more that can be done.

8.   Action Required
     The North East Ambulance Service Trust Board is asked to:

     Receive this report as a statement of readiness and resilience of NEAS to
     respond to a second and subsequent escalation of the A (H1N1) swine flu
     pandemic.

     Paul Liversidge
     Director of Ambulance Operations and Flu Resilience
     15th September 2009

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