Pandemic Influenza Plan - Tees, Esk and Wear Valleys NHS ...

Pandemic Influenza Specific 

Guidance Plan 

Prepared by TEES, ESK AND WEAR VALLEYS NHS FOUNDATION TRUST 

JANUARY 2012 – Version 10

Document Control 

Organisation Reviewed By Title Role Date for 

Review/Approval 

TEWV NHS Foundation Chris Parsons Director of Estates and Plan author V 1 - 18.12.2008 

Trust 

Facilities Management 

V2 – 30.04.2009 

Executive lead for PI 

V3 – 05.05.2009 

(from August 1st 2009) 

V4 – 17.07.2009 

Chris Stanbury 

Executive Director of 

V5 – 24.08.2009 

Nursing and Governance 

V6 – 01.12.2009 

Angela Ridley 

Lead Senior Nurse, 

V7 – 19.02.2009 

Infection Prevention and 

V8 - 31.01.2010 

Control and Physical 

V9 – 09.02.2011 

Healthcare 

V10 –05.01.2012 

NOTE: Certain generic text within this document have been adapted from the North East SHA Pandemic Influenza Plan with permission. 

STATEMENT OF PLAN PURPOSE: The purpose of this plan is to describe the arrangements that Tees, 

Esk and Wear Valleys NHS Foundation Trust has in place to ensure the effective management of Pandemic 

Influenza outbreak. The plan sets out the responsibilities, roles and actions that would be invocated in the 

event of a PI outbreak, the phased approach to Business Continuity and the specific responses that would 

be required. 

In planning and preparing for a PI outbreak the Trust objectives are: 

To prevent the spread of infection by advice and information provided to service users, their 

carers, their families and staff. 

To minimise the potential health impact of a PI on the service users and staff of the organisation 

and support service users to access the health services provided during a PI outbreak. 

To ensure that service users, both in the community and in Trust in-patient units, have equitable 

access to anti viral medication and ongoing supply of their essential psychotropic medication. 

To organise and prioritise the delivery of Trust services to provide ongoing critical care and 

treatment to service users of the organisation. 

To support the PCT‟s and Strategic Health Authority in their efforts to prevent and detect the 

emergence and prevent, slow and limit the spread of influenza. 

To plan to cope with the possibility of significant numbers of additional deaths in hospital and in 

the community caseloads of Trust staff. 

To instil and maintain trust and confidence by ensuring the Trust staff, service users, their carers 

and families are engaged and well informed in advance of and throughout the pandemic period. 

To provide additional training and development for Trust staff in advance of and throughout the 

pandemic period to enable them to deal with PI presentation effectively. 

To ensure that there is a robust and predefined command and control system within the 

organisation to respond to a PI outbreak. 

To work with partner agencies and PCT‟s to ensure local plans are mutually supportive and 

collaborative. 

The Chief Executive of Tees, Esk and Wear Valleys NHS Foundation Trust has overall 

responsibility for ensuring the organisation has a Pandemic Influenza Plan in place. From 1 

August 2009, the Trust has appointed Flu Directors who have the responsibility for the delivery 

and leadership of this plan: 

Director of Flu North East SHA - Chris Parsons, Director of Estates and Facilities 

Management 

The Executive Director of Nursing and Governance, as the Director of Infection Prevention and Control, will 

support the operation of this plan. 

The Chief Executive, Chairman and Executive Team will support the operational delivery of the plan and 

have authorised the delegation of authorities within the plan. 

Signed by: 

Chairman – Jo Turnbull 

Chief Executive – Martin Barkley 

Director of Estates and Facilities (Flu Director) – Chris Parsons 

Executive Director of Nursing and Governance – Chris Stanbury 

Pandemic Influenza Plan 2012 v10 

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DOCUMENT CONTROL …………………………………………………………………………….……. 2 

QUICK REFERENCE GUIDE ................................................................................................ 3 

INTRODUCTION .............................................................................................................. 5 

GLOSSARY OF TERMS ....................................................................................................... 6 

BACKGROUND ............................................................................................................... .8 

DEFINITION OF AN INFLUENZA PANDEMIC ........................................................................ ...8 

WORLD HEALTH ORGANISATION (WHO) AND UK ALERT LEVELS ....................................................................... ...8 

FLUCON - FLU CONDITION STATUS................................................................................................................. .9 

NORTH EAST ESCALATION PLAN (NEEP)........................................................................................................ 10 

POTENTIAL IMPACT OF AN INFLUENZA PANDEMIC ............................................................................................. 11 

SUMMARY OF ROLES AND RESPONSIBILITIES ....................................................................................... 12 

PANDEMIC INFLUENZA COMMAND AND CONTROL ................................................................................. 15 

SITUATION REPORTS .................................................................................................................................. 17 

COMMUNICATIONS WITH EXTERNAL AGENCIES ................................................................................................. 18 

PANDEMIC NEEP STATE ACTION PLAN .............................................................................. 19 

INPATIENTS .............................................................................................................................................. 20 

NEEP 1 .............................................................................................................................................. 20 

NEEP 2 .............................................................................................................................................. 22 

NEEP 3 .............................................................................................................................................. 24 

NEEP 4-6 ........................................................................................................................................... 26 

COMMUNITY PATIENTS ............................................................................................................................... 28 

NEEP 1 .............................................................................................................................................. 28 

NEEP 2 .............................................................................................................................................. 30 

NEEP 3 .............................................................................................................................................. 32 

NEEP 4-6 ........................................................................................................................................... 34 

PHARMACY AND MEDICINES MANAGEMENT…………………………………………………….………..36 

LEGISLATIVE FRAMEWORK…………………………………………………………………………….…..41 

SPECIALIST SERVICES…………………………………………………………………………………..…41 

RECOVERY PLANNING…………………………………………………………………………………...…42 

TRIGGER POINTS AND ACTIONS ....................................................................................... 43 

INTER-PANDEMIC PERIOD ........................................................................................................................... 43 

PANDEMIC ALERT PERIOD ........................................................................................................................... 43 

PANDEMIC PERIOD – NEEP 1 ...................................................................................................................... 45 



PANDEMIC PERIOD – NEEP 4-6 .................................................................................................................. 48 

POST PANDEMIC PERIOD ............................................................................................................................. 49 

ACTION CARDS FOR COMMAND AND CONTROL .................................................................... 51 

ACTION CARD – COMMAND AND CONTROL ...................................................................................................... 52 

ACTION CARD – COMMUNICATION LEAD ........................................................................................................ 53 

ACTION CARD - IPC LEAD .......................................................................................................................... 54 


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ACTION CARD - HR LEAD ............................................................................................................................ 55 

ACTION CARD – EP/EFM LEAD .................................................................................................................... 56 

ACTION CARD - SPECIAL INSTRUCTIONS – INFECTION CONTROL ......................................................................... 57 

ACTION CARD - OPERATIONAL SERVICES LEAD ................................................................................................ 58 

ACTION CARD – SPECIAL INSTRUCTIONS - OPERATIONAL SERVICES LEAD ............................................................ 59 

ACTION CARD - OBTAINING ANTI-VIRAL MEDICATION FOR INPATIENTS IN DURHAM, DARLINGTON, TEES ....................... 60 

ACTION CARD - OBTAINING ANTI-VIRAL MEDICATION FOR INPATIENTS IN NORTH EAST YORKSHIRE ............................ 62 

ACTION CARD - ON CALL ............................................................................................................................ 63 

ACTION CARD – PERSONAL PROTECTIVE EQUIPMENT .................................................................................... 65-67 

APPENDIX 1 – INFECTION CONTROL GUIDELINES ........................................................... 68-74 


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Introduction 


Pandemic Influenza Specific Guidance Plan 

This is the Trust‟s Pandemic Influenza Plan and in conjunction with the Trust‟s Business Continuity 

Plan contains all essential elements of Command and Control, Critical Service Scope, Trigger Points 

and lists Action Cards that will be available for operational instructions including emergency 

protocols and procedures. The Plan is to be used to manage the Trust‟s response to any of the 

following: 

Escalation of the UK Pandemic Influenza FluCon assessment by the Department of Health, 

which is used as the key threat indicator throughout this document. 

Increase in preparedness and case management as directed by WHO and Department of 

Health prior to Pandemic FluCon assessment implementation . 

Reporting of any disruption or impact upon a critical service during the period of pandemic 

as set out by WHO level 6 

Invocation of regional and/or local North East Escalation Plans (NEEP) by the Strategic 

Health Authority or PCT(s) 

This Plan document is to be used in conjunction with the Trust‟s Business Continuity Plan by the 

Command and Control Team. Each service directorate and service management team has their own 

specific Business Continuity Plan, action cards and emergency procedure packs that they will use when 

reporting an incident or service interruption, and as a set of action instructions when directed to initiate 

critical management or continuity measures by the Command and Control Team. The Trust has a duty 

to prepare for emergencies, maintain plans for preventing emergencies, and for reducing or controlling 

the effects of emergencies. These must include a specific plan for Pandemic Influenza that will be 

demonstrably workable and effective if activated in a real situation. The Trust has a responsibility to 

take command from and communicate with: 

North East SHA and 2 PCT clusters for County Durham and Tees 

Yorkshire and Humber SHA and NE Yorks PCT 

The Trust will cooperate and collaborate with other external agencies, Acute Trusts, Local Resilience 

Forums and emergency services through the command and control of the PCT Emergency Planning 

arrangements. The Trust, however, will only respond directly to requests to initiate plans or for 

support, help and advice in times of emergency activation when they are channelled through the 

relevant PCT Emergency Operations Lead to the Trust Executive lead for PI. 

Alongside dealing with an emergency, the Trust must continue to deliver its most critical services at an 

acceptable level and return to „Business as Usual‟ working as soon as possible after the emergency 

situation ends. The Trust has therefore developed Business Continuity plans to support these objectives. 

This Plan has been developed to meet the DH guidance for Mental Health Trusts and the directives of 

the North East SHA, is based upon the results of the Trust‟s comprehensive Business Impact Analysis 

and has been benchmarked against other similar plans including Pennine Care and Northumberland, 

Tyne and Wear. The Plan provides the detailed arrangements of the Trust‟s response to pandemic 

influenza. This Plan will complement existing Resilience arrangements, as detailed in the following table: 

Document Name Document Location 

Major Incident Plan Shared Board of Directors secure drive and hard copy in TECR 

Business Continuity Plan Shared Board of Directors secure drive and hard copy in TECR 

Emergency Plan (Internal) Shared Board of Directors secure drive and hard copy in TECR 

Service Business Continuity Plans Shared Board of Directors secure drive and hard copy in TECR 

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Glossary of Terms 

The following glossary should assist the reader in understanding the words and expressions used in this 

document relating to Business Impact Analysis, Pandemic Influenza and Business Continuity. 

Action Cards 

Action cards are physical documents containing easy-to-follow instructions on how to execute a key 

activity or set of activities. 

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. 

Command and Control 

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

attached team in order to efficiently manage an organisation‟s response to a major incident or 

emergency. Command and control functions are performed through an arrangement of personnel, 

equipment, communications, facilities, and procedures employed by the Team Leader in planning, 

directing, coordinating, and controlling designed to continue delivery of critical services at acceptable 

levels and effect an orderly return to Business as Usual operations. 

FluCon Assessment 

DOH summary measure of how the health services (at primary and secondary care levels) are coping 

during a pandemic. The FluCon status levels 0 – 3 will be used throughout this document as an 

invocation of actions. 

Infection Prevention and Control 

The discipline concerned with preventing the spread of infections within healthcare settings by 

means of prevention (hand hygiene/hand washing, cleaning/disinfection/sterilization, vaccination, 

surveillance) and investigation and management of demonstrated or suspected spread of infection. 

Invocation 

The act of declaring that an organisation‟s Business Continuity Plan needs to be put into effect in 

order to continue delivery of critical services within the timeframe indicated by the Business Impact 

Analysis. 

Local Resilience Forum (LRF) 

A group of key emergency responders and specific supporting agencies based on Police areas, which 

allows responders access to a forum to consult, collaborate and disclose information with each other 

to facilitate planning and response to emergencies. 

North East Escalation Plan (NEEP) 

A common indicator to be used by all health organisations within the NESHA to show the level of 

escalation of PI Plans (and surge/emergency impact) as issues develop. The NEEP levels are graded 

on a scale 1-6. 

Pandemic Influenza Planning 

Development of strategies, plans and management structures to prepare for and manage planned 

response to a Pandemic Influenza outbreak that may severely impact an organisation‟s ability to 

deliver its critical services at acceptable levels. 

Regional Civil Contingencies Committee (RCCC) 

A committee which co-ordinates the recovery from an emergency at a regional level. 

Resilience 

The ability of an organisation to prevent its critical services being disrupted by an incident. 


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Resources 

All assets, people, skills, information (whether electronic or not), technology (including plant and 

equipment), premises and supplies that an organisation must have available in order to meet its 

service delivery objectives. 

Science and Technical Advice Cell (STAC) 

Gives public health, environmental, scientific, technical and operational advice to Gold/Tactical 

groups. 

Trigger Points 

Significant milestones or anticipated events during the planning, exercising and execution of this 

Plan. One or more prepared actions should be taken in response to a Trigger Point being reached, 

usually regardless of impact upon the Trust or its critical services, although impact may determine 

which options are selected within certain action plans. 

World Health Organisation (WHO) 

A specialised agency of the United Nations (UN) that acts as a coordinating authority on international 

public health. Established on 7 April 1948 and headquartered in Geneva, Switzerland, the WHO 

inherited the mandate and resources of its predecessor, the Health Organization, which had been an 

agency of the League of Nations. The WHO‟s mandate includes monitoring Pandemic Influenza and 

reporting alerting governments and the public to likely or actual outbreaks of a Pandemic strain in 

any member state. To facilitate this, the WHO has developed a set of standard Pandemic Influenza 

Phase and Threat Level definitions. 


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Background 

Definition of an Influenza Pandemic 

A pandemic of influenza results when a new influenza virus emerges which is markedly different from 

recently circulating strains and is able to: 

infect people (rather than, or in addition to, other mammals or birds); 

spread readily from person to person; 

cause illness in a high proportion of the people infected, and also; 

spread widely, because most people will have little or no immunity to the new virus. 

A pandemic exists when the new virus has been confirmed to cause clinical illness at epidemic levels in 

more than one country. It is impossible to predict when this will occur; there could be varying levels of 

warning that a pandemic has started world wide, there could be some outbreaks locally in the UK or 

none at all when a pandemic starts. Previous pandemics suggest that there will be more than one 

epidemic wave. Local organisations would not invocate any plans without the direct briefing from their 

Command and Control Lead. 

World Health Organisation (WHO) 

The table below shows the definitions of the phases of an Influenza Pandemic as currently defined by 

the World Health Organisation (WHO) Levels and definitions. 

Inter Pandemic Period 


WHO International Phase WHO Level 

No new influenza virus sub-types detected in humans 1 

Animal influenza sub-type poses substantial risk 2 

Pandemic Alert Period 

Human infection(s) with a new subtype but no (or rare) person-to-person 

spread to a close contact 

Small cluster(s) with limited person-to-person transmission but spread is 

highly localised, suggesting that the virus is not well adapted to humans 

Large cluster(s) but person-to-person spread is still localised, suggesting 

that the virus is becoming increasingly better adapted to humans 

Pandemic Preparedness Period 

Large cluster(s) but person-to-person spread is still localised, suggesting 

that the virus is becoming increasingly better adapted to humans 

Pandemic Period 

Increased and sustained transmission in general population 6 

3 

4 

5 

5 

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FluCon – Flu Condition Status 

Experience has demonstrated that a nationwide alert system is too inflexible and a more locally based 

status system has been developed by the DOH to measure how the health services (at primary and 

secondary care levels) are coping during a pandemic. This is known as FluCon status. The status levels 

are described below. 

Primary Care 

(Including community 

pharmacies, GPs, Out-of-hours 

etc) 


Secondary care 

Pandemic not yet in locality / preparation or recovered 

- Current status as „normal‟ for 

season 

- Preparatory work underway 

- Available appointments at GPs 

- Increased number of „worried well‟ 

- Reviewing plans for business 

continuity 

- Returning to normal operation 

Low surge: slight effect on services 

- Implementation of business 

continuity plans 

- Planned closures 

- Reduction in non-critical services 

- Enhanced coordination between 

health and social care 

- Antiviral assessment and collection 

points working as planned 

Medium surge: moderate effect on services 

- Triage of patients attending service 

- Implementation of admission and 

discharge criteria 

- Unplanned closures of some critical 

services and treatment 

High surge: major disruption to services 

- Critical – services not coping 

- Demand outstripping supply for 

critical services 

(Including Acute, Mental health, Speciality, 

Foundation & Ambulance Trusts etc) 

- Current status as „normal‟ for season 

- Preparatory work underway 

- Discharging non-critical care patients 

- Increased number of „worried well‟ 

- Reviewing plans for business continuity 

- Returning to normal operation 

- Implementation of business continuity plans 


- Reduction in non-critical services 

- Enhanced coordination between health and social 

care services 

- Antiviral assessment and collection points working 

as planned 

- Triage of patients attending service 

- Implementation of admission and discharge criteria 

- Escalation of service reductions and closures 

(including reduced treatment regimes) 


- Critical – some services not being delivered 

- Demand outstripping supply for critical services 

Status 

FluCon 0 

FluCon 1 

FluCon2 

FluCon3 

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North East Escalation Plan (NEEP) 

The NESHA has developed a common indicator to be used by all health organisations to demonstrate 

the level of impact/escalation of pandemic influenza/winter pressures or any long term emergency 

situation which threatens the organisations delivery of services. The NEEP indicator levels are as 

follows: 

NEEP ALERT LEVEL IMPACT BCP STATUS 

1. Normal Services operating as normal. White 

2. Concern Minimal impact on delivery of services due to 

increased pressure on beds, service delivery or 

staff absence of 5-10%. 

3. Pressure Moderate impact on delivery of services due to 

additional pressure on beds, service delivery or 

staff absence in excess of 10-20%. 

4. Severe pressure Severe pressure on delivery of services leading to 

possible closures and breaches of performance 

targets. Staff absence levels between 20-30%. 

5. Critical Significant impact on service delivery, 

performance targets and in-patient services 

leading to closure of non-essential services and 

redeployment of community staff. Staff absence 

levels 30-40%. 

6. Severe Severe impact on service delivery, leading to 

possible breakdown in ability of organisation to 

maintain patient care delivery. All community 

service staff redeployed to in-patient units. Staff 

absence 40-50%. 


Green 

Yellow 

Red 

Purple 

Black 

NOTE: All health organisations in the NESHA will use this indicator to report pressure to Silver/Gold 

Command. 

The detailed NEEP action plans can be located in the Trust‟s Emergency Plan. 

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Potential Impact of an Influenza Pandemic 

Influenza pandemics pose a severe risk to health for a number of reasons: 

Pandemics take hold quickly around the world. This is facilitated by the continuous increase in 

long distance travel. 

The mode of virus spread is through large respiratory secretions (i.e. droplet spread). The 

virus can also be spread less commonly by small respiratory particles (i.e. aerosol spread) and 

by direct contact with surfaces contaminated by respiratory secretions (i.e. direct contact and 

fomites). 

In the event of a newly emergent strain almost everyone will be non-immune and therefore 

susceptible to the virus. 

There are high levels of person-to-person spread and a high attack rate. 

There may be insufficient vaccine (or no vaccine at all) to protect all those who are susceptible 

until a later phase in the pandemic. 

The scale and severity of pandemic influenza is likely to be of a different order to seasonal 

influenza. 

There will be a sudden and unprecedented demand on health services. 

Due to the infectious nature of the illness, it is a hazard to staff working and caring for 

patients. 

High levels (up to 50 percent) of staff sickness in health, social care and all essential services 

will compromise the capacity of the services to cope with the demand. The services may 

become overwhelmed. Particular effects include: 


o Increased workload; 

o Increased need for local resilience and self-dependency for up to 24 days; 

o Increased need for high dependency care, infection control facilities and 

equipment; 

o Workforce depletion due to illness, as well as carer responsibilities, anxiety and 

bereavement; 

o Disruption of non-clinical processes and resources that clinical services depend 

upon; 

o Disruption to main lines of communication and supply; 

o Local/national authority restrictions on travel 

o Failure of essential supplies such as gas, electricity, water and food; 

o Increased pressure on mortuary facilities due to high numbers of deaths; 

Sources: World Health Organisation, National Performance Advisory Group, Department of Health “Pandemic 

Influenza: Guidance for Infection Control in Hospitals and Primary Care Settings” (DH 080772) and Department of 

Health “Pandemic Influenza: Guidance on Preparing Mental Health Services in England” (DH 085926). 

Range of possible excess deaths for various permutations of case fatality and clinical attack rates, based 

on UK population. 

Range of possible excess deaths in UK 

Overall case fatality 

rate (%) 

25% clinical attack rate 35% clinical attack rate 50% clinical attack rate 

0.4 55,000 77,700 111,000 

1.0 150,000 210,000 300,000 

1.5 225,000 315,000 450,000 

2.5 375,000 525,000 750,000 

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Summary of overall Pandemic Influenza Roles and Responsibilities 

Department of Health 

The Department of Health as lead government department has a role in setting guidance and seeking 

assurance that organisations are prepared for an Influenza Pandemic. It has done this through the 

2009/109 Operating Framework and will continue throughout the 2010/11 Operating Framework; 

assessed against delivery of the appropriate targets. 

During a Pandemic the Department of Health has a role alongside the Cabinet Office as the lead 

government department. This means they will be responsible for the government response to the 

Pandemic in addition to their position at the top of NHS command and control structure coordinating 

regional mutual aid. The DH Flu Resilience Directorate leads the Command Structure. 

Strategic Health Authorities (SHAs) 

SHAs act as the regional headquarters of the NHS. In the event of an influenza pandemic, it is 

anticipated that some central decision-making powers – including decisions on service priorities and 

suspension of targets – will be delegated to them. SHAs will need to make these decisions in discussion 

with the Department of Health, who will also discuss any effect on annual health checks with the Care 

Quality Commission and liaise with Monitor where there is an impact on foundation trusts. 

SHAs provide a critical link to their respective regional Government Offices and, through designated 

pandemic influenza coordinators, ensure the development, maintenance and testing of effective and 

integrated health response plans across their areas. 

During a pandemic, each will also coordinate the strategic response across its health economy, be 

responsible for the general oversight and coordination of the delivery of healthcare and ensure the most 

effective deployment of available resources. 

SHAs will also provide health service advice and information to Regional Civil Contingency Committees 

(RCCCs), act as reporting links to the Department of Health, collate and forward monitoring information, 

provide a communications link and support media handling and the provision of public information. 

Primary Care Trust Commissioners 

Primary care trust commissioners are responsible for assessing local risk and for 

commissioning, supporting and monitoring the development of integrated health response plans. PCT 

commissioners are responsible for the delivery and co-ordination of the health response in their locality, 

in the treatment phase this includes distribution of anti-viral medication and PPE to providers. 

They are also responsible for developing contracts arrangements to maintain and support patients in a 

community setting and for ensuring that health plans take account of the needs of the independent 

sector as well as military bases, prisons, nursing homes or other establishments that may require 

specific planning in their area. 

Through designated pandemic influenza coordinators, PCTs provide a health input to Local Resilience 

Forums (LRFs), coordinate plans with those of neighbouring authorities and ensure that social care and 

other key partners – including third sector care and support service providers – are fully involved and 

informed of outcomes from these meetings. PCTs take the lead in the health response to the PI 

management and treatment. 

Hospital Trusts (including Foundation, acute, mental health and primary care services) 

Foundation and other hospital trusts, mental health trusts and primary care provider services are 

directly responsible for the provision of a wide range of health services. Those organisations should 

appoint a dedicated Pandemic Flu Director who will be responsible through Command and Control for 

the support of local planning and to develop their internal contingency arrangements for responding to 

the additional demands whilst maintaining essential healthcare throughout an influenza pandemic. Each 

Trust will ensure a resourced team is in place to support operation of the Trust PI plan. 

Plans should pay particular attention to the projected requirement for significant surge capacity, 

increased demand for specialist beds, patient transport, support to maintain patients in community 

settings, redeployment of staff at short notice, staff protection and strict infection control. 


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Mental Health Trust 

TEWV as a Mental Health Trust is not a CAT 1 or CAT 2 responder and as such plays a secondary 

supporting role in the planning for and responding to a Pandemic Influenza outbreak. TEWV has a 

primary responsibility for the provision of care continuity to the service user population that requires 

those specialist secondary mental health and learning disability services. This would include the 

ongoing provision of the highly specialised in-patient services that are prioritised to be maintained and 

the wider support of those service users maintained in the community to both reduce the likelihood of 

need for in-patient admission and excess strain on the Primary Health Care and Acute Hospital facilities 

by promotion and delivery of basic physical health care. 

TEWV, in conjunction with PCT leads and Local Authority partners is required to work closely in the 

identification and support of all vulnerable patient groups to maintain their health care needs 

throughout a pandemic. 

TEWV will provide support to primary care during the recovery phase of a pandemic to not only restore 

the full range of services to patients at the earliest opportunity, but also to provide additional support 

to patients and NHS staff, through primary care centres, for those requiring additional psychosocial care 

as a result of the pandemic. 

TEWV therefore would not liaise directly with the LRFs but would report to and take command from the 

PCT cluster groups who commission services. TEWV links with three PCT commissioning clusters in 

Durham, Tees and North Yorkshire. TEWV daily situational reporting in the acute phase for PI therefore 

would include all three PCT Emergency Planning systems as well as the North East Strategic Health 

Authority. 

North East Ambulance Service 

The Ambulance Service response will heavily effect how the wider NHS system can respond to the 

demands of a Pandemic Influenza outbreak. The Ambulance Service are responsible for ensuring that 

they have robust plans and that these plans are tied into the levels of service delivery expected by both 

PCT and trust colleagues. It‟s important to ensure that there is sufficient capacity in order to continue to 

respond to Emergency Calls as well as supporting services such as patient transfers for hospitals 

discharges in order to keep the system flowing. 

Health Protection Agency 

The Health Protection Agency (HPA) in England – working in conjunction with its equivalent public 

health organisations in the devolved administrations – is the lead agency responsible for providing 

public health advice to the Department of Health and supporting all aspects of the public health 

response to an influenza pandemic. Locally and regionally, the HPA will support regional responses / 

arrangements and ensure cascade of public health / health protection information to partner 

organisations 

Regional Directors Public Health 

The Regional Directors of Public Health have an important role to play both in ensuring 

consistent accurate public health advice is shared with the public and also to act as local spokespersons 

for the NHS in their area, reassuring the public and directing them towards support systems available 

for them. 

Directors of Public Health and their departmental colleagues at SHA and PCT levels will provide input to 

local structures and decision-making processes throughout. Senior public health practitioners will work 

in rotation with chief executives and non-public health directors to provide representation to interagency 

command structures. Public health staff will assist in STAC provision as necessary. 

NHS Direct 

Demand for health advice and information is likely to increase significantly during a pandemic. 

NHS Direct and its equivalents in the devolved administrations will continue to play an important role in 

providing health advice and information through their normal telephone numbers, the NHS Direct Online 

website www.nhsdirect.nhs.uk and NHS Direct Interactive on digital satellite television, thereby 

alleviating pressures on other parts of the system. 


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Regional and local planning/response – wider aspects 

Planning and response at regional and local government level will focus on wider aspects, including 

support of the health response, the maintenance of social care and other essential local services, 

managing potentially large numbers of deaths, keeping the region “running”, and ensuring local and 

central reporting and coordination arrangements are met. 

Generic response arrangements at regional and local level are set out in detail in Emergency Response 

and Recovery, which is available at http://www.ukresilience.info/ 

Regional Resilience Forums (LRFs)/Regional Civil Contingency Committees (RCCCs) 

Government Offices represent central government in the English regions. Each has established a 

Regional Resilience Team and formed a Regional Resilience Forum, allowing key responders to plan 

together and improve the coordination and flow of information across and between regions and the 

centre. In response to wide-scale civil emergencies such as an influenza pandemic, RCCCs are likely to 

be established. 

Working closely with SHAs, the RCCCs would collate a regional picture of the evolving situation, provide 

an information channel between central (COBR in the Cabinet Office Briefing Room) and local tiers, 

identify issues that cannot be resolved locally, facilitate mutual aid, coordinate wider response efforts, 

advise on priorities, monitor progress and minimise disruption. 

RCCC members are likely to be drawn from the Regional Resilience Forums. Specific planning and 

response arrangements have been established for London and in the devolved administrations. 

Regional Science and Technical Advice Cell (STAC) 

During an Influenza Pandemic the Science and Technical Advice Cell (STAC) will support a Regional Civil 

Contingencies Committee by providing a single point of contact for coordinated scientific, technical, 

environmental and public health advice fed into the RCCC and cascaded to the Outbreak committees, 

Local resilience forums and health response teams. 

Local resilience forums 

There are three local resilience forums (LRFs) in the North east which are coterminous with police 

authority boundaries. 

The LRF is the principal mechanism for the coordination of multi-agency planning at local level. 

Its membership includes all Category 1 responders (such as emergency services, local 

authorities and health bodies) which are subject to a range of civil protection duties under the Civil 

Contingencies Act 2004. In London, local influenza pandemic committees feed in at the RCCC level. 

In the event of a pandemic influenza outbreak, it is likely that SCGs will be convened. The purpose of 

the SCG is to take overall responsibility for the multi-agency management of an outbreak at local level, 

working closely with PCTs. Membership of the SCG is likely to mirror the Category 1 membership at the 

LRF. 

Local authorities as CAT 1 responders play an important supporting role in planning for and responding 

to a pandemic influenza outbreak. They have responsibility for a wide range of functions including social 

care and children‟s services and crucially exercise a community leadership role. Additionally, in the event 

of an emergency that exceeds existing mortuary provision, the local authority will liaise with the 

coroner‟s office to provide emergency mortuary capacity. 

As most influenza sufferers will need to be cared for in a community setting, developing integrated 

health and social care plans is a particularly important part of local planning. In addition, sustaining the 

provision or commissioning of a range of services on which many vulnerable people rely, including 

residential and nursing homes, is also important. 


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Pandemic Influenza Command and Control 

Command and Control will be established by the invocation of the Trust‟s Business Continuity Plan 

(BCP). The Pandemic Influenza Plan gives specific guidance on how to manage this incident and will 

be consulted to in conjunction with the Trust‟s BCP. 

The Trust‟s Pandemic Influenza planning, preparation and response shall be managed and directed by 

the Pandemic Influenza Control Team (PICT) as follows, using the North East Escalation Plan (NEEP) 

framework: 

NEEP 1 (White – normal impact) – see table on page 12. 

Normal directorate structures manage day to day activities. 

PICT members meet and review all emergency planning arrangements quarterly. 

NEEP 2 (Green – minimal impact) 

PICT members establish Flu Control Team and Executive Director Lead for PI nominated 

(Team Leader). 

Weekly update reports to the Chairman and Board members, Executive Management Team 

(EMT) and PICT members. 

PICT meets regularly, either face to face or by teleconference. 

Pandemic Influenza Operational Team will be formed to run the Trust‟s temporary Flu 

Control office and meet weekly. 

Flu Director/Team Leader attends all Silver (PCT) meetings and Gold meetings by 

invitation. 

NEEP 3 (Yellow – moderate impact) 

Emergency Control Room (ECR) activated during normal hours and manned by skeleton 

PICT members on rota. 

Flu Director/Team Leader assumes delegated authority of the Board of Directors to execute 

plans and action as the situation dictates, and is based in the ECR. 

The Board of Directors has approved delegated authority in the following order: 


o PI Team Leader and nominated deputy. 

o Director on Call (out of hours). 

o Director of Nursing and Governance. 

At all times, and as time allows, the Chief Executive or their nominated deputy is to be 

consulted. However, the instructions from the duty PI Team Leader are to be executed as 

directed. 

All actions and decisions taken by the PICT members will be recorded in the decision log by 

the duty loggist or designated senior secretary. 

The full PICT or their nominated deputies will meet weekly and minutes and a decision log 

maintained by the duty loggist. 

Briefings to Board of Directors, Executive Management Team and staff once every 48 

hours. 

15

The Team Leader or deputy will attend all Silver Command meetings and teleconferences 

and Gold Command meetings by invitation. 

The Director on Call and Second on Call Managers will be placed „on standby‟ to man the 

ECR out of hours should the situation arise. 

NEEP 4-6 (Red : Severe pressure / Purple : Critical / Black : Severe) 

ECR activated 24/7. During day light hours (6.00 a.m. to 6.00 p.m.) all PICT members will 

be based in the ECR on a rota. Out of hours (6.00 p.m. to 6.00 a.m.) the Director on Call 

and 2 nd on Call Manager will be based in the ECR. 

Daily briefings to Board of Director members, Executive Management Team and staff. 

Delegated authority and decision making continues as for NEEP 3. 

The Team Leader will attend all Silver Command meetings and teleconferences. 

The full PICT or their nominated deputies will meet daily at 12:00 hours and notes and a 

decision log maintained by the duty loggist. 

Pandemic Influenza Operational Team (PIOT) 

During NEEP 2 a PIOT will be formed as the operational team providing day to day 

management and support to the PICT. Any PI situation is fluid and the PIOT will be drawn 

from service and support service areas as required. 

Minimum membership will be: 

o Flu Directors 

o Secretarial support 


o Infection Prevention and Control support 

The PIOT will operate from a designated temporary FluCon office in Craglea Villa, Lanchester 

Road Hospital, Durham. At NEEP 3, the PIOT will be absorbed into the PICT/ECR. 

16

Situation Reports 

During NEEP 2, The Team Leader will provide an internal weekly SITREP (appended to this Plan as 

Appendix 2) at least weekly to the Chairman, Chief Executive, Board of Directors, Clinical Directors and 

Service Directors, on call Director and 2 nd on call manager. This SITREP would not be for distribution 

across the organisation. 

External reports would be made as required to the SHAs and PCTs to populate the civil contingencies 

SITREP through the Local Resilience Forums (LRFs). The format of reports will be as directed by Gold 

Command and the LRF‟s. 

Informational briefings would be supplied by the SHAs as part of the communications plan. The Team 

Leader would provide operational instructions to Trust staff disseminated by the Communications Lead 

on direction. 

During NEEP 3, the Team Leader shall provide a full report at 0800 hours every 48 hours to: 

EMT Members 

On call Directors / 2 nd On Call Manager 

Board of Directors and Clinical Directors 

A copy of the internal SITREP is to be forwarded by fax/email to the above list and to external contacts 

as requested. 

External reporting would be in the format as directed by Silver/Gold Command. 

During NEEP 4-6, the Team Leader will provide a full SITREP daily at 0800 hrs to: 

EMT Members 

On call Director / 2 nd On Call Manager 


All managers/Council of Governors 

A copy is to be sent by fax/e-mail to the above list, external contacts and posted on the intranet. All 

external reporting will be in the format as directed by Silver/Gold Command. 

The Chief Executive shall provide additional briefing to the Chairman and Non Executive Directors as 

required. The Chairman will identify any briefing that needs to be cascaded to the Council of 

Governors. 


17

Communications with External Agencies 

The Command and Control Team SHA/PCT Lead, or their deputy, will be responsible for communicating 

all relevant types of information to their contacts within the SHA, PCT clusters and other key external 

agencies. A full list of external agency contacts is appended to this plan as Appendix 6. 

Types of information that must be communicated to external agencies are: 

Communication Type Recipient Agencies 

NEEP 2 

Update position through Outbreak Control Team 

Meetings (attendance) 


NHS Durham and Darlington 

NHS Tees 

NHS NEY 

Media briefings As per communication plan as directed by Gold 

Command 

Daily SITREP reporting Collated and reported to SHA by 10.00 a.m. 

Daily Flucon monitoring Collated and reported to SHA by 1.00 p.m. 

NEEP 4-6 

Daily SITREP reporting Collated and reported to SHA by 10.00 a.m. 

Daily Flucon monitoring Collated and reported to SHA by 1.00 p.m. 

Hospital surveillance report SHA (Gold Command) 

Exception reporting for LRF As directed by PCT 

Media briefings As per communication plan as directed by Gold 


Daily / weekly teleconferences PCTs 

18

Pandemic NEEP State Action Plan 

Set out on the following pages are the additional Business Continuity and Pandemic Influenza 

actions which are required to be undertaken by services and corporate support services as 

identified by the colour coding. 

Actions listed are to be checked / actioned as shown until: 

NEEP / BCP state is raised 

NEEP / BCP state is lowered or cancelled. 

The following colour code has been used. 

COLOUR KEY 

Command and Control Estates and Facilities Management 

Multi-Agency Operations IT and Telecoms 

Essential Services and Business Continuity Infection Prevention, Control and Clinical Procedures 

Staffing / HR Recovery Post-Pandemic 

Communications / PR Testing Schedules 

The Trust FluCon/BCP Alert States are: 


BCP State NEEP 

White 1 

Green 2 

Yellow 3 

Red 4 

Purple 5 

Black 6 

19

Pandemic Alert Level Action Plan 

Inpatients 

NEEP Status : 1 BCP State : White 

Element 

CONTINUOUS ROUTINE 

Action When Lead 

Command and 

Control: 

Minimum level ECR testing 

Minimum monthly briefs to EB/BCP group 

Monthly 

PI Lead 

Minimum bi-monthly PICT contact and plan review quarterly 

Attendance at SHA and PCT Emergency Planning and PIP Forums 

Bi-Monthly 

Multi-Agency 

Meeting of MHLD multi agency PIP group 

Bi-Monthly PI Lead 

Operations 

Project work as indicated by programme for multi-agency worker 

Liaison as required with PCT EP Groups 

Essential 

Ensure BCP and service plans up to date and reviewed regularly 

Monthly 

Service / IPC Leads 

Operational 

Maintain appropriate stocks of PPE and other physical care equipment 

Monthly 

Services and 

Ensure awareness in staff of PIP, knowledge of emergency planning and PI awareness Monthly 


Ensure mandatory levels of IPC training maintained 

Monthly 

Staffing/HR Develop emergency policy and procedural set 

Maintain ESR accuracy 

Develop training schedules as required 

Maintain presence at PICT and emergency planning 

Finalisation of emergency policy and procedural set 

Liaison with staff side reps 

Update of ESR information 

Preparing information collection systems for activation 

Communications/PR Maintain contact with SHA communications lead 

Ensure media directed to PI team leader and PICT 

Maintain comms plan up to date 

Estates and 

Facilities 

Management 


Ensure BCP Plans in place and regularly reviewed 

Ensure BCP in place with suppliers wherever possible 

Implement stock control measures as required 

Usual maintenance and facilities management programmes updated as required. 

Identify and circulate priority cleaning schedules 

Prepare emergency training procedures for re-skilling reserve staff 

Identify where all routine maintenance, external FM provision and outstanding works 

are 

HR Lead 

Comms Lead 

EFM Lead 

20

Ensure knowledge of external contractor activity 

Check supply chain contingency plans for stock piling and agree acceptable stock piles 

at present 

Take responsibility for procurement of PPE supplies from PCTs and store appropriately 

and liaise with IPC Team to distribute to relevant services 

Review transport arrangements 

Provide weekly security updates, maintain knowledge of emergency services security 

planning 

Support testing and equipping of ECR and emergency staff accommodation 

IT and Telecoms Information strategy development and business management proceed as usual IT Lead 

Infection Prevention 

and Control 


Maintain robust IPC policies 

Liaise with Logistics Team at Flatts Lane to assess levels of PPE in central store and 

initiate order if necessary via internal ordering systems or via PCT 

Work with communications team to emphasise the importance of effective respiratory 

and hand hygiene messages to all staff via weekly operational instruction 

Initiate and plan clinical procedures for staff to use in case of pandemic (action cards 

on how to manage potential case) 

Liaise with HPA/SHA for regular updates on impending outbreak and brief staff 

accordingly 

IPC Lead 

Systems in place N+G Lead 

Recovery Post 

Pandemic 

Testing Schedule Minimum 3 times yearly table top and rehearsal testing through PICT and operational 

services 

Participation in multi agency and other Gold Command organised testing 

Contact details checked/updated 

3 times yearly 

Quarterly 

EFM Lead 

EP Lead 

21


Inpatients 

NEEP Status : 2 BCP Status : Green 

FROM WEEK 1 ONWARDS 

Element Action When Lead 


Control 

Multi-Agency 

Operations 

Essential 

Operational 




Facilities 


ECR Testing 

Test SITREP 

Director SITREP 

Operational instructions brief for Trust workforce 

PI Ops team meeting 

PICT meeting 

Plan review 

Briefing updates from SHA 

Attendance as required to PCT and SHA Incident Control and Outbreak meetings 




Liaison PCT EP‟s 

Brief partner agencies 

Normal operations 

Ops reports 

Identified isolation bed planning and management with PICT operational lead 

Review bed usage once activated 

Distribution of PPE and equipment for isolation bed management 

Continuous review of alerted cases through SHA regarding potential admissions 

Staffing / HR Staff list updates 

Activate FluCon Status 1 training plan 

Alert reserve staff list 

Review outstanding DP/G/CP 

Communications / 

PR 

Activate distribution of SHA briefs and other staff information from SHA and LRF as 

required 

Deal with media enquiries and collate media information 

Activate In-Touch information sheets 

Prepare service user briefings 

Disseminate operational instructions as directed by team leader 

Planning priority cleaning schedules 

Training and re-skilling reserve staff 

Monthly 

Monthly 

Weekly – Wednesday 

Weekly 

Weekly 

Fortnightly 

Weekly 

Weekly 

Bi-Monthly 

Weekly 

Weekly 

Weekly 

Daily 

PI Lead 

N+G Lead 

Monthly HR Lead 

Service / IPC Leads 

Comms Lead 

EFM Lead 

22

Management Review all routine maintenance, external FM provision and outstanding works 

Review external contractor activity 

Invoke supply chain contingency plans for stock piling 

Take responsibility for procurement of PPE supplies from PCTs and store appropriately 

and liaise with IPC Team to distribute to relevant services 


Provide security updates 

IT and Telecoms Impact analysis of national networks 

Regular impact analysis of local server, network and national network issues 

Ensure communication support for PICT and communications team – ensuring out of 

hours communication systems available 

Ensure communication support for emergency control rooms 

Infection 

Prevention, Control 

and Clinical 

Procedures 


Weekly 

Daily 

IT Lead 


Liaise with Logistics Team at Flatts lane to assess levels of PPE in central store and 

initiate order if necessary via internal ordering systems or via PCT 

IPC Lead 


and hand hygiene messages to all staff via weekly operational instruction 

Weekly 


accordingly 

Prepare clinical procedures for staff to use in case of pandemic (action cards on how to 

manage a potential case) 

Ensure supply of PPE and face masks are available for in-patient staff to use if a case 

is identified 

Weekly 

Co-ordinate and log any suspected/new cases 

Daily 

Ensure supply of antiviral medication available 

Pharmacy lead 


Recovery Post 


Testing Schedule C&C Test 

Plan review and test 

Contact details checked/updated 

Weekly 

Monthly 

Monthly 

EFM Lead 

PI Lead 

23

NEEP Status : 3 BCP State : Yellow 




Control 

Multi-Agency 

Operations 

Essential 

Operational 




ECR manning 9.00 a.m. to 5.00 p.m. 

Director on Call/2 nd Manager On Call „on standby‟ 

SITREP report 

Director Situation report 

Operational instruction for staff 

Surveillance intelligence gathering 

Invoke essential external contractor contingency plans 

PCT liaison 

Monitoring MHAct activity 

Monitoring CJS activity 

Reducing down non-essential interagency work 

Reduced admissions to forensic services 

Review patients, daily, increasing discharges 

Ops reports 

Ward section planning 

Checks of PPE and consumables 

Invocation of emergency clinical procedures 

Staffing / HR Updating staff contacts 

Skills rehearsals – further training 

Ceased all non-essential HR ops activity 

Tracking staff attendance – daily reports to C&C 

Implement staff contact line and invoke occupational advisory briefings 


Staff brief and In Touch update 

PR 

Media release as required 


Facilities 

Management 

Cessation of all non-essential cleaning 

Invocation of emergency cleaning procedures and briefing 

Prioritise emergency maintenance, external FM provision and works 

Redeploying reserve staff 

Monitoring external project contactors 


Continue with priority transport 

Implementing emergency security plan 


Implement emergency contingency plan 

Infection 





is identified and check daily 

Daily 

Daily 

Daily 

Weekly 

Weekly 

Daily 

PI Lead 

Weekly N+G Lead 

Daily 

Weekly 

Weekly 

Daily 

Daily 

Services / IPC Lead 

HR Lead 

Every 48 hours Comms Lead 

Daily 

Daily 

EFM Lead 

IT Lead 

IPC Lead / Pharmacy 

lead 

24

Procedures Co-ordinate and log any suspected / new cases daily 

Initiate clinical procedures for staff to use in case of pandemic (action cards on how to 

manage a potential case and availability of antiviral medication) 

Support operational staff with regular clinical and IPC advice 

Daily 

Recovery Post 



Testing Schedule Test emergency comms plans 

Prepare initiation of BCPs 

Monthly EFM Lead 


25

NEEP Status : 4-6 BCP State : Red/Purple/Black 




Control 

Multi-Agency 

Operations 

Essential 

Operational 




TECR manned 24/7 

SITREP system in place 

Local external information scanning from SHA / PCT / media 

Directory situation report 

Incident and staff & service deployment monitoring 


Monitor continuity of essential external contract provision 

Monitor contingency planning 

Monitoring and adapting PI implementations 

Increased PCT liaison 

Monitoring MHAct activity 

Monitoring criminal justice 

System activity reducing down non-essential interagency work 

Liaison with PCT 

Essential LA contact re: safeguarding 

Contact with LA re: Essential Mental Health Act operation as required 

Priority or essential admissions only to non-forensic services 

Stopped admission to forensic services 

Review patients daily, increasing discharges 

Ops reports 

Ward section planning – reduction of capacity – planned ward closures in line with 

BCPs 

Reduction to minimum staff levels – deployment of staff to community services 

Redeployment of clinically trained corporate staff and reserves 

Cessation of non-critical services in community, day services, outpatients as per service 

continuity plans 


Staffing / HR Continue staff contact line & occupational health advisory briefings 

Tracking staff attendance daily, daily reports to C&C 

Updating staffing lists and contacts 

All non-essential ops activity ceased 

Emergency contact centres invoked 

Emergency redeployment measures invoked 

Staff contact system invoked 

Discontinuation of all educational & student placement activity as per continuity plans 


PR 



Daily x 2 (0800/1600) 

Daily 

Daily 

Daily 

Daily 

Daily 

Daily 

Daily 

Weekly 

Daily 

Daily 

PI Lead 

N+G Lead 


HR Lead 

Daily – 1600 hrs Comms Lead 

26


Facilities 

Management 


Continuation of emergency domestic schedules 


Redeploying reserve staff 

Cessation of non-essential external project work 

Use only essential clinical supplies transport 


Implement maximum security level 



Implement urgent communication network 

Infection 



Procedures 

Daily 

EFM Lead 

IT Lead 


IPC Lead 


is identified and check 

Daily 

Co-ordinate and log any suspected / new cases 

Support operational staff with regular clinical and IPC advice 

Monitor implementation of emergency clinical procedures 

Daily 

Ensure supply of antiviral medication available 

Pharmacy lead 


Recovery Post 


Testing Schedule Testing emergency comms plans 

All systems live 

Weekly EFM Lead 

27


Community 

NEEP Status : 1 BCP State : White 

CONTINUOUS ROUTINE 



Control 

Multi-Agency 

Operations 

Essential 

Operational 




Minimum level ECR testing 

Minimum monthly briefs to EB / BCP group 

Minimum monthly PICT contact and plan review quarterly 

Attendance at SHA and PCT 

Emergency Planning and PIP Forums 






Ensure BCP and service plans up to date and reviewed regularly 

Maintain appropriate stocks of PPE and other physical care equipment 

Ensure awareness in staff of PIP, knowledge of emergency planning and PI awareness 

Ensure mandatory levels of IPC training maintained 

Ensure team awareness of multi-agency and partner planning regarding PI an EP 

Normal Operations with addition of identifying emergency plans with caseload service 

users. Those plans should include crisis support requirements identification of “buddy” 

network and lead health practitioner 

Staffing / HR Develop emergency policy and procedural set 

Maintain ESR accuracy 

Develop training schedules as required 

Maintain presence at PICT and emergency planning 


PR 

Maintain contact with SHA communications lead 

Ensure media directed to PI team leader and PICT 

Maintain comms plan up to date 

Monthly 

Monthly 

Bi-Monthly 

Monthly 

Weekly 

PI Lead 

N+G Lead 


HR Lead 

28


Facilities 

Management 


Ensure BCP Plans in place and regularly reviewed 

Ensure BCP in place with suppliers wherever possible 

Implement stock control measures as required 

Usual maintenance and facilities management programmes updated as required. 

Identify and circulate priority cleaning schedules 

Prepare emergency training procedures for re-skilling reserve staff 

Identify where all routine maintenance, external FM provision and outstanding works 

are 

Ensure knowledge of external contractor activity 

Check supply chain contingency plans for stock piling and agree acceptable stock piles 

at present 

Supply IPC Team with PPE from stock to supply isolation arrangements 


Provide security updates, maintain knowledge of emergency services security planning 

Support testing and equipping of ECR and emergency staff accommodation 

IT and Telecoms Information strategy development and business management proceed as usual IT Lead 

Infection 



Procedures 

Weekly 

EFM Lead 


IPC Lead 

Assess levels of PPE in central store and initiate order if necessary via internal ordering 

systems or via PCYT 

Weekly 


and hand hygiene messages to all staff 

Initiate and plan clinical procedures for staff to use in case of pandemic (action cards 

on how to manage potential case) 


accordingly 

Weekly 

Liaise with SHA/PCTs to access supplies of antiviral medication 

Pharmacy lead 


Recovery Post 


Testing Schedule Table top and rehearsal testing through PICT and operational services 

Participation in multi-agency and other Gold Command organised testing 

Minimum 3 times 

yearly 

EFM Lead 

29

Community Patients 

NEEP Status : 2 BCP State : Green 




Control 

Multi-Agency 

Operations 

Essential 

Operational 




ECR Testing 

Test SITREP 

Director SITREP 

Operational instructions brief for Trust workforce 

PI Ops team meeting 

PICT Meeting 

Plan review 

Briefing updates from SHA 

Attendance as required to PCT and SHA Incident Control and Outbreak meetings 



Intelligence gathering regarding other agencies provision for community packages 

Normal operations 

Ops reports through team managers 

Checks of PPE, consumables and any required clinical equipment 

Caseload reviews, early detectors of high risk patients 

Exception reports through team managers to operational lead on PICT 

Issues of specific PPE packs as required for initial isolation 

Procedures and suspected cases 

Issue of clinical procedural notes to ensure understanding of HPA 

Algorithms for initial isolation procedures, prophylaxis and management of suspected 

cases 

Caseload reviews, early detectors of high risk patients 

Review of medication management regimes in relation to vulnerable and high risk 

patients 

Working with communications to develop service user and carer briefing sheets 

Staffing / HR Finalisation of emergency policy and procedural set 

Liaison with staff side reps 

Update of ESR information 

Preparing information collection systems for activation 

Staff list updates 

Activate level 1 training plan 

Alert reserve staff list 

Begin planning for fuel allocation licences for community staff 

Review current location proximities staff to bases 

Monthly 

Monthly 

Weekly – Wednesday 

Weekly 

Weekly 

Fortnightly 

Weekly 

Weekly 

Weekly 

Weekly 

Weekly 

Weekly 

Weekly 

PI Lead 

N+G Lead 


HR Lead 

30


PR 


Facilities 

Management 


Activate distribution of SHA briefs and other staff information from SHA and LRF as 

required 

Deal with media enquiries and collate media information 

Activate In-Touch information sheets 

Prepare service user briefings 

Disseminate operational instructions as directed by team leader 

Review security of team bases including lone working arrangements 

Review all routine maintenance, external FM provision and outstanding works 

Review external contractor activity 



Provide security updates 

Identify non-essential base areas for cleaning schedule amendments 

IT and Telecoms Impact analysis of national networks and mobile systems 

Review of staff contact systems and mobile phone allocation 

Business as usual 

Regular impact analysis of local server, network and national network issues 

Ensure communication support for PICT and communications team – ensuring out of 

hours communication systems available 

Ensure communication support for emergency control rooms 

Infection 



Procedures 

Recovery Post 


Testing Schedule C&C Test 

Plan review and test 

Caseload scenario tests 

Weekly 

Daily 

Weekly 

Comms Lead 

EFM Lead 

IT Lead 

Advice staff on IPC precautions hand hygiene and respiratory precautions 

Ensure staff, service users, carers and families about IPC and flu management at home 

Ensure all community staff have access to PPE (disposable apron, gloves, face masks 

and clinical waste bag) as a precautionary measure 

Co-ordinate and log any suspected / new cases daily and any staff queries re PI 

IPC Lead 


and hand hygiene messages to all staff 


accordingly 

Daily 

Ensure availability of antiviral medication 

Pharmacy lead 


Weekly 

Monthly 

Fortnightly 

EFM Lead 

31

NEEP Status : 3 BCP State : Yellow 




Control 

Multi-Agency 

Operations 

Essential 

Operational 




ECR manning 9.00 a.m. to 5.00 p.m. 

Director on Call/2 nd Manager On Call “on standby” 

SITREP report 

Director Situation report 

Operational instruction for staff 


PCT liaison 

Monitoring and reducing non-essential inter-agency work 

Monitor impact of other agency planning on care packages 

Continue business as usual 

Team liaison with inpatient areas regarding increased discharge rates 

Ops report 

Robust caseload reviews and care plan amendments 

Begin briefing of patients on caseload, their carers and families 


Indication of all emergency clinical procedures 

Staffing / HR Updating staff contacts 

Skills rehearsals – further training 

Ceased all non-essential HR ops activity 

Tracking staff attendance – daily reports to C&C 

Implement staff contact line and invoke occupational advisory briefings 

Update staff contacts 



PR 



Facilities 

Management 

Cessation of all non-essential cleaning 

Invocation of emergency cleaning procedures and briefing 

Monitoring external project contactors 

Invocation of supply chain contingency for stock piling 

Cessation of stock supply to non-emergency areas 

Invocation of priority transport plan 

Implementing emergency security plan 



Infection 

Advise staff on IPC precautions hand hygiene and respiratory precautions 




Ensure all community staff have access to PPE (disposable apron, gloves, face mask 

Daily 

PI Lead 

Daily 

Daily 

Weekly 

Weekly 

Daily 

Weekly N+G Lead 

Daily 

Weekly 

Weekly 

Daily 

Daily 


HR Lead 

Daily 

Every 48 hours Comms Lead 

Daily 

EFM Lead 

IT Lead 

IPC Lead 

32

Procedures and clinical waste bag) as a precautionary measure 


Invoke immediate infection prevention control precautions via action card 

Daily 

Ensured continued access to antiviral medication 

Pharmacy lead 

Recovery Post 



Testing Schedule Test emergency comms plans 

Caseload management scenario rehearsals 

Prepare initiation of BCPs 

Monthly EFM Lead 


33

NEEP Status : 4-6 BCP State : Red/Purple/Black 




Control 

Multi-Agency 

Operations 

Essential 

Operational 




TECR manned 24 / 7 

SITREP system in place 

Local external information scanning from SHA / PCT / media 

Directory situation report 

Incident and staff & service deployment monitoring 


Monitor continuity of essential external contract provision 

Monitor contingency planning 

Monitoring and adapting PI implementations 

PCT liaison 

Liaison with other partner agencies in relation to memorandae of understanding and 

contingency planning 

Liaison with PCT 

Emergency inter-agency work only 

Ops reports 

Essential referrals only – priority to discharged in-patients 

Caseload reviews 

Maintain crisis and acute services 

Cessation of non-critical community services, day services and out-patients as per 

service continuity plans 

Redeployment of staff to essential services 

Check of PPE and consumables 

Patient review 

Essential visits only 

Priority to high risk patients where mental health / LD worker nominated key agency 

worker 

Invocation of emergency relocation and redeployment plans when transport issues 

present 

Essential admissions to in-patient services only – use of emergency criteria for both 

TEWV admissions and Acute Trust as agreed in SHA plan 

No routine administration project or development work 

Monitoring of infection cases to be fed through intelligence systems 

Development of physical health and end of life care plans as required from ongoing 

assessment and triage 

Staffing / HR Continue staff contact line & occupational health advisory briefings 

Tracking staff attendance daily, daily reports to C&C 

Updating staffing lists and contacts 

Daily x 2 (0800/1600 ) 

Daily 

Daily 

Daily 

Daily 

Daily 

PI Lead 

Daily N+G Lead 

Daily 

Daily 

Weekly 

Daily 

Daily 


HR Lead 

34


PR 


Facilities 

Management 


All non-essential ops activity ceased 

Emergency contact centres invoked 

Emergency redeployment measures invoked 

Staff contact system invoked 

Logistics fed into SITREP regarding deployment to C&C 

Discontinuation of all educational and student placement activity as per continuity 

plans 



Emergency domestic schedules only 


Cessation of non-essential external project work 

Use only essential clinical transport and supplies transport 

Continuation of essential services only 

Prioritise transport and fuel plans in place 

Highest security level 



Cease all non essential work 

Infection 



Procedures 

Daily 1600 hrs Comms Lead 

Daily 

EFM Lead 

IT Lead 

Advice staff on IPC precautions hand hygiene and respiratory precautions 


Invoke immediate infection prevention control precautions via action card 

Monitor usage of PPE (disposable apron, gloves, face mask and clinical waste bag) for 

community staff and replenish as necessary 

IPC Lead 


Invoke emergency end of life procedures 

Daily 

Ensure continued access to antiviral medication 

Pharmacy lead 


Recovery Post 


Testing Schedule All systems live 

Testing emergency comms plan 

Weekly EFM Lead 

35

Trigger Point 

Pharmacy and Medicines Management 

There are four elements to planning for pharmacy services and medication supplies during an influenza 

pandemic. 

1. To maintain the essential psychotropic medication required to manage and contain the 

symptomatic presentation for inpatients with mental health and learning disability problems. 

2. To maintain the supply of emergency medication used in the management of challenging and 

aggressive behaviour in inpatient areas. 

3. To ensure that staff advising or delivering care for physical symptomatic presentations of 

influenza infection have access to the range of usual medicines for treatment. 

4. To ensure that the vulnerable populations served by the Trust have access to and are supplied 

with the antiviral medicines that are available to the general population. 

For elements 1 and 2 the Pharmacy Services Business Continuity Plans reflect the maintenance of supply 

chains. However should shortages of medicines develop clinicians will need to work with Trust 

pharmacists to identify possible alternatives for individual patients. This will be done on an individual 

patient basis and will depend on the availability of products and formulations at that particular time. 

For element 3 the Trust Pharmacy Service will identify a range of medications that will need to be 

procured in addition to normal stock supplies held within inpatient areas. These will include antibiotic 

medication and analgesia. 

For element 4 the Trust will work in collaboration with the PCT cluster groups who will be co-ordinating 

the supply and distribution processes for the antiviral medicines. 

Inpatients will have access to antiviral medicines through the Trust Pharmacy Team who will work in 

conjunction with Lloydspharmacy to dispense and issue supplies with the exception of Hambleton and 

Harrogate where requests should be made directly to the Acute Trust Pharmacy. During working hours 

requests for treatment should be made using the following numbers: - 

Durham locality wards – 0191 441 5775 

Darlington locality wards – 01325 552106/552105 

North and South Tees locality wards – 01642 838360 

Hambleton wards – contact Pharmacy, Friarage Hospital 01609 764002 

Harrogate wards – contact Pharmacy, Harrogate District Hospital 01423 555631/553083 

To access a supply of antiviral medication for an inpatient out of normal working hours the ward 

must contact the 1 st On-Call with details of: 

Patient‟s name 

Ward 

Medicine prescribed and dose 

Ward contact name and telephone number 

The 1 st On-Call will then contact the On-Call Pharmacist and inform the Director On-Call as directed in 

the following action plans. 


36

Plan for obtaining antiviral medicines for inpatients in Durham, Darlington, Tees, 

Scarborough & Ryedale Localities out of normal working hours – Treatment Phase 

Plan for obtaining antiviral medicines for inpatients in Hambleton and Harrogate out of 

normal working hours – Treatment Phase 

Care co-ordinators of the service user population maintained in the community will need to identify 

those who would be unable to access the usual antiviral distribution centres. For vulnerable service 

users without family or carer support, crisis plans will reflect the arrangements to be in place for 

accessing antiviral medication. Note that PCTs have delivery systems in place for patients who are 

unable to collect from the designated antiviral collection points. 

Special patient populations 

Clozapine patients 

Blood monitoring requirements during the Flu Pandemic will not been relaxed. All patients must 

continue to have their bloods checked regularly. Arrangements must be made to visit patients to take 

bloods if they are unwell. Any patients who report having flu like symptoms should have their bloods 

checked to rule out neutropenia. Oseltamivir (Tamiflu®) can safely be given to patients taking 

Clozapine. 

Medicines Information 

For general enquiries about access to or availability of medicines contact a member of the Trust 

Pharmacy Services: 

Durham locality wards – 0191 441 5775 / 0191 441 5778 

Darlington locality wards – 01325 552106/552105 

Tees locality, Scarborough and Ryedale wards – 01642 838360 

For specific queries about medicine indications, interactions, compatibilities etc. contact the Medicines 

Information Pharmacist – 0191 441 5778 

Trigger Point 


37

Plan for obtaining antiviral medicines for inpatients in Durham, 

Darlington & Tees Localities out of normal working hours – Treatment 

Phase 

First Steps 


Medication needs will be based on clinical diagnosis of H1N1 (swine) flu based on 

clinical symptoms. Medication must be prescribed on the drug prescription and 

administration chart. 

All cases needing treatment must be notified in the first instance to the 1 st On-Call 

by the ward. The 1 st On-Call will then contact the On-Call Pharmacist and inform 

second on call. The second on call will inform the Director On-Call. On-call 

Pharmacist - 07787 105 800 

The on-call Pharmacist will then arrange for the ward to access a supply from the 

emergency cupboard. 

38

Alternate 

Resources 

Preparing for 

Continuity 

Continuity 

Procedures 

Recovery 


The following table lists the resources that will be used during continuity 

operation of the service 

Resource Quantity Location Contact 

Oseltamivir 75mg 5 x 10 Emergency 

Cupboard, Roseberry 

Park Hospital 

Oseltamivir 30mg 2 x 10 Emergency 


Park Hospital 

Oseltamivir 75mg 5 x 10 Emergency Cupboard 

West Park 

Oseltamivir 75mg 5 x 10 Emergency Cupboard 

Lanchester Road 

Hospital 

Zanamivir 

(Relenza®) 

Zanamivir 

(Relenza®) 

Zanamivir 

(Relenza®) 

HPA website 

(www.hpa.org.uk) 

for up to date 

information 

HPA tel: 0191 202 

3978 

Roseberry Park 

reception 01642 

837300 

West Park reception 

01325 552000 


reception 0191 441 

5700 

Locate the action card 

1 pack Emergency 


Park Hospital 

1 pack Emergency Cupboard 

West Park 

1 pack Emergency Cupboard 


Hospital 

Follow the instruction on the appropriate action card 

On-Call 

pharmacist 

On-Call 

pharmacist 

On-Call 

pharmacist 

On-Call 

pharmacist 

On-Call 

pharmacist 

On-Call 

pharmacist 

On-Call 

pharmacist 

39

Plan for obtaining antiviral medicines for inpatients in North East 

Yorkshire out of normal working hours – Treatment Phase 

First Steps 

Alternate 

Resources 

Preparing 

for 

Continuity 

Continuity 

Procedures 

Recovery 


Medication needs will be based on clinical diagnosis of H1N1 (swine) flu based on 

clinical symptoms. Medication must be prescribed on the drug prescription and 

administration chart. 

All cases needing treatment must be notified in the first instance to the 1 st On-Call 

by the ward. The 1 st On-Call will then contact the Acute Trust Emergency Duty 

Pharmacist and inform the second on call. The second on call will inform the 

Director On-Call. To contact the Emergency Duty Pharmacist call Scarborough 

Acute Trust switchboard and request the Emergency Duty Pharmacist – 01723 

368111 

The Emergency Duty Pharmacist will then arrange for a supply to be issued to the 

ward. 

The following table lists the resources that will be used during continuity 

operation of the service 

Resource Location Contact 

Oseltamivir 75mg Pharmacy, 

Scarborough Acute 

Trust 

Oseltamivir 30mg Emergency 

Pharmacy, 


Trust 

Zanamivir 

(Relenza®) 

HPA website 

(www.hpa.org.uk) 

for up to date 

information 

HPA tel: 0191 202 

3978 


Trust switchboard 

01723 368111 

Locate the action card 

Pharmacy, 


Trust 

Emergency Duty 

Pharmacist 


Pharmacist 


Pharmacist 

Follow the instruction on the appropriate action card 

40

Legislative Framework 

Trust services are delivered within a number of legislative frameworks, that impact directly on the care 

processes delivered. These primarily include: the Mental Health Act, the Mental Capacity Act, 

Safeguarding Adults and Safeguarding Children. 

During a pandemic outbreak the administration of all of those processes may be significantly reduced 

or indeed cease. 

The Trust is currently awaiting guidance from the Department of Health regarding the contingency 

plans for the delivery of the Mental Health and Mental Capacity Acts processes during a PI. In the 

event of that guidance being unavailable and there being disruption or inability to deliver the service 

then a shadow system, using Trust procedures and internal staff from different teams to that of the 

Responsible Clinician (RC) will operate. Protection of the patient‟s rights and the protection of the 

public will be the prime objectives of an emergency system. 

In addition, the PCT cluster groups have responsibility for the commissioning of specific elements of 

Mental Capacity Act infrastructure and the Trust is currently awaiting guidance from those agencies 

regarding the contingency planning for the delivery of the Deprivation of Liberty Standards. Proposals 

from the Department of Health hwere received in 2011 to temporarily amend legislation in the event of 

a pandemic but no definite decision has been made. 

The implementation of Sections 135/136 within the Mental Health Act require collaboration between 

the local constabularies and the Trust – the Trust is currently awaiting specific information regarding 

the contingency planning by the local forces for the use of Section 135/136 during a PI. Similarly the 

Criminal Justice System Activity will suffer impact at different stages of a PI and advice is awaited with 

regard to the continuity and contingency plans for the local Criminal Justice Systems. 

The Trust is currently awaiting information from the Local Authority PI Plans regarding the 

maintenance of infrastructure for delivery of Safeguarding procedures. 

Other elements of the assurance systems that are important to maintain as they form part of the 

compliance framework will maintained in line with BCP. Wherever possible disruption of corporate 

assurance systems will be minimal. 


41

Specialist Services 

The Trust delivers a number of services that are either in partnership with another agency or that have 

a wider impact across the Health and Social Care economy. Specialist arrangements will need to be 

developed to ensure the robust planning of contingency for these services during Pandemic Influenza 

out break. 

1. Forensic Services (medium and low secure) – a memorandum of understanding will need to be 

developed with the neighbouring Mental Health Trust to ensure continuity of services within the 

SHA region for this specific service user group. Further work will also be required with regard to 

the access to higher levels of secure forensic services outside the SHA area. 

2. Specialist Young People Services (Tier 4) – currently there are NHS Tier 4 YPS beds in Newcastle, 

Teesside and York with some additional independent sector provision. The bed numbers are 

particularly limited for this service and contingency planning will need to include shared services 

that will require a memorandum of understanding. 

3. Liaison Services into Acute Trusts – these services are commissioned on a limited basis and may 

quickly become overwhelmed by the triage demands in the Acute Trust. Further partnership 

planning is required to ensure service user needs are appropriately prioritised and met in these 

scenarios. 

Recovery Planning 

As the impact of the pandemic wave subsides and it is considered that there is no threat of further 

waves occurring the UK will move into the recovery phase. Although the objective is to return to prepandemic 

levels of functioning as soon as possible, the pace of recovery will depend on the residual 

impact of the pandemic, ongoing demands, backlogs, staff and organisation fatigue and continuing 

supply difficulties in most organisations. A gradual return to normality therefore should be anticipated 

and expectations shaped accordingly. Plans at all levels should recognise the potential need to prioritise 

the restoration of services and to phase the return to normality in a managed and sustainable way. 

The reintroduction of performance targets and normal care standards also need to recognise the loss of 

skilled staff and their experience. Most others will have been working under acute pressure for 

prolonged periods and are likely to require rest and continuing support. Facilities and essential supplies 

may also be depleted, re-supply difficulties might persist and critical physical assets are likely to be in 

need of backlog maintenance, refurbishment or replacement. (North East SHA 2008) 

For Tees, Esk and Wear Valleys NHS Foundation Trust there are further specific recovery issues 

pertinent to the nature of the delivery of mental health and learning disability services. 

The rates of referral for non urgent assessment and treatment during the pandemic will result in 

waiting lists where the acuity of the presentation will be increased – this is likely to require a higher 

level of intervention than would have been anticipated normally pre-pandemic. 

There are likely to be sections of the population who were vulnerable to emotional stress and loss 

and previously may not have required specialist or secondary mental health care that are now 

referred. 

The NHS has a long history of responding effectively to emergencies and increased demands upon 

individuals and teams. Some staff may, however find this experience overwhelming and will need 

support in sustaining their psychological resilience. The Trust will through the Health at Work policy 

provide timely appropriate psychosocial support and interventions for those staff members who need 

them. The aim being to support the development of personal and if necessary collective team 

resilience following a pandemic. 

The complex nature of the care packages for many of the Trusts service users require the 

collaborative work of a number of agencies. It may be therefore that certain aspects of care packages 


42

can be restored at earlier times than others resulting in a range of unmet needs that will need to be 

managed. 

The range of non critical services that are planned to be suspended during the pandemic will have 

reduced some of the infrastructure normally required to deliver services to the level of safety, 

efficiency and effectiveness normally expected by service users, their families, carers and partner 

organisations. Managing demand and expectation in the recovery phase will, therefore, be a key issue 

for the Trust. 

Although all organisations will be affected by the loss of skilled and experienced staff the succession 

planning lead in times for the training and development of the specialised workforce required by the 

Trust are lengthy and it may take considerable time for that workforce to be redeveloped to prepandemic 

standards. 

The recovery plan therefore will be determined by the impact analysis that would be made as the final 

phases of the pandemic are coming to a close and would be of a dynamic nature to reflect the ongoing 

assessment and intelligence from further analysis post pandemic. The plan would, however, have key 

principles of: 

1. Reintroduction of higher priority services, particularly assessment and treatment in the opposite 

ascending order to the close down plan. 

2. Prioritisation of safety and effectiveness, particularly with regard to the prudent use of the 

workforce skills that remain. 

3. Referral to the Business Continuity Planning that reflects the contractual obligations and guidance 

from Commissioners and Department of Health with regard to reintroduction of priority services. 

Trigger Points and Actions 

The following tables are used to document actions to be taken by the Trust in response to significant 

events and/or threat level escalations, referred to as “Trigger Points”. The purpose of these actions is to 

ensure that preparations are made in time for the Trust to be able to respond to the Pandemic when 

called upon to do so. 

The examples used here are based on the UK Pandemic Influenza Alert Levels definitions. Any other 

type of Trigger Point that may be applicable to the Trust‟s needs should be added and documented in 

this section. 

Inter-Pandemic Period 

NEEP 1 WHO Alert State : 1 BCP : White 

Description/Trigger Action(s) Action Card 

1. UK not affected unless 

infection starts in the UK or it 

has strong travel and trade 

connections with affected 

country. 

2. A declared state of enhanced 

preparedness may also trigger 

these actions as the spread of 

an infection in other parts of the 

world results in a small number 

of cases in the UK. The NHS 

may invoke this state within a 

state of pandemic containment 

aimed at preventing spread to 


1. Continue with PIP and testing 

2. Development and review of all 

emergency procedures and systems 

3. Development and review of all training, 

demonstration and coaching packages for 

emergency clinical procedures 

4. Review of all Business Continuity Plans 

on regular review schedule 

5. Maintenance of robust ESR systems and 

data accuracy 

Team Leader action 

card 

EP Lead action card 

IPC Lead action card 

EP Lead action card 

HR Business 

Continuity Plan – HR 

lead action card 

43

or within the UK. 6. Development of reserve staffing and 

volunteer databases 


7. Agreed stock piling levels to be 

maintained 

8. Regular review of patient contact, family 

and carer scenario – updating of 

community packages and support networks 

through normal CPA reviews 

9. Inclusion of PIP/BCP objectives in all 

service annual plans 

10. Inclusion of PIP/BCP arrangements for 

new service developments 

HR Business 

Continuity Plan – HR 

lead action card 

EFM Business 

Continuity Plans – 

EFM lead action card 

CPA Policy and 

instructions regarding 

role of care coordinator 

Operational Services 

Lead action card 

TEWV annual planning 

guidance 



TEWV annual planning 

guidance 

44

Inter-Pandemic Period 

Description Action(s) Action Card 

UK not affected unless it has 

strong travel and trade 

connections with affected 

country 


11. 4 weekly testing of Trust emergency 

control room systems and stock control 

12. Ongoing training and development of 

loggists 

13. Monthly meeting of EP/BCP Steering 

Group 

14. Monthly update with Control and 

Command Team and their deputies 

15. Regular security review and update of 

security arrangements 

16. Engagement with SHA and PCT 

Emergency and Pandemic Influenza 

Planning networks and processes 

TECR invocation 

instructions and stock 

check list 

Training schedule and 

work plan for loggists 

Role of EP/BCP special 

instruction 

All Control and 

Command Team 

members special 

instruction cards 

Security Lead action 

card 


card and EP Director 

action card 

45


NEEP 1 BCP : White 


NEEP 1 

WHO Alert State : 3-5 

BCP : White 

Virus / Cases only outside the 

UK 


1. Invoke level 1/2 - PIP Plans for Control 

and Command 

2. Invoke level 1/2 - PIP Plans for 


3. Invoke level 1/2 - PIP Plans for HR 

Services 

4. Invoke level 1/2 - PIP Plans for EFM 

Services 

5. Invoke level 1/2 - PIP Plans for 

Communications and PR 

6. Invoke level 1/2 - PIP Plans for Infection 

Prevention Control and Clinical Procedures 

7. Invoke level 1/2 - PIP Plans for IT and 

Telecoms 

8. Invoke level 1/2 - PIP Plans for internal 

Security services 

9. Establish regular SHA and PCT liaison 

arrangements 


card 



HR Lead action card 

EFM Lead action card 

Communications Lead 

action card 


IT and Telecoms Lead 

action card 


card 


card 

10. Routine intelligence scanning IPC Lead action card 

11. Initiate internal reporting Team Leader action 

card and EP Directors 

action card 

12. PIOT on standby to form PIP page 18 

46


NEEP 2 BCP : Green 


NEEP 2 

WHO Alert : 5/6 

BCP : Green 

New virus isolated in the UK – 

containment / investment phase 


1. Invoke level 1/2 PIP Plans for Control 


2. Invoke level 1/2 PIP Plans for 


3. Invoke level 1/2 PIP Plans for HR 

Services 

4. Invoke level 1/2 PIP Plans for EFM 

Services 

5. Invoke level 1/2 PIP Plans for 


6. Invoke level 1/2 PIP Plans for Infection 


7. Invoke level 1/2 PIP Plans for IT and 

Telecoms 

8. Invoke level 1/2 PIP Plans for internal 



arrangements 


card 






action card 



action card 


card 


card 

10. Routine intelligence scanning IPC Lead action card 

11. Increase internal reporting as per plan Team Leader action 


action card 

47


NEEP 3 BCP : Yellow 


NEEP 3 

WHO Alert : 6 

BCP : Yellow 


1. Invoke level 3 PIP Plans for Control and 


2. Invoke level 3 PIP Plans for Operational 

Services 


card 



3. Invoke level 3 PIP Plans for HR Services HR Lead action card 

4. Invoke level 3 PIP Plans for EFM Services EFM Lead action card 

5. Invoke level 3 PIP Plans for 


6. Invoke level 3 PIP Plans for Infection 


7. Invoke level 3 PIP Plans for IT and 

Telecoms 

8. Invoke level 3 PIP Plans for internal 


9. Continue daily SHA and PCT SITREP 

reporting 


action card 



action card 


card 


card 

10. Daily intelligence scanning IPC Lead action card 

11. Increase internal reporting as per plan Team Leader action 


action card 

12. Stand down EP/BCP Steering Group – 

Command and Control systems now place 

daily 

13. Board of Directors and EMT delegation 

of authorities invoked 

EP Director action 

card 

Chief Executive action 

card and Chairman 

action card 

48


NEEP 4-6 BCP : Red/Purple/Black 


NEEP 4-6 

WHO Alert : 6 

BCP : Red/Purple/Black 


1. Invoke level 3-6 PIP Plans for Control 


2. Invoke level 3-6 PIP Plans for 


3. Invoke level 3-6 PIP Plans for HR 

Services 

4. Invoke level 3-6 PIP Plans for EFM 

Services 

5. Invoke level 3-6 PIP Plans for 


6. Invoke level 3-6 PIP Plans for Infection 


7. Invoke level 3-6 PIP Plans for IT and 

Telecoms 

8. Invoke level 3-6 PIP Plans for internal 



arrangements 


card 






action card 



action card 


card 


card 

10. Daily intelligence scanning IPC Lead action card 

11. Daily internal reporting as per plan Team Leader action 


action card 

12. Control and Command systems fully 

operational – delegation of authorities to 

continue 

13. All Department of Health central 

guidance invoked regarding targets, 

financial planning, emergency legislative 

framework changes and other state of 

emergency instructions 


card, Chief Executive 

and Chairman action 

card 

EP Director action 

card and SHA 

communication 

49

Post Pandemic Period 


Return towards Inter-Pandemic 

period. 

NOTE: Further waves of illness 

caused by the pandemic strain 

are likely 3-9 months after the 

first wave has subsided. The 

second wave may be as, or 

more, intense than the first. 


1. Responding to intelligence and briefings 

through SHA/PCT SITREP responses – 

instruction to begin standing down from 

alert level 4 

2. Daily SITREP and monitoring to continue 

– move to impact analysis and stage 1 

recovery plans 

3. Maintain Command and Control systems 

as per recovery plan 

4. Board of Directors and EMT to resume 

normal levels of authority as per recovery 

plan 

5. Business Impact Analysis programme to 

commence 


card 


card 


card 

Chief Executive and 

Chairman action card 

Finance Director and 

Planning and 

Performance Director 

action card 

6. Full recovery plan invoked Team Leader and EP 

Director action card 

7. Return to inter-pandemic review, testing 

and preparatory planning for second wave 

and invoke level 0 Business Continuity Plans 

for each service 


card 

50

Action Cards for Command and Control 

Action cards for the innovation of the Business Continuity Plan are in all of the ECR rooms and the 

following action plans have been developed specifically for pandemic influenza. Copies of this plan and 

the action cards will be kept in each ECR room. 

The following action cards provide easy-to-follow instructions for members of the Pandemic Influenza 

Command and Control Team. As the Pandemic Influenza Plan is maintained and revised, additional 

cards may be added to this section, as well as updates to existing cards. 


51


Action Card 

Command and Control Team Leader 

NEEP : 1-2 BCP STATE : White/Green 

Continue with PIP implementation and testing programme. 

Engage with SHA/PCT PIP and EP networks and processes 

Monthly update with PIP Core team or deputies 

Arrange ongoing training and Development of Loggists 

Maintain communications plans 

Review and place on standby PIOT and PICT members 

All SHA/PCT/NHS contact details to be checked and updated monthly at Appendix 6. 

NEEP 2 – PICT on one month on-call rota 

NEEP : 3-6 BCP STATE : Yellow/Red/Purple/Black 

Take Category 3 position in Gold Command Structure 

Establish regular liaison with PCT/SHA PI systems –attending communication/;liaison/planning sessions as 

required. 

Invoke plans at appropriate levels in response to Gold Command instructions 

Initiate internal and external reporting at appropriate level to alert level 

Author sit-rep and ops communications 

Author Board of Directors Papers 

Disseminate external briefing as required 

Initiate and implement communication and awareness raising systems 

Initiate and implement training plans 

Initiate and implement recording and advisory contact systems 

Commission ECR and alternative CR room as required. 

Ensure library systems implemented of communications and briefings 

52


Action Card 

Communications Lead including External Agency 

Communications 


1. Maintain contact and engage with PCT/SHA Comms teams 

2. Set up PIP Intranet pages 

3 Set up internal communication systems in readiness for use 

4. Research available information and awareness materials 

5. Ensure media training attended by key staff in internal Command and Control structure 


1. Invoke communication plans appropriate to alert level 

2. Ensure internal and external reporting systems in place as required 

3. Deal with media inquires ands press releases 

4. Disseminate press releases and briefings through Gold Command structure 

53



Action Card 

IPC Lead 

Development and review of all training , demonstration and coaching packages for emergency clinical 

procedures 


As above 

Implement plans as appropriate to alert levels 

Implement routine intelligence scanning 

54


Maintenance of robust ESR processes and data accuracy 


Action Card 

Human Resources Lead 

Liaise with bank administrators regarding capacity of bank to support services 

Develop and agree plans for validation of information held and undertake validation exercise as required. 

Develop training schedules and plans for rollout of training. 

Undertake assessment of staff working in non-clinical environment that may be deployed to support critical 

clinical services. 

Regular briefings to staff side representative body. 

Agree plan for capturing staff attendance and mechanism for feeding through sitrep reports. 

Review/refresh all emergency HR procedures 

NEEP: 3 BCP STATE: Yellow 

Validation of essential staffing information if not already commenced. 

Agree plan for suspending all non-essential HR related activities. 

Implement emergency reporting of staff absence and sitrep reporting procedures. 

Issue Occupational Health briefings 

Maintenance of regular briefings to staff side representatives. 

Roll out training as identified in training schedules. 

Develop plan for implementation of redeployment of staff working in non-clinical areas. 

NEEP: 4-6 BCP STATE: Purple/Black 

Continue to track staff attendance and daily sitrep reports 

Invoke emergency redeployment measures 

Continue regular briefings to staff side representatives 

Ensure appropriate access to Occupational Health briefings and services 

55



Action Card 

EP/EFM lead 

1. Development and review of all emergency procedures and systems 

2. Ensure logistics and procurement plans in place 

3. Work with suppliers to ensure all BCPs are in place 

4. Arrange transport systems for distribution of anti viral medication, PPE and medical devices. 

5. Review all Business Continuity Plans on regular review schedule 

6. Convene/chair monthly EP/BCP meeting 

7. Engage with SHA emergency Planning systems and networks 


1. Invoke appropriate PI plans 

2. Stand down EP/BCP Steering Group - Command and Control systems now in place 

3. Board of Directors and EMT delegation of authorities invoked 

56


Action Card 

Special Instructions 

Infection Prevention and Control 

If patient admitted with the agreed criteria for H1N1 Influenza (‘Swine’) Flu 

1. Place in single room with appropriate hand hygiene facilities (en-suite facilities if possible). 

Wash hand basin, disposable paper towels and liquid soap. 

2. Contact IPCNs, 0191 333 6343. for further advice on patient management (out of hours contact 

Director on call). 

3. Ensure you have supply of Personal Protective Equipment (PPE) disposable apron, gloves and 

face masks. 

4. When in direct patient contact (within 3 feet) PPE must be worn. If possible the patient should 

wear a mask (this will depend on patients mental health state). 

5. All PPE is single use only and must be discarded after use as clinical waste. 

6. Staff and patient must follow strict hand hygiene procedures after each contact and after 

coughing or sneezing. 

7. The patient must be encouraged to cover their nose and mouth when coughing and sneezing. 

8. Paper tissues should be disposed of immediately after use as clinical waste and hand hygiene 

performed. 

9. All staff and patients to be reminded of the Catch it, Bin it and Kill it Campaign. 

10. The patient‟s room must be cleaned daily. 

11. For more detailed information please refer to IPC Guidelines during Pandemic Influenza. 

12. Action cards for specific management of patients with H1N1 swine flu are available on the 

temporary intranet site and have been circulated previously with Trust Operational Instruction. 

57


1. Ensure awareness of individual service BCPs 


Action Card 

Operational Services Lead 

2. Monitor regular sit reps and operational instructions 

3. Maintain awareness of PI plan 

4. Maintain knowledge of state of PI alert 

5. Include PIP/BCP objectives in all service annual plans 

6. Include BCP/PIP arrangements in all new service developments 

7. Regular reviews of patient contacts, family and carer scenario – CPA review/updating of community 

care plans and support networks 

8. Support HR preparedness plans with regular HR staff monitoring 

9. Implement outbreak monitoring as instructed through command and control 

10. Implement PI plan activities through operational Directorate leads 


1. Take note of regular sit rep and workforce monitoring situation. 

2. Ensure awareness of individual service BCPs. 

3. Arrange contact with operational Directorate leads 

4. Review outbreak situation 

5. Review staffing situation. 

6. Review invocation thresholds with each Directorate lead 

7. Agree level of continuity plan action for each Directorate 

8. Agree staff redeployment as required to maintain safe service levels 

9. Maintain decision log of agreed continuity planning and staffing 

10. Maintain record of incidents through duty period. 

11. Include in incident log any emergency legislative activity 

12. Maintain duty log 

13. Arrange handover briefing to next operational lead 

DURING RECOVERY STATE 

1. As above 

2. Monitor staffing situation 

3. Implement staff review and support systems 

4. Implement HR procedures 

58


Action Card - Special Instructions 


1. To ensure staff aware of usual site security procedures 

Operational Services Lead 

2. To spot check and review usual site security arrangements 

3. To maintain register of site security vulnerabilities 

4. To maintain awareness of PI developments and security implications 

5. Implement basic security awareness standards across sites through operational site management 

6. Monitor areas of security vulnerability and implement any contingency planning through operational site 

management. 


1. As in level 2 

2. Implement specific security plans as agreed with operational site management 

3. Monitor security incident reports – liaise with local police force 

59


Action Card 

For obtaining a supply of antiviral medication for 

inpatients out of normal working hours in Durham, 

Darlington and Tees 

The 1st On-Call to contact the On-Call Pharmacist to request a supply of antiviral treatment. 1 st on-call will 

advise the second on call manager who will in turn advise the Director on Call. 

The following details will be required: - 


Ward 

Medication prescribed and of dose 


Following a request from the 1st On-Call for a supply of antiviral treatment the On-Call Pharmacist will 

contact the ward to confirm patient details, treatment required and check assessment procedures have been 

followed. 

Diagnosis of H1N1 (swine) flu to be made by assessing clinical symptoms: 

Fever (temperature > 38ºC) or clinical history of fever and 

Influenza like illness (TWO OR MORE of the following symptoms: cough, sore throat, rhinorrhoea, limb or 

joint pain, headache, vomiting or diarrhoea). 

Patients at high risk of becoming seriously ill from swine flu are those with: - 

Chronic lung disease 

Chronic heart disease 

Chronic kidney disease 

Chronic liver disease 

Chronic neurological disease 

Immunosuppression 

Diabetes mellitus 

Oseltamivir should be prescribed unless the patient is pregnant or has renal failure and regularly attends a 

specialist renal clinic. These patients should be prescribed zanamivir. 

Oseltamivir dosages: 

Over 7 and under 13 years (23-40kg) 60mg (2 x 30mg capsules) twice a day for 5 days. 

Over 13 years (over 40kg) 75mg twice a day for 5 days. 

Patients with swallowing difficulties or unable to take medicines orally: Instruct to open 

capsule and mix contents with 10ml water. 

Zanamivir dose: 

Adults and children over 5 years: Two 5mg blisters to be inhaled (using the diskhaler) twice a day for 5 

days. 

60

Ward to be instructed to obtain a supply from the emergency cupboard. 

Durham locality wards to access from emergency cupboard at Lanchester Road Hospital via the Standing In 

Nurse. 

Darlington locality wards to access from emergency cupboard at West Park Hospital via the Standing In 

Nurse. 

North and South Tees locality wards to access from the emergency cupboard at Roseberry Park Hospital via 

the Duty Manager. 

Instruction to the ward when removing supplies of antiviral medication from the emergency cupboard: 

Complete the following information on the stock control sheet 

Date 


Ward 

Quantity 

Batch no & expiry date 

Name of prescriber 

Name of person removing supply 

Stock balance 

The box is overlabelled and the patient‟s name should be completed on the label. 

See Appendix 1 & 2 Emergency Cupboard instruction sheet and stock control sheets 

The next working day the On-Call Pharmacist to notify the relevant Technical Services Manager at 

Lanchester Road Hospital, West Park Hospital or Rosberry Park Hospital to notify of supplies taken from the 

emergency cupboards. 


61


Action Card 

For obtaining a supply of antiviral medication for 

inpatients out of normal working hours in North 

East Yorkshire 

The 1st On-Call to contact the Emergency Duty Pharmacist via the Acute Trust switchboard (01723 368111) 

to request a supply of antiviral treatment. 1 st on call will advise the second on call manager who will in turn 

advise the Director on Call. 

The following details will be required: - 


Ward 

Medication prescribed and of dose 


Following a request from the 1st On-Call for a supply of antiviral treatment the Emergency Duty Pharmacist 

will contact the ward to confirm patient details, treatment required and check assessment procedures have 

been followed. 

Diagnosis of H1N1 (swine) flu to be made by assessing clinical symptoms: 

Fever (temperature > 38ºC) or clinical history of fever and 

Influenza like illness (TWO OR MORE of the following symptoms: cough, sore throat, rhinorrhoea, limb or 

joint pain, headache, vomiting or diarrhoea). 

Patients at high risk of becoming seriously ill from swine flu are those with: - 

Chronic lung disease 

Chronic heart disease 

Chronic kidney disease 

Chronic liver disease 

Chronic neurological disease 

Immunosuppression 

Diabetes mellitus 

Oseltamivir should be prescribed unless the patient is pregnant or has renal failure and regularly attends a 

specialist renal clinic. These patients should be prescribed zanamivir. 

Oseltamivir dosages: 

Over 7 and under 13 years (23-40kg) 60mg (2 x 30mg capsules) twice a day for 5 days. 

Over 13 years (over 40kg) 75mg twice a day for 5 days. 

Patients with swallowing difficulties or unable to take medicines orally: Instruct to open 

capsule and mix contents with 10ml water. 

Zanamivir dose: 

Adults and children over 5 years: Two 5mg blisters to be inhaled (using the diskhaler) twice a day for 5 

days. 

The Emergency Duty Pharmacist will arrange for a supply to be issued to the ward. 

62

NEEP 1 

Action Card 

On-Call 

1. Existing on call arrangements to continue, i.e. Director on-call, Second on-call, First on call. 

2. Weekly briefing of Director on-call and 2 nd General Manager on-call by Director of Flu – Friday pm. 

NEEP 2 

1. Existing on-call arrangements to continue, i.e. Director on-call, Second on-call, First on-call. 

2. North and South localities first on-call managers, to act as “partners” in providing any additional 

support to each other if required. 

3. Weekly briefing of Director on-call and 2 nd General Manager on-call by Director of Flu – Friday pm. 

4. Director of Flu to brief Director on-call / GM on-call on out of hours activation of ECR. 

NEEP 3 

1. Command and Control Team Leader to escalate on-call arrangements and log decision 

appropriately. On call to move to „on standby‟. 

2. There will be TWO first on-call managers in EACH of North and South localities, to provide additional 

support. 

3. Enhanced second on-call rota to be activated as below: 

additional shadow manager identified at second on-call level 

period of on-call to continue on a planned weekly basis 

4. Named individual responsible for co-ordinating rota to contact those named and advise of escalation. 

5. Escalation arrangements to be briefed through 0800 full report, as 

per PICT Plan reporting agreement, to: 

EMT Members 

On-call Directors 


On-call communications manager. 

6. The Chief Executive to provide additional briefing to the Chairman and Non Executive Directors, as 

required 

NEEP 4 

1. Command and Control Team Leader to escalate on-call arrangements and log decision 

appropriately. On-call Director/Manager to be based in ECR 6.00 p.m. to 6.00 a.m. daily. 

2. There will be TWO first on-call managers in EACH of North and South 

localities, to provide additional support. 

Period of on-call to be rotated on a daily basis. 

3. Enhanced second on-call rota to be activated as below: 

There will be TWO managers allocated at second on-call level 

period of on-call to be rotated on a daily basis 

4. Named individual responsible for co-ordinating rota to contact those named and advise of escalation. 

5. Escalation arrangements to be briefed through 0800 and 1600 full 

reports through either electronic email or conference call facilities as per PICT Plan reporting 

agreement, to: 

EMT Members 

On-call Directors/General Managers (1600 hours only) 


On call communications manager. 

T:\Policies\Policies - TEWV\Plans\Pandemic influenza plan 2012.doc 

63

6. The Chief Executive to provide additional briefing to the Chairman and Non Executive 

Directors, as required 

POST FLU CON 

1. Command and Control Team Leader to de-escalate on-call arrangements and log decision 

appropriately. 

2. De-escalation to be briefed through full reports (0800/1600 hours), as per PICT Plan reporting 

agreement, to: 

EMT Members 

On-call Director/General Managers 


3. Named individual responsible for co-ordinating rota to contact those named and advise of deescalation. 

4. Carry out review to establish lessons learnt and areas of good 

Practice. 


64

BACKGROUND 

Action Card 

Ordering of Personal Protective 

Equipment (PPE) for clinical staff 

For the management of H1N1 Swine Flu it is recommended that all clinical areas and 

community teams hold an agreed stock of PPE (1 month supply). Details of when to use PPE 

can be found in the Infection Prevention and Control Guidelines and Swine Flu Action Cards – 

available on the Trust Intranet. 

1. All clinical leads must ensure they have a minimum 2 weeks stock of the 

following: 

Disposable gloves 

Disposable aprons 

Eye protection 

Disposable surgical face masks 

Tissues 

Paper towels 

Detergent wipes 

Liquid soap 

Waste bags 

Staff should ensure that all stocks are maintained and replenished. 

2. If no stocks are available from your normal supply chain (CARDEA) or there has 

been a delay in delivery there is a small limited emergency stock at Flatts lane 

Stores Department, which can be accessed. 

3. Contact Flatts lane on 01642 516437 to order required stock. 

4. Arrange to collect stores from Flatts lane using Trust transport with agreement 

from Unit manager/lead. 

5. The Stores Department will log your PPE request to ensure accurate records are 

maintained. 

6. Ensure you re-order stocks using normal supply chain route. 


65

Action Card 

Distribution of Personal Protective 

Equipment (PPE) for procurement staff at 

Flatts Lane stores 

BACKGROUND 

A small supply of PPE is stored in a central area at Flatts Lane 

All PPE has been logged with the expiry dates where applicable and is available for collection 

by TEWV staff in the event of wards not having the appropriate PPE. 

1. If TEWV staff contact department please ask the following: 

1.1 They have no stock of the item requested within their unit. 

1.2 They have a patient with clinical diagnosis of swine flu. 

1.3 They have already processed an order for the PPE through their normal 

supply chain route (CARDEA). 

2. Arrange for collection/delivery of required PPE using Trust transport agreed by 

unit manager/lead. 

3. Log all PPE that leaves the store on the agreed sheet. 

4. Inform PI flu team 0191 333 6361 to ensure that action is logged. 


66

BACKGROUND 

Action Card 

For ordering Personal Protective 

Equipment (PPE) via PRONE system for 

procurement staff and PI Control Team 

This system will only be operational in the event of a national shortage of any of the agreed 

PPE required for Swine Flu. This is not to be used as a top-up system but only when supplies 

are exhausted. Only the procurement lead for the Trust or nominated persons will be able to 

order. Current leads are Derek Stokoe and Linda Parsons. 

Prior to contacting PRONE – ensure the following actions are taken: 

1. Ensure that there are no local stocks and that the normal supply chain is not 

functioning. 

2. There are no further supplies at Flatts Lane 01642 516255 in the central stock. 

3. Follow agreed PRONE procedure to order out of stock product. 

4. Once an order has been placed PRONE will check their stock against the Trust‟s 

allocation. 

5. If we are within our stock allowance it will be despatched to the designated 

location on the agreed delivery date. 

6. If we are not within our stock allowance refer problem to Command and Control 

team on 0191 333 6361 

7. Log and record all activity. 


67

ndix 2 – Standard Situation Report (SITREP) 

Appendix 1 – Infection Control Guidelines 

INFECTION PREVENTION AND CONTROL GUIDELINES DURING PANDEMIC INFLUENZA 

1. PREVENTION AND CONTROL MEASURES 

In the event of a pandemic, clear guidance will be issued based on the advice of the UK National 

Influenza Pandemic Committee, guidance from the WHO or real time modelling as the evidence 

evolves or the need arises. However it is likely that strategies for the prevention and control of 

influenza in health care facilities will include the following: influenza vaccination (when available) for 

person at high risk for complications, vaccination (when available) for health care personnel, 

respiratory hygiene/cough etiquette programmes, Standard Precautions and Droplet Precautions, 

use of antivirals and restriction of ill visitors and personnel. 

In the early stages of pandemic, it is likely that there will be a lag between virus identification and 

manufacture of vaccine supply of up to 6 months. It is also unclear whether antivirals will be 

effective and/or widely available. Therefore infection control procedures outlined here will focus on 

Standard Precautions (including hand hygiene), respiratory hygiene/cough etiquette programmes, 

Droplet precautions and restricting unnecessary social interactions as much as possible. 

The adherence to the following Infection Prevention and Control (IPC) control measures will 

minimise the risk to patients, staff and visitors to the organization. 

2. HAND HYGIENE 

2.1 Introduction 

Hand hygiene using recognised techniques is the single most effective means of reducing the risk of 

cross-infection. There is no limit to the varieties of organisms both pathogenic and non-pathogenic 

that may be on the skin at any one time. 

2.2 Aims of Hand Hygiene 

To prevent potential pathogenic organisms colonising the hands of staff and being transported to 

others, therefore creating a risk of infection 

2.3 Levels of Hand Hygiene 

1. Thorough hand washes with liquid soap and water, rinsing and thorough drying 

with a disposable towel will remove transient organisms and reduce the level of 

resident organisms. 

2. Alcohol hand rubs are a rapid decontamination method and are very effective at 

removing transient bacteria. They must only be used if the hands are physically 

clean. 

Frequently for hand hygiene is determined by actions: those completed and those intended to be 

performed. 

2.4 Hand Decontamination 

Before regular hand decontamination begins all wrist watches, and ideally, hand jewellery, should 

be removed. Cuts and abrasions must be covered with waterproof dressings before starting work. 

2.5 Handwashing 

When to wash Hands 

Hands must be decontaminated before and after every episode of patient contact and 

whenever hands are visibly dirty 

after visiting the toilet 


68

efore preparing, handling or eating food. 

When to Decontaminate Physically Clean Hands with Alcohol Hand Rub 

Examples: 

before caring for any patient 

after removing gloves, aprons and masks 

between patient contacts 

after contact with paper tissues 

Respiratory Hygiene/Cough Etiquette Programs 

Respiratory hygiene/cough etiquette should be implemented at the first point of contact with a 

potentially infected person to prevent the transmission of all respiratory tract infections in health 

care settings. Respiratory hygiene/cough etiquette programs include: 

Posting visual alerts instructing patients and persons who accompany them to inform health 

care personnel if they have symptoms of respiratory infection. 

Ensure that supplies for hand washing areas available where sinks are located; providing 

liquid soap, disposable paper towels and dispensers of alcohol-based hand rubs. 

Encouraging coughing persons to sit at least 3 feet away from others, if possible. 

Standard Precautions 

During the care of any patient with symptoms of a respiratory infection, health care personnel 

should adhere to standard precautions; 

Wear gloves if hand contact with respiratory secretions or potentially contaminated surfaces 

is anticipated. 

Wear an apron if soiling of clothes with a patient‟s respiratory secretions is anticipated. 

Change gloves and apron after each patient encountered and perform hand hygiene 

Decontaminate hands before and after touching the patient, after touching the patient‟s 

environment, or after touching the patient‟s respiratory secretions, whether or not gloves 

are worn 

When hands are visibly soiled or contaminated with respiratory secretions, wash hands with 

liquid soap and water 

If hands are not visibly soiled, use an alcohol-based hand rub for routinely decontaminating 

hands in clinical situations. Alternatively, wash hands with liquid soap and water. 

Droplet Precautions 

In addition to Standard Precautions, health care workers should adhere to Droplet Precautions 

during the care of a patient with suspected or confirmed influenza: 

Place patient into a single room. If a single room is not available, place suspected influenza 

patients with other patients suspected of having influenza. (Cohort Nursing) 

Wear a surgical or procedure mask upon entering the patient‟s room or when working 

within 3 feet of the patient. Remove the mask when leaving the patient‟s room and dispose 

of the mask as hazardous waste. 

If patient movement or transport is necessary, have the patient wear a disposal surgical 

face mask, if possible. 

3. GUIDANCE ON STANDARDS FOR CLEANLINESS DURING A PANDEMIC INFLUENZA 

The standards of cleanliness during a Pandemic Influenza will be influenced by: 

Staff levels 

Cohorting of patients with influenza 

Reduction in non essential services 

The Hotel Services staff will ensure that minimum standards are maintained within the resources 

they have available to them. 

Key target areas which must be cleaned daily include: 

- Those wards with patients with pandemic influenza. 

- Bathroom and toilet areas of all in patient facilities 


69

- Prompt correct and disposal of all used tissues, face masks 

4. CONTROL OF INFLUENZA OUTBREAKS IN HEALTH CARE SETTINGS 

When influenza outbreaks occur in health care settings, additional measures should be taken to limit 

transmission. These include: 

Identify influenza virus as the causative agent early in the outbreak by obtaining rapid 

influenza virus testing of patients with recent onset of symptoms suggestive of influenza. 

In addition, obtain viral cultures from a subset of patients to determine the infecting virus 

type and subtype. 

Implement droplet precautions for all patients with suspected or confirmed influenza. 

For management of admissions/patients who develop flu or fulfil the criteria set out by the 

HPA – see Action Plans in PI Plan. 

Separate suspected or confirmed influenza patients from asymptomatic patients. 

Restricted staff movement from areas with outbreaks to other units and buildings. 

Curtail or eliminate elective admissions on advice from Command and Control 

Obtain anti-virals for any symptomatic patients using the agreed Department of Health 

procedures via local PCTs where the patients NHS number will be required 

Restrictions for Relatives and Visitors 

If there is no or only sporadic influenza occurring in the surrounding community: 

Discourage persons with symptoms of a respiratory infection from visiting patients. Inform 

the public about restricted visitation through educational activities. 

Follow SHA/DoH guidance for informing the staff and general public ie developments. 

If widespread influenza activity is in the surrounding community: 

Actively communicate to the public at large (e.g. via public service announcements) and 

visitors (e.g. via posted notices) not to visit for 5 days following the onset of a respiratory 

illness. 

For further guidance for visitors see Appendix (ii). 

5. Management of Patients in Community Settings 

Influenza patients who are unable to access secondary care will need to be cared for in their own 

home or residential settings as far as possible and where required and appropriate care taken to 

them. Advising those who are ill with the influenza virus to stay at home asked to self care (if they 

are able to) or access care from their own home is likely to be the most effective way of slowing or 

limiting the general spread of infection. 

Users of mental health and learning disability services presenting symptoms of pandemic influenza 

should approach health services in the same way as the rest of the population. This includes 

accessing anti viral treatment and information via the local PCTs. 

However for many people who cannot do this directly their families, neighbours and Trust staff, may 

need to arrange access to services on their behalf. 

6. PROTECTIVE CLOTHING 

6.1 Disposable Aprons 

Staff must wear a disposable and water repellent plastic apron to protect uniforms and clothes 

during patient contact when there is a risk that clothing may be exposed to blood, body fluids, 

secretions or excretions, with the exception of sweat. 

Plastic aprons should be worn as single-use items, for one procedure or episode of patient care. 

The clothing of health care workers will require protection during certain procedures. 

The use of disposable and water repellent plastic aprons will prevent: 

a. Heavy contamination of the uniform with micro-organisms 


70

. Moist soilage of the uniform. 

6.2 Gloves 

The use of gloves should never be viewed as a substitute for appropriate hand hygiene. 

Provided gloves are correctly used they are an important aid in reducing the transfer of microorganisms. 

For gloves to be effective health care staff need to wear them appropriately. 

- Gloves must be change both between patient contact and between performing 

separate procedures on the same patient. 

- Gloves must be removed immediately after completion of the patient process for 

which they were worn. 

- Gloved hands should neither be wiped with any form of alcoholic substance nor 

washed. 

- Gloves must be correct size. 

- Gloves are not required for routine care of patients with pandemic flu, but are worn 

when standard universal precautions are necessary e.g. contact with body fluid 

including respiratory secretions. 

6.3 Surgical Face Masks 

Required for close patient contact with symptomatic patients (e.g. within 3 feet). 

Surgical face masks should cover both the nose and the mouth and not be allowed to 

dangle around the neck after usage. 

Must not be touched once put on. 

Must be changed when they become moist. 

Must only be worn once and discarded in an appropriate receptacle as hazardous waste. 

Hand hygiene must be performed after disposal is complete. 

Must be worn by staff when undertaking any aerosol generating procedures in health care 

settings. 

6.4 Gowns 

Gowns are not required for the routine care of patients with influenza. 

Gowns are only required on the rare occasion when extensive soiling/splashing of 

uniform/clothing is anticipated e.g. intubation and activities which require the patient to be 

held close. Example: medical emergency, resuscitation. 

6.5 Cohorted Areas (Where patients with symptoms are nursed 

together) 

May be practical for staff to wear a single surgical face mask upon entry to clinical area and 

keep on for duration of activity or until the mask needs replacing eg when it becomes moist 

approximately after 20 minutes. 

Gloves/aprons must be removed between patients and hand hygiene performed. 

All contaminated PPE must be removed before leaving a patient care area. 

Surgical face masks must be removed last followed by thorough hand hygiene. 

Environmental cleaning must be maintained in all key areas. 

6.6 Additional 

Hand hygiene must be carried out after removing protective clothing. 

Patients and staff should be encouraged to cover their nose and mouth when coughing or 

sneezing. Paper tissues should be disposed of immediately after use and hand hygiene 

performed. 

6.7 Occupational Health 

Prompt recognition of Health Care Workers (HCW) with influenza is essential to limit the spread 

of the pandemic. 

HCW with pandemic influenza should be excluded from work; exceptions may be necessary. 

HCW at high risk of complications should not provide direct care. 


71

Bank and agency staff should follow the same deployment advice as permanent staff. 

If a member of staff develops symptoms whilst on duty he/she must report to their manager 

immediately. 

Those with symptoms of pandemic flu should be excluded from work. 

Staff who have recovered from pandemic flu 

All HCW who have recovered from flu should report to their manager before resuming work. 

All staff illness should be recorded as it may affect future deployment. 

This group of HCW can care for people with influenza. 

Workers at risk from complications from Pandemic Flu 

Pregnant women and immunocompromised staff should be considered for alternate work assignment 

away from direct care for the duration of the pandemic. 

This must be agreed prior to outbreak by line manager, staff member and OHD. 


72

1. Signs of 

influenza 

temperature 

cough 

PANDEMIC INFLUENZA PATIENT ADMISSION FLOWCHART 

Admit to nominated 

flu ward or place in 

single room or if in 

cohorted area 

Check temperature 4 

hourly. Ensure all 

respiratory 

precautions are in 

place as per IPC 

guidance 

Once symptom free for 

72 hours patient can 

be transferred to nonflu 

area/ward 

2. Diagnosed as 

influenza 


3. No signs of 

influenza 

Admit to ward 

where no cases of 

pandemic influenza 

have been 

diagnosed 

Monitor as normal 

If patient develops 

symptoms follow 

from Step 1 

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VISITING POLICY DURING PANDEMIC INFLUENZA 


(Appendix ii – IPC) 

1. If there is no or only sporadic influenza occurring in the surrounding community: 

Please contact he ward/unit if you have a respiratory infections or symptoms of flu. Do not visit 

if you do have symptoms and seek advice on when you are well enough to resume visiting the 

ward/unit. 

2. If influenza is widespread in the community: 

Please contact the ward/unit prior to visiting to be advised on the current influenza status on 

the ward. 

Look out for posted or televised announcements. 

Please do not visit for 5 days following any respiratory illness. 

74

Pandemic Influenza Plan - Tees, Esk and Wear Valleys NHS ...

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