Whilst many threats to
service sustainability arise
from local economic and
increasing globalisation can
have profound local effects.
As the world saw with the spread of the severe
acute respiratory syndrome – better known as
SARS – rapid human transport systems meant that
the disease spread to some 30 countries and areas
worldwide with frightening speed.
Planning for a pandemic in NHS Lothian is at an
advanced stage but intensive preparations are still
required over the coming year. This article sets out
recent progress at national and local level.
It is over 40 years since the last influenza
pandemic. As the three pandemics which occurred
in the last century did so at intervals of less than 38
years it is recognised that a pandemic is due. But
we still do not know when it will occur. Pandemic
influenza occurs when an influenza A virus
sub-type emerges or re-emerges which is:
Markedly different from recently
Able to infect people;
Readily transmissible from person to person;
Capable of causing illness in a high proportion
of those infected; and
Able to spread widely because few – if any –
people have natural or acquired immunity to it.
It is impossible to forecast the precise
characteristics, spread and impact of a new
influenza virus strain. Modelling suggests that
from the time it begins in the country of origin it
may take as little as two to four weeks to build
from a few to a thousand cases and could
reach the UK within another two to four weeks.
Once in the UK, it is likely to spread to all major
population centres within one or two weeks, with
its peak around six to seven weeks from initial
entry. The pandemic may occur in one wave or a
series of waves, weeks to months apart. A fully
effective vaccine is unlikely to be available until
after the first wave.
The impact on the health service, as on all
public services and the private sector, is likely to
be on a scale not witnessed before by the current
work force. The increase in patient demand will
be coupled with a potential one third reduction in
workforce as staff themselves are unable to work
due to flu affecting them or their family members.
Sustainability of health services therefore requires
very significant planning.
The national context
In November 2007, the Scottish Government
released ‘A Scottish framework for responding to
an influenza pandemic’. This document set out the
framework within which planning for a pandemic
should take place and recommended planning
for up to a ‘reasonable worst case scenario’ of
50% attack rate, 25% complication rate, medical
assessment rate of 32%, hospitalisation rate of
4% and excess death rate of 2.5%.
The Government also announced strengthened
counter- measures that saw :
Doubling the stock of antivirals to cover at least
half the population;
14.5 million (m) courses of antibiotics for
at risk groups;
34m disposable respirators and 350m surgical
masks for frontline staff;
Stockpiling of 3.3m doses of H5N1 prepandemic
Advance supply agreements with vaccine firms
to deliver vaccines for the entire population once
the virus strain is known.
Pandemic ‘Flu in Lothian
Over the whole course of the pandemic, estimates
based on Scottish Government projections
suggest that some 400,000 people could be
infected. This is nearly half the Lothian population.
These infections are likely to lead to 128,000
additional GP consultations and 16,000 extra
hospital admissions. Unfortunately we can also
expect some 10,000 additional deaths.
We can expect the pandemic will peak around
six weeks after the first cases have happened in
Lothan. During that peak week, we can expect to
have to deal with:
88,000 new cases;
30,000 GP consultations;
3,500 hospital admissions; and
2,240 additional deaths
Per GP practice within the peak, this equates to
around 210 additional consultations, 30 hospital
admissions and 20 deaths.
Planning in Lothian
Planning is ongoing at all levels throughout the
NHS in Lothian. Our degree of preparedness was
last assessed in November 2006. A summary of
this self-assessment is contained in Box 1.
The co-ordinating group for the NHS Lothian
response is the Avian Influenza and Pandemic
Preparedness Group (AIPG). This group reports
to the Lothian Emergency Planning Strategic
Advisory Group. It works closely with the Business
Continuity Planning Group and Divisional
Emergency Planning Groups.
The AIPG is currently working to ensure that
there are sustainable:
Primary care services;
Hospital and other secondary care services;
Supplies of medicines;
Means of controlling other communicable
Joint working arrangements between health and
social care services;
Human resources and staff management
Bereavement support for those who have
A Lothian multi-agency pandemic plan has been
in place since October 2005 and is currently being
updated to reflect the new national framework. The
plan has been exercised on a number of occasions:
Exercise Fawkes – provision of primary care
services (March 2006);
Exercise Long Shadow – overall NHS Lothian
response (April 2006);
Exercise Big Chill – a joint NHS Health
Protection Scotland exercise for South East
Scotland (May 2006);
Exercise Mindful Peace – provision of hospital
and secondary care services (June, 2006); and
Exercise Winter Willow - the UK national pandemic
‘flu exercise (January/February 2007).
The two key elements of work within 2006/07
were on operationalising the plan and business
continuity planning. The initial focus of work has
been at Lothian NHS Board and secondary care
level. It is now appropriate to prioritise primary
care issues in this area for 2008 and 2009.
It is also important for people and
professionals to be aware of the risk associated
with pandemic ‘flu and how the Government is
planning its response. If you want to know more
about pandemic ‘flu you can sign up for the
Scottish Government’s e-newsletter at
A pandemic is inevitable and its impact will
be immense. We can’t predict when it will
happen but we can plan our response.
We already know that during the peak week
of the pandemic we can expect that, on
average, each GP practice in Lothian will
have to deal with to around 210 additional
consultations, 30 hospital admissions and
The Scottish Government’s view of
Lothian’s response to a national self
assessment exercise concluded that
‘preparations for pandemic flu are
advanced in NHS Lothian’.
Whilst NHS Lothian staff have achieved a
great deal within the last year in pandemic
influenza and business continuity planning,
there is more that can and will be done.