Philip DaSilva on preparing for a pandemic

In the uncertain wait to see what pattern the swine flu virus will take, the UK has a small window of opportunity to prepare. Plans must be integrated and ready for swift, flexible implementation depending on the numbers and location of confirmed cases.

It is perhaps unusual to focus so much energy on flu as we blow the dust off heatwave plans and enjoy the summer months. However, as the World Health Organisation last week declared the first pandemic for 40 years and with more confirmed cases being identified daily by the Health Protection Agency, we need to prepare now for what may be a tough winter.

It is therefore right for all NHS organisations to refresh their flu plans and gain assurance they are fully integrated into core business. Although the H1N1 virus that has been spreading is relatively mild, with few hospitalisations, the pandemic declaration must make this become a top priority for all boards: it is a key governance issue, not just a public health responsibility.

This may require fine-tuning structures and, where necessary, enhancing support through, say, public health teams, to ensure the wider “winter planning” process is fully integrated. It is unacceptable for organisations to keep pandemic flu planning with public health departments while they prepare winter plans for the customary seasonal increase in activity. It is important that all NHS boards are assured now that their local plan is robust, integrated and can be implemented successfully.

The good news is that we are approaching this challenge from a strong platform. Many people have been working tirelessly on preparing pandemic plans for several years, albeit built on the science and knowledge of the moment. The Department of Health has acted with clear leadership through the national director for pandemic influenza preparedness and this is now complemented with the secondment of a strategic health authority chief executive to support the implementation of pandemic plans across the NHS.

The SHAs have responded and are working with their constituent organisations, including the Health Protection Agency, to co-ordinate a review of plans and encouraging frontline organisations to work collegiately with local stakeholders to prepare to implement plans as required.

The lead for this implementation at a local level must come from the primary care trusts, in harmony with their NHS partners and wider stakeholders. PCTs should assure themselves that the local health and social care economy is well prepared to respond to the imminent increase in confirmed cases.

Win confidence

The NHS has worked through two previous pandemics, the Asian flu pandemic of 1957 - which coincidentally was when the number of beds in the NHS was at its peak - and 1968; but we are now planning for a pandemic with fewer NHS beds. While this subject is too often a political football, it does reflect the significant advances in technology and improvements in the efficiency of care and patterns of treatment, while also revealing that the NHS is operating more efficiently.

But this requires plans to be robust and to use all available modes of intervention and flexible use of resources, avoiding all unnecessary hospitalisation of cases. It is also vital that as organisations move from planning to implementation, they retain the confidence of the public and the good reputation of the NHS through clear and timely communication.

This, together with advances in medicine, particularly in vaccines and the advent of antivirals, offers us a real chance to plan to control the impact of any pandemic and minimise the morbidity and mortality of disease. But we will only achieve this if all NHS staff appreciate the important role they play.

There is a social responsibility and professional duty on all staff to ensure they understand the actions required to contain and control the spread of the virus. This includes conveying good hygiene messages and intervening to minimise the effects of any pandemic. This will only be achieved if all staff, especially frontline clinicians, feel supported, and this is particularly important for the primary care teams, which will inevitably be facing the biggest challenge of all.

This governance issue requires all NHS boards to act now and assure themselves they not only have a tested plan, but that there is a clear process to implementation. All NHS staff must respond to the threat of a pandemic and make themselves aware of their organisation’s plan and how to respond when it comes to implementation.

Do not rely on the emergency planning officer or flu lead to do it - they may not be there.

• See NHS flu czar warns PCTs over pandemic plans