How to maintain business as usual in a swine flu pandemic

Around 50 people file into the education centre at University College London Hospitals foundation trust. They are there to prepare for pandemic flu.

A flu pandemic game was originally developed in 2006 by NHS Camden and Camden council so the primary care trust and council could help voluntary groups and businesses plan for a pandemic. It has been part of the foundation trust’s pandemic preparations for some years.

It is now downloadable from the Department of Health’s websites in two versions, adapted for GP surgeries and for other NHS organisations.

“It’s an artificial scenario designed to consider the effects of a pandemic on business continuity,” says UCLH infection control nurse and flu lead Martin Bruce. “It is all about getting people with managerial or service level responsibility to think about what impact a flu pandemic would have.”

Today’s session is “about making sure all our staff have thought about all the eventualities and what would happen in the worst case scenario,” says Mr Bruce. “Hopefully they will go away and review their divisional plans.”

Chance events

The chair for today is NHS Camden public health and pandemic planning lead Suzanne Lutchmun.

“We called it the Camden flu game because we all know how to play games and roll dice,” she says. “So here we have a game of probability and chance, played over 15 weeks of a flu pandemic. We hope it will help you to see the interdependencies between organisations and how chance events that are out of your control entirely can affect you.”

Everyone sits in teams of four or five, and on each table is a file with company information, a set of job roles, five dice and a staff absence sheet. HSJ joined a transport manager, finance manager, communications manager and service manager.Our table is a staffing agency providing IT, HR and administrative staff to, among others, a large local NHS trust.

At other tables are a supermarket, a station, the local post office, a nursery and a car mechanics business. We share out the paper figures denoting the jobs we represent.

Ms Lutchmun announces week one of the pandemic and instructs us to roll the dice four times for each character. Roll four sixes and our character is off sick with flu for three weeks.

Out of 50 people in the room, only one gets infected - a car mechanic.

As the weeks go on, the odds of getting flu get shorter and more succumb. By week five the post office is severely hit, with the keyholder off sick. At the station both security officers have flu and the station must be closed at night. The mechanics have only one person qualified to do MoTs. The business has a huge contract with the ambulance service, so it looks as if there may be problems ahead for the NHS. The nursery, which provides a service for NHS workers, calls in agency staff.

Week six and Ms Lutchmun throws in the first chance card: the public transport system is down. On our table we are to assume half our staff travel by public transport and to throw the dice once for each of them. If we roll a one, then that person is off sick for a week. The odds of getting flu continue to shorten; we lose our managing director but another business loses the person who runs the payroll.

“So now your staff are overworked and not being paid,” says Ms Lutchmun. “How do you think they feel?”

Week 10 and the odds of catching flu get longer again, following the flu pandemic curve (see graph). But another chance card: half the local schools close for two weeks because of a flare-up of infections. The mechanics have no one to do MoTs and three weeks later go bust. The GP surgery loses two doctors and the receptionist and starts advising patients to go to accident and emergency.

Interdependence

By week 15 things are settling down. New infections are rare and most people are back at work. At my table, managers agree it gives a good insight into how we depend on each other.

One service manager says: “We are a new hospital and have very little storage room so rely on regular deliveries of dressings and other supplies. I need to check our contingencies.”

That is music to Mr Bruce’s ears: “It gives people an understanding of how a pandemic could impact on their daily work and their colleagues and makes them think ‘what would I do if…’”