Planning for pandemic flu

[This will also be located in "Preparations" on the side-bar for future reference]

12 Mar 2009

If an outbreak of pandemic flu hits England, the health service as we know it will be overwhelmed. Sufferers will be directed to the National Pandemic Flu Line for advice and help. Clinical Solutions is providing some of the tools that will power the line. Sarah Bruce reports.

Clinical Solutions is working with the Department of Health and NHS Direct on the helpline services that will be put in place if England is hit by a flu pandemic.

The British Medical Association and Royal College of General Practitioners warned recently that the 24-hour National Pandemic Flu Line service would be the only route for people to get advice and antiviral medicines in the event of an outbreak.

Dr Laurence Buckman, chair of the BMA’s General Practitioner Committee, said a pandemic would be a “major health emergency that would require a totally different way of helping patients.”

The National Pandemic Flu Line

A flu pandemic is regarded as a certainty, even though it is impossible to say when one will hit. The National Framework for Responding to an Influenza Pandemic, issued by the Cabinet Office and the DH in 2007, predicted that when it does, “half the population could develop the virus.”

About 4% of those infected will need medical treatment and between 0.2% and 2.5% will die. The National Framework calculated that this meant “between 50,000 and 750,000 additional deaths could have occurred by the end of a pandemic in the UK.”

It also warned that GPs and other primary care services would have to focus on particularly high risk groups and on caring for people who might normally be admitted to hospitals, since these would come under “severe pressure.”

Neither hospitals nor GPs will dispense antiviral drugs. Once the World Health Organisation says that a pandemic is underway, people will be told to call the flu line, which will assess their symptoms and issue them with a unique reference number (URN) for antiviral medicines.

People will be asked to send “flu friends” to pick up points arranged by primary care trusts to collect their drugs. Therefore, the flu line will not only provide the public with advice without receiving face-to-face clinical assessment, but help to limit the virus from spreading through contact.

The flu line will be organised around local influenza coordination centres. The DH predicts that these will need to be able to handle a “minimum of 11,000 influenza-related telephone calls per 100,000 population” in each 24 hour period.

It advises primary care trusts to call on local authorities and others running call centres to help find the necessary staff. They will use Clinical Solutions tools to assess patients and provide them with advice or URNs and to record who has been given antiviral drugs.

The role of Clinical Solutions

Clinical Solutions is known for its InterfleCS products, which help health professionals to assess symptoms and direct patients to appropriate services. Its customers include NHS Direct, NHS 24 in Scotland and many of the Walk-in Centres across England.

It has developed a tool known as InterfleCS Health Watch to help governments with symptom assessment, health information and public health incident management.

This was created for the government in Australia, where the company helped to run a major simulation called Exercise Cumpston 06 to test preparations for a pandemic flu outbreak.

The DH and NHS Direct subsequently decided to adopt the tool to assist in the early detection of pandemic flu, monitor the development of an outbreak and to assist sufferers.

Richard Craven, director of Clinical Solutions, told E-Health Insider: “We are being told to expect millions of contacts over a 16 week period [if a pandemic hits]. So, the tool has to be able to operate on a massive scale and to be hugely flexible.”

Health Watch will help the people staffing telephone service to steer clinicians and consumers through the complex healthcare delivery process. However, Craven acknowledged that if it was overwhelmed, callers would be directed to an automated service instead.

“People will be able to access the tool on the web to carry out a self-assessment, they can also call the helpline to receive appropriate advice, and when that begins to get clogged they can be put through to an integrated voice recognition system,” he explained.

Tested in Australia

IntefleCS Health Watch was originally piloted in 2006 in Exercise Cumpston, Australia’s largest ever health simulation exercise, which tested its preparations for a pandemic flu outbreak.

It simulated the arrival of an international flight carrying a strain of the flu virus able to cause a pandemic outbreak, the emergence of a significant number of infected individuals in the community and the trial of the health system’s capacity to contain and manage a pandemic.

The simulation involved 1,500 participants and control staff from a range of government and non-government agencies. Clinical Solutions was used to power the exercise, to determine if a person had been infected, exposed or was simply concerned, and then direct them to the most appropriate point of care.

The exercise allowed officials to analyse what happened to identify gaps and make improvements. Craven continued: “Health Watch proved to be an exceptionally successful management tool for pandemics, so NHS Direct asked us to work towards providing a similar service in the UK.

“Lots of other people and companies can do symptomatic surveillance but we believe that we’re the only ones who have the tool to manage the results of that surveillance.”