Royal National Orthopaedic Hospital NHS Trust

Flu & Winter Resilience Planning 2009/10

1.Introduction

This paper outlines the plans for flu and winter resilience at the RNOHT for 2009/10.

2. Director of Flu Planning and Resilience

The Trust has appointed the Director of Nursing the responsible Director for Flu Planning and Resilience. The Director of Nursing is being supported in this role by the Deputy Director of Nursing and the Senior Infection Control Nurse.

3. Pandemic Flu Resilience Committee

The Trust has now instigated a weekly flu resilience committee chaired by the Director of Nursing which is attended by the following:

  • Director of Nursing / Infection Prevention and Control (Chair)
  • Chief Pharmacist
  • Consultant (Anaesthetist)
  • Consultant (Paediatrician)
  • Consultant (Spinal Cord Injury)
  • Deputy Director of Human Resources
  • Deputy Director of Nursing
  • General Manager (Clinical Support Services)
  • Head of Communications and Corporate Affairs
  • General Manager (Clinical Support Services)
  • Lead Nurse (Critical Care)
  • Matrons
  • Senior Infection Control Nurse
  • Senior Respiratory Physiotherapist

The terms of reference for the committee are:

  • To provide leadership for the provision of acute care
  • To report to The Trust Board and local health economies
  • To interpret and act upon national and regional guidance on the flu pandemic
  • To maintain essential healthcare services wherever possible
  • To map hospital capacity against demand
  • To make decisions about deployment of local resources, including restricting or withdrawing the usual standards of services to minimise loss of life during the pandemic
  • To work collaboratively with other local resilience partners in dealing with local implications of a flu pandemic
  • To maintain staff vaccination programme

The committee will also review:

  • Medicines (including anti viral stocks)
  • Communication strategy (staff, patients and visitors)
  • Workforce plans
  • Infection control plans
  • Specific plans for Spinal Cord Injury Centre and ITU

4. SITREP Reporting

Reporting of flu issues to NHS London / DoH will be coordinated by the Director of Nursing. In the event of the Director of Nursing being absent from the organisation this responsibility will be assumed by the Deputy Director of Nursing / Senior Infection Control Nurse.

Workforce reporting will be coordinated by the Director of HR in discussion with the Director of Nursing.

Our current responsibilities for reporting are:

  • Monthly workforce report to NHS London
  • Weekly “Flucon” report to NHS London (exception reporting)
  • Weekly winter resilience reporting (UNIFY)

Flucon level 3 requires CEO sign off prior to submission.

5. Infection Control

Increase in infections would be dealt with utilising Trust Infection Control Policy, due to the elective nature of the organisation surges in non flu related infection is not predicted.

Outbreaks within the hospital population due to H1N1 would result in activation of outbreak plan and cohorting or discharging of infected patients as appropriate.

Elective admissions will be stopped to areas where patients are symptomatic to H1N1.

Personal protective equipment (PPE) will be worn to protect staff from contamination with body fluids and to reduce the risk of transmission of influenza between patients and staff and from one patient to another.A/H1N1 has non-specific symptoms of swine flu and the low incidence of seasonalflu at this time of the year, it is reasonable to consider a diagnosis of A/H1N1 swine flu in anypatient presenting with a flu-like illness. Therefore PPE will be recommended for face to facecontact with these patients (FFP3 face mask, apron and gloves).

A disposable respirator that provides the highest possible protection factor available i.e. an FFP3 respirator will be worn by healthcare workers when they perform procedures that have the potential to generate aerosols. If an FFP3 disposable respirator is not immediately available, the next highest category of respirator available will be worn (i.e. FFP2).

The Senior Infection control Nurse is responsible for liaising with Barnet PCT to ensure adequate stocks of masks within the RNOHT.

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6. Managing Demand and Capacity

As a provider of elective and specialist spinal cord injury services the RNOHT will continue to provide these services throughout the pandemic flu. Continued assessment of workforce availability (section 9) will be crucial in ensuring the continued safe and effective running of both clinical and support services within the hospital.

The influenza pandemic may compromise the Trusts ability to provide normal services. The Trust must be able to direct resources to respond to the situation and will need to be able to put in place measures to maintain critical health and critical non health functions for several weeks at high levels of staff absenteeism.

As a tertiary centre the Trust does not serve a local population. Therefore planning will be based on available capacity rather than on strike rates within the community.

The RNOHT does not have accident and emergency services but does have a supportive role to acute trusts (major incident policy 2009).

Any requirement to reduce elective admissions / close services due to workforce issues, flu outbreak within the hospital or a reduction in vital supplies (drugs, blood, isotopes etc) will be coordinated by the Director of Nursing and the Director of Operations and involve full consultation with the executive and clinical teams.

Response to requests to provide support services outside the usual remit of the hospital will be coordinated by the Director of Nursing, Medical Director and Director of Operations in conjunction with the executive and clinical teams.

Specific roles related to ITU are outlined in section 8 (critical care).

7. Service Prioritisation

Requirement to prioritise services will be coordinated as per section 4.

Severe shortages of clinical and support staff or resources will be managed through the declaration of an internal major incident as outlined in the RNOHT major incident policy (2009).

8. Critical Care

Critical care services are expected to become more pressurised during a flu outbreak and it may be necessary to prioritise the beds available.

Advice and updated information is provided both from the DIPC and also from the North West London Critical Care Network to identified staff within the department.

The Trust has made plans to expand critical care from 6 level 3 (ITU) & 6 level 2 (HDU) beds to 12 level 3 and 12 level 2 if required by the wider health community. This will require suspension of all but urgent and emergency surgery at the RNOHT as the HDU beds will be placed in the theatre recovery area due to the lack of piped medical gases in all other areas of the Trust. Should this plan be activated all available staff from adult and paediatric wards and theatres will be redeployed to the HDU area.

Due to the specialist nature of the hospital it is envisaged that the RNOHT would take transfers from other ITU / HDU and could care for the following patients (including children over 5 years old:

  • Orthopaedic trauma patients (with no other injury requiring surgical intervention)
  • Muscular conditions requiring ventilation (e.g. Guillain Barre)
  • Difficult to wean and longer term ITU / HDU patients
  • Spinal injury patients

Any reduction in elective work to support increased pressure from a flu outbreak will be made through communication between the critical care team, the Director of Nursing and the Director of Operations.

10. Medical Staff (EWTD)

All junior doctor rotas are EWTD compliant. We have recruited an additional 6 Core Surgery CT 3 post with effect from June this year. We haveadjusted the SpR rotas to ensure adequate rest is taken.

11. Workforce Issues

The Director of Human Resources is responsible to ensuring monitoring of staff availability during the pandemic flu period and ensuring the workforce plan outlined in the pandemic flu policy is activated, working in conjunction with the pandemic flu committee and managers.

In an emergency there may be a necessity to reallocate and redeploy staff. Consultation has taken place with staff side at the workforce partnership forum regarding the policy and procedure in place to respond to workforce issues during the current flu pandemic.

This may include asking staff to undertake duties outside their normal professional area. Additional staff may also be required, sourced from a pool of bank staff, retirees, volunteers and local partnership staff.

Current job descriptions and employment contracts allow some flexibility in the ability to allocate existing staff other tasks or work, whereas permanent or very long term redeployment would require consultation under the staff affected by change policy.

The following arrangements would only apply in an emergency situation during the pandemic should workforce numbers become critical:

In an emergency where staff may need to be redeployed or work may need to be reallocated, managers will assess:

Whether it is necessary for staff to report to their normal place of work and whether there is a need to redeploy staff or reallocate work. In deciding this managers will, wherever possible:

  • Direct staff to sites which are convenient
  • Allocate staff work with which they are familiar
  • The location of staff, their access to public/private transport, any reasonable constraints on their flexibility, as appropriate.

In considering redeployment, managers will take account of:

  • Any known/stated restriction on work that could safely be undertaken by an individual on health grounds. This may include, for example, pregnancy and in the case of communicable infection, whether the individual had received any appropriate vaccination.
  • Any training or professional qualification that would be a prerequisite to carrying out certain duties safely
  • Any other circumstance that may make working unreasonably unsafe, for example, severe staff shortages.
  • Any official communication from bodies with emergency powers by law, for example, advising against travel/other activity in all/some circumstances. The Trust will provide advice to staff on interpreting such communications. For example, essential workers would normally be expected to travel to work if there were advice to refrain from non-essential travel

Working Hours

Part time staff will be invited to increase their contractual hours for a specified period of time, however, will not be obliged to do so.

Staff on other flexible working arrangements may be asked to temporarily alter these arrangements in response to the emergency situation, if it is reasonable for them to do so. However, flexible working solutions may also enable as many staff to continue working as possible. This may include home working, childcare schemes/facilities, staff accommodation, and special travel arrangements (e.g. car pools). HR and managers will therefore continue to promote and agree flexible working options where possible.

In normal circumstances, no staff should be asked to work in excess of 48 hours per week, nor without appropriate rest breaks and to take annual leave. In an emergency situation, it will be important to ensure that staff continue to receive appropriate rest breaks or compensatory rest and that they are not asked to work more than 48 hours on average over a 17-week reference period, in accordance with the Working Time Regulations (WTR). If a member of staff however wishes to work beyond the 48 hours they must complete a WTR opt out form.

Annual leave requests may need to be more tightly controlled and staff may not be able to take leave at the exact times they request, depending on service needs. However, staff will remain entitled to take their annual leave allocation and must take at least four weeks’ leave during the leave year, in accordance with WTR.

It will be important for both staff and managers to monitor working time and ensure that excessive working time without appropriate rest does not occur as this could adversely affect staff health and therefore their ability to remain at work to support colleagues and the running of services.

Managing Absence

Any staff who are exhibiting symptoms of H1N1 will be asked to report as off sick under the normal procedure or if already at work will be asked to go home and follow the normal reporting procedures, until the risk of infecting others has passed and they are well enough to return. For all other illnesses, no staff will be required to attend work if they are not fit enough to do so safely. Managers may seek Occupational Health advice regarding the fitness of staff and making adjustments to enable the early, safe return of staff where appropriate.

The normal procedure for managing sickness should be followed in line with the Trust sickness absence policy and procedure however local discretion should be used when dealing with episodes of absence due to emergency situation as this will need to managed on an individual basis depending on the circumstances.

In addition the Deputy Director of Human Resources will be responsible for ensuring levels of sickness attributed to H1N1 are monitored.

Managers should note that there could be problems for staff obtaining medical certificates due to GPs being overloaded during a pandemic flu. However, any staff requiring a medical certificate would need to be cleared by OH during an emergency to be approved as fit and well for work. OH clearance would suffice in the interim to obtaining a medical certificate from their GP. Management will have to be flexible in their approach and will make this clear as an alternative action.

In relation to redeployment/reallocation of work, if staff refuse without good reason to follow a management request that is reasonable in the circumstances, this may lead to disciplinary action being taken, in accordance with the Disciplinary Procedure.

Again, such action may be stayed until the end of the emergency or until resources allow the matter to be dealt with.

Cancellation of Annual Leave

During an emergency management will reserve the right to cancel annual leave if this will affect the running of their department and if travelling in or outside the UK has been stopped by the government. Any cancellation of annual leave would have to be at the discretion of the manager and dependant on the circumstances.

Requests for annual leave taken at short notice due to family circumstances or emergencies would have to be considered and authorised as quickly as possible.

Study Leave / Training

It would be expected that all study leave would be put on hold until after the crisis is over. All staff would be needed to work, colleges etc would most probably be closed and staff would be expected to report for duty.

All training courses except those required for supporting and training redeployed staff, volunteers or reserves, should cease until the clearance is given and the pandemic is declared over. Staff in the training department can be redeployed if there is insufficient work in the Training and Development department.

Emergency clearance for new and/or temporary staff (employment checks)

Emergency clearance arrangements would be notified to the Trust by the relevant organisations. This may be difficult to arrange given they would be addressing the same staff shortage problems as the Trust.

The Trust would need to assess the risk of using staff that have not been cleared; full clearance could be postponed until after the pandemic is over. Telephone clearance could operate during an emergency.

Staff Support

To enable staff to continue working, it will be important to ensure they are appropriately supported during and after an emergency. This may be in the form of trauma counselling, Occupational Health or support groups set up by other agencies. Managers will also play a key role in identifying concerns, supporting their staff and ensuring their health, safety and well-being at work.

Retirees

HR will identify all retirees who have retired in the last year. Retirees will be contacted to see if they would like to be entered on an emergency register of staff. All staff who have retired more than six months ago will be health screened and CRB checked again and a reference sought from their previous line manager. If professional registration or training has lapsed, retirees will not be asked to undertake duties for which either would be a requirement. Retirees would be engaged as bank workers on the same rates of pay as in operation for the Trust Bank.

Volunteers

Those already on the volunteer register may be called upon in an emergency. New volunteers will need to be health and CRB screened with appropriate references being taken up. Volunteers’ competence, qualifications and skills will also need to be assessed by way of an application form, skills audit and/or interview/test. Volunteers are normally deemed to be helping out rather than fulfilling a discrete role and are therefore not usually paid. If a particular role is being filled, they will be subject to the recruitment procedures in operation at the time for bank workers and paid accordingly.

12. Staff Flu Vaccination Plan

The RNOH has capacity through occupational health to vaccinate up to 500 front line staff over a 5 day period. Additional nursing staff competent to vaccinate have been identified.

13. Communications

It is not anticipated that communications will work in a significantly different way from any other outbreak, however the length of the outbreak may necessitate our planning for intense demands for information during periods of potentially high levels of staff absence and heightened public concern.

The RNOHT has developed information guides for staff, patients and visitors.

Information for patients is sent out with all letters of admission to hospital and with all outpatient appointments.

14. Supplies

The procurement department has already ordered additional supplies as outlined in the Trust pandemic flu policy.

The pharmacy department has identified and ordered additional stocks of fluids and other vital supplies.

15. Winter Resilience Plan / Business Continuity

The Trust has assisted with the winter resilience plan being created by Barnet PCT