Pandemic Flu – Preparation and Containment Budget Transfers
Background
The Treasury and Resources Minister has approved £1,347,000 of additional funding in respect of Pandemic flu preparation and containment. This has initially been allocated to the Treasury and Resources Department
The Minister has requested that an officer group review the funding request (Appendix B) before the budget is transferred to the relevant departments.
Officer Group Review
The Officer Group, comprising the States Chief Executive, Treasurer of the States, States Assistant Chief Executive and the Emergency Planning Officer, has reviewed the funding request, questioning both the States Medical Officer of Health and Health and Social Services Acting Chief Officer.
The outcome of this review is that the group recommends the Minister immediately transfers budget from Treasury and Resources to the following departments:
- Health and Social Services – £622,000
- Home Affairs Department – £7,000
- Chief Ministers Department - £10,000
The Group also recommends that a further £497,000 of equipment and consumables be purchased and initially held as stock and funded as needed.
In addition, the Group asked for further information on some areas of proposed expenditure.
The Group also recommends that expenditure incurred against these budgets is subject to an internal audit.
As part of the transfer, Accounting Officers should be asked to confirm the following in respect of expenditure against these budgets:
- That the goods and services being purchased are required immediately and are needed to respond to the threat to the safety of the island's inhabitants
- That insufficient funds are available within existing budgets
- that there are appropriate controls in place to ensure that funds are being spent appropriately,
- that value for money is being achieved; and
- that financial directions are being complied with in respect of this expenditure.
In summary, the expenditure recommended by the Group is detailed in Appendix A.
CHIEF MINISTER’S DEPARTMENT (CMD) CO-ORDINATION GROUP – PANDEMIC FLU
H1N1 INFLUENZA PANDEMIC IN JERSEY: URGENT FUNDING REQUEST REPORT
1.0 Purpose of report
The purpose of this report is to state the case for the urgent expenditure of £1.3 million for the further containment and preparation phases for Pandemic influenza (H1N1) 2009 - previously known as swine flu.
2.0 Background
Since the end of April 2009, when ‘swine flu’ was identified and a pandemic declared imminent by the World Health Organisation (WHO), Jersey has been successful to date - to a major extent – in preventing the spread of the infection within the island. The first case of swine flu was diagnosed here on 12th June, one day after WHO announced that the spread of the new virus around the world met the definition of a global pandemic. Currently 10-20 new cases are confirmed each week on the island. The majority of islanders to date have caught flu abroad.
A major wave of illness due to pandemic influenza A H1N1 2009 (swine flu) is expected this autumn and/or winter. Access to additional funding is needed now to take action to reduce the impact on the people of Jersey. Preparations are also needed to allow Jersey General Hospital to be ready to expand to maximum capacity, as we expect will be needed.
The finite capacity of health care facilities and staff is of concern: one island, one hospital, one intensive care unit. There is no doubt that even with an effective community response the Jersey General Hospital will have to get ready with plans and supplies to admit a lot more patients than usual.
Pandemic flu is likely to be the biggest challenge yet to face the Island’s Health and Social Services Department with a vaccination programme offered to the entire population for the first time and potentially an unprecedented number of islanders unwell all at once. The situation currently faced by the island, and indeed the world, is exceptional, with the flu pandemic predicted to reach proportions last seen in 1968.
Purchases of the antiviral drug tamiflu and the H1N1 vaccine have already taken place, along with other preparations. The cost of these preparations to date amounts to £2.9 million; this has been funded from previous expenditure approvals. This report recommends further immediate expenditure relating to the containment and preparation of H1N1 influenza.
3.0 Current situation
We now stand at a junction with broadly two possibilities as to how the flu pandemic will affect Jersey during this autumn and winter:
Optimistically:
- We will continue to be successful in containing the spread of the virus until the vaccine arrives and, through an island-wide vaccination programme, largely prevent the outbreak of flu which is imminent.
Or:
- The vaccine will not be available soon enough and in sufficient quantities to prevent the majority of the cases we expect. In this case, the approach would be to protect flu sufferers as far as possible from serious illness by treating them with the antiviral drugs Tamiflu or Relenza and through enhancing the capacity of GP and other community health services. This approach would in turn prevent the hospital from becoming overwhelmed; the hospital should then remain in a position to treat those islanders who do become seriously ill as a result of flu. NB Vaccination would also be offered in due course, under this scenario, to prevent a potential second wave of flu.
The current situation remains current for a relatively short period of time in relation to the new flu. The situation changes weekly across the world and locally with new findings emerging which require our planning and actions to be flexible and timely.
4.0 Funding request
Expenditure on the equipment, consumables and services detailed below is required immediately to respond to the threat of a wave of illness relating to H1N1 influenza that will affect a significant proportion of the island's inhabitants.
There are insufficient funds available within existing budgets to meet these immediate costs.
Resources are needed immediately to address the following phases of the pandemic flu response:
- Continued containment to prevent the spread of the virus
- A vaccination programme to protect islanders from becoming infected
- Community treatment for those who could be about to become ill
- Hospital escalation (increasing hospital bed numbers) in order to ensure sufficient hospital capacity to treat those with severe illness as a result of flu.
- Preparing for the possibility that more deaths may occur than usual.
It is estimated that the cost of these phases (i.e. containment and preparation) could total £1,347,000. The following paragraphs detail this proposed expenditure.
4.1 Containment (estimated cost £216k)
At the current time the island is in the ‘containment phase’ which means limiting spread from the small number of cases as they occur. It is important to remain in the ‘containment phase’ for as long as possible.
A mainstay of this phase has been the public awareness campaign – ‘Catch it, bin it, kill it’ and the more detailed advice available through leaflets. This campaign will be ratcheted up further during the next few weeks. The approach advises hygiene measures which individuals can follow to protect themselves and others.
GPs have already become extremely busy with additional home visits and it has been agreed that patients will be funded by the Health Insurance Fund for the difference of the cost of a home visit versus an appointment at the surgery if the home visit is associated with suspected flu.
For each flu sufferer, once H1N1 flu is confirmed (following the result from a throat swab sent to a laboratory in the UK), their contacts are identified and offered a course of Tamiflu in order to contain and prevent the spread of the virus.
The key advance preparation actions and costs associated with this phase are as set out in Appendix 1:
- Initial Public Hygiene Campaign
- Set up gold and strategic command centre structures
The key actions and costs as the Island is in this phase are as set out in Appendix 1:
- Additional H1N1 swabs tested by the UK laboratory
- Distribution of Tamiflu to all suspected and confirmed patients and their contacts once the test is confirmed positive
4.2 Vaccination (estimated cost £55k)
The aim of the vaccination programme is to offer pandemic-specific vaccine to all islanders to protect them from the effects of this flu pandemic. If the vaccine is available ahead of the major wave then the number of people catching flu would be considerably reduced. The vaccination programme is predicted to begin in a matter of weeks.
The key advance preparation actions and costs associated with this phase are as set out in Appendix 1:
- Arrangement of storage for vaccines
- Purchase of consumables for vaccine programme
The key actions and costs once the Island is in this phase are:
- Costs associated with the first phase of the vaccination programme
4.3 Community treatment (estimated cost £278k)
With up to 35% of the population experiencing flu like symptoms an enhanced primary and community care service will be needed. Flu sufferers would remain at home, off work “sick”, for about a week. These patients would be treated with the Island’s stock of Tamiflu. The majority of individuals wouldn’t need anything further and would remain at home until they had recovered. More vulnerable patients, however, would require some additional community support with an emphasis of trying to make sure that only the very unwell are admitted to the hospital.
The key advance preparation actions and costs associated with this phase are as set out in Appendix 1:
- Recruitment of a Social Care Coordinator
- Preparation of liaison leaflets to various voluntary groups and the parishes who will work together to support the vulnerable and sick in their communities
- Secure storage for Tamiflu stock
- Purchase of Relenza
- Purchase of community equipment
- GP telephone triage for Tamiflu distribution (first phase)
4.4 Hospital escalation (estimated cost £788k)
Inevitably there will be those members of the population who become so unwell that they will no longer be able to be cared for in the community and the hospital will have to be ready to respond. The hospital will focus entirely on the management of severe acute illness. We are expecting up to an estimated 700 additional admissions to the hospital as a result of the anticipated flu outbreak. Many of these patients will be suffering from severe chest infections and respiratory problems but also some will be experiencing exacerbations of underlying medical conditions such as heart failure.
To cater for this marked increase in patients needing admission to hospital, the Jersey General Hospital plans to scale up capacity in a number of ways:
- Increasing the number of hospital beds, on a temporary basis, from 206 to 348; an increase of 142 beds (69%). Providing these beds, over and above the existing funded beds, will require additional resources. The cost of these resources has been calculated by using an average H&SS cost per occupied bed day enhanced for the use of overtime, potential use of agency staff and higher cost respiratory drugs.
- the hospital will also require additional specialist equipment and supplies for adult and paediatric patients.
- in severe cases a number of the admissions are expected to require Intensive Care facilities which will place an additional burden on these areas.
The key advance preparation actions and costs associated with this phase are as set out in Appendix 1:
- Locum support for Microbiology services
- Purchase of additional protective clothing and consumables
- Purchase of additional equipment
- Staff training for use of new equipment
- Purchase of additional oxygen supplies
- Refurbishment work in Mckinstry Ward and preparing a ward at St Saviour’s
- Staff training to increase intensive care capacity
4.5 Preparing for possibility of flu deaths (estimated cost £10k)
The flu pandemic could claim the lives of some of the Island’s more vulnerable patients and some previously healthy individuals. This reflects the experiences of other countries which are already in the grip of their outbreaks.
As a consequence of this, additional storage facilities and mortuary services will be made available.
The key advance preparation actions and costs associated with this phase are as set out in Appendix 1:
- Preparation for access and readiness of the temporary storage and mortuary
5.0 Recommendation
It is recommended that £1.347 million is made available immediately to fund the measures outlined in this report, necessary to prepare for, contain and manage H1N1 influenza.
Appendix I
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