Meeting of the United Kingdom National Influenza Pandemic Committee (UKNIPC) held on 28 February 2006

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Present

Sir Liam Donaldson, Chief Medical Officer, Department of Health
Dr David Harper, Head of Health Protection, International Health and Scientific Development
Dr David Salisbury, Head of Immunisation,Department of Health
Gron Roberts, Department of Health
Dr Maureen Baker, RCGP
Dr Penny Bevan, Department of Health
Dr Philip Bryan, Department of Health
Dr John Coakley, Homerton NHS Foundation Trust
Dr Lorraine Doherty, for CMO Northern Ireland
Dr Paul Gayford, Defra
Dr Diana Grice, Surrey & Sussex PCT
Tom Griffin, LGA
Sharon Horan, Royal College of Nursing
Kathryn Hudson, Department of Health
Dr Stephen Inglis, NIBSC
Dr Bill Kirkup, Department of Health
Ros Moore, for Chief Nursing Officer
Emma Robinson, Lambeth PCT
Gul Root, for Chief Pharmaceutical Officer, DH
Dr David Salter, for Chief Medical Officer, Wales
Dr Joyshri Sarangi, Glos & Wilt HPU
Dr Rashmi Shukla, RDPH West Midlands
Sir John Skehel, National Institute of Medical Research
Dr Elizabeth Stewart, for Chief Medical Officer Scotland
Dr Alan Smith, Department of Health
Professor Pat Troop, Health Protection Agency

Secretariat
Pamela Gardiner, Department of Health

Apologies
Lorraine Lambert, South Tyneside NHS Trust
Philip Selwood, Gloucestershire Ambulance Trust
Professor Kent Woods, MHRA

1. Introduction and Welcome
The chair welcomed everyone to the meeting.

2. Minutes of the meeting held 11 November 2005
The minutes were agreed without comment.

3. Matters Arising
3.1 Update on work with RCGP
A pandemic influenza group has been set up comprising representatives from the RCGP, BMA and DH. Two productive meetings have taken place thus far and work under way includes:

• business continuity guidance for GP practices - to be published on RCGP website;
• infection control guidance for general practice drawing on the guidelines for healthcare settings already published on DH website;
• work on an ethical framework with the support of GPs.

The group had also discussed the concept of NHS operations currently being developed and broadly supports the treatment at home approach but wished to explore the resource and logistic implications in more detail. It also accepted the need for more directive and detailed planning guidance and central control during a pandemic.

Exercise Common Ground
Dr Bevan updated the Committee on Exercise Common Ground and explained that this was an EU exercise run by the HPA over two days with Ministers participating on the first day. The main lessons learnt were:

• Effective communications across 25 countries was difficult.
• There was a need to maintain business continuity and improve links to Regional Resilience Committees.
• Further work was needed on NHS command arrangements and NHS capacity issues
• It was important to get one set of agreed information passed up and down the line.
• There was a need for consistent international and national public advice eg travel restrictions

Professor Troop noted that the ECDC was expanding and that there was a need for HPA to engage with the ECDC to ensure consistency in advice.

Issues raised during the discussion about the exercise were:

• The competency of the EU and relationship between EU and WHO
• How much of these issues had been captured for the next stage of planning
• Information gathering and reporting should be as minimal as possible - using existing data wherever possible
• The existing Gold Command arrangements was an easy and established process to communicate and receive feedback
• More work was needed on health command and control structures
• The issue of travel restrictions was being looked at across Government
• It was felt that expectations may not be commonly shared by all countries and there was a possible gap in this area that needed to be built
  

3.3 Role of the Regional Civil Contingency Committee
It was agreed that clarity of the role of regional resilience fora and their relationship to PCT planning needed to be built into ongoing work.

Action Point: Drs Shukla and Bevan to liaise with Gron Roberts and Tom Griffin to produce a paper on command and control arrangements and links with the civil contingency committees.

4. Developments since the last meeting
Dr Harper updated the Committee on the latest developments based on the paper circulated to the Committee. He explained that there continued to be a high level of interest in the whole area of pandemic influenza and avian influenza preparedness, as reflected in the enquiry by the House of Lords Science and Technology Committee. The end of the EU Presidency had not seen any reduction in international work, and Ministers had since attended meetings in Beijing, Geneva and Vienna.

Avian Influenza

• Paul Gayford from the Department of Environment Food and Rural Affairs gave an update on the avian influenza situation in Europe and elsewhere. The risk of H5N1 spreading to the UK was increased but remained low and contingency planning was continuing - an exercise was being held in April to test UK systems.
  

5. Scientific Advisory Group (SAG)
Dr Harper provided an update on the work of the SAG. It was noted that the terms of reference were "to advise the UK Government on scientific matters relating to the health response to an influenza pandemic".

The SAG would play a critical role in ensuring that the UK National Influenza Pandemic Committee and Ministers are provided with high standard of Scientific advice to support the health response to a pandemic in the UK and are kept informed of any new developments in science and research.

Three meetings of the SAG had taken place, discussing three main issues.

• Modelling of public health measures
• Near patient testing
• Antiviral strategy

The next SAG meeting would discuss the vaccination strategy.

The minutes of the meetings would be circulated to the Committee. In discussion, the following points were noted:

• GP practices could be severely affected by any school closures due to many staff having to take time off to care for young children. It was noted that discussions around these areas were on-going and that the potential impact on health care staff would be included in further considerations of the issue;
• There would also be a wider impact on the local workforce outside the NHS;
• Possible closure of colleges and universities should also be considered in context of school closures
• Whether risks in different forms of transport (e.g. crowded public transport) had been considered and potential impact on fuel supplies if car use increased;
• Mode of working may have to change - e.g. more home working should be considered;

A recent outbreak of influenza B led to closures of many schools. Information on the possible impact this might have had on secondary and primary healthcare was being collected.

6. Critical Care
Dr Kirkup, as chair of the Critical Care Group updated the Committee on the work of this group, which had two meetings to date. Some of the issues discussed were:

• Critical care thresholds would need to change in the event of flu pandemic;
• The Intensive Care Society was willing to share observations and to join work on planning;
• There might be a need to increase temporary capacity to deliver ventilatory support;
• Use of theatre spaces and recovery spaces could also increase capacity
• The main issue which would affect delivery would not be space or equipment, but staffing;
• There would be demand from NHS staff for equipment which would be perceived as making their job safer e.g. masks. This was an unresolved issue and it would be helpful if thinking was shared with the NHS more explicitly.
  

7. NHS preparedness
Gron Roberts explained that almost all returns from the audit of pandemic flu preparedness in NHS organisations had been received. The plans confirmed that all NHS organisations were engaged in planning and all were asking for more guidance and information. Points arising included:

• Most NHS organisations now had plans and a designated co-ordinator.
• Plans were generally well thought through and linked to the regional resilience mechanisms, but most had not been tested.
• More detailed operational guidance was required from DH, particularly on antivirals, their distribution and vaccination strategies;
• Plans for closed communities needed improvement and more engagement with social care was required at local and national levels.
• Better GP engagement was required.
• Information on staff protection was inadequate and there was not enough material available
• Care in the home was an area of work which needed to be developed, particularly on protecting carers in a domestic setting
• Legislation and regulation were being looked at to identify possible barriers to a flexible response to the pandemic.
• In some organisations, planning assumptions were based on the bottom range of assumptions and might not take sufficient account of people being unwilling to work due to concerns about the virus. This needed further consideration.
• There was concern about the availability of supplies e.g. antibiotics, oxygen and personal protection equipment both now and during a pandemic.

Overall it was agreed that a more consistent national approach was needed. The Department of Health would continue to work across government not only on issues on how the NHS would cope during a pandemic but how other sectors would cope.

8. Antiviral Strategy
Dr Bryan updated the Committee on the ongoing work with the antiviral strategy. Due to availability, ease of use and wider indications, oseltamivir was the treatment of choice although potential use of zanamivir as an adjunct would be kept under review. Amantadine would be a less desirable antiviral due to evidence of resistance, efficacy and safety profile. The current strategy was for treatment of cases, with possible limited prophylaxis in the very early stages of a pandemic to limit spread. The UK stockpile of 14.6m treatment courses of oseltamivir was expected to be complete September 2006.

The antiviral strategy, including potential use of alternative antivirals and potential alternative prophylaxis strategies, was under ongoing review by SAG. Resistance of antivirals was also under review by the SAG.

9. AOB
Members wanted to know if targets in the NHS would be relaxed during a pandemic. The Department was addressing this issue with a view to having a clear understanding of the issues in advance of a pandemic.

Date of next meeting 16 May.

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