Swine Flu – A regional Overview

1. Swine Flu – A regional Overview Helen Hipkiss Programme Consultant Children Services

2. The facts • Influenza pandemics are natural phenomena that tend to occur two or three times each century. • Pandemics arise when a new influenza virus emerges and spreads rapidly across the world with widespread epidemics in various countries. • The severity of a pandemic varies but, in the last century, there were three pandemics: ‘Spanish flu’ of 1918/19, in which between 20 and 40 million people worldwide died (with peak mortality rates in people aged 20 to 45); ‘Asian flu’ of 1957/58; and ‘Hong Kong flu’ of 1968/69. • While the pandemics in 1957/58 and 1968/69 were much less severe, they also caused significant illness levels (mainly in the young and the old) and an estimated 1 to 4 million deaths between them.

3. Planning • Planning was well underway before this Pandemic. • A temporal profile based on the three pandemics that occurred in the 20th century and current transmission models was constructed. • This predicts the national profile of a single wave to last 15 weeks. • Local PCTs were expected to produce Flu Plans that included providers and the SHA is reviewing those plans, including events to test out readiness.

4. Children and Young People Planning • In the event of influenza pandemic causing high death rates in the West Midlands there will be particular needs of children and young people, especially for Children whose family members die or are too ill to care for them. • A survey has been undertaken to assess PCTs readiness to support these Children and Young People.

5. Aims of the Survey • To outline current services/capacity for provision of bereavement support for children and young people and plans in place. • To outline potential provision/plans in place for children requiring emergency and longer term temporary care and accommodation as a result of family bereavement. • To report on gaps in provision and planning and make recommendations for action.

6. Project Processes • Research national guidance. • Telephone interviews with appropriate 17 PCT and 14 LA managers commissioners using a structured question pro-forma. • Present the information on an area to area basis in a data spreadsheet, mapped against local need. • Analyse information alongside expected need and report on gaps in provision and planning. • Make recommendations for future action to support facilitation of plans.

7. Regional Findings • The total number of children up to the age of 19 is 1,355,200. • Using the range of estimated deaths from the DH the incidence ranges for people at all ages from 25-50% of the population with clinical attacks and 0.4-2.5% of these people will die. • From the total population of the West Midlands: • Using highest estimate - 50% of population have Flu = 2,683,500 • 2.5% of these die = 67,087 • Using lowest estimate - 25% of population have flu = 1,341,750 • 0.4% of these die = 5,367 • So a range of between 5,367 and 67,087 people of all ages may die. For children and young people the range could be from 1,355 at the lowest estimates and 16,940 at the highest estimated rate.

8. The impact Many children and young people will require support following bereavement alongside the need for care of children whose parents/carers are not able to look after them due to ill health or death.

9. Are we ready to support these Children and Young People? • 17 individuals representing 7 Local Authorities and 15 PCTs, some of whom represented more than one agency were interviewed. • We were unable to get responses from 2 PCTs and 7 Local Authorities despite many attempts.

10. Current Flu Pandemic Plans • All respondents confirmed that they had basic plans in place. • 9 were specifically mentioned as joint plans between the LA and PCT. • Most of the plans were based on the DH national plan. Some included sections from local major incidence plans and Business Continuity planning. • Some areas reported that they had recently begun to develop their plans further with more local detail.

11. Current Flu Pandemic Plans • Most interviewees’ reported that they had considered the needs of children and young people in their plans although in review of individual plans available there was limited evidence that his was the case. • Two areas have detailed plans that included the needs of children and young people.

12. Current bereavement services • The majority of areas were unclear about the current bereavement services that are commissioned. • Very little detail was given from either PCTs or Local Authorities. • There was some mention of voluntary organisation provision but only one was able to provide detail of these services.

13. Plans for additional bereavement support in event of Pandemic • 2 LAs suggested they would bring in additional Voluntary organisation support. • Several areas (3 PCTs and 2 LAs) mentioned that they would expect CAMHS to provide additional support and prioritise this group of children. • However, only one area mentioned a re-prioritisation to support CAMHS in this role. Often this was not accompanied with evidence of a workforce plan being in place, to demonstrate the CAMHS would be able to flex the service to accommodate these children. • We have no evidence that any of the CAMHS or other providers of bereavement services have been involved in the development of the plans.

14. Current LAC places • The information provided was inconsistent across all areas and the information was not complete enough to provide a full picture of current capacity.

15. Plans for additional capacity for care of children in event of Pandemic • Local Authority plans in place varied. • Most areas would be looking for increased capacity from external organisation and would also look to work with neighbouring authorities. • Some areas had asked for business continuity plans from all of their providers, although not all had responded. Some areas mentioned looking to the wider family to provide care and the relaxation of CRB checks to enable them to quickly increase the pool of carers. • One Befriending Support system would actively look at provision of local community care for children including friends, families and local community organisations. • When asked about linking with Local Authorities to provide care of children, PCTs struggled to give ways in which this is or might happen.

16. Summary of Key issues and recommendations • National Guidance. • Roles and Responsibilities. • Communication and Understanding. • Future Planning.

17. National Guidance • There is limited cohesive national and regional guidance that clearly outlined the needs of children and young people.

18. Recommendation • Regional guidance on the needs of children and young people in the event of a pandemic should be produced jointly between health and Local Authority services. • A template for local plans relating to the needs of children and young people that can be linked to Major incidence plans, business continuity plans and Emergency Plans for Pandemics.

19. Roles and Responsibilities • There was a huge difficulty in identifying the person with information about the needs of children and young people in the event of a pandemic. • People were often unclear about their role in planning and even about the potential effect on children’s lives of a pandemic, sometimes because they had an overall planning role and were not knowledgeable out children services. • Within health services the focus remains on the physical aspect of provision, there is a real confusion about who’s responsibility it is to consider the broader needs of children and young people.

20. Recommendation • Each local Flu Pandemic plan should identify a children lead who working across the Local Authority and PCT are responsible for identifying local plans for all needs of children and young people including the provision of bereavement and counselling and care of children and young people who are orphaned.

21. Communication and understanding • We found that there was limited understanding of the needs of children and young people beyond their immediate physical needs. The long term effects of a pandemic were given very little thought by most areas.

22. Recommendation • A regional workshop to be delivered to examine the potential longer term needs of children and young people in a pandemic beyond their immediate health needs. • This would also assist in identifying roles and responsibilities of agencies and begin discussion around regional planning. • This would also be a forum for disseminating the good practice identified in some areas.

23. Future planning • Information held by commissioners about current bereavement services available patchy and held in a variety of places.

24. Recommendation • We suggest local mapping exercises of current bereavement services are undertaken by contacting each local provider of services and to include location, hours of operation, workforce, access routes. • A full regional mapping exercise to be undertaken.

25. Conclusion • Planning for Children and Young people is limited. • Needs are considered within overarching plans but the specific needs of the group are not addressed within current plans.

26. So what do you know locally that could be used to improve the planning?How do you get involved?