At 11am today the government published an Independent Review of the UK response to the 2009 influenza (swine flu) pandemic.
The 28 recommendations are summarised as follows:
RECOMMENDATION 1:Ministers should determine early in a pandemic how they will ensure that the response is proportionate to the perceived level of risk and how this will guide decision-making. This approach should be reflected in the revised pandemic-specific Concept of Operations by summer 2011.
RECOMMENDATION 2: The Cabinet Office should enshrine the position of the four nations mechanism for certain types of emergencies in a revised Concept of Operations by summer 2011. The mechanism should then be included in the exercise programme for emergencies in a devolved matter.
RECOMMENDATION 3: The four health ministers should meet to discuss emergency preparedness (and a range of other issues) at least once a year. Officials should aim to meet face to face more regularly.
RECOMMENDATION 4: The Cabinet Office should review the technological support available for emergency ministerial and official
meetings, to ensure that those joining in meetings remotely can be engaged as fully as possible in the discussion.
RECOMMENDATION 5:Departments should consider how best to increase the resilience arrangements for key roles in an ongoing crisis
response, including those in charge of the response and committee members, and revise their resilience arrangements accordingly.
RECOMMENDATION 6: By December 2010:
(i) Ministers should decide the levels of deaths for which planning is appropriate as part of the process of revising Pandemic flu: A national framework for responding to an influenza pandemic.
(ii) The Home Office, working with others including the Ministry of Justice, the Department of Health, the Cabinet Office, Communities and Local Government and the devolved administrations, should ensure that plans are in place to deal with those levels of deaths during a pandemic, linking with other elements of mass fatality management and specifying clear responsibilities for the collection, transportation, storage and burial or cremation of bodies.
RECOMMENDATION 7: The Government Office for Science, working with lead government departments, should enable key ministers and senior officials to understand the strengths and limitations of likely available scientific advice as part of their general induction. This training should then be reinforced at the outbreak of any emergency.
RECOMMENDATION 8: The four Chief Medical Officers should jointly commission further work to support key decision-making early in a pandemic by January 2011. This should consider the practicalities of developing methods to measure the severity of a pandemic in its early stages. In particular, further exploration of population-based surveillance, such as serology, should be considered.
RECOMMENDATION 9: The Government Chief Scientific Adviser and the Department of Health should ensure that there is an appropriate balance of contribution in the Scientific Advisory Group for Emergencies for future pandemic outbreaks.
RECOMMENDATION 10: The Cabinet Office, with the Government Chief Scientific Adviser (GCSA) and the four Chief Medical Officers (CMOs), should devise a process through which UK government ministers and the devolved administrations are presented with a unified, rounded statement of scientific advice. This process should engage CMOs (or CSAs for other emergencies) and should be included in a revised Concept of Operations by summer 2011.
RECOMMENDATION 11: The Government Chief Scientific Adviser and UK health departments should convene a working group to review the calculation of planning scenarios and how they are used in public. This should report by April 2011.
RECOMMENDATION 12: The Joint Committee on Vaccination and Immunisation should report directly to the central emergency meetings in a future pandemic, although the Scientific Advisory Group for Emergencies should be used at the appropriate time to provide its challenge function. This should be clarified in a revised COBR Response Guide for Pandemic Influenza by summer 2011.
RECOMMENDATION 13: The Department of Health should build relationships between the Behaviour and Communication sub-group of the Scientific Pandemic Influenza Advisory Committee (SPI-B&C) and the Department of Health’s policy and communications teams so that the SPI-B&C’s expertise can be used in addition to in-house resources in planning for vaccine uptake and other relevant policy areas.
RECOMMENDATION 14:Any future Scientific Advisory Group for Emergencies should adhere as closely as possible to the established
principles of scientific advice to government and should release its descriptive papers and forecasts (as distinct from any policy advice) at regular intervals. This should be clarified in a revised Concept of Operations by summer 2011.
RECOMMENDATION 15: The Government Chief Scientific Adviser should provide expert technical briefings to respected scientists not directly involved with the Scientific Advisory Group for Emergencies. This would enable a wider group of experts to comment in an informed manner on the government’s approach.
RECOMMENDATION 16: The Department of Health, working with others through the revision of the National Framework, should explore a more flexible, evidence-based approach to triggering actions during a pandemic than the current WHO phases and UK alert levels. In particular, this work should ensure that clear guidance is set out to enable the rapid adjustment of the prophylaxis policy as more is learned about the nature of the virus. Work to revise the National Framework should be concluded no later than March 2011.
RECOMMENDATION 17: The Department of Health, working with others through the revision of the National Framework, should ensure that there is an appropriate balance between local flexibility and UK-wide public confidence in the response. A national strategic approach can and should be compatible with increased subsidiarity and therefore increased variation according to circumstances; triggers agreed and understood on a UK-wide level could be applied flexibly in different geographical areas on the basis of local circumstances. This should be set out in the revised National Framework and published no later than March 2011.
RECOMMENDATION 18: The Department of Health and the devolved administrations should agree triggers responsive to the capacity of primary care in the activation and stand-down of the National Pandemic Flu Service at both national and regional levels. These triggers should be set out in the revised National Framework and published no later than March 2011.
RECOMMENDATION 19: The Department of Health should commission an independent evaluation of the National Pandemic Flu Service, covering value for money, risk analysis and any potential for wider application.
RECOMMENDATION 20: The four health departments should reflect on the proposals identified by the Swine Flu Critical Care Clinical Group and incorporate them, as appropriate, into the revised National Framework no later than March 2011.
RECOMMENDATION 21: The Department of Health should negotiate advance-purchase agreements that allow flexibility over the eventual quantities purchased.
RECOMMENDATION 22: The Joint Committee on Vaccination and Immunisation should be asked to advise on vaccination strategies across a range of scenarios, including severe and less severe pandemic viruses. This advice should incorporate the views of behavioural scientists and economic analysis, and be published in the revised National Framework no later than March 2011.
RECOMMENDATION 23: The four health ministers should commission officials to put in place arrangements to ensure the rapid implementation of a vaccination programme during a pandemic. For example, a sleeping contract with GPs and/or other willing providers could be negotiated.
RECOMMENDATION 24: The Department of Health and the devolved administrations should explore what more can be done to raise levels of public awareness and understanding about the key characteristics of a pandemic and the core response measures.
RECOMMENDATION 25: The four UK health departments should review their use of language during pandemics to ensure that it accurately conveys the aims of the response efforts and the levels of risk. In particular, the use of the terms ‘containment’ and ‘reasonable worst case’ should be reconsidered as they are easily misunderstood. The National Framework and communications strategies should be amended to reflect such revisions by no later than March 2011.
RECOMMENDATION 26: The four UK health departments should consider new ways of proactively engaging with both journalists and the public. These could include disseminating transcripts of media briefings, using podcasts and making more use of social networking and digital technology to reach specific sections of the public. The National Framework and communications strategies should be amended to reflect any changes no later than March 2011.
RECOMMENDATION 27: The Cabinet Office should ensure that the communications approach (weekly briefings, Q&A sessions, regular releases of facts and figures) adopted by the Department of Health and the devolved administrations is used, where appropriate, as a model of best practice for future emergency situations.
RECOMMENDATION 28: The Department of Health and the devolved administrations should discuss with professional health bodies how best to create sources of direct clinical advice for health professionals during a pandemic. This may be most appropriately hosted by one or more of the professional bodies.
Click here for the full pandemic review report.
