1. Health Protection Response to Pandemic Influenza in Scotland Dr Martin Donaghy, Health Protection Scotland, 15 th September 2010

2. Contents Introduction Overview of Pandemic »Timeline »Pandemic management Pandemic Recommendations »Policy »Functions »Processes

3. Investigation Surveillance & Assessment Control Communication Health Protection Functions

5. Scottish Government Health Directorate Policy & Performance Management Operational NHS Boards Pandemic Response Structures UK Ministers/Officials SAGE JCVISPI-M PICO Scottish Government Health Protection, Healthcare, Civil Contingencies, Public Communications HPS NSS Divisions Immunisation Steering Group HPA Tactical Strategic SFREC NHS 24

6. Processes Preparedness Generic Planning Health Protection Framework Exercises Quality assurance Containment Phase Response co-ordination (Policy, UK implementation, Scottish Boards) Surveillance and investigation Guidance and expert advice Immunisation Planning Communications (internal, service and public) Information Management Treatment Phase; Influenza Response Co-ordinating Team Intelligence and Surveillance Guidance and expert advice Immunisation Programme Management Communications (internal, service and public) Information Management and Technology Lessons learned.

7. Laboratory testing of those suspected of having contracted H1N1 antiviral treatment of cases meeting the agreed case definition contact tracing, and prophylaxis of close contacts closure of schools based on expert advice self-isolation of cases in the community detailed investigation of cases and contacts Containment: Reduce rate of transmission & gather evidence

8. Containment Phase

10. Treatment phase: mitigate impact Cases would be identified through clinical diagnosis, not swabbing Contact tracing would cease Cases would be offered antivirals on the clinical discretion of GPs Vaccination would be offered to those most at risk Increasing the coverage of surveillance by involving all GPs Ensuring preparedness of hospital services.

11. Treatment phase

13. Policy Precautionary approach: international comparisons, triggers Flexibility: UK vs devolved De-escalation of response Scientific advice: openness, structures, understanding Prioritisation of public health activities

14. Functions Surveillance National and local needs UK Harmonisation Burden of disease: mortality, severe morbidity Review shape of surveillance Investigation Field epidemiology Serological studies Molecular testing Socio-economic gradient

15. Functions Risk Assessment International collaboration Modelling Scottish dimension Control Immunisation: mass vaccination, effectiveness Case & contact management: clinical input, effectiveness, Social mixing: PH legislation powers Port health: UK collaboration Infection Control: respiratory precautions

16. Functions Communications Importance of web Co-ordination of service and public communications

17. Processes Governance Formal Framework: Boards, HPS, Scottish Government Flexibility; national vs local Performance monitoring Intellectual property Ethical Framework Response Co-ordination National framework Common management structures Primary care input, National support: call centres, teleconferences Labs, public health capacity

18. Processes Preparedness Primary care input Incident Guidance frameworks National and local surveillance Good Practice Rapid production of Guidance Clinical Input Evidence base in uncertainties

19. Processes Information Immunisation: Lifelong record Health protection; SHPIMS Primary care: consultation data Capacity Data management Workforce Development Capacity and resilience Epidemiology Leadership

20. Conclusion Overall management of the pandemic response went well Many lessons learnt now being reported Need for targeting and prioritising of recommendations Experience of great relevance to Health Protection Stocktake