H1N1 Influenza Pandemic in Jersey: funding.

STATES OF JERSEY

H1N1 INFLUENZA PANDEMIC IN JERSEY: FUNDING

Presented to the States on 22nd September 2009 by the Minister for Treasury and Resources

STATES GREFFE

2009   Price code: B  R.105

REPORT

Background

The States' Pandemic Flu Co-ordinating Group has advised the Minister for Treasury and Resources that a major wave of illness due to pandemic influenza A H1N1 2009 (swine flu) is expected this autumn or winter and that action is needed now 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 Group have advised that robust escalation plans for community and hospital care are essential to manage during the major pandemic wave period if the hospital is to be able to care for those with the greatest health needs.

The Minister wishes to present the Group's report, attached at the Appendix, to the States.

Financial implications

The Group have estimated the total additional cost of managing the flu could reach £5.5m (this excludes all Social Security and Health Insurance Fund costs). The detail of this is shown in the attached report and can be summarised as –

• Preparation expenditure and maintaining containment phase £1.3m.

• Pandemic management and recovery phase £4.2m.

The Group advise that urgent funding is required for the first phase, of preparation and containment,  and  is  asking  the  Minister  for  Treasury  and  Resources  to  consider authorising this expenditure urgently under Article 16 of the Public Finances (Jersey) Law 2005.

Funding for the management and recovery phase will only be required if a major wave of illness due to pandemic influenza occurs.

Funding

Under Article 16 of the Public Finances (Jersey) Law 2005, where the Minister is satisfied  that  there  exists  an  immediate  threat  to  the  safety  of  all  or  any  of  the inhabitants of Jersey and that immediate expenditure is required and it cannot be met from existing expenditure approvals, and that there is insufficient time to secure any additional expenditure approval through Article 11(8), the Minister may authorize the States funded body to withdraw the money or additional money so required from the consolidated fund.

The Minister will keep under the review the emerging data and consult with the Pandemic Flu Political Steering Group as he considers the request for immediate urgent funding. If authorisation is given, a Report and Proposition will, at the same time, be lodged with the States seeking approval for the authorisation.

If a major wave of illness due to pandemic influenza occurs over the coming weeks, the Minister will consider a further request under Article 16 of the Public Finances (Jersey) Law 2005 to make further funding available.

APPENDIX Report of The States' Pandemic Flu Co-ordinating Group

CHIEF MINISTER'S DEPARTMENT (CMD) CO-ORDINATION GROUP – PANDEMIC FLU

H1N1 INFLUENZA PANDEMIC IN JERSEY: FINANCIAL PLAN Foreword

(Foreword from Dr Rosemary Geller, Medical Officer of Health, 16/09/09)

Throughout history, global pandemics have occurred from time to time: in the 20th Century, the world experienced widespread flu due to new pandemic viruses in 1918, 1957 and 1968. 41 years on, it has long been recognised that the next pandemic was overdue and now it has begun.

In  late  April  this  year,  the  World  Health  Organisation  (WHO)  announced  the emergence of a new influenza A virus and warned that a flu pandemic was imminent. This particular H1N1 strain, including human, avian and swine viral genetic material, had not circulated previously in humans. The virus was entirely new. On 11th June, WHO  declared  that  the  pandemic  virus  was  spreading  in  more  than  two  WHO Regions, and thus the pandemic was declared to have started. The next day, on 12th June, the first Jersey case was confirmed.

At the time of writing most countries have reported cases of the new virus, initially widely referred to as swine flu, but more correctly now termed Pandemic (H1N1) 2009.  Although  most  people  infected  to  date  have  experienced  a  relatively  mild illness, a minority have experienced severe illness and some have died, with the countries of the Southern Hemisphere worst affected during their winter season. With on average 10-20 flu cases a week in Jersey, together with the rest of the world, we too have been witnessing the beginnings of the 2009 influenza pandemic.

No previous pandemic has been detected so early or watched so closely, right from its inception. In Jersey we can reap the benefits of our pandemic preparedness planning which has taken place over the last four years. In addition intensive work has been underway  since  May  to  further  develop  the  Community  Escalation  and  Hospital Escalation Plans ready to face large numbers of flu cases during this autumn and winter. These recent plans have been tailored to meet the specific challenges posed by the new H1N1 flu strain.

Throughout the pandemic so far we have planned for the worse and hoped for the best. Pandemics are unpredictable, nevertheless, the financial plan attempts to quantify what may happen during the forthcoming autumn and winter period. With continuing efforts underpinned by investment to contain the spread of the virus, treat infection and ensure as far as possible the sustainability of our hospital, we would have taken every reasonable and practicable precaution to protect the people of Jersey.

The finite capacity of health care facilities and staff is of concern: one island, one hospital,  one  intensive  care  unit.  Every  effort  must  be  targeted  at  protecting  the capacity we have available so we can treat the most sick when they need care. The

ability of the hospital to provide specialist care to those in need during a flu pandemic is reliant on adequate investment, as well as the effectiveness and funding of the Community  Escalation  Plan  to  prevent  severe  illness  and  keep  extra  hospital admissions to a minimum.

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. As Dr Margaret Chan, Director-General of WHO has said "We are all in this together, and we will all get through this, together."

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1.0  Purpose of report

The purpose of this paper is to provide a summary of the actions required to manage the H1N1 flu pandemic which is expected to strike Jersey in the autumn of 2009. This report aims to inform the States Assembly of the risk mitigation strategy, proposed actions and potential cost.

2.0  Background

A major wave of illness due to pandemic influenza A H1N1 2009 (swine flu) is expected this autumn 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.

Robust escalation plans for community and hospital care are essential to manage during the major pandemic wave period if the hospital is to be able to care for those with the greatest health needs.

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.

3.0  Current situation

Whilst  Jersey  has  sustained  and  achieved  success  in  containment  (testing  and identifying cases, offering Tamiflu to contacts), other jurisdictions have not been able to do likewise. The UK, where containment was abandoned in early July, remains the most heavily affected in Europe and the source of the majority of the 10-20 cases of the new flu occurring each week on the island.

In Jersey, we can now reap the benefits of our pandemic preparedness planning which has taken place over the last four years. Intensive work has been underway since May to further develop the Community Escalation and Hospital Escalation Plans ready to face large numbers of flu cases during this autumn and winter. The plans have been tailored to meet the specific challenges posed by the new H1N1 flu strain. Community

efforts to prevent the spread of the virus and to treat people at home are of paramount importance in an island situation with limited healthcare resources. The primary aim is therefore to keep the impact of swine flu on Jersey to a manageable minimum and within the (expanded) capacity of Jersey General Hospital and to prevent deaths and serious illness as far as is possible.

4.0  Modelling the potential forthcoming flu outbreak for Jersey

Throughout the pandemic so far we have planned for the worse and hoped for the best. Studies of past flu pandemics suggest that infection, once established, has tended to spread through the island over a period of 4-6 weeks. Studying the nature of swine flu' outbreaks in other parts of the world has also shaped our island planning. Whilst this new pandemic remains unpredictable, the potential Jersey flu outbreak for this autumn and winter has been modelled (Figure 1).

Figure 1 - The predicted timeline and size of the pandemic wave

25% 20% 15% 10% 5% 0%

1 2 3 4 5 6 7

Month

Table  1  Estimated  Increase  in  Health  and  Social  Care  Activity  from  H1N1 pandemic as a basis for planning

It is anticipated that approximately 35% of the population would be affected by the influenza pandemic during a four to six week period. A high proportion of sufferers, 87% are expected to be unwell' but these people would recover simply with the aid of Tamiflu. A significant number though, 12% could require additional primary care treatment  for  flu  complications  e.g.  chest  infections.  Finally, 2%  are  expected  to require hospitalisation due to the severity of these complications and up to 0.4% could die prematurely as a result of swine flu infection.

The expected scenario assumes that the pandemic wave hits the Island in advance of the pandemic-specific vaccine being available. The use of Tamiflu as the main line of defence should decrease hospitalisations by about 60%. We are hopeful, however, that with continued effort to slow flu circulating among islanders, the vaccine could arrive in time to prevent much of the potential island flu outbreak.

0. Preparation, Containment and Treatment

Previous funding was agreed by the States in order to make preparations for pandemic flu (Proposition 67) in May 2008. This funding was largely used to stockpile certain supplies  based  on  the  premise  that  once  the  World  Health  Organisation  (WHO) declared pandemic phases 5-6, stocks of essential supplies would not be available due to international demand exceeding manufacturer's capacity to supply.

These preparations were relevant to any flu strain with pandemic potential so, much of the stockpiling of essential supplies for the current H1N1 flu pandemic threat have already been funded. Now that a pandemic is underway the action phases which are yet to be funded or remain partially funded are:

1. The containment phase

As a flu pandemic has now been declared by WHO, the aim is to initially contain the virus  and  minimize  the  spread  within  the  community.  This  includes  the  Public Hygiene  Campaign  and  the  diagnosis  and  treatment  of  flu  cases  and  their  close contacts.

2. The community treatment and social care response

When the pandemic strikes and the Island can no longer remain in the containment phase, the aim will be to care for as many patients as possible in the community without them being admitted to hospital. GPs would be the mainstay of this work. Family Nursing and Home Care would divert resources to offer more care to flu sufferers and social care provision would need to continue and to be co-ordinated well.

3. The hospital escalation response

Inevitably there are those who would become so unwell that they would no longer be able to be cared for in the community and the hospital would have to be ready to respond. Up to an estimated 700 additional hospital admissions might be needed with patients suffering from severe chest infections and respiratory problems or worsening of their underlying medical problems.

To manage this additional activity extra beds and staffing would be freed up by postponing routine surgery to be cancelled and rebooked for after the pandemic. Also outpatient clinics would be reduced and some patients discharged to their home or to nursing or residential care if this was considered safe.

4. The vaccination programme

The aim of the vaccination programme is to offer vaccination to all islanders to protect them from the effects of this flu pandemic. If the vaccine becomes available ahead of the major wave then the number of people experiencing the effects of flu would be considerably reduced. This in turn would reduce work absenteeism, reduce losses to the economy and of course reduce the pressure on the hospital.

5. Estimated Costs

The total additional costs of managing the flu pandemic have been estimated as £5.5m (excluding all Social Security and Health Insurance Fund costs). The detail of this is shown in Appendix I.

As a guide this sum can be broken down into the following estimates:

• expenditure committed and spent to date - £0.3m

• Further funds to be spent immediately as essential preparation and to sustain containment - £1.0m (£0.9m revenue and £0.1m capital)

Preparation expenditure and maintaining containment phase £1.3m:

• funds needed during a major pandemic wave - £3.5m

• recovery costs - £0.7m

Pandemic management and return to business as normal phase £4.2m

The CMD Co-ordination Group – Pandemic Flu recommends that:

• the Treasury and Resources Minister approve immediate access to £1.3m to enable the urgent purchases to date and the further necessary preparation and containment process to be funded

• a further £4.2m be made available to enable the Island to manage in the event of a flu pandemic.

The total additional cost, if the island suffers from an influenza pandemic is estimated at £5.5m (excluding £1.7m of Social Security and Health Insurance Funds costs).

There are no additional permanent manpower implications to this proposal, all staff costs are temporary appointments or payments to existing staff.

It  is  recommended  that  any  additional  funding  is  managed  by  the  Minister  for Treasury  and  Resources,  with  funding  being  issued  to  departments  where  the expenditure is proven necessary.

This recommendation is compatible with the overall island wide strategic aims of:

• Protecting the people of Jersey against the consequences of pandemic swine flu

• Organising and adapting health and social care systems to provide treatment and support for those suffering from pandemic swine flu or its complication.