H1N1 Influenza Pandemic Funding: expenditure approval.

STATES OF JERSEY

H1N1 INFLUENZA PANDEMIC FUNDING: EXPENDITURE APPROVAL

Lodged au Greffe on 15th October 2009 by the Minister for Treasury and Resources

STATES GREFFE

2009   Price code: C  P.174

PROPOSITION

THE STATES are asked to decide whether they are of opinion

in accordance with Articles 16(3) and 11(8) of the Public Finances (Jersey) Law 2005, to amend the expenditure approval for 2009 approved by the States on  23rd  September  2008  in  respect  of  the  Treasury  and  Resources Department –

1. to permit the withdrawal of up to an additional £1,347,000, from the consolidated fund in accordance with Articles 16(3), to be reallocated for the net revenue expenditure of a number of departments in order to fund costs associated with preparation and containment of a H1N1 influenza  pandemic  and  that  the  funding  should  only  be  made available  to  departments  from  the  allocation  to  the  Treasury  and Resources Department by public Ministerial Decision of the Minister for Treasury and Resources based on evidence of the need to incur these  additional  costs  in  order  to  prepare  for,  and  contain  H1N1 influenza;
2. to permit the withdrawal of up to an additional £4,200,000 from the consolidated fund in accordance with Articles 11(8), to be reallocated for the net revenue expenditure of a number of departments in order to fund costs associated with managing the consequences of a wave of illness caused by H1N1 influenza and that the funding should only be made available to departments from the allocation to the Treasury and Resources Department by public Ministerial Decision of the Minister for Treasury and Resources based on evidence of the need to incur these  costs  to manage  the  consequences  of  an  H1N1  pandemic influenza.

MINISTER FOR TREASURY AND RESOURCES

REPORT

Background

1. 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.
2. The  Group  have  advised  that  robust  escalation  plans  for  community  and hospital care are essential during a major pandemic wave period, if the hospital is to be able to care for those with the greatest health needs.
3. The Minister presented the Group's report (Appendix 1) to the States on 21st September 2009 (R.105/2009).
4. Purchases of the antiviral drug tamiflu and the H1N1 vaccine have already taken place, along with other preparations. The cost of these preparations to date amounts  to  £2.9  million;  this  has  been  funded  from  previous  expenditure approvals.
5. The Group have estimated the total additional cost of managing the flu could reach £5.5 million (this excludes Social Security and Health Insurance Fund costs, estimated at £1.7 million). 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.

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

Expenditure approval under Article 16 of the Public Finances Law

7. The Pandemic Flu Co-ordinating Group have advised that urgent funding is required for the first phase, of preparation and containment, and have asked the Minister for Treasury and Resources to consider authorising this expenditure immediately under Article 16 of the Public Finances (Jersey) Law 2005.
8. The Minister has considered this matter in consultation with the Pandemic Flu Political  Steering  Group,  comprising  the  Chief  Minister  and  Ministers  for Health and Social Services, Social Security, Education, Sport and Culture and Treasury and Resources and receiving advice from the States Medical Officer of Health,  and  the  States'  Pandemic  Flu  Co-ordinating  Group.  This  advice  is attached as Appendix 2.
9. The  Minister  for  Treasury  and  Resources  is  satisfied  that  there  exists  an immediate threat to the safety 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)  of  the  Public  Finances  (Jersey) Law 2005.

10. In accordance with Article 16(2) of the Public Finances (Jersey) Law 2005, the Minister authorized the withdrawal of up to £1,347,000 from the Consolidated Fund by the Treasury and Resources Department.
11. In accordance with Article 16(3) of the Public Finances (Jersey) Law 2005, the Minister is now seeking States approval for this expenditure withdrawal.

Expenditure approval under Article 11(8) of the Public Finances Law

12. The Pandemic Flu Co-ordinating Group have advised the Minister that in the event of the pandemic striking the Island, the aim will be to care for as many patients as possible in the community without them being admitted to hospital. However, it is inevitable that some islanders 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.
13. The Group has advised that if a vaccine becomes available ahead of the major wave then a vaccination programme offering vaccination to all islanders would be put in place.
14. The costs associated with the pandemic management and recovery will only be incurred in the event of a major pandemic wave of illness. This expenditure is therefore  not  required  immediately,  only  in  the  event  of  a  pandemic materialising.
15. The Pandemic Flu Co-ordinating Group, together with officers from Health and Social Services, estimate that the cost of managing a H1N1 influenza pandemic could  be  up  to  £4,200,000,  as  detailed  in  the  Group's  report  attached  at Appendix A.
16. Expenditure approval for these costs is sought under Article 11(8) of the Public Finances (Jersey) Law 2005.
17. If the pandemic occurs before the States have the opportunity to debate this proposition, the Minister will consider authorising expenditure under Article 16 of the Public Finances Law at that time. The Minister will keep under the review the emerging data, receive regular briefings from the Pandemic Flu Co- ordinating Group, and consult with the Pandemic Flu Political Steering Group.

Management of expenditure approvals

18. All funds approved through this proposition will initially be allocated to the Treasury and Resources Department.
19. The  Minister  will  appoint  a  group  of  senior  officers  to  recommend  the allocation of this funding to departments based on evidence of the need to incur these  additional  costs  in  order  to  prepare  for,  contain,  and  manage  H1N1 influenza.  The  allocation  of  funds  will  be  reported  in  a  public  Ministerial Decision and subject to the relevant Accounting Officer confirming –

• that the goods and services being purchased are required immediately and are  needed  to  respond  to  the  threat  to  the  safety  of  the  island's inhabitants;

• that insufficient funds are available within existing budgets;

• that there are appropriate controls in place to ensure that funds are being spent appropriately;

• that value for money is being achieved; and

• that  financial  directions  are  being  complied  with  in  respect  of  this expenditure.

Financial and manpower implications

20. There are no additional permanent manpower implications arising from this proposal, additional staffing requirements will be met through overtime and temporary appointments.
21. The financial implications are to increase States expenditure approvals by up to £1,347,000 and up to a further £4,200,000 as set out in this report and its Appendices.

APPENDIX 1

R.105/2009

H1N1 INFLUENZA PANDEMIC IN JERSEY

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.

R.105/2009 – 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.

APPENDIX 2

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

H1N1 INFLUENZA PANDEMIC IN JERSEY: URGENT FUNDING REQUEST REPORT

1.0  Purpose of report

The purpose of this report is to state the case for the urgent expenditure of £1.3 million for the further containment and preparation phases for Pandemic influenza (H1N1) 2009 – previously known as swine flu.

2.0  Background

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. Currently 10-20 new cases are confirmed each week on the island. The majority of islanders to date have caught flu abroad.

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

The finite capacity of health care facilities and staff is of concern: one island, one hospital, one intensive care unit. There is no doubt that even with an effective  community response the Jersey General Hospital will have to get ready with plans and supplies to admit a lot more patients than usual.

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. The situation currently faced by the island, and indeed  the  world,  is  exceptional,  with  the  flu  pandemic  predicted  to  reach proportions last seen in 1968.

Purchases of the antiviral drug tamiflu and the H1N1 vaccine have already taken place, along with other preparations. The cost of these preparations to date amounts  to  £2.9  million;  this  has  been  funded  from  previous  expenditure approvals. This report recommends further immediate expenditure relating to the containment and preparation of H1N1 influenza.

3.0  Current situation

We now stand at a junction with broadly two possibilities as to how the flu pandemic will affect Jersey during this autumn and winter:

Optimistically:

1. We will continue to be successful in containing the spread of the virus until  the  vaccine  arrives  and,  through  an  island-wide  vaccination programme, largely prevent the outbreak of flu which is imminent.

Or:

2. The vaccine will not be available soon enough and in sufficient quantities to prevent the majority of the cases we expect. In this case, the approach would be to protect flu sufferers as far as possible from serious illness by treating them with the antiviral drugs Tamiflu or Relenza and through enhancing the capacity of GP and other community health services. This approach  would  in  turn  prevent  the  hospital  from  becoming overwhelmed; the hospital should then remain in a position to treat those islanders who do become seriously ill as a result of flu. NB Vaccination would also be offered in due course, under this scenario, to prevent a potential second wave of flu.

The current situation remains current for a relatively short period of time in relation to the new flu. The situation changes weekly across the world and locally with new findings emerging which require our planning and actions to be flexible and timely.

0. Funding request

Expenditure  on  the  equipment,  consumables  and  services  detailed  below  is required immediately to respond to the threat of a wave of illness relating to H1N1  influenza  that  will  affect  a  significant  proportion  of  the  island's inhabitants.

There are insufficient funds available within existing budgets to meet these immediate costs.

Resources  are  needed  immediately  to  address  the  following  phases  of  the pandemic flu response:

• Continued containment to prevent the spread of the virus

• A vaccination programme to protect islanders from becoming infected

• Community treatment for those who could be about to become ill

• Hospital escalation (increasing hospital bed numbers) in order to ensure sufficient hospital capacity to treat those with severe illness as a result of flu.

• Preparing for the possibility that more deaths may occur than usual.

It is estimated that the cost of these phases (i.e. containment and preparation) could  total  £1,347,000.  The  following  paragraphs  detail  this  proposed expenditure.

1. Containment (estimated cost £216k)

At  the  current  time  the  island  is  in  the  containment  phase'  which  means limiting spread from the small number of cases as they occur. It is important to remain in the containment phase' for as long as possible.

A mainstay of this phase has been the public awareness campaign – Catch it, bin it, kill it' and the more detailed advice available through leaflets. This campaign will be ratcheted up further during the next few weeks. The approach advises hygiene measures which individuals can follow to protect themselves and others.

GPs have already become extremely busy with additional home visits and it has been agreed that patients will be funded by the Health Insurance Fund for the difference of the cost of a home visit versus an appointment at the surgery if the home visit is associated with suspected flu.

For each flu sufferer, once H1N1 flu is confirmed (following the result from a throat swab sent to a laboratory in the UK), their contacts are identified and offered a course of Tamiflu in order to contain and prevent the spread of the virus.

The key advance preparation actions and costs associated with this phase are as set out in Appendix 1:

• Initial Public Hygiene Campaign

• Set up gold and strategic command centre structures

The  key  actions  and  costs  as  the  Island  is  in  this  phase  are  as  set  out  in Appendix 1:

• Additional H1N1 swabs tested by the UK laboratory

• Distribution of Tamiflu to all suspected and confirmed patients and their contacts once the test is confirmed positive

2. Vaccination (estimated cost £55k)

The aim of the vaccination programme is to offer pandemic-specific vaccine to all islanders to protect them from the effects of this flu pandemic. If the vaccine is available ahead of the major wave then the number of people catching flu would be considerably reduced. The vaccination programme is predicted to begin in a matter of weeks.

The key advance preparation actions and costs associated with this phase are as set out in Appendix 1:

• Arrangement of storage for vaccines

• Purchase of consumables for vaccine programme

The key actions and costs once the Island is in this phase are:

• Costs associated with the first phase of the vaccination programme

3. Community treatment (estimated cost £278k)

With up to 35% of the population experiencing flu like symptoms an enhanced primary and community care service will be needed. Flu sufferers would remain at home, off work "sick", for about a week. These patients would be treated with the Island's stock of Tamiflu. The majority of individuals wouldn't need anything further and would remain at home until they had recovered. More vulnerable  patients,  however,  would  require  some  additional  community support with an emphasis of trying to make sure that only the very unwell are admitted to the hospital.

The key advance preparation actions and costs associated with this phase are as set out in Appendix I:

• Recruitment of a Social Care Coordinator

• Preparation  of  liaison  leaflets  to  various  voluntary  groups  and  the parishes who will work together to support the vulnerable and sick in their communities

• Secure storage for Tamiflu stock

• Purchase of Relenza

• Purchase of community equipment

• GP telephone triage for Tamiflu distribution (first phase)

4. Hospital escalation (estimated cost £788k)

Inevitably there will be those members of the population who become so unwell that they will no longer be able to be cared for in the community and the hospital will have to be ready to respond. The hospital will focus entirely on the management of severe acute illness. We are expecting up to an estimated 700 additional admissions to the hospital as a result of the anticipated flu outbreak. Many  of  these  patients  will  be  suffering  from  severe  chest  infections  and respiratory  problems  but  also  some  will  be  experiencing  exacerbations  of underlying medical conditions such as heart failure.

To cater for this marked increase in patients needing admission to hospital, the Jersey General Hospital plans to scale up capacity in a number of ways:

1. Increasing the number of hospital beds, on a temporary basis, from 206 to 348; an increase of 142 beds (69%). Providing these beds, over and above the existing funded beds, will require additional resources. The cost of these resources has been calculated by using an average H&SS cost per occupied bed day enhanced for the use of overtime, potential use of agency staff and higher cost respiratory drugs.
2. the hospital will also require additional specialist equipment and supplies for adult and paediatric patients.
3. in  severe  cases  a  number  of  the  admissions  are  expected  to  require Intensive Care facilities which will place an additional burden on these areas.

The key advance preparation actions and costs associated with this phase are as set out in Appendix 1:

• Locum support for Microbiology services

• Purchase of additional protective clothing and consumables

• Purchase of additional equipment

• Staff training for use of new equipment

• Purchase of additional oxygen supplies

• Refurbishment  work  in  Mckinstry   Ward  and  preparing  a  ward  at  St Saviour's

• Staff training to increase intensive care capacity

5. Preparing for possibility of flu deaths (estimated cost £10k)

The flu pandemic could claim the lives of some of the Island's more vulnerable patients and some previously healthy individuals. This reflects the experiences of other countries which are already in the grip of their outbreaks.

As a consequence of this, additional storage facilities and mortuary services will be made available.

The key advance preparation actions and costs associated with this phase are as set out in Appendix 1:

• Preparation  for  access  and  readiness  of  the  temporary  storage  and mortuary

5.0  Recommendation

It is recommended that £1.347 million is made available immediately to fund the  measures  outlined  in  this  report,  necessary  to  prepare  for,  contain  and manage H1N1 influenza.

Appendix I

Health & Social Services

H1N1 Influenza Pandemic in Jersey - Preparation and Containment Phase Urgent Expenditure

H&SS CMD

Preparation Capital Pandemic Preparation Total Costs Costs Costs Costs Costs £000s £000s £000s £000s £000s

Containment Phase

Public hygiene campaign 15 15 Establishment of Gold and Strategic Command Centres 27 27 Additional Laboratory tests for H1N1 164 164 Distribution of Tamiflu 10 10

Total Cost of Containment Phase 15 0 174 27 216

Preparation Costs

Vaccination Programme

Vaccine storage

Preparation of fridges and space etc. 2 2 Vaccine programme (first 6 weeks) 36 36 Consumables for vaccine programme 17 17

Community Treatment Phase

Social Care Co-ordinator 7 7 Carers leaflets and information packs 10 10 Secure storage for tamiflu stocks (inc. transport) 35 35 Purchase of Relenza 125 125 GP telephone triage first phase 45 45 Additional community equipment

12 pulse oximeters 6 6

Strip thermometers plus leaflets 9 9

50 x oxygen concentrators 41 41 Hospital Escalation Phase

Locum support for microbiology service 60 60 Additional personal protective equipment for staff 78 78 Additional hospital equipment

10 x non-invasive ventilators 24 24

12 x Pulse oximeters 6 6

FFP3 test kits 5 5

Additional Pathology reagents 30 30

30 x Portaneb Nebulisers 2 2

50 & 65 x Additional bed frames and mattresses 126 126

Paediatric costs and equipment 24 24

New ward areas equipment/set up 100 100 Paediatric/adult intensive care training 85 85 Staff training for use of non-invasive ventilators 10 10 Additional oxygen supplies

Cylinder rental 64 64 Trolleys, regulators etc. 38 38 Storage at Sandringham site 26 26 Preparation of Mckinstry Ward and St Saviours ward areas 110 110

Flu Deaths

Preparation of storage facility 10 10 Total Cost of Urgent Preparation 930 110 81 10 1,131 Total Cost 945 110 255 37 1,347