Preparations to maintain delivery of the MPS critical activities in the event of an influenza pandemic

Report: 15
Date: 7 December 2007
By: by AC Central Operations on behalf of the Commissioner

Summary

This report gives background information on pandemic influenza and reports on action being taken by the Metropolitan Police Service to put in place Business Continuity plans to ensure, as far as is practicable, that delivery of their critical activities in providing a Police Service to London, is maintained during such a pandemic.

A. Recommendation

That members note the actions taken to prepare for an influenza pandemic and endorse the procedures to be put in place in the event of a pandemic to maintain an acceptable level of service to the people of London.

B. Supporting information

What is pandemic influenza?

1. Pandemic influenza is different from ordinary influenza because it occurs when a new influenza virus emerges into the human population and spreads from person to person worldwide.

2. As it is a new virus, the entire population will be susceptible because no one will have any immunity to it. Therefore healthy adults as well as the elderly, young children and people with existing medical conditions may be affected. The lack of immunity in the UK population will mean that the virus has the potential to spread very quickly between people. This may result in many more people becoming severely ill and possibly many deaths. The circumstances exist now for a new influenza virus to emerge and spread worldwide. Although a pandemic has not yet occurred, experts warn that it could soon. It is most likely that the new virus will arise from an avian (bird) ‘flu’ virus mixing with an ordinary human influenza virus and becoming able to infect people.

What is avian ‘flu’ and how is it contacted?

3. Avian ‘flu is a subtype (H5N1) of the Influenza ‘A’ virus that primarily affects poultry and ducks and emerged in South East Asia, but is increasingly occurring around the world, with recent incidents in the UK and Europe. It is highly pathogenic to poultry causing considerable morbidity and mortality in flocks and there is some evidence that it has jumped to some mammals (cats and pigs).

4. Since 1997 there have been 335 cases reported in humans, predominately in the Far East – all cases have resulted from direct contact with infected poultry. A very high proportion (>60%) of the humans affected have died.

5. There has been one case, in Thailand, in which human to human spread is suspected. Following the death of a child, in whom it has not been possible to prove H5N1 infection, her mother and aunt who nursed her are known to have contracted H5N1.

What is a pandemic and how does it occur?

6. A pandemic is a worldwide epidemic in which outbreaks or epidemics occur in many countries and most regions of the world. Previous influenza pandemics in the 20th century - in 1918, 1957 and 1968 – led to high levels of morbidity and mortality. There are three prerequisites for the start of a pandemic:

• A novel virus subtype must emerge to which the general population will have little or no immunity
• The new virus must be able to replicate in humans and cause serious illness
• The new virus must be efficiently transmitted from one human to another; efficient human to human transmission is expressed as sustained chains of transmission causing community-wide outbreaks.

7. The Avian ‘flu’ virus, H5N1, has met the first two of these criteria, but not the third, therefore there is no immediate threat of a pandemic from this source. The prevalent influenza subtypes that are currently circulating in Europe and North America are of the H3 antigenic variety. These do not meet the first criterion, but do meet the other two. It is thought that a pandemic could occur either as a result of:

• A genetic change in the Avian ‘flu’ virus such that it develops the ability to be efficiently transmitted form human to human; or
• A genetic change in another sub-type of the virus e.g. a H3 sub-type, such that the general population will have little or no immunity to it.

8. In the event of a pandemic occurring the currently available vaccine will be ineffective. The World Health Organisation (WHO) has been working with pharmaceutical companies to ensure that they can respond by developing a new vaccine as soon as a new sub-type emerges. However, it will still take up to 6 - 9 months to produce large quantities of a vaccine. In the event of a pandemic up to 50% of the population could be affected.

9. While the elderly and chronically ill will be susceptible to the complications of influenza in a pandemic, the modifications to the virus can alter this, e.g. in the 1918 outbreak it was young adults that were more susceptible to severe morbidity and mortality.

Anti-viral drugs

10. Anti-viral drugs are used to treat the illness. They must be taken in the very early stages of the illness – preferably within 12 hours and at the latest within 48 hours of developing symptoms.

11. Their effectiveness in a pandemic situation has not yet been tested, it is possible that resistance could be developed to the drug. The main effects of anti-viral drugs are lessening the severity of symptoms, reducing the total duration of illness by up to two days, reducing the risk of complications such as pneumonia and reducing the infectivity of cases by up to 50%.

12. The GLA Group has purchased 100,000 packs of the anti-viral drug Oseltamivir (proprietary name Tamiflu), each containing 10 x 75mg capsules, to be held as an emergency stock by TfL on behalf of the GLA Group as part of a plan to maintain key public services in the event of an influenza pandemic. The MPA has in particular bought into this arrangement to ensure there is sufficient dosage for every member of the MPS. Tamiflu is a prescription only medicine and is intended to be taken, subject to the assessment process, by GLA Group staff members when they become ill.

How is Pandemic Influenza caught and spread to others?

13. Pandemic influenza is spread from person to person by close contact as the following examples:

• Infected individuals can pass the virus to others through large droplets when coughing, sneezing and even talking within a close distance (usually 1 metre or less).
• The virus can be passed on by direct contact with an infected individual by actions such as kissing. Shaking or holding hands with an infected individual followed by touching your own mouth, eyes or nose without first washing your hands will also allow the virus to spread to you.
• The influenza virus can be spread when environmental and inanimate objects, such as door handles, light switches and handles on public transport, become contaminated with the virus. Once again if a person touches these objects and then touches his/her mouth, eyes or nose without first washing their hands, their chances of catching the virus are increased.
• In some circumstances, the virus can also be passed on in fine airborne droplets or on dust particles. This is not considered to be a major route of transmission.

Advice to police forces

14. An advisory document has been produced jointly by the Department of Health (DH) and the Health Protection Agency (HPA) in collaboration with the Home Office Joint Advisory Group and ACPO, which gives guidance to Police Forces on the preventative measures to be taken.

15. The document makes it clear that during the pandemic there is no need for officers and staff to wear face-masks, unless they are dealing with a member of the public who is displaying influenza type symptoms. In those circumstances, a disposable surgical mask should be worn, and where appropriate, surgical gloves. Additional measures should include the provision of alcohol wipes or hand wash for those occasions when soap and water are not readily available, and improved cleaning routines within offices and public areas. The type of masks that a police officer uses should correspond to the type used by healthcare workers in similar settings. Unless a police officer is involved in aerosol producing activities (for example assisting an ambulance worker in putting a tube into someone’s lungs), a surgical mask will provide an appropriate level of protection. If the police officer is involved in aerosol producing activities (coughing and sneezing are not aerosol producing activities), then they should use a FFP3 mask.

Use of PPE (surgical mask, gloves etc) when dealing with people in Custody

16. If someone in custody develops influenza like symptoms, they (the prisoner) should wear a surgical mask and be medically assessed. In addition, any officer who enters their cell or who knows he / she will be in close proximity to the person (within 1 metre), should wear disposable gloves, aprons and surgical mask (PPE).

17. After leaving the cell any protective equipment should be disposed of and this should be followed by thorough hand washing. Disposable gloves should be used when handling any used dishes etc and these should be washed in a dishwasher or with hot soapy water. There may be environmental contamination in the cell and it is advised that any hard, horizontal surfaces should be washed down with normally available detergent or disinfectant after a prisoner with influenza like illness has vacated the cell. The virus is reasonably delicate and is thought to only be infectious on soft furnishings for about 15 minutes. If there is more than one person with influenza like symptoms in custody mask, gloves and apron should be changed between each person and hand hygiene performed.

18. There is no need to wear PPE if the person in custody does not show any influenza like symptoms.

Business Continuity Planning

19. Vaccinations against the specific strain of influenza will not be available until 4–6 months after it has struck and up to 9 months for the supply of large-scale dosage. ACPO has therefore advised that Chief Officers should be planning for a significant reduction in Officers and Staff. The planning assumption is that up to 50% of the population could be affected over a 12-week period, with 20 - 25% loss of affected workers, over and above the usual absentee levels, at the peak of the pandemic.

20. The Commissioner recognises the anticipated impact a pandemic influenza outbreak is likely to have on all public service resources and that it is imperative the Metropolitan Police Services ensures it has appropriate contingency plans in place. These are targeted to minimise disruption to essential service delivery and if necessary prioritising the remaining resources to maintain key critical services.

21. Consultations through the Autumn of 2006 with Senior Officers of all Business Groups, both Operational and Support, resulted in agreement of the concept to define in broad terms the Critical Activities of the MPS as follows:

• Receipt of ‘999’ calls
• Command and Control
• Response to Emergency calls
• Major Incident response
• Crime Investigation
• Management of ‘operational’ information and intelligence
• Maintenance of public order
• Custody management
• Security and protection
• Community Policing and liaison
• Criminal case progression
• Communications and Media management
• And the overarching: Health, safety and welfare of MPS staff

22. By the use of a common template all OCUs and Business Units have been tasked with assessing what the impact of a 25%, 40%, 60% and 80% absenteeism would be on their Unit’s ability to deliver their specific activity that supports or delivers the MPS Critical Activities and any other essential activities undertaken. Each Business Group is to then strategically review the responses of their respective Units and to submit an aggregated response to the Business Continuity Management Team within C03 to undertake a corporate review.

22. There is also recognition that service delivery is in many instances dependent upon support provided from other MPS OCU/ Business Units and especially external Contractors and Suppliers. Hence, the templates also call for such areas of dependency to be recorded.

23. The Business Continuity Management Team will analyse the template returns and present to the MPS ‘influenza pandemic Gold Group’ in the first instance and then Management Board an overall summary of the impact on service delivery arising from the respective degrees of abstraction and particularly areas of vulnerability.

Procedures to be put in place in the event of a pandemic

24. The World Health Organisation (WHO) has defined a number of phases to communicate the status of pandemic influenza. It is proposed that no action be taken by the MPS until Phase 6: Pandemic phase (increased and sustained transmission in the general population) is reached.

25. A number of UK Alert levels will then follow having reached Phase 6:
UK Alert level 1: Cases outside the UK:

• No MPS Action.
• A Regional Civil Contingencies Committee (level I) will sit. The MPS will be represented at this meeting by a CO ACPO officer or OCU Cmdr CO3.

26. UK Alert level 2: New virus isolated in the UK:

• Representatives of all MPS Business Groups, HR and DPA are called to the first Gold Group to refresh plans and procedures.
• A Regional Civil Contingencies Committee (level II or III) will sit. The MPS will be represented at this meeting by a CO ACPO officer or OCU Cmdr CO3.

27. UK Alert level 3: Outbreak(s) in the UK, (Outbreak may not be in London, but if it is move straight to Alert Level 4):

• CO3 put all Business Groups on standby, and will provide daily advise on developments.
• GLA ‘family group’ meeting will be held regarding distribution of Tamiflu to affected MPS staff.
• A Regional Civil Contingencies Committee (level II or III) will sit. The MPS will be represented at this meeting by a CO ACPO officer.

28. UK Alert level 4: Widespread outbreaks across the UK:

• The MPS activates the following procedures with daily sitting of the MPS Pandemic Gold Group and Business Groups set up their Reporting centres.
• LRRF sits with MPS representation and a MPS representative sits on the GLA pandemic Gold Group.
• A Regional Civil Contingencies Committee (level II or III) will sit. The MPS will be represented at this meeting by a CO ACPO officer.

29. The proposals to corporately manage the impact of such large-scale absenteeism are predicated by the need for each Unit to submit (electronically) a daily Situation Report (SITREP) to an appointed reporting centre within each Business Group.

30. Each Business Group having set up it’s Reporting Centre will receive these daily SITREPs, undertake a Business Group overview and arrange ‘mutual aid’ transfers between their Business Group Units where practicable to maintain the appropriate balance of service across the Group’s Critical Activities.

31. All Business Groups will submit daily status returns to CO3, who will support a Pandemic ‘Gold Group’ (Chaired by AC Central Operations [ACCO]). These status returns will report on individual Unit’s levels of absenteeism and the impact such absenteeism is having on delivery of Critical Activities and any Group level action taken to mitigate this impact.

32. The Gold Group, chaired by ACCO will have senior representatives from all Business Groups with HR having a particularly essential role to play in respect of staff welfare and Employer relations and DPA for Media and Stakeholder communications.

33. Business Groups will make requests to the Gold Group for additional resources to maintain Critical Activities at acceptable levels of service where ‘mutual aid’ between it’s own Units is no longer viable.

34. The ‘Gold Group’ will sit daily and review the Business Group status returns including any requests for additional resources. The ‘Gold Group’ will prioritise activities to be undertaken, taking into account inter-Unit dependencies of service provision and any changing priorities of the MPS as the impact of the pandemic across London unfolds. The ‘Gold Group’ will maintain an overview of operational activity to ensure appropriate account is given to the changing operational situation.

35. The ‘Gold Group’ will agree Business Group recommendations for cessation of un-viable activity and arrange, where practicable, ‘mutual aid’ transfer of resources between Business Groups (where skill sets meet the requirements) to maintain delivery of those Critical Activities that must continue. This will take full account of specific staff skills/ qualifications and experience, meet all Health and Safety requirements and utilise where possible the HR Volunteer scheme and the Police staff mobilisation programme.

GLA Group Pandemic Influenza Response Plan

36. The MPS has been actively involved with other GLA Organisations in developing the GLA Pandemic response plan, with senior representatives of CO3 attending the Gold Review and planning group meetings. The plan was originally published in July 2006 with some minor revisions thereafter. The Purpose of the plan is to ensure that:

• The GLA Group continue to provide essential services to Londoners under pandemic conditions
• Continuation of services is pre-planned, as far as possible
• The health, safety and welfare of staff is promoted; and
• Normality is restored in the capital as soon as is possible by supporting other stakeholders and service providers wherever resources allow.

37. It is accepted that each GLA Group member, and the GLA itself, have different statutory duties and responsibilities. Under the circumstances of a pandemic, however, each GLA Group member will be dealing with a situation that is similar in many ways. It has therefore been agreed by all signatories to the plan, that existing resources will be pooled collectively and collaboratively where ever practicable to best meet the needs of all.

38. To cope with the projected peak demand for assessment of staff for TAMIFLU, it is proposed to pool GLA Group occupational health resources. Additional external health resources may be required to deal with the peaks in demand. Packs of the drugs will be distributed to designated hubs in and around London. Five initial hub locations have been agreed. Because of the risk of theft it is planned to use a ‘lean’ supply chain approach to stock replenishment. Minimal stocks will be held at the hubs with a responsive replenishment process. The MPS will provide 24/7 security at the hubs.

39. Each member of the GLA Group is expected to have in place business continuity plans that detail their essential services. These plans shall include management arrangements for how they will operate in a crisis situation (potentially over an extended period) and maintain its essential services. All GLA members are to put in place plans that contain strategies that will be effective in dealing with significant loss of staff during a pandemic. This for the MPS is as described in paragraph 24 above.

40. The command and control structure of this GLA plan is similar to that used under the London Resilience Strategic Emergency Plan. Membership of GLA Gold (Strategic) Group comprises:

• Mayor of London (Chair)
• Director of Finance and Performance (GLA)
• Head of Risk (LFB: EPT)
• Head of Human Resources (LDA)
• Senior Officer (MPS)
• Senior Officer (MPA)
• Director Group Health and Safety (TfL)
• Senior Project Manager Business Development Team (GLA)

MPS HR arrangements

41. HR are regularly reviewing their stratagem for personnel management during a pandemic. It is however generally believed that the existing Attendance Management policy is sufficiently flexible to cope with the demands of a pandemic. It is recognised that there will be an issue with carers and the increase in potential absenteeism as more staff during a pandemic would have increased carer responsibilities arising from school closures and other family members being ill. HR will in the New Year undertake a scoping review with all OCUs and Business Units to try and gauge the impact this might have on delivery of the critical activities.

42. 'At risk' staff with health conditions that render them more susceptible to contracting influenza will be aware of this. Prophylactic immunisation is routinely offered free every year to people who are 'at risk' and this may provide some protection in the event of a pandemic. In the event of an influenza pandemic, 'At risk' staff who have specific concerns relating to their health, will be encouraged to discuss their particular circumstances with Occupational Health. Every case will be considered individually in relation to the individual’s specific illness or circumstances.

43. It is not considered necessary to undertake generic pandemic risk assessments as there are no particular roles that will render an individual more susceptible or less susceptible to contracting influenza, provided as explained by the use of PPE, appropriate health measures are taken where there is increased risk of exposure to the illness.

C. Race and equality impact

There are considered to be no specific Race and Equality issues relating directly to these recommendations. However, as before said staff welfare will play a major part in decisions being taken particularly transfers and assignment of staff to locations other than their usual place of work. Arrangements are already in place within the GLA family for the distribution of Tamiflu to MPS employees, in which respect HR/OH medical staff will undertake a key role.

D. Financial implications

The financial implications on the MPS of a pandemic are indeterminate at this stage, as the degree of severity of attack, demographic profile and impact on the MPS cannot be determined. However, as absenteeism increases there will inevitably be the need for increased overtime as shift patterns and working periods expand to cover for the absenteeism to ensure delivery of the MPS critical activities.

E. LEGAL IMPLICATIONS

The MPS being a Category one responder under the Civil Contingencies Act 2004 has a duty to ’ensure they can continue to exercise their functions in the event of an emergency, in this instance a pandemic, so far as is reasonably practicable and this duty relates to all functions not just their emergency response functions’.

F. Background papers

None

G. Contact details

Report authors: David Hill, Business Continuity and Logistical Support Coordinator: CO3, MPS, in consultation with Dr. Eileen Cahill-Canning.

For information contact:

MPA general: 020 7202 0202
Media enquiries: 020 7202 0217/18

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