A nationwide outbreak of swine flu would severely test the National Health Service. Demand for services will soar just as staff sickness absence increases. The NHS needs to manage its human resources carefully, says Steven Weeks
MPs’ expenses might have stolen the headlines from swine flu but behind the scenes preparations continue. The NHS will feel the effects twice over and needs to put in place plans to maximise workforce capacity.
It is recognised that a flu pandemic will place unprecedented pressures on the NHS. It will have the double impact of reducing staff numbers through sickness and increasing demand for services as the virus spreads.
A flu pandemic also presents a different set of challenges from other emergencies such as terrorist attacks and flooding. A terrorist attack is likely to be quite short in duration, with demands on the NHS being short and intensive. The pressures from flooding will obviously last longer than a terrorist attack but the effects will be generally quite localised.
Any flu outbreak would be expected to spread nationwide, last for up to 18 weeks and have a knock-on impact for months more. This means that traditional approaches are of limited effectiveness.
Flu hits the UK every year and pressure is put on the NHS. This year’s especially cold winter provides a good recent example. As well as the usual festive over-indulgence and seasonal flu combined with norovirus, there were more accidents caused by the weather. What sets a pandemic apart from seasonal flu is that the former will be caused by a new, often more virulent, strain of flu and will thus spread more widely. The H1N1 (swine flu) strain might yet develop into such a nationwide emergency.
Nevertheless, we have been expecting a pandemic for some time and the NHS has had years to prepare. NHS Employers, which represents trusts on workforce issues, was asked by the Department of Health to draw up the workforce element of the national guidance on a flu pandemic. It is one of eight central pieces of guidance. NHS Employers is part of the department’s Pandemic Preparedness Group and it has been in close contact with NHS organisations and their workforce directors in publicising the guidance.
The typical workforce response to NHS emergencies or specific periods of intense staff pressure is to bring in extra staff or for organisations to help each other out. But there are not large numbers of ‘reserve’ health care professionals who could be called upon in the event of a pandemic. However, there are some clinical professionals who are not currently working. At national level, the NHS has been working with the British Medical Association’s retired members forum and the General Medical Council has begun to identify possible cohorts of doctors who are no longer practising or on the medical register. NHS Employers recommended that employers should seek to develop ‘a reserve pool’ of former staff who could be drawn on, for example, by keeping track of those who leave or retire.
The guidance therefore advises employers to think quite widely in assessing the likely impact of pandemic flu on their workforce. They should look at both the direct impact of absence levels due to infection – which could average 20%–30% at the peak of the pandemic – and indirect impact such as the pressures on other public services.
Staff absence is likely to be affected by travel disruption and, in the case of those with school-age children, by closure of schools. Our guidance advises that employers should identify those most at risk of being unable to attend work and ask employees for a range of data that would assist in contacting them – such as telephone numbers, complexity of travel arrangements and potential impact on caring responsibilities. Disclosure of the latter is voluntary but will help employers plan for potential impact.
The pandemic would also increase demand for some services, such as respiratory care beds, while all non-essential work would be suspended. Employers need to carry out a skills audit of their workforce and identify any gaps that could be filled, for example by training more staff to prescribe drugs. The professional regulatory bodies have issued guidance on staff taking on additional duties during a pandemic. There will be a need for staff to be flexible, provided they are competent to take on new tasks and have adequate support.
There will be limited scope for redeployment into specialist services but employers need to consider if staff could assist in general at-risk areas, such as nursing and care homes, to help prevent hospital admissions.
Health employers should work with local staff organisations to develop protocols on the treatment of staff who are absent. It will be essential that infected staff do not attend to limit the spread. Frontline health care staff will have access to antivirals and vaccines once developed. Staff are also unlikely to be able to return to work as quickly as would normally be expected.
In terms of indirect problems, employers will, for example, need locally agreed policies on the treatment of staff that have childcare or other caring responsibilities. The guidance recommended that employers should take a sympathetic view in areas where other provision cannot be made, especially as the decision to close schools would be outside employees’ control and it could be hard to make alternative arrangements. This needs to be balanced, however, against the needs of the service.
At the same time, it is worth noting that legal safeguards such as the European Working Time Directive will remain in place during a pandemic. The duration of a pandemic means that the ‘round the clock’ working practised in other emergencies is not a sustainable response. Reference periods for the 48-hour working time limit, over which working hours are calculated, could for example be extended to up to 52 weeks with rest breaks and shift times being amended.
Where necessary, and in exceptional circumstances, the option remains for employers to identify staff who might be asked to agree to work more than 48 hours a week under the directive’s opt-out provision.
At the moment, such relatively extreme measures have not been necessary and the number of cases remains quite low. Furthermore, in the Commons last week, Health Secretary Alan Johnson and his opposite number Andrew Lansley agreed that the UK is among the best prepared countries for a flu pandemic.
We have also been lucky so far in that the flu strain we are dealing with seems to be less virulent than expected. The NHS is not complacent, however, and has already seconded Ian Dalton from NHS North East Strategic Health Authority to take over as director of flu resilience. We will continue to support our members as they face such serious potential demands on their services and staff.
Steven Weeks is a policy manager at NHS Employers and headed the organisation’s workforce planning guidance on pandemic flu
