Could social services cope with a flu pandemic

Nobody knows when the next flu pandemic will strike. It could be next month, next year or in 10 years’ time. The only certainty is that, at some point, there will be a worldwide outbreak of influenza. And when it happens the con­sequences for the UK and for social care in particular could be devastating.

The government’s latest apocalyptic forecast, contained in a Home Office consultation document published last month, estimates that up to 650,000 people in England and Wales could die during the outbreak. It envisages a scenario in which coffin makers cannot keep up with demand and the dead are buried in common graves. Up to 50% of the population are expected to become ill at some stage over a three-month period.

With social services users likely to be among those hardest hit by the pandemic, the strain on social care will be immense. High-risk groups for influenza include the elderly, the immuno-compromised, those living in enclosed institutions such as care homes or prisons and very young children. Social services will also be expected to ensure extra support is offered to difficult-to-reach groups such as homeless people, mental health service users and disabled or isolated people living alone. This extra work will fall to a service that will itself be depleted by the pandemic.

The Department of Health estimates that during a pandemic up to 50% of the social care workforce will, at some stage, require sick leave of between seven and 10 days. There is expected to be a two- to three-week period when about one in five social workers is off sick. Staff may also have to take time off to deal with care responsibilities and family bereavement or simply because they cannot get to work if the transport system breaks down. It is also likely that many schools will shut, forcing staff to take time off work to look after their children.

Although a national contingency plan to prepare for a future flu pandemic has been in place since 2005, and most local authorities and health care organisations have their own local strategies, doubts remain over the ability of the social care sector to cope.

Anecdotal evidence suggests that the care home sector in particular is unprepared for a future pandemic and with many services now contracted out to private companies it may be difficult for local authorities to ensure that each of their suppliers has the proper contingency plans in place.

Indeed, one recent survey of managers and human resources directors found that 70% admitted their companies were not sufficiently organised to protect their workers against a flu pandemic.

The survey carried out by the Continuity Forum, a business information company, also quizzed 2,200 workers, and found that only 13% believed their employers had policies in place to tackle an outbreak.

And a recent trial run of the national contingency plan for a flu pandemic revealed a number of shortfalls, particularly in the way that central government sends out information. Code-named Exercise Winter Willow, the operation involved more than 5,000 people from the public, private and voluntary sectors and was intended to test the UK response at local, regional and national levels during a level 4 alert (widespread cases of influenza in the UK). A key finding was that, although procedures may work well at central and regional level, important information was often not reaching the public.

The findings report concluded: “Post-exercise feedback indicated that many people thought that public messages needed to be refined and that communications from central government departments and agencies needed to be better co-ordinated to ensure clarity and consistency.”

Some of the lessons learned from Winter Willow have been incorporated into a draft social care strategy and guidelines for social care staff issued in March by the DH, which has also organised a number of regional roadshows and workshops to promote awareness among social care staff of its pandemic contingency plans.

The strategy offers guidance for social care organisations on managing staff absences, protecting staff health, training and education, infection control and specific guidance for settings such as residential care and home care (see panels, facing page).

As civil contingencies lead of the Association of Directors of Adult Social Services and a member of the DH’s committee on the ethical aspect of pandemic influenza, Roy Taylor has helped prepare the strategy and the guidance.

He believes that, although there is no room for complacency, the social care sector has gone a long way to preparing itself for any future flu pandemic.

“Preparations have already begun via pandemic influenza planning groups, primarily primary care trust-led, but with local authority involvement,” he says. “There is much in social care’s basic values, and the commitment of the workforce which will help, although it’s essential to plan for possible sickness of some key workers and managers – including senior managers.”

Taylor, who is director of community services in Kingston, also emphasises that the social care response to any future flu pandemic should not be viewed in isolation. Rather, he says, the key to coping with a widespread flu outbreak will be the ability to ensure close co-operation between staff from various agencies.

“Much depends not just on the state of readiness of the social care sector, but the quality of the working relationships on emergency planning between directors of adult social services and directors of children’s services in England, the relationship with emergency planners, and ownership by the whole council and partners, especially the NHS,” he says.

When health minister Dawn Primarolo recently awarded £155.4m worth of advance supply contracts to supply the vaccine for a possible flu pandemic she claimed that the UK was “on the front foot if a flu pandemic occurs” and “among the best prepared countries in the world”. To find out what this means in practice we will have to wait for the pandemic an event that the World Health Organisation has described not only as inevitable but imminent.


● Cover your nose and mouth when sneezing and coughing and use disposable single-use tissues. Dispose of used tissues in the nearest waste receptacle.
● Wash your hands after coughing, sneezing, using tissues or contact with respiratory secretions and contaminated objects.
● Wash your hands frequently before and after contact with a symptomatic client.
● Avoid touching your eyes, nose or mouth with contaminated hands.
● Regularly clean frequently touched surfaces.
● Ensure that you are aware of your employer’s infection-control procedures and that you are following them correctly.
● Do not bring your children or other members of your family into the workplace.

Extracted from Guidelines for Social Care Staff – Planning for Pandemic Influenza in Adult Social Care


How social care organisations should prepare for the flu pandemic:

● Inform staff on how to keep well and how to self-care when ill.
● Consider how to handle the cancellation of planned leave.
● Involve trade unions.
● Map skills and profile existing workforce, including commitments and locations.
● Collaborate with employers outside social care.
● Consider regional agreements, particularly as a pandemic is likely to occur in waves in different areas.
● Train staff in infection control and basic physical care.
● Identify in advance the work patterns that staff will need to follow to combine home and work responsibilities.
● Work with your health colleagues, as accident and emergency staff will need awareness and guidelines about dealing with people with mental health problems or learning disabilities, migrant workers, asylum seekers, homeless people and tourists.
● Establish pairing or buddying arrangements between services and establishments.
● Consider terms and conditions issues (such as the working time directive and certification).
● Identify staff to work from home.
● Consider verifying the identity of casual and voluntary staff.
● Match level of risk to level of vulnerability in the use of checked and unchecked staff.
● Learn lessons from seasonal influenza.
● Recruit volunteer drivers.

Extracted from An Operational and Strategic Framework – Planning for Pandemic Influenza in Adult Social Care

Planning for a Possible Influenza Pandemic – A Framework for Planners Preparing to Manage Deaths, Home Office, August 2007
Exercise Winter Willow Lessons Identified, Department of Health, August 2007
An Operational and Strategic Framework – Planning for Pandemic Influenza in Adult Social Care, DH, March 2007
Guidelines for Social Care Staff – Planning for Pandemic Influenza in Adult Social Care, DH, March 2007

This article appeared in the 4 October issue under the headline “Bug that could send social care into meltdown”


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