Report of the Swine Flu Critical Care Clinical Group and Key Learning Points for Future Surge Planning

As part of the Department of Health (DH) response to the challenges faced by the National Health Service (NHS) due to the pandemic of H1N1 (2009) influenza, the DH established the Swine Flu Critical Care Clinical Group (SFCCCG) in September 2009. The specific context was that Strategic Health Authorities in England had submitted plans to the DH setting out how the critical care services delivered by general Intensive Care Units (ICUs) and Paediatric Intensive Care Units (PICUs) could be surged, and this additional capacity sustained, during the expected second wave of the H1N1 pandemic. Building on these local plans, the Department of Health published an H1N1 Critical Care Strategy on 10 September 20091 that described the approach to surging critical care during the pandemic. Similar approaches were taken in Northern Ireland, Scotland and Wales as part of a coordinated UK wide response to the pandemic. 2. The role of the group was to provide senior clinical support at a national level to Strategic Health Authority (SHA) and local plans to surge capacity. This advice was also shared with all four UK health departments. A significant task was to ensure that general and paediatric intensive care services were as prepared as possible for the expected surge in demand and its implications before the NHS headed into the second wave and the traditional flu season. 3. Dr Judith Hulf CBE, the former President of the Royal College of Anaesthetists was invited to chair the group, and its membership was drawn from the medical, nursing and pharmacy professions as well as the professional societies involved in critical care. To ensure coordination across all parts of the United Kingdom, representatives from the other three UK health departments were invited to join the group. A full list of the group’s membership is at annex A. 4. From the outset, the members of the group emphasised the importance of building on the extensive work already carried out by the Department of Health, professional bodies and local clinicians over a period of years that had looked at both the ethical issues and detailed service patterns needed to respond to an influenza pandemic. 5. Where the group saw its particular focus was on advising on the practical issues involved in surging capacity and sustaining it during a second wave. This would include the consideration of the information supplied to the DH by SHAs in England, assist the DH in evaluating it and to help SHAs to identify and manage risks associated with their plans individually and collectively.