Former US defence secretary Donald Rumsfeld’s famously obscure quote about “known knowns”, and “known unknowns” has strong parallels for local government’s response to the swine flu pandemic.
Councils across the nation have long been warned that the spectre of a new pandemic was “not a question of if but when”, with a principal difficulty being to prepare for all possible eventualities of an emergency that could plunge all key services into crisis.
Certainties are few and far between, except for an autumn peak and local authorities being expected to deliver more to residents with a workforce as susceptible to H1N1v as the communities they serve.
The Department of Health’s (DH) generalised worst case scenario modelling envisages up to 750,000 potential deaths from an unspecified pandemic, up to half of the population suffering symptoms and potentially more than 1 million needing hospital care – all with a long-term cost to society of £1,242 billion.
Current predictions for H1N1v fall way below this estimate with 19,000-65,000 additional deaths seen as a “reasonable” planning assumption.
The DH makes no bones about seeing local authorities as a safety net, fully anticipating that councils will be taking up the strain of increased pressures that the National Health Service cannot cope with when the anticipated peak occurs. This will also involve stepping up work to allow for the early release of patients to free up vital bed space, as well as preventative work to keep people out of hospital when services are reaching capacity.
Simon Cole, social care lead at the DH’s pandemic influenza preparedness programme team, said councils should be modelling for a 25% absence rate in social care services, making the challenge to deliver an increased level of services “that much greater”.
“Hospitals will fill up quickly, and community services will need to care for people with a wider range of needs than usual,” he said.
Added to that is the potential increased burden that illness among the nation’s estimated 5 million ‘informal’ carers could place on the local social services.
The results of an LGC survey showed almost 90% of council chief executives and senior managers had measures in place to move staff away from low-priority roles to help deliver front-line services in the event of severe outbreaks.
Temporarily closing non-essential services, introducing remote or home working, cancelling leave and bringing back recently retired staff were also seen as important strategies.
Paul Bettison (Con), chair of the Local Government Association’s environment board and civil contingencies lead, insisted that councils will need to be bold about what services are essential and what can be cut at little or no notice.
“I’d take people off cutting grass for a week if it those staff can be put to better use distributing Tamiflu,” he said.
“It won’t kill everybody if the grass is a bit long.”
Cllr Bettison also insists that councils should have clear plans for which services can safely be shut down because of staff absences, to avoid drafting staff in to keep them open. He gave leisure services as one area ripe for suspension.
Others cite debt-collection, library services, back-office administration, and recycling as non-essential.
Paul Dudley, chair of the Association of Local Authority Risk Managers (ALARM) insists councils are well-prepared for the pandemic and in daily dialogue with the government’s regional offices, and senior managers in close contact with their neighbouring counterparts.
“From an ALARM perspective, we’d expect all public service organisations to have a well thought through plan” he explains.
But he accepts that the very unpredictability of the virus will lead to very localised staff shortages, with traditionally thinly-staffed births, deaths and marriages teams potentially coming under particular pressure.
John Barradell, deputy chief executive at Westminster City Council, said councils should have an “excess deaths plan” that has assessed the capacity of local funeral directors, crematoria, and mortuaries, including their ability to deal with the needs of all local faith groups.
Mr Barradell believes that the nation ought to be able to deal with an increase in deaths on the scale anticipated by the DH, but points out that capacity issues are so localised that only individual councils are capable of properly assessing local needs.
But he accepts that in some areas council staff may need to help with body collection following deaths at home, and points to recent government guidance that funeral services could be shortened, crematoria operating hours extended, and undertaker staff pooled depending on local needs.
Pooling of other staff in services for the living is an option that Jim McManus, Birmingham’s joint director of public health, is keen for the city to explore.
Having overseen the response in England’s first swine flu “hot spot”, Mr McManus said the city was keen to see teachers and social workers vaccinated against the virus, and for the creation of a social-work “resilience pool” that could share council and NHS staff to ensure that vital services were maintained.
One of the city’s lessons from the spring outbreak of swine flu that saw one child fatality and the closure of 34 schools has been that there is no point in cancelling classes to contain the virus.
Instead, Mr McManus believes that keeping as many of the city’s schools running, even if it means drafting teachers from closed schools into ones that could be kept open, will be the best way to minimise disruption to social care and NHS services in the city.
“There are some things we have done very well, and there are some things that we can learn from,” he said.
“This next wave will test us to destruction.”
Roy Taylor, former director of adult social services at Kingston upon Thames RBC and now the DH’s national director for social care flu resilience, believes Birmingham’s experiences with its neighbouring authorities could provide important lessons for the rest of the country.
At the very least Mr Taylor thinks councils and primary care trusts will emerge from the pandemic with better joint-working arrangements and new initiatives.
What by definition is unspecified, however, is the third part of Donald Rumsfeld’s trilogy of knowledge – the “unknown unknowns”.
Despite a wealth of emergency planning around the pandemic, local government is highly likely to discover some things it never knew it didn’t know when the pandemic reaches its height.