Exercise Winter Willow Liz McIntosh Health Desk Civil Contingencies Secretariat Cabinet Office

1. Exercise Winter Willow Liz McIntosh Health Desk Civil Contingencies Secretariat Cabinet Office

2. Content • Recap on planning and response • Exercise programme for pandemic flu • Exercise Winter Willow 1 and 2 • Objectives • Staging • Scope • Possible issues at national level

3. Planning workstreams • Gathering information and getting it to those who need it, at all levels. • Modelling – the virus; its spread; its impact; response measures. • The medical response: • Vaccines. • Anti-virals purchase, distribution and use. • Treatment protocols and clinical guidelines. • Ethics • Policies on response in particular settings – schools; social care; prisons; transport. • Continued operation of the judicial process. • Management of the dead. • British nationals overseas. • Ensuring business continuity. • Communications. • Crisis management arrangements. • Stakeholder engagement – Category 1 responders and the private sector. • Exercises and other testing and assurance. • Wider international engagements with EU partners, the US and multilateral organisations.

4. Crisis co-ordination • National, regional and local structures to manage the consequences when/of the pandemic arrives: • Department of Health – lead • Civil Contingencies Committee (“COBR”) for central Government • Based on understanding of the virus, COBR will issue firm advice on the full range of response policies • Regional Civil Contingencies Committees. • Local “multi-agency GOLD” crisis co-ordination arrangements • International dimension – WHO; EU; G8.

5. WHO Alert Phases Pandemic alert period Phase 3 Human infection(s) with a new subtype, but no human-tohuman spread, or at most rare instances of spread to a close contact Phase 4 Small cluster(s) with limited human-to-human transmission but spread is highly localized, suggesting that the virus is not well adapted to humans. Phase 5 Larger cluster(s) but human-to-human spread still localized, suggesting that the virus is becoming increasingly better adapted to humans, but may not yet be fully transmissible (substantial pandemic risk). Pandemic period Phase 6 Pandemic: increased and sustained transmission in general population.

6. UK alert levels at WHO Phase 6 WHO Phase 6 Pandemic: increased and sustained transmission in general population. UK: • Alert level 1 Cases only outside the UK (in a country or countries with or without extensive UK travel/trade links) • Alert level 2 New virus isolated in the UK • Alert level 3 Outbreak(s) in the UK • Alert level 4 Widespread activity across the UK

7. Testing plans – so far… • Regional and local level exercises since 2004, eg, in London in 2004;Yorkshire and Humberside and East Midlands in 2005; off the shelf HPA product ‘Coldplay’ (health sector focus). • Two table top exercises to test the central Government response held in 2005. • National level exercise held in June 2006 – Exercise Shared Goal – set at WHO Phase 5. CCC and CCC(O). • EU wide exercise ‘Common Ground’ in autumn 2005. • Private sector exercising, eg, financial sector market-wide exercise in autumn 2006. • More to come next year and beyond….DH and medicines; another at EU level, one at UN level…

8. Winter Willow 1 and 2 – objectives: • Familiarise Ministers and officials involved in central response with policy and response issues at WHO Phase 6 - UK alert levels 2 and 4 • Familiarise key players throughout the UK (regional and local) with government interactions during a response • Stimulate and analyse impact upon the CNI • Test information flows, real-time modelling and access to timely expert advice • Identify gaps in response to inform future planning work

9. Winter Willow 1 – staging: • Stage 1 – national level tabletop ie, CCC and CCC(O) to meet • Builds on Ex Shared Goal scenario (June 2006) • UK alert level 2 ie, first UK cases • 30 January • No regional or local play • Decisions and outputs will be fed into WW2

10. Winter Willow 2 – staging: • Stage 2 – full national exercise over 2 days on 19 and 20 February • CCC and CCC(O) to meet both days • Builds on WW 1 • UK alert level 4 ie, widespread cases in UK • To test UK response at local, regional and national levels • RCCC/LRFs ‘multi-agency golds’ • NHS • DAs • CNI sectors • ‘pool filming’ during Ex and real media via ‘mock press conferences’ after CCCs • WHO, ECDC, EC to play as part of Excon

11. Winter Willow 2 – regional/local play:

12. Winter Willow 2 – NHS play Strategic Health Authorities and related health communities: • East Midlands SHA + Leicestershire • East of England SHA + East and NW Hertfordshire • North East SHA + Northumberland, N’cle, N Tyneside, Gateshead, S Tyneside, Sunderland and Durham and Darlington • London SHA + Lambeth • South Central SHA + Thames Valley, Isle of Wight and Hampshire • South East Coast SHA + West Sussex • South West SHA + Avon • West Midlands SHA + South Staffs • Yorkshire and Humberside SHA + Hull • North West SHA + East Lancs, Blackburn and Central Lancashire

13. Winter Willow 2 – CNI play (1) • Food sector: • Range of manufacturers, retailers, primary producers, wholesalers • Water sector: • Ranges of water companies and regulators • Fuel sector: • Downstream oil

14. Winter Willow 2 – CNI play (2) • Transport sector: • Range of transport operators – buses, trains, air travel, marine • Finance sector: • Simulated input based on 6-weeks market-wide exercise (autumn 2006)

15. Possible issues at national level for WW2 • …some exercise engineering to make sure there are good range of issues on the table for COBR… • Looking ahead from early days of Alert Level 4 towards peak of UK epidemic (some weeks hence..) • Cases • Deaths….triggers for more radical measures? • Absences from work and impacts • Health service • Antiviral stocks • Outlook for essential services • Significant issues at local and regional levels • Impacts on economy • What can HMG do to manage and/or minimise impacts?

16. Thanks for your attention Questions?