Security and the Health Sector

This guidance has been developed to assist the health sector in addressing a range of security issues relating to possibility of a terrorist attack to a crowded place within their site. The advice provided in this booklet is built on knowledge, learning and best practice developed between the National Counter Terrorism Security Office, health sector security professionals including the NHS Counter Fraud and Security Management Service (NHS England), and representatives from the devolved health care administrations across the UK.

Got the sniffles? Get a tissue

Verdant looks at the communications around the flu epidemic

Andrew Lansley's decision to pull the Flu advertising campaign in the run up to Christmas has caused a huge amount of debate and criticism targeted at the Government who have been accused of putting the nation's health at risk in order to save money. 

Massive leap in hospital admissions despite a 'mild' Pandemic

The NHS faced a sevenfold increase in people admitted for flu last year (2009) it has revealed with 33,376 bed days taken up by people against only 4,163 in 2008.

The rise was worst in the last quarter of the year with some 20,744 hospitalised between October and December compared to 1,585 in the same quarter of 2008.

Bio threats - politics or preparation. A changing landscape


Preparing or Politics?

Proper preparation can prevent poor performance

Can the politics and the science surrounding Bio Threats ever be separated and progress made ? This is the important question that persisted, following the SDA Bio-preparedness debate held at the Solvay in Brussels.
A range of thoughtful, serious experts came together and shared their views on the level of the threats faced, and the measures in place and being planned to help combat any Bio-Threat events. 
The consensus of opinion from the report contributors and conference speakers made it crystal clear that Biological Threats were indeed very real from natural and also manmade sources. Although there was some divergence of opinion on the likely risks of a biological attack, it was interesting to note that such differences were focused more on the impact and type of attack, rather than its inherent probability.

Formal Pandemic announced ... but how well are organisations prepared?

Swine Flu (H1N1) status change to Pandemic (Level 6)… amidst general business apathy.

11 June 2009

The World Health Organisation has increased the alert level for A(H1N1) or Swine Flu to a level 6 Pandemic alert.

This Pandemic Alert, the first for 40 years, confirms that the H1N1 virus is now maintaining sustained human to human infection in at least two geographic areas. With outbreaks as far apart as Australia and Europe, the upgrade to alert level 6 Pandemic is no surprise as the formal announcement is linked to a confirmation of wide geographic spread rather than any specific increase in the severity of infections.

Dr Keiji Fukuda, Assistant Director-General of the World Health Organisation speaking yesterday was at pains to stress that confirming Pandemic Status for this novel H1N1 virus “does not mean that the severity of the situation has increased and that people are getting more seriously sick at higher numbers or higher rates than they are right now”

He added, “We also do not know how this virus is going to evolve. It could become more mild over time, or it could become more severe over time, or it could stay pretty much as it is now. These are uncertainties that we have to take into account but we really do not know how that is going to go forward.”

In speaking on the infections to date that are now approaching 30,000 cases with many more suspected of going unreported, Dr Fukada indicated that most were in those below 60, with many infections occurring in those from in their mid 20’s. He stated that at the moment it was unclear whether or not this was due to the travel patterns or if there were other clinical factors involved. Of the 141 deaths seen so far half were in people with underlying health issues and the infection is currently generally assessed as “Mild and Self Limiting”, although it should be said that this could change as the virus develops.

What is clear though is that many people are likely to fall ill over the coming months and that this will have an impact, as they will be unable to work for between 7-10 days.

The Continuity Forum has been compiling data on the planning in place to cope with possible disruption caused by a pandemic over the course of the past month. Over 800 responses have been received from organisations of all types and their content reveals a stark difference in attitude between the public and private sectors.

Against a backdrop of rapidly rising cases (roughly doubling each week) the majority of businesses have still failed to heed government advice to plan for the effects of staff losses and other disruption. Amongst our very largest companies and in the Public Sector planning has generally been untaken, though there are doubts about the depth and likely effectiveness of measures taken and there is little evidence of real commitment to the process across the country.

Taking the top tier of organisations, fewer than half (46%) have implemented Pandemic specific plans with 78% of these being described as incomplete. Organisations with a significant international dimension fare only slightly better with 59% stating they have plans, although 67% are said to be incomplete.

Public Sector Organisations are generally better prepared in terms of planning, but outside of these sectors preparations and planning in organisations rapidly declines. Across the whole of the UK research suggests that fewer than 10% have any kind planning in place to help manage the impact of the Pandemic, which can reasonably be expected to continue to grow over the coming months and particularly in the traditional Flu season later in the year.

Hopefully the WHO announcement will motivate and stimulate many more organisations to start planning now.

Forum Comment

Commenting on the WHO announcement, Russell Price of the Continuity Forum stated “ The World Health Organisation are really just validating what has been evident for the past few weeks with the confirmation of this novel H1N1 virus as Pandemic. The issue isn’t what we are seeing at the moment but rather how it will develop, spread and evolve. Whilst 30,000 may appear to be a large number of cases, over the coming months this will continue to rise especially after the summer when the Northern Hemisphere enters its Flu season”

He added, “Caution and prudence are key in reacting to this threat, we should be careful to be neither complacent and underestimate or ignore the threat, or panic and over estimate it’s potential impact. There is a lot still to learn about the virus and there are issues around how it will develop … will it get more or less severe? We just don’t know at this time, and it must seen as prudent or indeed the responsibility of organisations to carefully consider how they may be affected later in the year. Failing to act now is throwing away the window of opportunity available to act and prepare for what could be said to be an inevitable period of disruption in the Autumn.”

The Continuity Forum is holding a Pandemic Summit on the 26th June that will provide a detailed update on the threat and the planning that can be undertaken by organisations.

In addition, there will be two Pandemic Planning workshops in July to further assist and support organisations develop their planning and response.

For more details on any of these sessions please contact us directly.


Pandemic Planning ... Time to act now

Dr Margaret Chan, director-general of the World Health Organisation, yesterday announced formally the arrival of the influenza pandemic, describing it as now “unstoppable”.  By the time you read this note, in the UK we’ll have had around 1400 cases identified, with probably many more going undiagnosed. 

The novel A(H1N1) virus causing the Pandemic is so far relatively mild, with much of the message coming from Health professionals giving reassurance that the virulence is moderate and for us all not to be alarmed.  Notably, the move to a Pandemic level has been described as reflecting geographic spread only and not marking a specific increase in the danger of the virus.

This all sounds not too bad; it’s not the H5N1 Bird Flu, which is far more deadly, the symptoms are pretty mild, and most get well without needing much medical intervention … so is it really something for us to be concerned about?

Well, I’d say yes.

From a medical perspective, the issue is that nature has created in the virus a very adaptive thing.  It is constantly evolving, changing and merging its structures to try and survive and spread. So far there have been 30,000 cases globally; this is a tiny percentage of those likely to be infected, and in a person infected with a tricky virus like A(H1N1), the possibility of the virus mutating still further not just exists, but is reasonably likely. What this means is we really don’t know just what the longer-term impact of the virus is going to be. It may stay as a mild seasonal ‘flu type strain or it may increase in its severity.  Crossing ones fingers and hoping, though, is a poor risk management tactic despite its frequent use. 

One thing is certain, people infected will be too ill to come to work and if the spread of the Virus does scale up dramatically in the Autumn then a lot of Offices, Shops and Factories are going to have to function with fewer people for a while.  There could well be further impact should Schools continue to close (and parents need to stay at home), or if the Transport networks were affected through staff loss.  

The Continuity Forum and the Government have been campaigning for BCM to be more widely adopted by organisations, and today around half our ‘corporates’ do have plans to some degree.  However, many of these (>65%) do not cover the People issues the threat of Pandemic raises.  In smaller organisations, as you may expect, the level of planning is much less. Scaling this up and taking a National view means more than 90% of organisations, covering something like 80% of the UK Workforce, have not developed proper plans.

This raises an important organisational issue. It is rare for those working in the Continuity field to get any significant notice of one specific event, but that is the case with the current Pandemic. 

Most of you reading this will be ‘believers’ in the value of BCM to an organisation, but you’ll also know that there are real difficulties in gaining the necessary support of develop effective plans. It should come as no surprise you that 8 out of 10 of those with BCM plans in the Corporate area (our best prepared) have not considered at all the financial impact of a Pandemic, and fewer than 30% have looked at their supply chain at all. 

Against this backdrop, I have reservations about how people will now act, particularly in the SME community, where pressures are intense just now. They may feel it is too late or hard, and choose to do little or nothing, putting their faith in luck.

Understanding how your organisation will be affected by a period of sustained staff absence is vital to coping well with any disruption - and maybe even averting a crisis. There is a lot of advice now available that people can follow, mostly practical and easily implemented. 

The first steps though are a real critical examination of the likely impact on foundations of the Organisation.  Look at areas like cash flow and production difficulties, consider how you would cope if you lost critical skills.  This is often overlooked, not just in areas such as IT or production, but in terms of people authorised under regulation to do certain tasks whether it is a safety licence as seen in the Gas, electricity and similar sectors or professional qualifications needed in other sectors such as Law, Banking, Insurance and of course Medicine.  Absence of other 'authorised' personnel such as those able to deal with banks and access sensitive information can also become a difficult issue for organisations if not considered fully ahead of time.

By carefully thinking through how your organisation relies on specific skills you'll be able to identify critical activities ahead of any skills shortage and develop a more measured and appropriate response to any absences affecting the organisation.

Remember to extend this thinking to other key partners on whom your organisation may rely too.  With most organisations having partnerships or outsourcing relationships that place key skills outside of your direct control it is vital that you understand the steps these organisations are likely to be taking and how they will impact on you.

Some will doubtless feel as though there are enough difficulties in the economy at the moment to spend time on what they may feel is just another 'health scare', but that is a very dangerous position to take.  With the economy under such pressure, further disruption could well be the final push that takes unprepared organisations over the edge.

The old adage of "a stitch in time ..." has never been more true and should the projections for the Autumn be realised you'll certainly appreciate the effort made.   

So the first task has to be to choose to act and act now or else we (and you) risk losing  the window of opportunity we have ahead of the traditional Flu Season to mitigate the potential effects to us all. 

There is a lot to consider and space is limited, but you are not alone and we can help.  If you would like to know more please contact us at

The Continuity Forum is holding our third Pandemic Summit on 26th June please contact us directly for more information. 


A(H1N1) initial research suggests parallels with 1957 Pandemic


Media criticise health organisations, but threat continues to develop 

As Swine Flu starts to slide down the news agenda, some are already declaring that the worst is over and it was an overreaction. Indeed nearly half of people in the US think the media exaggerated the threat, mirroring the view in the UK.

Is the really the it over?

Well no and Business Continuity planners to need to heed the warnings coming from World Health Organisation and the US CDC as well as the Department of Health.

The A(H1N1) is still continuing its spread and Keiji Fukuda of WHO is stressing that they continue to be worried about what will happen as the southern hemisphere starts to enter Winter. Richard Besser of the CDC speaking on the 10th May warns that Mexico is still seeing significant transmission and there continues to be an upswing in infections in the US. Fukuda continues stating that “there is a good chance that the virus will re-emerge in the autumn and winter months in the northern hemisphere and that it could become more virulent.

Science Magazine is reporting the results of an initial study in the Mexico Swine Flu outbreak led by Professor Neil Ferguson of Imperial College, London confirming that the virus is a virulent as the 1957 pandemic, but not as bad as that seen in 1918. Estimates have calculated the more than 2,000,000 around the world in 1957.

The international teams provisional findings suggests that the case fatality rate for the A(H1N1) ranges between 0.3% and 1.5%, less dangerous than 1918, but still a substantial threat. The study also estimates that infection characteristics could change as the virus evolves and that we need to continue to develop information quickly to more fully understand its development.

Across the world and in little more than a month more than 5000 have been infected and 50 have died in this initial phase of the outbreak, certainly substantial enough to be case for considerable concern amongst informed experts and BCM planners should share this concern. It is far too soon to draw back from Pandemic planning or to be influenced media naysayers.

The Continuity Forum would stress the view from the Department of Health statement on Monday that “all infections in the UK so far had been "mild", but it is right to prepare for the possibility of a global pandemic. The UK's arrangements are continuing to ensure that we are well-placed to deal with this new infection."

This is especially important as Professor Ferguson states clearly that it is difficult to quantify the impact on human health at this stage. This is especially important when the statistics developed so far confirm that A(H1N1) is more infectious than usual; seasonal flu affects 1 in 10 and this novel virus potentially 1 in 3 and that per 1000 infected between 4 and 14 could die.

Against this background it is folly to start dismissing the risk, but we are already seeing signs of this with some BCM planners telling us that they are not getting the support from organisations to ensure the robustness of their plans. Perversely many report a wait and see approach being taken despite the guidance coming from WHO, CDC, HPA and a host of others to act now and ensure plans are in place.

The Continuity Forum is urging organisations to utilise Business Continuity expertise and knowledge to develop and assess plans that will support your business quickly; take the threat seriously and match your response.

Taking responsibility for your organisation and its personnel now and develop a better understanding of what you can do to mitigate the risks. Through active planning you can help reduce the spread of the illness across society and importantly your staff, limiting the financial and personnel impact on the organisation. You'll also be demonstrating prudent and professional management to clients and suppliers.

For more information on or assistance in planning please do get in touch. If you would like to comment on this feature please do contact us directly.

to find out more or attend our Special Summit on Pandemic Planning please follow the link from the front page.




A(H1N1) threat needs careful balance - Continuity Forum


Continuity Forum urges organisations not to be complacent

5th May 2009

Swine Flu, or A(H1N1) as the World Health Organisation would prefer it called continues to dominate the news media internationally, with nearly 1100 cases in 21 countries now reported with 27 fatalities.

Good reaction, planning and Tamiflu intervention appears to be working and the symptoms are being described as Mild. This appears to be good news and in the last few days accusations are being levelled of the whole Pandemic scenario being hyped out of all proportion.

Radio phone-in's and media commentators articles are suggesting an over reaction by WHO, governments and the media in the face of what they describe as a relatively 'minor' Health scare. Despite information from the World Health Organisation and health agencies urging against complacency, many people are starting to trivialise the threat posed despite the warnings being given.

Pandemic transmission

Above is the predicted spread of an influenza Pandemic as developed by Professor Neil Ferguson and submitted to the House of Lords Science and Technology committee, which has responsibility for Pandemic Influenza.

As can be seen, the peak shows infections rising over time to over 1 million cases a day after about 7-8 weeks from the first UK infection. As with all modelling, it is an educated interpretation based on experience and analysis and Professor Ferguson's model may be incorrect or have errors that misrepresent the spread of infections (if it is, then so are many others that have been published), but look closely at the curve above.

We have had the A(H1N1) virus for just one week here in the UK; the government and HPA have done a sterling job, but one week in and the media are talking about the second phase potential. This is happening just four weeks BEFORE the research shows the rapid escalation of cases in the first phase model … we at the Continuity Forum think this is a little premature at least and potentially quite dangerous.

At the moment the instantaneous news media is giving immediate opinions on matters that need to be thoroughly understood. The epidemiology of A(H1N1) needs to be understood in much greater depth, and it is rash to dismiss this 'initial' stage of the current outbreak as over or under control just yet.

More needs to known about the source in Mexico and particularly the rate of fatalities that has not yet been seen elsewhere in the world. The death of 25 people from 590 cases suggest a Case Fatality Rate (CFR) of 4.24% which is much higher than Seasonal Flu and towards the upper levels of the worst case planning scenarios, yet in the US some 286 cases resulted in the death of one infant, a CFR of 0.35%.

Why is there such a huge difference?

Was it the source numbers underestimating the total number of cases in Mexico or was it something else?

Perhaps it is the early intervention with Anti-Virals given at the optimum time, stalling progression of the virus?

What ever the reason now is not the time to be suggesting the worst is over, and indirectly creating a sense of complacency in the minds of the general public and business.

The UK government is delivering advice to all homes urging vigilance and good hygiene protocols, trying to keep folks informed and aware of the potential risk of infection - and the simple steps required to mitigate them. This though is against a real mix of opinion in the general populace; some alert, informed and not unduly alarmed, but others dismissing it as Hype and overreaction!

Mexico will be returning to work tomorrow with shops, businesses, schools and restaurants all reopening. Hopefully the worst is past for them, but over the next few weeks we'll see what happens both in Mexico and the other countries as the Virus continues to develop.

Yes, we did say develop, as this is exactly what a virus does. It'll continue its evolution, changing and mutating, trying to find new ways to propagate itself. We are still at the the very earliest stages of this situation and our knowledge of it, and we should exercise caution in rushing to judgement.

Careful consideration of the potential impact and sensible measures addressing them should be developed to help your organisation, and importantly be rehearsed and communicated. Of course, the naysayers could turn out to be right and the threat may fizzle out, but what incredible folly would it be to do nothing when the window of opportunity exists to really bolster resilience and create the potential for far better continuity.

The Continuity Forum can help and advise your organisation please mail us here Pandemic Support

Any organisation requiring advice or support should contact us immediately, we are also holding a Continuity Forum Special Pandemic Summit on June 26th for more details follow the front page link or contact us directly. More information on pandemic research

We are changing our registration systems and if have yet to complete the new registration process please click on the link above.


For more details on our events, workshops and industry development work, as well as the general activities of the Continuity Forum please contact us directly on +44 208 993 1599 or mail us HERE! Please do contact Sara McKenna or Russell Price .


If you would like to know more about how your organisation can get involved and benefit from working with the Continuity Forum, please email us HERE! or call on + 44 (0) 208 993 1599. 

WHO upgrades Alert level to 5 ... what next?

Current level of influenza pandemic alert raised from phase 4 to 5

29 April 2009

Following discussions and further assessment of all currently available information, Dr Margaret Chan, WHO's Director-General has raised the current level of influenza pandemic alert from phase 4 to 5.

She stated that all countries should immediately activate their pandemic preparedness plans. At this stage, effective and essential measures include heightened surveillance, early detection and treatment of cases, and infection control in all health facilities.

WHO raises threat level

BCM - Flu Support and Advice - Swine Flu - H1N1 - April 28th

In an important step the World Health Organisation has raised the Pandemic Alert status to level 4.

Phase 4 is characterized by verified human-to-human transmission of an animal or human-animal influenza reassortant virus able to cause “community-level outbreaks.” The ability to cause sustained disease outbreaks in a community marks a significant upwards shift in the risk for a pandemic. Any country that suspects or has verified such an event should urgently consult with WHO so that the situation can be jointly assessed and a decision made by the affected country if implementation of a rapid pandemic containment operation is warranted. Phase 4 indicates a significant increase in risk of a pandemic but does not necessarily mean that a pandemic is a forgone conclusion.

A(H1N1) Resources & Links

Category Business Continuity Management BCM - Flu Support and Advice - Continuity Forum - Swine Flu - H1N1

Useful Resources for Swine Flu (H1N1)

Below is a list of resources that may prove useful to a wide range of organisations. Much of the planning and preparation undertaken for Avian Flu is completely appropriate for Swine Flu. Whilst the situation concerning Swine Flu is developing quickly organisations should thoroughly review their plans, protocols and the measures proposed for their organisation. Of particular importance are the following:

  • Hygiene and Healthcare measures
  • Policies on Staff availability and absence issues
  • Impact on Supply Chain, Critical relationships and dependencies
  • Stake-holder Communications
  • IT security and Distance/Teleworking protocols
  • Staff travel policies and issues

The Continuity Forum provides support and guidance for organisations of all types on Pandemic Planning. If you need help or advice please do contact us directly on +44 (0) 208 993 1599 or via email on


OTHER PANDEMIC FLU LINKS (You can also contact us directly and we'll do our best to help)

WHO EPR Update Link - World Health Organisation

National Pandemic Plans by Country

WHO Outbreak Communications Planning guide

Pandemic Flu - National Framework Document responding to a Pandemic Cabinet Office/Dept of Health

Pandemic Flu - Advice for Business

Pandemic Flu - Guide for Hospitals and Healthcare - useful for Business and organisations to understand local considerations in planning

Pandemic Flu - Surge Capacity & prioritisation planning for Hospitals - useful for Business and organisations to understand local considerations in planning

Department of Health: Pandemic flu, frequently asked questions Pandemic flu and its impact on society - updated 19 Oct. (.pdf, 16 pages, 104KB)

Department of Health: Important information for you and your family This leaflet describes pandemic flu, the risk of it occurring in this country, what makes it different from the 'ordinary' flu we get every winter, and what the UK is doing to prepare for a possible influenza pandemic. Updated 19 Oct (.pdf, 16 pages, 1MB)


Foreign Office: Advice for Travellers and Business

Any organisation requiring advice or support should contact us immediately.



For more details on our events, workshops and industry development work, as well as the general activities of the Continuity Forum please contact us directly on +44 208 993 1599 or mail us HERE! Please do contact Sara McKenna or Russell Price .


If you would like to know more about how your organisation can get involved and benefit from working with the Continuity Forum, please email us HERE! or call on + 44 (0) 208 993 1599

Mexican Swine Flu outbreak spreads

UK Health experts are closely monitoring the developing Swine Flu situation in Mexico City. Deaths from the outbreak of the are rising rapidly with so far up 81 reported dead from pneumonia associated with the infection of the flu virus.

No cases have so far been reported in Europe, although 8 have been recorded in Southern California. As a precautionary measure a Male crew member returning from Mexico on a British Airways flight has been hospitalised at Northwick Park after feeling unwell with 'flu' symptoms. He reported as responding well to treatment.

Mexican Swine Flu outbreak creates international concern

Mexican officials and international experts are studying an outbreak of of Swine Influenza that has emerged in Mexico and which is suspected of killing up to 60 in the past month.

International Experts for the World Health Organisation and the US Centre for Disease Control are suggesting the outbreak in Mexico may be connected to a further 8 cases in the USA. It is suspected the virus may also have infect over 900 and the Mexican government has already moved closing public buildings and suspending public events to try and limit the spread of infection.

WHO backs investigation into Bird Flu situation in Egypt

Following an increase in infection rates and what appears to be a change in the pattern in Egypt the World Health Organisation is backing more detailed investigation

In Egypt the World Health Organisation is backing further examination and investigation as the numbers contracting the disease rise and and the pattern of infection change. At first sight the changes appear to be good news with all of those infected in the country have survived pointing to a reduction in the virulence of the H5N1, but clinically this change could be bad news.

Guidelines for GP's from RCGP and BMA

The document sets out guidelines for business continuity planning within a General Practioners practice.

The document sets out guidelines for business continuity planning within a General Practioners practice.


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