Scotland's "resilience room" planning response to H1N1

Inside Scotland’s swine flu bunker
Deep underground in the centre of Edinburgh, emergency planners are hard at work preparing Scotland’s response to the H1N1 virus. At its heart is the ‘resilience room’, where crucial decisions are taken each day.

WE'RE INSIDE "THE BUNKER", the Scottish government's equivalent to Cobra (Cabinet Office Briefing Room A), Westminster's nerve centre for dealing with national emergencies, disasters and terrorism. It's here, in the Bunker, that the nation's battle against H1N1 is being fought.

The suite of offices, hewn straight from the volcanic rock of Edinburgh's Calton Hill, lies deep beneath St Andrew's House, the doughty mid-war monolith that is the headquarters of Scottish government.

In this sober, subterranean environment, the country's crack emergency planners are tracking the progress of the pandemic, and preparing to respond to its twists and turns.
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Seated at functional workstations, surrounded by maps, telephones, computers and radios, they chart minute-by-minute what is happening on the ground far above their heads. Ministers and senior officials from all government departments are kept directly informed of developments, and media coverage is monitored on large, wall-mounted plasma screens - a welcome window on the world.

At the heart of the Bunker is the "resilience room", a windowless cell capable of seating 15 people, and accommodating many more by telelink. It is here that critical decisions are taken by those charged with protecting public safety. There is a tense awareness that if they get it wrong, the consequences out there could be disasterous.

The first time the resilience room was used in this way was the aftermath of the Glasgow Airport terrorist attacks; then came the Grangemouth strike and consequent fuel crisis. This time swine flu has struck, and it is the big one.

"The team don't know how long they'll have to be in occupation, but they are prepared to operate around-the-clock until the danger has passed," a senior official said.

The world has known that a flu pandemic was coming for some time: they tend to strike in 30 to 40 year cycles, and this one is well overdue. Contingency plans have been in place for years, but no-one can really be sure what the next manifestation of the virus will bring until it hits.

Here, anticipating all the possible worst-case scenarios is the task of the Scottish government's resilience team. Formed in February 2008, it has an over-arching disaster planning and management role that can be applied to any number of nightmare eventualities, from pestilence and catastrophic flood to suicide bombers and "blackstart'"ultility failure.

For the resilience room, swine flu poses particular challenges, government sources involved in emergency planning say. "Not only is there a risk to human health and even civil order, but the economy could also suffer from a particularly bad dose," they add. "So far, efforts at containment have proved a comparative success, but a recent dip in the infection rate may have more to do with early school holidays than anything else. The big test will come with the onset of autumn and the traditional flu season, so extreme vigilence have to be the watchwords."

There is no doubt that the virus is raging out of control in England, which brings both threats and opportunites for Scotland. On one hand, it would be easy to flood over the Border, and the influx of students to colleges and universities in a few weeks' time is a potential flashpoint; but experience elsewhere is yielding important lessons that may allow specific defenses to be built.

Every day, there are meetings in the resilience room where links are established with public and private sector organisations across Scotland, and with the resilience room's Cobra counterparts in Whitehall.

Cobra is leading the anti-flu fight in England, and its response is being closely monitored. Recent confusion about advice for pregnant women underlines the need for clear public communication, for instance, and this is a lesson that Scotland will learn.

The Scottish government's Resilience Board is a Cabinet sub-committee, and it is chaired by ministers - in the case of swine flu, Nicola Sturgeon is in charge. Its members include representatives of the NHS and emergency services, local authorities and the business sector. Collectively, they consider the advice received from experts, and the actions that could be taken to manage local impact - always cognisant of the "real world" consequences: the pros of cancelling major events, for instance, or closing schools en masse, have to be balanced against the cons of economic impact, and potentially delicate judgement calls may have to be made.

It is this steering group that considers the toughest "What if...?" questions. What if tens of thousands of people die? What if there are not enough lorry drivers to ensure food supply? What if animals cannot be moved from farms and have to be disposed of in situ?

The legislation is being prepared to allow swift responses to such "known unknowns": to permit EU working time limits to be breached, or to sanction farm-based burials of livestock as required. Plans are in place to share crematorium facilities, and suchlike.

According to a senior government insider: "One of the distinct advantages of Scotland is its size, and willingness to pull together when required. It has already been determined that, should the flu virus overwhelm one area, critical staff such as nurses and doctors, police and care workers can be drafted in from elsewhere and even redeployed: that has taken the agreement of trade unions, who are also closely involved in discussions about the pandemic response. Similarly, plans are in place to share services such as crematoriums, should that be required."

Organisations such as the CBI and the Federation of Small Businesses are encouraging members to consider how they would cope if the flu hit them directly, to identify critical functions and how they would be managed in a crisis. Schools are considering how they would deliver home-based tuition to pupils, and managers are identifying ways of promoting home-working.

But even then the unexpected can happen, and that is the true test of resilience preparation: consider how swiftly a bed was found in Sweden for an Ayrshire patient who needed specialist equipment and expertise.

So far it has been identified that other known-unknowns might include a mutation between the H1N1 swine flu and the H5N1 bird flu that is currently ravaging parts of Africa and South East Asia: thankfully, the consequences of that are being scoped out by the scientists, and steps being taken to prepare a vaccine.

Despite the uncertainty, the country is doing its best and the officials in the Bunker say there is no need for panic.

"In terms of scale," insiders say, "Scotland has never seen a resilience exercise as large and comprehensive as that being lined up against swine flu.

"Terror attacks may be more dramatic, but they are shorter lived. We will have to maintain our national vigilence against H1N1 for many more months to come, but at the end of the alert we will have learned a great deal about how to improve our chances of survival, whatever the future may bring."