NHS ISLE OF WIGHT CLINICAL COMMISSIONING GROUP INCIDENT RESPONSE PLAN

Transcription

1 NHS ISLE OF WIGHT CLINICAL COMMISSIONING GROUP INCIDENT RESPONSE PLAN NHS Isle of Wight Clinical Commissioning Group - 1 -

2 AUTHOR/APPROVAL DETAILS Document Author Written By: Phil Hartwell Authorised Signature Authorised By: Date: July 2016 Job Title: Head of Corporate Governance Effective Date: 15 September 2016 Approval At: Clinical Executive Committee Helen Shields Date: 15 September 2016 Job Title: Chief Officer Review Date: 14 September 2018 Date Approved: 15 September 2016 VERSION CONTROL Version Date Changes 0.1 July 16 First draft 0.2 Aug 16 Review by CM 0.3 Aug 16 Amendments following consultation with NHS England Wessex, IW Council, IW NHS Trust 1 15 September 2016 Final NHS Isle of Wight Clinical Commissioning Group - 2 -

3 CONTENTS Part Description Page 1 Plan Summary 4 2 Definitions 5 3 Response Levels 6 4 Statutory duties 6 5 Local risks 7 6 NHS Emergency Preparedness, Resilience & Response (EPRR) 8 7 Major Incident Alerting 11 8 Major Incident response 13 9 Command & Control Independent Contractors Incident Stand down Recovery 19 Annex Description Page A Roles & responsibilities 21 B Liaison with the Media 24 C Vulnerable People 26 D Data Sharing 27 E Plan Supporting Information 28 NHS Isle of Wight Clinical Commissioning Group - 3 -

4 1. PLAN SUMMARY 1.1 Aim The aim of this plan is to provide a framework by which the Isle of Wight Clinical Commissioning Group (CCG) will prepare for and undertake its role in a major incident. This Incident Response Plan details the planning and response stages of the CCG in preparation for a Major Incident along with supporting information. The Incident Response plan is key to the CCG s ability to respond to a major incident and it is important staff and clinicians are aware of its content and their own responsibilities. 1.2 CCG responsibilities Clinical Commissioning Groups are responsible for commissioning health services on behalf of the population they serve. The CCG has the following EPRR responsibilities as: Ensure contracts with all commissioned provider organisations (including independent and third sector) contain relevant EPRR elements, including business continuity Monitor compliance by each commissioned provider organisation with their contractual obligations in respect of EPRR and with applicable Core Standards Ensure robust escalation procedures are in place so that if a commissioned provider has an incident the provider can inform the CCG 24/7 Ensure effective processes are in place for the CCG to properly prepare for and rehearse incident response arrangements with local partners and providers Be represented at the LHRP, either on their own behalf or through a nominated lead CCG representative Provide a route of escalation for the LHRP in respect of commissioned provider EPRR preparedness Support NHS England in discharging its EPRR functions and duties locally, including supporting health economy tactical coordination during incidents (Alert Level 2-4) Fulfil the duties of a Category 2 responder under the CCA 2004 and the requirements in respect of emergencies within the NHS Act 2006 (as amended). 1.3 Applicable legislation The CCG legal responsibilities are set out in Civil Contingencies Act 2004 (CCA 2004), Health & Social Care Act 2012 NHS Constitution The CCG mandatory responsibilities are set out in NHS England Emergency Preparedness Resilience & Response Guidance (EPRR) 2015 NHS England Core Standards for EPRR 1.4 EPRR Principles a) Preparedness and Anticipation the NHS needs to anticipate and manage consequences of incidents and emergencies through identifying the risks and understanding the direct and indirect consequences, where possible. All individuals and organisations that might have to respond to incidents should be properly prepared, including having clarity of roles and responsibilities, specific and generic plans, and rehearsing arrangements periodically. All organisations should be able to demonstrate clear training and exercising schedules that deliver against this principle. b) Continuity the response to incidents should be grounded within organisations existing functions and their familiar ways of working although inevitably, actions will need to be carried out at greater pace, on a larger scale and in more testing circumstances during response to an incident. NHS Isle of Wight Clinical Commissioning Group - 4 -

5 c) Subsidiarity decisions should be taken at the lowest appropriate level, with coordination at the highest necessary level. Local responders should be the building block of response for an incident of any scale. d) Communication good two way communications are critical to an effective response. Reliable information must be passed correctly and without delay between those who need to know, including the public e) Cooperation and Integration positive engagement based on mutual trust and understanding will facilitate information sharing. Effective coordination should be exercised between and within organisations and local, regional and national tiers of a response. Active mutual aid across organisational, within the UK and international boundaries as appropriate f) Direction clarity of purpose should be delivered through an awareness of the strategic aim and supporting objectives for the response. These should be agreed and understood by all involved in managing the response to an incident in order to effectively prioritise and focus the response. The underpinning principles apply to all commissioners and providers of NHS funded services. 1.5 Plan publishing The plan will be available on the CCG website: NB. This policy does not include Standing Operating Procedures There is a separate document detailing the standing operating procedure for the incident control centre and accompanying action cards which contains operational details and contacts 2. DEFINITIONS The following definitions are terms widely used in Emergency Preparedness, Resilience & Response (EPRR) by multi-agency organisations and the NHS a) Emergency: The Civil Contingencies Act 2004 defines an emergency as: an event or situation which threatens serious damage to human welfare in a place in the UK, the environment of a place in the UK and the security of the UK or of a place in the UK b) Major incident: For the purposes of this plan a major incident is defined as: A major incident is any occurrence that presents serious threat to the health of the community or causes such numbers or types of casualties, as to require special arrangements to be implemented c) Critical incident: A critical incident is any localised incident where the level of disruption results in the organisation temporarily or permanently losing its ability to deliver critical services, patients may have been harmed or the environment is not safe requiring special measures and support from other agencies, to restore normal operating functions. d) Business Continuity Incident: A business continuity incident is an event or occurrence that disrupts, or might disrupt, an organisation s normal service delivery, below acceptable predefined levels, where special arrangements are required to be implemented until services can return to an acceptable level. NHS Isle of Wight Clinical Commissioning Group - 5 -

6 3. RESPONSE LEVELS The NHS needs to be ready to respond to a variety of risk and threats which are identified in the National Risk Register by the Cabinet Office and assessed locally in the Hampshire & Isle of Wight Community Risk Register. The latest NHS framework identifies three levels of response: Level 1: An incident that can be responded to and managed by a local health provider organisation within their respective business as usual capabilities and business continuity plans in liaison with local commissioners; Level 2: An incident that requires the response of a number of health providers within a defined health economy and will require NHS coordination by the local commissioner(s) in liaison with the NHS England local office; Level 3: An incident that requires the response of a number of health organisations across geographical areas within a NHS England region; NHS England to coordinate the NHS response in collaboration with local commissioners at the tactical level Level 4: An incident that requires NHS England National Command and Control to support the NHS response NHS England to coordinate the NHS response in collaboration with local commissioners at the tactical level 4. STATUTORY DUTIES Health & Social Care Act 2012 CCGs are designated as Category 2 responders in the Health & Social Care Act The Act also places additional duties on CCGs to maintain emergency plans and to have in place formal business continuity arrangements as well as: Ensure contracts with provider organisations contain relevant emergency preparedness, resilience (including business continuity) and response elements. Supporting NHS England in discharging its EPRR functions and duties locally. Providing a route of escalation for the Local Health Resilience Partnership should a provider fail to maintain necessary EPRR capacity and capability Fulfilling the responsibilities as a Category 2 responder under the CCA including maintaining business continuity plans for their own organisation. Ensuring representation on the Local Health Resilience Partnership Civil Contingencies Act 2004 The Civil Contingencies Act 2004 (CCA04) categorises responding agencies into Category 1 and Category 2 responders and places statutory duties on the named organisations. Category 1 Responders have the following statutory duties placed on them: To carry out a Risk Assessment of their operational area To have emergency plans To have business continuity plans To warn and inform the public To cooperate with other responders through the Local Resilience Forum To share information with other responders Category 2 responders have the following statutory duties placed on them: To cooperate with other responders To share information with other responders. NHS Isle of Wight Clinical Commissioning Group - 6 -

7 Hampshire & Isle of Wight Local Resilience Forum (LRF) The Civil Contingencies Act states that multi-agency emergency preparedness should be undertaken in areas based on Police Service boundaries known as the Local Resilience Forum. The CCG is part of the Hampshire & Isle of Wight Local Resilience Forum (LRF) information about the LRF can be found on the following website: LRF Meeting structure Hampshire & Isle of Wight LRF has a formal meeting structure to facilitate the business of the LRF and the NHS is represented by the NHS England Wessex Main Meetings Description NHS Representation LRF Executive Strategic group NHS England Wessex Director of Ops & Delivery LRF Delivery Group Tactical group NHS England Wessex Head of EPRR Working on Tuesdays Operational meetings CCG Head of Governance 5. LOCAL RISKS A formal risk assessment of hazards and risks is undertaken by a multi-agency LRF risk assessment group every year as required by the Civil Contingencies Act Health assessments feed directly into the Community Risk Register for Hampshire & Isle of Wight Local Resilience Forum and can found: Summary of the top risks on the Hampshire & Isle of Wight LRF Community Risk Register (2012): CATEGORY Pandemic flu South Coast Flooding Inland Flooding Severe Weather Loss of critical infrastructure DESCRIPTION An influenza (flu) pandemic is a worldwide event in which people are infected with a noval flu virus to which they have no immunity. The risk of coastal inundation (flooding) is one of the most significant risks on the National Risk Assessment. The South coast is under threat from the possibility of tidal inundation caused by a combination of low atmospheric pressure over the English Channel, high tide levels (spring tides) and gales driving a storm surge down the English Channel. As the events of summer 2007, Cumbria in 2009 and Hampshire and Isle of Wight in 2013 showed, flooding can take different forms and, at its most serious, can affect many different aspects of our daily lives. The UK experiences severe weather due to its maritime temperate climate with occasional continental and arctic influences. These can bring with them heavy rain or snow, strong winds and extreme temperatures. Critical Infrastructure is the name given to all of the different essential services which we rely on as part of modern society and the economy. The UK s critical infrastructure is made up of electricity, water, gas, oil / fuel, transport, telecoms, food, health and financial services. NHS Isle of Wight Clinical Commissioning Group - 7 -

8 Industrial accidents Certain industrial activities involving dangerous substances have the potential to cause accidents. Some of these accidents may cause serious injuries to people or damage to the environment both nearby, and further away from the site of the accident. National Risk Register The National Risk Register of Civil Emergencies is published annually and provides an assessment of the likelihood and potential impact of a range of different civil emergency risks (including naturally and accidentally occurring hazards and malicious threats) that may directly affect the UK over the next 5 years. NRR-WA_Final.pdf National Threat level The level of threat from terrorism is under constant review by the Security Services. The latest threat level can be viewed: 6. NHS Emergency Preparedness, Resilience & Response (EPRR) 6.1 NHS England EPRR Guidance 2015 Key Responsibilities outlined in the guidance: The Accountable Officer is responsible for ensuring that the CCG has an incident response plan and is able to respond to an emergency. The board is regularly briefed on the CCGs preparedness, additional risks, training and exercises. An Accountable Emergency Officer is appointed Communications exercise should be carried out every 6 months A table top exercise should be carried out yearly A live exercise should be carried out every 3 years 6.2 Clinical Commissioning Groups Responsibilities: The Isle of Wight CCG has the following EPRR responsibilities: Ensure contracts with all commissioned provider organisations (including independent and third sector) contain relevant EPRR elements, including business continuity Monitor compliance by each commissioned provider organisation with their contractual obligations in respect of EPRR and with applicable Core Standards Ensure robust escalation procedures are in place so that if a commissioned provider has an incident the provider can inform the CCG 24/7 Ensure effective processes are in place for the CCG to properly prepare for and rehearse incident response arrangements with local partners and providers Be represented at the LHRP, either on their own behalf or through a nominated lead CCG representative Provide a route of escalation for the LHRP in respect of commissioned provider EPRR preparedness Support NHS England in discharging its EPRR functions and duties locally, including supporting health economy tactical coordination during incidents (Alert Level 2-4) Fulfil the duties of a Category 2 responder under the CCA 2004 and the requirements in respect of emergencies within the NHS Act 2006 (as amended). NHS Isle of Wight Clinical Commissioning Group - 8 -

9 6.4 Chief Officer The NHS Act 2006 (as amended) places a duty on relevant service providers to appoint an individual to be responsible for discharging their duties under section 252A. This individual is known as the AEO. All NHS funded organisations are required to have an AEO with regard to EPRR. Chief executives of organisations commissioning or providing care on behalf of the NHS will designate the responsibility for EPRR as a core part of the organisations governance and its operational delivery programmes. Chief executives will be able to delegate this responsibility to a named director, the AEO. 6.5 Accountable Emergency Officer The AEO will be a Board level director responsible for EPRR. They will have executive authority and responsibility for ensuring that the organisation complies with legal and policy requirements. They will provide assurance to the Board that strategies, systems, training, policies and procedures are in place to ensure an appropriate response for their organisation in the event of an incident. AEOs will be aware of their legal duties to ensure preparedness to respond to an incident within their health community to maintain the public s protection and maximise the NHS response. The AEO will be supported by a non-executive director or other appropriate Board member to endorse assurance to the Board that the organisation is meeting its obligations with respect to EPRR and relevant statutory duties under the CCA 2004 and the NHS Act 2006 (as amended). This will include assurance that the organisation has allocated sufficient experienced and qualified resource to meet these requirements. Specifically the AEO will be responsible for: Ensuring that the organisation, and any sub-contractors, is compliant with the EPRR requirements as set out in the CCA 2004, the NHS Act 2006 (as amended) and the NHS Standard Contract, including the NHS England Emergency Preparedness, Resilience and Response Framework and the NHS England Core Standards for EPRR Ensuring that the organisation is properly prepared and resourced for dealing with an incident Ensuring that their organisation, any providers they commission and any sub-contractors have robust business continuity planning arrangements in place which are aligned to ISO or subsequent guidance which may supersede this Ensuring that the organisation has a robust surge capacity plan that provides an integrated organisational response and that it has been tested with other providers and partner organisations in the local area served Ensuring that the organisation complies with any requirements of NHS England, or agents of NHS England, in respect of monitoring compliance Providing NHS England with such information as it may require for the purpose of discharging its functions 6.6 Head of Governance The Head of Corporate Governance is responsible for: Supporting the accountable emergency officer Providing EPRR technical support to the on call manager 6.5 Hampshire & Isle of Wight Local Health Resilience Partnership (LHRP) LHRPs provide strategic forums for joint EPRR planning across a geographic area and support the health sector s contribution to multi-agency planning through the LRF. These forums will be co-chaired by NHS England and local lead director of public health (DPH). LRFs lead the multi-agency planning for any incident. LHRPs coordinate EPRR across their operational area and provide health input into LRFs. NHS Isle of Wight Clinical Commissioning Group - 9 -

10 LHRPs will ensure coordinated strategic planning for incidents impacting on health or continuity of patient services and effective engagement across LHRP and local health economies. The DPH co-chair will have a specific responsibility to provide public health expertise and coordinate public health input. The NHS England co-chair will provide local leadership on EPRR matters to all providers of NHS funded services and maintain engagement with CCGs to ensure resilience is commissioned effectively, reflecting local risks. The LHRP should consider, and contribute to, the CRR developed by the LRF. These assessments should inform the planning and strategy set by the LHRP The LHRP will coordinate health input to NHS England, PHE and local government in ensuring that member organisations develop and maintain effective health planning arrangements for incidents. Specifically they must ensure: That the arrangements reflect strategic leadership roles, ensuring robust service and local health economy response at the tactical level to incidents Coordination and leadership across health organisations within local health economies is in place That there is opportunity for coordinated training & exercising That the health sector is integrated into appropriate wider EPRR plans and structures of civil resilience partner organisations with in the LRF area(s) covered by the LHRP Accountability LHRPs are not statutory organisations and accountability for EPRR remains with individual organisations. Each constituent organisation remains responsible and accountable for their effective response to incidents in line with their statutory duties and obligations. The LHRP provides a strategic forum for joint planning and preparedness for incidents, supporting the health sector s contribution to multiagency planning and preparation through LRFs. Membership Members of LHRPs will be executive representatives who are able to authorise plans and commit resources on behalf of their organisations. They must be able to provide strategic direction for health EPRR in their area. Individual members of the LHRP must be authorised by their employing organisation to act in accordance with their organisational governance arrangements and their statutory status and responsibilities. Working groups Due to the strategic nature of the LHRP the co-chairs will determine the need for any specific working groups and/or local health economy sub-groups to reflect locally identified risks and to ensure effective tactical and operational planning/response arrangements. It is for the co-chairs of the LHRP and the chair of the corresponding LRF to agree the coordinated approach to health planning between any LRF sub-groups and LHRPs to avoid any duplication. NHS Isle of Wight Clinical Commissioning Group

11 7. MAJOR INCIDENT ALERTING 7.1 Major Incident Declared by Ambulance Service The IW ambulance service is responsible for informing the receiving hospital and the NHS England Wessex whenever the service declares a major incident or major incident standby. NHS England Wessex is responsible for advising NHS South of England of any major incidents or other critical incidents. 7.2 Major Incident Declared by IW NHS Trust NHS funded provider organisations are responsible for informing their commissioning CCGs and the ambulance service whenever they are activated or declare a major incident or major incident standby. The CCGs will in turn inform the NHS England Wessex. 7.3 Major Incident Declared by the NHS England NHS England Wessex is responsible for informing the ambulance service and CCG of any national, regional or area major incident, major incident standby or similar message where there is a need to respond locally or cross border mutual aid is required. The Ambulance Service will then inform the Hospital and the CCG will inform other provider organisations. 7.4 Independent Plan Activation Any on-call manager may activate the Incident Response Plan regardless of any formal alerting message. Such action may be taken when it is apparent that severe weather or an environmental hazard may demand the implementation of special arrangements or when a spontaneous response by members of the public results in the presentation of major incident casualties at any health care setting e.g. acute or community hospital, walk in centre, health centre, GP Practice or minor injuries unit. 7.5 National Alerting messages NHS MESSAGE Major incident standby Major incident declared activate plan Major incident cancelled Scene Evacuation complete Major incident stand down APPLICATION This alerts the NHS that a major incident may need to be declared. Major incident standby is likely to involve the participating NHS organisations in making preparatory arrangements appropriate to the incident, whether it is a big bang,a rising tide or a pre-planned event. This alerts NHS organisations that they need to activate their plan and mobilise additional resources This message cancels either of the first two messages at any time Message from the Ambulance Service to the Trusts to inform them that no more casualties are at the scene It is the responsibility of each Trust to determine when it is appropriate for them to stand down NHS Isle of Wight Clinical Commissioning Group

12 Critical Incident or Major Incident, Standby or Declared When there is a CRITICAL INCIDENT or MAJOR INCIDENT, DECLARED OR STANDBY NHS Provider Organisation will: INFORM AMBULANCE CONTROL NHS Provider Organisation will: INFORM CCG ON-CALL DIRECTOR Ambulance Control will inform: 111 CENTRE MANAGER CCG On-call Director and Ambulance Control will: INFORM NHS ENGLAND (WESSEX) DIRECTOR ON-CALL PUBLIC HEALTH ISSUES Ambulance Control will inform: 1. PUBLIC HEALTH ENGLAND CENTRE ON-CALL 2. LOCAL AUTHORITY DIRECTOR OF PUBLIC HEALTH ON-CALL CASUALTIES FROM THE INCIDENT Ambulance Control will inform: ALL HOSPITALS THAT WILL RECEIVE CASUALTIES NHS England (Wessex) Director On-call will: PRIORITISE AND INFORM OTHER PROVIDERS AND CCGs FOR 1. ACTION 2. INFORMATION NHS England (Wessex) Director On-call will inform: NHS ENGLAND (SOUTH) DIRECTOR ON-CALL NHS Isle of Wight Clinical Commissioning Group

13 8. MAJOR INCIDENT RESPONSE 8.1 Initial emergency call The initial major incident alert should come through to the on call manager in the first instance but it may also come via CCG switchboard. 8.2 Initial actions Switchboard Record details of the incident Immediately contact the Chief Officer or an available director Contact the on call director Call a second member of staff to assist with phone calls 8.3 Initial action - On-call Manager/Director First actions are to: Record details of the emergency situation; Action Card 1 o DECISION: TO DECLARE A MAJOR INCIDENT FOR THE CCGs o ACTION: START A PERSONAL LOG Contact a second manager to conduct the internal cascade (Action Card 2) Contact external partners as per (Action Card 1) Carryout an initial risk assessment (page 19) Alerting list Action Card 1 (on-call Manager) Alerting list Action Card 2 Establishing contacts Establish CCG response 1. Other CCG Senior Managers Communications on-call 2. NHS England Wessex GP OOH Provider 3. Neighbouring CCGs Clinical Leaders 4. IOW NHS Trust Support staff to ICC 5. IW Council Go to Emergency Control Centre 8.4 Setting up the Incident Control Centre (ICC) The CCG Incident Control Centre will be located at: Building A, The Apex, St Cross Business Park, Newport, Isle of Wight, PO30 5WB 8.5 Incident Control Centre Role The Incident Control Centre (ICC) is to provide a central contact point for the CCG staff and partner organisations to assist the CCG in the coordination of the local NHS response working in conjunction with the NHS England Wessex While the specific activities undertaken by the ICC will be dictated by the unique demands of the situation, there are five broad tasks typical of ICCs: Coordination matching capabilities to demands Policy making decisions pertaining to the response Operations managing as required to directly meet the demands of the incident NHS Isle of Wight Clinical Commissioning Group

14 Information gathering determining the nature and extent of the incident ensuring shared situational awareness Dispersing public information informing the community, news media and partner organisations Manual of Operations - The detailed working of the Incident Control Centre is set out in a manual of operations and a copy is held at the Apex. 8.6 Incident Management Team The CCG incident management team will comprise of the following: Incident Manager Primary Care coordinator Emergency & Urgent care coordinator Community Care coordinator Communications lead Decision loggist Response room manager Incident Management Team Key Actions 1. Conduct an immediate assessment of the emergency situation using the agreed National format (which may have already been carried out by the Ambulance Service) Major incident declared? Exact location of the incident(s) Type of incident Hazards health risks to the population Access access route to the incident Number of Casualties Location Emergency Services present 2. Review the status and resources of the local NHS Appoint a Response Room Manager to manage the control room and to: Plan rotas Ensure decision logs maintained Monitor staff welfare 3. Confirm emergency contact arrangements to: NHS England Wessex IOW Ambulance Service IOW NHS Trust IOW Council Emergency Centre Other relevant local agencies 4. Prepare a press holding statement with other local agencies 5. Carry out a local health risk assessment of the impact 6. Maintain regular contact with the NHS responding agencies 7. Plan for prolonged response and to start working shifts 8. Designate a senior manager to initiate a Recovery Team to start to plan the strategy for recovery after the initial response is organised NHS Isle of Wight Clinical Commissioning Group

15 8.7 CCG external representation There are three potential roles that the CCG might have to fulfil as part of the NHS and LRF response infrastructure: NHS Gold Command CCG senior representative to the NHS gold command cell in Southampton at the request of NHS England Wessex Tactical Coordinating Group delegated authority from NHS England to represent the NHS at the multi-agency tactical (TCG) based on the Island Trust Incident Control Team provide a CCG liaison officer to provide the link between the CCG and IW NHS Trust CCG rep at TCG Primary Care Coordinator (GPs and Pharmacies) Communications lead INCIDENT MANAGER INCIDENT RESPONSE TEAM Response room Manager Decision loggist Emergency Care Coordinator (Amb & Acute) Community Care Coordinator (Community & Mental Health) CCG liaison at IW NHS Trust 8.8 Incident Control Support Team To support the incident management team the following response staff roles are necessary Response room Manager Call handlers x2 Loggist Information Manager ICT Support Action Cards - Action Cards providing detailed instructions and information concerning emergency procedures, functional roles and responsibilities applicable to a specific post holder are available in the manual of operations with hard copies at CCG reception. 8.9 Incident Control Meetings Incident control team meetings will be held every hour for 15 minutes, chaired by the incident commander to a strict agenda with brief factual reports from each lead. They will be held in designated briefing room and calls to the control centre will be received in the call centre. Decisions: Key decisions logged in the decisions log NHS Isle of Wight Clinical Commissioning Group

16 8.10 Incident Control Logs Immediately the CCGs start to respond to an incident then a personal log of actions must be started by key officers in the organisation. When established the CCG incident control room will maintain Master Log information entering the information cell must be logged including all phone calls and s Action log must be completed by all key Action Card holders Decision log records the key corporate decisions, the process for deciding and the considered alternatives. A decision log must be kept by the CCG incident manager and the incident manager MUST sign the decision log after each key decision is agreed. Logs will be issued to all Action Card holders who will keep a record of: All instructions received, Actions taken Other key information The log should be signed off at the end of the shift before being handed on to the next post holder or if the holder is relieved during the incident. Following stand-down all logs will be returned to the Head of Governance for safe storage. LOGS MUST BE KEPT WITH DATED & TIMED ENTRIES BY ALL STAFF MAKING DECISIONS IN A MAJOR INCIDENTS ON APPROVED LOG BOOKS - NO RECORDS NO DEFENCE 8.11 Incident Control Shift arrangements In the event of a critical / major incident or emergency having a substantial impact on the local population and health services, it may be necessary to continue operation of the Incident Management Team for a number of days or weeks. In particular, in the early phase of an incident, the Incident Management Team may be required to operate continuously 24/7. Responsibility for deciding on the scale of response, including maintaining teams overnight, rests with the Incident Manager. A robust and flexible shift system will need to be in place to manage an incident through each phase. These arrangements will depend on the nature of the incident and must take into consideration any requirements to support external (for example SCG) meetings and activities. The Incident Manager is accountable for ensuring appropriate staffing of all shifts. During the first two shift changes 1-2 hours of hand over time is required CCG Staffing a. Staff Reporting Staff contact details are held by on call managers and can be used to inform staff of the invocation of the Incident Response Plan. b. Staff off Duty Off duty staff that learn indirectly of an emergency that is likely to involve a CCG response should remain at home until contacted. The incident may be protracted and require shifts over several days so the CCG will have to manage staffing to match the demands of the incident. c. Health and Safety The CCGs have a responsibility to their workforce to ensure that staff welfare is considered in a Major Incident and to ensure staff are supported and have rest periods even though they may be required to work longer hours than normal during the early stages of the response. Occupational Health should be informed of all staff involved in the Major Incident response so that any follow up support may be given. A debrief strategy will be in place as described below. The CCGs have a staff support service which offers information, advice and support 24/7. Any incident that affects the local population may well impact on individual members of staff whose family members could be involved in the incident itself. Managers should consider that staff from NHS could be among the casualties or victims of an incident in the county. NHS Isle of Wight Clinical Commissioning Group

17 d. Responsibilities of Staff On appointment and periodically thereafter it the responsibility of all members of staff to familiarise themselves with this plan, the location to which they should report when an emergency situation is declared and the emergency roles and responsibilities pertinent to their appointment as detailed in the Action Cards. Individual members of staff are responsible for reporting any change in their home address or telephone number to their Line Manager to enable out of hours contact lists to be maintained. 9. COMMAND & CONTROL 9.1 Multi agency command & control The arrangements for the LRF are described in the LRF response manual and this is a brief outline where the NHS and CCG responsibilities lie a. Tactical Coordinating Group The Tactical Co-ordinating Group will normally include the following; Police: Police Incident Officer, Fire: Incident Commander, and a scientific advisor if applicable. Ambulance: Ambulance Incident Officer Local Authorities: A senior representative from the local authorities Public Health/Health Protection: A senior health protection or public health professional CCGs: CCGs may be required to attend a TCG with delegated authority from NHS England Wessex Other: Other representatives will depend on the type of the incident. Location The Tactical Co-ordinating Group will meet at a suitable place near to the scene. b. Strategic Coordinating Group The Strategic Co-ordinating Group will normally include the following; Police: Incident Commander (usually chair SCG meetings) Fire: Senior Commander Ambulance: Director Local authorities: A Chief Executive (or their representative) from the affected local authorities NHS: A Director from NHS England Wessex representing the NHS Public Health/Health Protection Advisor: the link with the Scientific and Technical Cell (STAC) Others: Other representatives will depend on the scale of the incident. Location - The Strategic Co-ordinating Group will meet at a place separate from the scene with suitable communications and meeting facilities. 9.2 NHS Command & Control The NHS will set up the following command structure: IW NHS Trust will set up its incident control centre to manage the operational response of the Ambulance, Acute hospital and Community services IW CCG will establish an incident control centre to coordinate the NHS response across the Island and to provide a contact point for NHS England Wessex and IW NHS Trust. It will coordinate the primary care response across the Island where required. NHS England will establish the strategic command for the NHS in Hampshire and Isle of Wight. CCGs may be required to support the NHS gold cell to ensure there is an agreed coordinated approach across the 8 CCGs supported by their control centres where necessary NHS Isle of Wight Clinical Commissioning Group

18 10. INDEPENDENT CONTRACTORS An escalation process similar to the one used by acute trusts is used by primary care contractors for in- and out-of-hours medical services. GREEN GPs see their own patients on their own practice premises. Out of hours (OOH) services see patients as required at primary care centres or at home. AMBER RED Incident is declared GP practices and OOH services activate their individual contingency plans or act as directed by CCG or NHS England Wessex GP practices are unable to continue providing routine services. Some or all routine work will have to stop. For OOH services, some National Quality Requirements may need to be relaxed locally / nationally in order to allow services to focus resources on treating patients. In-hours GP may need to allocate resources to help OOH services. BLACK Care is delivered 24/7 on an out of hour s model, essentially telephone triage and consultations. Human and material resources are concentrated on a couple of sites per locality, which patients needing to be seen face to face will be invited to attend. These sites will need to be located close to pharmacies which will be supported to remain open and stocked up in order to enable patients to access medication, if needed. Teams of house visiting GPs in- and out-of-hours will also need to be set up. OOH services are only able to deliver core services, all / most NQRs suspended. Support provided by the CCG Specific communication channels can be activated to ensure that primary care contractors are kept informed at all times. All local representative committees are consulted and/or advised of developments at all times. A dedicated primary care helpdesk can also be mobilised, if needed. There is a fax system in place to communicate with pharmacies at the moment and close links are maintained between the Contracting and Medicines Management teams and pharmacies in order to support contractors needs and ensure adequate communication. 11. INCIDENT STAND DOWN The Incident Management Team will determine the time for the declaration of the Stand Down from emergency procedures for the CCG. This decision will not necessarily coincide with receipt of notification of stand down by other NHS Organisations Record Keeping Following a major incident the CCG may be required to provide evidence to an appropriate enforcement agency, for example the Health & Safety Executive, Judicial inquiry, Coroner's inquest, the Police or Civil Court hearing compensation claims. In the course of any or each of these, the CCG may well be obliged or advised to give access to documents produced prior to, during and as a result of the incident. Under no circumstances must any document that relates or may in any way relate to the incident, be destroyed, NHS Isle of Wight Clinical Commissioning Group

19 amended, held back or mislaid. For these purposes "documents" means paper, photographs, audio and videotapes, and information held on word processor or other computer. It also includes internal electronic mail. The vital message 'Preserve and Protect' - needs to be spread very quickly during a major incident and must reach those who might quite unknowingly hold significant documents. The CCG will issue appropriate instructions and guidance on procedures to be adopted in the immediate aftermath of a major incident to preserve all documentation Debrief Senior managers should ensure that their staff are able to attend all necessary debriefs following an incident. The CCG will ensure that a system of appropriate debrief is put in place following best practice and LRF recommendations: Hot debrief - immediate feedback session at the end of a shift or the incident to identify any immediate points of learning Cold debrief a more planned and formal debrief at a later date to capture identify key points of learning Multi-agency debrief held by the LRF to identify multi-agency points of learning Post incident report a post incident report will be produced by the CCG Head of Governance based on outcomes from the debrief process to ensure lessons are captured. Lessons identified will be entered into an action log to ensure that the lessons identified become lessons learned and any necessary improvements to the response are adopted by the organisation. Staff involved in the Major Incident should be given a chance to discuss their views and opinions to talk about their role and to identify ways of improving the Incident Response Plan and response. 12. RECOVERY Response and recovery are not two discrete activities and should not occur sequentially; the Recovery team will begin to plan recovery activities at the onset of the incident. As soon as the initial response phase is over the main focus of the management of the incident will be on returning to the new normality. The Recovery team will be guided by the HM Government Response and Recovery Guidance available on the Cabinet Office website Psychosocial It is essential to understand the psychosocial resilience in order to be able to plan to meet the needs of staff. Psychosocial resilience is a multi-dimensional construct. It is the capacity of individuals, families, communities, systems and institutions to anticipate, withstand and/or judiciously engage with catastrophic events and/or experiences, actively making meaning out of adversity, with the goal of maintaining normal function without fundamentally losing their identify. Psychosocial resilience is not about avoiding short-term distress. It is about recognising: how people adapt to, and recover realistically from adverse events and/or circumstances; that the abilities of people to accept and use social support and the availability of it are two of the most important features of resilience; There is evidence that adequate support reduces the effects of exposure to challenging events and emergencies. NHS organisations must ensure there are robust arrangements in place that support responding to the psychosocial needs of staff affected by significant incidents, emergencies, and disasters Long term health implications The CCGs may have to commission additional services to monitor and or screen individuals on a long term basis depending on the nature of the incident. NHS Isle of Wight Clinical Commissioning Group

20 12.3 Initial recovery actions The initial recovery actions to be considered include: In partnership: To assess the medium term impact on the community and priorities for the restoration of normality To consider the need for long term health monitoring with advice from the Public Health England Working with the local authority in the recovery working group Ensure local health services are supporting local community Physical reconstruction of facilities. Reviewing key priorities for service provision and restoration. Ensure in media and communication recovery messages and response to recovery related inquiries Socio-economic effect of the incident on staff and the public. VIP Visits. Funeral, memorials and anniversaries. As a CCG: Bereavement affecting or involving NHS staff. Occupational health and welfare of all staff and their families. To review the financial implications of the response for the CCG Staffing levels and resilience. Routine annual performance targets. Ongoing needs for assistance from and to NHS partners or other agencies. Equipment and supplies. Rewarding, acknowledging the efforts of, and thanking staff. Financial implications, remuneration s and commissioning agreements. Staffing and resources to address the new environment Scaling down Incident Control Centre The ICC will need to be scaled back as the response phase of the incident come to an end. The appointed recovery lead director will assume overall responsibility for the managed return to normal operations. A nominated person will be required to ensure that telephone calls and s directed towards the ICC are still picked up; either by redirecting them to a monitored phone or account or by maintaining continuity of the ICC phone and inbox for a period after the incident room has been closed Legal Framework, Public Enquiries, Coroners Inquests and Civil Action During the day to day management of people and patients the NHS is subject to legal frameworks, duty of care and moral obligation. This does not change when responding to an emergency, critical incident, major incident or events that generate high profile media attention however public and legal scrutiny can become greater. Following a critical incident or emergency or event that has generated high profile media attention a number of legal investigations and challenge can and will be made. These may include Coroners Inquests, Public Enquiries, Criminal Investigations and Civil Action. These processes can occur many years after the incident, 12.6 Recording information When planning for and responding to a critical incident or emergency or an event that has generated high media attention it is essential that any decisions made and actions taken are recorded and stored in a way that can be retrieved at a later date to provide evidence. It may be necessary to provide all relevant documentation immediately afterwards therefore robust and auditable systems for documentation and decision making must be maintained. NHS Isle of Wight Clinical Commissioning Group

21 ANNEX A ROLES AND RESPONSIBILITIES Main Roles of Responders (taken from LRF Plans) Hampshire & Isle of Wight Constabulary Alert the other emergency services and local authorities; Save lives by working alongside the other emergency services; Co-ordinate the emergency services and other organisations during the response phase; Protect and preserve the scene; Investigate the incident alongside other investigative organisations; Collect and pass on information about casualties; Identify those involved; and Restore stability with the aim of restoring normality. IW Fire and Rescue Service Alert the other emergency services and local authorities; Save lives by working alongside the other emergency services; Tackle fires or chemicals which have been spilt and other dangerous situations; Rescue trapped casualties; Make sure all personnel involved in the rescue work are safe; Gather information and carry out hazard assessments; Help the ambulance service get live casualties away from the scene; Help the Police recover bodies; and Restore stability with the aim of restoring normality. IW Ambulance Service Alert the other emergency services and local authorities; Save lives by working alongside other emergency services; Provide a focal point for all NHS and medical resources; Identify and alert the appropriate receiving hospitals; Set up a casualty clearing station; Prioritise casualties so their injuries can be treated; Prioritise which casualties must be evacuated using appropriate transport; and Restore stability with the aim of restoring normality. IW NHS Trust Provide and control a clinical response for managing a large number of casualties; Maintain hospital and community services so patients can be cared for in a routine way; Manage communications, the media, relatives, friends, general enquiries and VIP visits; Liaise with the emergency services, other receiving hospitals, supporting hospitals, community services and other agencies; and Keep records of casualties by working with the Police. IW Clinical Commissioning Group Ensure contracts with provider organisations contain relevant emergency preparedness, resilience (including business continuity) and response elements. Support NHS England in discharging its EPRR functions and duties locally. Provide a route of escalation for the LHRP should a provider fail to maintain necessary EPRR capacity and capability. NHS Isle of Wight Clinical Commissioning Group

22 Fulfil the responsibilities as a Category 2 responder under the CCA including maintaining business continuity plans for their own organisation Will be represented on the LHRP (either on their own behalf or through representation by a lead CCG). NHS England Wessex Responsible for ensuring the local roll-out of LHRPs, coordinating with PHE and local government Ensure the NHS has integrated plans for emergencies in place across the local area. Where appropriate develop joint emergency plans with PHE and local authorities, through the LHRP. Seek local assurance of the ability for NHS funded organisations to respond to, and be resilient against, emergencies that cause increase demand or disruption to patient services. Discharges the local NHS England EPRR functions and duties. Provide the NHS co-chair of the LHRP who will also represent the NHS on the LRF. Have the capability to lead the NHS response to an emergency at a local level. Ensure a 24/7 on-call roster for NHS emergency response in the local area, comprising staff with the appropriate competences and authority to coordinate the health sector response to an emergency. Determine, in the light of the impact on NHS resources and with advice from the Director of Public Health, at what point the lead role in response to an incident or emergency will transfer, if required, to the NHS. IW Council Support the emergency services; Help people in distress; Co-ordinate the activities of their various departments and other agencies; Release information that has been agreed by the Police to the media and give advice to the public; Keep local authority services going in as normal a way as possible; and Restore stability with the aim of restoring normality. In Hampshire these roles are shared between the County Council and the District and Borough councils. Public Health England Provide expert advice on communicable disease Provide links to national expertise in the Public Health England Provide and maintain the out of hours public health rota Environment Agency The Environment Agency has the responsibility for protecting water, land and air. To prevent or deal with the effects of an incident; To provide specialist advice; To give warnings to those likely to be affected; To monitor the effects of an incident; and To investigate the cause of the incident. Utility companies The utility companies, gas, water, electricity and phone companies, play a central role in responding to a major incident, particularly during the recovery phase. They may also have to make working areas safe very early on. Ferry Companies The IW NHS Trust has a MOU with the ferry companies to ensure mutual aid can have priority access in a major incident. NHS Isle of Wight Clinical Commissioning Group

23 Armed Forces Through a system called Military Aid to the Civil Authority (MACA), the armed forces can help in an emergency if there is danger to human life or if there is a breakdown in services vital to the welfare of the community. The Police, Hampshire County Council or the Isle of Wight Council will only ask for their help in line with MACA procedures. Within Hampshire and Isle of Wight, the Army will take the lead for the three services - Army, Navy and RAF. HM Coroner The Coroner will liaise with the Police and Senior Supervising Pathologist to decide if a temporary mortuary is needed. The Coroner will liaise with the receiving hospitals and, if necessary, the coroners of the areas in which the receiving hospitals are based, to make sure that any casualties from the incident who die (either in hospital or while being moved) are moved to the Temporary Mortuary. The Coroner, Senior Identification Manager and Senior Supervising Pathologist will form the Identification Commission and decide on what criteria should be used to identify those who have died. Voluntary Agencies Voluntary groups such as St John Ambulance and British Red Cross have the resources to provide significant aid to category one responders during a major incident, such as vehicles and highly trained personnel. Category one and two responders plan and exercise together to ensure there can be seamless partnership working during an actual incident. There are Island MOU in place with RAYNET to provide local communications and 4x4 clubs to provide vehicles access in an emergency. Religious Groups LRF emergency planning and exercising schedules involve leaders from religious groups in order to ensure close links and an understanding of issues which may be raised during a major incident. Leaders of religious groups can provide crucial support and advice to category one responders which helps temper the response of those groups during the actual incident and afterwards during the recovery phase, helping communities return to (some sort of) normality. NHS Isle of Wight Clinical Commissioning Group

24 ANNEX B - LIAISON WITH THE MEDIA INTRODUCTION 1. Background and roles. An emergency situation will generate significant media and public interest. The media, be they press, radio or television, wish to obtain information of interest to readers, listeners or viewers and to produce this information as quickly as possible. The role of communications staff is: To ensure that the public receives accurate and timely information about the incident To ensure mutually beneficial relations with the media and to ensure that such relations are managed to minimise any adverse impact on the handling of the incident To manage media and public communication within an organisation dealing with the incident To advise on presentation of the incident to the public and the community directly affected 2. Key responsibilities. In terms of communications during an emergency, it is vital to: Provide accurate, timely and frequent information to the media Have appropriate mechanisms for working with the media to provide advice to the public Have appropriate mechanisms to establish telephone lines for the public Ensure co-ordination of media and communications between NHS organisations Ensure co-ordination of media and communications with partners from other sectors 3. Release of information. It is necessary to balance the right of the public to be kept informed under the Civil Contingencies Act 2004 & Freedom of Information Act 2000 versus professional ethics, and the need to protect the privacy of individuals as enshrined in the Data Protection Act 1998 and the Human Rights Act. STAGE 1: WHEN AN INCIDENT OCCURS 4. Early notification. The Communications lead for the organisation needs to be notified at the earliest opportunity. Where the Media and Communications lead for the organisation is unavailable due to sickness or annual leave, there will be liaison with the IW NHS trust communications team as back-up. He / she will then undertake the actions as outlined on the Media and Communications Action Card. 5. Immediate media requirements. News media invariably respond to an incident within 15 minutes of it starting. This is often faster than health and other emergency services can respond. It is essential to be responsive to media requests as failure to respond quickly and accurately can have serious implications for the management of an incident and can jeopardise the ability to get clear public health and operational information to the general public. 6. Media contact. It is important to follow the following guidelines: Establish a 'clear and dedicated number for media enquiries Recognise the media s legitimate role in providing and seeking information Provide accurate and timely information for the media, preferably proactively Identify trained spokespeople who will be available for interviews and press briefings Explain honestly when it is not possible to meet a request for information, and when information is likely to be available Recognise that media liaison may need to take place at the scene as well as at key health settings 7. Social media The CCG has access to a Twitter accounts and it will be used during an emergency to tweet key messages to our followers. In time it is anticipated that the CCG will develop their use of other forms of social media and these will be used in an emergency as appropriate. NHS Isle of Wight Clinical Commissioning Group

25 STAGE 2: DURING AN INCIDENT 8. Establishing a media centre. It is vital to work with other organisations to: Identify a safe point near the scene, if there is one, where the media can congregate Identify a fixed point at which information will be provided in a planned way Identify a location where press briefings can take place Identify locations where individual interviews can take place Ensure coherent approach to media liaison (e.g. messages and times of briefings) 9. Working with other agencies. Most incidents will require good working relationships with partner organisations. It is essential to: Liaise with other agencies dealing with media enquiries Issue information only relating to health services unless clearly agreed Issue copies of press statements to partner organisations Liaise with the NHS England Wessex who will liaise with the media cell at Strategic Coordinating Centre where this is established Share resources and information to ensure the best service to the public and the media Work co-operatively to provide 24 hour cover during long running incidents 10. Public Health information. The NHS has a responsibility to provide public health information in the event of a major incident. In incidents where a Strategic level has been established, the information will be agreed with the Science & Technical Advice Cell (STAC) via the Media and Communications Lead at the Strategic level. 11. Informing staff and clarifying their role. Key responsibilities to staff, primary care contractors and associated NHS services will include: Cascading public health and other health information to staff so they are able to deal with public enquiries and are kept up to date as to the developing incident Providing information to the media about the health services and their role in the incident. Providing information to the media and the public on the role of primary and community health services as a source of health advice (e.g. advising the public to visit their GP if they have a concern) Providing information to the media about the role of the health service on the scene Managing media requests to talk to staff and primary care contractors about the incident Managing media requests to talk to patients receiving care and treatment STAGE 3 AFTER AN INCIDENT 12. Evaluation and reporting. In the stand down and review stages the Communications lead should prepare a detailed overview of media and communications including recommendations for future action. Issues of media handling should be included in debriefing reports and the lessons shared. NHS Isle of Wight Clinical Commissioning Group

26 ANNEX C - VULNERABLE PEOPLE VULNERABILITY It is not easy to define in advance and for planning purposes who are the vulnerable people to whom special considerations should be given in plans. Those who are vulnerable will vary depending on the nature of the emergency. For planning purposes there are broadly three categories that should be considered: Those with mobility difficulties eg physical disabilities, a medical condition or pregnant women; Those with mental health difficulties Others who are dependent, such as children Vulnerable Individual/Group Children Older People Mobility impaired Mental/cognitive function impaired Sensory impaired Individuals supported by health or local authorities Temporarily or permanently ill Individuals cared for by relatives Homeless Pregnant women Minority language speakers Tourists Travelling community Examples and Notes Where children are concerned, whilst at school the school authorities have duty of care responsibilities. Certain schools may require more attention than others. Sections of the elderly community including requiring regular medication and/or medical support equipment wheel chair users; leg injuries bedridden/non movers; slow movers. For example: developmental disabilities; clinical psychiatric needs; learning disabilities. Blind or reduced sight; deaf; speech and other communication impaired. Those that need regular medical attention and chronic illnesses that may be exacerbated or destabilised either as a result of the evacuation or because prescription drugs were left behind. Target through the following organisation/agency LEA schools via Local Authorities Non-LEA schools through their governing body or proprietor. Crèches/playgroups/nurseries Residential Care Homes Help the Aged Adult Social Care Nursing Homes Residential Care Homes Charities Health service providers Local Authorities Charities e.g. the Deaf Council Local groups Social services GP surgeries GP surgeries Other health providers (public, private or charitable hospitals etc.) Community nurses GP surgeries Carers groups Shelters, soup kitchens GP surgeries Community Groups Job centre plus Transport and travel companies Hoteliers LA traveller services Police liaison officer NHS Isle of Wight Clinical Commissioning Group

27 ANNEX D - DATA SHARING Guidance and protocol The Hampshire and Isle of Wight Local Resilience Forum information sharing protocol describes the agreed method in HIOW to share information in an emergency. The key principle and guidance for sharing data are outlined in the Cabinet Office guidance Data Protection and Sharing: Guidance for Emergency Planners and Responders. This guidance should be used by the CCG Incident Response Team when making decisions on sharing information; the guidance can be accessed via the following linkhttp:// Key principles The key principles for data sharing outlined in the cabinet office guidance are: Data protection legislation does not prohibit the collection, and sharing of personal data it provides a framework where personal data can be used with confidence that individuals privacy rights are respected. Emergency responders starting point should be to consider the risks and the potential harm that may arise if they do not share information. Emergency responders should balance the potential damage to the individual (and where appropriate the public interest of keeping the information confidential) against the public interest in sharing the information. In emergencies, the public interest consideration will generally be more significant than during day-today business. Always check whether the objective can still be achieved by passing less personal data. Category One and Two responders should be robust in asserting their power to share personal data lawfully in emergency planning, response and recovery situations. The consent of the data subject is not always a necessary pre-condition to lawful data sharing. You should seek advice where you are in doubt though prepare on the basis that you will need to make a decision without formal advice during an emergency. The way in which emergency planners and responders may use the personal data that they hold is governed by the 8 data protection principles; these require that information is: Processed fairly and lawfully and in accordance with a legitimising condition Processed for specified and not incompatible purposes; Adequate, relevant and not excessive; Accurate and up-to-date; Not kept longer than necessary; Processed in accordance with individuals rights; Kept secure; and Not transferred to countries outside the European Economic Area without adequate protection Recording decisions It is vital that all decisions concerning information sharing are documented. The following information about the decision process should be documented in a formal logbook: Record of the information to be shared Clear evaluation of the information to be shared against the key principles The option chosen and clear reasoning for the decision NHS Isle of Wight Clinical Commissioning Group

28 ANNEX E - SUPPORTING INFORMATION 1. Emergency Planning Cycle 2. Document management Plan review and audit The plan will be reviewed on a basis as a minimum in line with the NHS England EPRR Core Standards Assessment Tool. The plan will also be reviewed after each exercise or actual incident to incorporate any lessons identified in post exercise or incident debrief reports. Consultation and dissemination The plan will be sent for consultation prior to publication: Internal - final draft of the plan will go for consultation to internal CCGs internal stakeholders External consultation the final draft of the plan will be forwarded to health and relevant LRF multiagency partners for a consultation. The final completed version of the incident response plan will be reviewed at CCG Officers Group and approved at the CCG Clinical Executive. When accepted the plan will be posted on the intranet and the CCG websites and disseminated to partner agencies via an link to the website and posted on Resilience direct. 3. Training National Requirements The CCGs are required to ensure mechanisms are in place to identify, select and train staff to participate in major incidents which ensures that staff: understand the role they are to fulfil in the event of an incident have the necessary competencies to fulfil that role NHS Isle of Wight Clinical Commissioning Group