The Royal Wolverhampton NHS Trust

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1 The Royal Wolverhampton NHS Trust Trust Board Report Meeting Date: 25 April 2016 Title: Executive Summary: Action Requested: Report of: Author: Contact Details: Resource Implications: Public or Private: (with reasons if private) References: (eg from/to other committees) Emergency Preparedness Response and Resilience (EPRR) Annual Report This report provides an account of the Emergency Preparedness resilience activities undertaken from 1 st April March It includes work undertaken in developing the Business Continuity Management process and provides evidence of the Trust plans, training and procedures to meet the Emergency Preparedness, Resilience and Response core standards and relevant statutory obligations under the Civil Contingencies Act It sets out the Trusts state of readiness and provides assurance to the Board of the Trusts continued effective resilience programme. The Board are asked to approve the Emergency Preparedness Resilience and Response Annual Report. Chief Operating Officer Head of Emergency Preparedness and Business Continuity Diane.preston@nhs.net Nil Public session Emergency Planning Group Appendices/ References/ Background Reading NHS Constitution: (How it impacts on any decision-making)

2 Background Details 1 Under the Civil Contingencies Act 2004, every NHS Organisation has to have Emergency Preparedness, Response and Resilience (EPRR) arrangements in place. The Royal Wolverhampton NHS Trust is classified as a Category 1 responder. As a category 1 responder, the Trust is required to fulfil the relevant legal and contractual EPRR requirements, and ensure a robust and sustainable 24/7 response to emergencies and disruptions. The Trust is further required to meet the core standards set out by NHS England under the EPRR arrangements The core standards cover a range of areas concerned with major incident response and ensuring business continuity plans and emergency preparedness is embedded within the Trust. Locally, the Trust links in with NHS England West Midlands. 2 This report identifies the work undertaken to ensure that the Trust is compliant with its legal and statutory requirements. It outlines the Trust s state of readiness in responding to any emergency or disruptive event which may impact on service delivery. It also sets the planning, training & exercising which have taken place and an outline of the priorities for 2016/2017. The detailed Annual Report is in Appendix 1. The Trust Board is asked to note and accept this report. Page 2 of 14

3 Appendix 1 Emergency Preparedness, Response and Resilience. Annual Report 2015/2016 Compiled by: Head of Emergency Preparedness and Business Continuity Page 3 of 14

4 Contents Abbreviations Glossary Section Detail Page No 1 Background 6 2 Introduction 6 3 Governance Arrangements 6 4 Planning and Preparedness activities 7 5 Training and Exercising 8 6 Response- live incidents 11 7 Good Practice 12 8 Partnership working 12 9 Assurance and Obligations under the CCA Priorities for 2016/ Page 4 of 14

5 Abbreviations/Glossary of Terms Abbreviation Detail AEO Accountable Emergency Officer Executive Lead for the Trust for EPRR. BCM Business Continuity Management Trust Process for ensuring business continuity. Cat 1 Responder RWT Category 1 Responder An organisation as designated by the CCA 2004 that is in a support and co-operating role during a major Incident. They are subject to a range of civil protection functions under the CCA. CCA Civil Contingencies Act 2004 Civil Contingencies Act the legal framework that sets the structure for civil protection and governs the response to an emergency in the UK CCG Clinical Commissioning Group CBRNE Chemical, Biological, Radiological, Nuclear, and Explosive ED Emergency Department EPG Emergency Planning Group Local Assurance Group EPRR Emergency Preparedness Resilience and Response NHS England Core Standards for EPRR (2015), the minimum standards which NHS organisations and providers of NHS funded care must meet. NHSE NHS England & West Midlands Regional team from NHS England that support the commissioning of high quality services and directly commission primary care and specialised services at a local level across England. For the West Midlands this covers Birmingham, Solihull and Black Country and Arden, Herefordshire and Worcestershire LHRP Local Health Resilience Partnership LHRF Local Health Resilience Forum LSMS Local Security Management Specialist MI Major Incident NPAG National Performance Advisory Group for resilience information sharing National Good Practice forum for information sharing. PHE Public Health England SAG Safety Advisory Group Wolverhampton local Authority WRG Wolverhampton Resilience Group Multi-agency Resilience Group U&ECC WMAS JESIP Urgent and Emergency Care Centre West Midlands Ambulance Service Joint Emergency Services Interoperability Principles Joint Emergency Services Interoperability Principles which sets a standard approach to ensure that multi agency services are trained and exercised to work together effectively in order to respond to a major Page 5 of 14

6 1.0. Background 1.1. The CCA Act 2004 outlines a single framework for civil protection in the United Kingdom. Part 1 of the Act establishes a clear set of roles and responsibilities for those involved in emergency preparedness and response at the local level. The Trust as a Category 1 responder is subject to the following civil protection duties: Assess the risk of emergencies occurring and use this to inform contingency planning Put in place emergency plans Put in place business continuity management arrangements Put in place arrangements to make information available to the public about civil protection matters and maintain arrangements to warn, inform and advise the public in the event of an emergency Share information with other local responders to enhance co-ordination. Co-operate with other local responders to enhance co-ordination and efficiency 1.2. NHS England Core Standards for EPRR (2015) are the minimum standards which NHS organisations and providers of NHS funded care must meet. The Trust is now required to follow the Emergency Preparedness, Resilience and Response (EPRR) framework (November 2015) and delivery of the NHS England Core Standards, which are the minimum standards which NHS Organisations and providers of NHS funded care must meet and provide assurance around EPRR to the Commissioning Board. The Trusts regional link is NHS England - West Midlands Alignment to the Business Continuity Standard ISO 22301, and the requirement under the EPRR Core Standards Introduction 2.1. This Annual report provides an outline of the Trust s emergency preparedness in order to meet the statutory requirements of a Category 1 responder under the Civil Contingencies Act 2004 and the NHS Commissioning Board Emergency Preparedness Framework The report covers the following activities that the Trust has undertaken during 2015/2016 to ensure the Trust s resilience in the event of a major incident or severe disruption. Review and Updates of a variety of Emergency plans Review of the Trusts Business Continuity Management process Training and Exercising Response- events/incidents the Trust has responded to during 2015/16 Partnership working Status regarding EPPR framework core standards Priorities for 2016/ Governance Arrangements The Trust has appointed a new Accountable Emergency Officer (AEO) to take executive responsibility and leadership at service level, supported by the Head of Emergency Planning & Business Continuity, who works to provide resilience to manage emergencies and incidents that affect the Trust, with escalation where necessary. They work collaboratively with local multiagency partners to facilitate inclusive planning and response and ensure preparedness to maintain Page 6 of 14

7 critical services in periods of disruption, along with facilitating NHS EPRR assurance including business continuity. The Trust has an Emergency Planning Group which meets on a quarterly basis supported by 2 sub-groups: Major Incident Planning and Business Continuity which includes pandemic planning. An assurance position is provided to the Trust Management Committee on a quarterly basis and any assurance statements required will be presented to the Trust Board as required Planning and Preparedness activities The following plans have been reviewed and updated Major Incident Plan In line with the EPRR framework issued in November 2015 and the opening of the new Urgent and Emergency Care Centre the Trust has reviewed and updated its Major Incident plan to ensure that it continues to have the capability of responding to major incidents of any scale in a way that delivers optimum care and minimises disruption of our services and to patients. This was approved at Trust Board in November 2015 and launched in November 2015 to senior managers & key responders to a Major Incident, in line with the opening of the new U&ECC. All Major Incident action cards have also been reviewed, with new ones produced. These are available locally and on the Trust s intranet. The Decontamination Unit was relocated as part of the new U&ECC development, with it now being based at the front of the new build within a purpose built compound area CBRN Plan The Trusts CBRN plan has been updated to incorporate changes to the opening of the new Urgent and Emergency Care Centre and the relocation of the Decontamination unit. This was approved at the Major Incident sub group and Emergency Planning sub group in June This is available on the Trust intranet and ED intranet site. Action cards for CBRN are also in the process of being updated following learning outcomes from a recent CBRN (radiation) table top/walk through exercise that took place in March In December 2015, the Trust was required to provide assurance that it was adopting the Initial Operational Response (IOR). This was developed under the Joint Emergency Services Interoperability Programme (JESIP). The IOR provides an updated approach for front line emergency service personnel to follow as first responders at the scene of a Chemical, Biological, Radiation or Nuclear event. Certain elements of the IOR are relevant to front line NHS services that may receive self-presenting patients from a CBRN incident. Therefore as an organisation we are asked to ensure that as an acute Trust and walk in facilities have plans in place and basic IOR training is undertaken. Another element of the guidance is to ensure that dry decontamination is undertaken in the event of an incident occurring. The Trust s CBRN plan does reflect this, one area that needs further consideration is in relation to community led facilities, this forms part of the work programme for 2016/ Business Continuity Management (BCM) The Trusts Business Continuity Framework has been reviewed and updated to incorporate changes in guidance set out in the EPPR framework and core standards. A new BCM Policy was approved at Trust Board in April 2015 and is available on the intranet. The Trust has been working with an external Company Bouceback Solutions since early 2015 to produce a new business continuity process for the Trust building on the migration of Cannock Chase Hospital and the service changes undertaken within the Trust. This has been an on-going process, resulting in up-to-date Business Impact Analysis (BIAs) and Business Disruption Risk Page 7 of 14

8 Assessments (BDAs), along with a clear understanding of the Trust s critical services and the development of business continuity plans across the Trust. Work is currently being finalised for all services with the expectation that BIAs, BDRAs and refreshed Business Continuity Plans with be available during Quarter 1 of Pandemic flu plan The Trusts pandemic flu plan was approved at Trust Management Committee in March This was updated to reflect the changes in the NHS landscape as of 1 April Key changes also include a signed Memorandum of Understanding between the Trust and Nuffield Healthcare. This is intended to extend local arrangements in providing extra bed capacity and supporting vulnerable patients to enable the delivery of a coordinated response, should a pandemic occur. This plan is due to be launched with key staff with it also being available on the intranet. As part of the EPRR core standards for 2015 the Trust took part in a pandemic flu multiorganisation workshop, in November The workshop was intended to develop plans and procedures to identify Command and Control arrangements for a conurbation wide planning and pandemic response. The outcomes of the post exercise review highlighted key issues which require further development. There is an expectation that this process is taken forward at a local level. This will form part of the local Health Protection Forum in Cold Weather Alert Planning The UK Cold Weather alert watch came into operation between 1 November 2015 and 31 March 2016, throughout this period senior managers have received alert communications to ensure preparedness across the Trust. The Trust s cold weather plan has also been updated in November 2015 to incorporate minor changes to reflect the NHS England Cold Weather Plan This was available to all staff on the intranet Heatwave Planning The Trust s plan was updated in line with the Heatwave Plan for England 2015, issued in May During the Heatwave period June September 2015 arrangements were in place should the heatwave triggers be reached. The heatwave triggers were not reached Training & Exercising 5.1. Training The Trust has undertaken a number of training sessions during 2015/16, please see table below. Internal training Training Training overview Date Gold (Strategic) Command Training On Call Directors (Gold) - this training allows Directors to practice responding to a major incident in a safe environment and to understand their roles and responsibilities at a Strategic level in line with the EPPR arrangements. A presentation was delivered by the NHS England, EPRR Locality lead for Birmingham, Solihull and the Black Country. July 2015 Silver (Tactical) Command Training A series of training sessions took place for On call managers- this training allows managers to keep up to date on the EPPR arrangements in terms of responding to a major incident and to build on their competence in responding to an emergency at tactical level, ensuring April 2015, August 2015 and February 2016 Page 8 of 14

9 that there actions are co-ordinated, coherent and integrated in order to achieve maximum effectiveness and efficiency. It was also an opportunity to test the revised command arrangements in the new MI plan. Major Incident training New ED silver control room Loggist training Major Incident training- CBRN Major Incident- Strategic and Tactical on call grab pack Business Continuity e learning package Trust Board development session Major Incident Medical A series of three training sessions took place to allow all on call managers to become familiar with the new Silver Command room in the Urgent and Emergency Care Centre. This included updates on the major incident plan and training to use the new communication radios that the Trust has recently purchased as a contingency for communication in the event of a major incident occurring. Further loggist training has been undertaken by some Trust staff. This was delivered by Public Health England and designed to give staff a comprehensive understanding of the health relationships during an incident, and the importance of evidential records and documents in any post incident legal proceedings. The training was successfully completed by staff and they have been awarded BTEC for Major Incident Decision Logging. In line with the opening of the new Urgent and Emergency Care Centre, the Emergency Department staff have undergone training to understand their roles and responsibilities in the event of a CBRN incident. The training specifically focused on changes to the CBRN plan and included training on the new systems in place in the event of a major incident. A new training programme is due to start in May This is an on-going requirement since 2012 where all On Call Directors and On Call Managers receive 1:1 training in relation to a major incident response. This contains useful guidance for commanders, which is regularly updated. During the last 12 months a further 12 sessions were held. An e learning package for Business Continuity has been launched. This is aimed at key staff to understand what Business Continuity Management is and their roles and responsibilities in implementing Business Continuity Management within the Trust and components which need to be considered to have effective business continuity plans at a service level. The e learning package is available on the KITE site and the EP intranet site. A presentation was delivered by the NHS England, EPRR Locality lead for Birmingham, Solihull and the Black Country at the Trust board development session. The purpose was for the Board to understand how the major incident plan links in with other external agencies i.e. NHS England West Midlands, CCG. This was attended by a member of nursing staff within the Critical Care Department. The course was designed November 2015 February 2016 October- November 2015 On- going October 2015 December 2015 September 2015 Page 9 of 14

10 Management and to provide the necessary training in order to effectively Support Course manage a major incident and to deliver the medical (MIMMS) support required. This is a supportive opportunity for the ED in responding to a MI. Emergency/mass casualty planning- Preparedness session External training The Trust took part in a multi organisation Mass Casualty Event. The aim of the session was to advise organisations the planning and preparation required to contend with a mass causally event in this region and to ensure that as a Trust we have reviewed Incident plans in line with the NHS England s Incident Response Plan. The outcomes of the post session highlighted key issues which require further development. This has been raised at the Major Incident subgroup meeting to ensure that as a Trust we can respond locally. This is an on-going piece of work. March Tests/ Exercises The Trust has undertaken a number of exercises to test plan and to build on lessons learnt during 2015/16, these are set in the table below. Internal exercises Exercise/Test Description/Outcome Date Project Argus- table top exercise This was an exercise facilitated by the West Midlands Police Service in line with the national police initiative in responding to a terrorism event. This was aimed at senior managers to raise awareness of suspicious activity and illustrate how the resources of the police, emergency services, local authority and private sector work together in the event of an incident of this type. The feedback received was that staff found the session valuable and highlighted areas which need to be considered by the Trust in responding to such an incident, along with the importance of working with other external agencies. It made staff more aware of the possible threats and actions they need to become more familiar with the MI plan and Trust command arrangements. September 2015 Live test- exercise Baby snatch 2 CBRN (radiation) table top exercise This was designed to test the effectiveness of the new baby tagging alarm system and to test the robustness of the Trust s response in relation to a baby being abducted from the Maternity Unit. This included testing the effectiveness of the security arrangements and implementation of building lockdown in the event of such an incident occurring. As part of the exercise the staff responded well and the abductor was unable to exit the maternity building. As a result of the exercise further adjustments to the system need to take place for which the company have been involved. This is being followed up by the Trust s LSMS. This was designed to test the response of the new Emergency Department in the event of a Radiation September 2015 March 2016 Page 10 of 14

11 incident, and to test the procedures and plans in place to deal with this type of incident. This exercise highlighted some learning outcomes, which are currently being addressed i.e. Updating radiation action cards and the role of the new Urgent Care service in the event of this type of incident. Major Incident table top exercise Communication Tests- Call Cascade Table top exercise Exercise Dark Star This was designed at testing the Trust revised Major Incident Plan and also to allow staff to draw upon any learning outcomes. The participants were given a scenario which involved a helicopter crash locally where a public event was taking place involving adults and children, resulting in 86 casualties. The exercise highlighted some key learning outcomes and the need to reinforce the different roles within Silver command and the changes to the MI plan (published Nov 2015) and communications. The Trust has undertaken 4 communication tests, throughout 2015/16. The tests have demonstrated areas of improvement that need to be addressed in terms of system set up and key staff knowing how to respond once they receive notification at declared. These actions have been taken forward through the Major Incident subgroup and will form part of the testing programme for 2016/17. External exercises The Trust took part in a regional exercise organised by NHS England. This was designed to assess the impact of NHS Trusts response to any disruption. The exercise involved power disruptions to multiple heath sites, and multi-agency health and resilience partners. The exercise highlighted the need for better communications across organisations and local authorities. It also highlighted the co-ordination role with NHS England regional teams and mutual aid support for affected site/services being a development requirement. February 2016 July 2015, August 2015, December 2015, March 2016 November Response- live incidents The events/incidents the Trust has responded to during 2015/16 are indicated below National Junior Doctor Industrial Action (December On-going) Following dispute over a new contract for junior doctors, there have been 5 periods of industrial action. The dates for this are listed below: 8 th December suspended 12 th and 20 th January th February th - 10 th March th 8 th April th 27 th April 2016 Page 11 of 14

12 The Trust has been undertaking pre planning to ensure several mitigation plans are in place or on standby to ensure business continuity of services are in place for patients. During periods of industrial action the Trust has been required to complete assurance statements and undertake sit rep reporting throughout the days of strike action. A number of doctors across the Trust have chosen to take part in the strike action. Strike action is ongoing National Supply Disruption Over the last 12 months, there have been 2 National Supply Disruptions that have taken place. This is in relation to Baxter equipment 27 March- 30 June 2015 (IV Administration sets and Blood Admin sets) 18 February- April 2016 (IV Administration Sets and Urology Irrigation Sets) 1 st disruption: This was due to a prolonged period of increased demand and difficulties in ramping up component supply. The Department of Health has recognised the serious nature of these issues and initiated a national supply disruption response to co-ordinate activity and communications across different areas of the system. The Trust instigated a Supply Disruption Business Continuity Response Team comprising of Procurement, Medical Physics, Operational Leads and Emergency Planning. No adverse impacts were experienced during this time due to the planning and response arrangements that were put in place. 2 nd disruption is on-going with the limited availability supply of the Baxter products for IV administration and urology Irrigation Sets. The Trust has adopted the same process that was instigated in the 1 st disruption Good Practise In order to enhance the shared learning approach already embedded in Emergency Planning, Resilience and Response throughout the NHS Trusts in the West Midlands, a series of peer review visits took place across the Region. The Trust took part in this and was peer reviewed in June The conclusion from the visits highlighted that there was a lot of EPRR practice being carried out locally and across the Region Partnership working The Trust continues to participate in the following health and multi-agency groups to ensure a proactive and co-ordinated approach to warning and informing and sharing best practice, encouraging a joint approach to emergency preparedness in terms of planning, responding and recovery. Local Health Resilience Partnership Executive Group (LHRP) Local Health Resilience Forum for Emergency Planning Officers Wolverhampton Resilience Group (WRG) Safety Advisory Group (SAG) Wolverhampton Council Health Protection Forum for Public Health response National Performance Advisory Group (NPAG) for Resilience sharing good practice Resilience Direct Page 12 of 14

13 9.0. Assurance and Obligations under the CCA EPPR Core Standards The core standards for Emergency Preparedness, Resilience and Response (EPRR) have been revised and were issued in November These standards are an underpinning requirement for NHS funded organisations and ensure that as an NHS funded organisation we can provide an assurance process and can demonstrate that we have plans, and can deal with a wide range of incidents and emergencies that could impact health and patient care. The Trust has an on-going requirement to provide assurance and undertake assessments in relation to compliance to the EPRR core standards. This is monitored by NHS England West Midlands and the LHRP. In July 2015 the Trust undertook a self-assessment of the new standards and was rated as substantially compliant. The findings from this were presented at the Trust Management Committee and Trust Board in July One area that the Trust was not fully compliant with, was the completion of updating Pandemic Flu planning due to the many national changes on guidance that have taken place. This has now been rectified, with a revised plan being approved at Trust Management Committee in March Major Incident Internal Audit An audit of the Trusts major incident arrangements was undertaken in January The purpose of the audit was to ensure that the revision of the Major Incident Plan is compliant with the publication of revised EPPR Framework and Core standards issued in November The audit was designed to ensure that these standards are adequately communicated and tested and to ensure all staff are aware of their roles and responsibilities should the plan be invoked. The Trust has been green rated, giving substantial assurance that the controls in place to plan and respond to a major incident are operating effectively CBRN audit The Trust has recently undertaken a CBRN self-assessment in March 2016, with a visit due to take place in April 2016 by the West Midlands Ambulance Service. This is to view the Trusts response to a CBRN incident, and it will test the Trust s readiness in the event of a CBRN incident occurring. The outcome of the audit is awaited CCA Obligations 2004 In terms of the Trust s statutory requirements, in line with the requirements: Requirements to be achieved are: Live Exercise Every 3 years Table Top Exercise Yearly Communication Test Every 6 months Trust s achievements for 2015/2016 are: Live Exercise Not required until 2016 Table Top Exercise Two Communication Test Four Workshop One The Trust has achieved its statutory requirements for 2015/2016, along with receiving a substantially compliant, in line with the EPRR core standards for Page 13 of 14

14 10.0. Priorities for 2016/ It is anticipated that much of the work for the Trust in 2016/17 will be related to the following areas: On-going delivery of statutory requirements under the CCA 2004, the framework for EPRR and Core Standards and NHS Standard Contract requirements & NHS Standard Contract. Embedding of the new Business Continuity Management Process the Trust adopted in Business Continuity test/exercise programme as part of embedding of new BC process. Development of mandatory e-learning training package for responding to a CBRN incident, Gold & Silver Commanders and Major incident & patient flow within ED. Table top exercise to support Pandemic flu Planning, testing the plan at a local level, with multi-agency colleagues. Training for Loggists/Commanders Update of the EP intranet site To plan for a Live exercise to ensure compliance with our statutory requirements of undertaking a live exercise every 3 years. Further development of the IOR (JESSIP) for community services. Update of Trust Induction for Emergency Preparedness due to site changes. Communication testing. Page 14 of 14

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