Wolverhampton CCG Major Incident Response Plan

Wolverhampton CCG Major Incident Response Plan 1

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Contents Contents PART 1 GENERAL INFORMATION... 6 1.1 STRATEGIC AIM... 6 1.2 STRATEGIC OBJECTIVES... 6 1.3 LEGAL FRAMEWORK... 7 1.4 JOINT EMERGENCY SERVICES INTEROPERABILITY PROGRAM (JESIP)... 7 1.5 DEFINING A MAJOR INCIDENT... 8 1.6 RISK... 9 1.7 ROLES AND RESPONSIBILITIES... 9 PART 2 NOTIFICATION, MANAGEMENT, CONTROL, CO-ORDINATION AND ESCALATION... 11 2.1 METHANE... 11 2.2 ROLES and RESPONSIBILITIES OF THE CCG... 11 2.3 INCIDENT LEVELS... 12 2.4 COMMAND AND CONTROL... 15 2.4.1 Strategic (Gold)... 15 2.4.2 Tactical (Silver)... 15 2.4.3 Operational (Bronze)... 15 PART 3: TRIGGERS, ALERTING PROCESS & ACTIVATION... 16 3.1 Notification... 16 3.2 ONWARD ALERTING... 16 PART 4: LOGISTICS... 17 4.1 Logging and Records management... 17 4.2 Shift arrangements... 17 PART 5: STAND-DOWN... 18 5.1 INITIAL STAND DOWN... 18 5.2 ADMINISTRATION... 18 5.3 RECORDS MANAGEMENT... 18 5.4 DEBRIEFS AND REPORTS... 18 5.5 LESSONS IDENTIFIED PROCESS... 19 ACTION CARDS... 20 APPENDIX 1:INCIDENT MANAGEMENT TEAM AGENDA... 31 APPENDIX 2:MAJOR INCIDENT SITUATION REPORT SITREP TEMPLATE... 32 APPENDIX 3:BATTLE RHYTHM TEMPLATE... 34 APPENDIX 4:INFORMATION RECODING TEMPLATE... 35 3

APPENDIX 5:BRIEFING TOOL... 36 APPENDIX 6:KEY CONTACTS... 37 APPENDIX 7:PLAN HOLDER RECORD... 38 4

Foreword Wolverhampton Clinical Commissioning Group has a significant role in preparing for, responding to and managing major incidents. The objective of WCCG s Emergency Preparedness, Resilience and Response (EPRR) framework is: To ensure that Wolverhampton Clinical Commissioning Group is capable of responding to incidents, major or otherwise, in a way that delivers optimum care and assistance to people affected, that maintains, wherever possible, business as uisual, minimises the consequential disruption to NHS services and that brings about a speedy return to normality. It will endeavour to do this by enhancing both its own, and its commissioned services, capabilities to respond in addition to ensuring it is prepared to work within a multi-agency response across organisational and geographic boundaries. The purpose of this document is to provide a brief summary of how major incidents are managed both within the CCG, wider NHS and in a multi-agency environment, and to give some guidance as to roles and responsibilities in a major incident. It must be borne in mind that all incidents are different. This can best be illustrated by recent incidents such as Swine Flu, Carvers Fire and Civil Disorder This guidance must be read in that light: it contains general principles and suggestions, but due account must be taken of the circumstances of the particular incident and any other extenuating circumstances. In addition the appendices contain an escalation flowchart, action cards and details of the core competencies expected of anyone undertaking a Director, or senior manager, on call role on behalf of Wolverhampton Clinical Commissioning Group. Please take the time and trouble to familiarise yourself with the information contained within this guide AND to complete the on call checklist found at Appendix 3. This should be used to identify training needs to ensure that both you, and the CCG, are prepared and equipped to manage whatever may arise in the best interests of the City of Wolverhampton and its residents. Dr Helen Hibbs Accountable Officer 5

PART 1 GENERAL INFORMATION 1.1 STRATEGIC AIM The strategic aims of Wolverhampton Clinical Commissioning Group (WCCG) 1, and of its commissioned services, with respect to a major incidents and disruptive challenges are: Save lives Minimise ill health Mitigate the adverse impacts of major incidents that cause (or have the potential to cause) significant disruption to the health of the population and/or normal NHS business The aim of this plan is to provide a framework for WCCG to respond to local incidents, support the NHS England (NHSE) West Midlands and, where necessary, co-ordinate the local NHS in the event of an emergency or major incident. 1.2 STRATEGIC OBJECTIVES The above aims will be achieved through the following objectives: Provide strong, local leadership and organisational co-ordination with clear lines of communication during preparedness; response; and recovery phases Coordinate provision of swift and effective health care to those affected escalating as necessary in light of subsidiary and mutual aid needs Provide a local supporting role for NHS England West Midlands in the event of a level 2 2 or above incident Maintain critical business functions and core service delivery through dynamic business continuity management Restore NHS services to normality as soon as possible Contribute appropriately to the overall multi-agency effort Work with partners to mitigate disruption to society Provide a robust EPRR contractual process to ensure that all commissioned services achieve appropriate capability. The objectives of this plan are to: Establish when the plan should be activated Define what the WCCG incident management structure should be in relation to: o o A locally managed incident An NHS England West Midlands managed incident Define what a major incident is and outline the types of emergency that the local NHS might be expected to respond to; 1 WCCG means Wolverhampton Clinical Commissioning Group 2 See Fig 2 Incident Response Levels Page 10 6

Outline the command, control and co-ordination arrangements internally, within in the local NHS and in the multi-agency context by identifying stakeholders and operational plans, including the decision making process; Establish a framework within which the AT s roles and responsibilities can be fulfilled through the CCG during the response to a major incident; Identify the arrangements for communicating information to staff, patients and stakeholders both prior to, during and after a major incident; Outline the process for recovery from a major incident. 1.3 LEGAL FRAMEWORK The Civil Contingencies Act 2004 (CCA) establishes a statutory framework of roles and responsibilities for local responders and is supported by Regulations (The CCA 2004 (Contingency Planning) Regulations) and statutory guidance (Emergency Preparedness). NHS organisation specific responsibilities are set out in section 46 (9, 10) of the Health and Social Care Act 2012, NHS CB Core Standards for EPRR and NHS CB EPRR Framework. The Health and Social Care Act 2012 provides that the Secretary of State for Health (and thus Public Health England) and NHSE will be Category 1 responders under the Civil Contingencies Act. CCGs are Category 2 responders. Category 2 responders are cooperating bodies and generically, their roles will be to co-operate and share relevant information with Category 1 responders. In this instance however CCGs are also required to have business continuity plans in place in addition to considerable responsibilities contained within the NHS England EPRR Core Standards. Given the large footprint of the NHS England West Midlands, and the limited staffing, the AT may at times request support from the CCGs to become part of the initial health response. This will be through agreement between the AT and the CCG on-call who will act on behalf of NHSE locally during the initial stages of an incident. Under any such agreement NHSE is still responsible for ensuring an effective response is delivered and, if the AT EPRR MoU is invoked, will have command and control of all NHS resources. 1.4 JOINT EMERGENCY SERVICES INTEROPERABILITY PROGRAM (JESIP) This plan has been written in line with JESIP principles now codified in the JESIP Joint Doctrine - Interoperability Framework. (http://www.jesip.org.uk/wp-content/uploads/2013/07/jesip-joint-doctrine.pdf) The Joint Doctrine focuses on the interoperability of Police, Fire and Ambulance services in the early stages of a response to a major or complex emergency. It is also acknowledged that emergency response is a multi-agency activity and the resolution of an emergency will usually involve collaboration with other Category 1 and 2 responders. The Joint Doctrine sets out what responders should do and how they should do it in a multiagency working environment to achieve a successful joint response. 7

The Joint Doctrine and the principles contained within it are equally applicable to the wider range of Category 1 & 2 response organisations. The Joint Doctrine has been designed so that it can be applied to smaller scale incidents, wide-area emergencies and pre-planned operations 1.5 DEFINING A MAJOR INCIDENT The CCA defines an emergency as: An event or a situation which threatens serious damage to human welfare in a place in the UK, the environment of a place in the UK, or war or terrorism which threatens serious damage to the security of the UK. For the NHS however the following definitions are detailed by the NHS England EPRR Framework: A significant incident or emergency can be described as any event that cannot be managed within routine service arrangements. Each require the implementation of special procedures and may involve one or more of the emergency services, the wider NHS or a local authority. A significant incident or emergency may include; a. Times of severe pressure, such as winter periods, a sustained increase in demand for services such as surge or an infectious disease outbreak that would necessitate the declaration of a significant incident however not a major incident; b. Any occurrence where the NHS funded organisations are required to implement special arrangements to ensure the effectiveness of the organisations internal response. This is to ensure that incidents above routine work but not meeting the definition of a major incident are managed effectively. c. An event or situation that threatens serious damage to human welfare in a place in the UK or to the environment of a place in the UK, or war or terrorism which threatens serious damage to the security of the UK. The term major incident is commonly used to describe such emergencies. These may include multiple casualty incidents, terrorism or national emergencies such as pandemic influenza. d. An emergency is sometimes referred to by organisations as a major incident. Within NHS funded organisations an emergency is defined as the above for which robust management arrangements must be in place. It therefore follows that a significant or major incident is any event where the impact CANNOT be handled within routine service arrangements. What is a major incident to the NHS may not be a major incident for other responding agencies. The NHS, or any part of it, can therefore declare a major incident when its own facilities and/or resources or those of partner organisations are overwhelmed. 8

1.6 RISK Risks are assessed at national, regional and locals levels and are used to direct specific planning, where appropriate. This plan is a generic, all risks plan to enable WCCG to respond to, and/or support NHSE AT in responding to, any significant incident or emergency at a local, regional or national level. In the event of a specific risk being identified then a sub-plan or process may be prepared however the major incident management and response process outlined in this plan will overarch any response. Examples are Mass casualty, fuel, severe weather A copy of the West Midlands Conurbation Community Risk Register can be accessed at the following link: https://www.wmfs.net/sites/default/files/crr%20publication%2004082014.pdf 1.7 ROLES AND RESPONSIBILITIES During the planning phase, CCGs are required to: Co-operate and share relevant information with Category 1 responders; Engage in discussions (including at the Local Health Resilience Partnership (LHRP)) where this will add value; Maintain robust business continuity plans for their own organisations; Test and update their own business continuity plans to ensure they are able to maintain business resilience during any disruptive event or incident. Support the NHS CB in discharging its EPRR functions and duties locally, ensuring representation on the LHRP. Provide their commissioned providers with a route of escalation on a 24/7 basis the CCGs maintain a shared rota of senior managers; Include relevant EPRR elements (including business continuity planning) in contracts with provider organisations in order to: Ensure that resilience is commissioned-in as part of standard provider contracts and to reflect local risks identified through wider, multi-agency planning; Reflect the need for providers to respond to routine operational pressures, e.g. winter, failure of providers to continue to deliver high quality patient care, provider trust internal major incidents; Enable NHS-funded providers to participate fully in EPRR exercise and testing programmes as part of NHS CB EPRR assurance processes. 9

During the response phase, CCGs will therefore: Respond to reasonable requests to assist and co-operate. This will include supporting the NHS CB Area Team (AT) should any emergency require local NHS resources to be mobilised; Have a mechanism in place to mobilise all applicable providers that support primary care services should the need arise; Support providers to maintain service delivery across the local health economy (LHE) to prevent business as usual pressures and minor incidents from becoming significant incidents or emergencies; Have systems to manage their provider organisations to effectively coordinate increases in activity across the local health economy; Escalate significant incidents and emergencies to the AT. 10

PART 2 NOTIFICATION, MANAGEMENT, CONTROL, CO- ORDINATION AND ESCALATION 2.1 METHANE In the event you receive a call regarding a potential incident then it is critical that you record as much information as possible. The accepted mnemonic used is as follows: M Major Incident Has major incident, or standby, been declared and by whom? E Exact location - T Type e.g. mass casualty; CBRN; terrorism; infectious disease outbreak etc. H Hazards e.g. fire, plume, flooding, contamination etc. A Access Access and egress routes to scene or rendezvous points N Number of casualties, and type (estimated) Emergency services At scene or required E There is a further information gathering template that can be used in addition to the above at Appendix 1. 2.2 ROLES and RESPONSIBILITIES OF THE CCG This section describes the roles and responsibilities required to deliver the response to a significant health related incident/emergency. For full details of the responsibilities and associated actions, please refer to the action cards in Appendix 1. Incident Manager (1st On Call in or out of hours) 1. Assess the initial information received in respect of a potential or actual significant / major incident and escalate to the on call Director/2nd on call as indicated. 2. Manage the incident as tasked by the Incident Director (when activated). Incident Director (CCG Incident Lead) 1. In liaison with the CCG On Call Incident Manager/1st on call, assess the initial information received in respect of a potential or actual significant / major incident and determine the appropriate initial course of action to be taken. 2. Direct all subsequent actions including stand-down decisions. 3. Coordinate the local NHS response as appropriate. 4. The Incident Director/2nd on call has full authority to respond to the incident on behalf of the CCG Accountable Officer or Accountable Emergency Officer. Incident Management Team 1. To provide WCCG with a 11

2. provide support to both providers and NHSE AT, as required, in addition to collating information regarding the operational/tactical response across the local NHS. This will include gathering intelligence from wider sources relating to the incident and ensuring the efficient flow of information between the chain of command and partner agencies. Incident Coordination Centre (ICC) The ICC serves as a focal point for the CCGs response and all liaison with NHS and partner agencies regarding the incident, and is established in the Boardroom. Alternatively, it could be co-located through mutual aid agreements with another organisation if required. The ICC will be staffed by the Incident Management Team, and other relevant personnel. Refer to the flow chart at Fig. 1 below and the ACTION CARD in Appendix A. 2.3 INCIDENT LEVELS Incidents require management at different levels according to the exact nature, scale or location involved and the first underlying principle for the NHS England EPRR Framework 2013 is as follows: The management of an incident should be at the level closest to the people affected by the incident as is practical In the event of an incident requiring additional resources the route of escalation will be to the NHS England West Midlands Director on-call who will consider whether to assume command and control of the incident. Equally West Midlands Incident Manager may contact the CCG on-call to mobilise, respond or coordinate the local NHS response. The AT will determine at what point command of the incident passes to the NHS. This is illustrated in Fig 2 below 12

Fig 1: Incident Activation Flowchart INCIDENT CCG on-call (in or out of hours) Verify information and complete METHANE. Consider possible impact on local NHS. Is this a potential/actual Major Incident? No Yes Maintain watching brief Level 1 CCG Action Card Level 2 Notify AT Incident Manager Notify appropriate personnel Reassess situation as further information becomes available No further action required Jointly assess information received: Consider/agree action Agree command & control with NHSE West Midlands Determine in Major Incident stand-by or implement should be declared Activate Plan Notify appropriate personnel Establish ICR / IMT Implement local response measures Refer to Fig 2 Incident Response Levels (below) 13

Fig 2: Incident Response Levels Response Level Definition and Description of Level 1 A health related incident that can be responded to and managed by single local health provider organisations within their respective business as usual capabilities. Local lead arrangements are in place, however the Director in charge at this level needs to contact the NHS England West Midlands Incident Director and agree the incident is to be dealt with at this level. Escalation of the incident will be agreed between the local lead and the NHS England West Midlands Incident Director 2 A health related incident which requires the response of a number of health provider organisations across the Birmingham, Solihull & Black Country Locality boundary and will require NHS England Response Arrangements coordinate local NHS support and respond accordingly. The On Call NHS England West Midlands Incident Director will lead the NHS response to the incident within the Locality and wider NHS England West Midlands sub region boundary and take responsibility for directing NHS resources. The NHS England West Midlands Incident Director will be responsible for contacting the On Call Regional Incident Director to agree the level at which the incident will be dealt with and therefore who is in command 3 A health related incident that requires the response of a number of health provider organisations that spans across the boundaries of several NHS England WMidlands- Sub Regions that requires NHS England Midlands & East Region will require NHS England regional coordination to meet the demands of the incident The On call Regional Incident Director will lead the NHS response to the incident and be responsible for directing the resources of NHS England Midlands & East. The Regional Incident Director will be responsible for notifying all other On Call within the NHS England Midlands & East region that an incident has happened and at what level the incident is being managed. They are also responsible for notifying neighbouring NHS England regions as well as NHS England national. 4 A health related incident that requires NHS England national coordination to support the NHS and NHS England response The On call National Incident Director will lead the NHS response to the Incident and be responsible for directing the national NHS resources. They are responsible for notifying all other NHS England regions an incident has happened and at what level the incident is being managed. 14

2.4 COMMAND AND CONTROL Command and control mechanisms within the NHS, and wider, are based upon the following levels. 2.4.1 Strategic (Gold) Refers to those responsible for determining the overall management, policy, and strategy for the incident whilst maintaining normal services at an appropriate level. They should ensure appropriate resources are made available to deliver the tactical plan and enable and manage communications with the public and media. Additionally they will identify the longer term implications and determine plans for the return to normality (recovery) once the incident is brought under control or is deemed to be over. In complex, large scale incidents, there is a need to co-ordinate and integrate the strategic, tactical and operational response of each responder organisation. The STRATEGIC CO-ORDINATING GROUP (SCG) is usually chaired by the Chief Constable and ordinarily meets at either Lloyd House or Tally Ho. The NHS is usually represented at SCG by NHSE AT. 2.4.2 Tactical (Silver) Refers to those who are in charge of managing the incident on behalf of their organisation. They are responsible for making tactical decisions, determining operational priorities, allocating staff and physical resources and developing a tactical plan to implement the agreed strategy. 2.4.3 Operational (Bronze) Refers to those who provide the immediate hands on response to the incident, carrying out specific operational tasks either at the scene, or at a supporting location such as a hospital, as directed by tactical/silver. NB: Not all these command levels are necessarily activated - depending on the scale of incident and response. The general approach is to escalate the levels with the increasing size and complexity of the response required. 15

PART 3: TRIGGERS, ALERTING PROCESS & ACTIVATION 3.1 Notification Notification of an incident can come from a variety of internal or external sources. The WCCG major incident plan can be activated when a situation arises that meets either or both of the following criteria; Any occurrence that presents serious threat to the health of the community, disruption to the service or causes (or is likely to cause) such numbers or types of casualties as to require special arrangements to be implemented by hospitals, ambulance trusts or primary care organisations; or Where WCCG considers it necessary to act to prevent, reduce, control or mitigate the effects of an emergency and would be unable to act without changing the normal deployment of resources, including support to commissioned services 3.2 ONWARD ALERTING The CCG on-call will be responsible for ensuring CCG staff, provider organisations and the AT Director on-call are alerted in line with the ACTION CARD. 16

PART 4: LOGISTICS 4.1 Logging and Records management An essential element of any response to an incident is to ensure that all records and data are captured and stored in a readily retrievable manner. These records will form the definitive record of the response and may be required at a future date as part of an inquiry process (judicial, technical, inquest or others). Such records are also invaluable in identifying lessons that would improve future response. The Incident Director is formally responsible for signing off the decision log, electronic or otherwise, and all briefing papers and documents relating to the incident. 4.2 Shift arrangements In the event of a significant/major incident or emergency having a substantial impact on the 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 Director. 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, may involve deploying staff to provider trusts affected and must take into consideration any requirements to support external 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. 17

PART 5: STAND-DOWN The CCG Incident Director will decide when an emergency or incident stand down should be declared for the CCG, which may be long after the emergency services response is over. If the AT are in command of NHS resources they will determine at what stage stand down occurs and when command returns to local trusts. This could be either a full or partial stand down with one or more individuals monitoring the situation. 5.1 INITIAL STAND DOWN All response level changes need to be communicated both internally and externally as appropriate. A brief description of the resource implications of the new level should be included. 5.2 ADMINISTRATION Once the decision has been taken, the CCG Incident Director will ensure that all appropriate elements of the local response are stood down. This may be a staged process. It is important to ensure that where communication channels have been specially created for the incident, forwarding mechanisms are in place to ensure that no traffic is lost. This will also ensure that people trying to contact the ICC, if established, have an alternative communications route. 5.3 RECORDS MANAGEMENT All logs, records and other details from the incident will be collected and secured from all personnel involved and kept safe in line with CCG data retention protocol. 5.4 DEBRIEFS AND REPORTS The aim of any debrief is not to apportion blame but to identify areas for improvement and ensure that future responses benefit from lessons identified. A hot debrief will be held within 24 hours of the close down of the incident. A full, internal debrief will be held within 14 working days of the incident. The initial incident report will be produced within 28 working days. Structured debriefs should be held with involved staff as soon as possible after de-escalation and stand down. Participants must be given every opportunity to contribute their observations freely and honestly. The Incident Director must ensure that the full debriefing process is followed. As part of the debriefing process a post incident report will be produced to reflect the actual events and actions taken throughout the response. Typically this will include: Nature of incident; 18

Involvement of the CCG; Involvement of other responding agencies; Implications for strategic management of the NHS; Actions undertaken; Future threats/forward look; Chronology of events. 5.5 LESSONS IDENTIFIED PROCESS A separate Lessons Identified report will focus on areas where response improvements can be made in future. This report will include the following sections: Introduction Observations Action Plan (detailing recommendations, actions, timescales and owner). Throughout the incident at whatever level, there will need to be an agreed process in place to evaluate the response and recovery effort and identify lessons. The Incident Director is responsible for activating the lessons identified process and may delegate the responsibility for lessons identified to the Emergency Planning Manager. The lessons identified process will be implemented at the start of the response and continue during and after the incident until all actions are completed. 19

ACTION CARDS Action Card Role Page Number 1 DIRECTOR or MANAGER ON CALL 20 2 INCIDENT DIRECTOR 21 3 LOGGIST 22 4 COMMUNICATIONS LEAD 23 5 OPERATIONS OFFICER 24 6 CRITICAL INFORMATION OFFICER 25 7 ICC ADMINISTRATOR 26 8 PROVIDER LIAISON OFFICER 27 9 TACTICAL ADVISER 28 20

ACTION CARD 1 Accountable to DIRECTOR or MANAGER ON CALL CHIEF EXECUTIVE/ACCOUNTABLE EMERGENCY OFFICER Responsible for: Assessing the initial information received, determining whether it constitutes a major incident for the CCG, escalating to a Director (if manager on call) and instigating the initial appropriate response. Number Actions required Time Completed 1. Gather relevant information by using the Information Template at Appendix 2. 2. If the incident fits, or is likely to fit, the Major Incident definition then: If Director - Declare Major Incident, or standby, and activate major incident response plan If Manager Escalate to Director 3. Commence personal log. 4. Continue to manage incident and on call until able to handover incident to Incident Director (Action Card 2) If it is NOT a potential or actual major incident for the CCG, or doesn t require a CCG response: If no further action is required, complete the log recording the information received and the action taken If it can be dealt with using normal resources, notify the appropriate personnel and maintain a watching brief Continue to reassess the situation as further information becomes available and determine if any additional action is required In the event of any increase in the scale / impact of the incident reassess the risk and escalate as needed. 21

ACTION CARD 2 INCIDENT DIRECTOR Accountable to CHIEF EXECUTIVE/ACCOUNTABLE EMERGENCY OFFICER Responsible for: assessing the initial information received, determining whether it constitutes a major incident for the CCG and instigating the response. Number Actions required Time Completed 1. In the event of a potential or actual major incident, either complete the Information Template at Appendix 2 or receive a briefing from the Director on Call. If not already declared determine whether it constitutes a major incident, or standby, for the CCG and declare as appropriate. 2. Start a personal log detailing information received and actions taken. Ensure formal logging of your actions/decisions is in place as soon as possible. 3. Advise the NHS England Director on Call. 4. Activate the Major Incident Response Plan and notify relevant personnel. 5. Establish an initial CCG Incident Management Team (IMT) meeting (actual or virtual) and provide an initial briefing. Consider activation of ICC. A sample agenda is at Appendix 3 6. If IMT and ICC activated contact identified staff and agree time of first meeting. Ensure Loggist attends and documents decisions and rationales 7. Determine the severity of the situation and consider the potential impact of the incident on the local health economy. Appendix 4 8. Establish liaison with the appropriate personnel from PHE, NHS Trusts and partner agencies and confirm that the relevant command and control structures have been implemented across the local health economy. 9. If a level 2 Major incident confirm with the AT Incident Director the AT s strategy, aim and objectives for responding to the incident. 10. If required deploy the Provider Liaison Officer (Action Card 8) to Provider Gold to establish strategic support. 11. Agree the Incident Battle Rhythm (Appendix 5) with all agencies and ensure that reports/sitreps are submitted/received in a timely manner 12. In the event that the incident is likely be over a prolonged period identify appropriate replacement staff and agree staggered handovers 13. Ensure that ALL actions tasked are completed and that reports are submitted to IMT 14. Continue to manage the incident, ensure sitrep updates are received and review decisions taken accordingly INCIDENT STAND DOWN When the Stand Down is agreed locally (Level 1) or command is given by the AT (Level 2), the Incident Director will: 1. Ensure a process is in place for an appropriate return to business as usual internally and externally across the local NHS. 2. Support the multi-agency recovery phase if required. 3. Agree when staff involved in the incident should return to their normal duties. 4. Debrief the staff working in the incident room ( hot debrief ). 5. Complete and sign off the incident log and ensure all relevant documentation is secured. 6. Ensure a formal report is prepared, highlighting any good practice or issues identified. 22

ACTION CARD 3 Accountable to LOGGIST The person for whom they are logging: either Incident Director or Incident Manager Responsible for: Recording and documenting all issues/actions/decisions made by the Incident Director, and reasons for that decision. If a member of IMT attends multi-agency meetings they will be accompanied by a loggist if possible. Within the ICC, a loggist will always be present working to the Incident Director. Number Action Time Completed 1. The loggist must use the log book, or electronic log, provided. 2. Prior to IMT commencement the loggist must record who is present and in what capacity. 3. The log must be clearly written, dated and initialled by the loggist at start of shift and include the location. 4. The log must be a complete and continuous record of all decisions taken, inclusive of the rationale for taking that decision, and actions taken as directed by the Incident Director. 5. Timings have to be accurate and recorded each time information is received or transmitted. If individuals are tasked with a function or role this must be documented and marked on the log when reported as completed. 6. If notes or maps are utilised these must be noted within the log. 7. If the loggist changes this must be recorded within the log and initialled by both the outgoing and incoming loggist 8. At the end of each session in the log a score and signature to be added underneath the documentation so no alterations can be made at a later date. 9. Where something is written in error changes must be made by a single line scored through the word and the amendment made. 10. All documentation is to be kept safe and retained for evidence for any future proceedings. The loggist MUST NOT: Take minutes Record for more than one decision maker Keep a separate chronological log Have responsibility for the decision/action The log and all paper work becomes legal documentation and could be used at a later date in a public enquiry or other legal proceedings. 23

ACTION CARD 4 Accountable to COMMUNICATIONS LEAD Incident Director Responsible for: Providing communication co-ordination, advice and support to the Incident Director Number Action Time Completed 1. Attend the initial IMT meeting and commence personal log 2. Contact the provider (Level 1) or AT (Level 2) communications lead and agree, with CCG Incident Director, who will be leading on media communications on the incident. 3. Invoke WCCG Crisis Communications Plan and, with Incident Director approval, issue a holding statement or pre-arranged public health / safety messages in conjunction with Public Health England, if appropriate, as above. 4. If leading on the incident media communications assume responsibility for managing all public information and media communications. If provider or NHS England is agreed as communications lead then liaise and respond according, continually updating IMT. *If an SCG is established, and it is likely that a media cell will be established to lead on media and communication, then act as the conduit for IMT and SCG 5. If leading, rapidly formulate and implement an integrated media handling strategy on behalf of the local NHS response, and agree approach with IMT. 6. Deal with all media enquiries/draft statements/organise press conferences and interviews as agreed, with Incident Director, in media handling strategy. Identify and brief any talking heads and advise media (and stakeholders) on the regularity and timing of future media updates 7. Brief NHS 111 on the information / advice to be given to the public. 8. Identify communications officer/ cell (based on incident requirements) to: log media calls, monitor media and social media, update IMT, develop rolling question and answer brief, develop comms for staff and undertake on-going liaison with responding NHS comms leads and partners. 9. On stand down, ensure that all original documentation (including notes, flip charts, e-mails etc.) are kept. Close personal log. 10. Attend Hot and Formal debriefs. 11. Manage any on-going media interest in the NHS response, including social media. 24

ACTION CARD 5 Accountable to OPERATIONS OFFICER Incident Director Responsible for: Supporting the Incident Director by undertaking, or delegating, tasks as determined by the Incident Director. In a smaller incident this role may be combined with the Critical Information Officer Number Action Time Completed 1. Attend the initial IMT meeting and commence personal log 2. Establish document control. 3. 4. 5. 6. 7. Establish the required Battle Rhythm and ensure that requirements are met Work in partnership with the Critical Information Officer to ensure IMT has sight of the latest information as required. Action decisions and processes as tasked and ensure compliance with set time scales. Assist in preparation of time critical documents including sitreps, CRIPS and other reporting or responding mechanisms such as Unify. Establish rotas and call in staff as required by the incident Director specific to incident requirements. 8. Ensure handover arrangements 9. Ensure staff supported with beverages and food and appropriate breaks. 25

ACTION CARD 6 Accountable to CRITICAL INFORMATION OFFICER Incident Director Responsible for: Reviewing, prioritising informing information, confirming accuracy where required and informing the Incident Director, and Incident management Team, of the same in a structured form against agreed priorities to enable timely decisions to be made. In a smaller incident this role may be combined with the Operations Officer Number Action Time Completed 1. Attend the initial IMT meeting and commence personal log 2. Establish an information cell/officer to review incoming information (non media), assign priority for action and update IMT accordingly 3. Record all information received, using the template at Appendix 6, noting time, from whom, information, expected actions and any timescales and prioritise. 4. Prepare briefing notes, as requested by the Incident Director using the IIMARCH tool at Appendix 7 5. Continue to review incoming information and review prioritisation against IMT aims, objectives and risk factors agreed with the Incident Director 26

ACTION CARD 7 Accountable to ICC ADMINISTRATOR Incident Director (Operations Officer if present) Responsible for: Providing comprehensive administration support to the Incident Coordination Centre. Number Action Time Completed 1. Set up Incident Coordination Centre as directed by the Incident Director (or Operations Officer if present). 2. Maintain a record of who is in the ICC at all times, including of arrivals and departures. 3. Maintain a record of queries/documents and responses. 4. Minute any meetings or teleconferences. 5. Work with the Operations Officers to ensure robust rotas are in place and appropriate rest breaks are scheduled. 27

ACTION CARD 8 Accountable to PROVIDER LIAISON OFFICER Incident Director Responsible for: Providing on-going strategic liaison and support at Provider Gold, operating within agreed levels of authority and acting as the Incident Director s representative. Number Action Time Completed 1. As directed by the Incident Director, attend Provider Gold as the WCCG strategic representative. 2. Agree levels of responsibility and authority for allocating resources with the WCCG Incident Director and receive a briefing of strategic aims and objectives. 3. Commence personal log. 4. Provide WCCG support to the provider within agreed brief limits. Refer back to IMT in the event of a decision being required that exceeds agreed authority 5. Adhere to the WCCG battle rhythm providing strategic updates/crips/sitreps from Provider to WCCG IMT via either the Critical Information Officer or direct to the Incident Director 28

ACTION CARD 9 Accountable to TACTICAL ADVISER Incident Director Responsible for: Providing tactical advice, knowledge and support to the Incident Director or other strategic or tactical command roles as directed. In the event of a significant major incident a tactical adviser may also be deployed with the provider liaison Officer or the SCG. Number Action Time Completed 1. As directed by the Incident Director, attend the initial IMT. 2. Commence personal log. 3. Provide support to the Incident Director, and IMT, in terms of invoking the MIRP, risk assessment, horizon scanning, multi-agency context and strategy. 4. Establish liaison between established IMTs, and other tactical advisers, and support the Critical Information Officer in establishing the initial CRIP/Sitrep 5. Provide on-going advice and support to the IMT 6. As directed, provide support to IMT staff deployed to the Provider or SCG. 7. Assist all staff in providing strategic oversight in that action cards are followed, strategic aims addressed, decisions logged, documents are controlled and that major incident process is adhered to. 8. At incident Stand Down, ensure that all documentation is retained, including decisions logs, and lead of arranging debriefs (hot and cold) 29

APPENDIX 2: Information Template M E T H A N E Major Incident Has major incident, or standby, been declared and by whom? Exact location where has the incident occurred? Type e.g. mass casualty; CBRN; terrorism; infectious disease outbreak etc. Hazards e.g. fire, plume, flooding, contamination etc. Access Access and egress routes to scene or rendezvous points Number of casualties, and type (estimated) Emergency services At scene or required Questions to consider What is the size and nature of the incident? Area and population likely to be affected - restricted or widespread Level and immediacy of potential danger - to public and response personnel Timing - has the incident already occurred or is it likely to happen? What is the status of the incident? Under control Contained but possibility of escalation Out of control and threatening Unknown and undetermined What is the likely impact? On people involved, the surrounding area On property, the environment, transport, communications On external interests - media, relatives, adjacent areas and partner organisations What specific assistance is being requested from the NHS? Increased capacity - hospital, primary care, community Treatment - serious casualties, minor casualties, worried well Public information Support for rest centres, evacuees Expert advice, environmental sampling, laboratory testing, disease control Social/psychological care How urgently is assistance required? Immediate Within a few hours Standby situation *Key = Yes X = no? = Information awaited N/A = Not applicable Information Collected?* 30

APPENDIX 3: INCIDENT MANAGEMENT TEAM AGENDA Time/Date Venue/Teleconference Details 1. Current situation report 2. Impact on the NHS 3. Current multi-agency command arrangements 4. Communications Reporting arrangements (NHSE AT; DH; SCG; DPH) Public information and media strategy Internal NHS communications and staff briefings 5. Staff and other resources required 6. Authorisation of expenditure 7. Horizon scanning 8. AGREED NHS command arrangements NHS Strategy and/or objectives (depending on level of incident) NHS Actions NHS Battle Rhythm (linked to AT/ SCG/ national rhythm if established) 9. Meeting Schedule A signed attendance sheet must be completed for every meeting detailing who was present and which role they performed. 31

APPENDIX 4: MAJOR INCIDENT SITUATION REPORT SITREP TEMPLATE Note: Please complete all fields. If there is nothing to report, or the information request is not applicable, please insert NIL or N/A. Organisation: Date: Name (completed by): Time: Telephone number: Email address: Authorised for release by (name & title): Type of Incident (Name) Organisations reporting serious operational difficulties Impact/potential impact of incident on services / critical functions and patients Impact on other service providers Mitigating actions for the above impacts 32

Impact of business continuity arrangements Media interest expected/received Mutual Aid Request Made (Y/N) and agreed with? Additional comments Other issues NHS CB Regional Incident Coordination Centre contact details: Name: Telephone number: Email: 33

APPENDIX 5: Battle Rhythm Template Strategic Tactical Operational Time Meeting Activity Output Meeting Activity Output Meeting Activity Output 34

APPENDIX 6: information Recording Template Date/Time Who From Information Received Priority Rating Action Taken Date/Time Choose an item. Choose an item. Choose an item. Choose an item. Choose an item. Choose an item. Choose an item. Choose an item. Choose an item. Choose an item. Choose an item. Choose an item. Choose an item. Choose an item. Choose an item. Choose an item. Choose an item. 35

APPENDIX 7: Briefing Tool Information Intention Method Administration Risk Assessment Communications Human Rights 36

APPENDIX 8: Key Contacts 37

APPENDIX 9: Plan Holder record Plan Number 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 Name Organisation 38