NHS Commissioning Board Command and Control Framework For the NHS during significant incidents and emergencies - 1 -
NHS Commissioning Board Command and Control Framework Date 7 January 2013 Audience NHS Commissioning Board directors of operations and delivery NHS Commissioning Board regional directors NHS Commissioning Board area team directors NHS Trust and NHS Foundation Trust chief executives Ambulance Service chief executives Clinical commissioning groups Accountable emergency officers. Copy to Members of local health resilience partnerships (LHRPs) NHS Commissioning Board emergency planning leads Strategic Health Authority emergency planning leads. Description From 1 April 2013, this document will replace the Strategic Command Arrangements for the NHS during a Major Incident Guidance published in December 2007. It should be read in the context of: NHS standard contracts the NHS Commissioning Board Emergency Planning Framework 1 (2013) post-2013 EPRR arrangements published on 3 April 2012 any further updates. Cross reference Action required 1 http://www.commissioningboard.nhs.uk/eprr/ Further links are listed in section 12. NHS organisations and providers of NHS funded care must follow this guidance from 1 April 2013. Timing As new health EPRR arrangements are introduced (by April 2013). Contact details NHSCB.EPRR@nhs.net NHS Operations, Quarry House, Leeds LS2 7UE. 1 From 1 April 2013 the NHS CB Emergency Planning Framework 2013 will replace the NHS Emergency Planning Guidance (published in October 2005). - 2 -
Contents 1. BACKGROUND 5 2. INTRODUCTION 6 3. WHO IS THIS DOCUMENT FOR? 6 4. ROLES AND RESPONSIBILITIES 6 5. THE COMMAND FRAMEWORK 7 Operational command 7 Tactical command 7 Strategic command 7 Multi-agency command 8 6. NHS COMMAND AND CONTROL 9 NHS Commissioning Board area teams 9 The area team Incident Coordination Centre (ICC) 10 Area team escalation 10 NHS Commissioning Board regional teams 11 National team 12 National emergency response structure 12 On-call Staff 13 Incident Coordination Centre (ICC) 13 7. IMPLICATIONS 14 Acute hospitals 14 Ambulance services 15 Community providers 15 Mental health providers 16 Primary Care (GPs and community pharmacies) 16 Other specialist services 17 Specialist clinical networks 17 NHS Commissioning Board (national, regional and local) 18 Clinical commissioning groups 18 Commissioning 19-3 -
8. TRAINING 19 9. TESTING AND EXERCISES 20 10. ASSURANCE 20 11. EQUALITY AND DIVERSITY 21 12. REFERENCES AND INFORMATION SOURCES 21 13. FREEDOM OF INFORMATION 22 14. GLOSSARY 22 15. APPENDIX 1 INCIDENT COORDINATION CENTRE 23 16. APPENDIX 2 CORE STANDARDS 25-4 -
1. Background 1.1. The NHS needs to be able to plan for and respond to a wide range of incidents and emergencies that could affect health or patient care. These could be anything from extreme weather conditions to an infectious disease outbreak or a major transport accident. Under the Civil Contingencies Act (2004), NHS organisations and providers of NHS funded care, must show that they can deal with these incidents while maintaining services to patients. This work is referred to in the health service as emergency preparedness resilience and response (EPRR). 1.2. During times of severe pressure and when responding to significant incidents and emergencies, NHS organisations need a structure which provides: clear leadership; accountable decision making; and accurate, up to date and far-reaching communication. This structured approach to leadership under pressure is commonly known as command and control. 1.3. Times of severe pressure can include winter periods, a sustained increase in demand for services (surge) or an infectious disease outbreak. 1.4. A significant incident or emergency is any event that cannot be managed within routine service arrangements. It requires the implementation of special procedures and involves one or more of the emergency services, the NHS or a local authority. The term emergency is used as defined in the Civil Contingencies Act 2004: To describe 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. For the NHS, a significant incident or emergency is defined as: 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 other acute or community provider organisations. 1.5. Within local NHS organisations these emergencies are often referred to as Major Incidents. - 5 -
2. Introduction 2.1. This document sets out the national NHS command and control structure for responding to local, regional and national periods of pressure, significant incidents or emergencies. The principles are applicable to all NHS organisations and providers of NHS funded care. 2.2. This document is applicable from 1 April 2013 at which point, it supersedes the Strategic Command Arrangements for the NHS during a Major Incident published on 19 December 2007. 2.3. This document should be read in the context of: the NHS Commissioning Board Business Continuity Management Framework (Service Resilience) (2013); the NHS Commissioning Board Emergency Planning Framework (2013); and the NHS Commissioning Board (NHS CB) Core Standards for Emergency Preparation, Resilience and Response (2013). 3. Who is this document for? 3.1. The principles set out in this document apply to: all NHS organisations at each level, including NHS Commissioning Board (NHS CB) and Provider organisations; providers of NHS funded care; clinical commissioning groups (CCGs); GPs; and other primary and community care organisations. 3.2. All accountable emergency officers and emergency preparedness managers must be familiar with the principles of NHS command and control and be confident of their roles and responsibilities when responding to major incidents and emergencies. 4. Roles and responsibilities 4.1. It is the responsibility of the NHS Commissioning Board to ensure that structures are in place in line with this document. 4.2. The majority of significant incidents and emergencies will only affect one NHS organisation, therefore each organisation must be confident that it can respond to increased pressure both independently and as part of a wider system with other partner organisations - 6 -
5. The command framework 5.1. All CCA category 1 responder organisations follow the nationally recognised operational, tactical, strategic framework as explained below. This corresponds to the emergency services bronze, silver, gold structure. 5.2. The following paragraphs explain the different command levels: Operational command 5.2.1. Operational (bronze) command refers to those responsible for managing the main working elements of the response to an incident. 5.2.2. They will lead a team carrying out specific tasks within a service area, geographical area or functional area. This may include a hospital ward, area of a community response, or aspect of a scene at a big bang type incident 5.2.3. They will act on tactical commands. 5.2.4. Individual organisations remain in command of their own resources and staff, but each one must liaise and coordinate with all the other agencies. Tactical command 5.2.5. Tactical (silver) command is responsible for directly managing their organisation s response to an incident. 5.2.6. They develop the tactical plan which will achieve the objectives set by strategic command. 5.2.7. They make sure that operational command provides a clear and coordinated response which is as effective and efficient as it can be. 5.2.8. They set response priorities in line with strategic command, allocate resources and coordinate tasks. 5.2.9. Tactical command should oversee and support, but not be directly involved in the operational response to an incident. If an organisation has several key sites providing an operational response, such as a large Acute Trust, there may be a tactical commander for each site. Strategic command 5.2.10. Strategic (gold) command has overall command of the organisation or sector s resources. They are responsible for liaising with partners to develop the strategy and policies and allocate the funding which will deal with the incident. - 7 -
5.2.11. They are also responsible for maintaining the organisation s normal services at an appropriate level during the incident. 5.2.12. They must consider the incident in its wider context to establish its longer term and wider effects. 5.2.13. They delegate tactical decisions to their tactical commanders, so are not involved in directly managing the tactical or operational detail. 5.2.14. The Chief Executive Officer remains accountable for business delivery of their organisation throughout all situations. For major incidents and emergencies, this is usually discharged through an on-call executive director. 5.2.15. If an incident involves several NHS organisations, one of them will take responsibility for strategic command over the others. The NHS CB area teams and regional offices will ensure there is capacity and capability for the strategic leadership to be taken at all levels, should it be required. Multi-agency command 5.3. If a significant incident or emergency is large or widespread, it may be necessary to coordinate the response of several organisations. This may be at tactical level or at both tactical and strategic level. 5.4. Multi-agency strategic coordination is undertaken through a Strategic Coordinating Group (SCG). Any organisation that feels a strategic multi-agency approach is necessary can request that an SCG convened (e.g. pandemic influenza). 5.5. The geographical responsibility of an SCG follows that of the Local Resilience Forum (LRF) and in turn with the local Police service boundary. The NHS is usually represented at the SCG by an NHS CB area team and Ambulance Service senior manager. 5.6. The SCG is a fast moving information-sharing and strategic decision making group. Its role is to allow organisations responding to the incident to share information and coordinate their response options. 5.7. The SCG is usually chaired by a Police Incident Commander and meets at a Strategic Coordination Centre (SCC) which will be identified in local multi-agency emergency plans traditionally police accommodation. Prior arrangements need to ensure that there is adequate space and the necessary equipment available for the NHS to be able to fulfil its SCG role at the SCC. 5.8. If multi-agency coordination is required at tactical level, a multiagency Tactical Coordinating Group (TCG) will be set up. This is a group of tactical commanders that meet and manage an incident, either as an independent tactical unit or in line with strategic objectives if there is an SCG. The TCG will be chaired by the lead responsible organisation, which is determined by the priorities of the incident. - 8 -
6. NHS Command and Control 6.1. Incidents can take many forms, therefore the responses need to match individual situations. Most incidents will be dealt with by individual NHS organisations at operational/tactical level without the need for others to be involved. However, some incidents may require a wider NHS or multi-agency response. NHS Commissioning Board area teams 6.1.1. Area teams provide leadership across a geographical area. If an incident requires a wider NHS or multi-agency response, this coordination and leadership is provided by an area team director. 6.1.2. Most incidents and emergencies can be managed at local or organisational level, so there is no need for the area team to take any action. However, local organisations must inform their commissioners and area team director on-call about any internal incidents, responses to local emergencies or cases of extreme pressure so that the team has a detailed understanding of local NHS demand and capacity. 6.1.3. In some cases, several NHS and partner organisations may be involved and the need for a coordinating role may arise. In these cases, the area team on-call director may take command and control of the situation. 6.1.4. If there is a Strategic Coordination Group, health will be represented by the on-call area team director (NHS Gold). If necessary, Public Health England, local authority directors and the Ambulance Service will also attend. 6.1.5. There will be a need for additional support. The area team director s support team should consist of: a staff officer or support manager; a communications manager; and a loggist (someone formally trained in recording decisions and rationale during an emergency). 6.1.6. The area team strategic commander will be supported by an emergency preparedness, resilience and response (EPRR) adviser taken from local on-call EPRR personnel. This adviser will be based in the area team Incident Coordination Centre (ICC) to draw together information about the operational/ tactical response and make sure there is effective coordination at all levels. - 9 -
The area team Incident Coordination Centre (ICC) 6.1.7. The ICC will serve as a focal point for all liaisons between NHS and partner organisations regarding the incident. It is likely to be located away from the SCC and will be equipped with robust and resilient IT and telecommunications. 6.1.8. The ICC will have direct contact with all responding NHS providers. Its role is to remain informed of their current status and provide relevant information to the SCG Health Gold representative. 6.1.9. The room will normally be staffed by: an area team senior manager; an EPRR tactical adviser; a communications manager; administrative support (including loggists); and other relevant personnel as necessary (including representatives from the wider health economy or partner organisations). 6.1.10. The main role of the area team ICC will be to: draw together information regarding the operational/tactical response across the NHS; gather information from wider sources relating to the incident; and make sure information flows efficiently between the chain of command and partner organisations. Area team escalation 6.1.11. If an incident affects two or more areas, the NHS response will normally be led by the area team first affected and responding to it. If the Commissioning Board regional office has to take command of all NHS resources across the region, this will be actioned through the area team. 6.1.12. If an incident escalates to a national level (for example, a fuel shortage or influenza pandemic), the Commissioning Board national office may take command of all NHS resources across England. In this situation, direction from the national office will be actioned through regional offices and onto the area teams. 6.1.13. In both cases, the NHS will be represented at the SCG by the area team on-call director. 6.1.14. If there is a large or prolonged incident in one area, the area team may need to request support from a neighbouring area team. - 10 -
NHS organisation / partner agency LAT on call manager Verify information if necessary Consider possible impact on NHS Is this a potential / actual major incident? No Yes No further action required Maintain watching brief Notify LAT on call director and EPRR manager Notify appropriate personnel Reassess situation as further information becomes available Jointly assess information received Consider / agree action to be taken Determine if major incident standby or implement should be declared Activate plan Agree who will lead response Notify appropriate personnel Establish LAT incident room if required No further action required Escalation of incident Implement local response arrangements as required NHS Commissioning Board regional teams 6.1.15. If an incident affects two or more areas, the NHS response will normally be led by the area team first affected and responding to it. If the Commissioning Board regional team has to take command of all NHS resources across the region, the team s on-call director will if necessary provide leadership and direction across the region. Actions for local organisations will be actioned through the area teams. 6.1.16. There will be a need for additional support. The regional oncall director s support team should consist of: a staff officer or support manager; a communications manager; and a loggist. - 11 -
6.1.17. The regional on-call director will be supported by an emergency preparedness, resilience and response (EPRR) adviser taken from on-call EPRR personnel. This adviser will be based in the regional team Incident Coordination Centre (ICC) to draw together information about the operational/ tactical response and make sure there is effective coordination at all levels. National team 6.1.18. In extreme situations such as pandemic influenza, a national fuel shortage or extreme weather, the Commissioning Board national team may take command of all NHS resources across England. In this situation, direction from the national team will be actioned through the regional teams. 6.1.19. The national team has an on-call director and support staff to be sure that national command and control are effective and immediate. National emergency response structure COBR SAGE Accountability Partnership National Lead Government Department Department of Health Secretary of State Regional Government Liaison Officer* PHE National Office PHE Regions x4 NHS Commissioning Board (NHS CB) NHS CB Regional Offices x4 STAC Local Resilience Strategic Coordinating Group (SCG) PHE Centres x15 NHS CB Area Teams x27 Local Services Local Authorities Ambulance Service NHS Provider Organisations Other Relevant Organisations Clinical Commissioning Groups (CCGs) *Normally led by DCLG RED. But can vary depending on the type of emergency - 12 -
On-call Staff 6.1.20. Each NHS organisation is responsible for ensuring appropriate leadership during emergencies and other times of pressure. Incidents, emergencies and peaks in demand can occur at any time of day or night, so each organisation must have an appropriate out-of-hours on-call system. A director will always need to be available to make strategic decisions for the organisation. However, other staff may also be on-call to provide support. 6.1.21. In most cases, the director on call is not the first point of contact. This role usually falls to a senior manager on-call rota. They will then make an informed decision whether to escalate the issue to the on-call director, resolve at their level or log the information as a message. 6.1.22. Best practice also suggests creating additional rotas for the roles required to support the director and senior manager on call for example, communications, technical EPRR support, loggists and staff to operate an ICC out of hours. Incident Coordination Centre (ICC) 6.1.23. Each NHS organisation has the responsibility to provide a suitable environment for managing an emergency. This is known as an Incident Coordination Centre. It provides a functional space for making decisions and collecting and sharing information quickly and efficiently. Appendix 1 sets out a suggested format for an ICC. 6.1.24. Large organisations with several sites will need an ICC at each location where tactical and operational functions can be coordinated. This should be supported by a separately located strategic ICC. - 13 -
7. Implications 7.1. All NHS organisations and those providing NHS funded care are required to have suitable plans in place to respond effectively to significant incidents, emergencies and periods of extreme pressure. These plans include the ability to apply a robust command and control structure which will provide strong leadership and management for internal and external incidents. 7.2. This command and control structure must include the strategic, tactical and operational functions set out in section 5 of this document and should provide cover 24 hours a day 365 days a year. Acute hospitals 7.3. Acute hospitals have an essential role in managing casualty based incidents. They are also affected greatly by peaks in demand, for example in winter and periods of hot weather. Because of this and the need to effectively manage internal incidents, it is vital that acute hospitals have a robust, recognised command and control structure which fits in with the wider NHS structure as described in the The command framework section (page 7). 7.4. Depending on the number and type of casualties, it may be necessary for several acute hospitals to work together to manage casualties. In this case, hospitals must communicate with each other through parallel command structures. The common understanding created through planning at the Local Health Resilience Partnership (LHRP) should support this process and may also facilitate the planning for mutual aid such as the sharing of resources, equipment or specialist services. Relevant core standards codes 5.0 5.2 5.24 5.25 5.27 5.28 5.30 5.31 5.33 5.35 5.36 5.39 5.40 5.41 5.42 5.48 5.51 5.52 6.0 6.1 6.2 6.3 6.4 7.0 7.17 7.18 7.19 7.20 7.21 7.22 7.24 7.25 7.29 7.31 7.32 7.33 7.41 7.43 Based on the NHS CB Core Standards for Emergency Preparation, Resilience and Response (2013) the applicable excerpts of which are contained in Appendix 1. - 14 -
Ambulance services 7.5. Ambulance services have a crucial role in managing casualty based incidents. They are also affected greatly by peaks in demand, for example in winter and periods of hot weather. Because of this and the need to effectively manage internal incidents, it is vital that ambulance services have a robust, recognised command and control structure which is compatible with other NHS organisations and emergency services. Relevant core standards codes 5.0 5.33 5.52 7.19 7.33 9.7 5.2 5.24 5.25 5.35 5.36 5.39 6.0 6.1 6.2 7.20 7.21 7.22 7.41 7.43 9.1 9.8 9.10 9.16 5.27 5.40 6.3 7.24 9.2 9.17 5.28 5.30 5.41 5.42 6.4 7.0 7.25 7.29 9.3 9.4 9.33 9.34 5.31 5.48 7.17 7.31 9.5 9.40 5.32 5.51 7.18 7.32 9.6 Based on the NHS CB Core Standards for Emergency Preparation, Resilience and Response (2013) the applicable excerpts of which are contained in Appendix 1. Community providers 7.6. Community providers have an important role in delivering a local, community based response in emergencies and during peak times such as winter and periods of hot weather. They also have an important role in managing surge during periods of high pressure such as winter and the long term recovery of communities following an emergency or major incident. Because their resources are often spread over a wide area, it is essential that community providers have a robust structure for command and control. Relevant core standards codes 5.0 5.30 5.40 6.1 7.19 7.31 5.2 5.31 5.41 6.2 7.20 7.32 5.24 5.32 5.42 6.3 7.21 7.33 5.25 5.27 5.28 5.33 5.35 5.36 5.48 5.51 5.52 6.4 7.0 7.17 7.22 7.24 7.25 7.41 7.43 5.29 5.39 6.0 7.18 7.29 Based on the NHS CB Core Standards for Emergency Preparation, Resilience and Response (2013) the applicable excerpts of which are contained in Appendix 1. - 15 -
Mental health providers 7.7. Mental health providers have an important role in delivering a local, community based response in emergencies and during peak times such as winter and periods of hot weather. Because their resources are often spread over a wide area, it is essential that mental health providers have a robust structure for command and control. Relevant core standards codes 5.0 5.2 5.31 5.32 5.40 5.41 6.1 6.2 7.19 7.20 7.31 7.32 5.24 5.33 5.42 6.3 7.21 7.33 5.25 5.35 5.48 6.4 7.22 7.41 5.27 5.28 5.36 5.39 5.51 5.52 7.0 7.17 7.24 7.25 7.43 18.0 6.0 7.18 7.29 18.5 Based on the NHS CB Core Standards for Emergency Preparation, Resilience and Response (2013) the applicable excerpts of which are contained in Appendix 1. Primary Care (GPs and community pharmacies) 7.8. Primary care organisations have an important role in providing direct local care to the public in emergencies. This is especially important for community based emergencies such periods of hot weather, evacuations and epidemics. For Primary Care to play its role during emergencies, there must be a senior out-of-hours contact and a procedure for escalating issues at all times. Relevant core standards codes 5.0 5.33 5.51 6.3 7.19 7.29 5.2 5.28 5.39 5.40 5.52 6.0 6.4 7.0 7.20 7.21 7.31 7.32 5.31 5.32 5.42 5.48 6.1 6.2 7.17 7.18 7.22 7.25 7.33 Based on the NHS CB Core Standards for Emergency Preparation, Resilience and Response (2013) the applicable excerpts of which are contained in Appendix 1. - 16 -
Other specialist services 7.9. There are several specialist NHS organisations that must respond in emergencies. These include NHS Blood and Transplant, NHS Logistics, and specialist Trusts such as tertiary children s, orthopaedic, burns and eye hospitals. It is important that each of these organisations have a command and control structure for both internal and external incidents as part of a joint NHS response. Relevant core standards codes (see Other NHS organisations in the core standards) 5.0 5.2 5.30 5.31 5.39 5.40 5.52 6.0 7.17 7.18 7.25 7.29 5.24 5.25 5.32 5.33 5.41 5.42 6.1 6.2 7.19 7.20 7.31 7.32 5.27 5.35 5.48 6.3 7.21 7.33 5.28 5.36 5.51 6.4 7.0 7.22 7.24 7.41 7.43 Based on the NHS CB Core Standards for Emergency Preparation, Resilience and Response (2013) the applicable excerpts of which are contained in Appendix 1. Specialist clinical networks 7.10. Many NHS provider organisations are supported by specialist clinical networks to help them coordinate specific services to meet demand, for example critical care, burns and major trauma. These networks must be able to increase their coordinating role during times of greater demand and emergencies. Relevant core standards codes (see Other NHS organisations in the core standards) 5.0 5.30 5.39 5.52 7.17 7.25 5.2 5.24 5.31 5.32 5.40 5.41 6.0 6.1 7.18 7.19 7.29 7.31 5.25 5.27 5.33 5.35 5.42 5.48 6.2 6.3 7.20 7.21 7.32 7.33 5.28 5.36 5.51 6.4 7.22 7.41 7.0 7.24 7.43 Based on the NHS CB Core Standards for Emergency Preparation, Resilience and Response (2013) the applicable excerpts of which are contained in Appendix 1. - 17 -
NHS Commissioning Board (national, regional and local) 7.11. The NHS Commissioning Board must maintain an ability to take command and control of the NHS at the most appropriate level if required. This is to ensure a consistent response to the public, but also to support local organisations in their response. Relevant core standards codes 5.0 5.2 5.31 5.32 5.42 5.48 6.4 7.0 7.25 7.29 10.3 10.4 5.24 5.25 5.33 5.35 5.51 5.52 7.17 7.18 7.31 7.32 10.5 10.8 5.27 5.28 5.36 5.39 6.0 6.1 7.19 7.20 7.33 7.41 11.0 11.4 5.29 5.40 6.2 7.21 7.43 11.5 5.30 5.41 6.3 7.22 10.0 11.6 7.24 10.2 11.9 Based on the NHS CB Core Standards for Emergency Preparation, Resilience and Response (2013) the applicable excerpts of which are contained in Appendix 1. Clinical commissioning groups 7.12. As category 2 responders under the Civil Contingencies Act 2004, CCGs must respond to reasonable requests to assist and cooperate during an emergency. The area team will decide whether to include CCG members on the team on-call rota and in the formal command and control structure based on: the local geography; the number of executives on the rota; and CCG members expertise in emergency preparation. 7.13. If a provider of NHS funded care has a problem either in or out of normal business hours, they must be able to escalate the matter through the CCG. This requires CCGs to draw up their own on-call rotas. 7.14. As part of any inclusion of CCGs in NHS Commissioning Board command and control arrangements, formal Memorandum of Understandings (MOUs), or equivalent, will be drawn and explicitly include those relevant Core Standards that are being delegated. Therefore the delegating NHS Commissioning Board organisation will hold the CCG to account for those relevant standards. - 18 -
Commissioning 7.15. Commissioners need to ensure all contracts include relevant command and control details if there is a possibility that the supplier may be required to respond to incidents and take direction from others. 7.16. The following commissioning notes are examples of these requirements. Commissioning notes NHS provider organisations must have robust arrangements for leading their organisations during times of great pressure, significant incidents and emergencies. NHS provider organisations must have a 24/7 single point of contact for significant incidents and emergencies. NHS provider organisations must have a 24/7 on-call rota for executive leaders and support staff. NHS provider organisations must be able to control their organisation s resources during times of pressure, significant incidents and emergencies. NHS provider organisations must have arrangements in place to provide briefings and reports as required to commissioners and the Commissioning Board during significant incidents and emergencies. 8. Training 8.1. All staff that have a command role during incidents or emergencies must complete training in line with the required competencies for that role. An example of this is the Strategic Leadership in a Crisis course. 8.2. Core standards for NHS Command Training are set out in the Skills for Justice National Occupational Standards (NOS) Framework. 8.3. Incident commanders should receive regular training to familiarise themselves with command and control procedures and make sure their skills and knowledge remain current. 8.4. Those other staff required to support the command team in the control function should also receive training to undertake their role. This includes control room familiarisation, loggist training and situation report writing. - 19 -
9. Testing and exercises 9.1. Organisations must test their plans regularly through exercises to make sure that they will be able to respond efficiently and effectively to an incident or emergency. Roles within the plan should be tested to ensure they are fit for purpose and include all the necessary actions to be carried out during an incident. 9.2. The testing and exercise process helps people to practise their skills and increase their confidence and knowledge in preparation for a real incident or emergency. 9.3. The Commissioning Board Emergency Planning Framework (2013) defines the process and timescales for achieving this. 9.4. The LHRP and/ or Local Resilience Forum (LRF) may coordinate exercise programmes to give organisations the opportunity to practise a multi-agency response. Area team EPRR staff will help with this process by working with EPRR leads in individual organisations. 10. Assurance 10.1. NHS provider organisations are responsible for providing assurance to its area team that: its plans have been tested and exercised in line with national guidance; and it has sufficient trained staff to cover the various roles in its plan during a prolonged incident. 10.2. In gathering wide ranging assurances from individual NHS organisations, the area team will provide assurance to the NHS Commissioning Board that all NHS funded healthcare providers within their area are fit for purpose. 10.3. Organisations must also make sure that their contingency plans are fit for purpose, in line with national guidance and recognised best practice and able to respond to any incident as part of a multiagency response. 10.4. Separately, or through the LHRP, CCGs will also be assured of plans and organisational resilience. 10.5. Directors of Public Health will seek NHS EPRR assurance though the LHRP processes. - 20 -
11. Equality and diversity 11.1 Investing in a diverse NHS workforce enables us to deliver a better service and improve patient care in the NHS. Equality is about creating a fairer society where everyone has the opportunity to fulfil their potential. Diversity is about recognising and valuing difference in its broadest sense. 11.2 When putting arrangements in place to reflect this suite of documents, organisations should be mindful of their obligations under the Equality Act 2010. The Equality Duty ensures that public bodies consider the needs of all individuals in shaping policy, delivering services, and in relation to their own employees. It encourages public bodies to understand how different people will be affected by their activities on different people so that policies and services are appropriate and accessible to all and meet different people's needs.. 12. References and information sources This document should be read in the context of the following sources of information. 12.1 The Civil Contingencies Act 2004 2. 12.2 The Cabinet Office website 3. 12.3 The Health and Social Care Act 2012 4. 12.4 NHS Commissioning Board EPRR documents and supporting materials 5, including: a. NHS Commissioning Board Business Continuity Management Framework (service resilience) (2013) b. NHS Commissioning Board Emergency Planning Framework (2013); and c. NHS Commissioning Board Core Standards for Emergency Preparedness, Resilience and Response (EPRR) 12.5 National Occupational Standards (NOS) for Civil Contingencies Skills for Justice 6. 12.6 BSI PAS 2015 Framework for Health Services Resilience 7. 12.7 ISO 22301 Societal Security - Business Continuity Management Systems Requirements 8. 2 http://www.legislation.gov.uk/ukpga/2004/36/contents 3 http://www.cabinetoffice.gov.uk/ukresilience 4 http://www.legislation.gov.uk/ukpga/2012/7/enacted 5 www.commissioningboard.nhs.uk/eprr/ 6 http://skillsforjustice.com/nos 7 http://shop.bsigroup.com/en/productdetail/?pid=000000000030201297-21 -
13. Freedom of information 11.1 This document is publicly available. 14. Glossary Bronze Operational level command C&C Command and control CCA Civil Contingencies Act (2004) CCG Clinical commissioning group COBR Cabinet Office Briefing Rooms EPRR Emergency Preparation, Resilience and Response Gold Strategic level command ICC Incident Coordination Centre LHRP Local Health Resilience Partnership LRF Local Resilience Forum NHS BT NHS Blood and Transplant NHS CB NHS Commissioning Board NOS National Occupational Standards (Skills for Justice) PHE Public Health England SAGE Scientific Advisory Group for Emergencies SCG Strategic Coordination Group SCC Strategic Coordination Centre STAC Scientific Technical Advice Cell Silver Tactical level command TCG Tactical Coordination Group 8 http://www.iso.org/iso/catalogue_detail?csnumber=50038-22 -
15. Appendix 1 Incident Coordination Centre An Incident Coordination Centre (ICC) is a facility to provide communication, coordination, leadership and decision making during an incident or emergency. The ICC works most effectively when divided into two: an area where control and communication can take place, which is generally busy and bustling; and a command area which allows for quiet discussion, thought and decision making without unwanted distractions. You could also include other areas such as quiet rooms to prepare briefings, media statements and situation reports. All incident coordination areas should be located close to each other. In most organisations they are rooms which are used for other purposes most of the time. An alternative fall back facility should be identified and equipped should the primary ICC be unavailable. The control area of an ICC should include: sufficient workstations for everyone who will be required to operate within it; computers with internet and email access; a dedicated ICC email account with relevant user access; a back-up NHS.net dedicated ICC email account with relevant user access; a colour A3 printer; a colour photocopier; sufficient incoming and outgoing telephone lines with a single nongeographic telephone number which can be diverted if you need to move to alternative premises; telephones on a hunt group or group call facility telephones with headsets and a small number of cordless phones; back-up direct copper wire telephone lines outside of the switchboard with connected telephones; two independent fax machines (one incoming and one outgoing) outside of the switchboard (direct copper wire); a TV with news channel access; TV recording ability; a DAB radio; a satellite telephone; - 23 -
a stationery pack; a smart board; white boards and pens; a satellite-controlled digital clock; access to restroom and refreshments; tabards to identify individual roles and functions; log books (call logs, decision logs and a master room log book); incident management software; IT files and templates (pre-prepared and in a dedicated incident folder); and hard-copy plans, directories and maps. The command/quiet room should include: one workstation; one computer; printer access; one telephone (with restricted telephone number); a meeting table and chairs; a teleconference unit; a video conference unit; meeting recording facilities; whiteboards and pens; a TV with news channel access; a decision log book ; and close proximity to the control room. - 24 -
16. APPENDIX 2 CORE STANDARDS These standards will be updated from time to time. The following extract is correct at the time of publication. To view the latest list of core standards, please see the NHS Commissioning Board Core Standards for Emergency Preparation, Resilience and Response Framework at www.commissioningboard.nhs.uk/eprr/ Cat 1 responders Cat 2 Not categorised 5 NHS Core Standards for Emergency Preparedness, Resilience & Response (EPRR) Acute trusts Ambulance trusts NHS CB area teams NHS CB regional & CCGs Primary care Other NHS organisatio Community providers Mental health All NHS organisations and providers of NHS funded care must have plans which set out how they plan for, respond to Note Note Note Note and recover from disruptions, significant incidents and emergencies. Incident response plans must: X X X X Note 1 1 1 1 1 5. 2 make sure that all arrangements are trialled and validated through testing or exercises; X X X X X X X X X Staff must be aware of the Incident Response Plan, competent in their roles and suitably trained. X X X X X X X X X 5. 24 There must be an annual work programme setting out training and exercises relating to EPRR and how lessons will be learnt. X X X X X - X X X 5. 25 Key knowledge and skills for staff must be based on the National Occupation Standards for Civil Contingencies. Directors of NHS CB on-call rotas must meet NHS CB published competencies. X X X X X - X X X 5. 27 It must be clear how key staff can achieve and maintain suitable knowledge and skills. X X X X X - X X X Set out responsibilities for carrying out the plan and how the plan works, including command and control X X X X X X X X X arrangements and stand-down protocols. 5. 28 Describe the alerting arrangements for external and self-declared incidents (including trigger points, decision trees and escalation/de-escalation procedures) X X X X X X X X X 5. 29 Set out the procedures for escalating emergencies to NHS CB area teams, regions, national office and DH - - X X - - - X - 5. 30 Explain how the emergency on-call rota will be set up and managed over the short and longer term. X X X X - - X X - 5. 31 Include 24-hour arrangements for alerting managers and other key staff, and explain how contact lists will be kept up to date. X X X X X X X X X Note 1. All NHS Organisations and providers of NHS funded care must maintain suitable incident response plans. However, the details in these plans will depend on the organisation s size and role. Providers of NHS funded care include: independent hospitals under contract to deliver NHS care; urgent care centres; nursing homes; residential and elderly mentally-impaired (EMI) homes; and patient care transport providers. - 25 -
NHS Core Standards for Emergency Preparedness, Resilience & Response (EPRR) Acute trusts Ambulance trusts NHS CB area teams NHS CB regional & CCGs Primary care Other NHS organisatio Community providers Mental health 5. 32 Set out the responsibilities of key staff and departments. X X X X X X X X X 5. 33 Set out the responsibilities of the Chief Executive or nominated Executive Director. X X X X X X X X X 5. 35 Identify where the incident or emergency will be managed from (the ICC). X X X X X - X X X 5. 36 Define the role of the loggist to record decisions made and meetings held during and after the incident, and how an incident report will be produced. X X X X - - X X X 5. 39 Refer to specific action cards relating to using the incident response plan. X X X X X X X X X 5. 40 Explain the process for completing, authorising and submitting NHS CB standard threat-specific situation reports and how other relevant information will be shared with other organisations. X X X X X X X X X 5. 41 Explain how extended working hours will apply and how they can be sustained. Explain how handovers are completed. X X X - X - X X X 6 5. 42 Explain how to communicate with partners, the public and internal staff based on a formal communications strategy. This must take into account the FOI Act 2000, the Data Protection Act 1998 and the CCA 2004 duty to communicate with the public. X X X X X X X X X Social networking tools may be of use here. 5. 48 Explain the process of recovery and returning to normal processes. X X X X X X X X X 5. 51 Explain who will be responsible for managing escalation and surges. X X X X X X X X X 5. 52 Describe local escalation arrangements and trigger points in line with regional escalation plans and working alongside acute, ambulance and community providers. X X X X X X X X X All NHS organisations must provide a suitable environment for managing a significant incident or emergency (an ICC). This should include a suitable space for making decisions and collecting and sharing information quickly and efficiently. X X X X Note 2 Note 2 6. 1 There should be a plan setting out how the ICC will operate. X X X X X X X X X 6. 2 There must be detailed operating procedures to help manage the ICC (for example, contact lists and reporting templates). X X X X X X X X X 6. 3 There must be a plan setting out how the Incident Coordination Team will be called in and managed over any length of time Note 2 Note 2 Note 2 X X X X X X X X X 6. 4 Facilities and equipment must meet the requirements of the NHS CB Corporate Incident Response Plan. X X X X X X X X X 7 All NHS organisations and providers of NHS funded care must develop, maintain and continually improve their business continuity management systems. This means having suitable plans which set out how each organisation will maintain continuity in its services during a disruption from identified local risks and how they will recover delivery of X X X X X X X X X key services in line with ISO22301. Organisations must: Business continuity plans should set out how the plans will be called into use, escalated and operated. X X X X X X X X X 7. 17 Organisations must develop, use, maintain and test procedures for receiving and cascading warnings and other communications before, during and after a disruption or significant incident. If appropriate, business continuity plans should be published on external websites and through other information-sharing media. X X X X X X X X X Note 2. Each NHS organisation is responsible for providing a suitable environment for managing a significant incident or emergency (an ICC). However, the exact specification of the ICC will depend on the organisation s size and role. - 26 -
NHS Core Standards for Emergency Preparedness, Resilience & Response (EPRR) Acute trusts Ambulance trusts NHS CB area teams NHS CB regional & CCGs Primary care Other NHS organisatio Community providers Mental health 7. 18 Plans should set out: the alerting arrangements for external and self-declared incidents, including trigger points and escalation procedures; X X X X X X X X X 7. 19 the procedures for escalating emergencies to CCGs and the NHS CB area, regional and national teams; X X X X X X X X X 7. 20 24-hour arrangements for alerting managers and other key staff, including how up-to-date contact lists will be maintained; X X X X X X X X X 7. 21 the responsibilities of key staff and departments; X X X X X X X X X 7. 22 the responsibilities of the Chief Executive or Executive Director; X X X X X X X X X 7. 24 where the incident or emergency will be managed from (the ICC); X X X X X - X X X 7. 25 how the independent healthcare sector may help if required; and X X X X X X X X X Business continuity plans should describe the effects of any disruption and how they can be managed. Plans should include: X X X X X X X X X 7. 29 a scalable plan setting out how incidents will be managed and by whom; X X X X X X X X X 7. 31 how decisions and meetings will be recorded during and after an incident, and how the incident report will be compiled; X X X X X X X X X 7. 32 how the organisation will respond to the media following a significant incident, in line with the formal communications strategy; X X X X X X X X X 7. 33 how staff will be accommodated overnight if necessary; X X X X X X X X X 7. 41 reference to the National Occupation standards for Civil Contingencies and NHS CB competencies when identifying key knowledge and skills for staff; (directors of NHS CB on-call rotas to meet NHS CB published competencies); X X X X X - X X X 7. 43 details of how suitable knowledge and skills will be achieved and maintained. X X X X X - X X X 9 NHS Ambulance Trusts must also: - X - - - - - - - 9. 1 refer to the National Ambulance Service Command and Control Guidance 2012 and any other relevant ambulance specific guidance relating to major incidents; - X - - - - - - - 9. 2 manage up to four incidents at a time in urban areas and two in rural areas; - X - - - - - - - 9. 3 have flexible IT and staff arrangements so that they can operate more than one control centre and manage any events required; - X - - - - - - - 9. 4 have formal arrangements for recalling staff to duty if necessary; - X - - - - - - - 9. 5 be able to provide a forward control team if necessary; - X - - - - - - - 9. 6 have an on-call and an on duty loggist drawn from a wide pool of staff; - X - - - - - - - 9. 7 have arrangements to communicate with and control resources from other ambulance providers; - X - - - - - - - 9. 8 have a 24-hour specialist adviser for incidents involving firearms or chemical, biological, radiological, nuclear, explosive or hazardous materials, and support gold and silver command in managing these events; - X - - - - - - - 9. 10 make sure all commanders maintain a continuous personal development portfolio; - X - - - - - - - 9. 16 be able to respond with assets across the organisation and the country and provide situation reports to the National Ambulance Co-ordination Centre; - X - - - - - - - 9. 17 be able to dispatch and receive assets following an agreed trigger mechanism, supported by a robust audit process; - X - - - - - - - 9. 33 explain the systems for alerting, mobilising and co-ordinating all primary NHS resources necessary to deal with an incident on the scene (in cooordination with NHS CB area team gold command); - X - - - - - - - 9. 34 list their key strategic, tactical and operational responsibilities as set out in the NHS Emergency Planning Guidance 2005 (or subsequent relevant guidance); - X - - - - - - - 9. 40 explain the roles of the Hospital Ambulance Liaison Officer (HALO) and Hospital Ambulance Liaison Control Officer (HALCO) in acute trusts; - X - - - - - - - - 27 -
10 NHS CB area teams must also: NHS Core Standards for Emergency Preparedness, Resilience & Response (EPRR) Acute trusts Ambulance trusts NHS CB area teams NHS CB regional & CCGs Primary care Other NHS organisatio Community providers Mental health - - X - - - - - - 10. 2 define when the NHS will take the leading role in a significant incident or emergency`; - - X - - - - - - 10. 3 mobilise primary and secondary care resources to support acute and non-acute trusts; - - X - X - - - - 10. 4 describe the arrangements for setting up a Science and Technical Advice Cell (STAC) in consultation with local Public Health England centres; - - X X - - - - - 10. 5 identify who will attend the Strategic Co-ordination Group (SCG); - - X X - - - - - 10 8 develop plans which demonstrate the command and control of resources from all NHS organisations and providers of NHS funded care within an LRF area to respond to a significant incident or emergency. - - X - - - - - - 11 NHS CB corporate and regional offices must also: - - - X - - - - - 11. 4 outline the procedure for responding to incidents which affect two or more LHRPs or LRFs; - - - X - - - - - 11. 5 outline the procedure for responding to incidents which affect two or more regions; - - - X - - - - - 11. 6 define how links will be made between the NHS CB, the Department of Health and PHE - - X X - - - - - 11. 9 outline how information relating to national emergencies will be co-ordinated and shared; and - - X X - - - - - 18 Mental healthcare providers must also: - - - - - - - - X 18. 5 make sure the needs of mental health patients involved in a significant incident or emergency are met and that they are discharged home with suitable support. - - - - - - - - X - 28 -