Emergency Preparedness, Resilience & Response (EPRR) 2014/15 Annual Report Public Board 24 September 2015

Agenda Item 13.4 Emergency Preparedness, Resilience & Response (EPRR) 2014/15 Annual Report Public Board 24 September 2015 Presented for: Presented by: Author Previous Committees Governance Professor Suzanne Hinchliffe CBE, Chief Nurse / Deputy Chief Executive Sharon Scott, Resilience Manager Quality Management Group - 10 September 2015 Trust Goals The best for patient safety, quality and experience The best place to work A centre for excellence for research, education and innovation Seamless integrated care across organisational boundaries Financial sustainability Key points 1. The 2014/15 EPRR annual report provides Trust Board with assurance that Leeds Teaching Hospitals NHS Trust (LTHT) has met its EPRR statutory duties and obligations. 2. The EPRR annual report details learning from incidents and events, achievements and improvements made to existing emergency response arrangements between 1 April 2014 and 31 March 2015. To provide a continuous cycle of improvement the annual report also sets out the key EPRR priorities for 2015/16. 3. Trust Board is asked to receive and note the EPRR annual report and the assurance that it provides to support the ongoing work of the Emergency Preparedness Coordinating Group, its sub-groups and emergency preparedness team. Information Information Discussion

1. Summary Trust Board are asked to receive and note the Emergency Preparedness, Resilience and Response (EPRR) 2014/15 Annual Report (Appendix 1) and the assurance that it provides. The EPRR annual report has been consulted on and approved by the Emergency Preparedness Coordinating Group. Further approval by Quality Management Group was received on 10 September 2015. 2. Background The EPRR annual report provides Trust Board with assurance that Leeds Teaching Hospitals NHS Trust (LTHT) has met its statutory duties and obligations in respect of Emergency Preparedness, Resilience and Response. The EPRR annual report details learning from incidents and events, achievements and improvements made to existing emergency response arrangements between 1 April 2014 and 31 March 2015. To provide a continuous cycle of improvement the annual report also sets out the key EPRR priorities for 2015/16. 3. Publication Under Freedom of Information Act Public Board meeting This paper has been made available under the Freedom of Information Act 2000 4. Recommendation Trust Board is asked to: Receive and note the EPRR annual report and the assurance that it provides to support the on-going work of the Emergency Preparedness Coordinating Group, its sub-groups and emergency preparedness team. 5. Supporting Information The following papers make up this report: EPRR 2014/15 Annual Report. Sharon Scott Resilience Manager 15 September 2015 2

APPENDIX 1 EMERGENCY PREPAREDNESS, RESILIENCE AND RESPONSE 2014/15 ANNUAL REPORT FOREWORD Continuing to improve the Trust s response to and recovery from a major incident or significant service disruption is at the heart of what the emergency preparedness team do here in Leeds Teaching Hospitals NHS Trust (LTHT). Under the Civil Contingencies Act (2004), NHS organisations and providers of NHS funded care, must show that they can plan for and deal with a wide range of incidents and emergencies that could affect health or patient care. This programme of work is referred to in the health community as emergency preparedness, resilience and response (EPRR). New arrangements for health EPRR also form some of the changes to the Health and Social Care Act 2012. All NHS-funded organisations must now meet the requirements of the Civil Contingencies Act (2004), the Health and Social Care Act (2012), the NHS standard contracts, the NHS England Core Standards for EPRR the NHS England command and control framework, and NHS England business continuity management framework. This framework supersedes both The NHS Emergency Planning Guidance 2005 and the Arrangements for Health Emergency Preparedness, Resilience and Response. Leeds Teaching Hospitals NHS Trust, its Executive Team and emergency preparedness team are committed to ensure that the Trust works closely with key stakeholders, managers and clinicians to ensure an effective, resilient and coordinated response to minimise the impact of emergencies as they occur and to direct planning for the resumption of normal activity. This work is led by the well-established Emergency Preparedness Coordinating Group (EPCG). EPCG oversees the development and maintenance of Trust emergency preparedness plans. The group is primarily an assurance group established to ensure compliance with statutory legislation, framework and national policy drivers. On a number of occasions over the past year our plans have been put to the test through pre planned events, incidents and exercises. We continue to learn from our experiences and use this feedback and learning to continually improve our response. I am pleased to present the EPRR 2014-15 annual report which identifies work undertaken to ensure the Trust is compliant with statutory duties and obligations, acknowledges its achievements over the last twelve months and sets out its key priorities for 2015/16. Professor Suzanne Hinchliffe CBE, Chief Nurse/Deputy Chief Executive Sharon Scott Resilience Manager 3

Contents 1. BACKGROUND... 5 2. PURPOSE... 5 3. STATUTORY FRAMEWORK AND NATIONAL POLICY DRIVERS... 5 3.1. Statutory Legislation... 5 3.2. Strategic National EPRR Framework and Core Standards... 5 4. RESPONSIBILITY AND ACCOUNTABILITY... 6 4.1. Accountable Emergency Officer (AEO)... 6 4.2. Emergency Planning Coordinating Group (EPCG) and Supporting Subgroups... 6 5. RISK ASSESSMENT... 7 5.1. Partnership Working... 8 6. EPRR PLANNING... 9 6.1. Resilience Plans (Service and Corporate Level)... 9 7. RESILIENCE PLANS (TRUST WIDE)... 9 7.1. Strategic Plan... 9 7.2. Significant Incident (Multiple Minor Injuries) Plan... 9 7.3. Resource Escalation Action Plan (REAP) Operational Response... 10 8. TRAINING, EXERCISING AND TESTING... 11 9. RESPONDING TO INCIDENTS AND PRE-PLANNED EVENTS IN 2014/15... 12 9.1. Tour de France (TdF)... 12 9.2. Ebola Virus Disease (EVD)... 14 10. INDUSTRIAL ACTION... 16 10.1. NHS National Industrial Action... 16 10.2. National Fire Brigades Union... 16 11. PREVENT... 16 12. IMPROVEMENTS AND ACHIEVEMENTS IN RESILIENCE PLANNING... 17 12.1. Generic and Incident Specific Major Incident Plans... 17 13. BUSINESS CONTINUITY... 17 13.1. LTHT Crisis Communication System... 18 13.2. Influenza... 18 14. EPRR PRIORITIES 2015/16... 19 15. RECOMMENDATIONS... 20 APPENDIX A - CSU MAJOR INCIDENT AND BUSINESS CONTINUITY PLANS STATUS AS AT 31ST MARCH 2015... 21 APPENDIX B - CORPORATE BUSINESS CONTINUITY PLANS STATUS AS AT 31ST MARCH 2015... 22 APPENDIX C - TRUST-WIDE RESILIENCE ARRANGEMENTS... 23 References... 24 4

1. BACKGROUND The NHS must be able to prepare for and respond to a wide range of incidents and emergencies that could affect health or patient care. These could be anything from severe weather, infectious disease outbreaks to a major transport accident or mass casualty incident. As a Category 1 responder as outlined in the Civil Contingencies Act (2004), the Health and Social Care Act (2012), the NHS standard contract, the NHS England Core Standards for EPRR the NHS England command and control framework, and NHS England business continuity management framework, NHS organisations and providers of NHS funded care must show that they can deal with these incidents whilst maintaining services to patients. 2. PURPOSE This 2014/2015 EPRR annual report provides Trust Board with assurance that Leeds Teaching Hospitals NHS Trust (LTHT) has met its statutory duties and obligations. This annual report details learning from incidents and events, achievements and improvements made to existing emergency response arrangements between 1 April 2014 and 31 March 2015. To provide a continuous cycle of improvement this annual report also sets out the key EPRR priorities for 2015/16. Quality Management Group has endorsed this report for submission to Trust Board. Trust Board is asked to receive and note this report and the assurance it provides. 3. STATUTORY FRAMEWORK AND NATIONAL POLICY DRIVERS 3.1. Statutory Legislation Under the Civil Contingencies Act 2004, LTHT is defined as a Category 1 responder and is subject to civil protection duties which are to: Assess the risk of emergencies occurring and use this knowledge to inform contingency planning. Ensure emergency plans and business continuity management arrangements are in place. Communicate with the public to ensure they are warned, informed and advised in the event of an emergency. Share information and cooperate with other local responders to enhance coordination and efficiency. 3.2. Strategic National EPRR Framework and Core Standards The Strategic National EPRR Framework contains principles for health emergency planning for NHS England at all levels including NHS provider organisations, providers of NHS-funded care, clinical commissioning groups (CCGs), GPs and other primary and community care organisations. EPRR core standards are an underpinning requirement for NHS funded organisations. NHS England set out expectations for the 2014-15 assurance process. This process is undertaken annually to ensure that the NHS is prepared to respond to an emergency and has resilience with regards to maintaining safe patient care. 5

As part of the 2014-15 EPRR assurance process, LTHT undertook a self-assessment against the core standards and achieved a substantial level of compliance. LTHT was fully compliant with all but one of the standards which related to the availability of Chemical Equipment Assessment Kits (ChEAKs). Public Health England (PHE) has since clarified their expectations for acute service providers. Quality Committee (on behalf of Trust Board) was sighted on the self-assessment, level of compliance achieved and improvement plan. A statement of compliance and improvement plan was submitted to NHS England (West Yorkshire Area Team). Following the clarification of the requirement to hold ChEAKs the Trust later declared full compliance against all core standards. The EPRR Core Standards assurance process will be repeated during 2015/16. 4. RESPONSIBILITY AND ACCOUNTABILITY 4.1. Accountable Emergency Officer (AEO) The Chief Executive is responsible for ensuring that LTHT is compliant with the Civil Contingencies Act 2004, supporting statutory legislation and EPRR Core Standards. The Chief Nurse/Deputy Chief Executive is the designated executive lead/accountable emergency officer (AEO) with responsibility for EPRR within the Trust. The Chief Nurse/Deputy Chief Executive has delegated responsibility to the Resilience Manager to ensure legislative requirements, all underpinning guidance and EPRR core standards are met. A full time Emergency Planning Officer was appointed in September 2014 to support the Resilience Manager discharge this duty. 4.2. Emergency Planning Coordinating Group (EPCG) and Supporting Subgroups The Emergency Preparedness Coordinating Group (EPCG), chaired by the Accountable Emergency Officer is authorised by the Risk Management Group (RMG), to support and report on activities related to EPRR. The EPCG oversees the development and maintenance of Trust emergency preparedness plans. The group is primarily an assurance group established to ensure compliance with EPRR statutory legislation, strategic framework and core standards. During 2014/15, the EPCG had delegated authority from RMG to oversee and monitor Trust activities relating to overall direction and set priorities for emergency preparedness activities. The group monitor risk and actions to ensure satisfactory progress is made to meet objectives. The EPCG is supported by a number of sub groups which lead on specific areas of planning and response, these include: The Emergency Department Major Incident Steering Group is chaired by a Consultant in Emergency Medicine/Emergency Department Majax Clinical Lead. This is primarily concerned with any major incident or service continuity disruption affecting the Emergency Department s resources or equipment and to continue to provide accident and emergency core functions during a major incident response. In addition, the group oversees the recruitment and training of Medical Emergency Incident Response Team (MERIT) volunteers. The Urgent Care Major Incident Plan was reviewed and updated in March 2015. Symphony software has been updated in both Emergency Departments and Command and Control Rooms. A business case for an electronic lockdown system at SJUH Emergency Department has been drafted and Urgent Care CSU is in the process of submitting the 6

business case. Going forward, a 2015/16 annual work plan is in place, continued focus and priority will be given to increase the number of MERIT volunteers and a Hospital Major Incident Medical Management and Support (HMIMMS) table top kit has been purchased to support Emergency Department staff training. The Chemical, Biological, Radiological, Nuclear (CBRN)/Hazmat (Hazardous Material) Sub Group is chaired by the Clinical Director for Adult Critical Care. This group, with multi-speciality and multi-agency membership, oversees the CBRN/Hazmat capability and response to ensure plans are critically appraised, integrated within existing policy, reflect changes to national guidance and consistency with other local responding agency arrangements. The Trust entered the West Yorkshire Resilience Forum s Acute Trust Powered Respiratory Protection Suits (PRPS) Memorandum of Understanding with four other West Yorkshire Acute Trusts. This enables PRPS to be shared in the event of a CBRN/HAZMAT incident. Initial Operational Response (IOR) Guidance was launched by the Joint Emergency Services Interoperability Programme (JESIP). This was based on extensive research from Public Health England and the University of Hertfordshire on the most appropriate approach to non-caustic chemical decontamination. The IOR is predominantly aimed at ensuring an immediate first aid type approach that is capable of being delivered by non-specialist staff to self-presenting casualties in any setting without delay. The Trust s CBRN/Hazmat plan and Emergency Department training programme for CBRN/Hazmat incidents has been updated to incorporate the IOR guidance. To ensure compliance with guidance published by NHS England on 1 April 2015 (Chemical incidents: Planning for the management of self-presenting patients in healthcare settings) across all NHS funded sites, the CBRN Sub Group will review all LTHT peripheral sites to determine the appropriate and proportionate plans and response arrangements required. To provide overall direction and set priorities for emergency blood management within the Trust in the event of a national blood or blood product shortage the Emergency Blood Management Group is chaired by the Deputy Chief Medical Officer / Medical Director (Operations) with senior multi-speciality clinical membership. This sub group oversees and ratifies the Emergency Blood Management Arrangements in the Trust, including communication with clinical and managerial colleagues and appropriate empowerment of the Transfusion Team. In addition to the above sub groups during 2014/15 task and finish sub groups were established to lead on specific planning when special measures were required to deal with the preparations for the Tour de France and to ensure Trust wide coordination and management of operational readiness in anticipation of a patient(s) attending LTHT with suspected or confirmed Ebola Virus Disease (EVD.) In line with the Major Incident Policy the Trust s EPCG and its sub groups have met at regular intervals throughout 2014/15. Summary assurance reports were provided to the RMG which included a summary of assurance reviewed against each of the policy areas and standards covered by the EPCG together with progress reports on the annual work plan, highlighting any issues for escalation or action. In addition to oversight from the RMG, status reports were taken to the Risk Management Committee (RMC) detailing the Trust s preparedness for and response to high impact / low probability events. 5. RISK ASSESSMENT NHS organisations and providers of NHS funded care must: 7

Have suitable up to date plans which set out how they plan for, respond to and recover from major incidents and emergencies as identified in local and community risk registers. The National risk register provides a national picture of the risks of emergencies occurring, these are usually referred to as high impact / low probability events. In planning for emergencies in the West Yorkshire area the national planning assumptions are taken into account together with Cabinet Office local risk assessment guidance, local knowledge and experience of risk within the area. Professor Suzanne Hinchliffe, CBE, Chief Nurse and Sharon Scott, Resilience Manager represent and attend the West Yorkshire Local Health Resilience Partnership (LHRP). The LHRP have considered all risks within the area and agreed the risk assessment for West Yorkshire. Agreement was reached at LHRP that all NHS organisations in West Yorkshire would update local risk registers in alignment with the West Yorkshire risk assessment. EPRR status reports to Risk Management Committee (RMC) during 2014/15 provided RMC with assurance that all emerging EPRR threats and hazards had been risk assessed, transferred to the Datix risk management system and were in alignment with the West Yorkshire LHRP risk assessment. Key Priority 2015/16 The EPCG will continue to monitor EPRR risks and hazards to ensure that the Civil Contingencies Act 2004, accompanying statutory duties and EPRR Core Standards are fulfilled by the Trust. 5.1. Partnership Working To facilitate information sharing, coordination and best practice the Trust is represented at health and multi-agency emergency preparedness groups within Leeds and across West Yorkshire. This engagement provides a valuable platform to collaborate with partner agencies in terms of planning and to share valuable learning from events and incidents which have required a multi-agency response. During 2014/15 the Trust was represented at the following groups: Local Health Resilience Partnership (health - regional) West Yorkshire Health Resilience Forum (health - regional) Interoperability Sub Group (multi-agency, regional) MERIT (health - regional) Leeds Resilience Group (multi-agency, local) Leeds Health and Social Care Resilience Group (health - local) Leeds Pandemic Influenza Group (health - local) Key Priority in 2015/16 The Accountable Emergency Officer and Resilience Manager will maintain membership of local and regional EPRR groups to enhance coordination and efficiency. The Resilience Manager will continue to participate in regular internal and multi-agency table top, live exercises and workshops to further enhance and improve resilience. 8

6. EPRR PLANNING 6.1. Resilience Plans (Service and Corporate Level) The emergency preparedness team engage across Clinical Service Units, Clinical Support Units (CSUs) and corporate teams to implement robust major incident and business continuity plans. During 2014/15 Major Incident and Business Continuity Planning across all CSUs and corporate services was reviewed monthly by the emergency preparedness team with performance reports taken to EPCG and assurance reports to RMG. Support was provided to CSUs and non-compliant CSUs were escalated as per the Major Incident Policy. Between 1st April 2014 and 31st March 2015, 59 out of 63 plans were reviewed and updated (Appendix A). In October 2014, 21 corporate plans were newly added to the Major Incident and Business Continuity Performance Report. All 21 corporate plans have been reviewed and updated (Appendix B). 7. RESILIENCE PLANS (TRUST WIDE) 7.1. Strategic Plan In June 2014 the Independent Report into Matters Relating to Savile at Leeds Teaching Hospitals was published. Recommendation 21 of the independent investigation team required the Trust to: Develop a major strategic plan for the management of potentially catastrophic issues where public confidence in the organisation may be at stake in the light of unprecedented events. This will enable greater clarity and consistency in matters of communication, accountability and action. To address the above recommendation a Strategic Plan was developed for use when responding to major public concerns during unprecedented media or high profile events. The Strategic Plan will support the Trust to minimise uncertainty; clarify roles and responsibilities; assess and establish immediate, medium and longer term resource requirements; implement strategies to ensure support and welfare is in place for staff, patients and public who have been affected by the incident or event, this includes access to vital support networks and helplines. The Strategic Plan now forms an integral part of the Trust s Emergency Preparedness, Resilience and Response (EPRR) framework. 7.2. Significant Incident (Multiple Minor Injuries) Plan Past events involving severe ice and snow have caused a significant rise in the number of patients with trauma and orthopaedic injuries attending the LTHT Emergency Departments. Attendances such as these whilst high in number may not necessarily invoke a full major incident response but will require the swift coordination of numerous services to maintain service continuity. A plan written in collaboration with the Emergency Department, Trauma and Orthopaedic colleagues and senior operational leads to respond to multiple minor casualties has been developed. This plan provides additional strategies to treat large numbers of minor injuries while maintaining services for non-orthopaedic patients. 9

7.3. Resource Escalation Action Plan (REAP) Operational Response To provide a consistent approach to trigger points and escalation within Leeds and across West Yorkshire, the Trust adopted the REAP escalation process. REAP was implemented and tested throughout winter 2014/15 when the NHS experienced an unprecedented level of demand. REAP levels were initially introduced as good practice for emergency services and are nationally adopted by the Ambulance Service. REAP levels ensure a structured set of arrangements when normal operating functions are challenged, either through loss of staff, resources or external factors including periods of high demand. LTHT has a variety of strategic and tactical options within REAP that are most suitable to deal with the situation or surge in demand. Implementation of REAP levels in place of the previous 4 escalation levels (Green, Amber, Red and Black) also allows health partners to better understand the levels of demand and activity within the Trust, incorporating bed occupancy issues as well as acute attendances, staffing shortages and the impact of outbreaks on our ability to function. REAP levels will also reflect constraints on capacity caused by diagnostic or resource issues which may not have previously impacted on the Trust s alert status. The 6 REAP levels are set out in the table below: Level 1 Level 2 Level 3 Level 4 Level 5 Level 6 Normal Concern Moderate Pressure Severe Pressure Critical Potential Service Failure The operational effects of sustained operational pressures, significant infectious disease (e.g. influenza, norovirus), severe weather etc., are very similar and the management of these issues will be driven centrally. A crucial element of the response is local integrated contingency arrangements to handle unforeseen circumstances, escalating actions as required. The LTHT 2014/15 Winter Plan provided a high level approach for effectively managing capacity within the Trust. The Winter Plan is designed to enhance the effectiveness of CSU procedures through proactive management processes and best practice; particularly bringing consistency where possible to the management of acute pressures. As part of the Trust s local response to support winter planning and REAP, an Operational Response Procedure was developed. This procedural document formalised command and control arrangements in response to the establishment of Operational Silver Command at REAP Level 4+ and is applied in conjunction with the Trust s Winter Plan. This procedural document describes the management of normal business within the daily operational performance (DOP) meetings through the management of REAP Levels within the Trust. This procedural document also includes roles and responsibilities of key staff within an Operational Silver Command at REAP Level 4+ to manage fluctuations in demand, both within its own resources and through liaison with other organisations. It is intended that this procedural document is used throughout the year and may be supplemented by other seasonal arrangements or at times of extreme pressure of demand (i.e. LTHT 2014/15 Winter Plan) and/or other supporting EPRR plans and procedures (i.e. Major Incident Plan, Heat wave Plan). 10

2015 2014 Agenda Item J1 Key Priority 2015/16 Learning from winter 2014/15 will be used to strengthen the Trust s 2015/16 Winter Plan and REAP process within the Trust and in conjunction with health and social care partners within Leeds. 8. TRAINING, EXERCISING AND TESTING The Trust has successfully complied with the NHS England Emergency Preparedness Framework and NHS England Core Standards for EPRR with regards to exercising plans and fulfilling the following criteria: Communications exercise every six months (see Table 2) Table top exercise once a year (see Table 2) Major live exercise every three years (this will be attained in September 2015) Date Training, Exercising and Testing April LTHT LGI Major Incident Switchboard Cascade Test May LTHT Command and Control Training June LTHT Tour de France Table Top Exercise (Operation Lycra) July LTHT SJUH Major Incident Switchboard Cascade Test August September LTHT Command and Control Training October LTHT LGI Major Incident Switchboard Cascade Test LTHT Command and Control Training November NHS England & PHE Ebola Discussion Based Exercise NHS England Pandemic Influenza Exercise (Exercise Deneb) December January LTHT SJUH Major Incident Switchboard Cascade Test February NHS Blood and Transplant Exercise (Exercise Paracelsus) LTHT Command and Control Training March LTHT Crisis Communication System MERIT Cascade Test Table 2. LTHT training, exercising and testing throughout 2014-15 The emergency preparedness agenda is varied and wide ranging. In addition to ensuring that staff have the skills and knowledge to respond to an emergency, the preparing for emergencies training strategy must also ensure that resilience planning is embedded within the normal business processes of the organisation and equip key individuals with the skills and knowledge to plan and prepare within their own area of responsibility. Over the years, various emergency planning training programmes have been delivered within the organisation, both in house and by external partners. Examples include mass decontamination service provided by Yorkshire Ambulance Service, Emergo training provided by the Health Protection Agency (now Public Health England), MERIT training and in house training for senior staff. Major incidents and casualty decontamination form part of the annual mandatory training programme in A&E. In addition the Trust has taken part and observed a number of multi-agency exercises which are a valuable training opportunity for those participating. Led by the Trust s Fire Safety Manager, the Trust carried out a series of interactive exercises with West Yorkshire Fire and Rescue Service (WYFRS) and hospital staff. 11

Benefits and challenges identified by this series of exercises are invaluable. These include partnership working with those that evaluate us against statutory compliance, collaborative working with other blue light services, testing of fire procedures and developing operational procedures that would be used in the event of an incident within our premises. These exercises have helped all those taking part to understand the dynamics of dealing with a fire in a complex organisation under as near as possible realistic operational constraints. A five year programme to improve electrical resilience on the St James s University Hospital site has continued throughout 2014/15. This programme of work will increase the available electrical supplies around the hospital to sustain future expansion and to improve the backup resilience required during an electrical supply interruption. A series of black start tests have been undertaken throughout the five year programme and it is expected that work will complete during August 2015 when a further series of planned black starts will take place to fully test the new system. Significant communication and engagement between the Trust Estates team and wards and departments has taken place throughout all tests to ensure appropriate awareness of testing, robust contingency arrangements and the required level of command and control is in place. Key Priority in 2015/16 The Trust will build on the Preparing for Emergencies Training Strategy during 2015/16 with a further live decontamination exercise which will be held on the SJUH site. The exercise will involve live play and will aim to test the strength and integrity of the CBRN/Hazmat plan in collaboration with partner organisations. In line with EPRR core standards the emergency preparedness team will seek to continually improve its EPRR training resource and explore new training opportunities to enhance delivery of training across tactical, operational and strategic levels. 9. RESPONDING TO INCIDENTS AND PRE-PLANNED EVENTS IN 2014/15 The Trust implemented its business continuity and command and control arrangements in response to a number of large scale, high profile events which had the potential to interrupt health care service delivery. Special measures were put in place to ensure the safe delivery of services to our patients, staff and the public. Responding to events as they unfold allows the Trust to fully test its emergency response plans and command and control arrangements. Valuable learning is then used to drive future response improvements. Events in 2014/15 and the Trust s response are described in detail below. 9.1. Tour de France (TdF) The Tour de France (TdF), one of the largest sporting events in the world, came to Yorkshire on the 5th and 6th July 2014. The Grand Départ Stage 1 commenced in Leeds from the Headrow and finished in Harrogate. Stage 2 started from York and finished in Sheffield. Just prior to the TdF weekend, on Thursday 3rd July 2014 a live, televised Riders Parade took place from Leeds University to Leeds Arena with all 22 teams taking part including cyclists from local clubs and community groups. Due to the unprecedented nature of the TdF, predicted additional visitors, extensive road closures and disruptions, high level planning and special measures were put in place in order to maintain safe patient care and access to services at our hospitals during the TdF weekend and in anticipation of the Riders Parade. Multi-agency collaboration, planning and 12

exercising with Health and Social care partners commenced in September 2013 and continued at regular intervals through to July 2014. To support internal planning a TdF Task and Finish Group, chaired by the Resilience Manager with senior operational and corporate membership met regularly. The group mitigated risk and developed operational plans to ensure safe access to all services across the Trust throughout this unprecedented event. These plans were tested for operational readiness during a Trust wide table top exercise, Operation Lycra on 19th June 2014. As a result of learning from the exercise Daily Operational Performance meetings were implemented during the immediate run up to the event with close engagement from health and social care partners which, in the lead up to the event reduced delayed discharges. Due to the unprecedented nature of this event, to provide a rapid response to any additional demand on services or unrelated major incident and due to the risk of increased attendance and operational pressures, a full Hospital Control Team (Silver Command) lead by the Chief Medical Officer was established on both main sites. Feedback was collated from staff who contributed to the extensive pre-planning and those on duty over the TdF weekend. There was a clear consensus among staff and partner agencies across Leeds and West Yorkshire that the TdF was a well-planned event and disruption was kept to a minimum. Staff and the public reported that they were well informed of the road closures and the impact this would cause. Despite over 250,000 additional visitors to Leeds no significant operational issues were experienced. Overall, Emergency Department attendances and admissions were lower than expected. Whilst positive feedback was received from staff and partners, vital lessons were learnt. A Lessons learnt report was shared with the Executive Team and partner agencies which concluded that: The Trust will continue to engage with partners to ensure all risks affecting access to our hospitals and any disruption to health care services are fully considered and taken into account by partner agencies to further minimise disruption and risk to patients. The Trust will continue to build and maintain strong multi-agency relationships and use the valuable learning identified by the TdF Leeds Resilience Health and Social Care Group to inform future planning. Learning from the TdF weekend will be used to inform future planning and risk assessment in regards to disruption to transport infrastructure within the city and access to the hospitals. Whilst all risks to safe delivery of services were fully mitigated, the Trust now has a precedent to set safe staffing levels and proportionate planning for future large scale events. This global sporting event attracted 3.8 million spectators between 5th and 7th July, with millions watching over 25 hours of live TV coverage. In hindsight, the celebration could have been shared more widely with patients and staff within the hospitals. Consideration of wider internal event publicity and celebration will be assessed for future large scale events held in Leeds. 13

Priorities for 2015/16 The Trust will be represented by the Resilience Manager at the Leeds City Council Strategic Safety Advisory Group (SSAG) to ensure that all risks to hospitals or hospital services are fully considered and mitigated against during large scale event planning. 9.2. Ebola Virus Disease (EVD) Ebola virus disease (EVD) is a Category 4 viral haemorrhagic fever (VHF). A fast evolving outbreak of EVD in West Africa was first reported in March 2014. Despite the expectation that the outbreak would be brought under control, at the end of May 2014 there was a surge in the number of new cases and the outbreak spread in previously unaffected areas. As a result of the emerging threat guidance was circulated internally and staff were instructed to remain vigilant for travellers who had visited the areas affected by VHF and develop unexplained illness. In August 2014, the World Health Organisation declared the outbreak a public health emergency of international concern under the International Health Regulations (2005). An Emergency Preparedness Status Report was submitted to the Risk Management Committee detailing the emerging threat of Ebola. Further national operational guidance continued to be cascaded to senior clinicians. The Infection Prevention and Control (IPC) Team published Ebola guidance on Leeds Health Pathways. Further information and guidance on the use of Personal Protective Equipment (PPE) and fit testing support was provided to high risk areas and Quality Committee received an update on the Trust s preparedness. The Trust established a multi-specialty EVD Steering Group in October 2014 chaired by the Clinical Director of Adult Critical Care. Reporting to the EPCG (business continuity) and the Health Care Associated Infection Group (operational management) the group continue to meet regularly and oversee coordination and management of operational readiness in anticipation of suspected or confirmed EVD cases attending LTHT, together with learning from workshops, training, exercises and best practice. In December 2014 LTHT was identified as the regional ID unit for high possibility EVD cases. Protocols were established to provide a pre-alert followed by immediate dialogue and risk assessment with PHE prior to transfer via the Yorkshire Ambulance Service (YAS), Hazardous Area Response Team (HART). Between August and December 2014, in accordance with national guidance, Trust wide procedures and service specific operational plans led by senior clinicians within ED, Infectious Diseases and Paediatrics were implemented. These operational plans identified appropriate locations for isolation, testing and management and were disseminated to departments in anticipation of pre-alerts and for suspected patients that may also selfpresent. A Senior Infection Prevention Nurse (IPN) was allocated the responsibility for identifying the appropriate personal protective equipment (PPE), ensuring a robust process was put in place for ordering, storing and maintaining stock levels, managing the practical and training aspects of Ebola preparedness and identifying and sourcing a safe method for internal transfer for high risk patients within LTHT. This included writing a Trust guideline for the management of patients with suspected or confirmed VHF; this was a dynamic document which reflected changing PHE advice. 14

Teams of IPNs were allocated to work with the operational teams to identify the admission pathway which would ensure the safe placement of patients, relatives and staff in the areas identified as high risk. Further work was undertaken with Estates, Facilities and Mortuary staff with emphasis on reducing staff anxieties, understanding VHF and practical aspects of keeping themselves safe. Several resources were developed, including a video and step by step hand held guide for application and removal of PPE which accompanied patients through their pathway. The IPN team ran daily practical training sessions to ensure staff are familiar with the procedure and reduce the risk of breaches in safety. These processes required high levels of activity from the IPNs and ward/department staff to ensure that staff felt confident and that their anxieties were managed effectively. Occupational Health advice and guidance was developed for healthcare workers called upon to work with patients with VHF in any setting and healthcare workers and students returning from countries affected. To ensure command and control in and out of hours, following attendance of a patient with a high possibility of EVD, an escalation process was established. To promote awareness and to provide a central resource for all staff, the Trust s EVD intranet site http://lthweb/sites/eprr/ebola-virus-disease/introduction was created. The Resilience Manager developed an overarching LTHT EVD Plan in consultation with the EVD Steering Group and approved by the Executive Team. The document forms part of the EPRR framework and supports LTHT to be as well prepared as possible to safely deal with a patient(s) presenting with a high index of suspicion or confirmed EVD in Leeds. EVD plans and procedures were thoroughly tested, following a live drill and the attendance of four suspected EVD cases up to the end of January 2015. Of these cases two were returning health care workers, both, although low possibility, required sampling and testing. Both samples tested negative for EVD. EVD testing was not undertaken on the remaining two patients as they were deemed low risk/low possibility following initial risk assessment by the Consultant in Infectious Diseases. Extensive preparedness, planning and training has been undertaken within LTHT to prepare its hospitals and staff for the presentation of a patient with a high index suspicion of Ebola. Valuable learning from suspected attendance and a live drill has enabled all teams involved to test operational plans, and where required, to take immediate action to update these plans to further improve operational response for future presentations of suspected EVD or other VHF to Leeds. A detailed report approved by the Executive Directors Group describing the current preparedness and preparations for receiving a case of Ebola together with valuable lessons learnt has been shared with PHE for wider cascade within the NHS. Whilst the risk of infection with MERS-CoV to UK residents remains very low, valuable learning from suspected presentation of EVD together with the framework already in place will be used to support and inform the Trust s preparations for MERS-CoV and other new and emerging infectious diseases that require a Trust wide coordinated response. Key Priorities for 2015/16 It is clear that the EVD outbreak is likely to continue for some months to come with new cases still presenting in West Africa. In view of this it is vitally important that staff remain vigilant and continue to follow the established procedure should a suspected case present. The Trust will therefore ensure that EVD preparedness remains a priority. 15

10. INDUSTRIAL ACTION 10.1. NHS National Industrial Action During 2014/15 a number of health trade unions took part in three separate days of national industrial action. To provide the safe continuation of all essential services, extensive contingency planning, led by the Industrial Action Management Group was undertaken. Membership of the group included senior operational directors, clinical and senior managerial representatives from Pathology, Radiology, Human Resources, Communications, Facilities and Emergency Preparedness. The group engaged with trade unions to identify and agree essential services for the Trust to secure safe emergency and acute care to patients throughout the periods of industrial action. The group reviewed learning from previous periods of national industrial action in 2011, 2014 and local industrial action by Pathology CSU in 2013 to assess and determine the required level of non-urgent activity rescheduling. To provide a coordinated response and escalation of any unexpected event or operational pressures a Hospital Control Team (Silver Command) lead by an Assistant Director of Operations was established for each period of industrial action. Whilst is was necessary to re-schedule some non-urgent activity, due to successful engagement with trade unions and contingency planning disruption to patient care was kept to a minimum and all patients were kept safe during all periods of industrial action. 10.2. National Fire Brigades Union The National Fire Brigades Union undertook 49 periods of industrial action between 2014/15. These periods ranged from two hour to 24 hour strikes. The main implication for our hospitals during these periods of industrial action was that in the event of a fire there was potential for a delayed response by the Fire and Rescue Service. To prepare our hospitals for this eventuality, the Fire Safety Manager implemented robust contingency plans during all period of industrial action and reminded staff of their requirement to be extra vigilant in all aspects of fire safety. Key priorities in 2015/16 The Trust will remain mindful of learning from these events to inform future industrial action priorities, engagement with trade unions, appointment rescheduling and contingency planning. 11. PREVENT PREVENT is the preventative strand of the Government counter terrorism strategy and recognises that some vulnerable groups may be susceptible to exploitation. PREVENT aims to protect those who are vulnerable to exploitation from those who seek to get people to support or commit acts of violence. PREVENT is the main strand of concern to local authorities and NHS staff and it is required that all frontline staff have an awareness of PREVENT and how it will affect their service area. LTHT has been recognised by NHS England for the committed work in embedding PREVENT within organisational learning and training. Work to raise awareness of PREVENT commenced in LTHT in 2012. The new Counter-Terrorism and Security Act 2015 has created a general duty on a range of organisations to prevent people being drawn into terrorism. PREVENT Duty Guidance was issued by the Government in March 2015 and PREVENT is now included in the NHS 16

National Contract. The duty requires certain bodies, including NHS Trusts, to have due regard to the need to prevent people from being drawn into terrorism when exercising their functions. It is fundamental to our duty to care and falls within statutory safeguarding responsibilities. Leeds has been classified as a priority area and, as such, there remains a dedicated work stream in place led by the Director of Strategy and Planning to meet statutory requirements. The Trust Security Advisor, Head of Safeguarding and Organisational Learning are working to ensure the organisation meets the required training objectives and compliance for PREVENT in line with the new NHS England PREVENT Training and competences framework. 12. IMPROVEMENTS AND ACHIEVEMENTS IN RESILIENCE PLANNING Lessons learnt from major incident response and incorporating learning outcomes within plans, policy and practice is a vital component of EPRR. Many valuable learning points were obtained from the events described above. This learning together with updated EPRR guidance, horizon scanning and work streams driven by national and local risk registers and EPRR Core Standards is continuously used to inform and improve resilience arrangements within LTHT. Many of the improvements to EPRR resilience throughout 2014/15 and areas for focus during 2015/16 are detailed below. 12.1. Generic and Incident Specific Major Incident Plans The Trusts generic Major Incident Plan is based upon a risk assessment that the Trust could be faced with incidents that create seriously ill and injured patients in excess of the Trust s capacity and requires the deployment of additional resources. The Major Incident plan aims to bring order in responding to a generic incident and is supplemented by a number of plans which are monitored via the Emergency Preparedness Coordinating Group. These plans were successfully reviewed and updated during 2014/15 (Appendix C). Key Priority in 2015/16 NHS England and all healthcare providers within the region have a statutory obligation to be prepared to deal with major incidents. However, incidents may be of such scale and complexity that we have to introduce additional special measures to deal with mass casualty events or for any incident that should happen within the country especially in regard to the threat from international terrorism. Terrible atrocities from international terrorism have occurred and the threat against the United Kingdom is currently set at severe. To support the coordination and management of a mass casualty incident involving terrorist activity the Trust will review and update its mass casualty arrangements. These strategies will support the provision of a mass casualty response directly affecting the city of Leeds and in support of a regional response in collaboration with multi-agency partners. 13. BUSINESS CONTINUITY Business continuity management is the management process that helps control the risks to the smooth running of the organisation or delivery of a service, ensuring that the business can continue in the event of a disruption. The Trust s responsibility, as a Category 1 responder, to have in place business continuity management and emergency planning arrangements is defined by the Civil Contingencies Act (2004) other statutory legislation and EPRR Core Standards. 17

The Trust therefore has a legal and contractual responsibility to develop robust business continuity management arrangements which set out how the Trust will maintain critical functions if there is a major emergency or disruption. During 2014/15 the Trust undertook a review of the Trust s IT Business Continuity Plans against the ISO 22301. ISO 22301:2012 specifies requirements to plan, establish, implement, operate, monitor, review, maintain and continually improve a documented management system to protect against, reduce the likelihood of occurrence, prepare for, respond to, and recover from disruptive incidents when they arise. An initial self-assessment of compliance against the standard has indicated that the current IT continuity plans are approximately 50% compliant. The Trust currently has over two hundred IT systems. Informatics are reviewing the number and use of smaller, locally used systems with a view to incorporating their functionality into more Trust wide solutions, for example into PPM or the variants thereof. Key priority in 2015/16 Existing and future IT continuity plans, commencing with critical systems will be reviewed against an ISO 22301 compliant continuity plan format and an action plan developed. 13.1. LTHT Crisis Communication System The ability to communicate rapidly and send clear instructions to staff is often negatively reported following incidents or business continuity disruptions. To address this the emergency preparedness team have implemented a crisis communication system and trained key staff on its use. This system will enable the Trust to send urgent messages through a variety of channels simultaneously including voice, data, SMS and e-mail to preidentified key personnel, wards and many clinical areas. Key Priority in 2015/16 Further integration will continue to take place in 2015/16 to fully embed the system and raise staff awareness to improve Trust wide communications during a time of crisis. 13.2. Influenza Pandemic influenza remains the top risk on the UK Cabinet Office National Risk Register of Civil Emergencies (Cabinet Office, 2015). Review and update of the Trust Pandemic Influenza plan commenced during 2014/15 in consultation with the Leeds Health and Social Care Pandemic Influenza Sub Group. Further improvements to the plan will continue to be made during 2015/16 to reflect valuable learning from multi-agency exercises, workshops and best practice. A separate report detailing the Trust s level of pandemic influenza preparedness and to receive sign off the updated pandemic influenza plan will be taken to Trust Board with status updates provided to the Leeds Health Protection Board. The impact of the seasonal influenza virus on the population is variable each year. Seasonal influenza is one of the key factors which cause NHS winter pressures (Public Health England, 2015). The annual immunisation programme helps to reduce unplanned hospital admissions and pressures on Emergency Departments. During the 2014/15 influenza season the Trust s Occupational Health Team worked closely with 198 peer vaccinators from wards and departments across LTHT to deliver the annual vaccination programme. 8,994 (76.4%) of frontline staff were vaccinated - the highest number of staff vaccinated across any Trust in England (PHE, 2015a). 18