AGENDA ITEM NO: 046/17 GOVERNING BODY MEETING: Governing Body Meeting DATE OF MEETING: 13 th September 2017 REPORT AUTHOR AND JOB TITLE: Rebecca Knight Head of Assurance & Risk REPORT TITLE: STRATEGIC OBJECTIVES: Update Report on Emergency Preparedness, Resilience and Response (EPRR) Please tick which strategic objectives the paper relates to NHS Constitution Improve quality of services Sustained financial balance Improve healthy life expectancy Reduce inequalities Build an effective and motivated workforce Sound governance arrangements OUTCOME REQUIRED (tick) Approval Assurance Discussion Information EXECUTIVE SUMMARY Annual Report for 2016-17 included for assurance and information Substantial compliance with NHS England Core Standards with a focus of the development of an Health and Social Care Pandemic Influenza Plan Deep dive for governance is also included, but is not included as part of the overall assurance statement RECOMMENDATIONS The Governing Body is asked to: a. Approve the proposal that NHS Warrington CCG is substantially compliant with EPRR core standards and is also therefore compliant with the Civil Contingencies Act 2004. Update Report on Emergency Preparedness, Resilience and Response (EPRR) Warrington CCG Governing Body Meeting 13 th September 2017
AGENDA ITEM NO: 046/17 Outline any engagement staff, clinical, stakeholder and patient / public Not applicable Are there any conflicts of interest which may be associated with this paper? None known Does this paper address any existing risks which are included on the Assurance Framework or Risk Register? Not applicable Have the following areas been considered whilst producing this report? Yes N/A Equality Impact Assessment (if yes, attach to paper) Quality Impact Assessment (if yes, attach to paper) Regulation, legal, governance and assurance implications (reference in the report if applicable) Procurement process (reference in the report if applicable) Document development Has this document been presented to any other Committee or Forum? If yes, please list which meeting, date and outcome of presentation Update Report on Emergency Preparedness, Resilience and Response (EPRR) Warrington CCG Governing Body Meeting 13 th September 2017
AGENDA ITEM NO: 046/17 STRATEGIC RISKS FOR 2017/18 A1 A2 A3 B1 B2 B3 B4 C1 C2 C3 D1 D2 E1 E2 Failure to performance manage to ensure continuous improvement Failure to agree and measure specified outcomes Failure to ensure clear arrangements are in place for quality management of noncommissioned providers in the independent sector Failure to implement the financial strategy Failure to ensure sound business practices are at the heart of running the CCG Failure to secure best value Failure to adequately provide for external factors, which impact on financial sustainability Failure to continuously develop the organisational culture that meets the needs of the changing needs of the workforce Failure of delivery by outsourced critical business functions Failure to establish primary care capacity Failure to ensure that we are compliant with our statutory duties Failure to demonstrate patient and public engagement Failure to provide appropriate reporting, for joint working arrangements Failure to describe benefit of integration and joint working arrangements to local people Update Report on Emergency Preparedness, Resilience and Response (EPRR) Warrington CCG Governing Body Meeting 13 th September 2017
EMERGENCY PREPAREDNESS, RESILIENCE AND RESPONSE (EPRR) ASSURANCE REPORT 2017-18 Background 1. NHS Warrington CCG is classed as a Category 2 responder under the Civil Contingencies Act 2004. Category 2 responders are considered to be co-operating bodies which are less likely to be involved in core planning work for emergency preparedness but may be heavily involved in the response to an emergency that affect their sector. Category 2 responders have a lesser set of duties co-operating and sharing relevant information with other Category 1 and 2 responders. 2. NHS England Core Standards for EPRR are the minimum standards which NHS organisations and providers of NHS funded care must meet. Assurance 3. In July 2017, NHS England issued a directive about the EPRR assurance process for 2017-18. This letter can be found below: https://www.england.nhs.uk/wp-content/uploads/2014/05/guidance-for- 2017-18-EPRR-assurance-process.pdf 4. This report provides an update against the requirements laid out in the NHS England letter. Assurance Outcome 5. NHS Warrington CCG is considered to be substantially compliant with the EPRR core standards (see Appendix A for further detail). The resulting action plan relates to the ongoing development of an Health and Social Care Pandemic Influenza Plan. Annual Report 6. The Annual Report for 2016-17 is also attached for information. This provides some further detail about how the CCG complies with the Civil Contingencies Act 2004 and the EPRR Core Standards. Recommendations 7. NHS Warrington CCG Governing Body is asked to: a. Approve the proposal that NHS Warrington CCG is substantially compliant with EPRR core standards and is also therefore compliant with the Civil Contingencies Act 2004.
EMERGENCY PREPAREDNESS, RESILIENCE AND RESPONSE (EPRR) ANNUAL REPORT 2016/17 Purpose 1. The purpose of this report is to provide an overview of NHS Warrington CCG role and responsibilities and its compliance with those, as stated in the Civil Contingencies Act (CCA) 2004 and the supporting guidance. Background 2. NHS Warrington CCG is classed as a Category 2 responder under the Civil Contingencies Act 2004. Category 2 responders are critical players in EPRR who are expected to work closely with partners. They are required to co-operate with and support other Category 1 and Category 2 responders. They are less likely to be involved in the heart of planning work, but will be heavily involved in incidents that affect their own sector Category 2 responders have a lesser set of duties co-operating and sharing relevant information with other Category 1 and 2 responders. CCGs are also expected to provide support to NHS England in relation to the co-ordination of their health economy. 3. NHS England Core Standards for EPRR are the minimum standards which NHS organisations and providers of NHS funded care must meet. Further guidance can be found relating to NHS England Core Standards for EPRR at: 4. http://www.england.nhs.uk/wp-content/uploads/2015/06/nhse-corestandards-150506.pdf Roles and Responsibilities 5. The EPRR role and responsibilities of CCGs are to: Ensure contracts with all commissioned provider organisations contain relevant EPRR elements, including business continuity; Monitor compliance by each commissioned provider organisation with their contractual obligations in respect of EPRR and with applicable Core Standards; Ensure robust escalation procedures are in place so that if a commissioned provider has an incident, the provider can inform the CCG 24/7; Ensure effective processes are in place for the CCG to properly prepare for and rehearse incident response arrangements with local partners and providers; Be represented at the Local Health Resilience Partnership (LHRP), either on their own or through a nominated lead CCG representative;
Provide a route of escalation for the LHRP, in respect of commissioned provider EPRR preparedness; Support NHS England in discharging its EPRR functions and duties locally, including supporting health economy tactical co-ordination during incidents; and Fulfil the duties of a Category 2 responder under the CCA 2004 and the requirements in respect of emergencies within the NHS Act 2006. Accountability 6. The Clinical Chief Officer is the Accountable Officer for emergency preparedness in NHS Warrington CCG. The Head of Assurance & Risk has delegated responsibilities for ensuring that emergency preparedness requirements are met within the organisation. Commissioning Support Unit (CSU) 7. NHS Warrington CCG has a Service Level Agreement in place with the CSU (NWCSU) to provide support to the CCG for its emergency preparedness arrangements, specifically in relation to business continuity planning. These arrangements are delivered by Midlands and Lancashire CSU (MLCSU). Local Health Resilience Partnership (LHRP) 8. The LHRP provides a strategic quarterly forum for local organisations to: a. Facilitate health sector emergency preparedness and resilience; b. Provide support to NHS England, Public Health England and public health colleagues to represent health sector emergency preparedness and resilience matters; c. Provide support to NHS England, Public Health England and public health colleagues in assessing and assuring the ability of the health sector to respond to emergencies 9. The Head of Assurance & Risk represents Warrington CCG as a member on the LHRP. In the event that the Head of Assurance & Risk cannot attend, the meeting has been attended by the Chief Operating Officer. 75% of the meetings were attended in 2016-17 which meets the requirements. On-call arrangements 10. NHS Warrington CCG has an on-call rota in place which operates on a 24/7 basis. The rota is populated by managers at Band 8b and above. All managers have received familiarisation training and have appropriate documentation in place to support any required response. 11. One additional manager was added to the rota within the financial year and received the necessary training.
Training and exercises 12. The Head of Assurance & Risk attended a Cheshire & Merseyside exercise in April 2016, to test the pandemic flu arrangements (known as Exercise Bluebird). 13. A post exercise report was produced following the exercise, which identified some key learning across the region. These are being followed through by the Local Health Resilience Partnership and a Pandemic Flu Group for the area. 14. Issues which specifically impact on CCGs included the need to review and update business continuity plans and the review of business continuity plans in care homes (see section on business continuity). 15. The requirement of all CCGs to provide support to NHS England in an emergency led to the delivery of tactical training to all CCG on-call staff. This training was delivered by NHS England and was held at Police Headquarters in Winsford. All members of staff, with the exception of two managers, who operate on the on-call rota have attended the tactical training. The training incorporated the following: a. Changes to NHS guidance; b. Roles of Providers; c. Role of CCGs; d. Role of NHS England; and e. Familiarisation of Police Headquarters. Business Continuity arrangements 16. The main area of support commissioned from MLCSU is in relation to the development of a Business Continuity Plan, including facilitation of the business impact analysis process, development of the plan, training of key staff and finally exercising of the final plan arrangements. 17. Key lead managers were identified to undertake business impact analysis (BIA) in their areas of work. The completion of the BIA in each area was preceded by a business continuity session, facilitated by the MLCSU to raise awareness of what was required. All BIAs have been completed for all key areas and the updated Business Continuity Plan is being finalised to incorporate the updated information. 18. At the end of 2016/17, a review of all business continuity plans for those homes with NHS funded patients has commenced. The local authority has the responsibility for reviewing business continuity plans for all care homes, where they hold the contract.
Assurance 19. In 2016/7, all CCGs were required to ensure that its contracts with commissioned providers contain relevant EPRR elements, including business continuity and that the compliance to these is monitored. 20. The NHS Standard Contract contains a section relating to EPRR which outlines the requirements of providers. 21. All NHS providers and commissioners are required to provide assurance of compliance with core standards to NHS England. Warrington CCG was advised that the following organisations self-assessed themselves as follows: a. Warrington and Halton Hospitals Foundation Trust (substantial compliance); b. Bridgewater Community Healthcare Foundation Trust (substantial compliance); and c. 5 Boroughs Partnership Foundation Trust (full compliance) 22. In addition, assurance must be provided to NHS England that the CCG is compliant with core standards. A statement of compliance (substantial) was submitted to NHS England in September 2016, following submission and approval by the Governing Body. 23. In last year s submission to NHS England, Warrington CCG declared that the Business Continuity Plan was undergoing review. All business impact analysis (BIA) templates have been completed and these are currently being reworked into the update of the Business Continuity Plan.
Emergency Preparedness, Resilience and Response (EPRR) Assurance 2017-18 STATEMENT OF COMPLIANCE NHS Warrington CCG has undertaken a self-assessment against the NHS England Core Standards for EPRR (v4.0). Following self-assessment, and in line with the definitions of compliance stated below, the organisation declares itself as demonstrating Substantial compliance against the EPRR Core Standards. Compliance Level Full Substantial Partial Non-compliant Evaluation and Testing Conclusion Arrangements are in place that appropriately addresses all the core standards that the organisation is expected to achieve. The Board has agreed with this position statement. Arrangements are in place however they do not appropriately address one to five of the core standards that the organisation is expected to achieve. A work plan is in place that the Board has agreed. Arrangements are in place, however they do not appropriately address six to ten of the core standards that the organisation is expected to achieve. A work plan is in place that the Board has agreed. Arrangements in place do not appropriately address 11 or more core standards that the organisation is expected to achieve. A work plan has been agreed by the Board and will be monitored on a quarterly basis in order to demonstrate future compliance. The results of the self-assessment were as follows: Number of applicable standards Standards rated as Red 1 Standards rated as Amber 2 Standards rated as Green 3 38 0 1 37 Acute providers: Specialist providers: Community providers: Mental health providers: CCGs: 38 1 Not complied with and not in an EPRR work plan for the next 12 months 2 Not complied with but evidence of progress and in an EPRR work plan for the next 12 months 3 Fully complied with Where areas require further action, this is detailed in the attached EPRR Core Standards Improvement Plan and will be reviewed in line with the organisation s EPRR governance arrangements. I confirm that the above level of compliance with the EPRR Core Standards has been or will be confirmed to the organisation s board / governing body. Signed by the organisation s Accountable Emergency Officer Date of board / governing body meeting Date signed
Deep Dive 2017 DD1 DD2 DD3 DD4 DD5 DD6 Core standard Self-assessment Action to be taken Lead Timescale The organisation s Accountable Emergency Officer has taken the result of the 2016/17 EPRR assurance process and annual workplan to a Green public Governing Body meeting for sign off within the last 12 months The organisation has published the results of the 2016/17 NHS EPRR assurance process in their annual Green report The organisation has an identified Further clarity is required about the requirement and non-executive Director / Governing expectation of this. The CCG has two lay members Body representative who formally Red who do not have sufficient capacity to hold additional holds the EPRR portfolio for the portfolios organisation The organisation has an internal EPRR oversight/delivery group that oversees and drives the internal work of the EPRR The organisation s Accountable Emergency Officer regularly attends the organisation s internal EPRR oversight/delivery group The organisation s Accountable Emergency Officer regularly attends the Local Health Resilience Partnership meetings Amber Green Green Management team is briefed on areas of EPRR work but this may need to be more formally briefed This response is based on the delegated officer attending the LHRP R.Knight January 2018
Organisation: NHS Warrington CCG Emergency Preparedness, Resilience and Response (EPRR) Core Standards Improvement Plan (2017/18) Core standard reference Core Standard description Improvement required to achieve compliance 12 Have arrangements for Pandemic Influenza Joint Health and Social Care Plan is in the process of being developed but is not yet complete Action to deliver improvement Public Health Warrington Borough Council is leading on the development of a joint pandemic influenza plan. This will be presented to the Health & Wellbeing Board and then the Governing Body for approval January 2018 Deadline