NHS LANCASHIRE NORTH CCG MAJOR INCIDENT PLAN

Agenda Item 12.0. NHS LANCASHIRE NORTH CCG MAJOR INCIDENT PLAN Version 2 Page 1 of 24

Version Control Version Reason for Date of Update by: Accountable NHS update update Emergency LNCCG Officer sign Governing off Body sign off Draft 22/10/14 J.A.Thompson 1.0 document for consideration by Executive Committee COMMENTS 31/10/14 J.A.Thompson 2.0 FROM SENIOR TEAM Page 2 of 24

Contents Page No 1.0 Introduction 4 2.0 Defining a Major Incident 4 3.0 Legal framework 6 4.0 CCG Major Incident Requirements and Response 9 5.0 Alerting Process and Activation 14 6.0 Role of the CCG On-Call Manager 19 7.0 Stand Down 22 8.0 Administration 22 9.0 Debriefs and reports 23 10.0 Lessons Identified Process 23 11.0 Long term effects 24 Page 3 of 24

1. Introduction As detailed within the Emergency Planning and Resilience Policy NHS North Lancashire CCG has a role to play in any serious incident such as floods, bad weather, heatwave or chemical incident. Although the key areas of CCG responsibility revolve around ensuring commissioned providers have emergency resilience plans in place (including Business Continuity and Major Incident Plans) and ensuring business continuity of CCG functions, it also has a role in supporting the wider health economy in the event of a major incident. The NHS is accustomed to normal fluctuations in daily workload. Whilst at times this may lead to services and facilities being stretched, such fluctuations are managed through established management procedures and the Local Health Economy s (LHE) resilience plans. This plan is not intended to deal specifically with these situations. The purpose of this plan is to set out how NHS Lancashire North Clinical Commissioning Group (CCG) will support NHS England (NHSE) Area Team (AT) to mobilise, and where necessary co-ordinate the local NHS in the event of an emergency or major incident. 2. Defining a Major Incident The CCA defines an emergency as: An event or a situation which threatens serious damage to human welfare in a place in the UK, the environment of a place in the UK, or war or terrorism which threatens serious damage to the security of the UK. The definition is concerned with consequences rather than the cause or source. For the purposes of this definition, an event or situation threatens damage to human welfare only if it involves causes or may cause: Loss of life; Human illness or injury; Homelessness; Page 4 of 24

Damage to property; Disruption of a supply of money, food, water, energy or fuel; Disruption of a system of communication; Disruption of facilities for transport; or Disruption of services relating to health. For the NHS, major incident is the term in general use. However, the term emergency may be used instead of incident. For the NHS, a major incident is defined by the Department of Health 1 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 primary care organisations. The NHS is accustomed to normal fluctuations in daily demand for services. Whilst at times this may lead to facilities being fully stretched, such fluctuations are managed without activation of special measures by means of established management procedures and escalation policies. It therefore follows that a major incident is any event where the impact cannot be handled within routine service arrangements. What is a major incident to the NHS may not be a major incident for other responding agencies. The NHS can therefore declare a major incident when its own facilities and/or resources or those of partner organisations are overwhelmed. 2.1 Types of Major Incident A major incident may arise in a variety of ways and the response will be sufficiently flexible to assess and respond appropriately to any of these situations. 1 DH Emergency Planning Guidance 2005 Page 5 of 24

Examples Big Bang A sudden incident, such as a major road traffic incident, explosion or series of smaller incidents Rising Tide A developing infectious disease epidemic, or capacity/staffing crisis or forecast of severe weather Cloud on the Horizon A serious threat such as a major chemical or nuclear release developing elsewhere, needing preparatory actions Headline News Public or media alarm about a perceived threat Internal Incidents Anything that affects a provider s ability to deliver services such as fire, breakdown of utilities, major equipment failure, hospital acquired infections, violent crime Deliberate Release This threat may come from an accident at a chemical or nuclear facility, from a transport incident, from a terrorist or dissident group or disaffected individuals Mass Casualties Casualty numbers that are beyond the capacity created by the local implementation of major incident plans or other major disruptive challenges to the delivery of health care, regardless of their cause Pre-planned Major Events Major events that require planning, such as sports fixtures, mass gathering of people, demonstrations etc. 3 Legal Frameworks The Civil Contingencies Act 2004 (CCA) establishes a statutory framework of roles and responsibilities for local responders. The CCA is supported by Regulations (The CCA 2004 (Contingency Planning) Regulations) and statutory guidance (Emergency Preparedness). Responsibilities of service providers are set out in section 46 (9, 10) of the Health and Social Care Act 2012, and in NHSE Core Standards for EPRR. 3.1 Civil Contingency Act (Responders) Organisations are categorised into two sets of responders in accordance with the Civil Contingency Act, Category 1 and Category 2. Page 6 of 24

Responders Category 1 Category 2 Police (Including British Transport Police) Fire Authorities Ambulance Trust Acute/Foundation Trusts National Health Commissioning Board Public Health England (Under the auspices of the Department of Health) Port Health Authorities Local Authorities (County, District, Unitary) Environment Agency Maritime & Coast Guard Agency Government Agencies Statutory duties Clinical Commissioning Groups Utilities companies (Electricity, Gas, water and sewage, Telecommunications providers) Transport (Rail Operators, Airport Operators, Harbours & Ports, Highway Authorities) Health & Safety Executive Food Standard Agency Category 1 Category 2 Assess local risks and use to inform emergency planning Put in place emergency plans Put in place business continuity management arrangements Put in place arrangements to make information available to the public about civil protection matters and maintain arrangements to warn, inform and advise the public in the event of an emergency Share information with other local responders to enhance coordination Cooperate with other local responders to enhance coordination and efficiency Provide advice and assistance to businesses and voluntary organisations about business continuity management (local authorities only) Cooperate with the lead category 1 responder in performance of the duty Provide information to the lead category 1 responder which will assist in performance of the duty Assist the lead responder in any exercises or training in connection with the duty As lead responder: Take the lead responsibility in that resilience area Cooperate with category 1 organisations Share relevant information, Page 7 of 24

Consult the non-lead category 1 responders in performance of the duty Keep the non-lead category 1 responders informed of how they are fulfilling the duty As far as reasonably practicable obtain approval from the non-lead category 1 responders for the way they are performing the duty In addition to the responsibilities set out in the CCA 2004, the CCG is cognisant of the need to meet the requirements of the Health and Social Care Act 2012 (section 46) and ensure that the CCG identifies a competent person to lead the emergency planning functions of the CCG. 3.2 The Health & Social Care Act 2012 also places additional duties on CCGs to maintain emergency plans and to have in place formal business continuity arrangements as well as: Ensuring contracts with provider organisations contain relevant emergency preparedness, resilience (including business continuity) and response elements Seeking assurance that provider organisations are delivering their contractual obligation. Supporting NHS England in discharging its EPRR functions and duties locally. Providing a route of escalation for the Local Health Resilience Partnership (LHRP) should a provider fail to maintain necessary EPRR capacity and capability Ensuring representation on the Local Health Resilience Partnership. How the CCG will undertake these duties and the individual roles of CCG employees is set out in the CCG Emergency Preparedness Resilience and Response Policy and should be read in conjunction with this plan. The purpose of this plan is to set out how NHS Lancashire North Clinical Commissioning Group (CCG) will support NHS England (NHSE) Area Team (AT) to mobilise, and where necessary co-ordinate the local NHS in the event of an emergency or major incident. Page 8 of 24

4 CCG Major Incident Requirements and Response Based on the limited role and responsibility of CCGs detailed above the CCG will initiate the following processes to ensure compliance. 4.1 Provider Response and Assurance: The CCG will ensure that our contracts with provider organisations contain requirements regarding emergency preparedness, resilience and response. The CCG will do this, via the Chief Commissioning Officer, through the contracting arrangements with NHS Staffordshire and Lancashire Commissioning Support Unit (CSU). During a Major Incident the CSU will also seek assurance from provider organisations that they are delivering their contractual obligation and will highlight areas of concern to the Chief Commissioning Officer for escalation. Local NHS provider organisations have 24/7 management arrangements in place through on-call systems. The CCG also has an on-call system in place to provide their commissioned providers with a route of escalation on a 24/7 basis, whether the issue relates to capacity or is incident related. This on-call system will be the single point of contact during a major incident. 4.2 Local Health Resilience Partnerships Under the Health and Social Care Act 2012 Local Health Resilience Partnerships (LHRP) will provide strategic forums for joint planning for emergencies for the new health system and will support the health sector s contribution to multi-agency planning through LRFs (Local Resilience Fora). They are not statutory organisations and accountability for emergency preparedness and response remains with individual organisations. The Accountable Emergency Officer, or an appointed deputy, will be the CCG representative at the Lancashire LHRP and will engage with and support the wider health economy in discharging its requirements through this group. The Accountable Emergency Officer, or an appointed deputy, will also be the conduit for escalation for Page 9 of 24

the LHRP should a provider fail to maintain the necessary Emergency Planning, Resilience and Reponses capacity and capability. 4.3 CCG Support to NHS England Area Team - Lancashire: The CCG is required to support the Area Team in discharging its EPRR functions and duties locally. The CCG will support the area team in their response to a major incident and will respond to reasonable requests for mobilisation of NHS resources; this will include: Supporting the area team through mobilising and assisting in the coordination of providers that support primary care. This will be achieved through the utilisation of the On Call Senior Manager and, in hours, commissioning managers to contact providers to mobilise resources in line with NHS England area team requirements. The CCG on-call manager will provide local knowledge and advice to NHS England s area team where necessary. In the event of the CCG being required to provide support to the Area Teams response to a major incident, or requirement to provide detailed prolonged support to the local acute trust during an incident, the Accountable Emergency Officer will have the option to convene an incident management team to manage the CCG response. Should a prolonged response or an incident where the CCG is required to lead the response then an Incident Control Room will be established within the Heritage Room at the CCG premises. 4.4 Shift arrangements In the event of a significant / major incident or emergency having a substantial impact on the population and health services, it may be necessary to continue operation of the Incident Management Team for a number of days or weeks. In particular, in the early phase of an incident, the Incident Management Team may be required to operate continuously 24/7. Responsibility for deciding on the scale of response, including maintaining teams overnight, rests with the Chief Officer. Page 10 of 24

A robust and flexible shift system will need to be in place to manage an incident through each phase. These arrangements will depend on the nature of the incident and must take into consideration any requirements to support external (for example Tactical Command Group) meetings and activities. The Chief Officer is accountable for ensuring appropriate staffing of all shifts. During the first two shift changes 1-2 hours of hand over time is required. 4.5 Records management An essential element of any response to an incident is to ensure that all records and data are captured and stored in a readily retrievable manner. These records will form the definitive record of the CCG response and may be required at a future date as part of an inquiry process (judicial, technical, inquest or others). Such records are also invaluable in identifying lessons that would improve future response. The Accountable Emergency Officer is formally responsible for signing off the decision log and all briefing papers and documents relating to the incident. 4.6 Mutual Aid Arrangements During a major incident the CCG may be required to or require help and assistance from another health partner to manage the incident to a successful conclusion. This assistance may include resources of any description (staff, equipment, materials and logistics). Mutual aid arrangements have been agreed between all Lancashire CCGs, as well as specific (and contractual) requirements of community, acute and mental health trusts. Providers may request mutual aid from the commissioners who are responsible for sourcing, if available, this requirement. Specific contractual response requirements have been agreed between the CCG and its community providers for support locally. 4.7 CCG On-Call Arrangements The CCG has an on-call system in place to provide their commissioned providers or NHS England with a route of escalation on a 24/7 basis, whether the issue relates to capacity or is incident related. This on-call system will be the single point of Page 11 of 24

contact during a major incident. The rota is staffed by senior members of the CCG (8C and above). All senior managers on the on-call rota have been made aware of their roles and responsibilities. These are summarised below: 4.7.1 During on-call period Be available to promptly answer calls Have access to a copy of the on-call pack (either electronic or hard copy) Manage all calls received in the best interests of the CCG Complete an On-Call Incident Report Log for each call received (and also forward this on as detailed on the form) Provide appropriate handover to the next on-call manager (either via telephone or email) Be prepared to escalate incidents to NHS England s Lancashire Area Team where an incident requires a Lancashire wide response or where this relates to their commissioned services (contact details within pack). Be available within 90 minutes to attend NHS England command centre or CCG premises. Have access to keys for CCG building. 4.7.2 Outside of on-call period Arrange own cover for any on-call period where you are unable to carry out your on-call commitment and to advise the CCG Corporate Affairs Manager immediately of the changes so that the rota can be amended. Ensure that you have an up-to-date copy of the on-call pack. Ensure that any changes in contact details are sent to the CCG Corporate Affairs Manager so that amendments can be made to the rota. Ensure that you attend training sessions. Page 12 of 24

4.8. Review and Monitoring of the Major Incident Plan This Plan is a working document and will be amended / updated as and when any notable change occurs, either through legislation or from learning from exercises/real incidents. The plan will be reviewed at least annually by the LHRP / LRF. 4.9 Training Requirements All Governing Body members and senior managers need to be aware of the contents of this plan, and ensure that they are acquainted with the CCG s on-call pack and, for those on the on-call rota that they have the necessary documents available to them at all times. Training/awareness raising will be initiated by the Senior Manager Planning and Partnerships and the Corporate Affairs Manager will keep a log of attendance. This will be repeated on a yearly basis and will be incorporated within the wider emergency planning and resilience training/awareness raising. The Senior Manager Planning and Partnerships will, on request, arrange support, assistance and advice, including instruction in the application of the process and use of the templates to any member of the CCG. Training will reflect the requirements of the CCG in terms of major incident response and on-call arrangements and will be in line with the requirements of the National Occupational Standards for Civil Contingencies and which relate to the category status and responsibilities of the CCG. 4.10. Implementation, Monitoring and Review The Accountable Emergency Officer is responsible for ensuring that this document is reviewed, and, if necessary, revised in the light of legislative guidance or organisational change. Review shall be at intervals of no greater than 6 months; this can be undertaken at team meetings. A full test of the plan will be undertaken yearly. All senior managers will be expected to take part in these exercises. A cold debriefing session will take place following the exercise to establish if any changes need to be made as a result of the exercise. Senior managers will be asked to review existing arrangement and Page 13 of 24

suggest amendments at this stage and submit to the Accountable Emergency Officer to co-ordinate the CCG s overall plans. 5. Alerting Process and Activation 5.1 Declaration of a Major Incident and Alerting Routes The NHS can declare a major incident when its own facilities and/or resources or those of partner organisations are overwhelmed. Specific messages are used in declaring and alerting NHS organisations to a Major Incident. NHS Message Applications Major Incident Standby Major Incident Declared Major Incident Cancelled Scene Evacuation Complete Major Incident Stand Down Alerts the NHS that a major incident may need to be declared. Organisations should make preparatory arrangements appropriate to the incident. Organisations need to activate their Incident Response Plan and mobilise additional resources. Message cancels either of the above messages Message from the Ambulance Service to the Trusts to inform them that no more casualties are at the scene. It is the responsibility of each Trust to determine when it is appropriate for them to stand down. 5.2 Declared Major Incidents The On Call Manager will immediately make contact with the Chief Officer for the CCG if they are informed of: Declared Major Incidents or Major Incident Standbys Serious capacity issues Incidents that have received, or are likely to receive, challenging media coverage Incidents that will affect the services of multiple provider organisations Page 14 of 24

Significant flooding, fires and incidents involving the release CBRN or hazardous materials with the potential to cause casualties, regardless of whether they are declared major incidents Requests for local CCG attendance at Strategic Co-ordinating Groups, their sub-groups, or any equivalent that requires strategic NHS support. 5.2.1 Major Incidents Declared by a Provider NHS funded provider organisations are responsible for informing their commissioning CCGs and the ambulance service whenever they are activated or declare a major incident or major incident standby. The CCGs will in turn inform NHS England Lancashire Area Team. Typically, provider organisations will contact the CCG on-call when: There is intelligence to suggest severe disruption to NHS services is likely, or where significant problems are being experienced by commissioned providers within the county that threaten the provider s ability to provide essential and critical care; Business continuity arrangements have been activated in support of a critical service; Estate related matters including theft, fire and vandalism concerning CCG owned/occupied estate have been alerted to the provider ; Serious clinical incidents and SUIs affecting public or patients; Serious performance issues; Where the provider has been made aware that a major incident or emergency has been declared by any Category 1 responder or NHS organisation in Lancashire North, or South Cumbria that will have an effect on service delivery; The incident requires the mobilisation of NHS resources; Any incident or occurrence likely to focus media attention on NHS funded care within the CCG area; Page 15 of 24

The provider has been asked to provide a service which is not funded under an existing contract, and for which they require authorisation. 5.2.2 Major Incidents Declared by the Ambulance Service The ambulance service is responsible for informing receiving hospitals and the NHS England Lancashire Area Team whenever the service declares a major incident or major incident standby. NHS England Lancashire Area Team is also responsible for advising the regional office of NHS North of England of any major incidents or other significant incidents. 5.2.3 Major Incidents Declared by NHS England Lancashire The NHS England Lancashire Area Team is responsible for informing the ambulance services and CCGs of any national, regional or area major incident, major incident standby or similar message where there is a need to respond locally or cross border mutual aid is required. The Ambulance Service will then inform Acute Hospitals and the CCGs will inform other provider organisations. 5.2.4 Major Incidents related to Public Health Incidents Most public health incidents are contained locally and do not require activation of LRF or AT level plans. All incidents have the potential to require NHS resources. The route of escalation in public health incidents will be from Public Health England. Management of significant Public Health incidents and outbreaks of infectious diseases in Lancashire is set out in the: draft Cumbria and Lancashire Multiagency Plan for Outbreaks of Infectious Diseases and the draft Memorandum of Understanding for the Mobilisation of NHS Resources in the event of a significant Public Health Incident or Outbreak. Page 16 of 24

CCGs are required to put in place the necessary arrangements for communication, release of resources and co-ordination of NHS public health responsibilities for managing incidents and outbreaks. This will include co-ordination of primary and community care response during management of incidents and outbreaks. It is the responsibility of CCGs to ensure that services it commissions are aware of their responsibilities and prepared to support public health incidents and outbreaks. To discharge this function, it is important that CCGs have arrangements in place including the availability of generic outbreak control plans for acute and primary care settings, arrangements for communication with local health care professionals and relevant health care settings. Page 24 5.2.5 Major Incidents related to actual, or potential, hazardous substance incident (chemical, biological or radiation). Operation Merlin is a multi-agency Lancashire plan which provides a framework within which statutory agencies (including the Emergency Services, local authorities, the Health Protection Agency, the NHS, the Environment Agency, the Health and Safety Executive and others) can assess and deal with an actual, or potential, hazardous substance incident (chemical, biological or radiation) in a co-ordinated manner and then deliver an appropriate graded response. Outcomes can range from taking no further action, information only, normal multi-agency service response, to a major incident. The Plan has been written in consultation with the organisations that form the Lancashire Resilience Forum Hazardous Substances Group. Lancashire County Council Lancashire Fire and Rescue Service Environment Agency Health and Safety Executive Blackburn with Darwen BC Lancashire Constabulary North West Ambulance Service NHS Trust Environmental Health Lancashire Health Protection Agency (LaRS) (Cumbria & Lancashire) Blackpool Council. The aim of Operation Merlin is to protect the health and safety of people and to safeguard the natural environment in relation to incidents involving hazardous substances. A Merlin Incident can be declared by any of the following organisations: An emergency service Health Protection Agency A Primary Care Organisation The A&E department of a designated hospital A local authority Page 17 of 24

Statutory agency e.g. Environment Agency. However, the response to an incident will normally involve the emergency services and in these cases, it can be anticipated that Lancashire Fire & Rescue Service will lead on the declaration of an Operation Merlin. As the CCG On Call manager you will assist, support the local response in conjunction with NHS England Area Team Lancashire Strategic Commander. In the event of you becoming aware of a hazardous substances incident for which Operation Merlin is not declared, discuss the matter with the Area Team Lancashire Strategic Commander (contactable through ambulance control on their emergency number of 01772 867640) to ask them to consider a declaration. 5.2.5 Independent Plan Activation Any On Call Manager may consider the activation of the Incident Response Plan, regardless of any formal alerting message. Such action may be taken when it is apparent that severe weather or an environmental hazard may demand the implementation of special arrangements or when a spontaneous response by members of the public results in the presentation of major incident casualties at any health care setting e.g. acute or community hospital, walk-in centre, health centre, GP Practice or minor injuries unit. THE ON CALL MANAGER HAS THE AUTHORITY TO DECLARE A MAJOR INCIDENT FOR LANCASHIRE NORTH CLINICAL COMMISSIONING GROUP ONLY AFTER CONSULTING WITH THE CHIEF OFFICER WHO WILL USUALLY TAKE THIS DECISION 6 Alerting In the event of a potential or actual significant / major incident, the 1st on call will usually be notified by: NHS England Lancashire Area Team North West Ambulance Service (NWAS) Provider organisations Public Health England (PHE) Page 18 of 24

Lancashire County Council Notification may also come from other partner agencies. The CCG on-call will be responsible for ensuring internal staff, provider organisations and the AT Director on-call are alerted to any declaration of a major incident. Contact details are contained within the On-Call Pack. 6.1 NHS England Area Team Lancashire Arrangements Where a major incident is declared or consideration is required to identify a major incident the Strategic Commander for NHS England Lancashire must be notified. In the event of a major incident the procedure to follow is to ring the NW Ambulance Health Control Desk on 01772 867640 and ask to speak with the NHS Strategic Commander for Lancashire. 7. Role of the CCG On-Call Manager If a major incident is declared or NHS England area team ask for assistance then the CCG on-call manager will: Make an INITIAL RISK ASSESSMENT, using the questions below, of the situation to determine what action needs to be taken informing provider organisations accordingly. In making this assessment, it is important to distinguish between: Events that can be dealt with using normal day to day arrangements; Events that can be dealt with within the resources and emergency planning arrangements of the CCGs and local NHS provider organisations; Events that require a joint co-ordinated response from the organisations across the area; Page 19 of 24

Events that require a strategic level co-ordinated multi-agency response across the wider health community, will become the responsibility of the Area Team. Questions to consider What is the size and nature of the incident? Area and population likely to be affected - restricted or widespread Level and immediacy of potential danger - to public and response personnel Timing - has the incident already occurred or is it likely to happen? What is the status of the incident? Under control Contained but possibility of escalation Out of control and threatening Unknown and undetermined What is the likely impact? On people involved, the surrounding area On property, the environment, transport, communications On external interests - media, relatives, adjacent areas and partner organisations What specific assistance is being requested from the NHS? Increased capacity - hospital, primary care, community Treatment - serious casualties, minor casualties, worried well Public information Support for rest centres, evacuees Expert advice, environmental sampling, laboratory testing, disease control Social/psychological care How urgently is assistance required? Immediate Within a few hours Standby situation *Key = Yes X = no? = Information awaited N/A = Not applicable Information Collected?* The CCG on-call manager will then: Consult with the Chief Officer using the INITIAL RISK ASSESSMENT and agree course of action. Inform the Area Team Director on-call if a multi-agency response is required. Page 20 of 24

Where the situation requires it, convene an INCIDENT MANAGEMENT TEAM and activate the CCG s INCIDENT CONTROL ROOM this decision should be based on the scale of the incident, its potential to impact on CCG commissioned NHS services, and the anticipated volume of communications likely to be flowing up and down the chain of command; Ensure appropriate documents and records are being kept and all organisations are aware of the need to capture accurate financial information of any expenditure incurred as a result of the incident; Ensure where possible that the response can be maintained within the Local Health Economy; Ensure the CCGs critical services are maintained; Ensure that the risk assessment is re-visited regularly and that any significant issues are escalated to the AT Director on-call immediately (see ESCALATION CRITERIA below); Decide when the incident is over and stand down the CCG response; Ensure that all CCG staff who have been involved in the response to the incident are debriefed; Ensure that any lessons learned are incorporated into future incident response arrangements and an incident report (where appropriate) is written. Ensure that the Chief Officer and CCG Clinical Leads are informed in a timely manner. Escalation or de-escalation of the incident does not necessarily occur sequentially. It can be driven by the nature and scale of the incident and the appropriate response. Reasons for escalation / de-escalation can include: Page 21 of 24

Criteria for Escalation to the AT Director on-call Increase in geographic area or population affected (pandemic, flooding etc.) The need for additional internal resources Increased severity of the incident Increased demands from government departments, the service or from partner agencies or other responders Heightened public or media interest Criteria for De-escalation Reduction in internal resource requirements Reduced severity of the incident Reduced demands from partner agencies or government departments Reduced public or media interest Decrease in geographic area or population affected 8: Stand Down For independent plan activation, consultation with the Chief Officer or for multiagency incidents the AT Director on-call, the CCG on-call manager will decide when the CCG responses to an emergency or major incident stand down should be declared. This may be long after the emergency services response is over. This could be either a full or partial stand down with one or more individuals monitoring the situation. 8.1 Initial Stand Down All response level changes need to be communicated both internally and externally as appropriate. A brief description of the resource implications of the new level should be included. 9 Administration Once the decision has been taken, the CCG on-call will ensure that all appropriate elements of the local response are stood down. This may be a staged process. It is important to ensure that where communication channels have been specially created for the incident, forwarding mechanisms are in place to ensure that no traffic is lost. This will also ensure that people trying to contact the Incident Control Room if established have an alternative access route. Page 22 of 24

9.1 Records Management Good record keeping is paramount if the major incident plan is initiated. The senior manager leading the response is responsible for ensuring that accurate records are kept of all decisions and actions taken. All logging forms etc are held in the On-Call pack and in the Heritage Room in the Major Incident Cupboard. All records created during the implementation of the Major Incident plan will be kept by the Corporate Affairs Manager. These records will be stored in line with the CCG s Record Management Policy. 10 Debriefs and reports A hot de-brief will be held within 24 hours of the close down of the incident. A full debrief will be held within 14 working days of the incident. The initial incident report will be produced within 28 working days. Structured debriefs should be held with involved staff as soon as possible after deescalation and stand down. Participants must be given every opportunity to contribute their observations freely and honestly. As part of the debriefing process a post incident report will be produced to reflect the actual events and actions taken throughout the response. Typically this will include: Nature of incident; Involvement of the CCG; Involvement of other responding agencies; Implications for strategic management of the NHS; Actions undertaken; Future threats/forward look; Chronology of events 10.1 Lessons Identified Process A separate lessons identified report will focus on areas where response improvements can be made in future. This report will include the following sections: Page 23 of 24

Introduction Observations Action Plan (detailing recommendations, actions, timescales and owner). Throughout the incident at whatever level, there will need to be an agreed process in place to evaluate the response and recovery effort and identify lessons. The Chief Officer is responsible for activating the lessons identified process. The lessons identified process will be implemented at the start of the response and continue during and after the incident and until all actions are completed. 10.2 Long Term Effects The CCG will ensure that any long-term effects, (operational and financial) will be included in planning of future services in conjunction with other local health care partners. Examples of these could be: - Co-ordinating and monitoring long term response of community health services. Assessing the impact of the major incident on every day health services Identifying necessary psychiatric and psychological support. Monitoring of long term effects. Page 24 of 24