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Document Control Document Title Road Fuel Supply Disruption: Strategic Guidance for NHS Boards in Scotland Owner & contact details Scottish Government Sponsor Area Publication Date Future Review Date May 2015 NHSScotland Resilience Scottish Government St Andrews House, Regent Road, Edinburgh EH1 3DG Tel: 0131 244 2429 nhsscotlandresilienceteam@scotland.gsi.gov.uk Health and Social Care Directorates (Health Workforce and Performance Directorate) Reader Information Box Target Audience Chief Executives, Territorial NHS Boards Chief Executives, Special Health Boards NHS Resilience Officers Circulation Document Purpose Description Chief Executives, Territorial NHS Boards Chief Executives, Special Health Boards NHS Resilience Officers To enable Health Boards to plan for and respond to potential disruptions in the supply of road fuel. Guidance to support Health Boards to plan for and respond to road fuel supply disruptions Superseded Documents Action required N/A All Health Boards to implement this guidance and ensure they have appropriate plans and processes in place. 2
Contents Page Glossary 4 Foreword 5 Introduction 6 Aim and Objectives 7 Local Business Continuity Management Arrangements 8 Identifying Essential Personnel and Functions 8 Fuel Reserves and Mutual Aid 11 Red Diesel 11 Relaxation of Targets and Regulations 11 Voluntary Sector Partners 12 Security of Staff and Property 12 Communication Strategy 12 Cost Capture 13 Validation 13 Appendix 1 National Emergency Plan Fuel 14 Appendix 2 Useful Links 16 3
Glossary BCP BCM BDS CCA CS DECC DCM DFS ESS GP MPS MoU NEP-F SGHSCD SCG TLS UFS Business Continuity Planning Business Continuity Management Bulk Distribution Scheme Civil Contingencies Act Commercial Scheme Department of Energy & Climate Change Demand Calming Measures Designated Filling Station Emergency Services Scheme General Practitioner Maximum Purchase Scheme Memorandum of Understanding National Emergency Plan for Fuel Scottish Government Health and Social Care Directorates Strategic Coordination Group Temporary Logo Scheme Utilities Fuel Scheme 4
Foreword Events over recent years have demonstrated that there is a clear risk of the country experiencing a period of significant disruption to its supply of road fuel. Industrial action is just one of a number of possible scenarios that might prevent users from accessing fuel when and where they need it. Given the dependence of the NHS on road fuel in many areas of service delivery, any widespread and/or prolonged fuel supply disruption has the potential to directly impact on the ability of the NHS to provide the levels of patient care that the public normally expect from it. This Guidance is intended to support NHS Boards in preparing for road fuel shortages so that the impact on patients and normal business is minimised so far as is possible and practical, and also identify steps Boards can take to reduce the quantity of fuel used. Boards must also consider how care provision could be scaled back in a safe and prioritised manner should the fuel shortage become so severe that it is not possible to maintain normal levels of service. Such planning represents an extension of business continuity management that most NHS Boards are obliged to perform as Category 1 or 2 responders designated under the Civil Contingencies Act 2004 (CCA). Additionally, the Guidance provides background to the measures that could help to protect fuel supplies for designated essential users (i.e. those providing emergency or continuing care), should the situation become serious enough that the Government adopt emergency powers under the Energy Act 1976. The full details of these measures are contained in the Department of Energy and Climate Change (DECC) National Emergency Plan for Fuel (NEP-F), which sets out the cross-government plans for dealing with a national fuel crisis. This Guidance is intended to be a supporting document to the NEP-F, providing advice and support to the NHSScotland organisations in recognition of the criticality of the NHS in Scotland and the scale and scope of its dependencies on fuel. NHS Scotland Resilience Team Scottish Government St Andrew s House Regent Road Edinburgh EH1 3DG Tel: 0131 244 2429 5
Introduction 1. This document provides guidance to NHSScotland organisations to assist with their Business Continuity Management (BCM) planning in response to a reduction of the normal availability of road fuel, from a minor disruption through to the activation of the National Emergency Plan Fuel (NEP-F). At the time of publication of this Guidance, DECC are reviewing the NEP-F although more information on the plan is available at Appendix 1. 2. A reduction in the supply of road fuel represents a significant challenge for NHSScotland in meeting its responsibilities and its duty of care. Effective business continuity plans (BCP) will allow NHS Boards to prioritise and, if the situation demands it, safeguard the most critical aspects of service delivery in a planned and considered way. 3. This guidance is intended to enable Chief Executives to plan appropriately; and to provide information on other activities they may be required to undertake. In this Guidance, the term NHS organisation includes all elements engaged in the delivery of healthcare in NHS Boards, and other National NHSScotland bodies directly or indirectly responsible for the delivery or management of health and social care. 4. Whilst it is the responsibility of NHS Board Chief Executives at local level to ensure that appropriate planning/prioritisation has taken place, the Chief Executive, NHSScotland has final responsibility for NHSScotland as a whole and therefore will need to be assured that Boards are prepared and resilient to the disruptive challenges that a road fuel shortage would bring. The responsibility for providing this reassurance will be through individual NHS Boards. 5. As a large public sector organisation, during periods of fuel disruption NHSScotland Boards have an obligation under the NEP-F to reduce its fuel usage through demand calming measures. Within the Energy Act 1976 certain journeys, such as home to work, are not included under the Emergency Powers during a period of the disruption. Plans must incorporate these constraints and include them as base line planning assumptions. 6. While a disruption to the normal supply of road fuel will impact on the delivery of health and social care services, in the worst case, NHS Boards will face very difficult challenges and will have to make difficult decisions in the face of ongoing and widespread fuel supply disruption. However, not all fuel supply disruptions will see the introduction of the NEP-F, so contingency arrangements must not rely on this occurring. As such, it is the responsibility of NHS Boards to ensure business continuity plans adequately address the issue of interruption to normal fuel supply and the measures that can be taken to maintain services. NHS Boards can also encourage and promote sensible use of fuel at local level to maintain public confidence and wherever possible a fuel supply, albeit reduced. NHS Boards should note that any decision to implement the NEP-F would only be taken if a very significant disruption to fuel supplies were to occur and the UK Government and fuel industry was unable to resolve the disruption without the use of emergency powers. 7. The development, exercise and validation of contingency plans should include the time and resources needed to ensure that as much resilience as possible is built 6
into operations across health and social care, including evidence of business continuity arrangements from business-critical suppliers. Since suppliers may also be affected by fuel supply disruption it is important that they have plans in place to maintain their own continuity of service. Service providers contracted by NHS Boards should be able to demonstrate adequate arrangements are in place and where appropriate provide evidence to ensure continuity of an acceptable level of service. Compliance or certification to BS25999 or ISO22301 by service suppliers may provide some assurance of their BCM capability. Aim 8. The aim of this Guidance is to assist NHS Boards when preparing their business continuity plans for a local or national disruption to road fuel supply in order to minimise the impact upon the safe and effective delivery of healthcare services. Objectives 9. This Guidance will focus on the following key objectives for Boards: a) Develop an understanding of their responsibilities to be resilient to road fuel disruption. b) Develop a strategy at NHS Board level (with consideration to the NEP-F) to identify functions/personnel who are vital to the delivery of healthcare services and systems who will require priority access to any available road fuel. c) Ensure all NHS Boards and their staff understand the legal limitations of the priority user scheme and the obligations the NHS has to reduce its use of road fuel during periods of disruption. d) Ensure NHS Boards identify critical suppliers and service providers who may be affected by disruption to road fuel supply and where appropriate ask them to provide evidence to ensure continuity of an acceptable level of service e) Ensure NHS Boards where possible, work with local independent contractors (GPs, Pharmacists etc) to develop road fuel resilience plans, and co-ordinate their arrangements with other Category 1 Responders. f) Develop a process by which contracted critical services are assessed and agreed by Boards as being suitable to be included on the NEP-F Utilities Fuel Scheme. This should include an estimate of the fuel consumption per week of these users. g) Develop appropriate agreements with multi-agency partners to ensure mutual aid arrangements are in place to support fuel sharing where Boards have access to bunkered fuel supplies. h) Work with the local Strategic Co-ordinating Group (SCG) to monitor road fuel 7
usage across area and access to local fuel sharing arrangements as well as maintain co-ordinated communication links. i) Respond to all requests for information as may be required by the Scottish Government Health and Social Care Directorates (SGHSCD). j) Ensure that all business continuity fuel disruption plans recognise the trigger levels within the NEP-F and that plans have appropriate escalation procedures that respond to these trigger levels. k) Develop and promote road fuel reduction schemes both in the short and longer terms. Local Business Continuity Management Arrangements 10. It is the responsibility of all bodies designated as Category 1 Responders under the CCA to have effective business contingency planning arrangements in place. Whilst not all NHS Boards (i.e. some Special NHS Boards) are covered by the requirements of the CCA, it is still good practice for these Boards to have in place business contingency arrangements which allow them to continue, as far as possible, their normal business functions. This guidance should therefore be considered in conjunction with NHS Boards generic business continuity plans. 11. These arrangements should ensure a co-ordinated NHS response to any fuel supply disruption as well as other challenges that might affect NHS Boards services and functions at any time such as staff shortages, denial of access, failure in technology, loss of utility services, and failure of key suppliers. Business continuity plans should ensure an NHS response takes place in a co-ordinated way including processes for recovery and restoration of essential functions and services. Boards plans should also include the development and promotion of road fuel reduction schemes which should also form part of NHS Boards longer-term sustainability plans e.g. car share schemes. 12. In developing plans, NHS Boards should give consideration and address the impact that a fuel shortage may have on a number of different levels not solely from a Board level strategy. Boards should identify critical suppliers and service providers who may be affected by disruption to road fuel supply; and should work with local independent contractors (GPs, Pharmacists etc) to develop road fuel resilience plans. Plans should set out a process by which contracted critical services are assessed, and agreed, as being suitable to be included on the NEP-F Utilities Fuel Scheme, including an estimate of the fuel consumption per week of these users. Appropriate agreements with multi-agency partners should be developed to ensure mutual aid arrangements are in place to support fuel sharing where Boards have access to bunkered fuel supplies. Identifying Essential Personnel and Functions by NHS Boards 13. One of the most challenging issues facing NHS Boards is the need to develop a strategy at NHS Board level (with consideration to the NEP-F) to identify functions/personnel who are essential to the delivery of healthcare services and 8
systems who will require priority access to any available road fuel to deliver these services (this does not include travel from home to work). However some staff respond to calls directly from their homes so some flexibility does exist for NHS Boards to manage this within the guidelines. In addition for shift-workers and those living in remote and rural areas, public transport may not always be available to allow those staff to get to work to provide their essential service. This issue should be managed locally, but with due consideration to equity and the need for the NHS to reduce its demand on fuel at the time of any crisis. 14. Detailed below are some arrangements which aim to support Boards to achieve a strategy for the identification of essential staff that are vital to the delivery of healthcare services and systems that will require priority access to any available road fuel: 1) Defining Essential Service/Users In order to access fuel via the Essential Services Scheme (ESS), NHS Boards need to predetermine what their core services are and who requires fuel to deliver them as part of their job, although this might change as the fuel shortage situation develops. This includes NHS priority users and their designated vehicles (whether or not they are NHS delivery vehicles e.g. pool cars) as well as essential support or contract staff and their vehicles. Boards need to be robust in determining priority users as too many will create strain on already limited stocks. NHS Boards should maintain an estimate of fuel usage of their priority users to support planning and inform their SCG and the Scottish Government. NHS Boards core services should be based on the definition used within their generic business continuity plans. However, as any fuel crisis escalates to the point where stocks are extremely limited, the Scottish Government may issue guidance to Boards for defining essential users/functions. An example which might be helpful to NHS Boards is to consider what level of service they expect to deliver on a public holiday i.e. Christmas Day. It is therefore likely that fewer services would be delivered than those which would be undertaken during for example a period of severe weather. 2) The Response Each NHS Board needs to ensure that it has an overview of all major incidents and emergencies within its boundaries and that appropriate arrangements are made to allow for a well co-ordinated response linked to both Scottish Government and Strategic Co-ordinating Group(s), in respect to key health functions to assist senior officers in the management of an incident. Detailed command and control arrangements at a local and Scottish level, in the event of a major emergency, can be found on the Preparing Scotland Web Site. If the incident causes major disruption to the provision of service by the NHS in Scotland, the Director-General Health and Social Care & Chief Executive, NHSScotland may convene a meeting of the Health and Social Care Management Board made up of SGHSCDs Directors or their representatives. Its main functions will be to: a) Oversee strategic coordination of the health service response in Scotland b) Liaise with the Department of Health in London c) Liaise closely with the affected NHS Boards, normally by contact with the Boards Senior Incident Management Team 9
The level of involvement by Scottish Government will be defined by the nature and scale of the threat, and the following options will be available: a) Monitoring and evaluating how local agencies are handling the incident. b) Working to co-ordinate government resources into the response. c) Only when necessary, taking a strong strategic and executive role in coordinating all resources at both local and Scottish level. The Scottish Government will act as a mechanism for sharing information about the impact of the incident between central government and Strategic Co-ordinating Groups, and will consider recovery and long-term restoration following the incident; whilst keeping Scottish Ministers briefed on events. 3) Roles and Responsibilities During a fuel disruption event NHS Boards should advise staff about responsible purchasing and conservation of fuel, and cascade central government messages to staff. If there is ongoing disruption the Government may introduce emergency powers and implement the NEP-F to both conserve fuel and ensure that priority services and infrastructure are maintained. Within the plan are contingencies to restrict the amount of fuel accessible to the public and to ensure that the emergency services are supplied with fuel to provide their services. NHS Boards should review their dependence on road fuels so as to prepare for any potential disruption. Different strategies can be used to manage a potential or actual fuel shortage, depending on the circumstances. These tools or schemes are designed to reduce panic buying and ensure fuel is shared fairly and prioritised for essential services. 4) Tools The NEP-F has the following tools at its disposal which would also be relevant for NHS Boards to factor into their plans (more information is available in Appendix 1). Maximum Purchase Scheme (MPS): This limits the amount of fuel the general public can buy at filling stations. Commercial Scheme (CS): This prioritises diesel supply to commercial filling stations and truck stops to support the continuation of critical supply chains. The Emergency Services Scheme (ESS): Fuel would be prioritised at Designated Filling Stations (DFS) to allow unlimited fuel to blue light emergency vehicles. Utilities Fuel Scheme (UFS): Fuel would be prioritised at Designated Filling Stations for use by logoed vehicles in the delivery of essential services including utilities, transport, cash movement etc. NHS Boards should note that the ESS and UFS could be operated together if necessary and would allow vehicles to re-fuel at any of the Designated Filling Stations across Scotland. Bulk Distribution Scheme (BDS): This enables oil companies and distributors to prioritise fuel products to supply retail filling stations, truck stops, depots and commercial storage sites in the event of an emergency. 10
Mutual Aid Scheme: SCGs would be encouraged to develop voluntary mutual aid arrangements amongst their members to support the delivery of essential services locally, particularly healthcare, where there is a reliance on non-logoed vehicles. The Temporary Logo Scheme (TLS): This scheme is designed to ensure extra fuel is available to drivers of non-logoed vehicles for the delivery of essential health, social care and critical life saving services. More details of how the scheme would be coordinated and responsibilities applied within NHS Boards are included within Appendix 1. Abuse of this scheme is a criminal offence under section 18(2) of the Energy Act 1976 and offenders may be prosecuted. The TLS is a last resort and every effort should be made to provide services using business continuity arrangements, alternative ways of working and the MPS. The TLS is generally not to be used to obtain fuel for the purpose of getting staff to work. 5) Exercising and Maintenance NHS Boards should carry out an annual review of their Temporary Logo Scheme users in order to maintain an accurate record of new starts, transfers and leavers within given business areas. Regular exercising should include the testing of roles, alerting mechanisms and the application of the TLS. 15. NHS Boards should note that any decision to implement the NEP-F would only be taken if a very significant disruption to fuel supplies was to occur and Government and fuel industry was unable to resolve the disruption without the use of emergency powers. Fuel Reserves and Mutual Aid 16. The Scottish Ambulance Service should ensure it has access to guaranteed diesel fuel reserves to maintain emergency services in the event of a complete disruption to road fuel supplies. All NHS Boards will be expected to support the principle of mutual aid to the Scottish Ambulance Service and other NHS Boards by allowing access to bunkered fuel stocks. Red Diesel 17. Some NHS Boards may hold supplies of Red Diesel, which is usually used in certain agricultural vehicles and other off-road vehicles. Red Diesel should not be used for road fuel unless a derogation has been obtained from Her Majesty s Revenues and Customs. However NHS Boards should note that a decision to allow the use of Red Diesel as road fuel is very unlikely to be given except in the most extreme situations. If a derogation is given, this will be communicated to the Scottish Government by DECC and then from the Scottish Government to SCGs. Relaxation of Targets and Regulations 18. National and local NHSScotland delivery target and performance assessments 11
will be kept under review during any fuel supply disruption. If necessary, targets and regulations can be adjusted to take account of local or national circumstances, but with full transparency via the use of risk and impact assessments. NHS Boards that do identify a requirement for this option are to seek the appropriate authority, but should not plan on this being an inevitable consequence of any fuel crisis, regardless of severity. 19. In order to further reduce fuel demand and maximise those who can get to work, NHS Boards should be prepared to review their existing practices, again based upon effective risk and impact assessments, with due account taken of any insurance or legal issues. This might include: a. Staff unable to get to work but who are within easy reach of a partner NHS Board could be temporarily stationed there to assist with the maintenance of capacity and capability in the NHS as a whole. This issue should be clearly articulated as a possibility to all staff as part of NHS Boards induction training. b. Reviewing all capacity management issues. Voluntary Sector Partners 20. Recognition of the scale of delivery of essential services by voluntary sector partners should form part of any risk analysis and determination of whether they should be supported in any bid to be recognised under the ESS. Security of Staff and Property 21. It is recognised that a disruption to normal fuel supply and any subsequent disruption to health service delivery could be an emotive subject for the general public. NHS Boards should therefore be aware of the potential of an increase in threat levels to staff and/or to NHS property as a result of any real or perceived reduction in services during a fuel crisis, and ensure they have appropriate HR and security processes in place to deal with these, which will include calling upon police support at the appropriate time. 22. In addition, Boards should also take measures to protect fuel within vehicles which could be a potential target for thieves; and Boards that hold bunkered fuel should ensure that they have appropriate security arrangements in place to protect these supplies. Communications 23. Effective communications both internal and external will be key to the successful implementation of Boards fuel disruption plans, and to demonstrate that NHSScotland is acting in the best interests of the public. High level communications will be issued by UK and Scottish Governments, and NHS Boards and their SCG partners should contribute to these as appropriate. NHS Boards should also ensure their own communications are consistent and are prepared and co-ordinated with their SCG partners. 12
Cost Capture 24. NHS Boards should ensure that all associated unforecasted costs attributed to this guidance and any response to an actual fuel crisis is captured for audit and the lessons identified process. Validation 25. NHS Boards should carry out their own local and regional testing/exercises to ensure their contingency arrangements are effective. NHSScotland Resilience Scottish Government 13
APPENDIX 1 THE NATIONAL EMERGENCY PLAN FOR FUEL (NEP-F) 1. The National emergency Plan for Fuel is not a publicly available document. However, information on the plan and the tools within it are available through the following links to the Department of Energy and Climate Change s (DECC) website: http://www.decc.gov.uk/en/content/cms/meeting_energy/en_security/downstream_oil/do wnstream_oil.aspx http://www.decc.gov.uk/assets/decc/what%20we%20do/uk%20energy%20supply/ener gy%20mix/security%20and%20resilience/1_20090711120935_e_@@_summaryofresp onsetoolsinthenationalemergencyplanforfuel.pdf 2. In addition, details of the Temporary Logo Scheme are set out below: Temporary Logo Scheme 3. NHS Boards are responsible for co-ordinating and issuing temporary logos to NHS staff. In order to access fuel under the ESS, staff designated as priority users will obtain fuel from Designated Filling Stations (DFS) and will be identified through their NHS logoed vehicles and ID cards. 4. Where priority users are in non-nhs logoed vehicles, a temporary logo scheme may be authorised by DECC. NHS Boards will manage this locally in accordance with the NEP-F guidelines and ensure control registers are kept of the number and to whom logos have been issued. NHS Boards should be prepared to be challenged about their use of the temporary logo scheme and overall fuel usage and should be able to justify their positions. The temporary logo template is contained within the NEP-F. 5. NHS Boards should ensure that all staff requiring a temporary logo have appropriate identification, including contractors e.g. General Practitioners, Pharmacists, or others deemed as falling into the category of a defined essential user. 6. Some staff and NHS Boards, particularly national ones, may cross NHS boundaries, but as the logo is a national one, this should not be an issue. Filling stations will accept logos of any region and will contact the relevant NHS organisation if there is a query. Staff who may need to make emergency journeys should ensure in advance that they have sufficient fuel for journeys rather than trying to fill up on the way. 7. NHS Boards should decide how many temporary logos they need and how these are managed internally. NHS Boards should not underestimate the administrative and control challenges they will be face when introducing this scheme. It is imperative that their method of activation, administration, and control of this process is exercised regularly. 8. Temporary logos should not be used to obtain fuel for getting staff to work when public transport should be used. However some staff respond to calls directly from their homes so some flexibility does exist for NHS Boards to manage this within the guidelines. In addition for shift-workers and those living in remote and rural areas, 14
public transport may not always be available to allow those staff to get to work to provide their essential service. This issue should be managed locally, but with due consideration to equity and the need for the NHS to reduce its demand on fuel at the time of any crisis. 9. NHS Boards should not underestimate the pressure there will be on people to access sufficient fuel to go about their own daily private lives. As such they must have robust and regularly exercised procedures in place to prevent abuse of the ESS and temporary logo schemes. Abuse of this scheme is a criminal offence under section 18(2) of the Energy Act 1976 and offenders may be prosecuted. 10. Guidance on disciplinary procedures to be followed in the event of an alleged abuse of the temporary logo scheme will be issued by DECC. NHS Boards should have clear internal communications arrangements in place to ensure that staff are aware of how seriously any fraudulent actions will be treated. External communication plans should also be prepared to respond to any negative publicity for the NHS, both locally and nationally. 11. The temporary logo scheme is a last resort and every effort should be made to provide services using business continuity arrangements, alternative ways of working and the MPS. 15
APPENDIX 2 USEFUL LINKS NHSScotland Business Continuity Management: http://www.readyscotland.org/ready-government/nhsscotland-resilience/businesscontinuity-management/ Preparing Scotland: http://www.readyscotland.org/ready-government/preparing-scotland/ Cabinet Office/DECC Business Continuity Management for Fuel Shortages: www.cabinetoffice.gov.uk/media/132628/bcp_fuel_nov2008.pdf 16