incident response plan - fareham and gosport ccg · fareham & gosport, south eastern hampshire...

Fareham & Gosport, South Eastern Hampshire and Portsmouth CCGs IRP version 1.0

INCIDENT RESPONSE PLAN

Review date: April 2014


Plan administration 1. Comments or suggestions Comments or suggestions regarding the Incident Response Plan should be addressed to the Strategy & Programme Officer at Fareham & Gosport and South Eastern Hampshire Clinical Commissioning Groups (CCGs) Commissioning House, Building 003, Fort Southwick, James Callaghan Drive, Fareham, Hampshire PO17 6AR The Strategy Officer and Accountable Emergency Officer are responsible for updating the plan and for its distribution. 2. Consultation This plan has been produced by the Fareham & Gosport, South Eastern Hampshire and Portsmouth CCGs and a draft version circulated to local health & LRF partner organisations. Following a month long consultation it will be taken to the governing bodies for approval and formal adoption. 3. Publishing This plan will be published on the websites of the Fareham & Gosport, South Eastern Hampshire and Portsmouth CCGs and shared with key partners in the Hampshire & Isle of Wight Local Resilience Forum. 4. Document Control

Plan version

Page

Changes

Date of

amendment

Author

Version 0.1 All First draft April 2013 PH Version 0.2 All CDO comments May 2013 PH Version 0.3 All Incorporate Portsmouth CCG May 2013 PH Version 0.4 All New Area Team alerting cascade June 2013 PH Version 0.5 All Post Consultation to Gov Bodies August 2013 PH Version 0.5 All Approved F&G Gov Body 11th Sept 13 PH Version 0.5 All Approved SEH Gov Body 18thSept 13 PH Version 0.5 All Approved Ports CCG Gov Body PH Version 1.0 All Issue Sept 13 PH


INCIDENT RESPONSE PLAN EXECUTIVE SUMMARY

The aim of this plan is to provide a framework by which the Fareham & Gosport, South Eastern Hampshire and Portsmouth Clinical Commissioning Groups (CCGs) will prepare for and undertake their role in a major incident. The three CCGs have a formal working compact and share commissioning, planning and performance and medicine management teams. They commission services from many of the same providers of NHS funded care and have a joint on call rota so there are number of reasons why it makes strategic sense to have a join Incident Response plan to prevent duplication of effort and resources and aid coordination. This Incident Response Plan details the planning and response of the CCGs during a Major Incident and is divided into 4 parts:

1. Incident Response Plan details 2. Roles and responsibilities 3. Annexes 4. Supporting information

Clinical Commissioning Groups are responsible for commissioning health services on behalf of the population they serve. The CCGs have the following roles in an emergency response:

• Supporting the NHS England Wessex Area Team in the local coordination of NHS funded health services

• Representation of the local NHS at multi-agency tactical coordinating group • Share resources as necessary when they are required to respond to a

significant incident or emergency The Civil Contingencies Act 2004 (CCA 2004), Health & Social Care Act 2012 and the NHS England Emergency Preparedness Resilience & Response Guidance (EPRR) 2013 set out the CCG legal responsibilities.

All staff and clinicians who work within the CCGs may have a role in supporting the response to a major incident. These plans have been developed with the support of colleagues and it is fundamental to the CCGs ability to respond to a major incident that everybody is aware of its content and their own responsibilities.

The plan is available on the CCGs websites: www.farehamandgosportcommissioning.info www.southeasternhampshireccg.nhs.uk www.portsmouthccg.nhs.uk

Signed ……………………………………. Chief Officer Fareham & Gosport and South Eastern Hampshire CCGs

Signed……….………………………..……Chief Officer Portsmouth CCG


Contents

INCIDENT RESPONSE PLAN ............................ ...................................................... 3

EXECUTIVE SUMMARY .......................................................................................... 3

CONTENTS .............................................................................................................. 4

INCIDENT RESPONSE PLAN - PART 1 ................... ............................................... 6

1. Introduction ..................................................................................................... 6

2. Levels of response ......................................................................................... 6

3. Types of Incidents .......................................................................................... 7

4. Civil Contingencies Act 2004 (CCA04)............................................................ 7

4.1 Statutory duties ............................................................................................ 7

4.2 Hampshire & Isle of Wight Local Resilience Forum (LRF)............................ 8

4.3 Local Risks .................................................................................................. 9

5. Emergency Preparedness in the health sector .............................................. 10

5.1 Clinical Commissioning Groups ................................................................. 10

5.2 Hampshire & Isle of Wight Local Health Resilience Partnership (LHRP) .... 11

5.3 NHS England EPRR Guidance 2013 ......................................................... 12

5.4 Equality & Diversity .................................................................................... 12

6. Alerting ......................................................................................................... 13

7. Emergency Response .................................................................................. 18

8. CCG Management Teams ............................................................................ 24

9. Technical Communications ........................................................................... 24

10. Stand Down .............................................................................................. 25

11. Recovery ................................................................................................... 26

PART 2 – ROLES & RESPONSIBILITIES ................. ............................................. 29

1. COMMAND & CONTROL ACROSS THE THREE CCGs ...................... 29

2. OUTLINE RESPONSIBILTIES OF CCGs DEPARTMENTS .................. 29

4. MULTI- AGENCY RESPONSIBILITIES ................................................. 34

5. MULTI-AGENCY COMMAND & CONTROL .......................................... 37

PART 3 ANNEXES .................................... ............................................................. 38

ANNEX A - LIAISON WITH THE MEDIA ............................................................. 38

ANNEX B VULNERABLE PEOPLE ..................................................................... 41

ANNEX C - MUTUAL AID PROCESS ................................................................. 43

ANNEX D - DATA SHARING ............................................................................... 47

PART 4 - SUPPORTING INFORMATION ................... ............................................ 49

1. Emergency Planning Cycle ........................................................................... 49

2. Document management ............................................................................... 49

3. Training ........................................................................................................ 50

4. Exercises ...................................................................................................... 51

5. Supporting documentation ............................................................................ 52

6. Useful websites ............................................................................................ 53

7. CCG supporting plans .................................................................................. 53

8. Distribution list .............................................................................................. 54


9. Glossary of Terms ........................................................................................ 55


INCIDENT RESPONSE PLAN - PART 1

1. Introduction The aim of this plan is to provide a framework by which the Fareham & Gosport, South Eastern Hampshire and Portsmouth Clinical Commissioning Groups (CCGs) will prepare for and undertake their role in a major incident. The three CCGs have a history of close collaboration and have a formal compact sharing many of their key functions. This Incident Response Plan details the planning and response of the clinical commissioning Groups during a Major Incident. It is divided into 4 parts:

• Plan details • Roles and responsibilities • Annexes • Supporting information

1.1 Definitions The following definitions are terms widely used in Emergency Preparedness, Resilience & Response (EPRR) by multi-agency organisations and the NHS a) Emergency : The Civil Contingencies Act 2004 defines an emergency as: ‘an event or situation which threatens serious damage to;

• Human welfare in a place in the UK • The environment of a place in the UK • The security of the UK or of a place in the UK’

b) Major incident: For the purposes of this plan a major incident is defined as: ‘Any accident, incident, natural disaster or hostile act which demands special

arrangements to cope with casualties or to counter actual or potential effects in the provision of services’.

c) Significant incident: NHS England guidance defines a significant incident as: Any occurrence that presents serious threat to the health of the community, disruption to the service or causes (or is likely to cause) such numbers or types of casualties as to require special arrangements to be implemented by hospitals, ambulance trusts or other acute or community provider organisations.’

2. Levels of response The NHS needs to be ready to respond to a variety of risk and threats which are identified in the National Risk Register by the Cabinet Office and assessed locally in the Hampshire & Isle of Wight Community Risk Register. The NHS Emergency Planning Guidance 2005 identifies three levels of response:

• Major: incidents such as multiple vehicle collisions where more patients will be dealt with, probably faster and with fewer resources than usual;


• Mass: larger scale incidents affecting hundreds of people, with possible evacuations of a major facility or persistent disruption over many days. The incident will require a collective response by several or many neighbouring NHS organisations;

• Catastrophic: events of potentially catastrophic proportions that severely disrupt health, social care and other functions and that exceed collective local capability within the NHS;

3. Types of Incidents Incidents involving the CCGs and the local health service may start in many ways

• Large scale accidents – rail, motorway or air crashes • Slowly emerging incident – infectious diseases outbreak e.g. Pandemic flu • Toxic gas plume drifting over the area – e.g. Fire or chemical release • Headline news report – sparking a health scare • Deliberate release of a Chemical, Biological, Radiological or Nuclear nature

(CBRN)

4. Civil Contingencies Act 2004 (CCA04) 4.1 Statutory duties Civil Contingencies Act 2004 The Civil Contingencies Act 2004 (CCA04) categorises responding agencies into Category 1 and Category 2 responders and places statutory duties on the identified organisations. Category 1 Responders have the following statutory duties placed on them:

• To carry out a Risk Assessment of their operational area • To have emergency plans • To have business continuity plans • To warn and inform the public • To cooperate with other responders through the Local Resilience Forum • To share information with other responders

Category 2 responders have the following statutory duties placed on them:

• To cooperate with other responders • To share information with other responders.

Health & Social Care Act 2012 CCGs are designated as Category 2 responders in the Health & Social Care Act 2012. The Act also places additional duties on CCGs to maintain emergency plans and to have in place formal business continuity arrangements as well as:

• Ensure contracts with provider organisations contain relevant emergency preparedness, resilience (including business continuity) and response elements.

• Supporting NHS England in discharging its EPRR functions and duties locally.


• Providing a route of escalation for the Local Health Resilience Partnership should a provider fail to maintain necessary EPRR capacity and capability

• Fulfilling the responsibilities as a Category 2 responder under the CCA including maintaining business continuity plans for their own organisation.

• Ensuring representation on the Local Health Resilience Partnership 4.2 Hampshire & Isle of Wight Local Resilience Foru m (LRF) The Civil Contingencies Act also states that multi-agency emergency preparedness is undertaken in areas based on Police Service boundaries and known as the Local Resilience Forum. The CCGs are part of the Hampshire & Isle of Wight Local Resilience Forum (LRF) area and information about the LRF can be found on the website: http://www3.hants.gov.uk/localresilienceforum/about-lrf.htm LRF Membership The following local organisations make up the Hampshire & Isle of Wight Local Resilience Forum and are categorised under the CCA04 as follows: Category 1 Responders South Central Ambulance Service NHS Foundation Trust Hampshire Hospitals NHS Foundation Trust Portsmouth Hospitals NHS Trust University Hospital Southampton NHS Foundation Trust Isle of Wight NHS Trust NHS England - Wessex Area Team Public Health England Hampshire Constabulary Hampshire Fire & Rescue Service Hampshire County Council Portsmouth City Council Southampton City Council Isle of Wight Council Hampshire’s 11 District & Borough Councils (This includes Havant, East Hampshire, Fareham & Gosport) Environment Agency Maritime & Coastguard Agency Category 2 Fareham & Gosport Clinical Commissioning Group Isle of Wight Clinical Commissioning Group North Hampshire Clinical Commissioning Group North East Hampshire & Farnham Clinical Commissioning Group Portsmouth Clinical Commissioning Group South Eastern Hampshire Clinical Commissioning Group Southampton Clinical Commissioning Group West Hampshire Clinical Commissioning Group Utilities - Gas, water and electric companies Network Rail &Train Operating Companies Harbour Authorities and Ferry Companies Telephone Operating Companies Airport operators


Highways Agency LRF Meeting structure Hampshire & Isle of Wight LRF has a formal meeting structure to facilitate the business of the LRF and health is represented by the Wessex Area Team Main Meetings Description NHS Representation LRF Executive Strategic group Wessex Area Team

Director of Ops & Delivery LRF Delivery Group Business, performance and

review group Wessex Area Team Head of EPRR

Core group s Risk Assessment Delivery of risk assessment

duty including production of the Community Risk Register and individual risk assessments

Wessex Area Team Head of EPRR

Emergency Planning

Delivery of emergency planning duty and assessment of capabilities


Training & Exercise Planning multi-agency training and exercise events


Category 2 Group Meeting of category 2 responders

Fareham & Gosport, South Eastern Hampshire and Portsmouth CCGs

Other sub groups Budget Oversees the allocation of

LRF finances Wessex Area Team Head of EPRR

Warning & Informing Delivery of duty to warn and to inform the public


Telecommunications resilience

Ensuring telecoms resilience across the county

Acute Trust Representative

Specialist Capability Emergency Planning for CBRN related incidents

Acute Trust Representative

Flooding & Environment

Ensure flooding risks are planned for

Fareham & Gosport, South Eastern Hampshire and Portsmouth CCGs

4.3 Local Risks A formal risk assessment of hazards and risks is undertaken by a multi-agency LRF risk assessment group every year as required by the Civil Contingencies Act 2004. Health assessments feed directly into the Community Risk Register for Hampshire & Isle of Wight Local Resilience Forum and can found: http://www3.hants.gov.uk/localresilienceforum/community-risk-register.htm

Summary of the top risks on the Hampshire & Isle of Wight LRF Community Risk Register (2012) are:


Ref CATEGORY DESCRIPTION RISK RATING H9 Industrial Accident Large toxic chemical release

VERY HIGH

HL2 Industrial Accident Local industrial accident involving toxic release

VERY HIGH

H18 Severe Weather Low temperatures and heavy snow VERY HIGH H19 Severe Weather Major coastal & tidal flooding

affecting >2 UK regions VERY HIGH

H21 Severe Weather Severe inland flooding affecting > 2 UK regions

VERY HIGH

HL16 Severe Weather Local coastal / tidal flooding affecting > 1 region

VERY HIGH

HL17 Severe Weather Local coastal / tidal flooding affecting 1 region

VERY HIGH

H23 Human Health Influenza-type Disease (pandemic) VERY HIGH H40 Telecoms No notice loss due to localised

incident VERY HIGH

H43 Telecoms – human error

Widespread loss of telecoms at regional level up to 5 days

VERY HIGH

4.4 National Risk Register The National Risk Register of Civil Emergencies July 2013 edition has been published and provides an updated government assessment of the likelihood and potential impact of a range of different civil emergency risks (including naturally and accidentally occurring hazards and malicious threats) that may directly affect the UK over the next 5 years. https://www.gov.uk/government/publications/national-risk-register-for-civil-emergencies-2013-edition 4.5 National Threat level The level of threat from terrorism is under constant review by the Security Services.

• Low - an attack is unlikely • Moderate - an attack is possible, but not likely • Substantial - an attack is a strong possibility • Severe - an attack is highly likely • Critical - an attack is expected imminently

The latest threat level can be viewed: https://www.mi5.gov.uk/home/the-threats/terrorism/threat-levels.html

5. Emergency Preparedness in the health sector

5.1 Clinical Commissioning Groups Responsibilities

The Fareham & Gosport, Portsmouth and South Eastern Hampshire CCGs have the following responsibilities in a Major incident


• Cooperate with other responding agencies in the business of emergency planning

• Share information for the purposes of emergency planning • Support the NHS England Wessex Area Team in its coordination role • Assess the local health impact of a Major Incident • Share resources as necessary when they are required to respond to a

significant incident or emergency

CCG Commitments Therefore the CCGs will ensure they:

• comply with the Civil Contingencies Act 2004 as a category 2 responder • comply with the NHS England EPRR guidance 2013 • publish this plan and distribute it to key partners • provide appropriate resources for EPRR • undertake regular review and testing of the plan • ensure the NHS Trusts they commission health services from comply with

NHS guidance and their duties under the CC Act 2004 • attend the Hampshire & Isle of Wight Local Health Resilience Partnership • contribute to an annual report by the NHS England on the health sectors

EPRR capability • produce an annual work programme

5.2 Hampshire & Isle of Wight Local Health Resilien ce Partnership (LHRP) The Local Health Resilience Partnership (LHRP) is a strategic forum for organisations in the local health sector. The LHRP facilitates health sector preparedness and planning for emergencies at Local Resilience Forum (LRF) level. It supports the NHS England, Public Health England (PHE) and Local Authority (LA) representatives, who attend the LRF, in their role representing the health sector. LHRP responsibilities

• Facilitate the production of local sector-wide health plans to respond to emergencies and contribute to multi agency emergency planning.

• Provide support to NHS England Wessex Area Team and PHE in assessing and assuring the ability of the health sector to respond in partnership to emergencies at an LRF level.

• Each constituent organisation remains responsible and accountable for their effective response to emergencies in line with their statutory duties and obligations. The LHRP has no collective role in the delivery of emergency response.

LHRP Membership Accountable Emergency Officers from:

• NHS England Wessex Area Team Director of Operations & Delivery (co-chair)

• Director of Public Health for Hampshire County Council (co-chair) • Ambulance Services • Public Health England


• NHS Acute Hospitals • NHS Community & Mental Health Providers • Clinical Commissioning Groups • Independent Health Sector • Voluntary Sector

Local Health Resilience Partnership Sub Group The LHRP sub group comprises the responsible managers from each of the above organisations and public health representatives from each Local Authority and is responsible for the delivery of the EPRR agenda 5.3 NHS England EPRR Guidance 2013 Key Responsibilities outlined in the guidance:

• The Accountable Officer is responsible for ensuring that the CCG has an incident response plan and is able to respond to an emergency.

• The board is regularly briefed with reports on the CCGs’ preparedness, additional risks, training and exercises.

• An Accountable Emergency Officer is appointed • Communications exercise should be carried out every 6 months • A table top exercise should be carried out yearly • A live exercise should be carried out every 3 years

EPRR in Fareham & Gosport, South Eastern Hampshire and Portsmouth CCGs The three organisations have a formal compact and work closely together. In emergency preparedness each organisation will have a designated Accountable Emergency Officer according to NHS England guidance In emergency response the CCGs will operate a joint Incident Response Team based either at

• St James Hospital or • Fort Southwick

According to operational need or location of the incident 5.4 Equality & Diversity Equality is about creating a fairer society where everyone has the opportunity to fulfil their potential. Diversity is about recognising and valuing difference in its broadest sense. When preparing arrangements in place to respond to an emergency, organisations should be mindful of their obligations under the Equality Act 2010. The Equality Duty ensures that public bodies consider the needs of all individuals in shaping policy, delivering services, and in relation to their own employees. It encourages public bodies to understand how different people will be affected by their activities so that policies and services are appropriate and accessible to all and meet different people's needs.


6. Alerting Declared Major Incidents Major Incident Declared by an Ambulance Service (Figure 1 p14) The ambulance service is responsible for informing receiving hospitals and the NHS England Wessex Area Team whenever the service declares a ‘major incident’ or ‘major incident standby’. NHS England Wessex area team is also responsible for advising NHS South of England, the regional office, of any major incidents or other significant incidents. Major Incident Declared by a Provider (Figure 2 p15) 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 the NHS England Wessex Area Team. Major Incident Declared by the NHS England (Figure 3 p16) The NHS England Wessex 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. Independent Plan Activation Any on-call manager may activate 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 THE FOLLOWING CLINICAL COMMISSIONING G ROUPS

o FAREHAM & GOSPORT,

o SOUTH EASTERN HAMPSHIRE

o PORTSMOUTH

CCG Alerting responsibilities When the Major Incident Alert is received the CCGs have the responsibility to alert the following organisations according to the NHS South of England Wessex Area team alerting cascade dated 7th June 2013

• Solent NHS Trust • Southern Health NHS Foundation Trust • Care UK • Spire Health care


Figure 1. The Cascade of ‘Major Incident’ and ‘Majo r Incident Standby’ declarations by the Ambulance Service (Diagram produced and revised by Wessex Area Team for local Adoption 7th June)

This diagram shows how the ambulance service will p ass a ‘major incident’ or ‘major incident standby’ declared directly by the ambulanc e service or by another organisation that has notified them of a ‘major inc ident’ or ‘major incident standby’.

111 Service

‘Major Incident’ or ‘Major Incident Standby’ issued by

Ambulance Service

Other ambulance

services

Public Health England On-call

NHS England (Wessex) on-call

Receiving Hospitals

Local Authority Public Health

On-call

CCG on-call for affected area

All providers in CCG area including

primary care

CCG on-call or areas not

directly affected

NHS England (South) on-call

KEY Direction of information flow for all major incidents and major incident standby declarations

Direction of information flow to services and organisations only informed if the scale or nature of the incident requires it.


Figure 2 - Escalation of Incidents and Establishmen t of Coordination Arrangements for Level 1-4 Incidents in Wessex (7 th June 2013)

Does the

incident need to be escalated?

Has a ‘major incident’

or ‘major incident standby’ been

declared?

Provider notifies CCG for information and action

Provider informs the ambulance service for cascade as shown in

diagram 2.

CCG informs NHS England (Wessex), agrees level of response, and jointly considers declaration of major incident if not already done.

Is it a level 2,

3, or 4 incident?

Manage with internal arrangements

NHS South of England (Wessex) establishes strategic coordination of NHS response

in Wessex

YES

NO

YES NO

Is it a Level 1

incident? YES

YES

NO

CCG and NHS England (Wessex)

consult regional director on-call

to agree level of response required NO

Incident Occurs

CCG establishes coordination of local NHS response and maintains contact with NHS

England (Wessex)

Act

ions

by

Pro

vide

r A

ctio

ns b

y C

CG

A

ctio

ns b

y A

rea

Tea

m


Figure 3 ‘Top-down’ Cascade by NHS England

(Diagram produced by Wessex Area Team 7th June)

NHS England (Wessex)

Ambulance Services CCGs

Other Blue Light Services

Non-Blue Light Service LRF

Partners

Acute Hospitals

Primary Care

Non-acute and non-NHS

commissioned services

NHS England (South)


National Alert Escalation Levels 1. CCG

A health related incident that can be responded to and managed by local health provider organisations that requires co-ordination by the local CCGs.

2. NHS England Wessex Area Team A health related incident that requires the response of a number of health provider organisations across an NHSCB area team boundary and will require an NHSCB Area Team to co-ordinate the NHS local support.

3. NHS England South of England Region A health related incident that requires the response of a number of health provider organisations across and NHSCB area teams across an NHS CB region and requires NHS CB Regional co-ordination to meet the demands of the incident

4. NHS England National Coordination A health related incident that requires NHSCB National co-ordination to support the NHS and NHS CB response.

Alert Activity Action NHS CB Incident levels

Ale

rt

Dyn

amic

Ris

k A

sses

smen

t

Dec

lara

tion

of In

cide

nt le

vel

1 A health related incident that can be responded to and managed by local health provider organisations that requires co-ordination by the local CCG.

2 A health related incident that requires the response of a number of health provider organisations across an NHSCB area team boundary and will require an NHSCB Area Team to co-ordinate the NHS local support.

3 A health related incident, that requires the response of a number of health provider organisations across and NHSCB area teams across an NHS CB region and requires NHS CB Regional co-ordination to meet the demands of the incident

4 A health related incident, that requires NHSCB National co-ordination to support the NHS and NHS CB response

National Alerting Messages NHS MESSAGE APPLICATION Major incident standby Alerts the NHS that a major incident may need to

be declared. Organisations should make preparatory arrangements appropriate to the incident.

Major incident declared Organisations need to activate their major incident plan and mobilise additional resources

Major incident cancelled Message cancels either of the above messages Scene Evacuation complete Message from the Ambulance Service to the

Trusts to inform them that no more casualties are at the scene

Major inciden t stand down It is the responsibility of each Trust to determine when it is appropriate for them to stand down


7. Emergency Response 7.1 Initial emergency call The initial alert should come through to the on call manager in the first instance but it may also come via switchboard. On-call Manager First actions are to: a. Record details of the emergency situation; Action Card 1

b. DECISION: TO DECLARE A MAJOR INCIDENT FOR THE CCGs

c. ACTION: START A PERSONAL LOG

d. Contact a second manager to conduct the internal cascade Action Card 2

e. Contact external partners as per Action Card 1

f. Carryout an initial risk assessment (page 19)

g. Start to use the decision making tool (page 20)

Switchboard If the alert is communicated to the switchboard then the receptionist will:

a) Record details of the emergency situation b) Inform the on-call manager and pass on the details c) Contact a second member of staff to assist at switchboard

Alerting list Action Card 2 (2nd Manager) Establish CCG response Communications on-call

Other CCGs

OOH Provider

Clinical Leaders

Support staff to ICC

Go to Emergency Control Centre

Alerting list Action Card 1 (on-call Manager) Establishing main contacts 1. Other CCG Senior Managers

2. NHS Wessex Area Team

3. Neighbouring CCGs

4. Portsmouth Hospitals NHS Trust

5. Solent NHS Trust

6. Southern Health NHS FT


Initial Risk Assessment completed by on call manage r

Questions to consider Information

Collected?*

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 th e 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


Decision making tool

The Association of Chief Police Officers (ACPO) National Decision Making Model can be used as a framework for decision making throughout the course of the incident. The model is cyclical where each step logically follows another and allows for continued reassessment of the situation or incident enabling previous steps to be revisited.

Source: Association of Chief Police Officers

http://www.acpo.police.uk/documents/president/201201PBANDM.pdf


7.2 Setting up the Incident Control Centre (ICC)

The CCGs Incident Control Centre will be located at one of the two locations below according to operational need or the location of the incident either at:

Fareham & Gosport and South Eastern Hampshire CCGs Commissioning House, Building 003, Fort Southwick, James Callaghan Drive, Fareham, Hampshire, SO17 6AR

Portsmouth CCG, St James Hospital, Locksway Road Milton Hampshire PO4 8LD

Role of Incident Control Centre The Incident Control Centre (ICC) is to provide a focal point for the CCGs and to assist in the coordination of the local NHS response working closely with the NHS England Wessex Area Team Manual of Operations The detailed working of the Incident Control Centre is set out in a manual of operations and a copy is held at the Commissioning House and St James Hospital. Incident Management Team The team will comprise of the following:

• Incident Manager and senior representatives from

• Fareham & Gosport CCG clinicians

• South Eastern Hampshire CCG clinicians

• Portsmouth CCG clinicians

• Commissioning Directorate

• Quality Directorate

• Finance Directorate

• Development Directorate

• Planning & Performance Directorate

• Communications

• Primary Care

• Medicines management Actions of the Incident Management Team

1. Conduct an immediate assessment of the emergency situation that needs to include

o Casualties – numbers involved o Hazards – health risks to the population o Access – access route to the incident o Location – exact location of the incident(s) o Emergency Services present


o Type of incident 2. Review the status and resources of the local NHS 3. Appoint a Response Room Manager to manage the control room processes

o Plan rotas o Ensure decision logs maintained o Monitor staff welfare

4. Confirm emergency contact arrangements to: o NHS England Wessex Area Team o South Central Ambulance Service o Community & Mental Health Trusts o Portsmouth Hospital o Neighbouring CCGs o Local District Council Emergency Centres o Hampshire County Council Adult and Children’s Services o Other relevant responding agencies.

5. Prepare a press holding statement 6. Carry out a local health risk assessment of the impact 7. Maintain regular contact with the NHS responding agencies 8. Plan for prolonged response and to start working shifts 9. Ensure a Recovery Team starts to plan the strategy for recovery after the

initial response is organised Meetings : Meetings held hourly for 15 minutes, chaired by the incident commander to an agenda with brief factual reports from each lead

Decisions: Key decisions logged in the decisions log

Equipment : Television, Phone, Teleconference facility, Laptops IS-BAR Briefing Tool I Identify

Who you are. Roll call of key areas

Who is present? (Ensure you have all key personnel present for the briefing

S Situation What is the current situation?

(If it is the initial brief then an overview of the incident will be required).

B Background Where are we up to? Each area gives an update on:

• Risks • Staffing levels • Resource issues

A Assessment Assessment of needs / concerns. R Recommendations Plan for the next 60 minutes. Be clear

what is required of each area / person. Confirm time & location of next briefing (on the hour).


Completion of Logs Immediately the CCGs start to respond to an incident then a log of actions must be started by key officers and the organisation

• Master Log – all information entering the information cell must be logged including all incoming phone calls and emails

• Action log – must be completed by all key Action Card holders

o Logs will be issued to all Action Card holders who should keep a record of:

o All instructions received, o Actions taken o Other information The log should be handed on and signed off if the holder is relieved during the incident and following stand-down it is to be returned to the Emergency Control Centre Co-ordinator for safe storage.

• Decision log – records the key corporate decisions, the process for deciding

and the considered alternatives. A decision log must be kept by the CCG incident commander The Incident Commander MUST sign the decision log a fter each key decision is agreed .

LOGS MUST BE KEPT WITH DATED & TIMED ENTRIES BY ALL STAFF MAKING DECISIONS IN A MAJOR INCIDENTS ON APPROVED L OG SHEETS

NO RECORDS NO DEFENCE Prepare 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 Incident Manager.

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 SCG) meetings and activities. The Incident Manager is accountable for ensuring appropriate staffing of all shifts. During the first two shift changes 1-2 hours of hand over time is required. Action Cards The Action Cards at Part 4 of this plan provide detailed instructions and information concerning emergency procedures, functional roles and responsibilities applicable to a specific post holder.


8. CCG Management Teams Staff Reporting A cascade calling system involving concurrent activity by the switchboard and on-call Senior Manager will be used to inform senior staff of the invocation of the Incident Response Plan. Staff off Duty Off Duty Staff who learn indirectly of an emergency that is likely to involve a CCG response should remain at home until called. The incident may be protracted and require shifts over several days so the CCG will have to manage staffing to match the demands of the incident. Health and Safety The CCGs have a responsibility to their workforce to ensure that staff welfare is considered in a Major Incident. To ensure staff are supported and have rest periods even though they may be required to work longer hours than normal during the early stages of the response.

• Occupational Health should be informed of all staff involved in the Major Incident response so that any follow up support may be given. A debrief strategy will be in place as described in section 26 below.

• The CCGs have a staff support service which offers information, advice and support 24/7.

• Any incident that affects the local population may well impact on individual members of staff whose family members could be involved in the incident itself.

• Managers should consider that staff from NHS could be among the casualties or victims of an incident in the county.

Responsibilities of Staff On appointment and periodically thereafter it the responsibility of all members of staff to familiarise themselves with this plan, the location to which they should report when an emergency situation is declared and the emergency roles and responsibilities pertinent to their appointment as detailed in the Action Cards.

Individual members of staff are responsible for reporting any change in their home address or telephone number to their Line Manager to enable out of hours contact lists to be maintained.

9. Technical Communications

a. Telephone Lists. It will be the responsibility of the Personal Assistants to ensure that telephone numbers (home, work and mobile) of all staff to be contacted in an emergency are reviewed at three monthly intervals. Secure copies will be held at the CCG offices

b. British Telecom Assistance. The Incident Commander will be responsible for requesting any emergency assistance concerning maintenance or the provision of additional services.


c. 111 111 can be used to support the response by answering public questions about the health effects of incidents and to give advice to the public either by agreed statements or via predetermined algorithms.

10. Stand Down The Incident Management Team will determine the time for the declaration of the ‘Stand Down’ from emergency procedures. This decision will not necessarily coincide with receipt of notification of stand down by other NHS Organisations. 10.1 Record Keeping Preservation of Documents . Following a major incident the CCG may be required to provide evidence to an appropriate enforcement agency, for example the Health & Safety Executive, Judicial inquiry, Coroner's inquest, the Police or Civil Court hearing compensation claims. In the course of any or each of these, the CCG may well be obliged or advised to give access to documents produced prior to, during and as a result of the incident.

Under no circumstances must any document that relates or may in any way relate to the incident, be destroyed, amended, held back or mislaid.

For these purposes "documents" means paper, photographs, audio and videotapes, and information held on word processor or other computer. It also includes internal electronic mail.

The vital message 'Preserve and Protect' - needs to be spread very quickly during a major incident and must reach those who might quite unknowingly hold significant documents. The CCG will issue appropriate instructions and guidance on procedures to be adopted in the immediate aftermath of a major incident to preserve all documentation.


10.2 Debrief Senior managers should ensure that their staff are able to attend all necessary debriefs following an incident. This comprises

• Hot debrief - immediate feedback session at the end of a shift or the incident to

• Identify any immediate points of learning • Cold debrief – a more planned and formal debrief at a later date to capture

identify key points of learning • Multi-agency debrief – held by the LRF to identify multi-agency points of

learning • Post incident report – a report compiled by the CCG based on the debrief

process • Action log – to ensure that the lessons identified become lessons learned and

adopted by the organisation Staff involved in the Major Incident should be given a chance to discuss their views and opinions to talk about their role and to identify ways of improving the Incident Response Plan and response.

11. Recovery Response and recovery are not two discrete activities and should not occur sequentially; the Recovery team will begin to plan recovery activities at the onset of the incident. As soon as the initial response phase is over the main focus of the management of the incident will be on returning to the new normality. The Recovery team will be guided by the HM Government Response and Recovery Guidance available on the Cabinet Office website - www.cabinetoffice.gov.uk/ukresilience/response.aspx The CCG Recovery team should begin to plan a return to normality as soon as the initial response phase is over so that services can begin to return to normal as soon as practicable. Psychosocial It is essential to understand the psychosocial resilience in order to be able to plan to meet the needs of staff. Psychosocial resilience is a multi-dimensional construct. It is “the capacity of individuals, families, communities, systems and institutions to anticipate, withstand and/or judiciously engage with catastrophic events and/or experiences, actively making meaning out of adversity, with the goal of maintaining ‘normal’ function without fundamentally losing their identify” Psychosocial resilience is not about avoiding short-term distress. It is about recognising:

• how people adapt to, and recover realistically from adverse events and/or circumstances;

• that the abilities of people to accept and use social support and the availability of it are two of the most important features of resilience;


• there is evidence that adequate support reduces the effects of exposure to challenging events and emergencies.

NHS organisations and NHS funded organisations must ensure there are robust arrangements in place that support responding to the psychosocial needs of staff affected by significant incidents, emergencies, and disasters. Long term health implications The CCGs may have to commission additional services to monitor and or screen individuals on a long term basis depending on the nature of the incident. Initial recovery actions

• The initial recovery actions to be considered include: • To assess the medium term impact on the community and priorities for the

restoration of normality • To consider the need for long term health monitoring with advice from the

Public Health England • Work with the local authority and community to support the recovery phase • To preserve all plans and documentation used or produced during the course

of the emergency response. • To prepare a post-incident report for consolidation in the NHS report to be

forwarded to NHS England Wessex Area Team. • To review the financial implications of the response for the CCG. • Occupational health and welfare of all staff and their families. • Bereavement affecting or involving NHS staff. • Physical reconstruction of facilities. • Reviewing key priorities for service provision and restoration. • Long term public health issues. • Ensure in media and communication recovery messages and response to

recovery related inquiries • Financial implications, remuneration’s and commissioning agreements. • Staffing and resources to address the new environment. • Socio-economic effect of the incident on staff and the public. • VIP Visits. • Funeral, memorials and anniversaries. • Staffing levels and resilience. • Routine annual performance targets. • Ongoing needs for assistance from and to NHS partners or other agencies. • Equipment and supplies. • Rewarding, acknowledging the efforts of, and thanking staff.

It may be necessary for the CCG to engage legal counsel to advise on preparations with regard to any public, criminal or other inquiry. Scaling down Incident Control Centre The ICC will need to be scaled back as the response phase of the incident come to an end. The appointed recovery lead director will assume overall responsibility for returning back to normal operations. A nominated person will be required to ensure that telephone calls and emails directed towards the ECC are still picked up; this can


be achieved by redirecting them to a monitored phone or email account or by maintaining continuity of the ECC phone and inbox for a period after the incident room has been closed. Legal Framework, Public Enquiries, Coroners Inquest s and Civil Action The day to day management of people and patients the NHS is subject to legal frameworks, duty of care and moral obligation. This does not change when responding to an emergency, significant incident, major incident or events that generate high profile media attention however public and legal scrutiny can become greater. Following a significant incident or emergency or event that has generated high profile media attention a number of legal investigations and challenge can and will be made. These may include Coroners Inquests, Public Enquiries, Criminal Investigations and Civil Action. These processes can occur many years after the incident, Recording information When planning for and responding to a significant incident or emergency or an event that has generated high media attention it is essential that any decisions made and actions taken are recorded and stored in a way that can be retrieved at a later date to provide evidence. It may be necessary to provide all relevant documentation immediately afterwards therefore robust and auditable systems for documentation and decision making must be maintained.


INCIDENT RESPONSE PLAN PART 2 – ROLES & RESPONSIBILITIES

1. COMMAND & CONTROL ACROSS THE THREE CCGs

2. OUTLINE RESPONSIBILTIES OF CCGs DEPARTMENTS Chief Officer/Operating Officer(s)

• To ensure the CCGs have adequate plans in place and that EPRR is adequately resourced and the staff trained and plans tested

• To appoint an Accountable Emergency Officer • To appoint a non-executive to support the Executive Director in carrying

out these responsibilities Accountable Emergency Officer

• Appointed as the Accountable Emergency Officer • To represent the CCG at Local Health Resilience Partnership meetings • To ensure the maintenance of the on-call manager rota • To maintain links the NHS communications leads • To provide major incident training to staff as appropriate • To ensure the Major incident plan is maintained on behalf of the CCGs • To ensure all staff are aware of their responsibility to help in the CCGs

response to an emergency

Fareham & Gosport CCG

Clinical Leaders

South Eastern Hampshire CCG Clinical Leaders

Portsmouth CCG

Clinical Leaders

Joint Management Team Quality – Development – Primary Care

Portsmouth Management

Team

INI

Commissioning Finance Planning & Performance

Medicines Management

NHS England Wessex Area Team Control & Coordination Primary Care

CSU Services HR Comms Legal

SHARED SERVICES

INCIDENT RESPONSE TEAM


Role of Accountable Emergency Officer The accountable emergency officer will be responsible for: • Ensuring that the organisation is compliant with the EPRR requirements

as set out in the civil contingencies act (2004); the NHS planning framework and the NHS standard contract as applicable;

• Ensuring that the organisation is properly prepared and resourced for dealing with a major incident or civil contingency event;

• Ensuring their organisation, and any providers they commission, have robust business continuity planning arrangements in place which reflect standards set out in the Framework for Health Services Resilience (PAS 2015) and ISO 22301;

• Ensuring the organisation has a robust surge capacity plan that provides an integrated organisational response and that it has been tested with other providers and parties in the local community(ies) served.

• Ensuring that the organisation is appropriately represented at any governance meetings, sub-groups or working groups of the local health resilience partnership (LHRP) or local resilience forum (LRF).

Human Resources (provided by CSU South)

• To provide access to staff support services with occupational health and counselling as required

• To ensure robust sickness reporting information available routinely • To include emergency preparedness on induction programmes • To ensure staff records maintained reference skill levels and

dependencies • To maintain an up to date list of staff responding in an emergency • To ensure staff are aware of their responsibility to help in the CCGs

response to an emergency

Quality (Provided both In House and by CSU) • To ensure staff are aware of their responsibility to help in the CCGs

response to an emergency • To provide staff support during and after an incident • To provide a pool of senior managers who are trained to assist in the

response phase of incident • To include emergency preparedness as part of the performance review of

Providers of NHS funded care Commissioning (shared service)

• To ensure staff are aware of their responsibility to help in the CCGs response to an emergency

• To include emergency preparedness as part of the performance review of Providers of NHS funded care

• To provide a pool of senior managers who are trained to assist in the response phase of incident

Finance (shared service)


• To ensure that emergency cost codes are available • To recognise the need for a budget for contingency planning


• To help lead the recovery • To provide a pool of senior managers who are trained to assist in the

response phase of incident Planning & Performance (shared service)


• To provide staff support during and after an incident • To provide a pool of managers who are trained to assist in the response

phase of incident • To assist in the planning of the recovery

Medicines Management (Shared Service)


• To provide a link to community pharmacies • To provide staff support during and after an incident • To provide a pool of managers who are trained to assist in the response

phase of incident


3. INDEPENDENT CONTRACTORS 1. Escalation process An escalation process similar to the one used by acute trusts has been developed for primary care contractors, specifically in- and out-of-hours medical services. GREEN GPs see their own patients on their own practice premises.

Out of hours (OOH) services see patients as required at primary care centres or at home.

AMBER Incident is declared – GP practices and OOH services activate their individual contingency plans or act as directed by Area Team

RED GP practices are unable to continue providing routine services. Some or all routine work will have to stop. Practice may need to activate their buddy group arrangements (e.g. groups of three/four practices working together in order to deliver core services out of a couple of sites). See 2 below For OOH services, some National Quality Requirements may need to be relaxed locally / nationally in order to allow services to focus resources on treating patients. In-hours GP may need to allocate resources to help OOH services.

BLACK Buddy groups are unable to continue delivering safe clinical care on their own, locality arrangements need to be activated (e.g. groups of several buddies usually mirroring CCG arrangements). OOH services are only able to deliver core services, all / most NQRs suspended. Care is delivered 24/7 on an out-of hours model, essentially telephone triage and consultations. Human and material resources are concentrated on a couple of sites per locality, which patients needing to be seen face to face will be invited to attend. These sites will need to be located close to pharmacies which will be supported to remain open and stocked up in order to enable patients to access medication, if needed. Teams of house visiting GPs in- and out-of-hours will also need to be set up.

2. Buddy and locality arrangements Buddy groups are composed of a few practices (two to four) that have agreed to help each other out in case of significant incident. Help means both human and material resources and potentially seeing each others’ patients. Each buddy group has submitted an escalation plan to the Area Team listing:

• basic practice information: names, workforce (head counts + whole time equivalents), list sizes, dispensing status

• point of contact for the buddy group and contact details • preparation work required • trigger point and activation process • practical implementation of buddy group arrangements.

Localities, which comprise several buddy groups and usually mirror CCG areas, are also closely linked to the out-of-hours providers. At the locality stage, all practices and buddies have agreed to concentrate human and material resources in a limited number of sites (two to three: e.g. a call/admin centre, a dirty site and a clean site). Localities will need to work closely and support their out-of-hours provider if needed.


All patients within the locality will be treated in the same way regardless of their usual registered practice. Each locality has also submitted a plan to the Area Team detailing:

• practices in locality and list sizes, • point of contact for locality and contact details, • preparation work required including the few sites that would be used / kept

open if all practices had to close down, • trigger point and activation process, • practical implementation of 24/7 OOH model of care.

3. Support provided by the CCG Specific communication channels can be activated to ensure that primary care contractors are kept informed at all times. All local representative committees are consulted and/or advised of developments at all times. A dedicated primary care helpdesk can also be mobilised, if needed. IT and telephony systems can also be mobilised to support GP practices and OOH providers at the red and black stages, if needed. The use of the Hampshire Healthcare Records would allow practices to access and record information for their non-registered patients at the third stage. The extension of the Adastra system currently used by OOH providers would support at stage four the delivery of an OOH model round the clock. In addition a single number could be used at stage four to direct patients to the most appropriate service and make best use of available resources and capacity. All dental practices have also been asked to ensure that they have robust contingency plans in place. In case of incident, the Area Team would most probably commission specific services from community services in several parts of the Area Team to ensure that patients in need of urgent dental care could access relatively local services. There is a fax system in place to communicate with pharmacies at the moment and close links are maintained between the Contracting and Medicines Management teams and pharmacies in order to support contractors’ needs and ensure adequate communication. If needed, optometrists would also be included in a major incident response; however as a minimum each optical practice is expected to have their own contingency plan.


4. MULTI- AGENCY RESPONSIBILITIES

The emergency services will normally provide the initial response to a major incident, supported by the local authorities, NHS, utilities (gas, water and electricity) companies and voluntary organisations. Main Roles of Responders

Police • Alert the other emergency services and local authorities; • Save lives by working alongside the other emergency services; • Co-ordinate the emergency services and other organisations during the

response phase; • Protect and preserve the scene; • Investigate the incident alongside other investigative organisations; • Collect and pass on information about casualties; • Identify those involved; and • Restore stability with the aim of restoring normality.

Fire and Rescue Service • Alert the other emergency services and local authorities; • Save lives by working alongside the other emergency services; • Tackle fires or chemicals which have been spilt and other dangerous

situations; • Rescue trapped casualties; • Make sure all personnel involved in the rescue work are safe; • Gather information and carry out hazard assessments; • Help the ambulance service get live casualties away from the scene; • Help the Police recover bodies; and • Restore stability with the aim of restoring normality.

Ambulance Service • Alert the other emergency services and local authorities; • Save lives by working alongside other emergency services; • Provide a focal point for all NHS and medical resources; • Identify and alert the appropriate receiving hospitals; • Set up a casualty clearing station; • Prioritise casualties so their injuries can be treated; • Prioritise which casualties must be evacuated using appropriate transport;

and • Restore stability with the aim of restoring normality. Receiving Hospitals and Community Health Services • Provide and control a clinical response for managing a large number of

casualties; • Maintain hospital and community services so patients can be cared for in a

routine way; • Manage communications, the media, relatives, friends, general enquiries and

VIP visits;


• Liaise with the emergency services, other receiving hospitals, supporting hospitals, community services and other agencies; and

• Keep records of casualties by working with the Police.

Clinical Commissioning Groups (CCGs) • Ensure contracts with provider organisations contain relevant emergency

preparedness, resilience (including business continuity) and response elements.

• Support NHS England in discharging its EPRR functions and duties locally.

• Provide a route of escalation for the LHRP should a provider fail to maintain necessary EPRR capacity and capability.

• Fulfil the responsibilities as a Category 2 responder under the CCA including maintaining business continuity plans for their own organisation

• Will be represented on the LHRP (either on their own behalf or through representation by a ‘lead’ CCG).

NHS England Local Area Team • Responsible for ensuring the local roll-out of LHRPs, coordinating with

PHE and local government partners. • Ensure the NHS has integrated plans for emergencies in place across the

local area. • Where appropriate develop joint emergency plans with PHE and local

authorities, through the LHRP. • Seek local assurance of the ability for NHS funded organisations to

respond to, and be resilient against, emergencies that cause increase demand or disruption to patient services.

• Discharges the local NHS England EPRR functions and duties. • Provide the NHS co-chair of the LHRP who will also represent the NHS on

the LRF. • Have the capability to lead the NHS response to an emergency at a local

level. • Ensure a 24/7 on-call roster for NHS emergency response in the local

area, comprising staff with the appropriate competences and authority to coordinate the health sector response to an emergency.

• Determine, in the light of the impact on NHS resources and with advice from the Director of Public Health, at what point the lead role in response to an incident or emergency will transfer, if required, to the NHS.

Local Authorities (County, Unitary, District & Boro ugh) • Support the emergency services; • Help people in distress; • Co-ordinate the activities of their various departments and other agencies; • Release information that has been agreed by the Police to the media and give

advice to the public; • Keep local authority services going in as normal a way as possible; and • Restore stability with the aim of restoring normality. In Hampshire these roles are shared between the County Council and the District and Borough councils.


Public Health England Centre • Provide expert advice on communicable disease • Provide links to national expertise in the Public Health England • Provide and maintain the out of hours public health rota

Environment Agency The Environment Agency has the responsibility for protecting water, land and air. • To prevent or deal with the effects of an incident; • To provide specialist advice; • To give warnings to those likely to be affected; • To monitor the effects of an incident; and • To investigate the cause of the incident.

Utility companies The utility companies, gas, water, electricity and phone companies, play a central role in responding to a major incident, particularly during the recovery phase. They may also have to make working areas safe very early on.

Armed Forces Through a system called Military Aid to the Civil Authority (MACA), the armed forces can help in an emergency if there is danger to human life or if there is a breakdown in services vital to the welfare of the community. The Police or Hampshire County Council will only ask for their help in line with MACA procedures. Within Hampshire, the Army will take the lead for the three services - Army, Navy and RAF.

HM Coroner The Coroner will liaise with the Police and Senior Supervising Pathologist to decide if a temporary mortuary is needed. The Coroner will liaise with the receiving hospitals and, if necessary, the coroners of the areas in which the receiving hospitals are based, to make sure that any casualties from the incident who die (either in hospital or while being moved) are moved to the Temporary Mortuary. The Coroner, Senior Identification Manager and Senior Supervising Pathologist will form the Identification Commission and decide on what criteria should be used to identify those who have died.

Voluntary Agencies Voluntary groups such as St Johns Ambulance and British Red Cross have the resources to provide significant aid to category one responders during a major incident, such as vehicles and highly trained personnel. Category one and two responders plan and exercise together to ensure there can be seamless partnership working during an actual incident.

Religious Groups LRF emergency planning and exercising schedules involve leaders from religious groups in order to ensure close links and an understanding of issues which may be raised during a major incident. Leaders of religious groups can provide crucial support and advice to category one responders which helps temper the response of those groups during the actual incident and afterwards during the recovery phase, helping communities return to (some sort of) normality.


5. MULTI-AGENCY COMMAND & CONTROL Tactical Coordinating Group The Tactical Co-ordinating Group will normally include the following;

• Police: Police Incident Officer (Silver Police), o Senior Investigating Officer, if this applies, o Minute taker.

• Fire: Incident Commander (Silver Fire), and a scientific advisor if applicable. • Ambulance: Ambulance Incident Officer (Silver Medic). • Local Authorities: A senior representative (Incident Liaison Officer) from

the local authorities providing support to the emergency services. • Public Health/Health Protection: A senior health protection or public health

professional to advise on issues relating to the health effects of the incident on the public.

• Other: Other representatives will depend on the type of the incident. It may be necessary to have an inner core of permanent members and an outer group of advisors, specialists and others who could be called upon to attend as necessary.

CCGs: CCGs may be required to attend a TCG in the event of an incident which impacts on the heath sector or at a known risk site with a predetermined TCG attendance Location The Tactical Co-ordinating Group will meet at the Incident Control Point at a suitable place near to the scene. The group may move to premises that are better equipped, although further from the scene, as operations progress. Strategic Coordinating Group The Strategic Co-ordinating Group will normally include the following;

• Police: Incident Commander • Fire: Senior Commander • Ambulance: Director • Local authorities: A Chief Executive (or their representative) from the

affected local authorities providing support to the emergency services • NHS: A Director from NHS England Wessex Area Team • Public Health / Health Protection Advisor providing the link with the

Scientific and Technical Cell (STAC) • Others: Other representatives will depend on the scale of the incident. It may

be necessary to have an inner core of permanent members and an outer group of advisors, specialists and others who could be called on to go to the meeting.

Location - The Strategic Co-ordinating Group will meet at a place completely separate from the scene with suitable communications and meeting facilities. Meetings - The group will decide the agenda for the strategic co-ordinating group meetings at the time. It will depend on the type and scale of the incident. It is important that this co-ordinating group focuses on strategic issues. Chair The Police will chair strategic co-ordinating group meetings until the co-ordinating role passes to the Lead Local Authority as the incident moves towards the recovery phase.



PART 3 ANNEXES

ANNEX A - LIAISON WITH THE MEDIA INTRODUCTION 1. Background and roles. An emergency situation will automatically generate

significant media and public interest. The media, be they press, radio or television, wish to obtain information of interest to readers, listeners or viewers and to produce this information as quickly as possible.

The role of communications staff in an incident is:

• To ensure that the public receives accurate and timely information about the incident and how it affects them

• To ensure mutually beneficial relations with the media and to ensure that such relations are managed to minimise any adverse impact on the handling of the incident

• To manage media and public communication within an organisation dealing with the incident

• To advise on presentation of the incident to the public at large and the community directly affected by the incident

• To ensure that media and public relations are reviewed following an incident and recommendations are made and implemented

2. Key responsibilities. In terms of media and communications during an emergency, it is vital to:

• Provide accurate, timely and frequent information to the media • Have appropriate mechanisms for working with the media to provide advice to

the public • Have appropriate mechanisms to establish telephone lines for the public • Have appropriate mechanisms to ensure co-ordination of media and

communications between NHS organisations • Have appropriate mechanisms to ensure co-ordination of media and

communications with partners from other sectors (e.g. emergency services, local authorities, voluntary organisations)

3. Release of information. It is necessary to balance the right of the public to

be kept informed under the Civil Contingencies Act 2004 & Freedom of Information Act 2000 versus professional ethics, and the need to protect the privacy of individuals as enshrined in the Data Protection Act 1998 and the Human Rights Act. There should be close liaison and clearing of media releases wherever possible during an incident with the following:

• Incident Control Centre • Police Liaison Officer • NHS England


STAGE 1: WHEN AN INCIDENT OCCURS

4. Early notification. The Communications lead for the organisation needs to be notified at the earliest opportunity. Where the Media and Communications lead for the organisation is unavailable due to sickness or annual leave, the back-up cover should be notified as specified in the on-call contact details. He / she will then undertake the actions as outlined on the Media and Communications Action Card.

5. Immediate media requirements. News media invariably respond to an

incident within 15 minutes of it starting. This is often faster than health and other emergency services can respond. It is essential to be responsive to media requests as failure to respond quickly and accurately can have serious implications for the management of an incident and can jeopardise the ability to get clear public health and operational information to the general public.

6. Media contact. It is important to follow the following guidelines:

• Establish a 'clear and dedicated number for media enquiries • Recognise the media’s legitimate role in providing and seeking

information • Provide accurate and timely information for the media, preferably

proactively • Identify trained spokespeople who will be available for interviews and

press briefings • Explain honestly when it is not possible to meet a request for

information, and when information is likely to be available • Recognise that media liaison may need to take place at the ‘scene’ as

well as at key health settings (e.g. hospitals receiving casualties). There may be a need to establish a ‘media centre’ at one or all of these locations

7. Social media

All three CCGs have access to Twitter accounts and these will be used during an emergency to tweet key messages to our followers. In time it is anticipated that the CCGs will develop their use of other forms of social media and these will be used in an emergency as appropriate.

STAGE 2: DURING AN INCIDENT

8. Establishing a media centre. It is vital to work with other organisations to:

• Identify a safe point near the scene, if there is one, where the media can congregate

• Identify a fixed point at which information will be provided in a planned way • Identify a location where press briefings can take place • Identify locations where individual interviews can take place • Ensure coherent approach to media liaison (e.g. messages and times of

briefings)

9. Working with other agencies.


Most incidents will require good working relationships with partner organisations. It is essential to:

• Liaise with other agencies dealing with media enquiries • Issue information only relating to health services unless clearly agreed with

other organisations • Issue copies of press statements to partner organisations • Liaise with the Wessex Area Team who will liaise with the media cell at

Strategic Coordinating Centre where this is established • Share resources and information to ensure the best possible service to the

public and the media • Work co-operatively to provide 24 hour cover during long running incidents

10. Public Health information.

The NHS has a responsibility to provide public health information in the event of a major incident. In incidents in which a Strategic level has been established, the nature of the information will be agreed with the Science & Technical Advice Cell (STAC) via the Media and Communications Lead at the Strategic level.

11. Informing staff and clarifying their role.

Key responsibilities to staff, primary care contractors and associated NHS services will include:

• Cascading public health and other health information to staff so they are able to deal with public enquiries and are kept up to date as to the developing incident

• Providing information to the media about the health services and their role in the management of the incident. (e.g. describing the role of specific services in treating illness and injury, providing information on the number of casualties received)

• Providing information to the media and the public on the role of primary and community health services as a source of health advice (e.g. advising the public to visit their GP if they have a concern)

• Providing information to the media about the role of the health service on the scene (e.g. local GPs may be assisting at the scene.)

• Managing media requests to talk to staff and primary care contractors about the incident

• Managing media requests to talk to patients receiving care and treatment STAGE 3 AFTER AN INCIDENT

12. Evaluation and reporting. In the close down and review stages the Media and Communications lead should prepare a detailed overview of media and communications including recommendations for future action. Issues of media handling are to be included in debriefing reports and the lessons learnt shared with partner organisations and the Wessex Area TeamANNEX B


ANNEX B VULNERABLE PEOPLE VULNERABILITY It is not easy to define in advance and for planning purposes who are the vulnerable people to whom special considerations should be given in plans. Those who are vulnerable will vary depending on the nature of the emergency. For planning purposes there are broadly three categories that should be considered:

• Those who for whatever reason have mobility difficulties, including people with physical disabilities or a medical condition and even pregnant women;

• Those with mental health difficulties • Others who are dependent, such as children

The CCG needs to ensure that in an incident people in the vulnerable people categories can be identified. Potentially Vulnerable

Individual/Group

Examples and Notes Target through the following

organisation/agency Children Where children are concerned, whilst at

school the school authorities have duty of care responsibilities. Certain schools may require more attention than others.

LEA schools through Local Authorities and non-LEA schools through their governing body or proprietor. Crèches/playgroups/nurseries

Older People Certain sections of the elderly community including those of ill health requiring regular medication and/or medical support equipment The “oldest-old” (aged 80 or over) are more likely to be widowed women, which may impact upon planning

Residential Care Homes Help the Aged Adult Social Care Nursing Homes

Mobility impaired For example: wheel chair users; leg injuries (e.g. on crutches); bedridden/non movers; slow movers.

Residential Care Homes Charities Health service providers Local Authorities

Mental/cognitive function impaired

For example: developmental disabilities; clinical psychiatric needs; learning disabilities.

Sensory impaired For example: blind or reduced sight; deaf; speech and other communication impaired.

Charities e.g. the Deaf Council Local groups

Individuals supported by health or local authorities

Social services GP surgeries


Potentially Vulnerable

Individual/Group

Examples and Notes Target through the following

organisation/agency Temporarily or permanently ill

Potentially a large group encompassing not only those that need regular medial attention (e.g. dialysis, oxygen or a continuous supply of drugs), but those with chronic illnesses that may be exacerbated or destabilised either as a result of the evacuation or because prescription drugs were left behind.

GP surgeries Other health providers (public, private or charitable hospitals etc.) Community nurses

Individuals cared for by relatives

GP surgeries Carers groups

Homeless Shelters, soup kitchens Pregnant women GP surgeries Minority language speakers

Community Groups Job centre plus

Tourists Transport and travel companies Hoteliers

Travelling community

LA traveller services Police liaison officer


ANNEX C - MUTUAL AID PROCESS AWAITING AGREEMENT AT THE LOCAL HEALTH RESILIENCE PARTNERSHIP


NHS INCIDENT SITUATION REPORT (SITREP) Note: Please complete all fields. If there is nothi ng to report, or the information request is

not applicable, please insert NIL or N/A.

Organisation: Date:

Name (completed by): Time:

Telephone number:

Email address:

Authorised for release by (name & title):

Exact location of Incident

Type of Incident (Name)

Resources Deployed 1 (e.g. Ambulance, Air Ambulance, HART)

Incident Casualties 2 Location P1: P2: P3 P4: Disch’d

Dead

Pre-Hospital

List Receiving Hospitals Location P1: P2: P3 Disch’d

Dead3

Hospital # 1

Hospital # 2

Hospital # 3

Hospital # 4

Total at Receiving Hospitals

Impact on Critical Functions 4

Capacity Issues 5a

Capability Issues 5b (e.g. major trauma, burns)

Impact on business as normal 6

Mutual Aid Request Made (Y/N) 7

Current / Potential Media Messages 8


NHS MAJOR INCIDENT SITUATION REPORT - SITREP

Note: Please complete all fields. If there is noth ing to report, or the information request is not ap plicable, please insert NIL or N/A .

Organisation: Date:

Name (completed by): Time:

Telephone number:

Email address:

Authorised for release by (name & title):

Type of Incident (Name)

Organisations reporting serious operational difficulties

Impact/potential impact of incident on services / critical functions and patients

Impact on other service providers

Mitigating actions for the above impacts

Impact of business continuity arrangements


Media interest expected/received

Mutual Aid Request Made (Y/N) and agreed with?

Additional comments

Other issues

NHS CB Regional Incident Coordination Centre contact details:

Name:

Telephone number:

Email:


ANNEX D - DATA SHARING Guidance and protocol The Hampshire and Isle of Wight Local Resilience Forum information sharing protocol describes the agreed method in HIOW to share information in an emergency. The key principle and guidance for sharing data are outlined in the Cabinet Office guidance “Data Protection and Sharing: Guidance for Emergency Planners and Responders”. This guidance should be used by the CCG Incident Response Team when making decisions on sharing information; the guidance can be accessed via the following link- http://www.cabinetoffice.gov.uk/media/132709/dataprotection.pdf Key principles • The key principles for data sharing outlined in the cabinet office guidance are: • Data protection legislation does not prohibit the collection, and sharing of

personal data – it provides a framework where personal data can be used with confidence that individuals’ privacy rights are respected.

• Emergency responders’ starting point should be to consider the risks and the potential harm that may arise if they do not share information.

• Emergency responders should balance the potential damage to the individual (and where appropriate the public interest of keeping the information confidential) against the public interest in sharing the information.

• In emergencies, the public interest consideration will generally be more significant than during day-to-day business.

• Always check whether the objective can still be achieved by passing less personal data.

• Category One and Two responders should be robust in asserting their power to share personal data lawfully in emergency planning, response and recovery situations.

• The consent of the data subject is not always a necessary pre-condition to lawful data sharing.

You should seek advice where you are in doubt – though prepare on the basis that you will need to make a decision without formal advice during an emergency. The way in which emergency planners and responders may use the personal data that they hold is governed by the 8 data protection principles; these require that information is:

• Processed fairly and lawfully and in accordance with a legitimising condition • Processed for specified and not incompatible purposes; • Adequate, relevant and not excessive; • Accurate and up-to-date; • Not kept longer than necessary; • Processed in accordance with individuals’ rights; • Kept secure; and • Not transferred to countries outside the European Economic Area without

adequate protection


Recording decisions It is vital that all decisions concerning information sharing are documented. The following information about the decision process should be documented in a formal logbook:

• Record of the information to be shared • Clear evaluation of the information to be shared against the key principles • The option chosen and clear reasoning for the decision

Flowchart of key principles for information sharing Executives involved in decision making around sharing information should use the following flow chart as an aid memoir (this flow chart is taken directly from the cabinet office guidance referenced above and the chapter references in it refer directly to that guidance).


INCIDENT RESPONSE PLAN PART 4 - SUPPORTING INFORMATION

1. Emergency Planning Cycle

2. Document management Plan review and audit The plan will be reviewed a 2 yearly basis as a minimum against the NHS England EPRR core Standards Assessment Tool. This plan will also be reviewed after each exercise or actual incident if recommended in the post exercise or incident debrief. Major incident telephone call in-lists and the contents of the emergency planning cupboard will be reviewed every 6 months. The Incident Control Centre will be tested every 6 months. The on-call pack will be reviewed every 3 months. Consultation and dissemination The consultation strategy will follow 2 stages:

• Internal consultation - final draft of the plan will go for consultation for a period of 1 month to internal CCGs internal stakeholders

• External consultation – the revised plan post internal consultation will be forwarded to health and relevant LRF multi-agency partners for a consultation period of 1 month.


The final completed version of the incident response plan will be reviewed and approved at the 3 CCGs Governing Bodies. When accepted the plan will be posted on the intranet and the CCGs’ websites and disseminated to partner agencies via an email link to the website.

3. Training Requirements The CCGs are required to ensure mechanisms are in place to identify, select and train staff to participate in major incidents which ensures that staff:

• understand the role they are to fulfil in the event of an incident • have the necessary competencies to fulfil that role • have received training to fulfil these competencies, and, as a minimum

standard, all NHS staff include in their induction training an introduction to the role of their organisation in major incident planning and response

Training, testing and exercising should take place within the context of:

• A training needs analysis that reflects normal good training practice • The definition of different training needs along a spectrum from general

awareness to specific training for staff with key roles • Providing a framework that states clearly who is accountable for ensuring

training and exercising takes place, the respective frequency for each element, is based on an annual plan for the process and is supported by appropriate documentation and record keeping and allows for post exercise reporting and debriefing

Training programme The training programme for CCG staff is based on a training needs analysis undertaken by the Development directorate from this a programme of training is outlined below. This is a minimum requirement and there is scope in the training programme to provide additional training as deemed necessary if the need arises.

Type of training Staff Group Frequency

Strategic Leadership Senior Managers & Clinical Leads

Yearly

Control room operations Control room staff Yearly

Loggist training Loggists 2 yearly

Refresher loggist training Loggists and Senior Managers

Yearly

Induction training for all staff New CCG staff Once

Media spokesperson and Media and comms working in an emergency

Senior Team Media Team

2 yearly

on-call training on-call staff Yearly


4. Exercises

As a minimum requirement, the CCGs are required to undertake the following: • A ‘live’ exercise every three years • A ‘table top’ exercise every year • A test of communications cascades every six months

Exercise programme The programme below outlines the generic exercise programme which includes internally organised exercises and the participation in multi-agency exercises.

Exercise Purpose Frequency Lead

Statutory exercises under CCA, NHS EPRR Guidance and best practice

Internal

communication

Meet requirements of NHS

EP Guidance

Every 6

months

CCG

External

communication

Multi-agency led test As required LRF

Control room set-

up

Ensure set-up of control

room is tested

Yearly CCG

Control room

functioning

Ensure functioning of

control room is tested

Yearly CCG

Table top

exercise

Meet requirements of NHS

EPRR Guidance

Yearly CCG

Other LRF

organised table

exercises

Test multi-agency plans As required LRF members

Other health

exercises

Test inter-health plans As required NHS


Statutory Exercises under REPPIR, COMAH & MACR regulations Plan Regulation Frequency Lead Agency CCG Area

AWE Aldermaston

REPPIR 3 years West Berkshire DC

North Hants

PORTSAFE multi-agency exercise

REPPIR 3 years Portsmouth City Council

Portsmouth & Fareham & Gosport

SOTONSAFE multi-agency exercise

REPPIR 3 years Southampton City Council

Southampton & West Hampshire

Fawley COMAH 3 years Hampshire County Council

West Hampshire

BP Hamble COMAH 3 years Hampshire County Council

West Hampshire

APPH, Basingstoke

COMAH 3 years Hampshire County Council

North Hampshire

Star Energy, Lasham

COMAH 3 years Hampshire County Council

North Hampshire

Oil fuel depot/Jetty, Gosport

MACR 3 years Hampshire County Council

Fareham & Gosport

DSDA, Gosport MACR 3 years Hampshire County Council

Fareham & Gosport

Records of all exercises and tests will be kept by the EPRR lead. Following an exercise or a major incident the CCGs ability to comply with each element of the plan will be analysed and evaluated and response arrangements amended to reflect lessons identified as necessary. The training and exercises identified above will ensure that the staff performing roles in a major incident will know what their role and responsibilities are.

5. Supporting documentation This Major Incident plan was compiled with reference to the following guidance and plans National guidance

• Cabinet Office: Emergency Preparedness • Cabinet Office: Emergency Response and Recovery • The Civil Contingencies Act 2004 • Cabinet Office: Data Protection and Sharing - Guidance for Emergency

Planners and Responders • Cabinet Office: Identifying people who are vulnerable in a crisis - Guidance

for Emergency Planners and Responders

NHS England Guidance • Core Standards for EPRR • FAQ for EPRR


• Emergency Preparedness Framework 2013 NHS England national plans

• National Burns plan • Heat wave pan • Cold weather plan • Pandemic flu plan

6. Useful websites

UK Resilience: www.cabinetoffice.gov.uk/ukresilience Department of Health: www.dh.gov.uk NHS England: www.england.nhs.uk/ourwork/gov/eprr/ Public Health England: www.gov.uk/government/organisations/public-health-england Hampshire & Isle of Wight LRF: www3.hants.gov.uk/localresilienceforum.htm

7. CCG supporting plans Incident control centre operating manual The document compliments this Major Incident Plan and provides the detailed procedures for operating an emergency control centre and the arrangements for the management of a major incident by an incident management team and support cells. On-call policy This document outlines the roles and responsibilities of the on-call senior managers. Training Needs Analysis A training needs analysis will be completed Complementary plans LRF plans - multi-agency plans which compliment this plan include:

• LRF Strategic Response Framework for emergencies • LRF Media Plan • LRF Mass Casualty Plan • LRF Scientific and Technical Advice Cell Plan • LRF Pandemic Influenza Framework • LRF Telecommunications Plan • LRF Disruption to road fuel supply • Hampshire and Isle of Wight CBRN Plan

Health Sector plans

• NHS England Wessex Area Team Incident Response plan • South Central Ambulance Service NHS Foundation Trust Major Incident plan • Solent NHS Trust Major Incident Plan • Southern Health NHS Foundation Trust • Portsmouth Hospital NHS Trust MI plan

LRF Partner Agency plans

• Hampshire Police Major Incident Plan • Hampshire Fire & Rescue Major Incident Plan


• Hampshire County Council Emergency plan • Portsmouth City Council Emergency Response Plan and Urgent Support Plan • Fareham BC Emergency Response plan • Gosport BC Emergency Response plan • Havant BC Emergency Response plan • East Hampshire BC Emergency Response plan

8. Distribution list

Sector Organisation Name NHS England Wessex Area Team Public Health England Hampshire & Isle of Wight CCGs North East Hampshire & Farnham

Portsmouth West Hampshire North Hampshire

NHS Trusts Portsmouth Hospitals NHS Trust Southern Health NHS Foundation Trust Solent NHS Trust

Independent providers Independent Sector Treatment Centre Ambulance Services South Central Ambulance Service NHS Foundation

Trust Emergency Services Hampshire Constabulary

Hampshire Fire & Rescue Service Local authorities Portsmouth City Council (including Port Health

Authority) Hampshire County Council East Hampshire District Council Fareham Borough Council Gosport Borough Council Havant Borough Council

Other Agencies or Bodies Environment Agency Local Medical Committee Local Pharmaceutical Committee


9. Glossary of Terms

CBRN Chemical, Biological, Radiological & Nuclear CCA Civil Contingencies Act CCG Clinical Commissioning Group COMAH Control of Major Accident Hazards DPH Director of Public Health EPRR Emergency Preparedness Resilience & Response HIOW Hampshire and the Isle of Wight ICC Incident Control Centre for Major Incidents IMT Incident Management Team IRP Incident Response Plan LRF Local Resilience Forum LHRP Local Health Resilience Partnership MACA

Military Aid to the Civilian Authorities include • Military Aid to the Civil Communities (MACC) –

assistance in an emergency • Military Aid to the Civil Ministries (MACM) – e.g.

assistance in the event of industrial action; • Military Aid to the Civil Powers (MACP) –

assistance to the Police MACR Major Accident Control Regulations OOH Out of Hours Prepared Rest Centre Local authority organised centre for evacuees from an

incident Receiving hospital A & E Hospital designated to receive casualties from a

major incident REPPIR Radiation (Emergency Preparedness & Public

Information) Regulations 2001 SCC Strategic Command Centre SCG Strategic Coordinating Group STAC Science & Technical Advice Cell TCG Tactical Coordinating Group - Multi-agency group of

operational managers leading the tactical response in Hampshire & Isle of Wight


FINAL PAGE

FAREHAM & GOSPORT

SOUTH EASTERN HAMPSHIRE &

PORTSMOUTH

CLINICAL COMMISSIONING GROUPS
