NHS CB London Regional Office
Incident Response Plan DRAFT
NHS CB London Regional Office
Incident Response Plan DRAFT
Date
09January 2013; Draft Version 6
Audience
NHS Commissioning Board (NHS CB) London Regional Director,
Executive Directors, Senior Managers, NHS trust and NHS foundation
trust chief executives, ambulance service chief executives, clinical
commissioning groups and provider accountable emergency officers.
Copy
Members of local health resilience partnerships (LHRPs), NHS CB
EPRR leads, SHA / PCT emergency planning leads.
Descriptio
n
From 1 April 2013, this document supersedes the NHS London
Strategic Operational Response – Planning for an Emergency
document and its associated Handbooks.
It should be read in conjunction with NHS CB London Regional
office EPRR Operating model and Command and Control Plan.
Cross
Reference
and Links
http://www.commissioningboard.nhs.uk/eprr/
Action
Required
Timing
To be used in the deployment of the new health EPRR arrangements
within London Regional Office from January 2013.
Contact
Details
epteam@london.nhs.uk
NHS Commissioning Board London Regional Office, EPRR Team,
Southside, 105 Victoria Street, London SW1E 6QT.
Table of Contents
FOREWORD
6
1. INTRODUCTION
7
2. PURPOSE
7
3. LEGISLATION AND GUIDANCE
7
4. TARGET AUDIENCE
8
5. INTENTION
Scope
8
8
Aim
8
Objectives
8
6. DEFINITIONS & INFORMATION
Major Incident
Emergencies
9
9
9
Types of Incident
10
Major Trauma
11
7. COMMAND AND CONTROL
Gold, Silver and Bronze Management Structure
11
11
Multi Agency Engagement
12
Partner Agency Engagement
14
Command & Control Algorithm
20
Major Incident Alert Messages
20
8. INCIDENT RESPONSE - ACTIVATE
Trigger
22
22
Dynamic Risk Assessment & Decision Making
23
Algorithm of NHS CB LRO Activation
25
London Regional Office Incident Coordination Centre
25
Staff Activation
26
9. INCIDENT RESPONSE - OPERATE
Roles and Responsibilities
26
26
Function of the LICC
31
Situation Reports (SitReps)
31
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Press, Media and Communications
31
Records Management
32
Workforce Management
32
Staff Welfare and Safety
34
Financial Management
34
Military Aid to Civil Authorities
36
10. INCIDENT RESPONSE – ESCALATION & DE-ESCALATION
Criteria for Escalation
36
36
Criteria for De-Escalation
36
Major Incident Stand Down
37
11. INCIDENT RESPONSE – RECOVERY
Recovery Strategy
37
38
NHS CB LRO Recovery
38
Multi-Agency Recovery
39
12. GOVERNANCE ARRANGEMENTS
Documentation
Post Incident Debrief
40
40
40
13. TRAINING
41
14. TESTING & EXERCISING
42
15. FREEDOM OF INFORMATION
42
16. EQUALITY AND DIVERSITY
43
17. REFERENCES & INFORMATION SOURCES
44
18. GLOSSARY OF TERMS
45
19. APPENDICES
Annex A - Action Cards
46
46
Annex B - Media Messages and Social Media
69
Annex C - Recovery Group Terms of Reference
74
Annex D - Recovery Group Draft Meeting Agenda
76
Annex E - Recovery Action Plan Template
77
Annex F - Debrief Report Form Template
78
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WARNING
If you have received notification or suspect there
to be a Major Incident/Emergency in progress:
Contact NHS01 immediately by calling
0844 822 2888
quoting pager reference: NHS01
During office working hours you may wish to try to contact the
EPRR Team Directly.
Then go directly to Section 8.0
and read your
Action Card in Annex A
If you are NHS Gold, read and use your Action Card and start a
log of all actions & decisions taken.
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FOREWORD
The NHS has a duty to protect and promote the health of the community during
major incidents and emergencies; as the Regional Director for the NHS
Commissioning Board (NHS CB) in London I have ultimate responsibility for
ensuring that NHS Organisations across London are prepared to respond
efficiently, effectively and appropriately to any such incident.As such the NHS CB
has a central role in planning for responding to any incident with major
consequences for health or health services in partnership with other responders,
such as the blue light emergency services and local authorities.
Historically NHS organisations across London have been involved in the
response to major incidents on many occasions, for example during the terrorist
bombings on 7th July 2005, and more recently during the response to the global
influenza pandemic in 2009/10, Industrial action leading to service and supply
chain interruption in November 2011 and to annual seasonal severe weather
pressures such as heatwave, winter pressures and flooding.
Under the Civil Contingencies Act 2004 and Health and Social Care Act 2012,
NHS organisations are required to have plans in place to deal with incidents and
emergencies. These plans must be built on the principles of risk assessment, cooperation with partners, communicating with the public and information sharing.
It is important that the transition from Strategic Health Authorities and Primary
Care Trusts to NHS CB and Clinical Commissioning Groups is managed
effectively to ensure that London remains resilient and able to respond
appropriately to any challenges faced.
The NHS CB in London will seek assurance that these plans are in place, and
that staff within organisations are familiar with them and that they are regularly
exercised and tested.
The information contained within this Incident Response Plan sets out the
framework for the NHS CB’s response during such an emergency. I recommend
all CB staff in London familiarise themselves with it.
Some staff will find that they have key roles which have dedicated action
cards.However, during an incident all NHS CB staff may be asked to work flexibly
in unfamiliar environments and for extended periods. I know I can rely on your cooperation and support in order to be able to manage any incident response
effectively.
A major incident can occur at any time, day or night, and it is essential that we all
maintain our preparedness to respond.
Anne Rainsberry
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1. INTRODUCTION
1.1. The NHS CB London Regional Office (NHS CB LRO)Incident Response
Plan (IRP) is the regional level plan that details how NHS CB London
reviews and responds to any relevant health related incident/emergency. It
is intended for use by NHS CB London staff and acts as a reference and
signposting document to provide appropriate direction for responding to
emergencies.
1.2. This plan enables the NHS CB LRO to corporately deliver its responsibilities
in response to any incident, in line with the statutory requirements of the
Civil Contingencies Act (CCA) (2004). The key objective is to provide
confidence through effective oversight, direction and coordination of the
NHS to enable it to provide a resilient response to incidents and
emergencies ensuring integrated emergency management with partner and
stakeholder agencies.
1.3. The IRP accords with the requirements of the CCA 2004, related
Contingency Planning Regulations 2005 and the NHS associated
responsibilities as a Category 1 responder. It is supported by its related
Standard Operating Procedures (SOPs) which contain the operational detail
and procedures to be put in place during a response.
1.4. This plan details roles and responsibilities and recognises the key
operational phases of response: Alerting, Activation,Operation, Escalation
and De-escalation, Stand Down and governance arrangements.
1.5. This document should also be read in conjunction with the NHS CB
LROEmergency Preparedness Response and Resilience (EPRR) Operating
Model and Command and Control Plan.
2. PURPOSE
2.1. All staff within NHS CB LRO need to be aware of the existence and content
of the Incident Response Plan and their individual contributions to the
success of the implementation of the Plan.
2.2. The EPRR will identify staff likely to be involved in incident response and
ensure they have the appropriate training, equipment and knowledge to be
able to respond safely and effectively.
2.3. Directors and Senior Managers must also ensure they are sufficiently
familiar with the contents and requirements of this Plan and that they are
ready and able to mount immediate response in accordance with the
provisions of the Plan.
3. LEGISLATION AND GUIDANCE
3.1. Within the Health and Social Care Act 2012 the NHS CB is defined as a
Category One Responder under the Civil Contingencies Act 2004
(Contingency Planning) Regulations 2005;as such NHS CB LRO has a
primary role in the response to incidents and places a statutory duty to:

Undertake Risk assessment
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Develop and maintain Emergency Plans
Arrange to make information available to the public about civil
protection matters and maintain arrangements to warn, inform and
advise the public in the event of an emergency
Share information with other local responders to enable greater
coordination
Co-operate with other local responders to enhance coordination and
efficiency
4. TARGET AUDIENCE
4.1. The principles outlined within this document are applicable to all employees
of the NHS CB LRO and specifically those individuals On-call with a
response during a major incident, included but not limited to:Directors,
Senior Managers, EPRR Team and administrators.
4.2. The NHS Commissioning Board is required to ensure structures are in place
in line with this document.
5. INTENTION
Scope
5.1. This plan provides the framework for responding to and recovering from
Major Incidents (including escalation of surge and capacity incidents) and
Emergencies (as defined in section 6) requiring the activation of specialist
plans within the NHS CB LRO. As such this plan is consistent with the
framework outlined in theNHS CB LRO Operating Model and Command &
Control Plan.
Aim
5.2. The aim of this plan is to increase NHS CB LRO resilience in responding to
incidents and emergencies by ensuring that those charged with managing
the response and recovery understand their role and responsibilities; are
competent to carry out the tasks assigned to them; and have access to the
required resources and facilities.
Objectives
5.3. The main objectives of this plan during an incident are to:


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
Define the type of incident for which these arrangements are intended
State the trigger points for activation, escalation and stand down of the
plan
Detail the roles and responsibilities of those staff involved with incident
management (Command and Control)
Outline the internal and external alerting arrangements
Outline the training and exercising arrangements required
Ensure the appropriate continuation of NHS services with the London
Region
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
Ensure NHS CB London Region meets its statutory requirements for
Emergency Planning and Business Continuity
6. DEFINITIONS & INFORMATION
Major Incident
6.1. NHS CB LRO adopts the Department of Health definition of a Major 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
primary care organisations
6.2. The extent of a Major Incident will also be categorised by the following:
Major
6.2.1.
A large scale incident affecting a large number of people, potentially
in the tens to the hundreds, which will require a significant response
from NHS services such as Ambulance, Trauma and Emergency
Departments (ED)
Mass
6.2.2.
Much larger scale events affecting potentially hundreds of people
rather than tens of people such as a major terrorist incident.
Catastrophic
6.2.3.
Events of such magnitude that they severely disrupt health and social
care and other functions within the UK.
National
6.2.4.
Events which affect the whole of the UK, affecting the ability to
provide services or increasing demand for services such as a blood
shortages, fuel strike, pandemic or multiple events that require the
collective capacity of the NHS nationally.
Emergencies
6.3. NHS CB LRO is cognisant that the term Major Incident is commonly used to
describe Emergencies, defined by the Civil Contingencies Act 2004 as:
“Any event or situation that threatens serious damage to human
welfare in a place in the UK or to the environment of a place in the UK,
or war or terrorism which threatens serious damage to the security of
the UK”
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Types of Incident
6.4. NHS CBLRO recognises that Major Incidents and Emergencies
maymanifest in a number of different ways, including but not restricted to:
Big Bang
6.4.1.
A serious transport or industrial accident, or series of smaller
unforeseen incidents e.g. a train crash or explosion at a gas storage
depot.
Rising Tide
6.4.2.
A developing infectious disease epidemic or outbreak e.g. Pandemic
Flu.
Cloud on the Horizon
6.4.3.
A serious threat such as a major chemical or nuclear release
developing elsewhere and needing preparatory action e.g. Chernobyl.
Headline News
6.4.4.
Public or media alarm over a health issue/scare e.g. reaction to the
MMR Vaccine.
Act of Terrorism
6.4.5.
The calculated use of violence or explosives against civilians or the
government e.g. 7/7 London Bombings.
CBRN Incident
6.4.6.
The intentional release of Chemical, Biological, Radiological or
Nuclear material either real or hoax e.g. Sarin, Anthrax or Polonium
poisoning. This may also involve the existence of an explosion with
the potential for contaminated casualties.
Hazmat Incident
6.4.7.
The unintentional release of a Chemical, Biological, Radiological or
Nuclear material through an industrial accident e.g. Chlorine release.
Mass Casualty
6.4.8.
Any event that results in a large number of casualties, with 100’s of
people injured.
Severe Weather Incidents
6.4.9.
Any dangerous or extreme meteorological events e.g. severe
flooding, heat-wave or snow.
Pre-Planned Major Events
6.4.10. Demonstrations, sports fixtures, air shows or music concerts which
have the potential to increase demand for NHS Services.
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Major Trauma
6.4.11. Access to hospitals in London with major trauma capabilities has
been organised around the formation of major trauma networks. Four
hospitals have been designated as major trauma centre;




St Mary’s Hospital, Paddington
The Royal London Hospital, Whitechapel
St Georges Hospital, Tooting
Kings College Hospital, Denmark Hill
6.4.12. Each major trauma centre is responsible for the coordination of their
local trauma networks, comprising of other acute hospitals.
6.4.13. During a major incident, London Ambulance Service will ensure that
major trauma patients are distributed between the major trauma
centres, in an attempt to prevent any one hospital from becoming
overwhelmed.
6.4.14. Major trauma patients may need to be stabilised in any London
EDbefore final transfer to a major trauma centre.
6.4.15. In a catastrophic incident, where the number of major trauma patients
far exceeds the whole system capability, then use of the major
trauma centres may be streamlined for the most appropriate cases
(i.e. for those patients who may be expected to achieve the best
outcome).
7. COMMAND AND CONTROL
7.1. An essential element of Command and Control is a clear and unambiguous
chain of command, from the top of the organisation to the lowest level, and
across agencies as required. Every person involved in the response to an
Incident must know exactly where they fit in, what their role and
responsibilities are, and what duties are placed upon them, with individuals
being accountable for decision making at their level.
7.2. As such NHS CB LRO implements Command and Control arrangements,
which are compatible with those of partners, stakeholders and the wider
resilience community in line with the NHS CB LRO EPRR Operating Model
and Command and Control Plan (2012) and London Emergency Services
Liaison Panel (LESLP) major incident procedure manual (2012).
Gold, Silver and Bronze Management Structure
7.3. ‘Gold’, ‘Silver’ and ‘Bronze’ are titles of tiers of management adopted across
the Emergency Services and are equivalent to those described as
‘Strategic’, ‘Tactical’ and ‘Operational’ as defined below.
Strategic Incident Management (NHS GOLD01)
7.3.1.
At the Strategic level, there must be an identified individual who is in
overall executive command of the organisationreferred to as Gold.
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7.3.2.
This person, will accept personal responsibility for the Strategic
Management of the incident (including for decision taken at a
strategic level), represents the top level of Command and Control and
will be the On-call Director.
7.3.3.
There must only be one NHS CB LRO Gold for any incident at any
time. Gold is responsible for setting the Strategy for resolving the
incident; determining the strategic intentions and communicating
them to the (Silver) Tactical Management (NHS01).
7.3.4.
Gold will operate remotely from the incident scene if there is one,
maintaining a strategic overview of the incident and will be located in
LRO Incident Coordination Centre, 4th floor of South Side, 105
Victoria Street, London, SW1E 6QT.
TacticalIncident Management (NHS01)
7.3.5.
At the Tactical level, there must be an identified individual appointed
to manage the incident, referred to as Silver.
7.3.6.
This person will accept personal responsibility for the Tactical
Management of the incident and represents the middle level of
Command and Control and will be the On-call Senior Manager.
7.3.7.
There will normally only be one Silver Incident Manager at any one
time as Silver is responsible for developing the plans to deliver the
Gold Strategy.
7.3.8.
Silver must remain tactical and not allow themselves to become
embroiled in operational matters, and will be located in LRO Incident
Coordination Centre, 4th floor of South Side, 105 Victoria Street,
London, SW1E 6QT.
Operational Incident Management (Provider Trusts and Primary Care)
7.3.9.
This is the operational level of Command and Control, required to
deliver the tactics set by the Silver in delivering an incident response.
7.3.10. Within the NHS CB LRO Structure this role is provided by those front
line organisations such as acute hospital trusts, tertiary and specialist
hospitals and primary care contractors such as general practice and
community pharmacies who deliver services directly to patients.
Multi Agency Engagement
7.4. Certain incidents such as mass casualty incidents will require a multi-agency
response with multi-agency groups set up to manage the response.
Gold Coordinating Group (GCG)
7.4.1.
At Gold level, the usual multi-agency forum is the Gold Co-ordinating
Group. Within London this group is based on the geographical
boundary of the Metropolitan Police Force and will usually be chaired
by the Chief Constable or their nominated deputy. The Gold Coordinating Group will comprise of Chief Officers and strategic players
representing the responding emergency services, agencies and
organisations. As incidents can move very quickly, representatives
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are expected to bring executive decision making power to the group
without having to refer back to the organisation for the authority to act
or commit resources. This group will meet as often as required, to
develop the strategy for dealing with the incident.
7.4.2.
In the event that there is a requirement for NHS CB LRO to attend a
GCG meeting alongside the Ambulance Service and Public Health
England, NHS Gold will attend with strategic support provided by the
Regional Lead for EPRR or their deputy from within the EPRR Team.
Tactical Coordinating Group (TCG)
7.4.3.
Tactical Co-ordinating Groups are generally held at or close to the
scene of the incident on an ad-hoc basis, and will usually be chaired
by the Police Silver Commander. The Tactical Co-ordinating Group
will comprise of Silvers from all emergency services, agencies and
organisations operating at the scene.
7.4.4.
Where an incident cordon affects a health care facility, the NHS CB
LRO may wish to appoint an individual to attend TCGs, or may rely
on feedback from organisations represented at the scene of the
incident.
Scientific and Technical Advisory Cell (STAC)
7.4.5.
During some types of emergency, the Gold Co-ordinating Group may
require expert scientific and technical advice on which to base
decisions. In England, this is facilitated through the Scientific and
Technical Advisory Cell provided by Public Health England. This will
comprise of a small group of experts working together within a Gold
Co-ordinating Centre, or virtually with experts working remotely.
There is no requirement for NHS CB LRO to send representation to a
STAC.
Scientific Advisory Groups for Emergencies (SAGE)
7.4.6.
Should the incident be significant enough to require the designation
of a Lead Government Department or COBR the SAGE will be
established to provide expert scientific and technical advice on which
to base decisions. The SAGE will have clear lines of communication
with the STAC as required. There is no requirement for NHS CB LRO
to send representation to a SAGE.
Emergency Coordination of Scientific Advice (ECOSA)
7.4.7.
It is recognised that due to their nature both STAC and SAGE can
take time to establish. In the interim period specialist scientific and
technical expertise can be provided by ECOSA facilitated by the
Atomic Weapons Establishment, Defence Scientific and Technology
Laboratory and PHE for any incident confirmed or expected to be a
counter terrorism or CBRN incident. There is no requirement for NHS
CB LRO to participate within ECOSA.
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Partner Agency Engagement
7.5. The following partner agencies are likely to be involved in the response to
an incident, requiring communication and information sharing between the
organisations.
Department of Health/National CB
7.5.1.
During a wide scale incident the Department of Health will be
expected to represent Health at Cabinet Office and Government
Meetings. In order to provide ministers with an accurate impact of the
incident to the NHS it may be necessary for additional situation
reports (SitReps) and assurance processes to be implemented or
guidance released. The NHS National CB will implement any
requests from the Department of Health, attending meetings as
required.
Public Health England (PHE) – To Be Confirmed
7.5.2.
Public Health England (PHE) provides an integrated approach to
protecting UK public health through the provision of support and
advice to the NHS, local authorities, emergency services, other armslength bodies and the Department of Health and devolved
administrations. Specialist advice includes infectious diseases,
outbreak surveillance, chemical, biological and radiation hazards.
7.5.3.
It is the PHE’s responsibility to:




Protect the wider public health
Provide specialist advice through the Scientific and Technical
Advice Cell (STAC) or directly to acute Trusts through the
National Poisons Information Service or The centre for Radiation,
Chemical and Environmental Hazards
Provide public health advice to the NHS CBLRO during an
incident
Provide updates on public health issues to the Local Authorities
via the Directors of Public Health when required
7.5.4.
PHE will also be responsible for establishing the Health Register at
the time of an incident.Following the 7/7 London bombings and the
repatriation of survivors after the tsunami, it was acknowledged that
there should be a single register of casualties compiled for all
incidents. PHE will undertake to deploy personnel to hospital EDs
after the event to compile this information, in partnership with the
hospital administration staff.
7.5.5.
Within London the PHE will operate via the Public Health Centre and
North and South London Units.
London Ambulance Service (LAS)
7.5.6.
The primary responsibility of the LAS is to save life in conjunction with
the other emergency services. During the incident LAS is responsible
for conveying patients from the scene of the incident to primary care
institutions or Acute Hospitals for treatment and/or on-going care.
LAS are responsible for designating hospitals and providing an
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Ambulance Liaison Officer within the ED to ensure effective
communications and appropriate distribution of patients.
7.5.7.
LAS are primarily responsible for communications around a major
incident from the point of onset, and for alerting key NHS
Organisations including the NHS CB London Region.
7.5.8.
It is the LAS responsibility to:

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

Co-ordinate the NHS response at the scene of a ‘big bang’ major
incident
Nominate and alert receiving hospitals and other NHS agencies
Undertake search and rescue of casualties using Hazard Area
Response Teams (HART)
Provide treatment, stabilisation and transport of those injured at
the scene, conveying patients who need further treatment to
receiving hospitals
Undertake decontamination of patients at the scene using HART
before conveying patients to hospital
Establish effective triage point and determine the priorities for
evacuation of the injured to hospitals
Provide liaison and communications with receiving hospitals
Maintain emergency and routine cover for the rest of London
Acute Hospital Trusts
7.5.9.
Acute Hospital Trusts will provide a safe and secure environment for
the assessment and treatment of patients from an incident as well as
providing space to receive patients’ relatives in addition to the ongoing treatment of patients already in their care. They are also
responsible decontamination of patients as required and for liaising
with the Police Service for the protection of evidence and
identification of persons.
7.5.10. It is Hospital Trust’s responsibility to:

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Activate major incident plans for internal or external emergencies,
notifying NHS CB LRO when self-declaring incidents
Provide treatment and care for the injured or ill, ensuring the
highest quality care is provided to all patients
Notify the Health Protection Unit in dealing with public health
emergencies
Work with the Emergency Bed Service, NHS CB LRO and
CCGs/CSUs to manage bed capacity, including special
arrangements such as Rapid Discharge
Manage tertiary referrals
Decontamination of patients as required and the protection of
evidence
Maintain emergency and routine service continuity as soon as
possible
Link with Clinical Commissioning Groups, Social Services, local
authorities in coordinating services
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Primary Care Services
7.5.11. Primary care services such as General Practice and Community
Pharmacies will support the NHS CB LRO in their front line response
to a major incident, either through the provision of services e.g.
distribution of prophylaxis via community pharmacies or the redeployment of staff to assist in incident response.
7.5.12. It is Primary Care Services responsibility to support the NHS CB LRO
response by:
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

Providing additional services for incident response as requested
and commissioned e.g. distribution of prophylaxis
Re-deploying staff to assist in incident response e.g. provision of
clinical staff to Survivor Reception Centres, Anti-Viral collection
points or medical facilities as appropriate
Reducing non-urgent referrals into acute hospital services
impacted by surge capacity/increased demand e.g. EDs and
Pathology
Mental Health Trusts
7.5.13. Mental health trusts will support the wider health economy during a
major incident, with regard to the mental health of individuals involved
in or affected by major incidents either as a responder or as a
patient/victim.
7.5.14. It is Mental Health Trust’s responsibility to:


Support the establishment of Humanitarian Assistance Centres
Monitor and treat the longer-term psychological impacts of a
major incident to those involved or affect either as a responder or
a patient/victim and the general public
Community Care Providers
7.5.15. Increasingly across London both Acute and Mental Health Trusts are
taking over the provision of Community Health services to their local
populations. During a major incident the providers of community care
can assist the wider health economy through the continuation of their
services and the provision of care within the community thus reducing
demands to acute hospitals. Clinical community staff may also be redeployed to assist with incident response e.g. in the administration of
prophylaxis.
7.5.16. It is Community Care Providers responsibility to:



Ensure the continuation of business as usual community care
provision
Provide additional services for incident response as requested
and commissioned e.g. additional care within the community for
patients discharged from hospitals
Re-deployment of staff to assist in incident response e.g.
provision of clinical staff to medical facilities or specialist
immunisation/prophylaxis clinics as appropriate
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Clinical Commissioning Groups (CCG)
7.5.17. Clinical Commissioning Groups are a Category Two responder under
the Civil Contingencies Act, and have a statutory duty to assist NHS
CB LRO in its response to an incident as required.
7.5.18. It is the CCGs responsibility to:
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Manage surge capacity and decant operations arising as a
consequence of a major incident in cooperation with providers
and other agencies, e.g. Social care
Inform LRO Incident Coordination Centre of contact details in the
event of a major incident (mobile number, email address, fax
number)
Provide local knowledge to LRO Incident Coordination Centre
where able to do so
Ensure that the actions taken and decisions made in relation to
the major incident are logged
Co-operate in and provide requested information at any
subsequent debrief
NHS Blood and Transplant (NHSBT)
7.5.19. NHS Blood and Transplant (NHSBT) are a special health authority
responsible for the collection and supply of blood, blood related
products and organ transplant.
7.5.20. NHSBT are also responsible for the maintenance and delivery of the
National CBRN Antidote stockpile (PODs of antidote medication for
nerve agents, cyanide and botulinum) accessed via the London
Ambulance Service.
7.5.21. It is the NHSBTs responsibility to:


Control, manage and deliver blood and blood related products to
meet the demand of major incident patients
Deliver CBRN Antidote PODS as required
Local Authority Director of Public Health
7.5.22. The Directors of Public Health have a responsibility to assure
themselves of the plans in place to respond to a major incident;
providing support to Public Health England with public health
incidents and emergencies within their local authority area.
7.5.23. It is the Directors of Public Health responsibility to:


Provide initial leadership in conjunction with Public Health
England to public health incidents and emergencies within their
local authority
Support longer term management of public health incidents in
their local area resulting from incidents
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Local Authority Emergency Planning
7.5.24. During a Major Incident the Local Authority is responsible for setting
up Rest and Evacuation Shelters for people who may have been
displaced or evacuated.
7.5.25. The Local Authority will also provide support to the Acute Hospitals,
by arranging for patients to transfer into the community/residential
care for on-going treatment where possible, to create bed capacity for
Major Incident Patients through adult social services. They will also
provide assistance with Patient Transfer, where possible.
7.5.26. The Local Authority will take over as the lead organisation for the
incident recovery phase.
7.5.27. It is the Local Authority responsibility to:




Support and care for the community, i.e. rest centres
Co-ordinate non-emergency services response
Provide emergency mortuary capacity
Manage the recovery and return to normality phases
Metropolitan Police Service (MPS)
7.5.28. The MPS is primarily responsible for preserving life, upholding the
law, and ensuring the protection of evidence and premises.
7.5.29. Where an incident is believed to be a criminal or act of terrorism
Police Officers will be deployed to designated hospitals and located
within EDs to oversee the collection of evidence, interview witnesses
and assist in person identification.
7.5.30. Casualty bureau is a national police managed resource which will
collate the details of any person involved in the incident, including the
deceased or believed missing. The bureau will collate all of the
details relating to people believed to have been involved or missing
from family members, relatives and friends contacting them, and is
responsible for identifying the locations of patients and the deceased
so they can inform the family or next of kin. As such the bureau will
require information about the patients being treated within Acute
Hospital Trusts.
7.5.31. It is the MPS responsibility to:







Co-ordination of the responding emergency services
Secure, protect and preserve the scene
Set up and maintain cordons
Lead the incident investigation and appoint Coroner’s Officers
Collect and distribute casualty information, via the Casualty
Bureau
Collect evidence and statements from those involved in the
incident
Informing bereaved families and management of the deceased
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London Fire Brigade (LFB)
7.5.32. The London Fire Brigade (LFB) are primarily responsible for
preserving life, tackling fires, search and rescue and for the health
and safety of those personnel working within the inner cordon.
7.5.33. The fire service is also able to undertake mass decontamination
should it be required.
7.5.34. It is the responsibility of the Fire Service to:






Fight fires
Undertake search and rescue of casualties
Management of hazardous materials
Advise regarding hazardous materials
Safety management of inner cordon
Provide Mass decontamination for uninjured but contaminated
casualties
Government Bodies
7.5.35. A range of other Government bodies will have key roles to play,
depending on the type of incident or emergency and may become the
Government Lead Department:





Environment Agency in an incident affecting the environment
(flood or pollution incidents)
Health and Safety Executive in its role of ensuring the health
and safety of people in their workplaces (including the responding
emergency services), as well as its regulatory role in sites such as
nuclear installations, hospitals, schools and railway safety, and its
specialist expertise in CBRN and major hazard industrial sites
Highways Agency in an incident affecting the road network in
England
Department for Energy and Climate Change in an incident
affecting the supply or distribution of fuel
Met Office will provide forecast information on severe weather
events, and are a key agency with regard to the Heatwave and
Winter Planning
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Command & Control Algorithm
Major Incident Alert Messages
7.6. NHS CB London Region will usually be informed of a Major Incident or
Emergency by the London Ambulance Service (LAS) Control or an Acute
Hospital Trust contacting NHS01, (however it is possible that notification of
an incident may come from different and multiple sources including partner
agencies) using the following standardised alert messages:
Major Incident Standby
7.6.1.
This message will be used when the situation is unclear, at an early
stage or has the potential to escalate, alerting NHS CB London
Region that a Major Incident may need to be declared. This could be
for either a ‘rising tide’ incident, or a sudden no notice ‘big bang’
incident.
7.6.2.
It will be the decision of NHS GOLD01 in conjunction with NHS01 to
activate Command and Control and the Incident Response Plan, or to
maintain Business as usual pending further information.
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Major Incident Declared
7.6.3.
This message will be used by NHS GOLD01 in conjunction with
NHS01 to declare a major incident based upon information received,
e.g. if specialist health arrangements are required.
7.6.4.
Declaring a major incident will automatically activate NHS CB LRO
Command and Control, Incident Response Plan and Major Incident
Cascade to inform personnel and mobilize appropriate additional
resources.
7.6.5.
In some rare circumstances this message may be received by
NHS01 from another agency or organisation declaring a major
incident. In such a situation NHS GOLD01 in conjunction with NHS01
will decide if specialist arrangements for health are required,
activating this plan as necessary.
Major Incident Cancelled
7.6.6.
This cancels either of the first two messages at any time and will
automatically stand down Command and Control and the NHS CB
LRO Incident Response Plan.
Scene Evacuation Complete
7.6.7.
This message is primarily for acute hospital trusts but will alert NHS
CB LRO that all live casualties have left the scene. Where possible
the LAS Incident Commander will make it clear if any casualties are
still on route to hospitals.
7.6.8.
The LAS are likely to stand down their response to the incident at this
point, however some agencies including Acute Hospital Trusts will
still require specialist arrangements to be in place, and will only stand
down their organisation once Business as Usual levels can be met by
normal arrangements or when moving into a recovery phase.
Major Incident Stand down
7.6.9.
This will alert NHS CB London Region that the incident response has
formally been stood down, indicating the return to business as normal
or start of the recovery period. NHS GOLD01 in conjunction with
NHS01 will be responsible for the stand down of Command and
Control and the Incident Response Plan once demand for services
has reduced to Business as Usual levels and can be met by normal
arrangements, or once the organisation moves into the recovery
phase.
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NHS CB Incident Alert and Response Levels
Alert
Alert
Activity
Action
Dynamic Risk
Assessment
Declaration of
Incident Level
NHS CB Incident Level
A health related incident that can be
responded to and managed by local
0 health provider organisations within
their respective business as usual
capabilities.
A health related incident that
requires the response of a number of
health provider organisations across
1
an NHSCB Area Team boundary
and will require an Area Team to coordinate the NHS local support.
A health related incident that
requires the response of a number of
health provider organisations across
2 NHSCB Area Teams across and
NHS CB Region and requires
Regional co-ordination to meet the
demands of the incident.
A health related incident that
requires NHS CB National co3
ordination to support the NHS and
NHS CB response.
8. INCIDENT RESPONSE - ACTIVATE
8.1. This section details triggers and arrangements in place for activating the
NHS CB LRO response to a major incident, through the activation of
command and control and the incident response plan.
Trigger
8.2. As the EPRR Team Manager On-call NHS01 will receive information and
alerts which may require the activation of the NHS CB LRO response to a
major incident as follows:



Receipt of a Major Incident Standby Message
Receipt of a Major Incident Declared Message
Receipt of information from a provider, ambulance service or primary
care contractor pertaining to an internal incident, surge in demand for
services or disruption to business as usual operations
8.3. NHS01 is responsible for undertaking a dynamic risk assessment of the
information received to ascertain if the situation/incident can be managed
using business as usual arrangements or if specialist arrangements are
required.Where specialist arrangements are required NHS GOLD01, in
conjunction with NHS01 has the authority to activate the NHS CB LRO
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Command and Control and Incident Response Plan, determining the most
appropriate level of response.
8.4. NHS GOLD01 in conjunction with NHS01 will have the authority to activate
any change in the level of NHS CB LRO response i.e. escalation, deescalation and stand down based upon on-going dynamic risk assessments.
8.5. When considering the level and organisation of the NHS CB LRO response
NHS GOLD01 and NHS01 should consider the implications of their decision
and the impact this will have to the delivery of health services e.g. declaring
a major incident and designating a hospital is likely to result in the rapid
discharge of patients and short term cancellation of elective surgery and
non-essential outpatient clinics.
Dynamic Risk Assessment& Decision Making
8.6. A dynamic risk assessment should be used to inform the
discussion/decision with regard to the appropriate level and organisation of
the NHS CB (London).
8.7. Details of the dynamic risk assessment undertaken and the rationale for the
level and organisation of the NHS CB LRO response must be documented.
8.8. To assist with dynamic risk assessment the following suggested criteria
should be considered; however this list is not exhaustive and dependant on
the incident/situation other criteria may need to be included.

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




The significance of the impact upon the NHS in terms of resources
required to manage the response
Public perception/concern – issues of public confidence e.g. an
incident with limited risk to the whole NHS might be escalated to a
higher level if there is widespread community or media interest
Media attention - regional, national, international
Implications for partners and partnerships - resources, reputation,
reciprocity
Impact on the NHS reputation and relationships
Complexity of situation, and associated competencies for handling
Potential malicious incidents (act of terrorism, deliberate release, and
hoaxes) will escalate the response level
The possibility of subsequent adverse events
In the initial stages, full implications of the incident may not be evident.
Consideration should be given to providing a response and deescalation when appropriate
A state of readiness following de-escalation of an incident in case the
situation escalates again (e.g. public riots) or a very low level response
and protracted ‘tail’ that still requires national coordination (e.g. Libyan
amputees)
8.9. An action card to assist with Risk Assessment can be found in Appendix A.
8.10.The Association of Police Officers National Decision Making Model can be
used as a framework for decision making throughout the course of incidents.
The model is cyclical where each step logically follows another, however the
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model allows for continued reassessment of the situation or incident
enabling previous steps to be revisited.
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Algorithm of NHS CB LRO Activation
London Regional Office Incident Coordination Centre
8.11.The response may require the activation of the LRO ICC- the London
Coordination Centre (LICC) located 4th floor of Southside, 105 Victoria
Street, London, SW1E 6QT.The function of the LICC is to provide a focal
point for coordination of the response, gathering, processing, archiving and
dissemination of information across the NHS and externally where
appropriate.
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8.12.Full details of the LICC operations can be found in the NHS CB London
Coordination Centre Operating Procedures, including;



How to access the LICC out of hours
How to set up and operate the LICC
Fall back arrangements including locations and activation procedures
8.13.Access to the LICC will be restricted to ensure only those required to be in
attendance have access. As such all staff should ensure they are wearing
their ID badge, any staff not wearing ID badges, authorised or required to
have access to the LICC will be challenged and may be refused entry or
asked to leave.
Staff Activation
8.14.NHS01 will alert staff required to attend the LICC via the PageOne pager
system. This message is activated by contacting 0844 822 2888 and
requesting a message to be sent to EPRR01, SM01, ADMIN01with the
following message:
Major Incident declared. Please confirm receipt of this message to
[insert detail] and attend the LICC [insert detail].
9. INCIDENT RESPONSE - OPERATE
9.1. This section details how the NHS CB LRO will operate during a major
incident response, including outlining roles and responsibilities required to
deliver the NHS CB LRO response.
Roles and Responsibilities
9.2. It should be noted that the roles required may vary depending upon the level
of response required. For full details of responsibilities and associated
actions, please refer to the Action Cards contained within Annex A.
Chief Executive NHS Commissioning Board
9.2.1.
The NHS CB Chief Executive has ultimate responsibility for the CB
nationallyand remains accountable for business delivery throughout
all situations; however in a response to extreme pressure, major
incidents or emergencies this is usually discharged through an on-call
executive director.
London Regional Office Chief Operating Officer
9.2.2.
The Chief Operating Officer is accountable to the NHSCB Chief
Executive for the national and corporate direction and delivery of the
NHS response to an incident; however this is usually discharged
through the on-call executive director.
London Regional Office Director
9.2.3.
The Regional Director for London (Action Card 8) will be alerted to a
major incident by NHS GOLD01 and will be responsible for:
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


Acting as the Trust spokesperson/representation for external
press and communications in conjunction with the
Communications Department/NHS CB National
Working in partnership with NHS GOLD01 to set the strategic
direction for NHS CB London Region as required
Ensuring an accurate Log of any actions and decisions is kept
contemporaneously, signed and passed to the Emergency
Planning Team for retention
London Regional Incident Director (NHS GOLD01)
9.2.4.
During a Major Incident the On-call Director will assume the role of
NHS GOLD01 as per Action Card 2;they will be based in the LICC
and will be responsible for:













9.2.5.
Setting the strategic aim for the NHS CB London and Provider
Trusts and Primary Care
Liaison with the National Incident Management Structure to
ensure it remains appraised of the incident as required/necessary
Liaising and communicate with other key agencies
Ensuring resources are made available to support the NHS
response
Informing the Regional Director
Attending Gold Co-ordinating Group meetings as required
Appointing a Director as Incident Recovery Manager
Agreeing the Press and Communications Strategy in conjunction
with the Incident Communications Manager
Ensuring the Intelligence/SitRep requirements of NHS National
CB are met as appropriate
Setting the Gold intelligence/SitRep reporting requirements for
NHS CB London Region, Provider Trusts and Primary Care
Ensuring an accurate Log ofactions and decisions is kept
contemporaneously, signed and passed to the Emergency
Planning Team for retention
Agreeing the stand downof the Recovery phase with the Incident
Recovery Manager
Participating within Post Incident debriefing to ensure
improvements and best practice are identified
NHS GOLD01 will be supported by the London Regional:






Incident Management Team Coordinator (SM01)
Incident Manager(NHS01)
Incident Management Team Task Manager (EPRR01)
Incident Communications Manager
Incident Control Centre Support Staff (Admin01)
Public Health England &STAC
London Regional Incident Recovery Director
9.2.6.
NHS GOLD01 will appoint a separate CB LRO director to assume the
role of Incident Recovery Manager (Action Card 7); they will be based
in South Side and will be responsible for:
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





9.2.7.
Determining opportunities for longer term regeneration or
restructure of NHS services
Activating Business Continuity Plans to manage the
recovery/return to business as usual or new normal, including the
procurement of staff or supplies should they be required
Ensuring post incident welfare arrangements are in place
Attending Recovery Gold Co-ordinating Group meetings as
required
Ensuring an accurate Log of actions and decisions is kept
contemporaneously, signed and passed to the Emergency
Planning Team for retention
Participating within Post Incident debriefing to ensure
improvements and best practice are identified
The Incident Recovery Director
Regional:











will be supported by the London
Incident Management Team Coordinator (SM01)
Incident Management Team Task Manager (EPRR01)
Incident Communications Manager
Incident Control Centre Support Staff (Admin01)
EPRR team
HR directorate
Delivery directors
Finance directorate
Nursing directorate
Strategy and system management
Other areas of the Commissioning Board as required
London Regional Incident Management Team Coordinator (SM01)
9.2.8.
During a Major Incident the On-call Senior Manager (SM01) will
assume the role ofIncident Management Team Coordinator as per
Action Card 4; they will be based in the LICCand will be responsible
for:






9.2.9.
Deputising for NHS GOLD01 as appropriate, appointed and
required
Supporting NHS GOLD01 in the making of strategic decisions.
AssistingNHS01 in the mobilisation and management of the NHS
response
Liaising with key external agencies as required/necessary.
Ensuring an accurate log of your actions and decisions is kept
contemporaneously, signed and passed to the Emergency
Planning Team for retention
Participating within Post Incident debriefing to ensure
improvements and best practice are identified
SM01will be supported by:

Incident Control Centre Support Staff (Admin01)
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London Regional Incident Manager (NHS01)
9.2.10. During a Major Incident the LROEPRR On-Call Manager (NHS01)will
assume the role of Incident Manager as per Action Card 1;they will be
based in the LICC and will be responsible for:








Setting the Tactical direction for the LICC to deliver Gold’s
Strategic Aims and Objectives through the mobilisation and
management of the NHS response with assistance and advice
from SM01
Managing the coordination of LICC for the duration of the incident,
allocating tasks and resources, determining priorities and
obtaining additional resources as required for incident response
and maintaining service continuity
Ensuring plans are implemented for the initial establishment of the
LICC, activating On-call personnel via the relevantPageOne Call
Signs
Planning for the continued staffing of the LICC over a prolonged
period including the management of EPRR01
Liaising with key external agencies as required/necessary
Ensuring suitable lines of communication are maintained post
incident stand down
Ensuring an accurate Log of your actions and decisions is kept
contemporaneously, signed and passed to the EPRR Team for
retention
Facilitating post Incident debriefing to ensure improvements and
best practice are identified and reported
9.2.11. NHS01 will be supported by the London Regional:



Incident Management Team Co-ordinator (SM01)
Incident Management Team Task Manager (EPRR01)
Incident Control Centre Support Staff (Admin01)
London Regional Incident Management Team Task Manager (EPRR01)
9.2.12. During a Major Incident the EPRR Team On-Call Officer
(EPRR01)will assume the role of Incident Management Team Task
Manager as per Action Card 5; they will be based in the LICC and will
be responsible for:






Providing Tactical advice and support as appropriate and required
Managing the LICC to ensure it meets the requirements of NHS
GOLD01 and NHS01
Fulfilling the LICC intelligence/SitRep requirements by ensuring
regular updates are received from Local Area Teams, Provider
Organisations and Primary Care to NHS GOLD01 and NHS01
Delivering workforce plans such as LICC Rotas for the continued
delivery of the LICC over a prolonged period
Liaising with key external agencies as required/necessary
Ensuring an accurate Log of actions and decisions is kept
contemporaneously, signed and passed to the EPRR Team for
retention
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

Facilitating the maintenance of suitable lines of communication
post incident stand down
Participating within Post Incident debriefing to ensure
improvements and best practice are identified
9.2.13. Tactical Support Officer will be supported by Regional;

Incident Control Centre Support Staff (Admin01)
London Regional Incident Communication Manager
9.2.14. A Communications Manager will be appointed to assist with general
communications and media messaging during the incident as per
Action Card 3, responsible for:




Managing the Press and Communications in conjunction with
NHS GOLD01
Brief the NHS CB LRO spokesperson as required
Liaising with NHS CB National Communications and CCG
Communications as required
Monitoring regional and local press coverage to ensure any
negative press is met with an appropriate response
London Regional Incident Control Centre Support Staff (ADMIN01)
9.2.15. Administrative Support On-call (Action Card 6) will be contacted by
NHS01 via the PageOne System and will be based in the LICC and
will be responsible for:



Undertaking general administrative tasks as assigned by
ADMIN01 e.g. taking meeting notes and answering phones)
Ensuring accurate logs are maintained for communications and
messages received and dispatched
Participating within Post Incident debriefing to ensure
improvements and best practice are identified
9.2.16. In addition some administrative support staff will be designated the
role of Loggistsand will be responsible for:


Recording and documenting all decisions made and activities
undertaken by the Gold/Silver/NHS01 whilst undertaking their
responsibilities in a contemporaneous log, following best practice
guidelines
Recording and documenting all messages received by
Gold/Silver/NHS01 in relation to the incident
All NHS CB LRO Staff
9.2.17. All staff may be requested to assist (as appropriate and trained) with
the response to a major incident. As such all staff should ensure they
are familiar with the arrangements for incident response. Staff not on
call will be alerted to a major incident via internal email and intranet,
and may be contacted directly by their managers, or members of the
incident management team.
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Function of the LICC
9.3. The LICC is structured to support the Strategic and Tactical incident
managers and facilitate effective communication and management of the
incident both internally and externally. As such the key functions of the LICC
are considered to be, but not restricted to:















Coordinating the local NHS response
Establishing communication with participating NHS organisations.
Liaising directly with other NHS Emergency Control Rooms
Collecting and assimilating information from each participating NHS
organisation - for assessment e. the situation, and for passing up to
National CB and Department of Health (DH) when required
Acting as the coordination point for the health media strategy for the
NHS
Supporting alocal public health response in conjunction with PHE
through the mobilisation of NHS resources as required
Assessing the on-going situation and identifying emerging issues
Maintaining links with NHS Direct regionally
Providing resources to support the local effort using mutual aid either
locally or regionally
Liaising with National CB to support the local effort, mobilising mutual
aid nationally or internationally, where required
Liaising with the National CBto support response elsewhere regionally,
nationally or internationally
Supporting the screening, epidemiology and long term assessment and
management of the effects of an incident
Making provision for a 24 hour emergency response
Acting as a conduit for information and instructions to the local NHS
and the Strategic Coordinating Centre (SCC)
Acting as a health focal point for liaison with partner agencies and
organisations
Situation Reports (SitReps)
9.4. During a Major Incident, the NHS CB LRO will be expected to meet the
SitRep requirements of NHS NCB in order that effective briefings can be
given to the Chief Executive and the Department of Health.In order to
complete these SitRepsthe LICC will collate information from provider Trusts
via the web based EP SitRep tool. The requirements for provider trust and
contractor SitReps will be defined by NHS GOLD01 in conjunction with
SM01 and NHS01.
Press, Media and Communications
9.5. In line with the NHS CB Major Incident Communications Plan, the
Communications Manager On-call and NHS GOLD01 are responsible for all
press and media relations, as well as ensuring NHS CB LRO staff are kept
informed of the incident response and the impact to services, arranging
press conferences, press releases and briefings to staff, patients and
journalists.
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9.6. All press and media information must be channelled through the LICC and
communications lead or their nominated deputy. No information is to be
passed to the media unless it has been sanctioned by the LICCin
conjunction with NHS GOLD01. As such staff should not talk to the press or
make statements on behalf of the organisation, with media requests referred
to the On-call press officer within the LICC.
9.7. For London-wide incidents, the NHS CB LROCommunications Lead will
form part of a multi-agency Media Cell co-ordinated by the Metropolitan
Police. The location of the Media Cell will be advised early on in an incident
during the initial multi-agency teleconference call and is dependent on the
location and severity of the emergency.
9.8. The NHS CB LRO Communications Lead will liaise with Communications
Leads in other NHS organisations to ensure a coordinated approach to
media messaging is maintained, in line with the agreed multiagency
messages
9.9. The Communications Lead may be required to attend meetings at the NHS
London Co-ordination Centre or the Strategic Co-ordination Centre.
9.10.Members of the press and media are not permitted to film or photograph
onsite and should not be allowed access to any area of the NHS CB LRO. If
staff suspect members of the press and media of being in the building,
filming, taking photographs or harassing staff they should inform NHS01
within the LICCimmediately.
9.11.It is the responsibility of the Communications manager to ensure that all
communications are in line with the NHS National CB arrangements.
Records Management
9.12.An essential element of any response to an incident is to ensure that all
records and data are captured and stored in a readily retrievable manner.
This is fundamental to the NHS CB LRO response and these records will
form the definitive record of the response and may be required at a future
date as part of an inquiry process (judicial, technical, inquest or others).
Such records are also invaluable in identifying lessons that would improve
future response.
9.13.The most senior manager (NHS GOLD01, SM01 or NHS01) is
responsiblefor sign off of all briefing papers and documents relating to the
incident which must be documented within Incident Logs.
Workforce Management
9.14.NHS CB London Region has workforce plans in to maximise the number of
staff available to respond to an incident, should they be required.It is
anticipated that a Major Incident may impact on the business as usual
operational response with the cancellation of some activities such as nonessential meetings.
9.15.The NHS CB London Region Business Continuity Management System
provides a framework for the prioritisation of services and activities, as well
as identifying those that could be suspended or operate minimum service
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levels. The incumbent staff of suspended services would then be available
for re-deployment for incident response.
Working Time Directive
9.15.1. The European Working Time Directive specifies clear rest
requirements and working hours limits for all staff. NHS CB London
Region will support all staff to comply with the rest requirements of
the Working Time Directive, wherever possible.
9.15.2. In respect of working hours limits in the event of a Major Incident
NHS01 will monitor the situation and will make the necessary
adjustments to ensure compliance with working hour limits where
possible.Given the significant surge of activity that could result from a
Major Incident NHS CB London Region expects staff to be able to
achieve an average working week of less than 48 hours over the 17
week reference period that is in place.
9.15.3. In accordance with the law, staff are able to opt-out of the working
hours limit (48 hours per week on average), and this option will
continue to be available to staff.However it is stressed that working
time regulations are Health and Safety legislation and it is essential
that staff achieve the appropriate rest to support safe operations.
Shift Arrangements
9.15.4. In the event of a major incident or emergency having a substantial
impact on the UK it may be necessary to continue operation of the
LICC for a number of days or weeks. In particular in the early phase
of an emergency the LICC may require to operate continuously for an
extended period of time.
9.15.5. Responsibility for deciding on the scale of response, including
maintaining teams overnight, rests with NHS GOLD01 in conjunction
with NHS01.
9.15.6. A robust and flexible shift system will need to be in place to effectively
manage an incident through each phase.Shift arrangements will
depend on the nature of the incident and must take into consideration
any requirements for preparatory work to support external
information/SitRep requirements that may require early or late
working to meet deadlines. It will be important that there is rotation of
staff to prevent ‘burn out’ in protracted incidents. NHS01 will
formulate suitable staffing and shift arrangements for all staff
(including NHSGOLD01) to deliver the LICC.
9.15.7. Outline shift arrangements are presented below:




Requirements for each shift should be monitored at each
handover
Handover briefings must be appropriately detailed
During the first two shift changes 1-2 hours of hand over time is
required. The Incident Manager is accountable for ensuring
appropriate staffing of all shifts
Shift changes should be considerate of both staff welfare and
operational requirements
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


Where possible initial shift changes in teams should be staggered
Where possible there should be continuity of staffing
Staff welfare and health and safety policies must be followed
Staff Welfare and Safety
9.16.NHS CB London Region acknowledges that the Health, Safety and Welfare
of staff and visitors is at the forefront of any Major Incident response and
accepts that it has a duty of care to safeguard the well-being of all staff and
visitors by employing all reasonable practicable measures.
Counselling and Support
9.16.1. Welfare and trauma support will be made available to staff
responding to a major incident, irrespective of their role. This support
will be available from the very outset and early stages of the incident.
The responsibility for identifying the need for welfare support rests
jointly with individuals, their managers and the department with
responsibility for staff welfare.
9.16.2. During and following a major incident, staff welfare is of paramount
importance. The following measures will be in place for staff:


A designated area for staff will be set up. This will be an area
where staff can get refreshment, talk to each other, sit quietly etc
Details of support available from Occupational Health will be
made available to those who wish to speak to a counsellor
confidentially in the days and weeks after the incident
Financial Management
9.17.During the response to or recovery from an incident additional costs may be
incurred either through the procurement of additional supplies and services
or through the alteration of existing contracts.
Delegated Authority to Incur Costs/Expenditure
9.17.1. NHS CB LROhas delegated authority to incur costsand make
expenditure to the NHS GOLD01.
9.17.2. NHS GOLD01 may act on behalf of one or more Trusts within
London, sourcing, procuring and entering into a contract for the
provision of goods, services or personnel to those trusts as Agent for
the trust(s). In such circumstances the trust will be liable for the
associated expenditure.
9.17.3. As part of emergency response, NHSGOLD01 will ensure that
Finance department representatives are aware of all expenditure as
soon as possible and that all costs are logged.
Delegated Authority to Vary Existing Contracts
9.17.4. During an emergency the rule of thumb is that all costs will lie where
they fall.
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9.17.5. NHS GOLD01 may as part of their duties require the variation of
existing contracts for the supply of goods services or staff.
9.17.6. They are explicitly empowered (during a major incident) to direct that
goods, services or personnel being supplied to one or more trust or
organisation, in one or more specified location, should be supplied
instead to another trust or organisation and/or in another specified
location or locations. They may vary the quantities or schedules of
deliveries in order to ensure an effective response to a major incident.
9.17.7. This power shall be exercised with discretion, following discussions
with trusts affected when possible, in order to reflect overall NHS
priorities.
Delegated Authority to Approve Payments to Staff
9.17.8. During a major incident the NHS GOLD01 has delegated authority to
call in additional staff to assist in the management of the incident.
Such staff may be called in for work outside normal office hours.
9.17.9. In the event of staff being required to work outside normal office
hours they will be recompensed for all hours worked and will be
entitled to repayment of travel costs at usual rates for the journey to
the place at which they are asked to work.
9.17.10. Subsistence allowances will be paid where appropriate,
arrangements for the supply of meals etc. cannot be made.
if
Recording Financial Information
9.17.11. It is the responsibility ofNHS GOLD01 to maintain adequate logs and
records of all activity undertaken in respect of the response to a major
incident.Where the action has financial implications, it is essential that
the records are adequate to identify:








The expenditure that has been incurred and for what item or
service
When and where the item or service is to be provided
To whom the expenditure is payable – the company or
organisations name and address, and a named individual as
contact
On whose behalf the expenditure was incurred, particularly if
acting as an agent for a trust
The relevant terms and conditions of sale
When the bill is payable
The name of the individual approving the expenditure at the time
The date of the transaction
9.17.12. In order to provide an appropriate audit trail, copies of such
information will be supplied as soon as possible to the NHS CB LRO
Director of Finance, or an officer nominated by the Director to
oversee the financial implications of the incident.
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Military Aid to Civil Authorities
9.18.Under extreme circumstances it the response to or recovery from an
incident it may be necessary to request Military Aid to Civil Authorities
MACA, whereby military aid may be mobilised.
9.18.1. Any decision to enact military assistance will be assessed and
processed at a Government level, and may incur additional costs.
9.18.2. MACA may be enacted to provide both additional personnel and
resources such as;
 Additional personnel to provide security, crowd management or
protect areas.
 Resources such as additional vehicles including helicopters for
the movement of patients.
10.
INCIDENT RESPONSE – ESCALATION & DE-ESCALATION
10.1.Escalation or de-escalation through the incident levels need not occur
sequentially, but will be driven by the nature, scale and complexity of
incidents, coupled with the expectations of the NHS response. Any incident
response can be changed following a review, including a dynamic risk
assessment of the strategic direction and operational management of the
incident.
10.2.The level of the response may need to be escalated or de-escalated for a
number of reasons which may include, but are not limited to:
Criteria for Escalation





Increase in geographic area or population affected (Pandemic,
Flooding etc.)
The need for additional internal resources
Increased severity of the incident
Increased demands government departments the Service or from
partner agencies or otherresponders
Heightened public or media interest
Criteria for De-Escalation





Reduction in internal resource requirements
Reduced severity of the incident
Reduced demands from partner agencies or other government
departments
Reduced public or media interest
Decrease in geographic area or population affected
10.3.NHS GOLD01 has the authority to change the level and operation of the
NHS CB LRO response in conjunction with SM01 and NHS01. Details of the
dynamic risk assessment undertaken and the rationale for the change in
level and organisation of the NHS CB LRO response must be documented.
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10.4.All response level changes need to be communicated both internally and
externally as appropriate. A brief description of the resource implications of
the new level should be included with this communication.
Major Incident Stand Down
10.5.Major Incident stand down will be received by NHS01 from the Ambulance
Service to declare that all casualties have left the scene. NHS GOLD01 in
conjunction with SM01 and NHS01 will be responsible for the stand down of
the NHS CB Incident Response, Command and Control and the Incident
Response Plan once the NHS CB response phase has finished.
10.6.If necessary NHS GOLD01 will formally hand the incident over to the
Incident Recovery Manager to continue the management of the recovery
phase until such time as the demand for services has reduced to Business
as Usual levels and can be met by normal arrangements (including within
provider Trusts) or the new normal has been established.
10.7.It is the responsibility of NHS01 to ensure that where communication
channels have been specially created for the incident suitable and effective
forwarding or alternative mechanisms are implemented to ensure there is no
loss of traffic once the major incident is stood down, and during the recovery
phase.
11.
INCIDENT RESPONSE – RECOVERY
11.1.This section outlines the recovery phase of the incident managed by the
Incident Recovery Manager, and outlines some of the principles and
considerations for recovery.
11.2.Recovery planning should begin as early into the incident as possible to
consider:



Consequence Management - Taking steps to prevent the escalation of
the impacts of the incident (e.g. restoring essential services following a
disruption)
Restoration of the well-being of individuals, communities, and the
infrastructure which supports them -Early identification of long-term
impacts to ensure they are adequately addressed allowing the
reintroduction of targets, budgets and financial management
Exploiting opportunities afforded by the incident - Establishing what
happened, identifying potential improvements and applying lessons
learned to proactively adapt systems, services and infrastructures
affected by the incident to meet future needs.
11.3.Planning for recoveries can be built around four key themes, which are
covered in the more detail within the National Recovery Guidance:




Humanitarian - physical and psychosocial impacts, including deaths
and community displacement
Economic - economic and business continuity
Environmental - pollution and decontamination issues
Infrastructure - loss of NHS facilities, resources etc
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Recovery Strategy
11.4.At the start of the recovery process, it is vital that a clear recovery strategy is
developed and agreed. The recovery strategy could cover some, or all, of
the following key objectives:









An Impact Assessment should be carried out as soon as possible and
this should be regularly updated – covering impacts on NHS resources,
staff, infrastructure, environment, etc
Determining at an early stage if there is an opportunity for longer term
regeneration or restructure of NHS services as part of the recovery
process
A concise, balanced, affordable recovery action plan should be
developed that can be quickly implemented, involves all agencies and
fits the needs of the emergency
The wider community should be fully involved in the recovery process
All agencies work closely with the community and those directly
affected, including on monitoring and protection of public health
Utilities (e.g. water) and transport networks are brought back into use
as soon as practicable
All affected areas are restored to an agreed standard so that they are
‘suitable for use’ for their defined future purposes
Information and media management of the recovery process is
coordinated
Effective protocols for political involvement and liaison are established
NHS CB LRO Recovery
11.5.The Recovery Incident Manager will chair internal Recovery Group Meetings
if required, with representation from directorates to consider:
Services
11.5.1. Staff at NHS CB LRO may be required to support the Incident
Coordination Centre in responding to the acute phase of the incident,
or may be victims directly involved in the incident. The impact of this
may require the prioritisation of work within NHS CB LRO.
Considerations of which services can be suspended and which must
be maintained are contained in the NHS CB LRO Business Continuity
Plan. The role of the recovery group is to advise the priority order of
reintroduction of services and the management of this process.
Finance
11.5.2. The response to an acute incident can generate the need to spend
funds not anticipated or allocated. Consideration should be given to
the recovery of budgets and financial positions.
Staff
11.5.3. During the response phase staff often work extended hours, in
unfamiliar environments and in some cases annual and study leave is
cancelled. Staff welfare and recovery is often overlooked but is an
essential aspect of returning the organisation back to full capacity.
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Policy
11.5.4. The impact on the ability of NHS CB LRO to develop and deliver
policy for London will need to be monitored and maintained where
necessary. This includes the ability to fulfil annual business planning
processes e.g. The NHS Operating Plan and World Class
Commissioning.
11.6.In addition there are a number of issues including but not limited to the
following which will need to be considered and addressed:

















Occupational health and welfare of all staff and their families
Bereavement affecting or involving NHS staff
Mid to long term community support and medical services
Physical reconstruction of facilities
Reviewing key priorities for service provision and restoration
Long term public health issues
Financial implications, remuneration and commissioning agreements
Staffing and resources to address the new environment
Socio-economic effect of the incident on staff and the public
VIP Visits
Funerals, memorials and anniversaries
Staffing levels and resilience
Routine Performance Targets
On-going needs for assistance from and to NHS partners or other
agencies
Equipment and supplies
Rewarding, acknowledging the efforts of, and thanking staff
Performance ratings
Multi-Agency Recovery
11.7.Where strategic coordination of the recovery effort is required a Recovery
Coordination Group (RCG) will take over from the Police chaired Gold
Coordinating Group at a mutually agreed time. This will be chaired by a chief
executive of an appropriate local authority - usually involved with the earlier
response.
11.8.Representation at the Recovery Coordination Group will be commensurate
with the recovery needs of the events or situations as determined by the
Chair. The Recovery Coordination Group will continue to convene until there
is no longer a need for strategic coordination of the recovery effort.
11.9.The CCA (2004) provides for the establishment of a Regional Civil
Contingencies Committee as a means of coordinating the recovery at a
regional level.
11.10.
The Recovery incident Manager or their appointed deputy will
represent the NHS at the Recovery Coordination Group.
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12.
GOVERNANCE ARRANGEMENTS
12.1.This section of the plan outlines the Governance arrangements in place for
major incident debriefing reporting, training testing and exercising.
Documentation
12.2.All documentation related to the incident response, including Gold/Silver
Logs should be submitted to the EPRR Team with 72 hours of incident stand
down for review and retention in line with NHS CB Corporate Governance
Arrangements.
Post Incident Debrief
12.3.Debriefing is an important part of the major incident stand down and
recovery process to ensure that the effectiveness of the NHS CB LRO
response is evaluated to highlight areas of best practice and for
improvement by identifying lessons.
12.4.The NHS CB LRO will adopt the following debrief protocol:
T = Incident
T asap
Hot debrief
T + 1-2 weeks
Formal Debrief
T + 3 weeks
1st draft report complete for each NHS organisation
involved
T + 5 weeks
NHS CB LRO arrange meeting a director level for all NHS
organisations involved
T + 6 weeks
Reports written by each NHS organisation and circulated to
other organisations involved for 48 hour turn around. Final
local reports sent to NHS CB LRO
T + 8 weeks
NHS CB LRO report completed, with each local report as
an appendix
T + 12 weeks
EPRR Team collate NCH CB LRO report into a summary
statement with action plan
T + 6 months
Follow up report completed by each organisation
Hot Debrief
12.4.1. All operational areas involved with the incident response and Gold
and Silver should undertake a hot debrief brief immediately (within
24hrs) following stand down of the incident by NHS GOLD01 in
conjunction with SM01 and NHS01.
12.4.2. The aim of undertaking a hot debrief is to ensure that immediate
lessons identified and good practice are captured, for feedback at the
Post Incident Debrief. Hot debriefing also allows any concerns,
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impacts and risks requiring immediate mitigating actions to put in
place to be highlighted.
12.4.3. Any actions requiring immediate mitigating actions should be
discussed with the Regional Lead EPRR immediately following the
hot debrief.
Post Incident Report
12.4.4. A formal structured Post Incident Debrief, chaired by a member of the
EPRR Team, with all key personnel will be held within 2 weeks of any
activation of this plan to identify areas for improvement or good
practice and to increase the NHS CB London Region’s emergency
preparedness and resilience.
12.4.5. It should be noted that at the time of debriefing the recovery phase
may still be on-going, and as such a secondary debrief may be
required to capture any further learning from the recovery phase once
stood down.
12.4.6. Typically the Post Incident debrief will include:




Nature of incident
Involvement of NHS CB LRO
Involvement of other responding agencies
Implications for strategic management of the NHS
Multi-Agency Debrief
12.4.7. After a Major Incident it is likely that a multi-agency debrief will be
held. It will be the responsibility of the NHS01 supported by the EPRR
Team to represent NHS CB London Region and capture areas where
isomorphic learning may be applied.
Post Incident Report
12.4.8. A Post Incident Report will be written by the EPRR Team within 1
month of the incident. The report must contain a Corrective Action
and Preventative Action (CAPA) log/plan capturing all of the
mitigating actions against any areas for improvement.
12.4.9. The Report will follow the NHS CB Corporate Governance
Arrangements, and will be agreed by the Regional EPRR Lead,
before being submitted to the Senior Management Team and the
London Local Health Resilience Partnership. Once agreed the report
will be submitted to the NHS National CB and shared with any
external agencies as required.
13.
TRAINING
13.1.Those undertaking command roles within an emergency / major incident
must undertake appropriate training for their function and in line with the
required competencies for their role/function.
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13.2.Core competencies for NHS Command Training are contained within the
Model Competencies for Members of NHS Commissioning Board
Emergency On-call Rotas.
13.3.Training for incident commanders should occur regularly to familiarise
themselves with command and control procedures and to ensure there is no
erosion of skills.
13.4.Those other staff required to support the command team in the control
function should also receive training to undertake their role.This includes
control room familiarisation, loggist training and situation report writing.
13.5.Training records will be used as documented evidence of the completion of
relevant and suitable training.
14.
TESTING & EXERCISING
14.1.Plans developed to allow organisations to respond efficiently and effectively,
must be tested regularly using recognised and agreed processes such as
table top or live exercises.Roles within the plan (not individuals) are
exercised to ensure any specific role is fit for purpose and encapsulates all
necessary functions and actions to be carried out during an incident.
14.2.Through the exercising process, individuals have the opportunity to practice
their skills and increase their confidence, knowledge and skill base in
preparation for responding at the time of a real incident.
14.3.The NHS CB Emergency Planning framework (2013) defines the process
and timescales in which this has to be achieved.This includes a minimum
expectation of a communications exercise every 6 months, a table top
exercise ever year, and a live exercise every three years.
14.4.A Post Exercise report will be written to summarise the test/exercise and to
highlighting areas of best practice and for improvement, with lessons
identified entered onto a Corrective Action and Preventative Action (CAPA)
Log.
14.5.Post Exercise Reports will follow the NHS CB Corporate Governance
Arrangements, and will be agreed by the Regional EPRR Lead, before being
submitted to the Senior Management Team and the London Local Health
Resilience Partnership. Once agreed the report will be submitted to the NHS
National CB and shared with any external agencies as required.
15.
FREEDOM OF INFORMATION
15.1. The Freedom of Information Act 2000 gives the public a wide-ranging right
to see all kinds of information held by the government and public
authorities.Authorities will only be able to withhold information if an
exemption in the Act allows them to. This document will therefore be made
easily accessible and publicly available.
15.2. Health organisations should consider carefully any request under the FOI
Act before releasing information. Where there is any doubt as to the
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sensitivity of the request, further guidance and support should be sought
from the NHS CB (LRO) EPRR team.
16.
EQUALITY AND DIVERSITY
16.1. Equality and diversity are at the heart of the NHS strategy. Investing in a
diverse NHS workforce enables us to deliver a better service and improve
patient care in the NHS. 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. This document will
therefore abide by the Equality Act 2010.
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17.
REFERENCES& INFORMATION SOURCES
This document should be read in accordance with the following sources of
information:
15.1 Civil Contingencies Act 20041
15.2 Health & Social Care Act 20122
15.3 NHS CB EPRR documentation and supporting materials as published3,
including but not limited to:
a. NHS CB Business Continuity Management Framework (Service
Resilience);
b. NHS CB Command & Control Framework; and
c. NHS CB Emergency Planning Framework.
15.4 National Occupational Standards (NOS) for Civil Contingencies – Skills for
Justice4.
15.5 London Emergency Service Liaison Panel (LESLP) Major Incident
Procedure Manual5
15.6 National Recovery guidance6
15.7 BSI PAS 2015 - Framework for Health Services Resilience7
15.8 ISO 22301 Societal Security - Business Continuity Management Systems –
Requirements8
15.9 Freedom of Information Act 20009
15.10
Equality Act 201010
1http://www.legislation.gov.uk/ukpga/2004/36/contents
2http://www.legislation.gov.uk/ukpga/2012/7/enacted
3www.commissioningboard.nhs.uk/eprr/
4http://www.skillsforjustice-nosfinder.com/epc/aboutnos.php
5http://www.leslp.gov.uk/docs/major_incident_procedure_manual_8th_ed.pdf
6http://www.cabinetoffice.gov.uk/content/national-recovery-guidance
7http://shop.bsigroup.com/en/ProductDetail/?pid=000000000030201297
8http://www.iso.org/iso/catalogue_detail?csnumber=50038
9http://www.legislation.gov.uk/ukpga/2000/36/contents
10http://www.legislation.gov.uk/ukpga/2010/15/contents
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18. GLOSSARY OF TERMS
AT
[NHS CB] Area Team
Bronze
Operational Level Command
C&C
Command and Control
CAPA
Corrective Action, Preventative Action
CBRN
Chemical, Biological, Radiological and Nuclear
CCA
Civil Contingencies Act 2004
CCG
Clinical Commissioning Group
COBR
Cabinet Office Briefing Rooms
CSU
Commissioning Support Unit
DH
Department of Health
ECOSA
Emergency Coordination of Scientific Advice
EPRR
Emergency Preparedness, Resilience and Response
GCG
Gold (Strategic) Coordination Group
Gold
Strategic Level Command
HART
Hazardous Area Response Team
LALO
Local Authority Liaison Officer
LAS
London Ambulance Service
LESLP
London Emergency Services Liaison Panel
LFB
London Fire Brigade
LICC
London Incident Coordination Centre
LLHRP
London Local Health Resilience partnership
LRO
London Regional Office
MACA
Military Aid to Civil Authorities
MPS
Metropolitan Police Service
NHSBT
NHS Blood and Transplant
NHS CB
NHS Commissioning Board
NOS
National Occupational Standards (Skills for Justice)
PHE
Public Health England
POD
CBRN antidote medication held by NHSBT
SAGE
Scientific Advice to Government in Emergencies
SCC
Strategic Coordination Centre
Silver
Tactical Level Command
STAC
Scientific and Technical Advice Cell
TCG
Tactical Coordinating Group
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19.
APPENDICES
Annex A - Action Cards
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Action Card
Regional Incident Manager
1
NHS01
INITIAL ALERTINGINFORMATION AND RESPONSE
NHS CB London Regional Office EPRR Manager On Call
Aim:
Key underpinning Elements:
Corporate BCP and EPRR Plans
To act as the first point of contact for
NHS CB London Regional Office and set Major Incident Response Training
the tactical direction. Facilitate
Corporate Induction
activation of a response.
Accountable to:
Location/Base:
EPRR Regional Lead
NHS CB LRO Incident Coordination Centre
(LICC)
NHS Gold
Role:
Act as a conduit for information received from NHS organisations undergoing an
1
emergency or major incident.
Provide initial guidance and support to the alerting organisation’s director on call or
2
emergency preparedness manager (as appropriate)
Confirmation of the incident after initial notification with the Emergency Bed Service and
3
LAS
Liaison with the LAS regarding the site and scale of the incident and NHS resources
4
committed and potentially required.
5
Set the Tactical direction for the NHS CB LRO Trust to deliver Gold’s Strategic Aims and
Objectives through the mobilisation and management of the NHS response with assistance and
advice from SM01.
Responsibilities:
1
2
3
4
5
6
7
8
9
10
To relay information received relating to an incident upwards within NHS CB LRO to NHS GOLD01,
SM01 and Incident Communications Manager.
Maintenance of full and accurate records of all information received and actions taken as a result of
an incident.
Participation in the decision (with NHSGold01) regarding the actions of NHS CB LRO in relation to
activation of the Incident Response Plan and LICC.
Notification of members of the LICC team if decision taken to fully enact NHS CB LRO Incident
Response Plan.
Ensuring the continued delivery of the LICC over a prolonged period including the management of
EPRR01
To facilitate NHS Gold and incident Communications Manager to attend the Gold Coordinating
Group as required.
Obtaining regular updates from organisations during smaller scale incidents where LICC is not
established.
Liaising with key external agencies as required/necessary.
At Heatwave level 3, in conjunction with SM01, convene the Incident Management Team - refer to
LRO Heatwave Plan.
Facilitate hot debrief is carried out; documentation is collected and stored; LICC is packed away; all
organisations are aware of LRO stand down.
The Role of the EPRR Team Manager On Call (NHS01 Regional Incident Manager) is to:
•
•
Receive the initial communication and start a log.
Undertake an initial and on-going risk assessment of the situation with NHS GOLD01;
- Monitor the situation and local management informing partner agencies as required
- Alert SM01 to manage the situation alerting partner agencies as required.
If activation of the NHS CB LRO Incident Coordination Centre (LRO LICC) is required:
Warn and Inform
• Phone 0844 822 2888 and page SM01, EPRR01, Communications Lead and ADMIN01 to attend
using the following message;
“Major Incident declared. Please confirm receipt of this message to [insert detail] and attend the LICC
[insert detail]”
• Inform the local NHS (including CCGs) and confirm contact numbers, mobiles, direct line and
Emergency Control Rooms numbers and fax.
• Consider whether to inform the Senior PHE Representative via the PHE on call.
• Consider the need to inform the DPH via Local Authority Operations Rooms.
• Consider the need to inform the London Resilience Team.
• Consider whether to inform the wider London Resilience partners via Operation Ringmain when
appropriate - contact details available separately within contact information.
• Inform EPRR Team members - ensure availability of support during the response.
Tactical Management
• Set the Tactical direction for the NHS CB LRO to deliver Gold’s Strategic Aims and Objectives through
the mobilisation and management of the NHS response with assistance and advice from SM01.
• Consider the possibility of dispatching other NHS CB LRO Managers to support NHS Gold, the
London Ambulance Service control room or Public Health England (PHE).
• Liaise with the Ambulance Service and Emergency Bed Service as required.
• Consider the need to activate wider resources, which could include NHS mutual aid, local authority,
and the military.
• Ensure that appropriate personnel are safely dispatched to fulfil their roles within both the Strategic
Coordination Centre (SCC).
• Assume overall management of the LICC through the allocation of tasks and management of EPRR01
such as;
o Collating all logs and documentation including that all calls received are logged, together with all
actions and decisions taken
o Workforce/rota plans
o Completition of SitReps.
• Seek advice and further information as required.
• Convene and support the Incident Management Team during a Heatwave level 3 incident.
• Consider the possibility of legal proceedings, inquiries and investigations and collate all logs and
records as appropriate.
On Stand Down
• Inform partner agencies and stakeholders ensuring suitable and sufficient lines of communication
remain open as required.
• Support the Incident Recovery Director as required/necessary.
• Collate all documentation and ensure Logs are signed off.
• In line with the Recovery Protocol facilitate hot debriefing on stand down of the incident and at key
personnel change overs, in addition to the full debrief once the recovery phase has been completed.
Action Card
Regional Incident Director
2
NHS GOLD01
INITIAL ALERTINGINFORMATION AND RESPONSE
NHS CB London Regional Office Director On Call
Aim:
Key underpinning Elements:
To provide strategic leadership for NHS Corporate BCP and EPRR Plans
CB LRO and NHS organisations in
Major Incident Response Training
London making strategic decisions
Corporate Induction
during the incident. To represent NHS
CB LRO at Gold Coordinating Group
Meetings.
Accountable to:
Location/Base:
Regional Director London
NHS CB LRO Incident Coordination Centre
(LICC) Gold Cell
Gold Coordination Group/SCC
Role:
1
Lead and direct the NHS CB LRO strategic response to a major incident.
2
Coordinate the overall NHS response to the incident via the LICC.
Represent the NHS at the Gold Coordination Group within the Strategic Coordination
Centre. Represent the NHS at any tripartite discussion as necessary.
Represent the NHS at the Regional Coordination Group (when established) during ‘slow
burn’ incidents.
Provide the link between the NHS CB LRO and NHS CB National.
3
4
5
Responsibilities:
To develop the NHS strategic response to an incident in London with assistance from
1
SM01.
To maintain full liaison with NHS01 - especially where direct contact may be received
2
from strategic commanders in partner agencies.
3 Appoint a Director to the role of Incident Recovery Manager.
To maintain full and accurate records of all information received and actions taken as a
4
result of an incident.
6 To ensure NHS capacity and resources to cope with any surge in demand.
8
To ensure consideration of the need for the activation of wider resources, this could
include NHS mutual aid.
To ensure Situation Reports for NHS CB National are compiled in a timely manner.
9
To ensure appropriate liaison with partner agencies.
10
To prioritise services and activities during times of pressure.
7
12
To monitor and assess the NHS response against expectations, monitoring the media
output and public levels of concern.
To participate in any hot debrief and subsequent cold debrief as required.
13
To provide all written documentation and logs to the EPRR Team.
11
The Role of the Director On Call (NHSGOLD01 Regional Incident Director) is to:
•
•
Receive initial communication from NHS01 and start a log.
Undertake an initial and on-going risk assessment of the situation with NHS01 determining the
appropriate level and response;
- Local management monitored by NHS01
- Management by SM01
- Activation of the LICC.
If activation of the NHS CB LRO Incident Coordination Centre (LRO LICC) is required:
Warn and Inform
•
Inform the Regional Director London as necessary and required, ensuring they remained
briefed.
•
Consider informing neighbouring regions which may be impacted or requested to assist.
•
Inform NHS Operations who will liaise with the Department of Health Major Incident
Coordination Centre if appropriate.
Strategic Management
• Set the Strategy for the NHS response in London using the LICC and the attached office as
your base/Gold Cell.
• Attend the Gold Coordination Group (GCG) or the Regional Coordination Group (RCG) as
required and necessary
o When notified of GCG establishment request NHS01 to begin the cascade
o NHS Gold is empowered to make corporate decisions on behalf of NHS CB LRO (and the
NHS in London) in support of the overall strategic coordination strategy.
o Support is provided in the form of a Gold Support Cell. This will consist of an NHS CB LRO
EPRR Team Member, communications manager and admin support.
•
•
•
•
•
•
•
•
•
•
•
Appoint a director to undertake the role of Incident Recovery Manager.
Assess the impact of all incidents on the NHS and the community.
Prioritise services and activities during times of pressure and identify resources required given
the likely duration of the event.
Ensure adequate NHS capacity and resources available to cope with any surge in demand in
conjunction and liaison with CCG on-call directors.
Ensure appropriate liaison with partner agencies including Public Health England.
Ensure that SitRepsfor NHS CB National are produced in a timely manner by NHS01 &
EPRR01.
Where necessary, activate wider resources, including NHS mutual aid where required.
Ensure resources are available for all NHS organisations, to deliver required objectives acting
on delegated financial authority.
In conjunction with the Incident Communications Manager ensure the NHS CB Spokesperson
remains appraised and briefed.
Ensure that all activities and decisions are logged appropriately, in case of the possibility of
legal proceedings, inquiries or investigations.
Monitor and assess the NHS response against expectations, monitoring the media output and
public levels of concern.
On Stand Down
•
Once complete stand down the response to the incident handing strategic direction to the
Incident Recovery Manager.
•
Ensure all documents and logs are complete, signed off and retained by the EPRR Team.
• Participate within debriefing.
Action Card
Regional Incident Communications Manager
3
Communications
INITIAL ALERTING INFORMATION AND RESPONSE
NHS CB London Regional Office Communications Manager On Call
Aim:
Key underpinning Elements:
To coordinate the communications
Corporate BCP and EPRR Plans
strategy relating to the incident in
Major Incident Response Training
conjunction with NHS CB National
Corporate Induction
Office and NHS organisations
Accountable to:
Location/Base:
London Regional Director
NHS Gold
Role:
1
NHS CB LRO Incident Coordination Centre
(LICC) with possible support to GCG
To manage the NHS CB LRO communications response to an incident.
2
To provide support to NHS Gold and the designated NHS spokesperson.
To develop key messages in conjunction with NHS Operations and responding partner
3
organisations.
To provide the link to NHS CB National and DH Communications team where
4
necessary.
Responsibilities:
1
2
3
4
To share common messages and media strategy with all London NHS organisations.
To maintain full and accurate records of all information received and actions taken as a
result of the incident.
To brief the NHS CB LRO designated spokesperson, and ensure their availability for
interviews when required.
To work with PHE regarding the development of any public health messages required.
7
To ensure contact with key partner communications teams, especially the London
Ambulance Service.
To gather information from local NHS Communications leads, and to monitor social
networking sites and media output.
To attend the Gold Coordinating Group to support NHS Gold when required.
8
To facilitate ministerial and VIP visits to NHS organisations.
9
To participate in any hot debrief and subsequent cold debrief as required.
10
To provide all written documentation and logs to the EPRR Team.
5
6
The Role of the Regional Incident Communications Manager On Call is to:
•
Receive initial communication from NHS01 and start a log;
- Manage the incident as requested by NHS GOLD01
- Attend the LICC.
If activation of the NHS CB LRO LICC is required:
Communications Management
 Gather as much information as possible about the incident.
 Establish links with communications leads at NHS Ops (National CB), DH and PHE
to ensure there is regular liaison and a joined up approach to health messages put
into the public domain.
 Establish links with press officers from other agencies within the Media Cell,
including LAS, Metropolitan Police etc.
 Draft key messages, in conjunction with other agency colleagues about the NHS
response to the incident.
NB: The Police may lead on what information is put into the public domain in
the initial stages of an incident.
 Provide support and media advice to NHS Gold.
 Identify and brief the NHS CB LRO designated spokesperson and prepare them for
media interviews - this should not be NHS Gold, but is likely to be the Regional
Director, their deputy or the Regional Director of Public Health.
 Gather intelligence from the local NHS communications teams.
 Identify communications gaps or resources that may be required for the duration of
the event.
 Develop key public messages in conjunction with PHE, NHS Ops, and the
Department of Health.
 Ensure that the NHS has communications capacity and resources to cope with any
surge in demand and request support via NHS Gold as appropriate.
 Be prepared to attend the Gold Coordinating Group to support NHS Gold with
Communications strategy if required.
 Be prepared to mobilise other members of the NHS CB LRO Communications
Team to support both the LICC and the Gold Coordinating Centre.
 Facilitate Ministerial or other VIP visits to NHS organisations.
 Collate all logs and records as appropriateand consider the possibility of legal
proceedings, inquiries and investigations.
 Monitor social networking sites, the media output and public levels of concern.
On Stand Down
• Stand down Incident communications and return to business as usual press, media
and communication management.
• Ensure all documents and logs are complete, signed off and retained by the EPRR
Team.
• Participate within debriefing.
Action Card
Regional Incident Management Team Coordinator
4
SM01
INITIAL ALERTINGINFORMATION AND RESPONSE
NHS CB London Regional Office Senior Manager On Call
Aim:
Key underpinning Elements:
To provide support to NHS Gold and
Corporate BCP and EPRR Plans
NHS01 in the making of strategic and
Major Incident Response Training
tactical decisions during the incident.
Corporate Induction
To deputise for NHS Gold within the
LRO LICC.
Accountable to:
Location/Base:
NHS Gold
Regional Director London
NHS CB LRO Incident Coordination Centre
(LICC)
Role:
Deputise for NHS Gold within the NHS CB LRO Incident Coordination Centre (LRO
1
LICC) when NHSGold01 is not present.
2 Coordinate the overall NHS response to the incident via the NHS CB LRO LICC.
3
To be accountable for the NHS CB LRO LICC.
To maintain close links with NHSGOLD01 and NHS01 at all times throughout the
4
incident response.
Responsibilities:
To support NHS Gold in developing the NHS strategy, and to support NHS01 with the
1
tactical response to ensure the strategic aims of NHSGold01 are delivered via the LICC.
To ensure the maintenance of full and accurate records of all information received and
2
actions taken as a result of an incident.
Provision of guidance to NHSGold01 in the method of handling and managing the
3
information received.
4 To consider the activation of wider resources, such as NHS mutual aid when necessary.
5
To ensure robust communication between local NHS Organisations and NHS CB LRO.
6
To ensure robust communications with partner agencies where necessary.
7
8
9
10
At Heatwave Level 3, in conjunction with NHS01 convene the Incident Management
Team – refer to LRO Heatwave Plan.
To maintain a dialogue with NHSGOLD01 and NHS01 throughout the incident.
For prolonged incidents (eight hours or more) to consider the need to develop rotas for
all key roles within the response, supported by EPRR01.
To participate in any hot debrief and subsequent cold debrief as required.
The Role of the Senior Manager On Call (SM01 Regional Incident Management
Team Coordinator) is to:
•
Receive initial communication from NHS01 and start a log;
- Manage the incident as requested by NHS GOLD01
- Attend the LICC.
If activation of the NHS CB LRO Incident Coordination Centre (LRO LICC) is required:
Strategic and Tactical Management
• In the absence of NHS Gold, take Strategic leadership of the LICC.
• Support NHS01 and EPRR01 with delivering the tactical aims of the response,
where this may require the mobilisation of NHS resources in conjunction with
partner agencies in response to an incident.
• Liaise with partner agencies as required.
• During a Heatwave Level 3 incident, convene and Chair the Incident Management
Team.
• Support and direct local NHS organisations involved in the response.
• Manage on-going service continuity of the health community at a strategic/tactical
level.
• Ensure adequate NHS capacity and resources to cope with any surge in demand
as directed by NHS GOLD01.
• With the support of EPRR01;
o Collate and assimilate information from the local NHS concerning demand and
capacity issues with support from EPRR01 as required
o Deliver SitReps as required by NHSGOLD01 for NHS CB National and via them
the Department of Health.
o Ensure appropriate data is logged (date, time and signature) including all calls
taken and sent, as well as decisions and actions taken.
o Liaise with all involved to facilitate communications; support resources and
issue resolution.
o Develop Rotas where an incident is likely to continue for more than eight hours,
covering all key roles.
o Ensure robust communication between local NHS organisations across
London.
• Ensure that the recovery protocol is followed and that there is a hot debrief within
the LICC immediately after the incident has been stood down.
On Stand Down
• Ensure all documents and logs are complete, signed off and retained by the EPRR
Team.
• Participate within debriefing.
Action Card
Regional Incident Management Team Task Manager
5
EPRR01
INITIAL ALERTING INFORMATION AND RESPONSE
NHS CB London Regional Office EPRR Officer On Call
Aim:
Key underpinning Elements:
Corporate BCP and EPRR Plans
To support NHS01 during the response
by facilitating the tactical
Major Incident Response Training
responsibilities to the incident.
Corporate Induction
Accountable to:
Location/Base:
NHS01
NHS GOLD01
Role:
1
NHS CB LRO Incident Coordination Centre
(LICC)
3
To support the role of NHS01 within the LICC.
To ensure that the tactical elements of the response are enacted through the
management of the LICC.
To coordinate any widespread tactical response that is required from within the LICC.
4
To provide information and feedback to NHS Gold and NHS01 where necessary.
2
Responsibilities:
To use the on call information folder/handbook to ensure that any requests for primary
1
care services to be mobilised are enacted.
2 Manage the LICC.
3
4
5
6
7
7
8
To maintain full and accurate records of all information received and actions taken as a
result of the recovery phase.
Where required, ensure that agreed information and messages are distributed to
primary care providers via the designated routes.
Fulfilling the NHS CB LRO intelligence/SitRep requirements by ensuring regular updates
are received from Local Area Teams, Provider Trusts and Primary Care to NHS
GOLD01 and NHS01.
Delivering workforce plans such as LICC Rotas for the continued delivery of the LRO
Incident Coordination Centre over a prolonged period.
To provide feedback to CCG on call officers regarding the use of primary care services
within their geographic area.
Assess the need for further tactical support to the LICC where the effects of the incident
are widespread across London.
Assess the need to transfer the tactical response function within the LICC to another
area within the office when appropriate.
9
Liaising with key external agencies as required/necessary.
10
Facilitating the maintenance of suitable lines of communication post incident stand
down.
Participate in the hot debrief, and ensure that all documentation is collated and stored.
11
The Role of the EPRR Officer On Call (EPRR01 Regional Incident Management
Team Task Manager) is to:
• Receive initial communication from NHS01 and start a log.
If activation of the NHS CB LRO Incident Coordination Centre (LRO LICC) is required:
Incident Coordination Centre Management
 Attend the LICC 4th Floor Southside or at the fall back location as specified.
 Manage the LICC ensuring;
o Set up of the LICC as per the Incident Coordination Centre Manual
o Workforce/rota plans are drawn up for the continuation of the LICC
o Logs and documentation are collated/logged such as all calls received, together
with all actions and decisions taken.
o Completition of SitReps.
 Work in support of NHS01 by undertaking responsibility for tactical actions during
an incident as directed by them.
 Ensure that partner agency requests for mobilisation of NHS resources are fulfilled
as directed by NHS GOLD01, SM01 and NHS01.
 Report any issues, difficulties or problems to NHS01 for resolution.
 Where directed by NHSGold01 or the Incident Communications Manager, ensure
that information and key messages are communicated to primary care providers.
 During widespread incidents, assess the need for further support for the tactical role
in conjunction with NHS01.
 During widespread incident, assess the need to transfer the tactical function out of
the LICC to another area of the office, to ensure that the strategic element of the
response is allowed to continue with minimum disturbance.
On Stand Down
• Ensure all documents and logs are passed are signed off and retained by the
EPRR Team.
• Assist with decommissioning the Coordination Centre ensuring all equipment is
suitably returned to storage and any consumables are replenished.
• Participate in any hot debrief and subsequent cold debrief as required.
Action Card
Regional Incident Control Centre Support Staff
6
ADMIN01
INITIAL ALERTINGINFORMATION AND RESPONSE
NHS CB London Regional Office Administrator On Call
Aim:
Key underpinning Elements:
To facilitate the NHS CB LRO response
Major Incident Response Training
to a major incident
Loggist Training
Corporate Induction
Accountable to:
Location/Base:
LRO LICC Manager
NHS01 Incident Coordinator
NHS CB LRO Incident Coordination Centre
(LICC)
In support of NHS GOLD01 at the GCG
Role:
1
3
To provide the administrative function within the LRO LICC.
To ensure that all relevant information is documented to an agreed high standard
following best practice.
To support NHS Gold at the Gold Coordinating Group.
4
To facilitate the establishment of the LRO LICC.
5
To manage all records and documentation.
2
Responsibilities:
1
4
To ensure that phones and computers are logged into with appropriate codes.
To ensure that phones are answered in a timely manner, and that emails are responded
to appropriately.
To maintain full and accurate records of information received and actions taken as a
result.
To facilitate the compilation of SitReps as required by NHS Gold/SM01.
5
To establish communication links with local NHS organisations as necessary.
2
3
6
7
8
To collect any necessary equipment for the Gold Coordinating Group and deliver as
required.
To participate in any hot debrief after the Recovery phase of the incident, and pass all
documentation relating to the incident to the EPRR Team.
Ensure all documentation is collated for secure storage which is readily retrievable.
The Role of the Administrator On Call (ADMIN01 Regional Incident Control Centre
Support Staff) is to:
•
Receive notification of the need to activate/attend the LICC.
If activation of the NHS CB LRO Incident Coordination Centre (LRO LICC) is required:
• Confirm receipt of the Page One message.
• Attend the LICC4th Floor Southside or at the fall back location as specified.
• Assist with the establishment of the coordination centre as per the Incident
Coordination Centre Manual; log into the computers and telephones using the login
details provided.
• Consider the possibility of legal proceedings, inquiries and investigations and
collate all logs and records as appropriate.
• Keep a log of all information, telephone calls, faxes etc. in the initial stages, writing
everything down and capturing on the system later, making sure the date and time
are noted correctly.
•
Use the web based SitRep system to obtain information from specific NHS
organisations across London, on the instruction of the LICC Manager.
If activation of the Gold Coordination Group (GCG) NHS Gold Cell is required:
Empress State Building (Primary Location)
• Attend the NHS Gold Cell within the Empress State Building (ESB) at Earls Court.
• Collect all necessary equipment from the NHS designated cupboard within ESB
and establish the room as per the NHS Gold Cell Operation Manual; accessing
email and SitReps remotely as per the login details provided.
Peel Centre, Hendon (Secondary Location)
• Collect the equipment pods from the Estates Department, Westgate Annexe,
Edgware Community Hospital, Edgware Road, Edgware, Middlesex, HA8 0AD.
o
These are held in two cupboards in the main corridor near the stairs. Out of
hours phone 0208 952 2381 and ask to be put through to the security guard
on duty and ask him to meet you and let you in to the building to collect the
equipment.
• Attend the NHS Gold Cell within the Peel Centre, Aerodrome Road Hendon and
establish the Gold Cell as per the NHS Gold Cell Operation Manual; accessing
email and SitReps remotely as per the login details provided.
On Stand Down
• Ensure all documents and logs are passed are signed off and retained by the
EPRR Team.
• Assist with decommissioning the Coordination Centre and NHS Gold Cell, ensuring
all equipment is suitably returned to storage and any consumables are replenished.
• Participate in any hot debrief and subsequent cold debrief as required.
Action Card
Regional Incident Recovery Director
7
GOLD RECOVERY
RECOVERY AND RESTORATION OF SERVICES
NHS CB London Regional Office Director
Aim:
Key underpinning Elements:
To provide strategic leadership for NHS LRO Incident Response Plan
CB LRO, making strategic decisions for LRO Business Continuity Plan
the restoration of services and
Emergency Response and Recovery
management of the recovery phase.
Accountable to:
Location/Base:
NHS Gold
Regional Director London
Role:
1
NHS CB London Regional Office
Lead and direct the NHS CB LRO strategic recovery from a major incident.
2
Coordinate the overall NHS response for recovery.
Represent the NHS at the Recovery Gold Coordination Group within the Strategic
3
Coordination Centre. Represent the NHS at any tripartite discussion as necessary.
Provide the link between the NHS CB LRO and NHS CB National Business Continuity
4
Team.
Responsibilities:
1
3
Establish membership of the NHS CB LRO recovery Group as required by the incident.
To maintain full and accurate records of all information received and actions taken as a
result of the recovery phase.
Consider occupational health and welfare of staff during and post incident.
4
Consider the need for physical reconstruction of any facilities across London.
2
7
Review the key priorities for service provision and restoration across the NHS in
London.
Establish longer term public health issues which may affect the NHS or increase
demands for services, liaising with Public Health England as necessary.
Consider the financial implications, remuneration and commissioning agreements.
8
Assess the impact to routine performance targets and ratings for the NHS.
9
Consider and plan for the possibility of VIP visitors.
10
Consider the on-going need for assistance from and to NHS partners or other agencies.
11
Assess the need for equipment and supplies outside of normal contracts.
12
Ensure that staff actions are acknowledged and thank staff.
13
Consider the need and impact of funerals, memorials and anniversaries.
14
Consider the impact of public confidence and any media issues.
15
Adopt the debrief protocol if not already undertaken.
5
6
The Role of the appointed Executive Director to the role of Regional Incident
Recovery Director is to:
•
Receive initial communication from NHS GOLD01 and start a log.
Undertake on-going risk assessment of the situation with NHS GOLD01 determining the
appropriate recovery strategy.
If activation of the NHS CB LRO Recovery Group is required:
Warn and Inform
•
Members of the Recovery Group.
•
Consider informing neighbouring regions which may be impacted or requested to assist.
Strategic Recovery Management
• Convene and Chair the NHS CB LRO Recovery Group
• Set the Strategy for the NHS recovery in London, leading and directing the recovery phase.
• Liaise with NHS Gold 01, SM01 and NHS01 with regard to Incident Response and longer term
recovery strategy.
• Attend the Gold Recovery Coordination Group as required and necessary
o
When notified of GCG establishment request inform NHS01
o
NHS Gold Recovery is empowered to make corporate decisions on behalf of NHS CB
LRO (and the NHS in London) in support of the overall recovery strategy.
o
Support is provided in the form of a Gold Recovery Support Cell. This will consist of an
NHS CB LRO EPRR Team Member, communications manager and admin support.
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Identify and consider potential improvement and lessons learned to proactively adapt systems,
services and infrastructures affected by the incident to meet future needs through NHS redesign
and restructure.
Ensure that SitReps/informationfor NHS CB National and NHS GOLD01 are produced in a
timely manner.
Prioritise services and activities for restoration in line with Business Continuity Plans.
Where necessary, activate wider resources, which could include NHS mutual aid.
Identify resources required given the likely duration of the recovery phase, including
procurement of supplies.
Liaise with Public Health England/Director of Public Health where necessary to consider the
impacts of longer term public health demands on the NHS.
Ensure adequate NHS capacity and resources available to cope with any surge in demand
during the recovery phase e.g. acute hospital 18 week targets.
Ensure appropriate liaison with partner agencies.
Provide the link to NHS CB National and via them Department of Health.
Ensure that all activities and decisions are logged appropriately, in case of the possibility of
legal proceedings, inquiries or investigations.
Ensure the commissioning of services to support staff/victim welfare as required.
Monitor and assess the NHS recovery against expectations, monitoring the media output and
public levels of concern.
Provide ultimate accountability for any money spent during the recovery phase.
Agree stand down of the recovery phase with the regional director.
On Stand Down
•
Once complete stand down the recovery phase, returning to business as usual operational
management.
•
Ensure all documents and logs are complete, signed off and retained by the EPRR Team.
•
Participate within debriefing.
Action Card
Regional Director
8
Regional Director
LIAISON AND REPRESENTATION
NHS CB London Regional Director
Aim:
Key underpinning Elements:
To represent NHS CB LRO as the
Corporate BCP and EPRR Plans
designated spokesperson. Liaise with
Major Incident Response Training
NHS CB National Management Structure Corporate Induction
as required.
Accountable to:
Location/Base:
Chief Operating Officer
NHS CB London Regional Office
Role:
1
2
3
Represent NHS CB LRO for external press and communications.
Liaison with the National Incident Management Structure to ensure it remains appraised
of the incident as required/necessary.
Agreeing stand down of the recovery phase.
Responsibilities:
Attend briefings with NHS GOLD01 and the Incident Communications Manager to
1
ensure you remain appraised of the situation.
To maintain full and accurate records of all information received and actions taken as a
2
result of the recovery phase.
Acting as the NHS CB spokesperson/representative for external press and
3
communications.
Brief the Chief Operating Officer or appointed officer to ensure the National Incident
4
management Structure remains appraised of the situation.
5 Assist NHS GOLD01 in setting the strategic direction for NHS CB LRO as required.
The Role of the Regional Director is to:
•
Receive initial communication from NHS GOLD01 and start a log if required.
If activation of the NHS CB LRO Incident Coordination Centre (LRO LICC) is
required:
Warn and Inform
• National Incident Management Structure as required.
• Consider informing neighbouring Regional Directors which may be impacted or
requested to assist.
Regional Response
• Do not become involved with the Regional Strategic or Tactical Response and
remain outward facing as the as the NHS CB LRO spokesperson/representative for
external press and communications.
• Attend briefings with NHS GOLD01 and the Incident Communications Manager to
ensure you remain appraised of the situation, agreeing Press and Communications
Strategy.
• Brief the Chief Operating Officer or appointed officer to ensure the National Incident
management Structure remains appraised of the situation.
• Maintain full and accurate records of all information received and actions taken as a
result.
• Monitor the recovery phase, considering options for regenerations of services within
the region.
• Agree Stand Down of the recovery phase in conjunction with Gold Recovery
Manager.
On Stand Down
• Ensure all documents and logs are complete, signed off and retained by the EPRR
Team.
• Participate within debriefing as required/necessary.
Action Card
Regional Medical Director
9
Medical
INCIDENT MEDICAL SUPPORT & ADVICE
NHS CB London Regional Office
Aim:
Key underpinning Elements:
To provide medical advice to NHS
Corporate BCP and EPRR Plans
GOLD01, SM01, NHS01 or Incident
Major Incident Response Training
Recovery Director as required by the
Corporate Induction
nature of the incident.
Accountable to:
Location/Base:
Chief Operating Officer
NHS CB London Regional Office
Role:
To support the Regional Incident Director and the Incident Management Team as
1
required during an incident.
2 Liaison with the National Medical Director as required/necessary.
Responsibilities:
1
Provide specialist medical advice as required/necessary.
2
Agree and mobilise any specialist medical resources as appropriate/required.
Ensure the NHS GOL01 and National Medical Directors are aware of the incident the
implications this may have to NHS medical operations.
Undertake other appropriate duties as requested by the Regional Incident Director or
National Medical Director.
3
4
The Role of the Regional Medical Director is to:
•
•
Receive initial communication from NHS GOLD01 and start a log if required.
Attend the LICC.
If activation of the NHS CB LRO Incident Coordination Centre (LRO LICC) is
required:
Warn and Inform
• National Medical Director as required.
• Consider informing neighbouring Regional Medical Directors which may be
impacted or requested to assist.
Regional Response
• Support the Regional Incident Director and the Incident Management Team by
providing specialist medical advice and support.
• Agree and mobilise and additional or specialist medical resources as required by
the incident.
• Support provider Trusts requiring specialist medical advice/support.
• Brief the National Medical Director and Chief Operating Officer to ensure the
national structure remains appraised of the medical situation and implications to the
NHS as required.
• Maintain full and accurate records of all information received and actions taken as a
result.
• Monitor the recovery phase, considering longer term impacts of the incident to
medical operations.
On Stand Down
• Ensure all documents and logs are complete, signed off and retained by the EPRR
Team.
• Participate within debriefing as required/necessary.
Action Card
Regional Lead Nurse
10
Nursing
INCIDENT NURSING SUPPORT & ADVICE
NHS CB London Regional Office
Aim:
Key underpinning Elements:
To provide nursing advice to NHS
Corporate BCP and EPRR Plans
GOLD01, SM01, NHS01 or Incident
Major Incident Response Training
Recovery Director as required by the
Corporate Induction
nature of the incident.
Accountable to:
Location/Base:
Chief Operating Officer
NHS CB London Regional Office
Role:
To support the Regional Incident Director and the Incident Management Team as
1
required during an incident.
2 Liaison with the National Chief Nurse as required/necessary.
Responsibilities:
1
Provide specialist nursing advice as required/necessary.
2
Agree and mobilise any specialist resources as appropriate/required.
Ensure the NHS GOL01 and National Chief Nurse are aware of the incident the
implications this may have to NHS operations.
Undertake other appropriate duties as requested by the Regional Incident Director or
National Chief Nurse.
3
4
The Role of the Regional Lead Nurse is to:
•
•
Receive initial communication from NHS GOLD01 and start a log if required.
Attend the LICC.
If activation of the NHS CB LRO Incident Coordination Centre (LRO LICC) is
required:
Warn and Inform
• National Chief Nurse as required.
• Consider informing neighbouring Regional Nursing Directors/Lead Nurses which
may be impacted or requested to assist.
Regional Response
• Support the Regional Incident Director and the Incident Management Team by
providing specialist nursing advice and support.
• Agree and mobilise and additional or specialist resources as required by the
incident.
• Support provider Trusts requiring specialist nursing advice/support.
• Brief the National Chief Nurse and Chief Operating Officer to ensure the national
structure remains appraised of the situation and implications to the NHS as
required.
• Maintain full and accurate records of all information received and actions taken as a
result.
• Monitor the recovery phase, considering longer term impacts of the incident to NHS
operations.
On Stand Down
• Ensure all documents and logs are complete, signed off and retained by the EPRR
Team.
• Participate within debriefing as required/necessary.
Action Card
NHS GOLD01 & NHS01
11
Initial Risk Assessment
NHS CB London Region
An assessment of the situation will determine what action needs to be taken. Using the
information at hand and taking account of a worst case scenario where knowledge is
limited, consider the following and record all relevant information.
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 by possibility of escalation
Out of control and threatening
Unknown and undetermined
What is the likely impact?
On people involved and the surrounding area
On property, the environment, transport and communications
On external interests, e.g. media, relatives and adjacent areas
What specific assistance is being requested from the NHS?
Increased capacity - hospital, primary care and community
Treatment - serious casualties, minor casualties and worried well
Public information
Support for rest centres/evacuees including primary care
Expert advice, environmental sampling, laboratory testing and 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
Annex B - Media Messages and Social Media
The Incident Communications Manager and NHSGOLD01 should consider using the
following social and media messages during the course of an incident.
Social Media
A number of NHS Organisations have now established social media channels on
Facebook and Twitter. In the event on an incident these channels will be used to get
messages out to the public alongside traditional media (TV, radio and print). A list of
local NHS social media channels is provided below along with the pages for NHs
Direct and NHS Blood and Transplant;
Organisation
NHS Direct
NHS Blood
Donation
London
Ambulance
Facebook
www.facebook.com/nhsdirect.uk
www.facebook.com/NHSblood
Twitter
@nhsdirect
@NHSBT
www.facebook.com/londonambulanceservice @Ldn_Ambulance
Generic message to media
 Please do not descend on the scene or receiving hospitals – the presence of
media could make it difficult for emergency services to deal with this major
incident.
 Regular proactive updates will be issued from xxx. All media enquiries should be
directed to xxx.
Generic early public health messages - Major Incidents
All messages should be prefixed with the following phrase:“Thus is an important public health message….”
Where a London regional information line has been activated, the message will end
with the phrase:“and ring xxx for the latest information”
Smoke caused by a large fire (not involving a chemical plume)
 Unless you have been advised by the emergency services to leave the area, the
advice to those who live in the area affected by the smoke from the fire is to stay
indoors with doors and windows closed as much as possible.
Social Media Feed: Unless you have been advised by emergency services to leave
the area affected by the smoke, please stay in doors with doors and windows closed
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 If people need to be outdoors, they are advised to avoid the areas affected by any
smoke or ash, or to limit the time they spend in them.
Social Media Feed: If people need to be outdoors, they are advised to avoid areas
affected by smoke or ash, or to limit the time they spend in them.
 Chemicals in smoke can worsen existing health problems like asthma so people
with these conditions should carry their inhaler and use it appropriately.
Social Media Feed: Chemicals in smoke can worsen health problems like asthma.
People with such conditions should carry their inhaler and use as appropriate.
 Any smoke can be an irritant and some of the substances present can sometimes
irritate the lining of the air passages, the skin and the eyes. If respiratory
symptoms such as coughing and wheezing or breathlessness occur, you should
seek medical advice or call NHS Direct 0845 4547 or 111.
Social Media Feed: Any smoke can be an irritant and some of the substances
present can sometimes irritate the lining of the air passages, the skin and the eyes.
Social Media Feed: If symptoms such as coughing and wheezing or breathlessness
occur, you should seek medical advice or call NHS Direct 0845 4547 or 111.
Chemical, Biological, Radiological and Nuclear (deliberate or accidental)
 Unless you have been advised by the emergency services to leave the area, stay
indoors, keep doors and windows closed and don’t go out until you hear more
about the nature of the incident on local radio/TV and social media channels regular updates will be broadcast/issued.
Social Media Feed:Unless you have been advised by the emergency services to
leave the area, stay indoors, keep doors and windows closed.
Social Media Feed: Stay indoors until you hear more about the nature of the incident
on local radio, TV or social media - regular updates will be issued.
 Emergency services are advising people involved in the incident to remain at the
scene for decontamination and treatment. Anyone who was involved in the
incident but who has made their way home should remove all clothing and put it in
plastic bags before showering or washing themselves thoroughly. The bagged
clothes should then be placed outdoors. This is a precautionary measure to
protect the individual and anyone else they may come into contact with. If you
start to feel unwell after going home you should ring NHS Direct straight away on
0845 4647 or 111.
Social Media Feed: If you have been involved in the incident please remain at the
scene for decontamination and treatment.
Social Media Feed: If you have already left the scene and gone home, please
remove all clothing, put it in plastic bags and shower/wash yourself thoroughly.
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Social Media Feed: The bagged clothes should be placed outdoors as a
precautionary measure.
Social Media Feed: If you start tofeel unwell after going home you should ring NHS
Direct straight away on 0845 4647 or 111.
 If you were outside when it happened and were not close enough to the scene to
be affected by the explosion or fumes but start to feel unwell - for example, if you
develop a headache, running nose or streaming eyes - contact NHS Direct on
0845 4647 or 111 where a trained nurse will give you advice.
Social Media Feed: If you were outside and start tofeel unwell (headache, running
nose or streaming eyes) contact NHS Direct on 0845 4647 or 111.
 If you think someone you know has been involved in the incident do not ring local
health or emergency services for information. They will be too busy dealing with
the incident and casualties to take your call. Instead listen to local radio, watch
television and monitor social media channels for helpline details. The number will
be advertised as soon as possible and the people operating this helpline will have
the latest information.
Social Media Feed: If you think someone you know has been involved please listen
to local radio, watch TV and monitor social media for helpline details.
Social Media Feed: A helpline number will be advertised as soon as possible and the
people operating this helpline will have the latest information.
Social Media Feed: Please do NOT ring local health or emergency services for
information about loved ones - they are busy dealing with casualties.
Large scale accident (train, plane or rail)
 Avoid the area of the accident. The presence of traffic or pedestrians could make
it difficult for emergency services to get to and from the scene.
Social Media Feed: Please avoid the area of the accident - increased traffic or
people will make it difficult for emergency services to get to and from the scene.
 If you think someone you know has been involved in the incident do not ring local
health or emergency services for information. They will be too busy dealing with
the incident and casualties to take your call. Instead listen to local radio, watch
television and monitor social media channels for helpline details. The number will
be advertised as soon as possible and the people operating this helpline will have
the latest information.
Social Media Feed: If you think someone you know has been involved please listen
to local radio, watch TV and monitor social media for helpline details.
Social Media Feed: A helpline number will be advertised as soon as possible and the
people operating this helpline will have the latest information.
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Social Media Feed: Please do NOT ring local health or emergency services for
information about loved ones - they are busy dealing with casualties.
 If you have been involved in the accident but have no injuries please do not leave
the scene without giving your details to emergency services. It will be important for
the emergency services attending the scene to account for everyone present. If
you leave the scene without telling them they may spend time looking for you.
Social Media Feed: If you have been involved in the accident but have no injuries
please do not leave the scene without giving your details to emergency services.
Social Media Feed: Emergency services at the scene need to account for everyone
present. Please don’t leave the scene without telling them.
 If you have been involved in the accident and have minor injuries the emergency
services on site will tell you where to go for treatment.
Social Media Feed: If you have been involved in the accident and have minor injuries
the emergency services on site will tell you where to go for treatment.
 If you have not been involved in the accident in any way but have a routine in any
way but have a routine appointment at the local hospital check with the
outpatients’ clinic to see if it is still on as doctors and nurses at the hospital may
be helping with the incident. In the same way, if you are thinking of going to A&E
for something totally unrelated to the accident, don’t go without first ringing NHS
Direct on 0845 4647 or call 111.
Social Media Feed: Please check with your local hospital before attending any
routine / non-emergency appointments - staff may all be helping with the incident.
Social Media Feed: If you think you need A&E for something totally unrelated to the
accident, please call NHS Direct 0845 4647 or call 111.
 If the ambulance or medical staff at the scene have seen you and have said it is
all right for you to go home or continue with your journey but you later feel ill, ring
NHS Direct on 0845 4647 or call 111.
Social Media Feed: If you have left the scene of the accident and later feel ill, please
contact NHS Direct on 0845 4647 or call 111 for medical advice.
Terrorist related incident
 Avoid the area of the accident. The presence of traffic or pedestrians could make
it difficult for emergency services to get to and from the scene.
Social Media Feed: Please avoid the area of the accident - increased traffic or
people will make it difficult for emergency services to get to and from the scene.
 If you think someone you know has been involved in the incident do not ring local
health or emergency services for information. They will be too busy dealing with
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the incident and casualties to take your call. Instead listen to local radio, watch
television and monitor social media channels for helpline details. The number will
be advertised as soon as possible and the people operating this helpline will have
the latest information.
Social Media Feed: If you think someone you know has been involved please listen
to local radio, watch TV and monitor social media for helpline details.
Social Media Feed: A helpline number will be advertised as soon as possible and the
people operating this helpline will have the latest information.
Social Media Feed: Please do NOT ring local health or emergency services for
information about loved ones - they are busy dealing with casualties.
 If you have been involved in the accident but have no injuries please do not leave
the scene without giving your details to emergency services. It will be important for
the emergency services attending the scene to account for everyone present. If
you leave the scene without telling them they may spend time looking for you.
Social Media Feed: If you have been involved in the accident but have no injuries
please do not leave the scene without giving your details to emergency services.
Social Media Feed: Emergency services at the scene need to account for everyone
present. Please don’t leave the scene without telling them.
 If you have been involved in the accident and have minor injuries the emergency
services on site will tell you where to go for treatment.
Social Media Feed: If you have been involved in the accident and have minor injuries
the emergency services on site will tell you where to go for treatment.
 If you have not been involved in the accident in any way but have a routine in any
way but have a routine appointment at the local hospital check with the
outpatients’ clinic to see if it is still on as doctors and nurses at the hospital may
be helping with the incident. In the same way, if you are thinking of going to A&E
for something totally unrelated to the accident, don’t go without first ringing NHS
Direct on 0845 4647 or call 111.
Social Media Feed: Please check with your local hospital before attending any
routine / non-emergency appointments - staff may all be helping with the incident.
Social Media Feed: If you think you need A&E for something totally unrelated to the
accident, please call NHS Direct 0845 4647 or call 111.
 If the ambulance or medical staff at the scene have seen you and have said it is
all right for you to go home or continue with your journey but you later feel ill, ring
NHS Direct on 0845 4647 or call 111.
Social Media Feed: If you have left the scene of the accident and later feel ill, please
contact NHS Direct on 0845 4647 or call 111 for medical advice.
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Annex C - Recovery Group Terms of Reference
Recovery Group
Terms of Reference
NHS CB London Regional Office
1.
Purpose
 The Recovery Group is the Strategic decision making body for the recovery
phase; able to give a broad overview and representation of the interests
and statutory responsibilities of NHS CB LRO.
 Provide visible and strong leadership during the recovery phase.
 Take advice from NHS LRO ICC, deciding the strategy and ensuring the
implementation of the strategy and rebuilding of public confidence.
 Ensure the coordination and delivery of consistent messages to the public
and media in conjunction with the Incident Communications Manager.
2.
Role
 To feed in recovery issues whilst the Strategic Coordination Group is
running.
 To decide the overall recovery strategy, including communications, clean
up, health, welfare, economic and business recovery.
 To ensure the relevant stakeholders, especially the communities affected,
are involved in the development and implementation of the strategy.
 To establish appropriate sub-groups as required by the incident.
 To produce an impact assessment on the situation.
 To coordinate the recommendations and actions of the sub-groups and
monitor progress.
 To monitor financial matters and pursue funding and other assistance.
 To agree exit strategy criteria and timescale dependant on the incident.
 To decide the final ‘state’ of the physical infrastructure and natural
environment affect by the incident.
 To deal with other issues which fall outside the scope of working groups.
 To provide reassurance to the public and to minimise fear and alarm.
 To make recommendations, at an early stage, to the NHS CB on the
strategic choice between ‘normalisation’ (restoring an area to its previous
condition) and ‘regeneration’ (aspiring to transform an area in support of
longer term development objectives) of an affected area.
3.
Chair and Secretariat
 The Recovery Group will be chaired by the Director appoint as the Incident
Recovery Manager by NHS Gold01.
 The chair will appoint appropriate administrative assistance to maintain
records of all minutes from Recovery Group Meetings, chase actions and
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coordinate a master record of all sub-group meetings.
4.
Membership
 Membership should be separate from the NHS CB LRO ICC, and should
include representation from the following areas;
o HR
o Delivery Directors
o Finance
o Nursing
o Strategy and system management
o Communications
o EPRR Team
o Administrative Staff and a Loggist
o Other areas of the Commissioning Board as required dependant on the
type and severity of the incident.
5.
Issues to be considered during the recovery phase
 The Recovery Group should consider a range of issues, including but not
limited to;
o Compensation
o Finance
o Personnel & Welfare
o Politics
o Public Confidence
o Resources
o Use of Military Aid
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Annex D - Recovery Group Draft Meeting Agenda
Recovery Group
Meeting Agenda
NHS CB London Regional Office
1.
Welcome
2.
Introductions
3.
Incident Update
- Current Situation
- Operational Position
4.
Actions from previous meeting
5.
Impact on NHS CB LRO work
5.
Impact on wider NHS Pan-London
6.
Issued raised by the last Incident Management Team Meeting
7.
Communications
8.
Recovery Action Plan Review/Update
9.
Any other business
10.
Date and Time of Next Meeting
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Annex E - Recovery Action Plan Template
Recovery Group
Recovery Action Plan
Action By Whom
By When
Status/Progress
Priority Rating
1
2
3
4
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Annex F - Debrief Report Form Template
Incident Debrief
Report
NHS CB London Regional Office
Date:
Time of call to standby:
Time of call to full Major Incident:
Time of call to stand down from Major Incident:
Incident grading:
5 (catastrophic)
2 (minor)
4 (major)
1 (insignificant)
3 (moderate)
0 (prevented incident)
Roles:
NHS GOLD01
NHS01
SM01
EPRR01
Comms
Admin 01
Report sent to:
Date:
Time:
Author:
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1. Description of Incident

2. Causes / Reasons

3. Could the incident have been prevented? If so how?

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4. Summary of Events

5. Issues Arising from the Incident

6. Recommendations / Lessons Learnt

Action Plan Drafted? Yes
/ No
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