NHS South Yorkshire and Bassetla · The NHS Emergency Planning Guidance 2005 requires a trained and tested Major Incident Plan be in place. The Operating Framework for the NHS in

ANNEX 2

MAJOR INCIDENT PLAN

NHS South Yorkshire and Bassetlaw

December 2011

NHS South Yorkshire & Bassetlaw Oak House

Moorhead Way Bramley

Rotherham S66 1YY

Draft Version 1 – Created 7th December 2011

Major Incident Plan 2

Page left Intentionally Blank


Contents

Chief Executives Statement 7

1 Introduction 9

Initial Action sheets

1 Duties of First Person Receiving Report 11

2 Duties of Strategic Lead (GOLD) 13

3 Duties of Tactical Lead(s) (SILVER) 15

4 Duties of Silver Staff Officer 17

5 Duties of Emergency Log Book Keeper 19

6 Duties of Communications Lead 21

7 Duties of Medical Lead 23

8 Duties of Administration Support Team 25

9 Duties of Security Manager 27

2 Major Incident 29

2.1 Definitions 29

2.2 “Emergency” as defined by the Civil Contingencies Act 2004 29

2.3 “Major Incident” as defined by NHS Emergency Planning guidance 29

2.4 Declaring a Major Incident 29

2.5 Alert Messages 30

2.6 YAS Notification procedures 30

2.7 Internal NHS alert 32

2.8 Duties of First Person receiving a report 32

3 Escalation 33

Fig.1 – Trigger points for escalation 34

4 Command and Control 35

Fig.2 – Command and Control structure 35

4.1 Incident Management Model 36


Fig.3 – Incident Management Model 36

4.2 Emergency Log Book 37

4.3 Bronze role – Operational 38

4.4 Silver role – Tactical 38

4.5 Gold role – Strategic 38

4.6 Major Incident Control Centre (MICC) 39

4.7 NHS Single Organisation Gold 40

4.8 NHS Locality PCT / CCG area Gold 40

4.9 NHS South Yorkshire & Bassetlaw area Gold 40

Fig.4 – NHS South Yorkshire & Bassetlaw Command & Control structure 42

4.10 Multi-agency Gold 43

4.11 Regional & National Command and Control 44

Fig.5 – Regional & National Command and Control structure 45

5 Activation of the South Yorkshire Strategic Co-ordinating Group 46

6 Roles of NHS organisations during a Major Incident 47

6.1 Department of Health 47

6.2 Strategic Health Authority (SHA) 47

6.3 NHS South Yorkshire and Bassetlaw 47

6.4 Primary Care Trusts 47

6.5 Primary & Community Care Services 48

6.6 Acute Hospital NHS Foundation Trusts 48

6.7 Yorkshire Ambulance Service 49

6.8 Regional Director of Public Health 49

6.9 Health Protection Agency 49

6.10 Scientific and Technical Advice Cell (STAC) 50

7 Roles of other organisations during a Major Incident 51

7.1 South Yorkshire Police 51

7.2 South Yorkshire Fire and Rescue 52

7.3 Local Authority 52


7.4 Environment Agency 53

7.5 HM Coroner 53

7.6 Military 54

7.7 The Third Sector ( including Voluntary Sector & Faith Groups) 55

8 Business Continuity Management 56

Fig.6 – Stages of an Incident 56

9 Ethical considerations 58

10 Recovery 60

10.1 Closure of Major Incident Control Centre (MICC) 60

10.2 Staff Support 61

10.3 De-brief 61

Appendices

1 Legislation and Guidance 62

1.1 NHS Emergency Planning Guidance 2005 62

1.2 Civil Contingencies Act 2004 62

1.3 Human Rights Act 1998 63

1.4 Health & Safety at Work Act 1974 63

2 Useful abbreviations 64

3 Glossary of Emergency Response Terms 66

Useful Forms

Draft Strategic Aim and Objectives 71

Major Incident Message Log 73

Draft Agenda for Major Incident Team meeting 75

Attendance sheet 77

Exhibit List 79

Sample Exhibit List 81

Bibliography 82

Plan History 83

Distribution List 84




CHIEF EXECUTIVES STATEMENT

NHS South Yorkshire and Bassetlaw has a duty to protect and promote the health of the

community, including in times of emergency. We are committed to complying with legislation

and guidance in relation to Emergency Preparedness, Resilience and Response.

The Civil Contingencies Act 2004 places a statutory duty on NHS organisations to prepare for

emergencies. The NHS Emergency Planning Guidance 2005 requires a trained and tested

Major Incident Plan be in place. The Operating Framework for the NHS in England 2012/13

states that Emergency Preparedness, Resilience and Response continues to be a core function

of the NHS. All NHS organisations are required to maintain a good standard of preparedness to

respond safely and effectively to a full spectrum of threats, hazards and disruptive events.

This is a generic Major Incident plan, designed to assist in the early management of a range of

potential events or incidents identified in the NHS South Yorkshire and Bassetlaw Emergency

Resilience Risk Assessment. It provides a framework in which to operate but does not restrict

managers from using their skills and knowledge to effectively respond to the individual

circumstances of an emergency.

All Directors are required to ensure that key staff are adequately prepared to respond effectively

in accordance with relevant resilience plans, and associated response arrangements required to

mitigate the effects of the emergency. All personnel have a responsibility to ensure they are

familiar with their individual role and responsibilities during an emergency.

The effectiveness of these arrangements will be monitored and reviewed and the NHS South

Yorkshire and Bassetlaw Cluster Board will require regular reports, at least annually regarding

Emergency Preparedness, Resilience and Response activities, including details of training and

exercising undertaken.

Signed for and on behalf of NHS South Yorkshire and Bassetlaw

Andy Buck

Chief Executive

Date:




1 INTRODUCTION

The purpose of this plan is to provide a framework for the emergency co-ordination of all NHS

organisations to ensure an integrated and co-ordinated approach to any emergency or major

incident in order to minimise the impact on the health and welfare of the communities of South

Yorkshire and Bassetlaw.

The formation of PCT Clusters is necessary as part of the ongoing NHS Reforms to secure the

capacity and flexibility needed for the transition period. In particular the Shared Operating Model

for PCT Clusters (28th July 2011) outlines the expectation that PCT Clusters will maintain the

capacity of NHS Commissioners to carry out Emergency Preparedness, Resilience and

Response (EPRR) functions during the transition period. They are also expected to support the

development of the new EPRR function within the NHS.

NHS South Yorkshire and Bassetlaw is the Barnsley, Bassetlaw, Doncaster, Rotherham and

Sheffield Cluster of PCTs.

This plan reflects these transitional arrangements. However, it does not detract from the need

for each NHS organisation to have its own robust Major Incident plans and does not affect

routine operating procedures, rather it complements them and provides additional measures

and command and control options for incidents that would stretch resources and be beyond

internal capabilities or routine escalation procedures of individual organisations and requires a

wider co-ordination of NHS resources.

This is a generic Major Incident plan, designed to assist in the early management of a range of

potential events or incidents identified in the NHS South Yorkshire and Bassetlaw Emergency

Resilience Risk Assessment. As such it cannot provide detailed response options for every

conceivable event. Rather it provides a framework and a range of options to be considered by

those involved in managing the initial response stage.

In addition there are specific plans to deal with certain types of incidents and these should be

referred to and read in conjunction with the Major Incident Plan where appropriate:

Pandemic Influenza Plan

Mass Casualty Plan

Mass Treatment Plan

Initial Action sheets

The plan provides a series of “initial action” sheets for a variety of roles that could possibly be

required to respond to an incident. These provide a menu of actions to be considered. Not all

will be relevant to every type of incident but are intended to act as an aide memoir for the

individual to consider and select as appropriate to the circumstances.

Management decisions will need to be based on the attendant circumstances of the event.

Initiative and flexibility will be essential in response to changing circumstances. The plan is not

intended to restrict managers from using their knowledge and skills to effectively respond to the

individual circumstances of an emergency. The scale of any incident will dictate whether it is

desirable to activate the whole plan or just relevant sections of it. The Emergency Resilience

Unit can be contacted for further advice and support if required.


Emergency Log Book

A comprehensive Log must be kept of all events, to record the context within which decisions

are made and any action to be taken and by whom. Appropriate “Emergency Log Books” are

kept in the Major Incident Control Centres across the Cluster area for this purpose. If these are

not readily available it is still important that contemporaneous records are kept in some other

form.

Later sections of this plan provide more detailed background information to assist in the

ongoing integrated emergency management required for an effective multi-agency response to

a Major Incident.


Initial Action sheet 1

Duties of First Person Receiving Report

On receiving a message regarding an incident or event, establish and record the following details:

Your name and contact details

Time and date message received

Name and contact details of person giving the information

Details of information

Consider the below mnemonic to extract more detailed information:

C – Casualties, number and severity

H – Hazards, present or potential

A – Access/Egress

L – Location, exact

E – Emergency services, present or required

T – Type of incident

What is NHS South Yorkshire and Bassetlaw being asked to do at this stage

Has anyone else at NHS South Yorkshire and Bassetlaw been informed and if so what actions have they taken

Is NHS South Yorkshire and Bassetlaw being put on standby or has a Major Incident been declared

What other agencies (if any) have been informed

Inform the NHS South Yorkshire and Bassetlaw Lead Director for EPRR

If unavailable inform On-Call SILVER

See Over for list of other contacts who may need to be made aware depending on the circumstances.

Record overleaf time, date and method of notification where appropriate.

Once completed this document to be forwarded to the Emergency Resilience Unit for inclusion in the Emergency Log Book


Incident Contact Record

Contact Person Who Took Call Time / Date Initials

Chief Executive

Lead Director EPRR

On Call Director

Director(s) of Public Health

Chief Operating Officer(s)

Emergency Resilience Unit

Yorkshire Ambulance Service

Acute Hospital Trust(s)

Community Service provider(s)

Health Protection Agency

Local Authority(s)

NHS North of England

All emergency contact details are contained in the Cluster On-Call information pack.



Duties of Strategic Lead (Gold)

The Strategic level of command for the NHS (often referred to as “Gold”) will normally be

assumed by the NHS South Yorkshire and Bassetlaw Director of Performance and

Accountability who is the Lead Director for EPRR. In the absence of this individual, this role will

be performed by the Director on the NHS Gold Commander On-Call rota.

The purpose of Gold is to provide overall Strategic co-ordination of all NHS resources across

South Yorkshire and Bassetlaw and to take overall responsibility for managing and resolving an

event or situation.

To perform this role effectively, this person must have the authority to make executive decisions

in respect of the organisations resources and finances, particularly if involved in a multi-agency

response.

If the incident requires a multi-agency response the Police will convene and chair a Strategic

Co-ordinating Group (SCG). The Health Gold would be expected to attend the SCG to

represent the NHS. Their role will be to co-ordinate the NHS response and contribute to the

overall strategic aim and objectives.

The considerations listed below are intended as an aide memoir for the Gold commander. Note: This is not an exhaustive list and items may be added or removed to suit the individual circumstances of the incident/event.

Determine a clear strategic aim and objectives for the health response to the incident (in a multi-agency response this task will be undertaken jointly by the SCG) Progress against the objectives should be reviewed regularly. See useful Forms for Draft Aim & Objectives

Consider appropriate location so as to be able to maintain effective strategic command of

the event. It is not recommended to be located directly with the Silver Team to avoid being drawn into the tactical level of response.

Consider the need for an appropriately resourced Support Team using the “Action Sheets” in this plan as a guide.

Where an SCG is established a Health Strategic Support Cell may be required and more information is available in Appendix A of the separate document “NHS South Yorkshire and Bassetlaw Strategic Framework for Emergency Preparedness, Resilience and Response” which should also be referred to.

A comprehensive Log must be kept of all events, containing issues arising, options considered, decisions made, and the reasoning behind those decisions and any action to be taken and by whom. Appropriate “Emergency Log Books” are kept in the Major Incident box at respective locations for this purpose. If these are not readily available it is still important that contemporaneous records are kept in some other form.

Appoint a person to act as “Log Keeper” on your behalf – a list of trained personnel is available in the On-Call folder. It is essential that the decision maker briefs the Log Keeper about the expectations of what is to be recorded. Note this role is not to be confused with a “Minute taker” which is a separate role that may be required for recording full details of any planning meetings.


Ensure activation of sufficient district Silver control centres to implement tactical plans and establish a policy framework within which the Silver Team(s) will work. (see also – Command and Control section)

Prioritise demands and allocate resources to meet requirements. Consider the need for additional resources and requesting mutual aid where appropriate.

Where appropriate, consult with the Director(s) of Public Health.

Where appropriate, consult with NHS North of England.

Formulate and implement media handling and public communications strategies. Appoint a communications lead to manage internal messages for staff and external messages for the public. Approve any media statements (in consultation with partner organisations if involved)

It may be necessary to appoint a Business Continuity Manager to ensure core functions are maintained whilst the Silver Team and other personnel are engaged in the response phase.

Consider any wider implications. What are the impacts to health – immediate and short term and what actions to minimise these and any requirements for public warning. Liaise with DPH or HPA and consider any long term monitoring and health surveillance.



Duties of Tactical Lead(s) – Silver(s)

The role of Silver is to develop and implement a Tactical plan to achieve the Strategic direction

set by GOLD and will be required to work within the framework of policy outlined at the Strategic

level. This is essential to ensure a consistent and co-ordinated response within an ethical

framework across the entire area affected. Tactical command should oversee, but not be

directly involved in, providing any operational response at the Bronze level.

The NHS Gold commander will need to establish sufficient Tactical level groups (Silver

Commands) to implement the actions set at the Strategic level. There is a potential for there to

be up to Five Silver level commands, corresponding to the 5 PCT/CCGs in the South Yorkshire

and Bassetlaw cluster. The role of each Silver level group will be to co-ordinate the overall

health response for their respective locality and provide the link to their local service providers.

The Silver level of command will be assumed by the Chief Operating Officer or nominated

deputy of the relevant PCT/CCGs involved. Out of hours, the Silver role may need to be

performed in the initial stages by the NHS South Yorkshire and Bassetlaw Silver On-Call officer

until such time as district silvers can be established.

The considerations listed below are intended as an aide memoir for the Silver commander. Note: This is not an exhaustive list and items may be added or removed to suit the individual circumstances of the incident/event.

If not already activated consider the need to escalate to a wider Strategic level of command (GOLD), either at local or regional level. See also “Action Sheet 2”

The District Silver Team(s) are the conduit responsible for cascading information and actions to all other local NHS resources, including Acute Hospital Trusts, Community Services and Primary Care providers.

Each Silver commander will consider the need to open their respective Control Centres and establish an appropriately resourced support team. The size and membership of this team will vary depending on the incident involved

Delegate and assign tasks to the support team using the relevant “Initial Action” sheets (in some cases an individual may be given more than one role – particularly in the initial stages) Keep a record of any tasks assigned.

Appoint a Deputy / Staff Officer to be responsible for receiving and disseminating information. This will be a key role to efficiently manage and filter information. This is essential to prevent information overload and by receiving a reliable and concise summary of relevant information will create the time to enable effective decision making.

Appoint a person to act as “Log Keeper” on your behalf – a list of trained personnel is available in the On-Call folder. It is essential that the decision maker briefs the Log Keeper about the expectations of what is to be recorded. Note this role is not to be confused with a “Minute taker” which is a separate role that may be required for recording full details of any planning meetings.


A comprehensive Log must be kept of all events, containing issues arising, options considered, decisions made, and the reasoning behind those decisions and any action to be taken and by whom. Appropriate “Emergency Log Books” are kept in the Major Incident box at respective locations for this purpose. If these are not readily available it is still important that contemporaneous records are kept in some other form.

It may be that other organisations locally and regionally are also responding. If so, appoint PCT liaison personnel to attend Silver and/or Gold commands at relevant locations. See also section 4 Command and Control for more information

Consider which external partner organisations or internal departments should be present in the PCT/CCG incident control centre to support the integrated management required for the particular incident.

Further departments or personnel to be considered are:

Public Health Yorkshire Ambulance Service

Human Resources Acute Hospital Trust

Strategy & Contracting Community Service providers

Finance GP out of hours service

Information Services General Practitioners

Estates and Facilities Infection Prevention and Control

Performance and Governance Medicines Management

Health & Safety Staff Support Services

Administrative and secretarial support Emergency Resilience Manager

External partners who may need to be involved or at least informed:

NHS North of England South Yorkshire Police

Health Protection Agency South Yorkshire Fire & Rescue Service

Other Primary Care Trusts Local Authority

Scientific & Technical Advisory Cell Environment Agency

Utility companies Voluntary Organisations

At this point, review the current situation and consider the following questions with direct regard to the role of the PCT/CCG:

What information do we have?

What information do we require?

What other actions are necessary – by whom?

Who else do we need to contact?

Provide continual updates for the Strategic level of command if active.

Check objectives have been achieved and actions completed. Then, invoke stand down procedure and any recovery issues.

Arrange de-brief (multi-agency if appropriate) to identify any learning or good practice.

Write report on the incident; include outcomes, learning points and future management issues. Liaise with the Emergency Resilience Unit and arrange for a review of the Major Incident Plan



Duties of Silver Staff Officer

The Staff Officer will work directly in support of and deputise for the Silver Commander and

should be an assistant Director or other senior management level and able to co-ordinate and

disseminate resources and information.

This will be a key role to efficiently manage information. This is essential to avoid the Incident

Manager being overloaded with spurious information.

With overall responsibility for receiving and disseminating information, this role requires the

authority and ability to be able to filter and deal with routine matters whilst selecting vital

information required by the Incident Manager to effectively manage the incident.

Providing a reliable and concise summary of relevant information to the Silver Commander will

create the time to enable effective decision making based on an accurate overview of the

situation.

The considerations listed below are intended as an aide memoir for the Staff Officer. Note: This is not an exhaustive list and items may be added or removed to suit the individual circumstances of the incident/event.

Open the Major Incident Control Centre using locally available set up arrangements and ensure the relevant I.T. and communications equipment is functional

In consultation with the Silver Commander arrange for the attendance of sufficient support staff to fill the roles required to effectively manage the specific incident. The “Initial Action” sheets suggest potential roles, but this can be varied depending on the overall circumstances.

Organise, in liaison with the Silver Commander, allocation of rooms, telephone lines and support staff for organisations/departments involved

Set up and maintain communications links with the Strategic level of command if active.

Set up and maintain communications links with any commissioned service providers involved in the response.

Appoint “Board keepers” and ensure all outstanding tasks are recorded on the dry wipe boards (or flip charts) and these are allocated for action accordingly.

Ensure the Log Keeper is aware of and recording all policy decisions. All records of the incident and responses to it must be maintained and retained.

Organise, on the request of the Incident Manager, the calling in of further personnel as required by the scale of the incident. Consider management of a long-term incident in terms of relieving personnel at regular intervals. Time is required for handover briefs.

Consider staff welfare, monitor the time on duty and ensure breaks and refreshments are available.

At the conclusion of the event ensure a hot de-brief is undertaken to capture any early examples of good practice or lessons identified to inform the full de-brief at a later stage

Ensure collection of all records pertaining to the Incident, which should be retained for 30 years in line with the NHS Code of Practice for Records Management.





Duties of Emergency Log Book Keeper

In the event of a major incident it is vital in order to facilitate operational debriefing and

to provide evidence for Audit purposes, to keep acurate records.

Record keeping also assists the decision–maker in reaching a reasoned, lawful and

justifiable decision at the time of a major incident.

This role should be performed by an appropriately trained person – a list of trained

personnel is available in the On-Call folder.

A comprehensive Log must be kept of all events, containing issues arising, options

considered, decisions made, and the reasoning behind those decisions and any action

to be taken and by whom.

Emergency Log Books are kept at the respective Major Incident Control Centre sites

across the Cluster. If these are not readily available it is still important that

contemporaneous records are kept in some other form.

Liaise with the Decision Maker (Gold or Silver Commander) to ascertain what logging

requirements are required, remember this role is separate from a minute taker

In line with training maintain a chronological log of all events in the Approved Emergency

Log book.

Write in permanent black ink using C.I.A. – Clear, Intelligible, Accurate

Initial and time and date each entry

At appropriate pause points after any meetings or significant discussions consult with

the Decision Maker to confirm accuracy of the Log Book, paying particular attention to

any policy decisions or actions required. Make amendments as required in accordance

with training and good practice.

Sign off notes at the end of the incident or at the end of your duty when you handover to

another Log Keeper.

Remember NO ELBOW

NO – Erasures

NO – Leaves torn out of the book

NO – Blank spaces – rule them through

NO – Overwriting

NO – Writing above or below the lined area

At the end of the incident, collate all documents, drawings, maps and other materials pertaining

to the incident for a hot de-brief.

These documents should be retained for a full de-brief at a later date and for any potential enquiries.





Duties of Communications Lead This role will be carried out by one of the communications managers. In their absence this

function may need to be performed by another appropriate manager.

The purpose of this role is to provide accurate, clear and timely advice to the public, the media

and other internal and external stakeholders and will require regular liaison with the Incident

Commanders.

Public

There is a duty to warn and inform the public during an emergency or major incident. Where

other organisations are also involved in the response it is essential to ensure a co-ordinated

response in accordance with the South Yorkshire media protocol.

Great care should be taken that no information about individual cases, or premature or

uncorroborated estimates of casualty numbers are released by any agency.

Media

Rapid development of a media strategy is essential. Any media statements will need to be

approved by the NHS Gold Commander for an incident only involving a Health service

response. See Initial Action sheet 2 for more information

Where a multi-agency response is required a lead agency should be identified to co-ordinate

information for the media / public. This would normally be South Yorkshire Police but not

exclusively so. The lead agency would be responsible for implementing the media strategy and

ensuring partner agencies are informed of developments. This could be done through the

Strategic Co-ordinating Group (SCG) if active.

Consider

An immediate holding statement

Appointing a media spokesperson

Timing and content of media releases

Necessity for a media conference

Necessity for a joint media centre

External stakeholders

It will be necessary to maintain regular liaison with communications leads from our partner

agencies. This will enable all organisations to share information and ensure that consistent

messages are being communicated as above.

Internal stakeholders

Regular and consistent updates will need to be communicated to staff to ensure a well informed

workforce able to support the response to a developing situation.

Record keeping

Ensure records are kept of all relevant details of the incident and any information circulated.





Duties of Medical Lead

This function may be assumed by a Director of Public Health or the Medical Director from NHS

South Yorkshire and Bassetlaw, depending on the geographic spread of any health emergency.

The Medical Lead will be responsible for providing and co-ordinating medical advice in

consultation with Clinical Leads from any responding provider services. It is stressed that the

Medical Lead should provide clinical advice to support the overall response and work within the

framework of policy outlined at the Strategic level. This is essential to ensure a consistent and

co-ordinated response within an ethical framework. Considerations are:

Assess the impact on local health and health services

Where clinical services need to be reduced, provide advice on priority medical services

Where appropriate provide advice on changes to discharge and admission criteria

Arrange epidemiological investigation and follow-up of affected individuals as necessary.

Obtain advice from relevant sources of expertise where necessary

Liaise closely with the Incident Commander.

Consider wider health implications and need to alert Regional colleagues

Ensure records are kept of all information and advice given, either personally or through the Gold Commanders‟ Emergency Log Book Keeper.

Health Protection Agency (HPA)

The Health Protection Agency provides public health advice to government departments, NHS

organisations, the statutory agencies and directly to the public. It provides a central source of

authoritative scientific/medical information and other specialist advice on both the planning and

operational responses to public health emergencies.

Where necessary the Medical Lead should liaise with the Health Protection Agency.

See also section 6.9 for more information on the role of the HPA.

Scientific and Technical Advice Cell (STAC)

If the emergency or incident requires a South Yorkshire wide multi-agency response then it is

likely that a Strategic Co-ordinating Group (SCG) will be activated.

See also section 4 Command and Control for more information

A Scientific and Technical Advice Cell (STAC) is most likely to be required in response to

complex incidents involving multiple scientific and technical issues, where there is potential for

conflicting expert opinion. Where appropriate the SCG will request the formation of a STAC.

If a STAC is formed then this group will become responsible for co-ordinating medical advice

and providing information through the SCG.

See also section 6.10 for more information on the role of the STAC.





Duties of Administration Support Team

There may be many individuals required to effectively manage this function, depending on the

scale of the incident. The role should be carried out by Personal Assistants and Project Support

officers.

Working under the direction of the Staff Officer, Duties will include:

Answer and Log incoming calls, using the appropriate message logs included in this

plan. Log faxes and any other written information, recording time received and action

taken.

Onward transmission of information to internal departments and partner agencies as

directed

Take minutes / notes of Incident Team meetings as required. Note: This is a separate

role to the Emergency Log Book keeper

Maintain Dry Wipe boards / Flip charts with details of:

Key events

Actions allocated with status and who assigned to

Key contacts (internal and external)

Resources deployed or available

Casualty information

Ensure Staff Officer is updated with any important new information.

Support the Emergency Log Book keeper by filing records, photograph dry wipe boards before

cleaning and ensure all flip charts and notes are retained. A sample “Exhibit List” is included in

this plan to give an indication of the type of information needed to be retained, note this is not

an exhaustive list.

All records pertaining to a Major Incident should be retained for 30 years in line with the NHS

Code of Practice for Records Management.





Duties of Security Manager

This role if required will be performed by the Local Security Management Specialist (LSMS) or in their absence a member of the HR/Health and Safety Team and will be responsible for maintaining the health and safety of staff, patients and visitors.

Liaise with the Silver Commander to agree on any additional requirements needed to maintain the health and welfare of those involved or responding to the incident

Liaise with the Communications Lead to establish level of media involvement and provide support in facilitating / managing any media attending at PCT sites

Assume overall responsibility for the security of personnel, buildings and grounds.

Consider the need for a lock down of premises. Restricting or preventing access / egress to whole or part of a building. Any such action must be legal, necessary and proportionate.

Ensure that the building and grounds are secure, whilst maintaining access for essential staff who may be responding to the incident

Request volunteer(s) to assist in this role if needed

Liaise with South Yorkshire Police for additional support if required.

Arrange for reception cover if necessary and brief staff as to any requirements of entry / exit

Ensure all staff wear and display I/D badges. Challenge if not worn

Any essential visitors should sign in and out and wear a visitors badge. Any non essential visitors should be advised to attend at another time




2 MAJOR INCIDENT

2.1 Definitions

Most incidents are geographically local and limited in time and impact and are dealt with in an

effective and efficient way by the emergency services and the Acute Trusts. Some events

require a broader level of co-ordination which may necessitate the involvement of NHS South


2.2 The Civil Contingencies Act 2004 provides a definition of “Emergency” as:

An event or situation which threatens serious damage to human welfare

An event or situation which threatens serious damage to the environment

War or terrorism which threatens serious damage to security

This definition of emergency defines the sorts of events that we should be prepared for.

Additionally it sets a threshold level to trigger the activation of this plan and our duty to respond

if it is:

Within our functions and necessary to take action to reduce, control or mitigate the

effects of the emergency

and

Would be unable to take that action within routine service arrangements and requires

changing the deployment of resources or acquiring additional resources.

2.3 NHS Emergency Planning Guidance 2005 provides a definition of a Major Incident:

Any occurrence that presents a 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.

2.4 Declaring a Major Incident

It is essential to remember that an incident may have a huge impact on one part of the health

service, while leaving other areas relatively unaffected. In a similar way, an NHS major incident

is not necessarily a major incident for other organisations, such as Police, Fire or Local

Authority. It is for this reason that any organisation either singularly or jointly can declare a

“Major Incident” based on either of the above definitions and the impact on their organisation.

If NHS South Yorkshire and Bassetlaw is affected by an incident that meets either of the above

definitions then a Major Incident should be declared and this plan activated. It is good practice

to inform our partner organisations but the level of their response will depend on the impact of

the incident on their own organisation.

Whether the response only involves NHS South Yorkshire and Bassetlaw or requires a co-

ordinated multi-agency response there may be a need to build appropriate command and

control structures. See section 4 Command and Control for more information.


Where other organisations are involved then integrated emergency management procedures

should be implemented and an appropriate lead organisation identified. See also section 6 and

7 for roles and responsibilities of other organisations.

2.5 Alert Messages

To avoid uncertainty and confusion in declaring the stages of a major incident, the NHS uses

the following alerting messages:

“Major incident standby” where a situation is unclear at an early stage or has the

potential to escalate.

“Major incident declared – activate plan” to indicate that the major incident plan

should be activated.

“Major incident stand down” when the major incident response is no longer required.

This can follow either of the above alerting messages.

2.6 Yorkshire Ambulance Service Notification

Yorkshire Ambulance Service (YAS) are the NHS contact for the other emergency services in

the event of an incident and it is therefore most likely that any notification of an incident will

come from them.

YAS use the below alert levels and will notify the organisations shown depending on whether it

is a local, South Yorkshire or Regional incident.

LEVEL 1 - INCIDENT CONTAINED WITHIN THE RESOURCES OF A SINGLE LOCALITY PCT/CCG

Incident/Event

RECEIVING ACUTE TRUST (Action)

AFFECTED PCT/CCG (Action)

HPA (SYHPU) If required

SHA (information and DH liaison role)

PCT CLUSTER SILVER ON CALL Information only in case of escalation resulting in the need for SY & B co-ordinating role

YAS

Key: Organisation leading the response


LEVEL 2 -

Incident/Event

SY & B ACUTE TRUSTS (Action)

SY & B PCT/CCGs (Action)

HPA (SYHPU) (Action)

SHA (DH liaison role and potential for escalation beyond South Yorkshire resources)

PCT CLUSTER GOLD ON CALL (SY & B NHS co-ordinating role)

YAS


INCIDENT CONTAINED WITHIN THE RESOURCES OF THE SOUTH YORKSHIRE &

BASSETLAW AREA

INCIDENT CANNOT BE CONTAINED WITHIN THE RESOURCES OF THE SOUTH YORKSHIRE

& BASSETLAW AREA AND ASSISTANCE SOUGHT FROM OTHER AREAS VIA SHA LEVEL 3 -

Incident/Event

SY & B ACUTE TRUSTS (Action)

SY & B PCT/CCGs (Action)

HPA (SYHPU) (Action)

SHA (Regional co-ordinating role and DH liaison)

PCT CLUSTER GOLD ON CALL (SY & B NHS co-ordinating role)

YAS



2.7 Internal NHS alert

It is possible that a local NHS service provider may be the first organisation to declare a Major

Incident in which case the local PCT/CCG should be notified immediately and where

appropriate escalated to the PCT Cluster to provide an overall co-ordinating role to support the

affected service.

It is essential that Yorkshire Ambulance Service is informed of the circumstances, in order that

they can commence the cascade system outlined above to notify any other organisations as

required.

2.8 Duties of First Person Receiving Report

The first person in NHS South Yorkshire and Bassetlaw taking a report of an incident or event

should use “Initial Action sheet 1” as an aide memoire to record relevant information. This

document can then assist with the assessment and dissemination of information to escalate the

response as required by the circumstances.

Further “Initial Action sheets” are available in this plan to provide a prompt for key post holders

potentially required to respond during a Major Incident.

The On-Call folder contains necessary contact information for key personnel and organisations

for both office hours and 24 hour emergency call out if needed.


3 ESCALATION Sudden impact events (“Big Bang”) whilst clearly challenging to manage are instantly

recognised due to their sudden and dramatic nature and obvious impact, thereby allowing

appropriate Resilience arrangements to be immediately activated.

Alternatively, increasing Demand and Capacity on Healthcare services can develop gradually,

almost unnoticed for some time (“Rising Tide or Creeping Crisis”) The impacts and disruption to

services and health care could be prolonged and the response may need to be sustained, with

potentially decreased levels of staff over a considerable period of time and affecting all health

and social care services.

Early recognition of a “Rising Tide” situation will allow for timely intervention and thus minimise

the impact and lead to a more efficient recovery. For this reason this plan identifies various

trigger points for action to ensure a consistent and co-ordinated approach to manage any

phased escalation of response. (See Fig. 1 below)

Note: these trigger points are intended as a guide to the Incident Commanders, and do not

preclude initiative and flexibility to respond to the particular circumstances of an incident.

Where a Major Incident impacts across Health Care Organisations, NHS South Yorkshire and

Bassetlaw will provide an overall co-ordinating role to ensure an integrated emergency

management approach involving any Health Care Organisations as necessary in order to

effectively and efficiently respond. All commissioned provider services will be expected to co-

operate and work flexibly to support the overall health response and divert resources to those

areas in most need and therefore minimise the impact on health to the community of South


See also Section 4 “Command and Control” for more information.

The relevant Business Continuity plans should also be referred to.

Fig.1 – Trigger points for escalation

Trigger Point Characteristics Strategies

Trigger Point – 0

Status normal for season

Normal staffing levels for season

Normal prioritisation of services

Patient contact at normal seasonal levels

All routine services being delivered

Ongoing surveillance monitoring

Ongoing liaison and partnership working

Business Continuity Plans in place

Major Incident Plans in place

Ongoing major incident training for key personnel

Plans routinely exercised, reviewed and updated

Trigger Point – 1

Slight effect on services

Can be managed internally by one organisation

Requires changed deployment of resources to manage

Up to 25% increase in patient contact

Inform NHS South Yorkshire & Bassetlaw of situation

Implement Business Continuity Management plans

Consider planned closures

Consider reduction in non critical activities / services

Trigger Point – 2

Moderate effect on services

Potential to impact on other Health Care organisations

Requires additional deployment of resources to manage sustained increased demand of up to 50%

Escalation of service reductions and closures (including reduced treatment regimes)

Unplanned closures of some services

Inform NHS South Yorkshire & Bassetlaw of Major Incident Standby

Activate PCT/CCG led co-ordinating group(s)

Consider need for Clinical Executive Group

Implement Business Continuity Management plans

Triage of patients attending service

Implementation of admission and discharge criteria

Trigger Point – 3

Major disruption to services

Critical services not coping

Demand outstripping supply

Continued or increasing pressure above level 2 point

Increased dependency between Health and Social Care Organisations to manage patients

Declare a Major Incident and implement this plan

Activate NHS South Yorkshire & Bassetlaw led co-ordinating group

Activate Clinical Executive Group

Alternative care settings implemented

Triage of patients attending service

Implementation of admission and discharge criteria

Trigger Point – 0

Recovery – returning to normal operations

Returning to normal operations

Returning to normal staffing levels

Inform NHS South Yorkshire & Bassetlaw of Major Incident stand down

Identify priorities for phased resumption of deferred treatment and services

4 COMMAND AND CONTROL

Most incidents are geographically local and limited in time and impact and are dealt with in an

effective and efficient way at the operational level by the Ambulance service and Acute Trusts.

However some events require a broader level of co-ordination. Whether the response only

involves the NHS or requires a co-ordinated multi-agency response there may be a need to

build appropriate command and control structures.

Command, Control and Co-ordination are important concepts in the multi-agency response to

emergencies. A nationally recognised three tiered command and control structure known as

Strategic (Gold), Tactical (Silver) and Operational (Bronze) has been adopted by the

emergency services and most responding agencies and private organisations, as outlined in

Fig.2.

Fig.2: Command and Control structure

The NHS South Yorkshire and Bassetlaw command and control arrangements are based upon

this system. These arrangements help to ensure interoperability between responders. The

level of command required will be determined by the nature and seriousness of the incident.

Invariably with spontaneous incidents, the command structure builds from the bottom up with

the „Operational‟ level being activated first and the other levels forming as the situation

escalates beyond the control of normal operations. It is possible with some incidents, that the

activation of the three levels will be concurrent.


4.1 Incident Management Model

It is not possible or advisable for a generic Major Incident Plan to be too prescriptive before all

the facts and issues are known as there is a danger that the decision making process will be

flawed if made to fit the plan rather than the circumstances prevailing.

Management decisions will need to be based on the attendant circumstances of the event.

Initiative and flexibility will be essential in response to changing circumstances. The plan is not

intended to restrict managers from using their knowledge and skills to effectively respond to the

individual circumstances of an emergency.

The Incident Management Model outlined below is a useful process to analyse the problem and

identify an appropriate and reasoned solution. It can be used at each Command level as

required. If there is more than one problem then prioritise accordingly and deal with one issue at

a time, then repeat the process until all actions are allocated.

Fig. 3: Incident Management Model

Information:

Consider all the information available at this time. This may only be the information obtained by

the first person taking the report and completing “Initial Action sheet 1” using the mnemonic

CHALET.

Repeat the process as new information emerges.

Consider also, what resources are available at this time.

Risk Assessment:

Consider who may be harmed and how and what control measures can be applied to minimise

these risks. Further advice may be required from the Medical Lead or the Health Protection

Agency. Risk could also include harm to reputation or financial implications.

Plans/Policies:

As well as the various Emergency Resilience plans, what other policies may be useful to assist

in the management of this incident eg HR policies, ESR, Estates and IT policies etc.

Plans/Policies

Actions

Information

Risk Assessment

Options


Options:

Then consider the context within which decisions are made, what response options are

available, always consider alternative options with advantages and disadvantages of each, are

the options lawful, necessary and proportionate?

Actions:

Using this thought process, select the most reasonable option and this will form the plan of

action. Record the decision made and ensure the task is allocated. Move on to the next problem

and repeat this process until all actions are allocated and concluded.

4.2 Emergency Log Book

A comprehensive Emergency Log must be kept of all events at both the Strategic (Gold) and

Tactical (Silver) level, containing issues arising, options considered, decisions made, and the

reasoning behind those decisions and any action to be taken and by whom. Appropriate

“Emergency Log Books” are kept at the respective Major Incident Control Centre sites across

the Cluster for this purpose. If these are not readily available it is still important that

contemporaneous records are kept in some other form.

The Gold / Silver commander should appoint a person to act as “Log Keeper” on their behalf –

a list of trained personnel is available in the On-Call folder. It is essential that the decision

maker briefs the Log Keeper about the expectations of what is to be recorded. Note this role is

not to be confused with a “Minute taker” which is a separate role that may be required for

recording full details of any planning meetings.

The senior people likely to be deployed in either a Gold or Sliver command role will make

management decisions on a regular basis in their usual role. These routine management skills

are transferable to managing an emergency or Major Incident. The most significant difference

will be the essential requirement to make speedy decisions often under extreme pressure using

limited information. It is this factor that makes it essential that your rationale is accurately

documented accordingly.

This plan provides a framework in which to operate and the Incident Management Model at

Fig. 3 above provides a useful process to help identify an appropriate and reasoned solution.

However the decision maker needs to reach and evidence that they reached a reasonable

decision, based on the circumstances and information available at the time. A “reasonable

decision” is one that other decision makers would have reached in the same circumstances.

This is akin to other legal doctrines throughout the health sector.

Correct use of the Emergency Log book in consultation with the Log Keeper will support

effective decision making and provide a clear audit trail to minimise problems should the

incident be later scrutinised by a court or public enquiry.


4.3 BRONZE Role – Operational

This level is usually the first to be activated as they respond to events at the operational level as

they unfold. As an incident escalates beyond this level of control, the command structure starts

to build to provide the level of co-ordination required to effectively resolve the incident. The term

Bronze refers to Operational team leaders who will manage the physical response to achieve

the tactical plan defined by Silver.

Controlling the management of resources within their given area of responsibility. There may be

several Bronze commanders based on either a functional or geographic area of responsibility.

4.4 SILVER Role -Tactical

Responsible for developing and implementing a Tactical plan to achieve the Strategic direction

set by GOLD and will be required to work within the framework of policy outlined at the Strategic

level irrespective of whether GOLD Command is set at the South Yorkshire, Regional, or

National level. This is essential to ensure a consistent and co-ordinated response within an

ethical framework across the entire area affected.

They provide the pivotal link between Gold and Bronze levels. Tactical command should

oversee, but not be directly involved in, providing any operational response at the Bronze level.

It will be necessary to establish sufficient Tactical level groups (Silver Commands) to implement

the actions set at the Strategic level. There is a potential for there to be up to Five Silver level

commands, corresponding to the 5 PCT/CCGs in the South Yorkshire and Bassetlaw cluster.

The role of each Silver level group will be to co-ordinate the overall health response for their

respective locality and provide the link to their local service providers.

The Silver level of command will be assumed by the Chief Operating Officer or nominated

deputy of the relevant PCT/CCGs involved. Out of hours, the Silver role may need to be

performed in the initial stages by the NHS South Yorkshire and Bassetlaw Silver On-Call officer

until such time as locality silvers can be established.

All emergency contact details are contained in the Cluster On-Call information pack

See Also “Initial Action” sheet 3

4.5 GOLD Role – Strategic

The purpose of the Strategic command level is to take overall responsibility for managing and

resolving an event or situation. Establishing a framework of policy within which tactical

managers will work by determining and reviewing a clear strategic aim and objectives.

See Useful Forms for draft Aim and Objectives

The strategic commander has overall control of the resources of their own organisation and

should ensure sufficient resources are made available to achieve the strategic objectives set.

Also considering the longer term resourcing implications and any specialist skills that may be

required.

This level of management also formulates media handling and public communications

strategies, in consultation with any partner organisations involved.


The Strategic Lead will then delegate actions to the respective Tactical (Silver) command level

for them to implement a Tactical Plan to achieve the Strategic aim. All Strategic actions should

be documented to provide a clear audit trail using the appropriate Emergency Log books.

There can only be one Strategic level decision making body to ensure a co-ordinated response,

particularly where more than one organisation is involved, otherwise there is potential for a

disjointed approach without a common policy agreed by all those involved. The Strategic

command will therefore be set at the level appropriate to the scope of the incident and escalate

up the scale where necessary as outlined below.

4.6 Major Incident Control Centre (MICC)

In order for an NHS Commander at either Gold or Silver level to make informed decisions,

sufficient support will be required to ensure an effective two way flow of information, to be able

to receive and report on the current health overview and to be able to disseminate information

and implement necessary actions.

The function of a MICC is to provide a central communication facility to collect, collate and

disseminate information on activity and pressures across any Health and Social Care

organisations involved and to provide the necessary oversight for the Gold or Silver commander

to make informed decisions. This will be essential in order to create sufficient resources to

effectively respond to the incident, whilst trying to maintain other priority functions.

The MICC will need an adequately resourced support team to effectively manage an incident

and provide the appropriate support to the commander. The size and membership of the

support team will be dictated by the scale and nature of the incident and will be decided by the

NHS Gold / Silver Commander, using the “Action Sheets” in this plan as a guide.

Likewise the location and number of MICC will be decided by the NHS Gold / Silver

Commander based on the nature and scale of the incident. Each local PCT/CCG within the

Cluster maintains their own MICC facility for this purpose and one or all of these may need to

be activated in the event of a widespread health emergency.

Where a number of local PCT/CCGs have an active MICC it is likely that NHS South Yorkshire

and Bassetlaw would provide an overall Strategic (Gold) level co-ordinating role and each

locality would effectively become a local Health SILVER level team responsible for working

within the framework of policy outlined at the Strategic level.

In this case, the NHS South Yorkshire and Bassetlaw Gold Commander will establish an

appropriate control facility to maintain sub regional Strategic level co-ordination. This would

normally be the Major Incident Control Centre at NHS Sheffield, however a flexible approach

will be used to provide resilience across the Cluster and any of the PCT/CCGs could host this

facility.

Where a multi-agency Gold level response is required the Police will establish a Strategic Co-

ordinating Group (SCG) See also Section 4.10 to Section 5 for more information.


4.7 NHS Single Organisation Gold

Where an incident is contained within a single locality and a single NHS organisation (e.g.

Acute Trust) and is manageable within their resources, it will implement its own Major Incident

procedures and command structure to manage the incident internally, keeping partner

organisations informed of the situation.

4.8 NHS Locality PCT/CCG area Gold

Where an incident extends beyond a single NHS organisation, but is contained within the health

sector of a single locality (i.e. Barnsley, Bassetlaw, Doncaster, Rotherham or Sheffield, Clinical

Commissioning Group / PCT area) the Strategic level of command and control will be assumed

by the Chief Operating Officer or nominated deputy of the PCT/CCG covering that locality. The

purpose will be to co-ordinate the overall Health response involving all commissioned provider

services locally to minimise the impact on health to the local community. Commissioned

provider services will be expected to co-operate and work flexibly to support the overall Health

response.

If required the PCT/CCG will also provide NHS representation to any multi-agency tactical

group that may be set up for that district. The PCT/CCG will keep NHS South Yorkshire and

Bassetlaw informed of the situation.

4.9 NHS South Yorkshire and Bassetlaw area Gold

Where an incident involves a South Yorkshire and Bassetlaw wide health response, but does

not impact on multi-agency partners, the Strategic level of command may be assumed by the

PCT Cluster to co-ordinate the Strategic level health response across the sub region. NHS

South Yorkshire and Bassetlaw will then provide and cascade strategic direction to any of the

locality PCT/CCGs involved (see Fig. 4)

The nature or scale of an incident will determine the requirement to establish this level of

Strategic co-ordination of the NHS across the South Yorkshire and Bassetlaw area.

Such NHS co-ordination may be required if, a PCT/CCG is asking for support, an incident

involves more than one PCT/CCG or at the request of NHS North of England. Any such

request should come from a Director at any constituent PCT/CCG and be made to the Cluster

Gold On-Call.

This role of PCT Cluster area Gold will normally be performed by the Director of Performance

and Accountability who is the Emergency Preparedness Lead for the PCT Cluster. In the

absence of this individual, this role will be performed by the Director on the NHS Gold

Commander On-Call rota.


The NHS Gold commander will need to establish sufficient Tactical level groups (Silver





(See Fig. 4)


Out of hours, the Silver role may need to be performed in the initial stages by the NHS South

Yorkshire and Bassetlaw Silver On-Call officer until such time as district silvers can be

established.

In order for the NHS Gold Commander to make informed decisions, sufficient support will be

required to develop and maintain clear lines of communication with respective Silvers to collect,

collate and disseminate information on activity and pressures across all Health and Social Care

organisations involved. See also section 4.6 Major Incident Control Centre.

If required the PCT Cluster will also provide NHS representation to any multi-agency Strategic

Co-ordinating Group (SCG) that may be formed (see also section 4.10 to section 5). The PCT

Cluster will keep NHS North of England informed of the situation.


Fig.4: NHS South Yorkshire and Bassetlaw Command and Control structure

Strategic (Gold)

Tactical (Silver)

Operational (Bronze)


4.10 Multi-agency Gold

Where Strategic level multi-agency co-ordination is required to deal with an emergency it will be

necessary to activate the South Yorkshire Strategic Co-ordinating Group (SCG) commonly

referred to as “Gold command” or simply “GOLD”. See Also Section 5.

In the event that NHS Bassetlaw are requested to provide support to a multi-agency Major

Incident being managed by the Nottingham and Nottinghamshire SCG then the South Yorkshire

NHS Gold Commander On-Call should be informed.

The role of the SCG is to agree joint aims and objectives to manage the incident and co-

ordinate the overall strategic response of all organisations involved in the management of the

Major Incident.

Consequently SCG representatives should be Chief Officer level and have the appropriate mix

of seniority and authority and be empowered to make executive decisions in respect of their

organisations finance and resources.

The Health Gold would be expected to attend the SCG to represent the NHS. The Health Gold

MUST be in possession of an NHS photo ID card. Their role will be to co-ordinate the overall

Health service response and contribute to the overall strategic aim and objectives. The Health

Gold will keep NHS North of England informed of the situation.

This role of Health Gold will normally be performed by the NHS South Yorkshire and Bassetlaw

Director of Performance and Accountability who is the Emergency Preparedness Lead for the

Cluster. In the absence of this individual, this role will be performed by the Director on the NHS

Gold Commander On-Call rota.


The NHS Gold commander will need to establish sufficient NHS Tactical level groups (Silver





See Fig. 4 above in relation to NHS Command and Control.

Out of hours, the Silver role may need to be performed in the initial stages by the NHS South

Yorkshire and Bassetlaw Silver On-Call officer until such time as district silvers can be

established.

Depending on the incident, multi-agency Tactical groups may be set up, usually by South

Yorkshire Police. Representation of the NHS at district level will be managed by the respective

PCT/CCG. If a South Yorkshire level Tactical group is established, the PCT Cluster, will liaise

with the relevant PCT/CCGs to determine the most appropriate representation to be deployed

for the NHS.

In order for the NHS Gold Commander to make informed decisions, sufficient support will be

required at the SCG to ensure an effective two way flow of information, to be able to receive

and report on the current health overview and to be able to disseminate information and actions


back to active Health Silvers. As a minimum the support should include a Staff Officer /

Emergency Planning Advisor and a Log Keeper and should have access to relevant emergency

plans, laptop, mobile phone and charger.

Where further support is required, it may be necessary to establish a Health Strategic Support

Cell (HSSC) The size, membership and location of a HSSC will be determined by the Gold

commander based on the nature or scale of the incident. Further information is available in

Appendix A of the separate document “NHS South Yorkshire and Bassetlaw Strategic

Framework for Emergency Preparedness, Resilience and Response” which should also be

referred to.

4.11 Regional and National Command and Control

In the event of an incident escalating beyond local boundaries, or if its duration or nature is such

that regional resources are required, then the NHS North of England will co-ordinate the health

service response. Where an incident is beyond the capacity of the region, the Department of

Health can implement national co-ordinating arrangements via the DH Major Incident Co-

ordination Centre. See Fig. 5 overleaf, which incorporates both sub-regional multi-agency

working and regional/national command and control arrangements.


Fig. 5: Multi-agency Command and Control structure

D of H

NHS

North of England

COBR

SY & B Health Strategic

Support Cell (HSSC) (Health Gold Support)

South Yorkshire Strategic

Co-ordinating Group (SCG)

YAS NHS HPU

Gold Gold Director

Commander Commander

Constituent PCTs

Tactical (Health Silver)

X5

Commissioned Services

Acute


Mental Health


Community


Primary Care

Media Cell

NHS Direct

Scientific & Technical

Advice Cell (STAC)

(Remote) Tactical

Co-ordinating

(Group(s) (TCG)

NHS Direct

National

Regional

Sub-regional

Resilience and

Emergencies

Division - North


5 ACTIVATION OF SOUTH YORKSHIRE STRATEGIC CO-ORDINATING GROUP (SCG)

Where Strategic level multi-agency co-ordination is required to deal with an emergency it will be

necessary to activate the South Yorkshire Strategic Co-ordinating Group (SCG)

It is possible that before activating an SCG that a Strategic Assessment Meeting may be called

as a pre-emptive forum to consider and prepare for an emerging risk. The purpose of such a

meeting is to share information and provide an early warning of a potential incident to allow as

much planning time ahead of a potential or planned future event.

Once called, an SCG will normally meet at the Strategic Co-ordination Centre (SCC) facility at

the South Yorkshire Fire and Rescue Training and Development Centre, Handsworth.

South Yorkshire Police are responsible for activating the SCC by contacting South Yorkshire

Fire and Rescue Control, however other Category 1 responders can request activation through

South Yorkshire Police. The Primary Care Trust is a Category 1 responder (see Appendix 1.2

for definition)

South Yorkshire Police will initially take the chair of an SCG and take responsibility for inviting

all organisations required by the circumstances of any particular event. There may be

emergencies where the chair is later taken up by another organisation, depending on the nature

of the emergency (e.g. Health emergency).

The initial notification to the Health Gold On-Call regarding the setting up of an SCG may come

direct from South Yorkshire Police or from Yorkshire Ambulance Service Operations Centre.

The Health Gold should attend the Strategic Co-ordinating Centre (SCC) with official

identification card with photo ID.

The Health Gold may need to consider arranging sufficient support to effectively perform their

role at an SCG. See also Section 4.10 above. Further information is also available in the

separate document “NHS South Yorkshire and Bassetlaw Strategic Framework for Emergency

Preparedness, Resilience and Response” which should be referred to.

It is important to point out that the SCG does not have collective authority to issue executive

orders. Each organisation represented on the SCG retains its own responsibilities and

exercises control of its own operations in the normal way. The SCG, therefore, has to rely on a

process of discussion and consensus to reach decisions, and ensure that the agreed joint

strategic aims and objectives are implemented through their respective organisations at the

tactical (silver) and operational (bronze) levels. The effectiveness of the SCG rests on every

representative having a clear understanding of roles, responsibilities, and constraints of other

SCG representatives.

These arrangements are compliant with the South Yorkshire Local Resilience Forum (LRF)

Strategic Leaders guide which should also be referred to.


6 ROLES OF NHS ORGANISATIONS DURING A MAJOR INCIDENT

6.1 DEPARTMENT OF HEALTH

In addition to it‟s Lead Government Department role, the Department of Health takes control of

the NHS resources in England in the event of a complex and significant emergency, including

those on a national and international scale, through its Emergency Preparedness Division Co-

ordinating Centre. It provides the co-ordination and focal point for the NHS and supports the

Health Ministers and Secretary of State. It also co-ordinates with the health departments in the

devolved administrations where health is a fully devolved function.

6.2 STRATEGIC HEALTH AUTHORITY (SHA)

NHS North of England is the Cluster Strategic Health Authority, formed as part of the ongoing

NHS Reforms and is made up from the 3 former Strategic Health Authorities of NHS North

West, NHS North East and NHS Yorkshire and Humber.

NHS North of England (SHA) are the regional headquarters of the NHS and, as such, are able

to mobilise and commit resources across the authority area. They are responsible for co-

ordinating the health response for a widespread incident affecting the authority area. They

provide the link with the Department of Health.

They are supported in this function by delegating responsibility to PCT Clusters in each county

area. Subsequently, NHS South Yorkshire and Bassetlaw will provide a command and control

function to co-ordinate the NHS response across the sub region.

6.3 NHS SOUTH YORKSHIRE AND BASSETLAW

NHS South Yorkshire and Bassetlaw is the Barnsley, Bassetlaw, Doncaster, Rotherham and

Sheffield Cluster of PCT‟s. The formation of Clusters is necessary as part of the ongoing NHS

Reforms to secure the capacity and flexibility needed for the transition period.

In particular the Shared Operating Model for PCT Clusters (28th July 2011) outlines the

expectation that PCT Clusters will maintain the capacity of NHS Commissioners to carry out

Emergency Preparedness, Resilience and Response (EPRR) functions during the transition

period. They are also expected to support the development of the new EPRR function within the

NHS.

Where an incident involves a South Yorkshire and Bassetlaw wide health response, the

Strategic level of command may be assumed by the PCT Cluster to co-ordinate the Strategic

level health response across the sub region. NHS South Yorkshire and Bassetlaw will then

provide and cascade strategic direction to any of the sub regional PCT/CCGs involved (see also

Section 4 Command and Control)

6.4 PRIMARY CARE TRUSTS (PCT)

Individual Primary Care Trusts (PCT) in each of the Localities of Barnsley, Bassetlaw,

Doncaster, Rotherham and Sheffield retain the responsibility for ensuring that local NHS

organisations and services are engaged in NHS emergency preparedness activities.

PCT‟s in this sub region are at different stages of transition towards developing as Clinical

Commissioning Groups (CCG) and are therefore referred to throughout this plan as PCT/CCG.


In the event of a major incident the PCT/CCG would provide a local command and control

function, reporting to the PCT Cluster and providing the conduit responsible for cascading

information and actions to all local service providers, including acute hospital trusts, community

service providers and primary care services.

Each Locality PCT/CCG has a Director of Public Health (DPH) who is responsible for the health

of the local population. Working closely with the Health Protection Agency, the DPH is

responsible for ensuring a local health response to any public health emergency.

6.5 PRIMARY and COMMUNITY CARE SERVICES

The provision of primary and community care services covers a range of health professions,

including general practitioners, community nurses, health visitors, mental health services and

pharmacists, many of whom would need to be involved, particularly during the recovery phase

of an emergency.

In the early stages, following an incident, the focus would be on the follow-up to injuries incurred

at the incident, i.e. the continuing recovery of patients, physiotherapy, chest clinics, orthopaedic

clinics, dressings, drug regimes and the post-traumatic stress caused by the event. Depending

on the nature of the emergency, there may then be a requirement for more long-term health

monitoring/surveillance.

All contact details for community care providers are contained in the Cluster On-Call information

pack. However it is not expected that direct contact would come from NHS South Yorkshire and

Bassetlaw.

Contact would normally be made through the respective locality PCT/CCG who are responsible

for the co-ordination of local service providers.

6.6 ACUTE HOSPITAL NHS FOUNDATION TRUSTS

Acute hospital trusts in South Yorkshire and Bassetlaw are listed below.

Barnsley Hospital NHS Foundation Trust

Doncaster & Bassetlaw Hospitals NHS Foundation Trust

Rotherham NHS Foundation Trust

Sheffield Children‟s NHS Foundation Trust

Sheffield Teaching Hospitals NHS Foundation Trust

All emergency contact details are contained in the Cluster On-Call information pack. However it

is not expected that NHS South Yorkshire and Bassetlaw would make direct contact with

hospital trusts.

Contact would normally be made either direct from Yorkshire Ambulance Service or through the

respective PCT/CCG who are responsible for the co-ordination of local service providers.

In the event of an emergency resulting in large numbers of casualties, the ambulance service

will designate receiving hospital(s) from one of the above organisations.

The primary responsibility of Acute Hospital trusts during a major incident is the provision of

care to incident victims in the hospital setting. However, if an Ambulance Incident Commander


(AIC) requests the attendance of specialist medical teams, potentially it would be Acute Trusts

that supply this mobile clinical response to provide general support and specialist healthcare to

casualties at the scene of the emergency.

Hospitals may need to implement internal escalation procedures to manage increased capacity

in collaboration with primary care services and other health care providers.

6.7 YORKSHIRE AMBULANCE SERVICES

As part of the NHS, Yorkshire Ambulance Service (YAS) have the responsibility for responding

to and co-ordinating the on-site NHS response to short notice or sudden impact emergencies.

This includes identifying the receiving hospital(s) to which injured people should be taken, which

depending on the types and numbers of injured, may include numerous hospitals remote from

the immediate area where the incident has occurred. The person with overall responsibility for

this, at the scene of an emergency, is the Ambulance Incident Commander (AIC). If necessary,

the AIC may seek the attendance of a Medical Incident Commander (MIC) and/or mobilise

specialist medical teams, for instance Medical Emergency Response Incident Teams (MERITs).

Both the MIC and these specialist medical teams would come from across the local NHS.

Ambulance Trusts, in conjunction with the MIC, medical teams and other emergency services,

endeavour to sustain life through effective prioritisation of emergency treatment at the scene.

This enables the AIC to determine the priority for release of trapped, treatment and where

necessary, decontamination of casualties. This will allow patients to be transported in order of

priority, to receiving hospitals.

Ambulance services may seek support from other organisations specifically the third sector

(e.g. British Red Cross, St John Ambulance) in managing and transporting casualties. If these

resources are deployed, these organisations would work under the direction of the Ambulance

Trust.

6.8 REGIONAL DIRECTOR OF PUBLIC HEALTH

Represent the Chief Medical Officer. In the event of a major public health emergency, the

RDsPH – working closely with the directors of the HPA – provide public health advice, support

and leadership to help SHAs and the wider NHS manage the emergency. They ensure co-

ordination with regional resilience mechanisms in preparing for and responding to outbreaks of

infectious diseases and other public health emergencies.

6.9 HEALTH PROTECTION AGENCY

The Health Protection Agency (HPA) is a non-departmental public body which makes public

health advice available to government departments, the NHS, the statutory agencies and

directly to the public. It provides a central source of authoritative scientific/medical information

and other specialist advice on both the planning and operational responses to public health or

other emergencies. This includes providing authoritative messages about health protection

measures in order to reduce public anxiety.

The HPA will undertake analysis of the health threat and in consultation with the Director of

Public Health, propose an appropriate treatment response to an infectious disease outbreak or

radiological and chemical incidents which have the potential to cause disruption, to

communities, on a large scale.


As part of the initial analysis process, particularly where it appears that a new virus is emerging,

the HPA may advise on any necessary surveillance testing of suspected cases to confirm the

virus and to better understand the epidemiology of a novel disease.

They will support the management of incidents and provide specialist input to Incident

Management Teams and will be involved as a member of a Scientific and Technical Advice Cell

(STAC) if required. They also provide the gateway to further specialist advice at a national level

if necessary.

The will also provide impartial and authoritative advice to health professionals, other agencies

and the public in monitoring long term effects of an outbreak.

6.10 SCIENTIFIC & TECHNICAL ADVICE CELL (STAC)

A STAC is most likely to be required in response to complex incidents involving multiple

scientific and technical issues, where there is potential for conflicting expert opinion. Where this

is the case a STAC should only be formed at the request of a multi-agency Strategic Co-

ordinating Group (SCG) Once requested the formation of a STAC will be arranged through the

NHS Sheffield Director of Public Health during office hours and through the Health Protection

Agency second on call rota outside office hours.


The purpose of the STAC is to provide a single point of understandable advice to the Chair of

the SCG. A South Yorkshire STAC may be co-located with the South Yorkshire SCG and report

directly to it. It should not provide advice to any other interested parties other than through the

SCG.

The STAC should not have a role in managing the incident, rather provide information and

advice about the scientific, technical, environmental and public health consequences of the

incident, including the impact of any evacuation or containment, impact on environmental

health, and effects on animal health. Its prime responsibility is to support the SCG strategy.

The STAC will take its tasking from the SCG. The SCG will ask specific questions of the STAC

and the STAC‟s role is to give a definitive answer, once it has consulted within the STAC and

decided upon the best course of action/answers.

The STAC will advise the SCG of the public health messages and advice to be given to health

care professionals and the public.

These arrangements are compliant with the Scientific and Technical Advice Cell Concept of

Operations which should also be referred to.


7 ROLES OF OTHER ORGANISATIONS DURING A MAJOR INCIDENT

7.1 SOUTH YORKSHIRE POLICE

The police will normally co-ordinate the activities of those responding to a land-based sudden

impact emergency, at and around the scene. There are however exceptions, for example the

Fire and Rescue Service would co-ordinate the response at the scene for a major fire.

For the police, as for other responders, the saving and protection of life is the priority. However

they must also ensure the scene is preserved, so as to safeguard evidence for subsequent

enquiries and, possibly, criminal proceedings. Once lifesaving is complete, the area will be

preserved as a crime scene until it is confirmed otherwise (unless the emergency results from

severe weather or other natural phenomena and no element of human culpability is involved).

The police oversee any criminal investigation. Where a criminal act is suspected, they must

undertake the collection of evidence, with due labelling, sealing, storage and recording. They

facilitate inquiries carried out by the responsible accident investigation bodies, such as the

Health and Safety Executive (HSE) or the Air, Rail or Marine Accident Investigation Branches. If

there is the possibility that an emergency has been caused by terrorist action, then that will be

taken as the working assumption until demonstrated otherwise.

Where practical, the police, in consultation with other emergency services and specialists,

establish and maintain cordons at appropriate distances. Cordons are established to facilitate

the work of the emergency services and other responding agencies in the saving of life, the

protection of the public and property and the care of survivors.

Where terrorist action is suspected to be the cause of an emergency, the police will take

additional measures to protect the scene (which will be treated as the scene of a crime) and will

assume overall control of the incident. These measures may include establishing cordons to

restrict access to, and require evacuation from, the scene, and carrying out searches for

secondary devices.

All agencies with staff working within the inner cordon remain responsible for the health and

safety of their staff. Each agency should ensure that personnel arriving at the scene have

appropriate personal protective equipment and are adequately trained and briefed. Health and

safety issues will be addressed collectively at multi-agency meetings on the basis of a risk

assessment. If it is a terrorist incident the police will ensure that health and safety issues are

considered and this will be informed by an assessment of the specific risks associated with

terrorist incidents.

The police process casualty information and have responsibility for identifying and arranging for

the removal of fatalities. In this task, they act on behalf of HM Coroner, who has the legal

responsibility for investigating the cause and circumstances of any deaths involved.

Survivors or casualties may not always be located in, or immediately around, the scene of an

incident. It is, therefore, important to consider the need to search the surrounding area. If this is

necessary, the police will normally co-ordinate search activities on land. Where the task may be

labour intensive and cover a wide area, assistance should be sought from the other emergency

services, the Armed Forces or volunteers.


7.2 SOUTH YORKSHIRE FIRE AND RESCUE SERVICES

The primary role of fire and rescue services in an emergency is the rescue of people trapped by

fire, wreckage or debris. They will prevent further escalation of an incident by controlling or

extinguishing fires, rescuing people and undertaking other protective measures. They will deal

with released chemicals or other contaminants in order to render the incident site safe or

recommend exclusion zones. They will assist other agencies in the removal of large quantities

of flood water. They will also assist ambulance services with casualty-handling, and the police

with the recovery of bodies.

In some areas there are agreements between fire and rescue and the police for controlling

entry to cordons. Where this is the case fire and rescue are trained and equipped to manage

gateways into the inner cordon and will liaise with the police to establish who should be granted

access and keep a record of people entering and exiting.

Although the National Health Service (NHS) is responsible for the decontamination of

casualties, fire and rescue services will, where required, undertake mass decontamination of

the general public in circumstances where large numbers of people have been exposed to

chemical, biological, radiological or nuclear substances. This is done on behalf of the NHS, in

consultation with ambulance services.

7.3 LOCAL AUTHORITY

Local authorities play a critical role in civil protection. They have a wide range of functions that

are likely to be called upon in support of the emergency services during emergency response

and recovery. Local authorities are one of the main bodies representing the community and

their role in emergency response and recovery largely reflects this.

The local authority will play an enabling role in close collaboration with a wide range of bodies

who are not routinely involved in emergency response (e.g. Regional Development Agencies in

England, building proprietors and land owners).

In particular, the local authority will work with partners to:

provide immediate shelter and welfare for survivors not requiring medical support and

their families and friends via Evacuation, Rest, Humanitarian and other Centres to meet

their immediate to short term needs.

provide medium to longer-term welfare of survivors (e.g. social services support and

financial assistance which may be generated from appeal funds and also provide help-

lines which should answer the public‟s questions as a one stop shop). Local authorities

have a large part in addressing community needs via drop-in centres and organising

anniversaries and memorials as part of the recovery effort.

provide Investigating and Enforcement Officers under the provision of the Food and

Environment Protection Act 1985 as requested by Defra;

facilitate the inspection of dangerous structures to ensure that they are safe for

emergency personnel to enter;

clean up of pollution and facilitate the remediation and reoccupation of sites or areas

affected by an emergency;

liaise with the coroner‟s office to provide emergency mortuary capacity in the event that

existing mortuary provision is exceeded.

co-ordinate the activities of the various voluntary sector agencies involved and

spontaneous volunteers;


may provide catering facilities, toilets and rest rooms for use by all agencies in one

place, for the welfare of emergency response personnel in the event of a protracted

emergency. This will depend on the circumstances and available premises;

lead the recovery effort, which is likely to carry on for a considerable time and is likely to

involve many organisations who are not ordinarily involved in, or used to the speed and

scale of the recovery effort.

7.4 THE ENVIRONMENT AGENCY

The Environment Agency is the leading public body for protecting and improving the

environment. As an environmental regulator, with a wide range of roles and responsibilities, it

responds to many different types of incident affecting the natural environment, human health or

property.

The Environment Agency‟s main priorities, during the response and recovery phases are to:

prevent or minimise the impact of the incident;

investigate the cause of the incident and consider enforcement action; and

seek remediation, clean-up or restoration of the environment.

The role of the Environment Agency at an incident depends on the nature of the event. For

example:

in a flood event, it focuses on operational issues such as issuing flood warnings,

predicting the location, timing and magnitude of flooding and operating its flood defence

assets to protect communities and critical infrastructure.

in a pollution incident, it will seek to prevent/control and monitor the input of pollutants to

the environment. In emergencies involving air pollution the EA will co-ordinate a multi-

Agency Air Quality Cell to provide interpreted air quality information.

in other emergencies (such as animal disease outbreaks), its principal role is usually to

regulate and provide advice and support on waste disposal issues.

7.5 HM CORONER

The role of the coroner is defined by statute (see www.statutelaw.gov.uk for details). In an

emergency, the coroner will be responsible for establishing the identity of the fatalities and the

cause and circumstances of death. Essentially, they will determine who has died, how and

when and where the death came about. The coroner will be supported by a deputy and an

assistant deputy. Current legislation dictates that a body lying in a coroner‟s district (irrespective

of where death has occurred) will trigger and determine jurisdiction, provided the deceased has

died from violence or sudden death of an unknown cause. If an emergency spans across more

than one district, a lead coroner should be established to deal with all fatalities.

Following the recovery of the deceased from the scene (which in most circumstances will be led

and co-ordinated by the police and carried out by trained body-recovery teams), it will be for the

coroner to decide whether a post mortem is required to establish the cause of death. On the

instruction of the coroner, a pathologist carries out the post mortem. If the death does not

require an inquest, the death may be registered on receipt of a coroner‟s certificate detailing the

cause of death; if an inquest is required, the coroner registers the death when the inquest is

concluded.

Coroners should have an emergency plan for dealing with multiple deaths for the local authority

mortuaries which are within their remit. This should include how dealing with multiple deaths


might impact on their normal working arrangements. Additionally, they are instrumental in the

development of local and regional emergency plans for extraordinary emergency mortuary

arrangements. It is also vital that coroners are familiar with any local emergency mortuary plans

developed by Category 1 and 2 responders.

7.6 MILITARY

The Armed Forces‟ national structure, organisation, skills, equipment and training can be of

benefit to the civil authorities in managing the response to, and recovery from, emergencies.

This support is governed by the Military Aid to the Civil Authority (MACA) arrangements. The

Ministry of Defence (MoD) joint doctrine publication Operations in the UK: The Defence

Contribution to Resilience sets out the detailed rules and procedures governing the employment

of the Armed Forces for MACA operations. Reserves, including Civil Contingencies Reaction

Forces (CCRFs), can be deployed alongside regular service personnel. The Defence

Contribution to Resilience includes templates for requesting military assistance. The solution to

any military assistance requests will be determined by the availability of military resources and

the commander‟s judgement.

The Armed Forces maintain no standing forces for MACA tasks. There are, by definition, no

permanent or standing MACA responses. Assistance is provided on an availability basis and the

Armed Forces cannot make a commitment that guarantees assistance to meet specific

emergencies. Neither the production of contingency plans nor Armed Forces‟ participation in

civil exercises guarantees the provision of MACA support. It is therefore essential that

responding agencies do not base plans upon assumptions of military assistance: the Armed

Forces should be called upon only as a last resort. The provision of Armed Forces‟ support

requires approval by a Defence Minister following a request by a government department. Unit

commanders have prior approval, in certain limited circumstances, to provide urgent assistance

where it is necessary to save life, alleviate distress or protect property in the event of an

emergency without specific approval.

The Army acts as the lead service for MACA on land. The Regional Brigade Headquarters will

be able to give advice and should be contacted in the first instance. All such headquarters have

24-hour emergency contact telephone numbers. The MoD‟s Joint Regional Liaison Officer

(JRLO) may act in a liaison capacity within local or regional civil emergency control centres

when appropriate, providing a link to the MoD‟s UK command structure. Liaison involves the

provision of advice and exchange of information. It does not guarantee the provision of support.

In exceptional circumstances, requests for assistance may be directed to any service unit,

station or establishment.

Where there is a direct threat to life, the MoD may, at its discretion, choose to waive the

recovery of costs for assistance provided. In cases where human life is not deemed to be in

danger, civil organisations will be required to meet all or some of the costs of the service

response. When the response moves towards the recovery phase and danger to human life

subsides, continued military assistance will be considered as routine and charged for at rates

determined by the MoD. Civil authorities should consider the disengagement of military

assistance at this point if very high costs are to be avoided.


7.7 THE THIRD SECTOR (including voluntary sector and faith groups)

The Third Sector can provide an extensive and diverse range of operational and support skills

and services to statutory responders. These skills and services include:

practical support (first aid; support to ambulance services; supporting hospital

personnel; referral to other organisations; search for survivors and rescue; refreshments

and emergency feeding; transportation and medical services - e.g. diagnosis and

administration of drugs);

psycho-social support (comforting; befriending; listening; help-lines; support lines;

support networks; advice; counselling; spiritual support and group therapy;

equipment (communications - e.g. radios; medical aid equipment - e.g.mobility aids;

bedding; clothing and hygiene packs - e.g. washing kits);and

information services (public training - e.g. first aid and flood preparation,

communications and documentation).

Statutory responders should be aware of the capabilities and capacity of local voluntary

organisations and the means of accessing their services, whether as individual volunteers or as

members of local or national volunteer organisations. Statutory responders should develop and

implement agreed processes for activating call-out mechanisms and systems for organising,

managing, briefing and debriefing volunteers. The voluntary sector should also be included in

post response review and evaluation activity.

Mutual aid arrangements do exist within and between many of the Third Sector organisations,

for activation as required, particularly across boundaries. In the event of a major or international

emergency, third sector support may be accessed through the head offices of the relevant

voluntary organisations or through the National Voluntary Sector Civil Protection Forum

(NVSCPF). In extreme circumstances or times of conflict, support may be provided by the

National Voluntary Aid Society Emergency Committee (NVASEC) - a standing committee that

will be convened at the request of the Ministry of Defence, Department for Health and the Civil

Contingencies Secretariat.

Through local multi-agency liaison arrangements (e.g. the Local Resilience Forum), the

statutory services will maintain an overview of the services that are offered across a range of

voluntary organisations and will provide an agreed system for co-ordinating the Third Sector

response, including members of the public who may volunteer their services in response to an

incident (convergent volunteers). It is important to avoid double-counting and gaps in service

provision by indicating which statutory responder has first call on (or priority need for) any

particular voluntary sector contribution.

Agencies using volunteers may become responsible for the health and safety of volunteers.

These volunteers should be appropriately equipped, trained, supervised and supported by their

own organisations. Statutory responders may also enter into agreements with voluntary

organisations in relation to the payment of costs.


8 BUSINESS CONTINUITY MANAGEMENT (BCM)

The purpose of this plan is to provide a framework for the emergency co-ordination of all NHS

organisations to ensure an integrated and co-ordinated approach to any emergency or Major

Incident, in order to minimise the impact on the health and welfare of the communities of South


However, it does not detract from the need for each NHS organisation to have its own robust

Major Incident and Business Continuity Management plans. It does not affect routine operating

procedures, rather it complements them and provides additional measures and command and

control options for incidents that would stretch resources and be beyond internal capabilities or

routine escalation procedures of individual organisations and requires a wider co-ordination of

NHS resources.

Business Continuity Management is an important feature of the overall response to a Major

Incident, as clearly, there is potential that the response to a large scale Major Incident can also

impact on routine business functions, either because of the nature of the incident itself or the

fact that a high proportion of resources are by necessity diverted to respond to the incident.

Whilst the Major Incident and Business Continuity roles are different these are not discreet

activities and BCM activities should overlap and be invoked once the initial Major Incident

response has been implemented and relevant control measures established to mitigate the

immediate threat. Likewise, Recovery activities should commence the return to normality at the

earliest opportunity.

Fig.6 – The below diagram outlines the relationship between the various stages of an incident.

Tim

e Z

ero

Incident!

Timeline

Incident response

Business continuity

Recovery


It is therefore feasible that the BCM team may be running in tandem with a Major Incident team.

Where a Command and Control structure is in place to manage an ongoing Major Incident the

BCM team Manager will liaise and report to the overall Incident Manager. Effectively there will

be a Silver BCM Team Manager and a Silver Major Incident Manager both working to their

respective responsibilities, under the Strategic Direction of Gold.

Where possible BCM is best dealt with at the local level and there is a potential for there to be

up to Five Silver level commands, corresponding to the 5 PCT/CCGs in the South Yorkshire

and Bassetlaw cluster. Each Silver Command may have its own Major Incident Lead and a

separate BCM Lead. The role of each Silver level group will be to co-ordinate the overall health

response for their respective district and provide the link to their local service providers. (See

Fig. 4)

The NHS South Yorkshire and Bassetlaw Gold commander will need to provide a strategic level

co-ordination of both the Major Incident response and Business Continuity Management

activities.

This will be essential to ensure a whole systems approach involving any local Health Care

Organisations as necessary in order to effectively and efficiently manage a widespread

disruption to services. This integrated emergency management will ensure priority is given to

the most urgent corporate functions so that NHS South Yorkshire and Bassetlaw is able to

maintain key priority functions and recover other functions in priority order.

Some services may not individually be experiencing a direct impact, but may be required to

support those who are adversely affected. Commissioned provider services will be expected to

co-operate and work flexibly to support the overall health response and divert resources to

those areas in most need.

This collaborative working will ensure the highest level of service achievable in the

circumstances is continued across the entire Health service and therefore minimise the impact

on health to the community of South Yorkshire and Bassetlaw.


9 ETHICAL CONSIDERATIONS

NHS South Yorkshire and Bassetlaw has a duty to protect and promote the health of the

community, including in times of emergency. The purpose of this plan is to put in place

appropriate arrangements to facilitate an efficient and effective response to a Major Incident

impacting on the NHS and the health of the community. As such it aims to, as far as reasonably

practicable, maintain the key principles and values of the NHS Constitution 2010 and also

discharge the positive duty placed on us by the Equality Act 2010, the Human Rights Act 1998,

and the Health and Safety at Work Act 1974.

During a Major Incident, NHS South Yorkshire and Bassetlaw NHS will provide an overall co-

ordinating role to ensure an integrated emergency management approach involving any local

Health Care Organisations as necessary in order to effectively and efficiently respond and

therefore minimise the impact on health to the community of South Yorkshire and Bassetlaw.

Commissioned provider services will be expected to co-operate and work flexibly to support the

overall health response and divert resources to those areas in most need.

The health and welfare of patients, staff and other stakeholders is the primary consideration.

Managing a Major Incident in a health care organisation will involve many difficult decisions.

These may create tension between the needs of individuals and the needs of the population.

Such decisions can be personal or wider, for example, affecting the organisation and delivery of

health or social care services.

Decisions will need to be made in accordance with the law and relevant National Guidance and

professional codes. In particular the Ethical Framework for Policy and Planning published by the

Department of Health in November 2007 should be referred to.

During a Major Incident it is possible that a Scientific and Technical Advice Cell (STAC) will be

formed to provide expert medical opinion to assist Strategic commanders develop appropriate

response options.

Where patient care is compromised due to the impacts of a Major Incident, then NHS South

Yorkshire and Bassetlaw may request the formation of a local Clinical Executive Group to

provide clinical advice on priority medical services to the NHS Strategic commander. Such a

group should consist of Clinical Executive Leads from NHS South Yorkshire and Bassetlaw,

relevant Acute Hospital Trusts, relevant Community Service providers and Professional leads

from relevant Local Authorities.

It is stressed that in the response phase, the Clinical Executive Group is not to debate or divert

from GOLD Policy or STAC guidance but to provide appropriate advice on local clinical

response options to achieve the overall strategy. The group should consider issues such as

changes to discharge and admission criteria or reductions or suspension of functions and

services locally to provide the necessary capacity to deal with exceptional demand on services

within an ethical framework and to minimise the impact on the health of the community during a

large scale response required for a Major Incident.

The overriding principle will be to provide the highest level of care available under the

circumstances and ensuring that people with an equal chance of benefiting from health and

social care resources have an equal chance of receiving them.


During a Major Incident decisions often have to be made quickly using the best information

available at the time. Consulting those concerned as much as possible in the time available, be

open and transparent about what decisions were made and why they were made. Decisions

should then be recorded and communicated accordingly.


10 RECOVERY

Response and recovery are not two discrete activities and should not occur sequentially. As the

emphasis moves from response to recovery the Strategic Lead should identify an individual or

group to Lead on the Recovery phase. For a multi-agency incident the Recovery process will

most likely be implemented by the Strategic Coordinating Group, which should activate a

Recovery Coordinating Group.

The Response phase will be formally stood down when deemed appropriate and all

organisations officially informed of any hand over arrangements and new points of contact need

to be communicated to all partners and all staff involved. The decision of when to stand down

the Response phase may be different for each organisation involved.

The overall priority for Recovery will be the restoration of the well being of individuals,

communities and the infrastructure that supports them, The Local Authority will take the lead in

facilitating the rehabilitation of the community and the restoration of the environment.

Depending on the nature of the incident, in the early stages of recovery, the NHS focus would

be on the follow-up to injuries incurred at the incident, i.e. the continuing recovery of patients,

physiotherapy, chest clinics, orthopaedic clinics, dressings, drug regimes and psychosocial

care, there may then be a requirement for more long-term health monitoring/surveillance.

It will then be important to re-establish normal clinical care and associated functions as soon as

possible, including managing the backlog of any cancelled or reduced activities. The Recovery

Coordinator will oversee a phased recovery of functions and procedures based on priorities

identified in the Business Impact Analysis. Early consideration needs to be given to replenishing

stocks of essential supplies that may have been depleted during the response. Where

appropriate the Department of Health and Strategy & Contracting will need to evaluate and

return to routine performance management measures.

Where Critical National Infrastructure of the NHS has been compromised wide area support

may be required from NHS North of England or the Department of Health. The NHS Gold

Commander will have a key role in supporting the co-ordination of any recovery efforts

especially where there are competing priorities for scarce resources.

Liaison may also be required with the Department for Communities and Local Government,

Resilience and Emergencies Division – North and other Government departments who may

have a role in recovery e.g. Government Decontamination Service (GDS).

10.1 Closure of the Major Incident Control Centres (MICC)

When the decision is taken to close the various MICC which may have been activated, it is the

responsibility of the Silver Staff Officer to ensure that all records and documentation are

collected and retained for de-brief and post incident review.

It will also be necessary to ensure that the incident control rooms are cleared and returned to

their normal state and that any equipment used or loaned is returned to where it belongs.

The Silver Staff Officer will facilitate a hot de-brief session before standing down personnel and

retain details of this to be used in the full de-brief at a later stage.


10.2 Staff Support

It should be recognised that staff will have been working under considerable pressure possibly

over an extended period of time and will need to recover before they can return to full efficiency.

Also members of staff may have been personally affected during the incident. Welfare support

should be considered where appropriate.

“Planning for the psychosocial and mental health care of people affected by major incidents

and disasters” is the title of interim guidance issued by the DH in July 2009 and should be

referred to.

All organisations have responsibility for their employees in terms of their staff health and well-

being and this is an important part of the incident and recovery management planning process.

Occupational Health Units should be involved at an early stage and consider the potential need

for psychosocial care for their staff and where appropriate should provide interventions based

on the principles of Psychological First Aid and provide access to augmented Primary

Healthcare services and Specialist Mental Health Services.

10.3 De-brief

At the conclusion of the incident there will need to be a full de-brief and evaluation of what

worked well and what lessons have been identified. Consideration should be given to arranging

internal and where appropriate multi-agency de-briefs.

All records pertaining to the response should be retained and stored for the de-brief and may

also be required as part of any external enquiry. This will include the “Emergency Log Book”

and the De-brief report. It will also be necessary to retain all other documents and notes created

during the incident.

The Emergency Resilience Unit will ensure that validation takes place across the South

Yorkshire and Bassetlaw health community and that de-briefs are evaluated to build on good

practice and to ensure that lessons identified are acted upon, taking steps to adapt systems

and services to improve future responses.

Findings should be reported to the relevant Boards of all organisations involved. Resilience

plans and associated training and exercise programmes should be reviewed to reflect the

outcomes of the de-brief.


Appendix 1

LEGISLATION & GUIDANCE

The Civil Contingencies Act 2004 places a statutory duty on NHS organisations to prepare for

emergencies. The NHS Emergency Planning Guidance 2005 requires a trained and tested

Major Incident Plan be in place. The Operating Framework for the NHS in England 2012/13

states that Emergency Preparedness, Resilience and Response continues to be a core function

of the NHS. All NHS organisations are required to maintain a good standard of preparedness to

respond safely and effectively to a full spectrum of threats, hazards and disruptive events.

1.1 Chief Executive

The NHS Emergency Planning Guidance 2005 states, the Chief Executive of NHS South

Yorkshire and Bassetlaw has overall responsibility for Emergency Planning. They will ensure

that the organisation has a Major Incident Plan in place that is built on the principles of Risk

Assessment, co-operation with partners, communicating with the public and information

sharing. They will ensure that the Board receives regular updates, at least annually, regarding

emergency preparedness, including reports on exercises, training and testing undertaken by the

organisation. The Chief Executive will also ensure that adequate resources are made available

to allow the discharge of these responsibilities.

The Chief Executive must ensure that Board level responsibility for Emergency Planning is

clearly defined and there are clear lines of accountability throughout the organisation leading to

the Board. The Director of Performance and Accountability is designated to take responsibility

for Emergency Preparedness, Resilience and Response and is supported in this role by the

Emergency Resilience Unit.

1.2 Civil Contingencies Act 2004

The purpose of the Act is to establish a statutory framework for civil protection at the local level.

It provides a clear set of roles and responsibilities for Category 1 responders which includes the

NHS (full list of Category 1 responders below)

Statutory Duties placed on Category 1 responders:

Assess the risk of emergencies occurring

Put in place emergency plans

Put in place Business Continuity Plans

Warn and inform the public in the event of an emergency

Share information with other local responders

Co-operate and co-ordinate with other local responders

The Civil Contingencies Act requires that emergency plans are validated through training,

exercising and testing. NHS guidance stipulates a minimum requirement for each NHS

organisation is for a live exercise to be conducted every 3 years, a tabletop exercise to be

conducted every 1 year and a communications cascade test to be conducted every 6 months


Category 1 Responders

Police Forces Foundation Trusts

British Transport Police Health Protection Agency

Fire Authorities Local Authorities

Ambulance Services Environment Agency

Primary Care Trusts Maritime and Coastguard Services

Acute Trusts

1.3 Human Rights Act 1998

Section 6(1) of the Human Rights Act 1998 makes it unlawful for a public authority to act in a

way which is incompatible with rights under the European Convention on Human Rights.

It is essential that any proposed course of action be:

Proportionate

Legal

Accountable

Necessary

Based on the best available information.

The principle purpose of this plan is to provide an appropriate response framework to facilitate

the protection of life in the event of a Major Incident affecting the health and welfare of the

community of South Yorkshire and Bassetlaw. As such it aims to discharge the positive duty to

protect life that is placed on NHS South Yorkshire and Bassetlaw by the Convention Rights.

Accordingly it is important that every effort is made to take account of the advice given in this

plan in order to fulfil this duty.

1.4 Health and Safety Legislation

NHS South Yorkshire and Bassetlaw as an employer has a duty under the Health & Safety at

Work etc Act 1974 to ensure, so far as is reasonably practicable, the health, safety and welfare

at work of all its employees.

Health and Safety advisors should be consulted to assist with carrying out risk assessment for

any activities outside normal working conditions.


Appendix 2

USEFUL ABBREVIATIONS

AAIB Aircraft Accident Investigation Branch

ACP Ambulance Control Point

ACPO Association of Chief Police Officers

A & E Accident & Emergency

AFIO Ambulance Forward Incident Officer

AIC Ambulance Incident Commander

ALP Ambulance Loading Point

AMMC Ambulance Mobile Medical Control

AWE Atomic Weapons Establishment

BCM Business Continuity Management

BCP Business Continuity Plan

BRC British Red Cross

BT British Telecom

BTP British Transport Police

CBRN Chemical, Biological, Radiological, Nuclear (terrorist attack)

CCA Civil Contingencies Act 2004

CCDC Consultant in Communicable Disease Control

CCG Clinical Commissioning Group

CFOA Chief Fire Officers Association

CHALET Casualties, Hazards, Access, Location, Emergency Services, Type of Incident

CHEMDATA Chemical Database

COBRA Cabinet Office Briefing Room

COMAH Control of Major Accident Hazard Regulations 2005

CPHM Consultant in Public Health Medicine

DEFRA Department for Environment, Food & Rural Affairs

DH Department of Health

DIM Detection, Identification & Monitoring equipment

DOE Department of the Environment

DOHSC Department of Health & Social Care

DPH Director of Public Health

DTI Department of Trade & Industry

EA Environment Agency

EPRR Emergency Preparedness, Resilience and Response

FCO Foreign & Commonwealth Office

FSA Food Standards Agency

GIS Geographical Information System

GNN Government News Network


GOYH Government Office for Yorkshire & Humber

GP General Practitioner

HART Hazardous Area Response Team

HAZMAT Hazardous Materials

HO Home Office

HPA Health Protection Agency

HPU Health Protection Unit

HSE Health & Safety Executive

IED Improvised Explosive Device

JTAC Joint Terrorist Analysis Centre

LAESI Local Authority & Emergency Services Information (on nuclear weapon transport)

LRF Local Resilience Forum

MACC Military Aid to the Civil Community

MERIT Medical Emergency Response Incident Team

METHANE My name, Exact location, Type, Hazards, Access, Number of casualties, Emergency Services (Alternative to CHALET)

MICC Major Incident Control Centre

MoD Ministry of Defence

MTPAS Mobile Telephone Preference Access Scheme

NAIR National Arrangements for Incidents Involving Radioactivity

NHS National Health Service

ODPM Office of Deputy Prime Minister

PCT Primary Care Trust

PNICC Police National Information & Co-ordination Centre

RCCC Regional Civil Contingencies Committee

RDPH Regional Director of Public Health

RIMNET Radioactive Incident Monitoring Network

RRF Regional Resilience Forum

RVP Rendezvous Point

SCC Strategic Co-ordinating Centre

SCG Strategic Co-ordinating Group

SHA Strategic Health Authority (NHS Yorkshire & Humber)

SIO Senior Investigating Officer (police)

SITREP Situation Report

SJA St Johns Ambulance

STAC Scientific & Technical Advisory Cell

VIP Very Important Person

WHO World Health Organisation

WRVS Women‟s Royal Voluntary Service


Appendix 3

GLOSSARY OF EMERGENCY RESPONSE TERMS

Assembly Point: A building or an area on the periphery of an evacuation zone where evacuees

can gather to get further information, await directions for, or transport to, a Rest Centre and

meet up with friends and relatives.

BRONZE: Operational level of management which reflects the normal day-to-day arrangements

for controlling events or situations. It is the level at which the management of „hands-on‟ work is

undertaken at the incident site(s) or associated areas.

Casualty Bureau: Central police controlled contact and information point for all records and

data relating to casualties.

Casualty Clearing Station: An area set up at a Major Incident by the Ambulance Service in

liaison with the Medical Incident Commander to triage, assess and treat casualties and direct

their evacuation.

Category 1 responder: A local responder organisation listed in Schedule 1 Part 1 of the Civil

Contingencies Act 2004 and likely to be involved with a central role in the response to most

emergencies.

Category 2 responder: A local responder organisation (though it may not be locally based)

listed in Schedule 1 Part 3 of the Civil Contingencies Act 2004 and likely to be involved in some

emergencies or in preparedness for them.

CheMet: A scheme administered by the Meteorological Office, providing information on weather

conditions as they affect an incident involving plumes of hazardous materials.

Command: The authority for an agency to direct the actions of its own resources (both

personnel and equipment)

Community Risk Register: An assessment of the risks within a local resilience area agreed by

the Local Resilience Forum as a basis for supporting the preparation of emergency plans.

Control: The authority to direct strategic and tactical operations in order to complete an

assigned function and includes the ability to direct the activities of other agencies engaged in

the completion of that function. The control of the assigned function also carries with it a

responsibility for the health and safety of those involved.

Control Room: Centre for the control of the movements and activities of each emergency

service‟s personnel and equipment. Liaises with other services control rooms.

Co-ordination: The harmonious integration of the expertise of all the agencies involved with

the objective of effectively and efficiently bringing the incident to a successful conclusion.


Cordon – inner: Surrounds and protects the immediate scene of an incident.

Cordon – outer: Seals off a controlled area around an incident to which unauthorised persons

are not allowed access.

Domiciliary care: Care given in the home to the elderly and disabled, including home helps,

meals on wheels and attendance by care assistants.

Emergency: An event or situation which threatens serious damage to human welfare or to the

environment in a place in the UK, or war or terrorism which threatens serious damage to the

security of the UK.

Escalation: Point at which it becomes necessary to involve additional plans / arrangements in

order to respond to the incident effectively.

Evacuation: The process by which people are moved away from a place where there is

immediate or anticipated danger to a place of safety, offered appropriate temporary welfare

facilities and enabled to return to their normal accommodation / activities when the threat to

safety has gone, or to make suitable alternative arrangements.

Evacuation assembly point: Building or area to which evacuees are directed for

transfer / transportation to a reception centre or rest centre.

Exercise: A simulation to validate an emergency plan or rehearse its procedures.

Forward Control Point: Each service‟s command and control facility nearest the scene of the

incident – responsible for immediate direction, deployment and security.

Friends and relatives reception centre: Secure area set aside for use and interview of friends

and relatives arriving at the scene (or location associated with an incident, such as an airport or

port). Established by the police in consultation with the local authority.

GOLD: Strategic management level, either single or multi-agency. Establishes a policy and

overall framework within which tactical managers will work. It establishes a strategic aim and

objectives and ensures long-term resourcing / expertise.

Hospital Documentation / Liaison Team: Team of police officers responsible for completing

police casualty record cards in hospital.

Identification Commission: Group representing all aspects of the identification process, which

is set up to consider and determine the identity of the deceased to the satisfaction of HM

Coroner.

Lead responder: A local responder charged with carrying out a duty under the Act on behalf of

a number of responder organisations, so as to co-ordinate its delivery and to avoid unnecessary

duplication.


Major incident: Any occurrence that presents a 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.

Major Incident Plan: Pre-planned and exercised procedures which are activated once a major

incident has been declared.

Media centre: Central location for media enquiries, providing communication, conference,

monitoring, interview and briefing facilities and access to responding organisation personnel.

Staffed by spokespersons from all the principal services / organisations responding.

Media Liaison Officer: Representative who has responsibility for liaising with the media on

behalf of his / her organisation.

Media Liaison Point: An area adjacent to the scene which is designated for the reception and

accreditation of media personnel for briefing on arrangements for reporting, filming and

photographing, staffed by media liaison officers from appropriate services.

Media plan: A key plan for ensuring co-operation between emergency responders and the

media in communicating with the public during and after an emergency.

Mutual Aid: An agreement between responders, within the same sector or across sectors and

across boundaries, to provide assistance with additional resources during an emergency which

may go beyond the resources of an individual responder.

Public Information Line: A help-line set up during and in the aftermath of an emergency to

deal with information requests from the public and to take pressure off the Police Casualty

Bureau (which has a separate and distinct purpose).

Receiving hospital: Any hospital selected by the ambulance service from those designated by

Strategic Health Authorities to receive casualties in the event of a major incident.

Reception Centre: Secure area to which uninjured survivors can be taken for shelter, first aid,

interview and documentation. This facility is run by the local authority.

Recovery: The process of restoring and rebuilding the community, and supporting groups

particularly affected, in the aftermath of an emergency.

Rendezvous point: Point to which all vehicles and resources arriving at the outer cordon are

directed for logging, briefing, equipment issue and deployment.

Rest Centre: Premises taken over by the Local Authority for the temporary accommodation of

evacuees from an incident.


SILVER: Tactical level of management which provides overall management and co-ordination

of the response to an emergency. Determines priorities in allocating resources and requests

further resources as required.

Strategic Co-ordinating Group: A group comprising senior managers of appropriate

organisations which aims to achieve effective inter-agency co-ordination at a strategic level.

This group should normally be located away from the immediate scene.

Temporary or Resilience mortuary: Building or vehicle – usually separate from the public

mortuary – adapted for temporary use as a mortuary in which post mortem examinations can

take place.

Triage: Process of assessment of casualties and allocation of priorities by the medical or

ambulance staff at the site or casualty clearing station prior to evacuation. Triage may be

repeated at intervals and on arrival at a receiving hospital.

Utilities: Companies providing essential services, e.g. gas, water, electricity, telephones.

Voluntary sector: Bodies, other than public authorities or local authorities, which carry out

activities otherwise than for profit.

Vulnerable establishment An institution housing vulnerable people during the day or at night.

Vulnerable people: People present or resident within an area known to local responders who

because of dependency or disability need particular attention during emergencies.

Warning and informing the public: Establishing arrangements to warn the public when an

emergency is likely to occur or has occurred and to subsequently provide them with information

and advice.




Draft Strategic Aim

AIM

To provide an integrated and co-ordinated response to mitigate and minimise the impact on the

health and welfare of the South Yorkshire and Bassetlaw community

OBJECTIVES

Protect and preserve life

Provide information and advice to the public, staff and media

Co-ordinate the local NHS response

Co-operate and co-ordinate with other responding organisations

Assist an early return to normality




MAJOR INCIDENT – MESSAGE LOG

Message No. 1.

Time received: Date received:

Received by:

Message from (name):

Organisation: Role:

Telephone No: E-Mail address:

Details of information / message

Action Required?

Action allocated to: Time / date allocated:

Action resulted: Time / date resulted:

Message finalised and for filing Signature: ………………………………………Print Name……………………………………………

Continue overleaf if necessary


Finalised forms to be submitted to the Emergency Resilience Unit for retention


Major Incident Team meeting

AGENDA

Time / Date:

Location:

1. Introductions to include roles and responsibilities

2. Complete attendance list

3. Review and update of Actions from any previous meetings

4. Overview of the present situation – Chair

Initial Impact (casualties /hazards)

Resources available / required

Further information required

Initial actions to be allocated

5. Establish / Review Aim and Objectives of the emergency response

6. Communication Links required

Internal / external

Local / regional

7. Media policy and information for the public

8. Confirm and agree any Policy Decisions for recording with the Emergency Log Book keeper

9.

10. Any other business

Details of next meeting:



Attendance Sheet

Meeting: Time / Date:

Name Organisation Signature




MAJOR INCIDENT

EXHIBIT LIST

No. Reference Description Produced by



MAJOR INCIDENT

EXHIBIT LIST

No. Reference Description Produced by

1 IR 1 Yellow post it note with rough notes timed 08:00 on 21.11.2011

Ian Ramsay

2 IR 2 Blue post it note with rough notes timed 08:10 on 21.11.2011

Ian Ramsay

3 GY 1 Rough notes on A4 paper timed 08:12 on 21.11.2011 Gaynor Young

4 DS 1 Agenda for first planning meeting timed 09:30 on 21.11.2011

Diane Smith

5 LC 1 Minutes of first planning meeting timed 09:30 on 21.11.2011

Lisa Corbridge

6 EB 1 Flip chart containing details of casualties timed 09:45 on 21.11.2011

Emma Black

7 EB 2 Flip chart containing details of resources available timed 09:50 on 21.11.2011

Emma Black

8 EB 3 Photograph of dry wipe board containing details of outstanding issues timed 10:25 on 21.11.2011

Emma Black

9 EB 4 Photograph of dry wipe board containing details of current actions allocated timed 10:32 on 21.11.2011

Emma Black

10 LC 2 Minutes of second planning meeting timed 14:00 on 21.11.2011

Lisa Corbridge

11 GY 2 Major Incident Message Log No 1 Gaynor Young

12 GY 3 Major Incident Message Log No 2 Gaynor Young

13 IR 3 E:mail sent by Ian Ramsay at 14:12 on 21.11.2011 Ian Ramsay

14 IR 4 E:mail received by Ian Ramsay at 14:15 on 21.11.2011 Ian Ramsay

15 JB 1 Emergency Log book from 08:00 to 17:00 on 21.11.2011

Jill Burkinshaw

Bibliography

Cabinet Office Emergency Response & Recovery Guidance 2009 Cabinet Office Emergency Preparedness Guidance 2005 Civil Contingencies Act 2004 NHS Emergency Planning Guidance 2005 Strategic Command Arrangements for the NHS during a Major Incident 2007 Business Continuity Institute Good Practice guidelines 2010 BS 25999 - 1 Code of Practice for Business Continuity Management BS 25999 - 2 Specification for Business Continuity Management NHS Resilience and Business Continuity Management Guidance 2008 Department of Health Major Incident planning and assessment tool for Primary Care Trusts 2009 Department of Health Ethical Framework for Policy and Planning November 2007

Department of Health Managing Demand and Capacity in Health Care Organisations April 2009 Department of Health NHS Constitution March 2010 Human Rights Act 1998 Health & Safety at Work Act 1974 Equality Act 2010 NHS South Yorkshire & Bassetlaw Strategic Framework for EPRR South Yorkshire Local Resilience Forum Strategic Leaders Guide South Yorkshire Scientific and Technical Advice Cell Concept of Operations NHS Shared Operating Model for PCT Clusters


Plan History

Details By Date

Draft Version 1 of a new generic Major Incident plan developed to reflect transition to PCT Cluster arrangements as part of ongoing NHS Reforms

Ian Ramsay 7.12.2011

Review

Next Review Due: December 2012

Any exercise or activation of this plan will require a de-brief and review of the plan


Distribution List

Copy No. Issued to Department

An electronic version of this plan is also available on – Cluster external website ??

Documents

NHS South Yorkshire and Bassetla · The NHS Emergency Planning Guidance 2005 requires a trained and tested Major Incident Plan be in place. The Operating Framework for the NHS in