Management of Public Health Incidents: Guidance on the Roles and Responsibilities of NHS led Incident Management Teams - October 2011 (Updated July 2013)
This document provides guidance for the NHS in preparing for, and managing public health incidents in collaboration with partners, especially the Local Authorities.
TIERED RESPONSE AND HIERARCHY OF GUIDANCE
20. This section describes the level of response required depending on the scale of the incident and the threat to the public health. However, the need to escalate the response may also be influenced by the capacity of the NHS Board, Local Authority and partners to respond.
21. Where an incident is being led by one NHS Board or where two or more NHS Boards are involved but with no major disruption of services, this guidance is to be used supplemented with any issue specific guidance. Links to sources of guidance are available in Annex C. For example where the incident is thought to be foodborne, the 'Guidance on the Investigation and Control of Outbreaks of Foodborne Disease in Scotland' would also be used. Further information on the management of incidents in healthcare settings is provided in Annex D, and environmental incidents in Annex E.
22. Where an incident is Scotland or UK wide, with some but no major disruption of services, HPS will lead the management and coordination of the incident in Scotland following the principles set out in this guidance and in the Memorandum of Understanding (MOU) between HPS and the Scottish Government. Please note this memorandum is being developed into a tripartite memorandum which will also cover NHS Boards in future.
23. When a Major Incident has been declared (an incident with major disruption of services and/or either affecting Scotland or UK wide), NHS Boards, HPS and the Scottish Government will be working to the local plans based on the principles set out in 'Preparing Scotland'. Preparing Scotland is the Scottish Government's guidance on responding to emergencies and brings together the guidance on implementation of the Civil Contingency Regulations, good practice and the integration of national and local planning for emergencies. A suite of guidance is available within 'Preparing Scotland' including specific guidance to be followed by NHS Boards, Local Authorities and other agencies on the role of Scientific and Technical Advice Cells (STACs).
24. An incident that takes place in a single NHS Board or Local Authority might also escalate sufficiently to necessitate declaration of a Major Incident and the consequent need to invoke the NHS Board Major Incident Plan and/or the SCG plans including arrangements for a STAC.
25. In addition to 'Preparing Scotland', the Scottish Government has published 'NHS Scotland: responding to emergencies'. This guidance includes annexes covering specific types of emergency including radiation; chemicals; burns and infectious disease. It should therefore be used alongside this guidance for any major public health incident. For more detail see Annex C.
26. Further detailed explanation of roles and responsibilities appears in Annex B and this includes a full explanation of how NHS Board, Local Authority and other agency roles will change as an incident escalates.
27. Table 1 below provides a summary of the likely level of response required depending on the threat to the public health with detail provided in subsequent sections. The use of levels to classify incidents has not been used in Scotland before and this needs to be tested against a range of scenarios or incidents to assess its use in practice. Further work is required to develop and refine this into a tool that could be used to determine the classification of incidents and trigger levels for action.
Table 1. Classification of public health incidents and response required
| Level |
Actual or potential impact of incident |
Response |
|||
| Management |
Resources |
Briefing during incident |
Formal Reporting |
||
| 0 |
Cluster of cases in space and time - no ongoing impact on public health |
NHS Board led Problem Assessment Group (PAG) |
Local HP team and LA staff IPCT (HAI) |
HPS |
None required HPS Incident surveillance |
| 1 |
Limited local impact - no significant risks to wider public health beyond group/setting affected |
NHS Board led IMT |
Local HP Team and LA staff IPCT (HAI) Support from HPS and other agencies as required |
HPS re Scottish alert DPH and senior managers in NHS Board and LA SGHD according to protocol |
SBAR1 to HPS and NHS Board/Local Authority committees HPS Incident surveillance |
| 2 |
Significant local impact -significant risk to wider public health beyond group/setting affected mainly in single NHS Board area |
NHS Board led IMT with links to other NHS Boards as required; Agree IMT lead |
Local HP team and LA staff Consider need for corporate response and/or mutual aid Support from HPS and other agencies as required. |
HPS re Scottish alert DPH/senior managers in NHS/LA; SGHD according to protocol; Consider briefing SCG partners & elected members |
Consider if SBAR or full incident report for NHS Board/Local Authority and HPN required2 HPS Incident surveillance |
| 3 |
Significant wider impact - significant risk to wider public health affecting more than one NHS Board |
HPS IMT with links to NHS Board IMTs as required Consider need for SCG co-ordinated response if wider consequences |
Local HP Team and LA staff Consider need for corporate response and/or mutual aid Consider need to activate Business Continuity Plan (BCP) or Major Incident Plan (MIP) |
HPA re UK and Euro alert DPH/senior managers in NHS/LA; SGHD according to protocol; SCG partners, if appropriate; Elected members |
Full Incident report required for NHS Board/Local Authority and HPN HPS Incident surveillance |
| 4 |
Severe local or wider impact - major ongoing risk to wider public health affecting one or more than one NHS Board with significant disruption of services |
NHS Board led Civil Contingencies response if impact in one NHS Board area. SG led Civil Contingencies response if impact greater than one NHS Board area |
All available public health resources in the NHS Board(s) and Local Authority staff deployed. Request mutual aid Consider HPS/HPA support Activate BCP and/or MIP |
HPA re UK and Euro alert DPH/senior managers in NHS/LA; SCG partners; SGHD according to protocol; Elected members |
Full Incident report required for NHS Board/Local Authority and HPN HPS Incident surveillance |
| 5 |
Catastrophic impact - major ongoing impact on public health with major disruption of normal societal functions |
SG led Civil Contingencies response |
All available public health resources in the NHS Board(s) and Local Authority staff deployed MIP activated |
HPA re UK and Euro alert DPH/senior managers in NHS/LA ;SCG partners; SGHD according to protocol; Elected members |
Full Incident report required for NHS Board/Local Authority and HPN HPS Incident surveillance |
1 SBAR - Situation, Background, Assessment and Recommendation. 2 Full report required if one or more of the following is associated with the incident: significant lessons identified that should be shared locally or nationally; actions required by other agencies to prevent recurrence of like event and/or address problems identified in response; novel agent, source or pathways of exposure; high mortality or morbidity; unusual presentation of illness; changes required in guidance; significant public or political interest.
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Email: Janet Sneddon
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