National incident response levels: guidance for health boards

3. Levels Of Response

An incident is described in terms of the level of response required. This level may change as the incident evolves. Incident response levels describe at which level coordination takes place. The levels in this guidance must be used by all NHS Boards when referring to incidents.

Level: 1

Type of Response

Impact felt in a single, limited location.

Can be responded to and managed locally within respective business as usual capabilities and business continuity/emergency plans of the affected Health Board.

Responders

Local Health Board

Multi-Agency/Regional

(if part of Business Continuity Plans)

Level: 2

Type of Response

Impact felt across a single Health Board.

Requires the response of more than one Territorial Board within a Resilience Partnership area; or Local impact on a National Board where support and coordination is required at local/regional level.

Responders

Territorial/National Health Boards Multi-Agency/Regional

Level: 3

Type of Response

Impact felt across more than one Health Board and / or regionally.

Requires a response from multiple Territorial Boards across regions and/or where there is sector impact from a National Board.

Responders

Territorial/National Health Boards Multi-Agency/Regional Awareness/Advisory Role

NHS Chief Executive & Chief Operating

Level: 4

Type of Response

Impact felt across several Health Boards and/or impacting national capacity and capability.

An incident that impacts the health sector across Scotland and requires national level command and control.

Responders

Chief Executive, NHS Scotland

Chief Operating Officer, NHS Scotland SGHSCD: HealthEPRR

Scottish Government/Ministers Ongoing Support Territorial/National Health Boards

Multi-Agency/Regional

While several Health Boards may be experiencing significant or sustained pressure this does not mean that NHS Scotland (as a single national entity) is operating at the same response level. The table above provides an overview of response levels used to help determine the level of local, regional, national and/or multi-agency involvement.

Local and regional governance structures will lead the response for Levels 1-3 and provide ongoing support to national response at Level 4. National response would normally not be required below Level 3, however reporting of and communication of incidents at these levels should be part of Board arrangements. This will ensure that at a national level there is awareness of escalating incidents at the earliest opportunity. National C3 response structures would be fully activated at Level 4^[2].

The criteria at Annex A sets out a range of indicators at which an incident/issue may be escalated to the next level of response. Requests to escalate an incident or issue to the next level may not in itself secure additional response measures depending on a range of factors as well as the ongoing situation. Each situation will be considered in detail along with other factors before a decision is made on what, if any, additional measures should be taken.

Health Boards must be able to demonstrate that they have identified, fully considered, and exhausted all mitigation measures and response options available to them before escalation.