Preparing for Emergencies- Guidance For Health Boards in Scotland

Section 4 Planning for Emergencies

This section highlights the wider context within which Health Boards should plan and prepare for emergencies. It sets out roles and responsibilities at various stages of the emergency planning process in line with the requirements of the Civil Contingencies Act 2004.

Introduction

4.1 Major incidents are inevitable and each one will present unique challenges. It is important for Health Boards to adopt an all-risks approach to planning for and responding to major incidents, to identify the skills and expertise available to them and how they will be deployed in various circumstances or scenarios, and to have arrangements in place to manage the uncertainty and unpredictability of events.

4.2 The planning process is key to preparing for emergencies. Under the Civil Contingencies Act 2004, Health Boards are obliged to have arrangements in place to plan, exercise and review their capability and responses against a range of disruptive challenges, crises, disasters or emergencies. These obligations involve three key functions as part of the planning process:

• assessing risk;
• ensuring that (scalable) plans are in place to reduce or mitigate the effects of the emergency situation if/when it occurs; and
• identifying other actions to be taken in relation to the emergency.

4.3 Health Boards must use the Integrated Emergency Management^[4] (IEM) cycle, working together with multi-agency partners via Regional and Local Resilience Partnerships to build resilience. The IEM cycle ensures a constant review of activity and therefore robust preparedness arrangements.

4.4 Essentially, the planning process should demonstrate that the Health Board has:

• engaged key internal and external stakeholders and partner agencies, particularly category 1 and 2 responders and voluntary sector agencies that have an emergency response and support capability in developing its major incident plan;
• developed appropriate and suitably resourced 'command, control and coordination' (C3) arrangements;
• established a programme of training, exercising and testing to ensure effective implementation of the plan;
• incident-recording arrangements and a system for identifying and sharing learning from incidents; and
• established a system for reviewing and updating the plan.

Responsibilities

4.5 Health Boards designated as category 1 and 2 responders should ensure they comply with the requirements of the CCA and are in a position to contribute to a co-ordinated response to major incidents, regardless of their nature or scale.

4.6 Non-designated Health Boards should comply, as a matter of good practice, with the requirements of the CCA and identify how they can support the designated Territorial and Special Health Boards.

4.7 The specific duties of Health Boards under the CCA are to:

1. Assess risk
Risk assessment (of hazards, threats and vulnerabilities) is the first stage in organisational resilience and business continuity planning. All Health Boards should ensure internal corporate risk management processes include risk to continuation of services that single and multi-agency plans are evidence-based and proportionate.

They must develop and maintain an internal/organisational Risk Register and actively participate in the development of multi-agency Local and Community Risk Registers produced by the Regional Resilience Partnership in the context of National Risk Assessment^[5].

2. Maintain emergency/major incident plans
Health Boards must produce and maintain major incident/emergency plans for a range of potential scenarios in line with guidance later in this section (See 5.13). They must also actively engage with partners on the RRP to ensure that the role of the NHS is appropriately reflected in multi-agency plans for various major incidents/emergencies.

3. Maintain business continuity plans
Business Continuity Management (BCM) is an essential activity in establishing an organisation's resilience by enabling it to anticipate, prepare for, respond to and recover from disruptions and to have a clear understanding of dependencies with other organisations.

Health Boards designated as category 1 and 2 responders must have robust up-to-date BCM plans to help maintain their key functions if there is a major incident or disruption. BCM plans should identify:

• management arrangements aligned to relevant risks;
• critical/prioritised services, analyse the effects of disruption and the actual risks of disruption and actions to mitigate them;
• activation procedures and escalation processes;
• recovery steps to ensure the service can return to operation;
• how the plan(s) will be maintained and reviewed; and
• how the plan(s) will be communicated to and accessed by staff.

For further information on BCM see appendix 2.

4. Communicate with the public
Category 1 Health Boards must have communication plans that can:

At the planning stage: Inform the public of the likely risks and threats being prepared for and, in general terms, of their potential responses if they occur; and

At the response stage: Warn, inform and advise the public using different types of messages and a variety of methods appropriate to the needs of the audience.

For further information on Communication, see section 5E.

5. Share information
Information-sharing is an integral part of civil protection and interagency cooperation. Health Boards must share information with other categorised responder organisations and their major incident plans should be available in the public domain, accepting that sensitive or confidential information cannot always be shared with partner agencies and/or the public.

Careful consideration must be given to the type of information that is required to plan for a major incident and what information can be shared in the context of the CCA and the Freedom of Information (Scotland) Act 2002^[6] while maintaining confidentiality.

Health Boards must ensure that there are free-flowing, informal channels of communication and information-sharing with other agencies involved in civil contingencies work. It is important that Caldicott Guardians advise on disclosure of information and are available to support and guide staff.

6. Cooperate
Health Boards designated as category 1 responders must cooperate with other responders. The principal mechanisms for multi-agency cooperation at local level are the Regional Resilience Partnerships (RRP) and Local Resilience Partnerships (LRP).

Health Boards should be represented on these multiagency groups by staff at an appropriate level within the organisation, as follows:

RRP - Chief Executive or a delegated Executive-level Director (Territorial Health Board); Director of Service Delivery or General Manager of the Scottish Ambulance Service (SAS);

LRP - Resilience Manager/Senior Manager (Territorial Health Board); General Manager or Head of Service (SAS).

It is important that Health Boards, especially those within the same RRP, develop capacity and capability for specific incidents especially those that may have a longer-term impact on service provision, by collaborating with each other, with NHS National Services Scotland (a category 2 responder) and with relevant non-designated Health Boards. Primary care services, relevant independent contractors, local authorities and voluntary agencies should be involved in these planning processes, as appropriate, so that they are aware of the Health Boards plans and/or its expectations in the event of a major incident.

Legal frameworks, public inquiries and civil action

4.8 NHS legal obligations and duty of care for patients does not change during major incidents or emergencies that are likely to generate high profile media attention or scrutiny. In such situations it is likely that legal investigations and challenge such as criminal investigations, fatal accident and/or public inquiries or civil action may follow. These may occur a long time after the incident.

4.9 When planning for major incidents it is essential that Health Boards have arrangements in place to record the decisions made and actions taken and store all the records and documentation safely for future reference should they be required for evidential or audit purposes.