Preparing for Emergencies- Guidance For Health Boards in Scotland

Section 6 Role of the Scottish Government

This section outlines the role of the Scottish Government in civil protection and resilience. It also highlights the action to be taken by Health Boards when faced with exceptional service pressures as a result of a major incident.

6.1 The Scottish Government, although not a category 1 or 2 responder, has a key role in civil protection and resilience. This can be broken down into:

Preparation: Having appropriate structures, policies and procedures in place to respond to major incidents and to develop relevant legislation and guidance; and

Response/Recovery: Creating the conditions to support other category 1 and 2 responders and the option of invoking emergency powers under Part 2 of the Civil Contingencies Act 2004 to enable responders to deal with exceptionally serious emergencies, including requesting cross-border mutual aid.

6.2 When the scale or complexity of an incident is such that it would benefit from central government coordination or support, the Scottish Government (SG) will activate its emergency response arrangements through the Scottish Government Resilience Room (SGoRR). The role of SGoRR will vary according to the nature, scale and impact of the incident.

6.3 During a SGoRR activation, Health Boards should submit Situation Reports (SitReps) to SG Health and Social Care Directorates (HSCD) via the NHSScotland Resilience Team. The reporting requirement and frequency will vary according to the impact of the incident and Health Boards will be informed of this at the time of the response.

Role of the Scottish Government Health and Social Care Directorates (HSCD)

6.4 HSCD's role during an emergency response is to:

• collate and coordinate incident information provided by Health Boards;
• brief the Cabinet Secretary for Health and Wellbeing and HSCD Director-General;
• provide government support for the NHS and the particular Health Board involved and ensure that all other health boards are in readiness to support if necessary;
• maintain an up-to-date overview of national critical care capacity;
• assess the impact of the incident on the Board's scheduled work and determine any action that needs to be taken;
• assess whether mutual aid is required from other nations in the UK if local capacity and capability is overstretched or inadequate; and
• maximise available communication channels at national and local levels to inform the public.

Health Board considerations

6.5 The following actions should be taken by a Health Board when the consequences of a major incident puts exceptional pressure on services, requiring external support. They are predicated on:

• decision-making in the interests of patients;
• the safety of patients and staff being paramount;
• the existence of up-to-date surge capacity plans for critical/intensive care and other priority services; and
• arrangements for mutual aid agreements with identified triggers with neighbouring Health Boards and other planning partners.

6.6 When the Health Board has invoked its major incident plan, the Command, Control and Coordination (C3) Group should, amongst other functions, monitor the impact of the emergency situation on 'business as usual'.

Suspension of legislative obligations in exceptional circumstances

6.7 Some major/mass casualty incidents will place considerable pressure on the Health Board's total capacity and capability and have a wider impact on the delivery of services in line with legislative obligations, such as Treatment Time Guarantees (TTG).

6.8 The Chief Executive or named Deputy may request assistance from neighbouring Health Boards to maintain scheduled appointments and TTG.

6.9 In exceptional circumstances a request for the suspension of TTG may be made to HSCD if it is clear that all reasonable interventions have been taken by the Health Board to manage the incident.

6.10 The initial request should be made via the NHSScotland Resilience Team and, where necessary, the extent of pressures and recovery measures will be discussed with the Health Board. However, the Health Board must also comply with the Treatment Time Guarantee Regulations and Directions set out in CEL 17 (2012)^[8] by ensuring that a written request is made to Scottish Ministers. The Scottish Government Health Care Directorates will have measures in place to ensure the approval of the suspension will be submitted to the Cabinet Secretary of Health and Wellbeing and Parliament timeously.

6.11 Once operational pressures linked to the management of the major incident have receded, HSCD will support the Health Board to restore service levels in line with TTGs as quickly as possible.