Preparing for Emergencies Guidance

Section 1 - Introduction

This section sets out the context of this guidance, explains its purpose and the process of producing it.

Context

1.1 The public expects the NHS to be there, functioning normally and safely when they need it. This expectation is constant even when faced with disruptive challenges or emergency incidents which may impact capability to maintain these services. The type and range of potential incidents vary hugely and can include adverse weather, utilities failures, industrial action, public health, and other types of major incidents and acts of terrorism. All carry with them short and longer-term impacts and consequences for maintaining business as usual service levels.

1.2 Scotland’s health and social care services continue to operate in a changing environment with new and increasing demands such as legislative changes (the integration of health and social care services), the redesign and continuous improvement of our health sector. In light of the Covid-19 pandemic, the challenges facing the health service require a robust approach to emergency preparedness which accounts for high pressures across Health Boards.

1.3 All Territorial and some National Health Boards have roles and responsibilities under the Civil Contingencies Act 2004 (as either Category 1 or Category 2 responders) which requires them to plan and/or co-operate on preparedness for a range of civil contingencies. Integration Joint Boards (IJBs) are also Category 1 responders as per The Civil Contingencies Act 2004 (Amendment of List of Responders) (Scotland) Order 2021 (S.S.I. 147/2021).

1.4 This guidance takes account of the changes facing the NHS and builds on progress that Health Boards have made to date in implementing the Civil Contingencies Act 2004. It supersedes ‘Preparing for Emergencies: Guidance for Health Boards’ in Scotland, published in 2013.

Purpose of the guidance

1.5 The purpose of this guidance is to:

• enhance the resilience of Health Boards and help ensure there is a consistent and coordinated approach to resilience planning
• enable Health Board Chief Executives, Executive Directors and resilience-planning leads to understand both their own and their Board’s roles and responsibilities under the Civil Contingencies Act 2004 and other key legislation
• ensure Health Boards comply with the relevant duties in preparing for and recovering from major incidents and emergencies
• ensure consistent approaches and standards of practice across Health Boards in relation to responding to major incidents and emergency situations
• promote continuous improvement of emergency preparedness

About the Guidance

1.6 The guidance recommends a framework and general principles for Health Boards to develop and maintain their capability to respond to major incidents and a range of other disruptive events. It can also be used by Integration Joint Boards in fulfilling their legally mandated emergency preparedness duties and has been prepared with this objective in mind.

1.7 The guidance is:

• strategic in focus and aims to support and inform local planning and preparedness
• set in the context of the Civil Contingencies Act 2004 (CCA) and associated regulations
• intended for use by all Health Boards as it is relevant to the full range of healthcare services, not only acute emergency care
• set in a 3-year review cycle to ensure that it reflects changes in policy and new developments

1.8 It should be read in conjunction with Preparing Scotland, which provides broader guidance on fulfilling CCA duties, and within the context of other legislation, policy and guidance applicable to Health Boards in Scotland such as business continuity and risk management, including linkages with the Scottish Risk Assessment (SRA) and National Risk Register (NRR) and the National Security Risk Assessment (NSRA) as appropriate.

1.9 This guidance was subject to review by a short life working group co-chaired by NHS Lothian and Scottish Government: Health Emergency Planning, Preparedness and Response division (see membership at Appendix 1).

Terminology

1.10 Although the term ‘emergency’ is used in the CCA, it is often used interchangeably with ‘major incident’ in civil contingencies planning documents and guidance. The term major incident is used predominantly in this guidance and is defined as:

‘Any occurrence that presents 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 one or more Territorial and/or national Health Boards simultaneously or in support of each other. It requires considerable resources and strategic input as it potentially threatens the survival of an organisation.’

1.11 The term is deliberately broad so that potential less-likely incidents are not excluded. It describes events that require special procedures and arrangements to be implemented and the involvement of one or more emergency planning partners. Further, it recognises the fundamental importance of public confidence and trust in the Health Boards to plan, prepare and respond to such incidents.

1.12 A major incident may present as a variety of different scenarios (see glossary for definitions of major incident scenarios). What constitutes a major incident for a Health Board may not be one for another organisation, or vice-versa.

1.13 A list of common terms used in this document are defined in the glossary.

Health Inequalities Impact Assessment (HIIA)

1.14 The previous guidance was subjected to a HIIA scoping exercise which highlighted three key issues that need to be considered by Health Boards (Category 1 and 2 responders) when preparing for emergencies and deploying resources in emergency situations. The issues from the HIIA have been incorporated into this guidance document, and the following remain the most relevant:

• Communication: The most effective and appropriate means of communication should be used to convey important and timely information to staff, patients, and the public. It should include a combination of different methods and approaches so that everyone is given appropriate, accessible information.
• Access to services: During major incidents or emergencies, some services may be disrupted or experience a surge in demand. Health Boards should identify services likely to be affected and prepare plans to mitigate the impact on the users of critical services who are most likely to be affected by these incidents.
• Staff training: Staff should have appropriate equalities and human rights training so that they are aware of and sensitive to the needs of different population groups, which will inform planning for emergencies and the duty to communicate effective advice to the public during an emergency. This will help staff understand how procedures followed and decisions taken in emergency situations may impact on injured patients and their relatives, particularly in the recovery phase of an emergency.

Who this guidance is aimed at

1.15 This guidance is principally aimed at Health Board Chief Executives, Executive Directors, senior managers, and staff responsible for resilience and emergency planning of health service delivery.

1.16 Health Boards should ensure that primary care (and other external) contractors are aware of this guidance and, where appropriate, engage them in developing and implementing the emergency planning processes relevant to their contracted services. This includes both contracted services directly commissioned by a Health Board and those contracted to deliver a service for a Health Board.

Role of Integration Joint Boards (IJBs)

1.17 Since 2021, IJBs are identified as Category 1 responders under Schedule 1 Part 2 17A of the Civil Contingencies Act (2004). IJBs employ no specific staff and own no facilities, and their business-as-usual function is to offer strategic direction to Health Boards through Health and Social Care Partnerships (HSCPs). They primarily operate a strategic and planning role in their relationships with Health Boards.

1.18 This strategic function should be recognised in emergency planning, where IJBs should play a key role in preparing the strategy for responses and in co-ordinating with Health Boards in line with JESIP principles (see Section 5). Part of this strategic planning should involve considerations of service recovery at the appropriate stage of the emergency response.

1.19 By contributing a strategic view to emergency response, IJBs can identify solutions to be delivered during an emergency, but their primary function should be the strategic planning of emergency responses, supporting and co-ordinating with Health Board preparations.