NHS Trusts and the UK International Emergency Trauma Register.

Transcription

1 NHS Trusts and the UK International Emergency Trauma Register. The ultimate beneficiaries from UK professional health workers gaining international experience are NHS patients in the UK Liam Donaldson, Chief Medical Officer Background There is a long tradition of volunteers from the UK responding to emergencies overseas. Currently many potential volunteers are working in the NHS. The benefits these volunteers bring to stricken countries can be considerable. UK- Med was established in 1995 to facilitate the deployment of health professionals from across the UK to support in a range of international humanitarian crises. A formal register, the UK International Emergency Trauma Register (UKIETR), of UK surgeons, anaesthetists, emergency physicians/nurses and other supporting medical, nursing and paramedical staff has been established and is run by UK-Med. This will ensure that those who respond through this mechanism are appropriately trained, prepared and accountable. Although the register can act as a resource for NGOs and other agencies to access trained quality assured health workers, it has been primarily established to provide an emergency medical/surgical team in support of a national, government funded, response to a large scale disaster overseas. Once deployed, the team will work under the auspices of Save the Children or other large international organisations who will be responsible for providing the logistical platform to support the team in the field. The register addresses the specific concerns of the NHS in regard to disruption of its own core services by ensuring that volunteers are drawn from across the UK and in rotation. It has been developed in collaboration with and with the support of the DoH, NHS and DFID to support a government funded, national medical/surgical team being deployed as part of an official national response to a sudden onset large scale disaster overseas. NHS Trusts can be assured that members of the register will have received the appropriate training.

2 There is also growing evidence that volunteering overseas is good for the NHS and its employees at all levels. The report Innovative workforce development: the case for international health links 1 shows that NHS staff returning from a period of volunteering demonstrate benefits in most of the six core areas of the NHS Knowledge and Skills Framework with specific improvements reported in: Communication skills Personal development Planning and organisation Cultural awareness Understanding of equality and diversity Resource management Innovative ways of working Enhanced work ethic In the emergency setting deployment to a sudden onset large-scale disaster provides NHS frontline staff with a unique experience of the management of mass casualties which can be brought to the benefit of major incident responses in the UK. Development and humanitarian work provides particularly relevant holistic learning and individuals can be personally motivated and inspired by these experiences, thus contributing to all four of the pillars identified in Human Resources in the NHS. There are particular benefits in supporting multicultural work, and delivering care to diverse patient groups in the UK. 2 Overseas experience can be very valuable for rapid learning to: Prioritise and allocate scarce resources. Plan, monitor and audit. Develop project management skills and disciplines. Conduct health needs assessment for local populations. Integrate primary and secondary care. Manage change. Thinking on your feet and making things happen. Manage yourself, finances and organisations. Train, teach and develop human resources. Work in multidisciplinary teams and provide leadership. Liaise between different sectors and localities. 3 1 Innovative workforce development: the case for international health links. Longstaff, Northumbria Healthcare. 2 Page 6 - International Humanitarian and Health Work: Toolkit to Support Good Practice. DoH Page 7 - International Humanitarian and Health Work: Toolkit to Support Good Practice. DoH 2003.

3 A toolkit has been developed to capture the knowledge and skills from international work for annual appraisal and Continuous Professional Development In his 2003 report Global Health Partnerships, Lord Crisp recommended that a database should be commissioned on which health professionals with agreed competencies could register. As part of registration, employers will be asked to commit to releasing staff provided that reasonable arrangements are put in place to continue local services and that the NHS, at country level (or strategic health authority level in England), should assist in and coordinate the release of staff and the cover needed for them as necessary. 4 Although the government s response at the time stated that, there appears to be no enthusiasm for this recommendation from the major humanitarian agencies 5, it does not say which agencies these are or who, within these agencies, was consulted. Moreover in a post-haiti and post-humanitarian Emergency Response Review world, the statement has become overtaken by events. Every frontline medical emergency response agency has difficulties in finding staff of sufficient quality in sufficient quantity during large emergencies. All have therefore shown full support for the UK International Emergency Trauma Register (UKIETR) and many have drawn staff from it including Médecins Sans Frontières, Medical Teams International (Merlin) and International Medical Corps. Lord Ashdown s Humanitarian Emergency Response Review stated that the UK should develop and deploy niche capabilities in a more focused way where they add value and incorporate surgical teams into first phase deployments. 6 This recommendation has been accepted by the government. In response to this, the Department for International Development (DFID) funds UK-Med to run the UKIETR which consists of NHS surgeons, anaesthetists and other key support staff who make themselves available for deployment to disaster affected countries. Staff can be requested from the register to join NGO development or emergency response programmes and DFID is also developing, with UK medical NGO Merlin, a deployable medical/surgical facility drawing staff from the register, many of whom work in the NHS. Benefits of the UKIETR to NHS Trusts. 4 Recommendation 6 - Global Health Partnerships. Lord Crisp Page 29, Global Health Partnerships The Government response. UK Department of Health Humanitarian Emergency Response Review, Lord Ashdown et al, 2011, Page 48.

4 The background section has outlined the benefits of volunteering to the NHS and its staff. In terms of NHS Trusts, the register is seen as a way of regularising and planning for staff absences. With the NHS workforce as ethnically diverse as it currently is, when a disaster strikes, many NHS staff make requests to go and assist especially when the disaster is in their region or country of origin. This can play havoc with rosters and service delivery, incur costs for back-filling and is not always the best option for either the staff member or the people they are hoping to assist. The UKIETR has the full backing of the Department of Health and DFID. The collaboration between these two key government departments is seen as a national UK response to emergencies which capitalises on and showcases the high quality and flexibility of NHS staff. It is envisaged to lead by example in a humanitarian setting where the quality of some foreign medical teams responding to disasters has been an issue of international concern The positive publicity, locally, nationally and globally, for Trusts with staff deployed from the roster can be a welcome addition to an often gloomy news cycle. Payment for back-filling Membership of the register is a collaborative arrangement between the staff member, their Trust, UK-Med and DFID. In the event that a staff member from the roster is deployed DFID, through UK-Med, undertakes to provide payment for back-filling the position. It is envisaged that the Trust will plan for the possible staff absence and avoid where possible expensive locum agency arrangements to replace the position for the three weeks of the deployment. Risk management Staff from the general register will not be sent to work in conflict zones. As members of the register remain employed by their Trust, duty of care for staff on deployment remains with the NHS Trust. However the Trust s liability only extends to taking all reasonable measures to ensure the safety of their staff. As a Trust in Yorkshire for example could not reasonably be expected to have a safety and security plan for Sudan, it is required that all agencies with a role in their deployment have also taken reasonable measures to ensure safety of staff. So UK-Med, DFID and any NGO with which the staff member is working overseas will also have to demonstrate that active and effective security measures are in place. All staff joining the register are provided with a pre-deployment training course by UK-Med which covers: working in a challenging environment, an understanding of the UN system, the type of in country conditions they are likely to experience, specific training in personal safety and security, managing personal health in an austere environment and the use of communications equipment.

5 In addition to the pre-deployment course, members of the register will be taken through a mock deployment where they will be familiarised with the tented hospital in which they will work. Opportunities also exist within UK-Med for members of the register to use their annual leave provision to work under the supervision of UK-Med with NGOs in resource poor countries. The Royal College of Surgeons of England working closely with UK Med has established a Surgical Training in Austere Environments course (STAE) for members of the register that will train surgeons in the specific techniques required to manage the range of injuries and conditions they are likely to experience on a deployment. Similarly working with the Royal College of Anaesthetists there will be an opportunity for members of the register to attend a Anaesthesia for the Austere Environment course. The close collaboration with these Royal Colleges exemplifies the wide support within the profession for the UK international emergency trauma register. Before participating in a deployment authorised by DFID, staff are expected to read and sign a Safety and Security Instruction. On arrival in country, all staff are provided with a security briefing and the NGO s security regulations for that country are explained in detail. The security briefing is based on a documented, comprehensive risk assessment which will be updated as soon as a deployment is authorised. Staff will also be given the number of the security focal point in country and all requests for travel outside of the work site will have to be cleared by the focal point. There is an extensive insurance policy which covers all staff on deployment. This insurance covers travel health repatriation and medical indemnity. UK-Med also has an agreement with the Well Travelled Clinic at the Liverpool School of Tropical Medicine (LSTM) which covers all necessary vaccinations for register members. Prior to being on the immediate on-call register all members will go through a health screening programme run by LSTM and following deployment they will be reviewed again on their return. During the deployment, staff are accommodated either in good quality hotels or on the work site where the quality of food and potable water can be guaranteed. Close attention is paid to work schedules and whilst work is demanding and intense, all staff are closely monitored for signs of over-work or physical and emotional stress so that burn-out can be avoided. What we are asking of NHS Trusts If a member of staff is a member of the UKIETR and eligible for deployment we ask that their Trust facilitates their deployment to a sudden onset disaster overseas as part of a national, government funded, official UK national response.

6 Commitment by register member: Where reasonably possible to be immediately available (within 12 to 24 hours) for deployment overseas for up to three weeks as part of the national surgical team. To participate (in their own time) in any pre-deployment training as designated by UK-Med. To keep UK-Med regularly updated on the status of their vaccinations. To ensure their passports have a minimum of three months validity beyond periods they are on call. To follow safety and security practices as outlined in their pre-departure and in-country written guidelines and verbal briefings. To consent to a post-deployment medical. To inform UK-Med and their Trust in writing should they decide to remove themselves from the register. Commitment by UK-Med: UK-Med will meet the cost to the Trust of their Members deployment by paying the cost of their backfill for the period of their deployment. UK-Med will provide pre-deployment training, vaccinations, visas, flights, accommodation, and ensure full insurance (professional indemnity, travel, sickness, accident, repatriation) is in place and post-deployment medicals including any necessary treatment to register members are available. The UK-Med Focal Point will inform on call register members verbally of the decision to deploy at the earliest possible opportunity. UK-Med will endeavour to keep the Trust updated on members deployment. Commitment by Trust: The Trust undertakes to release as far as is reasonably possible, first on call register members for up to three weeks within 12 to 24 hours of being

7 given notice of a mobilisation to deploy. It is envisaged that this will not occur more than once in any 18 month period. In the event of a disaster of such proportions that a series of teams needs to be mobilised over a longer period of time, the Trust will support as far as possible those on the register not first on call but required to deploy. The Trust understands that duty of care for register members in their employ remains with them. However it shall be further understood that all other organisations involved in the deployment of a register member are legally obliged to show that they have taken all necessary measures to ensure the safety, security and well-being of the register member immediately prior to, during and immediately following a deployment. The Trust will continue to pay the salary including the pension of the register member. The Trust will undertake as far as is reasonably possible to identify in advance those who will replace the deployed register member. The Trust will endeavour to back-fill posts using the least expensive means available to them and avoid using expensive locum agencies wherever possible. The Trust will provide UK-Med with an invoice outlining costs for backfilling of deployed register members at their earliest convenience. For the Trust: Name Signature Date: For UK-Med: Name Signature Date Register member: Name Signature Date

8 Summary of key points: If a member of staff is deployed DFID, through UK-Med, will provide payment for back-filling of the position. There are comprehensive fully funded health care and insurance packages in place for register members. A comprehensive insurance policy held by UK-Med is in place for all volunteers on deployment. A Level 3 disaster is estimated to occur every two years so the chance of being deployed is quite small. Staff must attend a pre-deployment training course which covers working in a challenging environment. Staff will not be sent to work in conflict zones.