DRAFT DRADDDDDFT. NHS Commissioning Board Incident Response Plan (National)

DRAFT DRADDDDDFT NHS Commissioning Board Incident Response Plan (National)

NHS Commissioning Board Incident Response Plan (National) Date 22 March 2013 Audience Copy NHS Commissioning Board (NHS CB) director of operations and delivery (corporate), NHS CB regional directors of operations and delivery, NHS CB corporate and regional EPRR leads. NHS CB executive management team, NHS CB area team directors, public health england (PHE), DH Emergency Preparedness Resilience and Response (EPRR) policy branch, NHS CB regional directors, NHS Leadership, DH Senior Management Teams and co-chairs of Local Health Resilience Partnerships. This document may be shared with other departments, responders and relevant organisations as required to meet the requirements of the CCA 2004 Description This NHSCB Incident National Response Plan (IRP(N)) sets out the arrangements that are in place to enable an effective and appropriate NHSCB corporate response in the event of a significant health related incident. Cross Ref Action Required Timing Contact Details This document supersedes the National Incident Response Plan of the Department of Health s NHS Operations team on 1 April 2013. It should be read in conjunction with the NHS Planning Framework, NHS standard contracts, the 2013 NHS CB Emergency Planning framework 1 and the NHS CB Command & Control Framework for the NHS during significant incidents and emergencies (2013) 1. 1 http://www.commissioningboard.nhs.uk/eprr/ To be used by the NHS CB corporate team to command, control and coordinate the NHS response to periods of pressure, significant incidents or emergencies at a national level. To be used by Public Health England and DH Emergency Preparedness Resilience and Response (EPRR) policy branch to consider in their EPRR planning for directing and managing their response to health related incidents. To be used in the deployment of the new health EPRR arrangements within their local area from 1 April 2013. NHSCB.EPRR@nhs.net NHS Operations, Quarry House, Leeds, LS2 7UE. 1 The 2013 NHS CB Emergency Planning Framework will supersede the NHS emergency planning guidance (published in October 2005) from 1 April 2013. 2

Contents Section Page Number FOREWORD BY THE CHIEF OPERATING OFFICER 4 1. INTRODUCTION 6 2. ROLES, ACCOUNTABILITIES AND RESPONSIBILITIES 8 3. ALERT 10 Initial Alerting NHSCB Operations and Delivery Internal Staff Alerting Alerting External Agencies 4. ACTIVATION 12 Activating the NHS CB Incident Management Team (National) and Incident Coordination Centre (National) 5. OPERATION 14 The NHS CB Incident Management Team (National) Records Management Shift arrangements 6. ESCALATE/DE-ESCALATE 17 7. STAND DOWN 18 Initial Stand Down Records Management Administration Debriefs and Reports Lessons Identified Process 8. REVIEW AND MAINTENANCE, TRAINING AND EXERCISING 20 9. ACRONYMS USED IN THE PLAN 21 10. ANNEX A - NHS OPERATIONS RESPONSE ROLES ACTION CARDS 22 3

Foreword by the NHS CB Chief Operating Officer 1. In accordance with the NHS Commissioning Board (NHSCB) Emergency Planning framework (2013) and the NHS CB Command & Control Framework for the NHS during significant incidents and emergencies (2013) 2, the NHS CB Incident Response Plan (National), (IRP (N)) sets out the arrangements of the NHS CB Operations and Delivery directorate for planning for, responding to, and the management of health related significant incidents and emergencies where a national response is required. 2. From 1 April 2013, this document supersedes the National Incident Response Plan of the Department of Health s NHS Operations team. 3. The emergency preparedness team within the NHS CB Operations and Delivery directorate of the NHS CB, continually reviews information relating to incidents, which may have an impact on health, in order to determine an appropriate response. 4. During a significant health related incident or emergency, NHS CB Operations and Delivery may invoke this plan and activate a team to command, control and coordinate the NHS response from an Incident Co-ordination Centre (ICC). The primary location of the NHSCB s national ICC (ICC(N)) is at Quarry House in Leeds. Alternative sites have been identified in Wakefield and London. 5. If required, the ICC(N) will operate deployed support to the DH EPRR Incident Response Centre in Richmond House, Whitehall, which, in turn, supports the Cross-Government concept of operations (CONOPs) which sets out the overarching command, control coordination and communication during significant incidents and emergencies, including the reporting requirements for Cabinet Office Briefing Rooms (COBR). 6. The Department of Health (DH) Emergency Preparedness Resilience and Response (DH EPRR) structure requires the DH, the NHS, public health, and local healthcare systems to provide a seamless and co-ordinated response to the challenge of natural hazards, accidents, outbreaks, the enduring threat of worldwide terrorism and service disruption. 7. This requires a robust and integrated system that enables health sector organisations to play their full part in the protection of the health of local communities, and the nation during emergencies, through coordinated preparation and response across the whole sector. These arrangements should reinforce the relationships at NHS CB area team level with the UK s existing civil resilience structures and emergency responder communities, and support effective responses to the whole range of incidents and outbreaks at regional and national 2 www.commissioningboard.nhs.uk/eprr/ - 4 -

levels as required. 8. The Health and Social Care Act 2012 introduces some significant changes to the Health Service in England, including the current arrangements for EPRR. 9. From 1 st April 2013, the NHS CB will be responsible for ensuring there is a comprehensive NHS EPRR structure that operates at all levels. The NHS CB will also be responsible for leading the mobilisation of the NHS in the event of an emergency or incident and for ensuring it has the capability for NHS command, control, communication and co-ordination and leadership of all providers of NHS funded care. Until 31 st March 2013, NHS Operations will respond with SHA Clusters in accordance with the arrangements as set out in the DH NHS CB Incident Response plan (National). Ian Dalton Chief Operating Officer NHS Commissioning Board - 5 -

1. INTRODUCTION 1.1. The NHS needs to be able to plan for - and respond to - a wide range of incidents, emergencies or disruptive challenges that could impact on health or patient care. These could range from extreme weather conditions, to an outbreak of an infectious disease, or a major transport incident. The Civil Contingencies Act (2004) requires NHS organisations, and providers of NHS funded care, to demonstrate that they can deal with such incidents while maintaining services to patients. This programme of work is referred to in the health community as emergency preparedness resilience and response (EPRR). 1.2. During times of pressure and in response to significant incidents and emergencies, NHS organisations require a mechanism to operate enhanced leadership and decision making in a structured manner. This structure provides a clear leadership pathway with accountable decision making that relies on an accurate and timely shared understanding of the situation which can be problematic in a potentially information poor environment. The structured approach to leadership under pressure is commonly known as command and control. 1.3. The NHS CB Incident Response Plan (National) (IRP(N)) is the overarching generic plan that details how NHS CB reviews and responds to any relevant health related significant incident or emergency at the national level. It is intended for use by NHS CB executive management team, the director of operations and delivery (corporate) and the national emergency planning lead and acts as a reference and signposting document to provide appropriate guidance in planning and response. The IRP(N) recognises that the NHS follows the principles of subsidiarity in that the management of an incident should be at the level closest to the people affected by the incident as is practical. 1.4. This plan sets out the NHS CB corporate response to an incident. Regional and area team NHS CB incident response plans will be modelled on this National plan to ensure consistency and standardisation of the NHS CB s response plans and functions across the NHS. 1.5. This Plan enables the NHS CB to deliver its corporate responsibilities in response to any incident or disruptive challenge. The key objective is to provide confidence through effective oversight, direction and co-ordination of the NHS to enable it to provide a resilient response to incidents and emergencies that could have a national impact upon the NHS. This will be achieved by working with and supporting the Department of Health, NHS CB regions, area teams, Public Health England and other collaborating agencies as appropriate. - 6 -

1.6. NHS Organisations are required to fulfil the requirements as Category 1 or 2 responsibilities, as appropriate, under the Civil Contingencies Act 2004 (CCA 2004), as well as the Department of Health Emergency Planning Guidance (2005) 3 and to also apply the principles of integrated emergency management in their preparation, for and in response to, incidents and emergencies. Aligned to the NHS response, operating at the national and strategic level, NHS CB Operations and Delivery is responsible for providing national oversight, direction and co-ordination of the NHS response to health incidents and emergencies where appropriate. 1.7. The NHS CB IRP(N) accords with the requirements of the CCA 2004, Contingency Planning Regulations 2005 and the NHS associated responsibilities as a Category 1 Responder. It is supported by its related Standard Operating Procedures (SOPs) which contain the operational detail and procedures to be put in place during a response. 1.8. The NHS CB IRP(N) details roles, accountabilities and responsibilities and then is structured in five sections, which cover the recognized phases of response; Alerting, Activation, Operation, Escalation and De-escalation, and Stand Down. The final section covers review, maintenance, training and exercising. 3 Note the DH EP Guidance has been recently revised but will not be published in time for the Exercise so current and extant guidance, read in conjunction with the Arrangements for health emergency preparedness, resilience and response from April 2013 (published 3 April 2012) should be referred to for Exercise play). - 7 -

2. ROLES, ACCOUNTABILITIES AND RESPONSIBILITIES Roles, Accountabilities & Responsibilities 2.1 This section describes the roles, accountabilities and responsibilities of those functions required to deliver a response under the terms of the NHS CB Incident Response Plan (National) (IRP(N)). It should be noted that the roles required may vary depending upon the level of response required. For full details of accountabilities, responsibilities and associated actions, please refer to the Action Cards contained within Annex A. a) NHS CB Chief Executive Overall accountability for the direction of an incident rests with the NHS CB Chief Executive. In the absence of the NHS Chief Executive, this responsibility defaults to the NHS CB Chief Operating Officer. The Chief Executive will delegate responsibility to the Chief Operating Officer to oversee NHS responses to significant health related NHS incidents in the vast majority of national and corporate incidents. b) NHS CB Chief Operating Officer The Chief Operating Officer is accountable to the NHS CB Chief Executive for the national and corporate direction and delivery of the NHS response to an incident. As appropriate the Chief Operating Officer will either assume the role of NHS CB National Incident Director or delegate the role to the NHS CB Director of NHS Operations and Delivery (Corporate), or other at the discretion of the Chief Operating Officer. The Chief Operating Officer is ultimately responsible for determining the escalation/de-escalation of the national and corporate NHS response. c) NHS Incident Director (National) Once appointed and regardless of the scale of incident, the NHS CB Incident Director (National) is accountable directly to either the Chief Executive or Chief Operating Officer as appropriate. The Incident Director will lead the NHS CB Incident Management Team (National) (IMT(N)) and is also formally responsible for sign off of all advice and briefing documents relating to the incident. Additionally, the Incident Director is responsible for activating the lessons identified process but may delegate the responsibility for lessons identified to an appropriate person. They will have the appropriate security clearance to attend the COBR as required. d) Deputy NHS Incident Director (National) The Deputy NHSCB Incident Director (National) is accountable to, and will support, the Incident Director (National) and deputise in their absence. Their role will normally be assumed by the Head of Operations (Corporate). - 8 -

2.2 In addition to the roles outlined above, the management of a response will be supported by a number of senior NHS CB Operations and Delivery staff who will provide the required expertise from within NHS CB Operations and Delivery, and appropriate NHS CB regional and area teams. They will have the appropriate security clearance to attend relevant COBR meetings as required. a) Incident Manager The Incident Manager (IM) is accountable to the Incident Director (National) and provides senior operational management support to the Incident Director, Deputy Incident Director and the Incident Control Team (National). The Incident Manager will provide leadership to the NHS CB Incident Co-ordination Centre (National) (ICC(N)), which will operationally support the Incident Management Team. The Incident Manager is responsible for the overall management of the NHS CB Incident Coordination Centre (National) (ICC(N)); and when required will ensure appropriate representation at all operational briefings and will oversee the gathering of all information related to the incident. The Incident Manager will have the appropriate security clearance to support the NHS Operations and Delivery representation at the Cabinet Office Briefing Rooms (COBR) back office as required b) Incident Co-ordinator The Incident Co-ordinator is accountable to the Incident Manager (National) and is responsible for ensuring that tasking from the DH, within the NHS and to/from Government is recorded and managed in an appropriate and timely manner. Also, for ensuring both timely receipt of information, log situation reporting (SITREPs) and central reporting. The Incident co-ordinator is responsible for the accurate production and distribution of any NHS Operations and Delivery Briefings SITREP, validation meetings and liaison between the NHS CB Incident Management Team and the DH EPRR Incident Response Centre. c) Incident Co-ordination Centre (National) (ICC(N)) Operational Support Staff ICC(N) operational staff are accountable to the Incident manager and will work within the Incident Co-ordination Centre and their role is to support the NHS CB Incident Management Team through facilitating effective communication and information flows both internal and external, also the maintenance and management of briefings, records and tasking associated with the NHS Operations and Delivery response during the incident. - 9 -

3. ALERT 3.1 This section covers all aspects of the alerting process both for NHS CB Operations and Delivery (NHS Operations and Delivery) to respond to an incident and for notifying staff of a requirement to support a response. As part of the alerting process, communication will be pre-fixed as either for information, to standby or to act. Initial Alerting 3.2 During working hours, initial alerting may be the result of an incident notification via DH Emergency Preparedness Resilience and Response (EPRR) and / or the NHS CB central, regional and area teams. Alternatively, the alert may be received from external sources such as Other Government Departments (OGDs) and Agencies, the Health Protection Agency Emergency Response Division (HPA ERD), Devolved Administrations, international bodies and the media. 3.3 Out of hours alerting will be initiated through the NHS CB Operations and Delivery Duty Officer system. The alerting process will normally be initiated by the NHS CB Operations and Delivery Duty Officer (for which a 24/7 on-call roster is in-place). Contact details are held by the NHS CB Operations Team and will be shared with on-call personnel NHS CB Operations and Delivery Internal Staff Alerting 3.4 The alerting process notifies NHS Operations and Delivery of an increased likelihood that they may be required to respond to an incident (standby alert) or that an incident has taken place and what action is required. Alerting External Agencies 3.4 In certain circumstances, external agencies will need to be notified of a health incident, which may require their action. This will be the responsibility of the NHS CB Director of Operations and Delivery via the NHS Operations and Delivery Duty Officer. - 10 -

NHS CB Incident Alert and Response Levels Alert Activity Action NHS CB Incident Levels A health related incident 0 that can be responded to and managed by local health provider organisations within their respective business as usual capabilities. A health related incident that requires the response of a number of health provider organisations across an NHS Alert Dynamic Risk Assessment Declaration of Incident level 1 CB area team boundary and will require an NHSCB Area Team to co-ordinate the NHS local support. A health related incident, that 2 requires the response of a number of health provider organisations across and NHS CB area teams across an NHS CB region and requires NHS CB Regional co-ordination to meet the demands of the incident 3 A health related incident, that requires NHS CB National coordination to support the NHS and NHS CB response - 11 -

4. ACTIVATION 4.1 The level and organisation of the NHS CB Operations and Delivery (NHS Operations and Delivery) national response will be determined through the use of the situational risk assessment criteria detailed below. The following is not exhaustive but indicate the form of assessment that will be undertaken when NHS CB Chief Operating Officer determines both the appropriate level of response and any subsequent escalation or de-escalation. a) The significance of the impact upon the NHS in terms of resources required to manage the response. b) Public perception/concern issues of public confidence. E.g. an incident with limited risk to the whole NHS might be escalated to a higher level if there is widespread community or media interest. c) Media attention national, international. d) Implications for partners and partnerships resources, reputation, reciprocity. e) Impact on the NHS reputation and relationships. f) Complexity of situation, and associated competencies for handling. g) Potential malicious incidents (act of terrorism, deliberate release, and hoaxes) will escalate the response level. h) The possibility of subsequent adverse events. i) In the initial stages, full implications of the incident may not be evident. Consideration should be given to providing a response and de-escalation when appropriate. j) A state of readiness following de-escalation of an incident in case the situation escalates again (e.g. public riots) or a very low level response and protracted tail that still requires national coordination (e.g. Libyan amputees). k) Establishment of Central Government emergency arrangements (COBR). 4.2 Authority to activate a national response lies with any of the following: a) NHS CB Chief Executive. b) NHS CB Chief Operating Officer. c) NHS CB Director Operations and Delivery. - 12 -

d) NHS CB Head of NHS Operations e) NHS CB EPRR Corporate lead. f) NHS CB Operations and Delivery Duty Officer. 4.3 An initial dynamic risk assessment should inform the discussions between senior staff with regard to defining an appropriate level of response. 4.4 One outcome of the dynamic risk assessment undertaken by NHS CB Operations and Delivery may be the declaration of a NHS national incident, for the purpose of this plan an NHS national incident is one that requires national command, control, communications and management processes to both support and ensure that the NHS as a whole is effective in managing a large scale, complex or evolving incident/emergency that could result in an adverse and national impact on the services effective delivery of care to the public. 4.5 The response may require the activation of one or more NHS CB Incident co-ordination centres (ICCs). The function of which is to provide a focal point for coordination of the response and gathering, processing, archiving and dissemination of information across the NHS and externally where appropriate. Activating the NHS CB Incident Management Team (National) (IMT(N)) and Incident Coordination Centre (National) (ICC(N)) 4.6 The decision to establish the Incident Management Team (National) rests with the NHSCB Director of Operations and Delivery in consultation with the NHS CB Chief Operating Officer. Dependent upon differing response requirements, the NHS CB IMT will be supported by an incident co-ordination centre (National) which will be located at either Quarry House, Leeds (Primary Location) or Richmond House, London, or even both. Dependent upon the nature of the incident the IMT could operate virtually. The choices will be determined by a number of factors: a) Location and ease of access to Civil Contingencies Committee and central government. b) The nature of the emergency. c) Security considerations. d) The potential for the NHS CB ICC (N) to be compromised by infrastructure restrictions e.g. during a terrorist attack. 4.7 The NHS CB Incident Management Team (National) supported by the Incident Coordination Centre (National) will form to provide an enhanced level of operational support to the NHS and the Department of Health. - 13 -

5. OPERATION The NHS CB Incident Management Team (National) 5.1 The NHS CB Incident Management Team (National) is structured to be accountable to and operationally support the Incident Director (National) and facilitate effective national direction, co-ordination, communication and operational management of the incident. 5.2 The Incident management Team (National) will work with the relevant NHS CB Regional and Area Team Incident directors and their Incident Management teams / Incident Coordination Centres (ICC) in the management of an incident where required. As appropriate, strategic direction and coordination of the NHS CB ICCs in national aspects of the response will be provided by the Incident Management Team (National). 5.3 NHS CB Incident management Team s may be required to provide an appropriate response to a widespread incident or individual centres to specific emergencies, Pandemic (H1N1) 2009 Influenza, CBRN incidents or mass casualty incidents. 5.4 Activation of the NHS CB IMTs will be at the direction of the appropriate NHSCB Regional or Local Team director and dependent upon the nature of the emergency and the level of response required. 5.5 In certain circumstances during the response, and following a dynamic risk assessment the NHS CB Incident Director (National), in consultation with the NHS CB Chief Operating Officer may decide to modify the responsibilities of the Incident Management Team (National). The function may be reduced in order to reflect specific strategic demands (Core NIMT). This may be applicable at the start of a low-level national incident where a fully staffed IMT and ICC would not be required. 5.6 Supported by the Incident Co-ordination Centre (National), the primary functions of the Incident Management Team (National) are; a) To support the NHS CB Incident Director (National) to direct and coordinate the response strategy and operations across the NHS in accordance with the established schedule. b) Provide corporate and strategic support to the operational delivery of the NHS. c) To be the route through which tasking from Cabinet Office Briefing Rooms (COBR) through the DH EPRR Incident Response Centre team is implemented. d) Advise on Policy as directed by the NHS CB Chief Executive. e) To manage information relevant to the incident and to disseminate as necessary. f) To liaise with the Department of Health and other Government Departments / Agencies - 14 -

as necessary. g) To provide Situation Report (SITREP) briefings and NHS capability statements to DH EPRR Incident Response Centre team (for sharing with COBR), and the NHS CB Chief Executive. h) Provide a forward look to issues that may arise, their consequences and forecasting our response. i) Co-ordinate and direct strategic meetings and/or teleconferences. j) Assisting DH EPRR Incident Response Centre and DH Comms with the information flow to the public domain via the media and to other key stakeholders. k) Operation of the Incident Co-ordination Centre (National) which is the operational hub through which information flows, both internally and externally. Moreover, tracking and management of tasking, as directed by the Incident Director (National), is processed and managed within the Cell. For example, ICC(N) staff will ensure briefing documents and situation reports (SITREPs) are produced and distributed for action on time and as directed. Records Management 5.7 An essential element of any response to an incident is to ensure that all records and data are captured and stored in a readily retrievable manner. This is fundamental to the NHS CB corporate response and these records will form the definitive record of the response and may be required at a future date as part of an inquiry process (judicial, technical, inquest or others). Such records are also invaluable in identifying lessons that would improve future response. 5.8 Regardless of the scale of incident, the NHS CB Incident Director (National) is formally responsible for sign off of all briefing papers and documents relating to the incident. All such advice/documents and Incident Director sign off must be logged by the NHS Operations and Delivery Cell. Shift arrangements 5.9 In the event of a major incident or emergency having a substantial impact on the UK, it may be necessary to continue operation of the NHS CB ICC (National) for a number of days or weeks. In particular, in the early phase of an incident, the Incident management Team (National) and Incident Co-ordination Centre (National) may require to operate continuously for an extended period of time. Responsibility for deciding on the scale of response, including maintaining teams overnight, rests with the NHS CB Incident Director (National). 5.10 A robust and flexible shift system will need to be in place to effectively manage an incident - 15 -

through each phase. NHS CB Incident Co-ordination Centre (National) will operate shiftworking arrangements as required. 5.11 These shift arrangements will depend on the nature of the incident and must take into consideration any requirements for preparatory work to support external (for example COBR) meeting and activities that may require very early morning starts to meet briefing deadlines etc. It will be important that there is rotation of staff to prevent burn out in protracted incidents. 5.12 Outline shift arrangements are presented below: Requirements for each shift should be monitored at each handover. Handover briefings must be appropriately detailed (template and SOPs). During the first two shift changes 1-2 hours of hand over time is required. The Incident Manager is accountable for ensuring appropriate staffing of all shifts. Shift changes should be considerate of both staff welfare and operational requirements. For example, shifts could change in the morning (7-9am) and evening (8-10pm). Where possible initial shift changes in teams should be staggered. Where possible there should be continuity of staffing. Staff welfare and health and safety policies must be followed. - 16 -

6. ESCALATE / DE-ESCALATE 6.1 Escalation or de-escalation through the incident levels need not occur sequentially, but will be driven by the nature, scale and complexity of incidents, coupled with the expectations of the NHS CB response. Any incident response can be changed following a review, including a risk assessment, of the strategic direction and operational management of the emergency Escalation/De-escalation 6.2 The level of the response may need to be escalated or de-escalated for a number of reasons. These may include: Criteria for Escalation increase in geographic area or population affected (Pandemic, Flooding etc.) the need for additional NHS external or internal resources increased severity of the incident increased demands from government departments on the NHS or from partner agencies or other responders heightened public or media interest Criteria for De-escalation reduction in incident resource requirements reduced severity of the incident reduced demands on the NHS from partner agencies or other government departments reduced public or media interest decrease in geographic area or communities affected Establishment of central government emergency arrangements (COBR). 6.3 Changes in incident level can only be authorised by the NHS CB Incident Director (National). 6.4 All response level changes need to be communicated both internally and externally as appropriate. A brief description of the resource implications of the new level should be included. - 17 -

7. STANDOWN Initial Stand Down 7.1 All response level changes need to be communicated both internally and externally as appropriate. A brief description of the resource implications of the new level should be included. Records Management 7.2 Once it has been decided that the NHSCB National response structure is no longer appropriate, the stand down process will be initiated by the NHSB Incident Director (National). Administration 7.3 Once the decision has been taken, the NHSCB Incident Director (National) will ensure that all appropriate elements of the response are stood down. This may be a staged process. It is important to ensure that where communication channels have been specially created for the incident, forwarding mechanisms are in place to ensure that no communications are lost. This will also ensure that people trying to contact the NHS CB Incident Co-ordination Centre (National) have an alternative access route. Debriefs & Reports 7.4 Structured debriefs should be held with involved staff as soon as possible after deescalation and stand down. Participants must be given every opportunity to contribute their observations freely and honestly. The NHS CB Incident Director (Corporate) must ensure that the full debriefing process is followed. 7.5 As part of the debriefing process a post incident report will be produced to reflect the actual events and actions taken throughout the response. Typically this will include: Nature of incident. Involvement of NHS CB Involvement of other responding agencies. Implications for strategic management of the NHS. Actions undertaken. Future threats/forward look. - 18 -

Chronology of events. 7.6 A hot de-brief will be held within 24-hours of the close down of the incident. A structured debrief will be held within 14 working days of the incident. The initial incident report will be produced within 28 working days. Lessons Identified Process 7.7 A separate Lesson Identified report will focus on areas where response improvements can be made in future. This report will include the following sections: Introduction. Observations. Action Plan (detailing recommendations, actions, timescales and owner) 7.8 Throughout the incident at whatever level, there will need to be an agreed process in place to evaluate the response and recovery effort and identify lessons. The NHS CB Incident Director (National) is responsible for activating the lessons identified process and may delegate the responsibility for lessons identified to the Incident Manager. The lessons identified process will be implemented at the start of the response and continue during and after the incident until all actions are completed. - 19 -

8. REVIEW AND MAINTENANCE, TRAINING AND EXERCISING 8.1 Within the regulations of the Civil Contingencies Act (CCA) 2004 every plan maintained by a general Category 1 responder under section 2(1)(c) or (d) of the regulations must include provision for:- a) the carrying out of exercises for the purpose of ensuring that the plan is effective; b) the provision of training of; i. an appropriate number of suitable staff; and ii. such other persons considered appropriate, for the purposes of ensuring that the plan is effective. 8.2 To meet these requirements: This plan will be exercised to ensure its effectiveness and validity. NHS Operations and Delivery staff with emergency response roles in the plan and those who potentially have a role within an emergency response will participate in a targeted training programme to ensure competency in those roles. 8.3 The maintenance of the document is currently the responsibility of NHS CB National Lead for EPRR; it will be reviewed as required by the NHS CB Operations Executive Team and approved by the Head of Operations (Corporate). Post 1 April 2013, the NHS Commissioning Board Chief Operating Officer will direct future maintenance responsibilities. - 20 -

9. ACRONYMS USED IN THE PLAN AT NHSCB Area Teams CCA Civil Contingencies Act (2004) CCC Civil Contingencies Committee COBR Cabinet Office Briefing Room CONOPS Concept of Operations C4 Command, Control, Coordination and Communication DAs Devolved Administrations DH Department of Health EPL Emergency Preparedness Lead EPRR Emergency Preparedness, Resilience and Response (DH) ICC(N) Incident Co-ordination Centre (National) ICo Incident Coordinator IM Incident Manager IMT(N) Incident Management Team (National) IRC Incident Response Centre (Department of Health) IRP(N) Incident Response Plan (National) NHS National Health Service NHS CB NHS Commissioning Board NACC National Ambulance Coordination Centre PHE Public Health England PHE(C) Public Health England (Centre) SITREP Situation Report SOPs Standard Operating Procedures - 21 -

Action Cards - ANNEX A NHS CB Operations Response Roles Action Cards Card Emergency Response Roles Page 1 NHS CB Chief Executive 23 2 NHS CB Chief Operating Officer 24 3 NHS CB Incident Director (National) 25 4 NHS CB Incident Manager (National) 27 5 NHS CB IMT Team Coordinator (National) 29 6 NHS CB IMT Records Manager (National) 31 7 NHS CB IMT SITREP Manager (National) 32 8 NHS CB IMT Task Manager (National) 33 9 NHS CB IMT Loggist (National) 34 10 NHS CB Communications Officer 35 11 NHS CB IMT Support Staff (National) 37 12 NHS CB Medical Director 38 13 NHS CB Chief Nurse 39 14 NHS CB IMT Briefing Requirements 40 15 NHS CB IMT Forward Look Requirements 41 RED ORANGE GREEN BLUE Essential (Core) Critical Supporting Requirements - 22 -

ACTION CARD 1 NHS CB CHIEF EXECUTIVE Accountable to the Secretary of State for Health Responsibilities To ensure the NHS continues to deliver its core functions during the response and recovery phases of any National Incident. Has overall responsibility and command of the NHS response to a national incident Provides liaison between DH and Central Government on NHS matters Initial Actions In discussion with the NHS CB Chief Operating Officer, and following a dynamic risk assessment decide or review the appropriate level and scale of the response. Delegate authority to the NHS CB Chief Operating Officer to oversee and delivery of the NHSCB response to the Incident Post Incident Debrief with the NHS CB Chief Operating officer on the NHS response to the Incident and agree Corporate Lessons Identified to be taken forward. - 23 -

Accountable to the NHS CB Chief Executive Responsibilities ACTION CARD 2 NHS CB CHIEF OPERATING OFFICER As directed by the NHS CB Chief Executive to ensure the NHS continues to deliver its core functions during the response and recovery phases of any significant health related Incident. Has overall responsibility and control of the NHS response to a national incident Provides liaison between the Department of Health and Central Government on NHS matters Initial Actions In discussion with the NHS CB Chief Executive, and following a dynamic risk assessment decide and agree the appropriate level and scale of the response. Appoint the NHS CB Director of NHS Operations and Delivery or other at the discretion of the the Chief Operating Officer, to the role of Incident Director (National); to direct the NHS CB corporate response. Ensure the NHS CB Incident Director (National) has set up the NHS CB Incident Management Team (National) and appointed appropriate response leads as required for the Incident Agree with the Incident Director (National) the NHS CB Corporate Battle rhythm and SITREP periodicity, plus situational update meetings Upon the termination of the incident, ensure that the Incident Director (Corporate) has followed the procedures set out in the IRP (C) and that all respective responding elements have been stood down. Post Incident Debrief with the NHS CB Chief Executive on the NHS response to the Incident and agree Corporate Lessons Identified to be taken forward. - 24 -

ACTION CARD 3 NHS CB INCIDENT DIRECTOR (NATIONAL) Accountable to the NHS CB Chief Operating Officer Function Specification To act as directed and on behalf of the NHS Chief Operating Officer. Director NHS Operations and Delivery or NHS CB COO Director or Deputy. Previous experience of leading an incident response Responsibilities Perform a dynamic risk assessment depending on the context of the overall situation. Lead for the direction of the incident Set up an Incident Management Team (National). Maintain regular dialogue with the NHS CB Chief Operating Officer / DH Response Team lead regarding the progress of the incident Required to provide assurance to the NHS CB Chief Operating Officer that the incident is being directed effectively Assurance that the required resources required are being, or have been secured To oversee the operation of the Incident Co-ordination Centre, supported by the NHS CB Incident Manager Responsibility for the health and safety of NHS CB and seconded staff involved in the response Holds the responsibility for sign off of SITREPs, briefings and media statements Initial Actions Ensure that the incident log is initiated. In discussion with the NHS CB Chief Operating Officer, decide or review the appropriate level and scale of the response Set up the Incident Management Team (National) and activate the NHS CB Incident Coordination Centre (National) Alert all NHS CB Corporate Directors to the activation of the Incident Management Team and the Incident Co-ordination Centre (National) and confirm its location Following the full activation of the Incident Management Team, appoint the members of the Team from the Staffing List to include the following: a. NHS CB Corporate Incident Manager b. NHSCB Corporate ICC Coordinator c. ICC(N) Support staff Ensure that NHS CB regional and area team directors are aware of the location and contact routes for the NHS CB Corporate Incident Director and NHSCB NIMT and NICC. Set up and chair the first coordination briefing meeting which will comprise of the Incident - 25 -

ACTION CARD 3 NHS CB INCIDENT DIRECTOR (NATIONAL) Management Team (National), appropriate NHS CB regional local area team leads and DH Response Team Manager as required At end of meeting announce time and location of next meeting ensure this is cascaded to relevant staff in order to facilitate the battle rhythm Actions when NHS CB Incident Management Team (National) established Establish contact with any NHS CB Incident Co-ordination Centres (ICC) already involved in the response Establish and maintain battle rhythm. With Incident Manager agree and arrange distribution of the schedule of meetings, events etc. With Incident Manager, identify initial objectives for the response cell. Ensure SITREPs are produced in time with the battle rhythm and approve them for distribution Chair regular operational response meetings/teleconferences. Ensure tasking is logged and priorities assigned and positively review these at future meetings/teleconferences Ensure briefings for the DH Response Team and NHS CB Chief Operating Officer prepared according to the agreed battle rhythm If the nature of the emergency requires NHS CB representation at COBR arrange an appropriate representative and accompany to COBR Assess the strategic direction of the incident Continue to assess the incident in regards to whether there should be any escalation/deescalation of the response level Set up an agreed process to identify any lessons identified, and if necessary delegate responsibility for lessons identified to an appropriate person Ensure that detailed handover is produced at the end of each shift for the incoming NHSCB Corporate Incident Director in order that a smooth transfer between each shift is maintained Attend COBR when necessary Post Incident Close incident log Organise all post-incident debriefing including hot wash ups Ensure that any lessons identified processes have been implemented and that formal lessons learned are recorded. Ensure that any post incident recovery or remediation issues are addressed Contribute to the post incident report - 26 -

ACTION CARD 4 NHS CB INCIDENT MANAGER (NATIONAL) Accountable to the NHS CB Incident Director (National)/Deputy Incident Director (National) Function Specification Experience of working in an Incident Management team and ICC and understanding how NHS CB operational arrangements should work during an incident Management role in usual position with operational and staff management experience Ability to be flexible and work in a pragmatic manner Good understanding of leadership in an incident situation Attendance on the NHS CB Incident Management Course Responsibilities Ensure decision and an incident management log is maintained Liaise with NHS CB Incident Management Team Coordinator (National) with regard to setting up of the IMT (National) and ICC(N). Ensure NHS CB ICC(N) staff are aware of any site-specific security requirements Attend NHS CB incident response related teleconferences Coordinate written briefs and SITREPs to provide senior operational management support to the NHS CB Incident Director (National) and Deputy Incident Director (National). To prepare and co-ordinate briefing packs for the NHS CB Chief Operating Officer, and senior corporate directors To service and support the regular strategic teleconferences during the Incident To prepare and co-ordinate briefing papers for other requests for corporate level advice from the NHS CB To support the ICC(N) and NHS CB Incident Director (National) by ensuring an effective flow of information regarding national and corporate matters To ensure that communications between the ICC(N), DH Response Team, NHS CB regional and local area teams and OGDs/External organisations are dealt with in a prompt and appropriate manner To provide leadership to the ICC(N) co-ordinator and operational support staff and to assist new staff to develop in their various roles within the ICC(N). To provide broad forward look strategy options for NHS CB senior staff and the Department of Health. To observe and review any lessons identified during the incident and take forward for incorporation into future planning To identify any staff resource impacts arising from the incident To provide support and guidance to the ICC(N) staff and expertise and knowledge of the NHS response functions and processes - 27 -

To ensure that the DH, NHS and NHSCB emergency plans and procedures are adhered to by the ICC(N). Initial Actions Start and maintain a personal log To assist the NHS CB Incident Director (National) and Deputy Incident Director in the formation of the initial response team as the ICC(N) is established. To gather battle rhythm information and disseminate across the ICC(N). Ensure that the staffing rota for the NHS CB Incident Director (National) and Deputy Incident Director is populated and follow up if necessary At the end of shift Ensure accurate handover notes are produced and make the incoming shift aware of any urgent/outstanding issues Handover incident log ensuring all records are completed and captured Assist in any debriefing/briefing of staff - 28 -

ACTION CARD 5 NHSCB INCIDENT MANAGEMENT TEAM COORDINATOR (NATIONAL) Accountable to the NHSCB Incident Manager (National) Function Specification A senior manager with experience of managing teams of staff Excellent organisational skills Attendance on the NHS CB Incident Management Course Responsibilities Support the function of the Incident Management Team (National) Manage the function of the ICC(N) Maintain an overview of all incoming information in the ICC(N) Ensure robust communication links with DH Response Team and NHS CB Regions and Area Teams To ensure set up and maintenance of the electronic Task List during the response To ensure that strategic and operational tasking both within the NHS CB and to/from DH Response Team and Government is recorded, tracked and managed in an appropriate and timely manner To ensure that critical actions are not missed and that progress towards delivery is monitored Manage workload of ICC(N) staff To ensure that all records and data are captured and stored in a readily retrievable manner To ensure awareness of records management procedure and check that correct protocol is being adhered to during the incident across the whole ICC(N) To provide/co-ordinate a records management procedure for the incident, to include a file architecture for storing electronic and hard copy data related to the incident Responsible for incident specific workload distribution within the ICC(N) To ensure that all records are archived accurately post incident and stored securely briefing/de-briefing of incoming/outgoing shift staff To ensure awareness of records management procedure within the ICC(N) Initial Actions Ensure a chronological incident log for the ICC(N) is started and maintained Ensure ICC(N) location and facilities are set up and functioning Ensure that records management procedures, as detailed in Records Management Action Card are put in place in order that all incident management information and decisions are recorded and readily retrievable In liaison with the NHS CB Incident Manager (National), appoint staff in the ICC(N) and allocate roles to ensure all key functions are covered with respect to: Information management, logging - 29 -

and support staff. Appoint up to 3 support staff to assist with logging contact points for use during the response and to provide information to feed into SITREP and briefing documents. Ensure ICC(N) staff are fully briefed and understand their roles Ensure IT and communications systems infrastructure is in place and functioning Ensure all emergency e-mail accounts, file storage and retrieval architecture, incident management and decision logs are available and ensure that communication systems infrastructure is in place and functioning Actions when NHSCB NICC is established Co-ordinate the production and distribution of SITREPS in accordance with the battle rhythm Maintain overview of incoming emails, faxes and phone calls to the ICC(N) and ensure they are dealt with appropriately Ensure communication links with other Incident Co-ordination Centres and ops/control rooms are robust at all times Collate and co-ordinate information data flows during an incident to ensure there is a correct audit trail and maintain accurate and contemporaneous records of all actions and decisions Map the key flow routes for information. All NHS CB corporate related communications and contact to be channelled through the ICC(N) It is important these information flow routes are confirmed and recorded To maintain the contacts list of staff roles within the ICC(N) At the end of shift Ensure accurate handover notes are produced and make the incoming shift aware of any urgent/outstanding issues Ensure all incident logs are completed and collected and handed over to the next shift Ensure ALL personal logs/notes from ALL STAFF who have worked in the Operations and Delivery Cell are collected and handed over or secured In liaison with the Records Manager ensure all IT based records (documents, e-mails, etc.) are archived electronically and backed up Ensure any information written on white boards and flip charts either stored electronically or copied and secured. white boards should then be cleaned - 30 -

ACTION CARD 6 NHS CB INCIDENT MANAGEMENT TEAM RECORDS MANAGER Accountable to Incident Manager (National) Function Specification To ensure that all records and data are captured and stored in a readily retrievable manner To ensure awareness of records management procedure and check that correct protocol is being adhered to during the incident across the whole Incident Management Team (National) To provide/co-ordinate a records management procedure for the incident, to include a file architecture for storing electronic and hard copy data related to the incident To ensure that all records are archived accurately post incident and stored securely Initial Actions Identify a person responsible to take on this function Set up the file structure for the incident using the records management agreed generic archival folder structure. This should be set up immediately in order that records can be maintained in realtime to avoid backlog. At the first meeting brief Incident Management Team (National) members on the arrangements for electronic logs, system for filing e-mails and the archiving of information relating to the incident and that recommended records management procedures are followed and understood in order that all incident management information and decisions are recorded Ensure that all staff are aware of the protocol for file naming during the incident. In liaison with the incident manager, ensure IT and communications systems infrastructure is in place and functioning. Co-ordinate the records management procedure to include a suitable file architecture for storing electronic and hard copy data related to the incident Actions once the NHS CB ICC(N) is established Collate and co-ordinate information data flows during an incident to ensure there is a correct audit trail and maintain accurate and contemporaneous records of all actions and decisions. Ensure that adequate records are kept of the cost implications of all decisions made and actions taken throughout the duration of the emergency/major incident Maintain accurate and contemporaneous records of all actions and decisions In liaison with the NHS CB Incident Director (National) and Incident Manager, brief staff as appropriate to ensure continuity of records management awareness e.g. at shift handover Assist in emergency application development or amendment of existing IT systems where required (subject to local permissions) At the end of shift Ensure that all records, notes and documents associated with the incident are collated and archived in an easily retrievable file system Ensure that all archived incident documentation is stored in a secure location - 31 -