BSO 111/2014
To: / BSO BoardFrom: / Director of HRCS
Subject: / Emergency Preparedness and Response
Annual Report PHA / HSCB / BSO
Status: / For Noting
Date of Meeting: / 30th October 2014
Emergency Preparedness & Response
Annual Report of PHA/HSCB/BSO
(DATES THE REPORT RELATES TO)
From: / 1 April 2013 / To: / 31 March 2014Report Completed by: / James Devlin & Liz Fitzpatrick
Position: / Emergency Planning Coordinator, PHA
Emergency Planning and Business Continuity Manager, HSCB
1
1.0 Context
The Department of Health Social Services and Public Safety (DHSSPS) policy circular HSC (PHD) Communications 01/2010 and 2/2010 clearly sets out the roles and responsibilities of the DHSSPS, the Public Health Agency (PHA), the Health & Social Care Board (HSCB),the Business Services Organisation (BSO) and the Health and Social Care (HSC) Trusts. The Policy Circular 01/2010 also outlines requirements with regard to reporting annual activities and the monitoring thereof.
The Northern Ireland Civil Contingencies Framework states that the DHSSPS should have a clear picture of activities, achievements and outstanding issues in relation to emergency preparedness.
The Joint PHA/HSCB/BSO Annual Report, which is co-ordinated by the PHA, provides detail on emergency planning activities to the DHSSPS, including the following key elements, in an agreed format: (i) leadership; (ii) multi-agency collaboration including any cross border initiatives; (iii) planning, validating and reviewing; and (iv) testing, exercising and training.
The HSCB liaises closely with the PHA in reviewing performance of the HSC Trusts in emergency preparedness. The Joint PHA/HSCB/BSO Annual Report includes an overview of the HSC Trusts’ performance in respect of Emergency Preparedness, based on the information provided to the HSCB and PHA, in the agreed format. Paragraph 5.2 of the Policy Circular refers.
2.0 Leadership
To ensure leadership and accountability, corporate mainstreaming and to embed emergency preparedness within the cultures of the three organisations , a joint PHA, HSCB, BSO Emergency Preparedness Working Group was established in April 2010 and meets quarterly. Further to this, in January 2013, a joint Flu Weather Major Event (FWME) Project Board from the HSCB and PHA was established. This Group is jointly chaired by the Director of Public Health (PHA) and the Director of Performance and Corporate Services (HSCB).
The FWME Project Board, within its Terms of Reference, has assumed responsibility for:-
· Co-ordinating HSC preparedness for flu, adverse weather and major events to respond to their individual and collective impacts;
· Seeking assurance from providers and other relevant HSC organisations on HSC preparedness;
· Facilitating work to enable HSC preparedness;
· Escalating key risks;
· Liaising with multi-partner organisations;
· Ensuring the Joint Response Plan and other related Plans, are up to date;
· Providing assurance to the DHSSPS on preparedness issues.
As part of the FWME Project Board’s working a Major Events Project Team under the chair of Dr Anne Wilson was also established in January 2013 in order to specifically plan and prepare for the three major events scheduled for the summer of 2013 in Northern Ireland. This Project Team met regularly through the first two quarters of 2013, including during the periods of the major events of the summer 2013. This Project Team coordinated the various strands of emergency planning and general service planning that was required for the major events, i.e. G8, World Police and Fire Games (WPFG) and the All Ireland Fleadh, held in Northern Ireland during 2013.
The FWME Project Board reports through its joint Chairs to the Senior Management Team (SMT) and Agency Management Team (AMT) of the HSCB and PHA respectively, and to each organisation’s Governance Committees.
This Joint Annual Report highlights the specific work that the Emergency Preparedness and Environmental Hazards (EmPEnH) Team and the FWME Project Board/Team have carried out in the period 1 April 2013 through to
31 March 2014. The report highlights the advances that have been made whilst also identifying the gaps and action plans for future work in the area.
The report also provides an overview of the performance of HSC Trusts in respect of emergency preparedness, and outlines the proposed arrangements to further enhance emergency planning performance management arrangements between the HSCB, PHA and the HSC Trusts during 2014/15
3.0 Multi-agency collaboration including cross border initiatives.
The Western HSC Trust through its acute hospital network provided support to Health Service Executive (HSE) colleagues following the serious flooding incident at Letterkenny General Hospital on 26 July 2013. This incident meant the loss of approximately 40% of their facility. The incident resulted in the activation of the Western HSC Trust’s business continuity plan and the establishment of an Incident Control Team (ICT) to manage the overall response. The incident was distinctive for the Trust in that, not only was the incident external to the Trust but it had also occurred within another jurisdiction. The co-operation between all agencies involved the Western HSC Trust, Letterkenny General Hospital, the Republic of Ireland Ambulance Service, HSE, NIAS, HSCB, DHSSPS and the National Medical Council (NMC). The liaison and co-operation between agencies was successful and lead to a effective and efficient response.
A number of meetings were held between representatives of HSC Silver and colleagues from the Health Service Executive in the Republic of Ireland in the planning and preparation for the G8 summit. This ensured that strong relationships were developed and sustained prior to and during this summit.
In addition, HSC Silver representatives also attended PSNI multiagency Gold and Silver G8 planning meetings.
The Western HSC Trust and Southern HSC Trust have in place, a Cross Border Emergency Management Working Group chaired by a member from within each jurisdiction for a period of two years. From Northern Ireland a total of ten nominated representatives from the Southern and Western First Responders Groups, including the Police Service for Northern Ireland (PSNI), NIAS, PHA, WHSCT, SHSCT and the Northern Ireland Fire and Rescue Service (NIFRS), along with local government representatives from the Southern and Western Environmental Health Groups. This Group is represented from the Republic of Ireland by members of the North West and North East Regional Working Groups (which represent Sligo, Leitrim, Donegal, Cavan, Monghan, Louth and Meath) and a nominee from Dublin.
4.0 Planning, Validating and Reviewing
4.1 Significant Events
During 2013/2014 there was a significant amount of emergency planning and preparation by the HSC family for a number of major events held during the summer of 2013. In June 2013, Fermanagh played host to the G8 Summit, in August 2013, events associated with the WPFG were held in various locations across Northern Ireland, and later in August 2013 the All-Ireland Fleadh was held in Derry/Londonderry as part of the 2013 European City of Culture celebrations.
The Project Team, led by Dr EA Wilson oversaw the development of a range of detailed and comprehensive plans to ensure that the HSC was as prepared as possible to deal effectively with any form of disruption that could arise during the Major Events; and to ensure that the systems were in place to minimise any impact on the wider HSC services for service users.
Process planning for these events followed the WHO Framework for Public Health Preparedness for Mass Gatherings. The Framework is divided into three broad areas. These are:-
1. Population Health
2. Health Services
3. Disaster Planning
1. Population Health - three specific work-streams were established. These were: - Safe Food and Water, including Outbreak Response; Enhanced Disease Surveillance Systems and Internal PHA/HSCB processes.
2.Health Services - eight work-streams were created. These were:- Local Access, On-Site Medical Team, Patient Pathways to and through South-West Acute Hospital (SWAH (included both Emergency Department (ED) and Out of Hours (OOH) work-groups), Patient Pathways for High Security Transfers, Major Incident Planning and Belfast International Airport; and the planning and development of a HSC Table-top Exercise. This Group also developed an appropriate Situation Report (SitRep) template which can be adapted to fit requirements for each major event/incident.
3.Disaster Planning had one work-stream which reviewed at Chemical, Biological, Radiation and Nuclear (CBRN) and Major Incident Plans.
The planning process also involved weekly teleconferences between PHA, the HSCB and the HSC Trusts from January 2013 through to June 2013. These teleconferences between all relevant HSC organisations and chaired by Dr Wilson ensured a consistent approach was adopted by all concerned.
As outlined above, the FWME Project Board gave strategic direction and to the planning process and ensured that effective governance arrangements were in place.
The PHA, on behalf of HSC Silver, also met with Republic of Ireland HSE colleagues to ensure strong relationships were developed prior to the G8 Summit. PHA and HSCB officers also attended PSNI chaired multi-agency Gold and Silver G8 planning meetings.
While each of the major events was ongoing, daily teleconferences were held to complete HSC SitReps. These daily meetings, chaired by PHA (during G8) and HSCB (in WPFG and the All-Ireland Fleadh), included staff from Performance Management, Integrated Care, Commissioning (HSCB) and Health Protection and Service Development and Commisioning (PHA). Communications staff from both PHA and HSCB were in attendance. These daily teleconferences ensured that HSC Silver had a tactical overview of the situation at an operational level. The SitReps were shared with Gold to inform strategic level in NI.
4.2 Performance Management of HSC Trusts
Each HSC Trust has provided a return to the HSCB based on the Emergency Planning reporting template contained within Circular 01/2010. As part of the performance review process, this information is shared with professionals in the PHA.
Review of the information received from the HSC Trusts indicates that all of the Trusts have provided the information in the required reporting format. All of the Trusts have activated their emergency plans, have held appropriate de-brief sessions, and have reviewed and updated their plans accordingly to include lessons learned. In addition, all Trusts have either activated or tested their Business Continuity Plans, and have reviewed and updated accordingly to include lessons learned.
A table providing a regional overview of incidents responded to by the HSC Trusts is provided in table 2. This table includes detail on a Trust by Trust basis of instances when Emergency Support Centres (ESC) were activated and Trust staff were required to attend.
Of note, the Belfast HSC reported a large increase in ESC activations (27) as a result of security alerts. While these were minor in nature, in that only a small number of individuals required assistance, it was often outside of normal operating hours. As a result of this increase, the Trust initiated discussions with key responding partners to assess how to best address this issue in the future.
Each Trust provides detail of debriefs held following declared major incidents, to include lessons learned.
One such major incident, which had implications for three of the HSC Trusts, ie the Northern Ireland Ambulance Service (NIAS), the Belfast and South Eastern Trusts, was the declared major incident of 6 February 2014 at the Odyssey Arena, Belfast when a high number of young people had presented to the ‘SOS Bus’ within a short time period, with alcohol and drugs related conditions. This resulted in over 100 young people being treated by paramedics for the effects of alcohol and drugs, 11 attendances at the Royal Victoria Hospital Emergency Department, 8 of which were subsequently admitted for care. No patients were taken to the Ulster Hospital. A debrief attended by the three HSC Trusts, was facilitated by an external co-ordinator.
The activation of the Belfast Trust Major Incident Plan in early January 2013 as a result of pressures within the Emergency Department (ED) at the Royal Victoria Hospital made media headlines. At the time the incident was declared there were 98 patients in the ED, of whom 41 were waiting on trolleys with no beds allocated. The incident was called on the basis of the number of Category 2 patients in the ED. Following the debrief of this incident, a number of recommendations were made mainly to ensure that the appropriate systems were in place and that supporting communications exists for management of escalating pressures in Unscheduled Care and across all Trust services. The Trust will develop, finalise and implement an Enhanced Capacity Plan as a direct result of this incident.
Having reviewed the Trusts’ documentation and reports, the HSCB and PHA are satisfied that the Trusts have in place mechanisms to manage emergency preparedness arrangements, responses to major incidents, etc and have structured arrangements in place to organise for debriefs following incidents and exercises. The HSCB and PHA are also satisfied that Trusts ensure that staff training is provided, detail of this on a regional basis is appended in table 3, and that each Trust exercises and validates their range of emergency preparedness plans on a rolling basis.
One area of concern would be a lack of consistency across the HSC Trusts in terms of staffing support to the emergency planning and preparedness function . The HSCB along with the PHA has undertaken a benchmarking and scoping exercise in an attempt to better align staffing support to this function. A proposal in this regard has been submitted to DHSSPS.
Specific HSC Trust risks relating to emergency preparedness and response have been highlighted to the HSCB and PHA, along with the individual Trusts action plans to address these risks. These include the need to develop Hospital Lockdown Plans for specific Trust sites, the development of directorate pandemic flu plans and the continued training programmes associated with the development of Mass Prophylaxis Plans.
4.3 Notification of Incidents to the PHA/Board
Table 1 identifies the incidents that were alerted in the time period 1 April 2012 to 31 March 2013.
In the reporting period the PHA/HSCB responded to a range of incidents. As part of the Joint Response Emergency Plan a matrix has been developed to highlight four levels of Joint Response, ranging from Level 1 – 4.
For reference the 4 levels within the JR Emergency Plan are as follows:
· Level 1 JR (An Acute Incident with no PH / Service Continuity implications)
· Level 2 JR (An Acute Incident with potential PH/ Service Continuity implications requiring advice) (this may or may not require an Incident Control Team to be convened – if required likely to be a virtual team)