Clinical Commissioning Group

Oxfordshire

Clinical Commissioning Group

Major Incident

Operational Response Manual

This manual has been designed to be used by the OCCG On call Director. The document summarises the practical steps that need to be taken and includes action cards.

Lead Director: / Sula Wiltshire, Director of Quality and Innovation and Accountable Emergency Officer
Date: / November 2015
Version: / 004
Author: / Julie Dandridge, Assistant Director – Medicines Management and Emergency Planning
Review date: / November 2018
Approved by: / OCCG Governing Body November 13

Oxfordshire

Clinical Commissioning Group

Document Control

Date / Author / Reason
19.12.2013 / Julie Dandridge / Addition of point 2.5
19.12.2013 / Julie Dandridge / Update to Communications on call action card
02.11.2015 / Rachel Jeacock / Comprehensive review. Change to correct name for NHS England, Oxford University Hospitals NHS Foundation Trust and South, Central and West Commissioning Support Unit. Update of Action Cards A, B, C and H.
19.11.2015 / Rachel Jeacock / Update to NHS England Incident Levels in line with Emergency Preparedness, Resilience and Response Framework dated 10 November 2015

Last Updated: 02/11/2015

Filename: o:\governance\emergency planning\on call file\2015 4th folder\nov 15 on call pack\occg operational response manual v4.docz:\governance\emergency planning\on call file\2015 fourth folder\occg operational response manual.doc

Author: Governance Manager

Oxfordshire CCG Operational Response Manual½

Contents

PART ONE: MANUAL 4

1. Introduction 4

2. Roles and responsibilities 4

3. Receiving the Alert 4

4. Begin a log and record 5

5. Cascading the Alert 6

6. Risk Assessment 6

7. The Incident Management Team 7

8. The Incident Coordinating Centre (ICC) 8

9. Full assessment and action phase 10

10. Escalation 1110

11. Communications 1211

12. Creating Capacity 1312

13. Reporting 13

14. Finance and resources 1413

15. Extended incident 1413

16. End of an Incident 1413

16.3. Legal Framework 1413

17. Recovery 1514

17.3. ACTION CARDS 1615

Appendix 1 - Cascade 1

Appendix 2 - Required Documentation 2

Appendix 3 – Incident Situation Reports 3

Appendix 4 - GLOSSARY 6

Last Updated: 02/11/2015

Author: Governance Manager

PART ONE: MANUAL

1. Introduction

1.1. This document details the actions to be taken by Oxfordshire Clinical Commissioning Group (OCCG) in the event of a major incident.

1.2. It is for use by OCCG staff and sets out the response to a significant health related major incident. It also describes command and control arrangements for the local NHS.

1.3. This Operational Response Manual will also assist the Director on Call in their duties as being the single point of contact in the organisation for any escalation or major emergency.

2. Roles and Responsibilities

2.1. Within the new NHS architecture, different organisations have different responsibilities in relation to emergency planning and response (see Major Incident Plan for full list).

2.2. OCCG may need to lead a response to a local issue but in all cases NHS England South (South Central) should be informed and may take over leadership (see Escalation, p10).

2.3. The responsibilities of OCCG are to respond to reasonable requests to assist and cooperate during an emergency. NHS England South (South Central) may decide to include CCG members in the formal command and control structure and to assist in any response to a major incident. CCGs may assist and support NHS England South (South Central) to undertake the following tasks:

· Mobilising resources from locally commissioned services;

· Providing local NHS leadership if required;

· Liaising with relevant partner organisations;

· Cascading information to relevant service level providers;

· Informing and maintaining dialogue with neighbouring CCGs when appropriate

· Supporting CCG commissioned organisations with any local demand, capacity and systems resilience issues.

2.4. The OCCG Director on Call will become the responsible lead in the case of a major incident.

2.5. The Emergency Accountable Officer is responsible for ensuring that this manual is regularly updated and tested.

3. Receiving the Alert

3.1. The Director on Call will be alerted to a major incident by NHS England South (South Central) Team or via the Oxford University Hospitals NHS Foundation Trust as the receiving hospital. It is, however, possible that an alert could come via a different route; for example the Public Health England Centre, other NHS organisation, or an individual CCG staff member.

3.2. Appendix 1 details NHS England South (South Central) cascade of ‘major incident standby’ or ‘major incident declared - activate the plan’.

3.3. The standard alerting messages are:

Major Incident – standby
This alerts staff members that a major incident may need to be declared. Preparatory arrangements are then made appropriate to the incident.
Major Incident declared – activate plan
This alerts staff members that the plan should be activated and additional resources mobilised.
Major Incident – cancelled
This alert cancels any previous messages.
Major Incident – stand down
All receiving hospitals are alerted as soon as all live casualties have been removed from the site. Where possible the Ambulance Incident Commander will make it clear whether any casualties are still en-route. The CCG will then assess its own appropriateness to stand down.

3.4. As soon as alerted, the Director on Call takes the role of OCCG Executive Lead (until this role is passed on to another colleague) and may therefore activate the Major Incident Plan.

Figure 1: process to follow on receiving an alert message.

4. Begin a log and record

4.1. The OCCG Director on Call should record in the Director on Call log book:

§ the time of the call;

§ the name and contact details of the caller;

§ the nature of the incident, e.g. type of incident, location, number of casualties;

§ when the incident occurred;

§ organisations involved, e.g. NHS Trusts;

§ current action being taken and by whom;

§ any plans made or expectations of what may happen next (e.g.evacuation plans);

§ what actions are being requested of OCCG.

5. Cascading the Alert

5.1. The CCG Director on call is responsible for initiating the communications cascade both in hours and out of hours to ensure all relevant individuals are aware of the alert.

5.2. The CCG on call director will need to decide whether the internal communications cascade should also be initiated. This will depend on the type of incident and those services/organisations likely to be affected.

Figure 2: Oxfordshire CCG Communications Cascade

6. Risk Assessment

6.1. An initial risk assessment should be under taken as soon as possible. This will determine the next steps to be taken.

6.2. The risk assessment template on page 7 should be used as a guide.

6.3. In making this assessment, it is important to distinguish between:

· Events that can be dealt with using normal day to day arrangements;

· Events that can be dealt with within the resources and emergency planning arrangements of the OCCG and local NHS commissioned services;

· Events that require a joint co-ordinated response from the organisations across the Thames Valley;

· Events that require a strategic level co-ordinated multi-agency response across the Thames Valley (or wider) health community;

· Events that need regional co-ordination.

Figure 3: Template to be used when undertaking a risk assessment on a recently declared incident

Questions to consider / Information Collected?*
What is the size and nature of the incident?
Area and population likely to be affected - restricted or widespread
Level and immediacy of potential danger - to public and response personnel
Timing - has the incident already occurred or is it likely to happen?
What is the status of the incident?
Under control
Contained but possibility of escalation
Out of control and threatening
Unknown and undetermined
What is the likely impact?
On people involved, the surrounding area
On property, the environment, transport, communications
On external interests - media, relatives, adjacent areas and partner organisations
What specific assistance is being requested from the NHS?
Increased capacity - hospital, primary care, community
Treatment - serious casualties, minor casualties, worried well
Public information
Support for rest centres, evacuees
Expert advice, environmental sampling, laboratory testing, disease control
Social/psychological care
How urgently is assistance required?
Immediate
Within a few hours
Standby situation
*Key √ = Yes X = no ? = Information awaited N/A = Not applicable

7. The Incident Management Team

7.1. The size and seriousness of the incident will need to be considered when deciding on the extent of response needed. It may be appropriate to manage certain incidents off site (e.g. from home) using the telephone to coordinate the response. Other incidents may require full use of office facilities and staff support, making it necessary to form the Incident Management Team.

7.2. Depending on the incident the Incident Management team could consist of:

o Director on Call – would chair and co-ordinate the Incident Management Team;

o Second on call – if support is needed;

o Administration support – to ensure key actions are logged;

o South, Central and West Commissioning Support Unit (SCW CSU) Communication Manager – to lead internal and external communications;

o Locality link – (if incident is in one locality);

o Lead Commissioner – (if only one service is affected by the incident);

o IT Lead – (if IT is involved in the incident).

7.3. Where possible, and where incidents dictate, the OCCG Incident Management Team may work alongside the NHS England South (South Central) Major Incident team and share resources and information. If this happens Conference Room B in Jubilee House will be designated as the Incident Coordinating Centre.

7.4. Out of Hours: The Director on Call will need to use their discretion when deciding to form a complete incident team out of hours. The out of hours Incident Management Team consists of:

§ On call Director (Chair);

§ SCW CSU Communications Manager on call

§ Senior staff called in (if required).

7.5. A standard agenda template for Incident Management Team meeting can be found in Appendix 2.

7.6. There is no duty on OCCG to have a Loggist to document decision making but it is good practice to ensure that all actions are clearly recorded. Some members of OCCG have been trained by NHS England South (South Central) and may be called to assist in their incident co-ordinating centre

8. The Incident Coordinating Centre (ICC)

8.1. The Director on Call may establish an Incident Coordinating Centre (ICC) from which the incident can be managed.

8.2. The ICC for OCCG is based in Conference Room B, Jubilee House, Oxford Business Park South, Oxford OX4 2LH

8.3. The role of the ICC is to:

· manage the operational response to the incident;

· Co-ordinate response across the local health economy;

· report to the NHS England South (South Central);

· handle media issues/enquiries;

· coordinate with district councils and unitary authorities;

· manage the return to normality;

· ensure liaison with other key partners as required.

8.4. The ICC will act as a focal point for all liaisons with NHS and partner organisations regarding the incident. It will have robust and resilient IT and telecommunications capability. The ICC will be staffed by the Incident Management Team.

8.5. The Incident Coordinating Centre may be shared with NHS England South (South Central) and will be set up by NHS England South (South Central) according to Figure 4. In the unlikely event that the OCCG Director on Call needs to set up the control room they should obtain the keys from Reception or the NHS England South (South Central) on call Director.

8.6. NHS England South (South Central), SCW CSU and OCCG have agreed to release Conference Room B from any bookings in the case of a major incident requiring an ICC.

8.7. Access arrangements to Jubilee House are as follows:

· 09:00hrs – 17:00hrs Open access

· 06:00hrs – 09:00hrs and 17:00hrs – 21:00hrs Photo ID Card access

· Out of Hours: To access Jubilee House outside of the above hours contact Security 01865 749 749 and state “Red Signal”. Security will come to Jubilee House and open the building when presented with an OCCG photo identification card.

8.8. Equipment for the ICC is stored in the emergency planning cupboards 1 and 7 on the ground floor of Jubilee House. It is likely that the Incident Room Manager from NHS England South (South Central) will set up the centre, but in the unlikely event that the OCCG Director on Call needs to set up the control room they should obtain the keys from Reception or the NHS England South (South Central) on call Director.
.

Figure 4: Layout of Incident Coordinating Centre

9. Full assessment and action phase

9.1. The role of OCCG Director on Call is to direct and coordinate the management of the incident. In particular OCCG Director on Call will:

§ form the Incident Management Team (if necessary);

§ remain available for consultation throughout the incident;

§ obtain input from all relevant sources of expertise and convene quickly, even if some areas cannot be represented immediately;

§ check the representation and expertise available to the group and ensure that all members of the Incident Management Team understand their roles and responsibilities;

§ ensure that meetings, investigations and actions are properly documented;

§ ensure (with communications managers) that the media are briefed;

§ ensure communication with NHS England South (South Central);

§ consider, recommend and implement measures to protect the public;

§ if required, coordinate the Oxfordshire Health NHS Foundation Trust response to the incident by convening an Oxfordshire Health Emergency Response Group with representatives from all NHS Trusts in Oxfordshire;

§ take executive decisions in the light of the best available information.

10. Escalation

10.1. Figure 5 describes the three broad levels of escalation and provides broad parameters for decision making. It is the responsibility of the senior manager leading the NHS response at any particular time to decide, in conjunction with colleagues, what level of command is appropriate for the local NHS.