AGENDA ITEM 5

TRUST BOARD24th April 2007

PAPERCONTINGENCY PLANNING UPDATE

PURPOSETo update the board on progress on Civil Contingencies Act 2004 (CCA), Department of Health (DH) Emergency Planning (EP) Guidance and the Department of Health National Pandemic Influenza Plan.

FORMATStrategy and Plans

THE BOARDNote progress and approve the Trust Contingency Planning Policy,

IS ASKED TOand associated contingency planning management structure

1. Executive Summary

United Bristol Healthcare Trust acquired a statutory duty to prepare for all manner of disruptive events in November 2005, when the Civil Contingencies Act became effective. This report provides an update on the latest position in respect of the Trust’s emergency preparedness and related matters.

2. Impact on Patients:No direct impact

3. Risk Issues:A fully comprehensive range of contingency plans, particularly business continuity plans, has yet to be produced. However, there is an agreed process and a plan for their completion. Risk will reduce with each completed plan.

4. Healthcare Standards:Domain 6, C24

5. Equality & Diversity Equality and Diversity issues will be incorporated into all

Issues:contingency plans.

Presented by:Graham Rich, Chief Operations Officer

Prepared by:Julian Williams, Contingency PlanningOfficer

Date:03/04/07

1.Legislation and Guidance

1.1The Civil Contingencies Actmakes it a statutory duty for the Trust, as a ‘Category 1 Responder’ to:

  • undertake a risk assessment in respect of ‘major incident-related risks‘, and publish these in the form of a ‘Community Risk Register’;
  • prepare adequate contingency arrangements reflecting those risks identified, which should include business (service) continuity plans, and exercise those plans;
  • co-operate and share related information with local emergency management partner agencies (through the ‘Local Resilience Forum’), and
  • communicate with the public in respect of the Trust’s contingency planning arrangements.

1.2 The Civil Contingencies Actis supported by statutory and non-statutory guidance – respectively the documents Emergency Preparedness and Emergency Response and Recovery – which can be found on the Government website (

1.3 In response to the Civil Contingencies Act, the Department of Health has released new guidance, NHS Emergency Planning Guidance 2005, which replaces the 1998 Planning for Major Incidents: the NHS Guidance. The new guidance is supported by a series of ‘underpinning material’, one of which focuses specifically on Acute and Foundation Trusts.

1.4 In addition to the above, the Department of Health’s National Influenza Pandemic Contingency Plan (2005) sets out information and guidance for the Trust in preparing for a flu pandemic.

2.Proposed Contingency Planning Policy

2.1Given the statutory duties now imposed on the Trust under the Civil Contingencies Act, it is suggested that it is appropriate that the Trust adopts a contingency planning policy. In this respect, the draft Trust Contingency Planning Policy (see Appendix 1), is submitted for approval.

3.Contingency Planning Management Structure

3.1Given the statutory duties now imposed on the Trust under the Civil Contingencies Act, it has been important that the Trust formalises its management processes by which contingency planning matters are addressed. Thus, contingency planning activities are overseen by the Trust Executive Group through the Trust Operations Group.

3.2In addition, it has been felt necessary to establish further working groups to ‘drive’ other aspects of contingency planning, these being a Pandemic Flu Planning Group and a Business Continuity Planning Group. It is also envisaged establish a Major Incident (Mass Casualty) Planning Group to formalise (‘sign off’) revision of the current Major Incident Plan and ensure appropriate involvement in emergency exercises and training.

3.3Para. 5 of the draft Contingency Planning Policy shows the reporting lines of the Trust contingency planning groups with one another, alongside the established ‘external’ contingency planning arrangements through the Local Resilience Forum.

4.Risk Assessment

4.1The Trust has a duty under the Civil Contingencies Actto compile and publish a register of ‘major incident-related’ risks, known as a Community Risk Register, in addition to other risk registers maintained by the Trust. In common with other areas, the Trust has contributed to a joint effort amongst local emergency management partner agencies to produce a joint Community Risk Register, which can be viewed on the Local Resilience Forum’s website:

4.2The Community Risk Register is kept under review and the Trust’s Emergency Planning Officer will ensure that the risks reflected therein tie-in with the Trust’s other risk assessment activities to ensure consistency and highlight potential omissions and areas of duplication.

5.Contingency Plans

5.1Under previous NHS Emergency Planning guidance, under an acute trust was encouraged to draw up a ‘major incident plan’, to set out the arrangements by which the hospital would respond to an event that resulted in large numbers of casualties. This requirement has now become a statutory duty under the Civil Contingencies Act. However, the Trust must now have in place arrangements to deal effectively, and in a ‘joined up’ way with local partner agencies, with a range of potentially disruptive events. Hence, the Trust’s existing Major Incident Plan is currently being revised to form a set of Major Incident Procedures, to include the following contingency plans:

  • Mass Casualty Plan(Due for completion at end of April 2007)
  • Chemical, Biological, Radiological & Nuclear Plan(Due for completion at end of April 2007)
  • Pandemic Influenza (Infectious Diseases) Plan(Completed February 2007)
  • Evacuation Plans(Completion date to be confirmed)
  • Business (Service) Continuity Plans(Scheduled for completion Summer 2007)

5.2Where appropriate, these plans will tie-in and build on with the Trust’s existing escalation procedures.

5.3The Trust’s Bomb Threat Contingency Procedures were revised in December 2006.

6.Business Continuity Planning Principles

6.1The Trust’s Business Continuity plans will based on the following general hierarchy:

However, the nature of any specific disruptive event will determine the appropriate level and magnitude of response.

6.2At a Corporate level, plans will provide the framework for all ‘subsidiary’ plans and include the continuity arrangements for the following ‘infrastructure’ services:

  • Information Management Technology –
  • Information and Communication Technology infrastructure/disaster recovery (including National Programme for Information Technology systems)
  • Information and Communication Technology support for all areas.
  • Human Resources –
  • General staffing and people management issues
  • Facilities–
  • Energy provision (gas and electricity)
  • Waste
  • Engineering support, etc.

6.3At the Divisional level, each clinical and non-clinical Division will need to establish ‘tactical’ level arrangements identifying how it will manage disruptions to its services. These arrangements will fit with the Corporate level plan whilst at the same time providing the framework for each of the respective Divisions’ departments and services continuity plans.

6.4At the Department / Ward/Function level, therefore, detailed plans will need to specify the arrangements by which essential departments / servicesof the various Divisions will be managed, and how they will continue to provide a level of service, when faced with disruption.

7.Training

7.1Recently, the main emergency planning focus has been to prepare a comprehensive Pandemic Flu Plan, and some of the command and control elements were able to be tested in a Department of Health-led national exercise – ‘Winter Willow’ over two days in February.

7.2In June 2006, the Trust’s Major Incident Plan was activated in response to a suspected unexploded bomb at the Broadmead development. Although the object in question was, in fact, inert, this provided an opportunity to respond as if it was an actual event. The lessons learned during this event are currently being incorporated into a revision of the Major Incident (Mass Casualty) Plan, including the need to re-locate the Emergency Co-ordination Centre.

7.3Within the Bristol Royal Infirmary’s Emergency Department, a core group of senior staff has been formed to maintain the Department’s supply of personal protective equipment and to provide training updates to Emergency Department staff regarding the setting up of the hospital’s decontamination unit and radiation monitoring equipment. By the end of March, all Emergency Department Band 5 Nurses, Assistant Nurses and Porters will have been trained to set up the decontamination unit and to respond to an incident involving patients contaminated with chemical, biological, radiological or nuclear materials.

7.4Two dates have been identified to conduct training / exercise opportunities to managers and other staff in respect of the Trust’s major incident arrangements. The Trust’s recently produced Pandemic Flu Plan will be tested on 19 June and, on the 2 October, a table-top exercise will be held on the Trust’s revised Major Incident (Mass Casualty) Plan.

8.Audit and Assessment

8.1The means by which the Trust’s performance in respect of its contingency planning activities are assessed are:

  • Healthcare Commission – ‘Core Standard C24’ states that “Healthcare organisations protect the public by having a planned, prepared and, where possible, practised response to incidents and emergency situations, which could affect the provision of normal services”;
  • Strategic Health Authority – Review of contingency plans, procedures, etc.;
  • Local Resilience Forum – On-going peer review of arrangements by local partnership organisations, through various working groups, joint exercises, etc.;
  • National Capabilities Survey – A bi-annual ‘health-check’ of the Trust’s capability to weather disruptive events, co-ordinated by the Department of Health on behalf of the Cabinet Office;
  • NHS Estates Return Information Collection – Since 2006 requires a return that contributes to the overall National Capabilities Survey by focusing on the resilience of the Trust’s estates and facilities services to disruptive events (e.g. power outages, no gas for heating, etc.), and
  • External Review of Major Incident Plan – The Trust plans to use a Health Protection Agency-approved team from CoventryUniversity to run the Table Top Exercise on 2 October, thereby providing a degree of external validation of the Major Incident Plan.

9.Joint Working with North Bristol NHS Trust

9.1To support and co-ordinate the Trust’s contingency planning / emergency management activities, to ensure compliance with the Civil Contingencies Actand in accordance with Department of Health Emergency Planning Guidance, the Trust now employs two specialist ‘emergency planning’ staff, on a part-time basis, through a joint agreement with North Bristol Trust.

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AGENDA ITEM 5

Contingency Planning Policy Statement

1. This policy statement underscores United Bristol Healthcare Trust’s commitment to develop an effective corporate contingency planning strategy, in accordance with its duties under the Civil Contingencies Act 2004 and NHS guidance in this respect.

2. It is the policy of the Trust to adopt a pro-active approach to contingency planning, with the aim of ensuring, insofar as is reasonably practicable, that appropriate arrangements are in place to enable the Trust’s various clinical and non-clinical Divisions (including subsidiary departments and sections thereof) to respond effectively and efficiently to incidents that result – or have the potential to result – in:

  • significant numbers of seriously injured casualties;
  • casualties who are contaminated with chemical, biological or radiological agents;
  • significant numbers of patients presenting with any highly infectious/contagious disease;
  • the large-scale evacuation of patients, visitors and staff from the physical areas of the Trust’s property, and to
  • ensure that critical/essential services are maintained during or following an emergency situation or disruption to services, even if the Trust is responding to that situation.

3. In this respect, the Trust shall:

  • comply with relevant Department of Health/NHS directives and instructions;
  • develop and maintain appropriate contingency arrangements;
  • identify and prioritise critical/essential Trust services and ensure that, insofar as is reasonably practicable, arrangements are in place to maintain the delivery of such services during and following a disruptive event, ensuring that such arrangements ‘tie-in’ with the Trust’s business risk management processes;
  • ensure that similar continuity arrangements exist in respect of the provision of services/supplies that are contracted out or otherwise dependent on third-party service-providers/suppliers;
  • engage with and support regional/local Health and other partner agencies through the Regional and Local Resilience Forum, for the purposes of ensuring that the Trust’s contingency arrangements reflect integrated, multi-agency, contingency planning, and to
  • undertake to train appropriate staff accordingly.

4. To ensure the viability of this policy, the Trust shall nominate/appoint the following responsible officers:

  • an Executive Director to be responsible for ensuring that the Trust’s contingency planning policy is complied with;
  • a Contingency Planning Officer / Manager to be appointed for the purpose of overseeing, co-ordinating and managing all aspects of the Trust’s contingency planning activities, and
  • a Manager from each of the Trust’s clinical and non-clinical Divisions to act as ‘lead’ officers for contingency planning purposes.

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AGENDA ITEM 5

5. The Trust’s internal contingency planning reporting structure, together with its links to external/Local Resilience Forum groups, is shown below:

* Note: Currently a ‘virtual’ group, with Emergency Planning Officer liaising with Divisional managers as necessary.

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