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					LEAD PRIMARY CARE TRUST FOR EMERGENCY

PLANNING AND RESPONSE IN MERSEYSIDE

ANNUAL REPORT (NOVEMBER 2008 – NOVEMBER 2009)

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Contents

Section
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Introduction Executive Summary Lead PCT Role Performance Management Coordinating Major Incident Response Major Incidents Training and Exercising Resources Liverpool PCT Commissioning Emergency Preparedness Liverpool PCT Commissioning Achievements 2008/09 Next 12 Months Summary References Appendix 1 – Diagram Merseyside Resilience Forum Structure Appendix 2 – Diagram Merseyside NHS Command and Control Appendix 3 – Summary of Recommendations 2009

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3 3 4 6 9 10 12 14 15 15 16 18 18 19 20 21

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1.

Introduction

The Civil Contingencies Act 2004 identifies NHS Trusts as Category 1 Responders and as such, places a number of statutory duties regarding emergency preparedness and response upon them. Liverpool Primary Care Trust is the ‘Lead PCT’ for activities relating to emergency preparedness within Merseyside and coordinates the development of local NHS Resilience, whilst ensuring that mechanisms are in place to provide a coordinated NHS response to incidents. 2008-09 has been a very busy year for the Emergency Planning Department, notwithstanding the advent of the Type A (H1N1) Swine Influenza global pandemic in April 2009. This report documents the achievements of that year, together with the expectations for further development in the future.

2.

Executive Summary

The core business of the Emergency Planning Department is to facilitate the development of NHS Resilience across Merseyside whilst ensuring the capability to coordinate the collective NHS response to major incidents is in place. Due to the limited number of resilience practitioners within local NHS organisations, additional work has been absorbed by the Department to develop work-streams, enhance awareness with multi-agency partners and protect the NHS reputation. During the course of the year, the Department has continued to focus upon the development of NHS Resilience in Merseyside, including:         Continued participation in Local Resilience Forum activities, locally, regionally and nationally; Reinforcement of the Memorandum of Understanding between the Lead PCT and NHS Trusts; Maintaining on-call rotas to support Lead PCT function, including the introduction of a communications on call rota; Developing and delivering training to on-call staff; Formation of additional NHS groups to focus on particular resilience topics; Auditing all NHS Trusts pandemic influenza plans and developing associated improvement plans; Responding to five multi agency incidents either in support of the NHS Gold Commander or acting as the NHS Silver Command locally; Establishment of the NHS Gold Cell and local command and control arrangements in response to the Swine Flu pandemic;

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            

Administrative support to the NHS Gold Commander, chairing the multi agency Strategic Coordinating Group for Swine Flu; Participation in regional and local teleconferences in relation to Swine Flu; Contributing to the development of a Department of Health regional pandemic exercise for Swine Flu; Delivery of a large scale health and social care Swine Flu exercise; Development of an NHS recovery plan for Swine Flu; Implementing local NHS command and control arrangements for a regional mass casualties exercise; Conducting a user trial of the emergency services radio system; Coordinating NHS participation in 5 multi-agency COMAH exercises and a number of workshops, locally, regionally and nationally; Facilitating a number of NHS pandemic influenza workshops; Developing a multi agency template plan for NHS Trusts with Chemical, Biological, Radiological and Nuclear decontamination capability; Participating in a number of event planning groups, e.g. The Matthews Street Festival; Contributing to the development of the North Mersey Urgent Care Action Team, and; Maintaining an NHS sharepoint site focusing upon resilience matters.

Significant local progress has been made during the second year, albeit impacted by the advent of Swine Influenza. Additional engagement with NHS Trusts at all levels has been conducted to gain further commitment in developing resilience, addressing critical weaknesses that have been identified through the auditing process. It is the intention of the Emergency Planning Department to continue to lead the local resilience agenda whilst improving awareness and capability across the NHS in Merseyside, even though the global pandemic is prevalent. The NHS must retain the flexibility and capability to respond to additional major incidents, over and above the current or potential demands from the pandemic now or in the future. This will be facilitated through the increase of trained staff and improved business continuity arrangements.

3.

Lead PCT Role

The Lead PCT acts on behalf of the SHA (from which it takes its mandate) and represents local NHS organisations, and especially the Primary Care Trusts (from which it takes its funding) at the Merseyside Resilience Forum (MRF), a multi-agency group which focuses upon resilience issues identified in the national capabilities programme, the aim of which is to ensure that a robust infrastructure of response is in place to deal rapidly, effectively and flexibly with the 4

consequences of civil devastation and widespread disaster inflicted as a result of conventional or non-conventional disruptive activity. The NHS organisations represented, include:                  Knowsley PCT Liverpool PCT Sefton PCT Wirral PCT Aintree University Hospitals NHS Foundation Trust Liverpool Heart and Chest Hospital NHS Trust Clatterbridge Centre for Oncology NHS Foundation Trust Liverpool Women’s Hospital NHS Trust Alder Hey – Childern’s NHS Foundation Trust Royal Liverpool and Broadgreen University Hospital NHS Trust Southport and Ormskirk Hospital NHS Trust St Helens and Knowsley Teaching Hospitals NHS Trust The Walton Centre for Neurology and Neurosurgery NHS Trust Wirral University Teaching Hospital NHS Foundation Trust Mersey Care NHS Trust (including high secure services) 5 Boroughs Partnership NHS Trust Cheshire and Wirral Partnership NHS Foundation Trust

To support the work of the MRF, a number of multi-agency groups are established, focusing upon particular work-streams (see Appendix 1). The Lead PCT attends and coordinates NHS representation at these groups, including the:               Humanities Sub-Group; Humanitarian Assistance Task and Finish Group; Mass Evacuation and Shelter Task and Finish Group; Mass Fatalities Task and Finish Group; Voluntary Agencies Forum; CBRNE (Chemical Biological Radiological Nuclear Explosive) Sub-Group; Flooding/Extreme Weather Sub-Group; Communications Sub-Group; Telecommunications Sub-Group; Risk Assessment Sub-Group; Exercise Sub-Group; Infectious Human Diseases Group (chaired by the Lead PCT); Transport Sub-Group, and; Maritime Sub Group.

NHS organisations within Merseyside are appraised of the activities highlighted above, through two forums; the NHS Health and Social Care Group (Emergency Planning) and the NHS Pandemic ‘Flu Group, which both meet on a frequent 5

basis. These two local NHS groups focus on improving resilience through the sharing of best practice and progressing particular pieces of work. To support the activities of NHS representatives, a SharePoint site for emergency planning was established on the North Mersey Health Informatics System (HIS). This site acts as a repository of information and provides easy access to:        An event and exercise calendar; Event and exercise supporting documents; NHS and national guidance documents; Local and regional plans; Documents from sub-group meetings; Discussion forums, and; Links to related websites.

The membership for the site has increased since its introduction 18 months ago and currently stands at 120 users.

3.1

Findings

Representation at the Merseyside Resilience Forum has improved substantially over the last 12 months, with NHS representatives attending all groups. In order to reduce the burden upon the Lead PCT, Trusts have been formally requested to provide additional representation on certain sub groups where their input would be most appropriate. 3.2 1. Recommendations The executive lead in trusts must be appraised of their organisations obligations under the Civil Contingencies Act 2004. The nominated representatives must be appraised of their individual obligations under the Civil Contingencies Act 2004.

2.

4.

Performance Management

All NHS Trusts are required to comply with the Civil Contingencies Act 2004 and supporting guidance. Trusts will also be assessed to ensure compliance with the NHS Operating Framework 2008/2009 and delivery of the Public Health Care Standard C24 which is monitored by the Health Care Commission. The Lead PCT has a role in performance managing NHS emergency planning, and assists the SHA in this task. This is conducted in a constructive manner as Trusts strive to achieve the required performance management standards.

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To assist this process a Memorandum of Understanding (MoU) was produced in 2008, clarifying the role and expectations of the Lead PCT and the respective countersigning Trusts, both in the development of emergency preparedness measures and when responding to a major incident.

4.1

Findings

A majority of NHS Trusts have signed the Lead PCT MoU for emergency preparedness, whilst the role of Monitor has been confirmed in relation to performance management for emergency preparedness for Foundation Trusts. Further work is required to resolve the issues raised by Trusts who are seated within 2 Lead PCT areas.

4.2 3.

Recommendations NHS North West to consult with the Department of Health regarding the role of Monitor for performance management of Foundation Trusts. Review Lead PCT arrangements for Trusts sitting across Lead PCT boundaries.

4.

4.3

Pandemic Flu Audit

All NHS Trusts participated in a Department of Health (DoH) Pandemic ‘Flu audit in January 2009, with the results subsequently audited by the Lead PCT during March and April 2009. Trusts were appraised of their outcomes and resultant work-plans agreed with those who fell short of the required standard set regionally by NHS North West. These Trusts were then set a deadline by which to address the shortfalls, with progress being monitored by the Lead PCT.

4.4

Findings

Over the past year, it has become apparent that Trusts plans have become more operationally focused and are being developed further in conjunction with neighboring Trusts and key stakeholders. These arrangements have been scrutinized in exercise conditions, from which work plans have been developed and acted upon.

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4.5

Recommendations

5. NHS Trusts complete actions in local work plans with neighbouring Trusts and key stakeholders.

4.6

Major Incident Plans Audit

All Trusts are currently conducting a self assessment of their major incident plans in anticipation of an on site audit conducted by the Lead PCT between October 2009 and February 2010. Following each site visit a report and appropriate action plan will be developed between the parties to address any shortfalls.

4.7

Local NHS Trusts Resilience Capability Survey

All NHS Trusts have completed a capability survey to identify what levels of emergency preparedness were in place. The survey included:    The identification of an executive lead for each of the contingency areas; What plans and procedures were in place, and; What training and exercising regimes were established.

This information will form the basis for the development of a 5 year resilience strategy and supporting work programme.

4.8

Findings

All Trusts have appointed an executive lead for emergency preparedness, displaying senior commitment. Trust plans are in place, supported by training and exercising programmes which require adjustment to reflect the National Capabilities Programme.

4.9

Recommendations

6. Continue to reinforce the responsibilities of NHS Trusts under the Civil Contingencies Act 2004 and NHS Emergency Planning Guidance 2005 during a programme of events. 7. Develop agreed work plans with Trusts to ensure compliance.

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5.

Coordinating Major Incident Response

In the event of a major incident, the Lead PCT function commands the NHS within Merseyside, acting on behalf of the SHA. The Lead PCT Function Activation Plan complete with a number of technical appendices, describes the role of the Lead PCT in a major incident. The plan includes arrangements for 24/7 availability of an NHS Gold Commander and is subject to continual review. Activation of the Lead PCT function comes via North West Ambulance Service (NWAS) Control Room, who contact the Chief Executive on-call rota. The activation is then cascaded to the Merseyside PCTs. NHS Trusts are likely to have been activated by NWAS, however a protocol exists for the NHS Gold Commander to check with NWAS that this has been conducted. NWAS would also contact the Cheshire and Mersey Health protection Unit and Public Health rota. Additionally, activation can also be initiated by a Director on call from any PCT, if the situation is warranting such a response. In the event of a major incident, the NHS Gold Commander plus a support team, attend the Strategic Co-ordinating Group (SCG) for multi-agency coordination purposes across Merseyside. This has occurred on a number of occasions during the reporting year. To support this function, a number of key actions have been accomplished by the Emergency Planning Department, as follows:        Creation of a radio call sign matrix; Maintenance of the Lead PCT Function Activation Plan and associated role specific handbooks; Role specific training; Maintenance of existing on-call rotas; Introduction of a communications on call rota; Development of an NHS Gold Cell complete with appropriate Information Technology, internet and satellite phone capability, and; Deployable equipment to support the NHS Gold function at a remote location including Information Technology, internet and satellite phone capability.

The activation exercise used previously to test the strategic and tactical on call arrangements, was extended to include all Trusts in Merseyside. This exercise was conducted 5 times since December 2008 in order to develop awareness and understanding, whilst testing the robustness of the procedures.

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5.1

Findings

All Trusts are becoming conversant with the role of the Lead PCT Function and the NHS Gold Command. This has been facilitated not only by extending the out of hours activation exercise to include all Trusts, but also the advent of the global pandemic.

5.2

Recommendations

8. Ensure all Trusts Major Incident Plans reflect the Merseyside Command and Control arrangements as part of the forthcoming audit.

6.

Major Incidents

In Merseyside, the Lead PCT function has responded twice whilst director level representation has been required at a tactical level for 3 incidents during this reporting year, including:  March 2009: Hostage Taking Incident – Strategic Coordinating Group convened in response to hostages being seized by a disgruntled client, claiming to have an Improvised Explosive Device in a premise which housed small quantities of toxic liquids. The evacuation of the local area required attendance by NHS staff at the designated rest centre. April 2009: Type A (H1N1) Swine Influenza – Strategic Coordinating Group convened in response to the declaration of the World Health Organisation’s Pandemic Response Plan Alert Level 4 due to the spread of the virus. The Strategic Coordinating Group chaired by the Lead PCT is currently still convening on a regular bass. A detailed report was submitted to the PCT Board in September 2009. To support the development and integration of NHS planning for Swine Influenza, smaller groups have also been established, focusing upon:      Paediatrics and neonatology; Accelerating discharge and creating capacity; NHS Recovery, and; Mortuary capacities and contingencies.

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June 2009: Fire involving Acetylene Cylinder – Tactical Coordinating Group convened for 24 hours in response a fire at a row of disused domestic garages involving an acetylene cylinder. This required the evacuation of an area 250 metres in diameter for 24 hours. Some local

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residents were evacuated and taken to a rest centre. NHS Staff attended the rest centre for the duration of the incident.  July 2009: Tower Crane Collapse – Tactical Coordinating Group convened in response to the collapse of a construction site tower crane onto occupied residential premises. The crane driver was the only individual injured in the incident and the premises suffered structural damage. Residents were evacuated and taken to a rest centre, whereupon NHS Staff attended to make an initial assessment of the evacuees. July 2009: Burst Water Main – Tactical Coordinating Group convened in response to a large street water main burst caused by a utilities company conducting during routine maintenance. An area including approximately 50 dwellings, a sheltered housing unit, 3 GP surgeries and a small number or retail premises were affected. Local NHS business continuity arrangements were implemented.

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6.1

Findings

The Lead PCT participated in the multi-agency and local NHS debriefs following these incidents. These incidents have highlighted that NHS Trusts are adjusting positively to the concept and role of the Lead PCT, positively. Merseyside Police are coordinating the response to incidents using a multi agency tactical level silver group. This removes the requirement for a Chief Executive from the NHS Gold to respond and places the responsibilities firmly at the PCT Director on call. To support this development, additional Directors from the PCTs have received appropriate training.

6.2

Recommendations

9. A review of existing arrangements to reflect the change in the Police concept of operations is required to ensure the NHS response is appropriate and fit for purpose. 10. Training to be adapted to reflect the outcomes of the review. Additionally, to support the national agenda for developing the NHS strategic response to major incidents, the Associate Director of NHS Resilience has been invited to join a multi agency stakeholder group sponsored by the Department of Health, to develop capabilities further.

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7.

Training and Exercising

The Department of Health Emergency Planning Guidance 2005 states that as a minimum requirement NHS Organisations are required to undertake a Live Exercise every three years, a tabletop exercise every year and a test of communications cascades every six months. To meet these requirements, the Department has coordinated local NHS attendance (as observers or as participants) at multi-agency exercises, workshops and seminars. The department has also developed and executed a number of activities involving NHS Trusts. The Director training has now been extended to all Trusts, targeting the executive leads for emergency preparedness.

7.1          

Training CEO (on call) half-day awareness (x 1); PCT Directors (on call) half-day awareness (x 5); NHS Trust Communications half-day awareness (x 2); Staff Officer (on call) half-day awareness (x 1); NHS Trusts Executive leads half-day awareness (x 10); Administrative Support (on call) half-day awareness (x 1); PCT Staff Induction 30 minute session (x 3 - 110 people in total); NHS HPA Loggist course (x 20); Geographical Information Systems (GIS) (x 3); NHS CBRN Self Presenters - Train the Trainer (x1).

To assist in the delivery of these activities, a Band 7 Emergency Planning Officer was recruited, taking post in February 2009, who is currently developing a training strategy and aligning training activities to the National Occupational Standards (NOS) for Civil Contingencies.

7.2

Findings

Further training is required to encompass the remaining executive leads from Trusts, with responsibility for emergency preparedness.

7.3

Recommendations

11. Schedule further training to raise awareness of remaining Trusts executive leads with responsibility for emergency preparedness.

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7.4

Exercises

The Lead PCT has been involved in a number of exercises since November 2008, including:  December 2008 – October 2009: Exercise First Call (5 in total) – Activation exercise to identify the strengths and weaknesses in the procedure for activating the NHS Gold Commander, PCT Directors on-call and Executives on call from all NHS Trusts in Merseyside. December 2008 – October 2009: COMAH Exercises (5 in total) – A number of tabletop and live exercises conducted to validate site-specific major incident plans at a number of upper tier COMAH sites following an industrial chemical accident. NHS Gold Commander and support team deployed to support the multi agency response. January 2009: Exercise Maximus – A regional NHS command and control exercise focusing upon the validation of the Regional Resilience Forum’s Mass Casualties Plan. NHS local command and control arrangements were implemented, seeing the activation of all Trusts major incident rooms. Locally, the emergency services radio system was utilised under trial conditions to evaluate its suitability for NHS operations. September 2009: Exercise Peak Practice – A regional NHS tabletop exercise being delivered nationally and focusing upon the validation of pandemic influenza plans. The Emergency Planning Department contributed to the development of the exercise in conjunction with the Health Protection Agency and the Department of Health. A representative number of Trusts from Merseyside participated in the exercise. October 2009: Exercise Fever Pitch – A health and social care tabletop Swine Flu exercise involving all of the Merseyside NHS Trusts, Local Authorities and representatives from other organisations. This exercise was developed and delivered by the Emergency Planning Department. This exercise was attended by approximately 100 people.

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7.5

Workshop/Tabletop Activities

The lead PCT has been involved in a number of workshop/tabletop activities either as a facilitator, presenter or participant since November 2008, including:     Department of Health – Health and social care in a pandemic; Department of Health – Human Resources - effects of pandemic on staff; Civil Contingencies Secretariat – Community resilience; NHS North West – Get Fluent pandemic flu workshops;

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         

Liverpool PCT and partners - Vaccination tabletop exercise; All NHS Trusts Merseyside (with decontamination capabilities) and key stakeholders – NHS CBRN Self Presenters Plan; Liverpool City Council – Cruise Liner contingencies; Liverpool City Council – Mass fatalities; Liverpool City Council – Excess deaths; Liverpool City Council – Pandemic flu; Sefton Metropolitan Council – Pandemic Flu; Aintree Hospital – mass casualties live exercise; Merseyside Voluntary Agencies and Faith Sector Forum – pandemic flu; NHS Trusts Mortuary Managers Merseyside – pandemic flu.

7.6

Findings

Acute Trusts with CBRN decontamination capabilities did not have an understanding of the multi agency response to support the Trusts if self presenters from either a large scale Hazardous Materials (HazMat) or CBRN incident became apparent. The Emergency Planning Department produced a multi agency template in consultation with other partners, for Acute Trusts to complete.

7.7

Recommendations

12. All Trusts with CBRN decontamination capabilities are to complete the multi agency framework plan for self presenters following a Hazmat/CBRN incident.

8.

Resources

Funding for the Lead PCT function comes from the Primary Care Trusts in Merseyside, which each make a contribution in relation to their population size. The current demands on the budget are to fund staffing, and to contribute to the Merseyside Resilience Forum Secretariat post. The Lead PCT function located within the Emergency Planning Department of Liverpool PCT comprises of:    Assistant Director of NHS Resilience; Administrative Support – in post since December 2008; Emergency Planning Officer – in post since February 2009.

The post of Liverpool PCT Emergency Planning Manager, besides focusing upon Liverpool PCT issues, also plays a deputising role to the Lead PCT role. 14

9.

Liverpool PCT Commissioning Emergency Preparedness

This section of the report focuses upon the PCT’s Commissioning emergency preparedness activities.

9.1

Liverpool PCT Major Incident Commissioning Response

Liverpool PCT has a Director on call 24/7 rota to respond to incidents either within Liverpool or to provide support as part of a wider NHS response. Liverpool PCT has a dedicated major incident room, to coordinate the local response and act as the link between NHS Gold Command and the NHS organisations within Liverpool. To support this function, the following actions have been completed and/or are ongoing:  A primary major incident room has been established in the basement of Arthouse, equipped with telephone, fax, satellite communications, digital television, radio and Information Technology equipment; A secondary location at Bevan House, equipped with portable equipment to enable a remote command and control capability, and; IT developments including Geographical Information Systems (GIS).

 

Directors on call have received training and been provided with a guidance handbook. A small number of staff has volunteered to provide out of hours assistance to the major incident room.

9.2

Findings

Directors will require additional training to maintain their skills and understanding of the local arrangements and procedures. New volunteers require initial training in order to join the volunteer register. 9.3 13. 14. Recommendations Additional training to be programmed for directors. Initial training to be provided to volunteers.

10. 

Liverpool PCT Commissioning Achievements 2008/09 A training programme has been developed and implemented, ranging from induction to role specific modules to increase response capabilities;

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    

The Major Incident Plan was reviewed and approved by the Integrated Governance Committee; The Trust Pandemic Influenza Plan received Board approval; The Business Continuity Project aligned to British Standard 25999, received Board approval; The Trust has responded to the Swine Flu pandemic, coordinating the local NHS and engaging with multi agency partners, and; The Trust participated in an NHS regional live command post exercise.

10.1

Findings

The Trusts Pandemic Influenza Plan although approved, required an Equality Impact Assessment. Having received approval by the Integrated Governance Committee, awareness and testing of the Trust’s Major Incident Plan needs to occur before March 31st 2010. The Trust has some business continuity arrangements in place, which have been reinforced with the pandemic flu planning. More activity is required to meet the requirements of British Standard 25999.

10.2

Recommendations

15. An Equality Impact Assessment on the Trust’s Pandemic Influenza to be completed. 16. Develop and implement a programme of raising awareness and exercising the revised Major Incident Plan. 17. Business continuity development required to meet requirements of BS25999.

11.

Next 12 Months

Although there have been significant achievements during the first 12 months, there is still much to do. Particular challenges and opportunities are as follows:  The priority will be to remain able to respond to any incident that may arise. Malicious acts and pandemic influenza remain significant threats.

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With environmental change apparently increasing, the threat of severe weather (heat, cold, rainfall or wind) causing disruption to health services and the wider economy remains significant;  Plans for responding to such events will continue to be maintained, developed and updated. Improved arrangements will ensure that this is regularly circulated to people on the rota and that they are given updated versions in both paper and electronic format; Audit all NHS Trust Major Incident Plans; Further training is planned for people on the call out rotas; Additional training on the local application of the Lead PCT’s Activation Plan. There will also be training for the people who volunteer as support staff; Local Resilience Forum issues will continue to be communicated to local NHS Trusts via the Health and Social Care Group and NHS Pandemic ‘Flu group. These groups will provide the platform for Trusts to share good practice and understand the national emergency preparedness agenda; The Lead PCT will continue to participate in, and coordinate other NHS participation in county, regional and national emergency planning groups, exercises, workshops and seminars; The continued development of an NHS emergency preparedness strategy supported by a modularized training strategy and an effective training programme; Progress Business Continuity Management against the NHS guidance for business continuity and the British Standard for Business Continuity (BS-25999), with the view of applying for accreditation against the British Standard. Develop and implement a major incident training and exercising programme for PCT Commissioning. Continue to address the ongoing issues raised from the 2008 report and also Appendix 4 Summary of Recommendations 2009. The implementation of the National Resilience Extranet (NRE) - an affordable software package that provides a browser-based tool to enable efficient and secure (accredited to ‘Restricted’ level) exchange of information during both routine planning and response to emergencies.

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12.

Summary

The activities of the past 12 months have focused upon the continuing development of corporate awareness of emergency preparedness across NHS Trusts in Merseyside, whilst improving the response capability. The engagement in the Merseyside Resilience Forum’s activities has proven difficult due to the effects of the global pandemic. However, the pandemic has provided the ideal opportunity for the NHS to lead the multi agency Strategic Coordinating Group over a protracted period. This combined with concurrent incident responses has demonstrated that the NHS has the capability and professionalism to contribute effectively to the Merseyside resilience agenda. The next 12 months will see engagement with NHS Trusts, as we continue to move towards an integrated emergency management approach (IEM - plans, systems and processes) to resilience matters. This, supported by the development of a resilience strategy, should reinforce the need for a harmonised approach to emergency preparedness and a cohesive response to any potential major incidents. PCTs will continue to have a pivotal role, encouraging Trusts to participate fully. It is anticipated that business continuity will focus high on the agenda in 2010/11. It is essential that the Lead PCT in conjunction with NHS Trusts continue to build cost effective resilient capabilities, in order to meet the challenges of the future. If you have any queries regarding the content of this report, please contact the undersigned.

Yours Sincerely

Stephen Corrigan MBE CMIOSH MEPS Associate Director of NHS Resilience (Merseyside)

13.

References

Civil Contingencies Act 2004 The Civil Contingencies Act 2004 (Contingency Planning) Regulations 2005 NHS Emergency Planning Guidance 2005 Strategic Command Arrangements for the NHS During a Major Incident 2007 NHS Operating Framework 2009/10 Healthcare Commission Standards for Better Health (C24) DoH Pandemic ‘Flu Audit 2009 Liverpool PCT Strategic Plan 2008/12 (Draft) Lead PCT Emergency Planning Mandate 2008 Liverpool PCT Emergency Planning Department Risk Register BSI 25999 – Business Continuity Management Part 1 and 2 18

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Appendix 1

NHS Representation in Merseyside Emergency Planning Structure
Merseyside Local Resilience Forum (MLRF) (MRF)

Other NHS Emergency Planning Forums

Merseyside Health and Social Care Group (HSCG)

Merseyside Resilience Forum General Working Group (GWG)

Merseyside Local Authorities Contingency Planning Group (MLACPG)

Pandemic Flu Sub Group

CBRN Sub Group

Humanities Sub Group

Flooding Sub Group

Transport and Maritime Sub Group

Exercise Sub Group

Risk Assessment Sub Group

Communications Sub Group

Mass Fatalities Task and Finish Group

Mass Evacuation and Shelter Task and Finish Group

Humanitarian Assistance Task and Finish Group

Voluntary Agencies Forum

Technical Communications Sub Group

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15.

Appendix 2 – Merseyside NHS Command and Control
Regional Civil Contingencies Committee

Department of Health

Strategic Coordinating Group Police Fire NHS Gold Commander NWAS Local Authorities Scientific and Technical Advice Cell (STAC) Government Liaison Officer Military Merseytravel Mersey Tunnels Police Others where appropriate

NHS North West

NHS Gold Commander plus support team

Liverpool PCT

Knowsley PCT

Halton & St Helens PCT If appropriate

Sefton PCT

Wirral PCT

Liverpool PCT Provider Services

Whiston Hospital

Southport & Ormskirk Hospital

WUTH

RLBUHT

5 Boroughs Partnership

Aintree Hospitals

Clatterbridge Onocology

Heart & Chest Hospital

Merseycare

Walton Neuro

Cheshire & Wirral Partnership

Royal Children’s Hospital

Women’s Hospital

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16.

Appendix 4 – Summary of Recommendations 2009 Recommendation The executive lead in trusts must be apprised of their organisations obligations under the Civil Contingencies Act 2004. The nominated representatives must be apprised of their individual obligations under the Civil Contingencies Act 2004. NHS North West to consult with the Department of Health for a decision on Foundation Trusts. Review Lead PCT arrangements for objecting Trust or the Commissioning PCT in another Lead PCT’s geographical area. NHS Trusts complete actions in local work plans with neighboring Trusts and key stakeholders. Continue to reinforce the responsibilities of NHS Trusts under the Civil Contingencies Act 2004 and NHS Emergency Planning Guidance 2005 during a programme of events. Develop agreed work plans with Trusts to ensure compliance. Ensure all Trusts Major Incident Plans reflect the Merseyside Command and Control arrangements as part of the forthcoming audit. A review of existing arrangements to reflect the change in the Police concept of operations is required to ensure the NHS response is appropriate and fit for purpose. Training to be adapted to reflect the outcomes of the review. Schedule further training to raise awareness of remaining Trusts executive leads with responsibility for emergency preparedness. All Trusts with CBRN decontamination capabilities are to complete the multi agency framework plan for self presenters following a Hazmat/CBRN incident. Additional training to be programmed for directors. Responsibility AD NHS Resilience AD NHS Resilience NHS North West CEO Lead PCT All NHS Trusts AD NHS Resilience

Ref Para/no 3.2 no 1 3.2 no 2 4.2 no 3 4.2 no 4 4.5 no 5 4.9 no 6

4.9 no 7 5.2 no 8 6.2 no 9

AD NHS Resilience AD NHS Resilience AD NHS Resilience

6.2 no 10 7.3 no 11 7.7 no 12 9.3 no 13

AD NHS Resilience AD NHS Resilience AD NHS Resilience Commissioning Emergency Planning

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Ref Para/no 9.3 no 14

Recommendation Initial training to be provided to volunteers.

Manager Responsibility

10.2 no 15 10.2 no 16 10.2 no 17

Commissioning Emergency Planning Manager An Equality Impact Assessment on the Trust’s Pandemic Influenza to be Commissioning completed. Emergency Planning Manager Develop and implement a programme of raising awareness and exercising the Commissioning revised Major Incident Plan. Emergency Planning Manager Business continuity development required to meet requirements of BS25999. Commissioning Emergency Planning Manager

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