Emergency Preparedness, Resilience and Response (EPRR)

The main reason is because disasters can and do happen and we are expected to have tested plans to deal with them. Emergency response plans are developed to mitigate the implications of incidents. The organisation has a duty of care to patients and their families, the staff, the community, and partner agencies. Mersey Care NHS Foundation Trust is a 'Category One Responder' under the Civil Contingencies Act 2004 and has a statutory obligation to plan, train and exercise for emergencies in consultation, coordination, communication, and cooperation with partner agencies like other NHS organisations, emergency services, local authorities, and commissioners. 

Major Incidents:

In line with the Civil Contingencies Act 2004, a major incident is any event that threatens life, the environment and security and has the potential to:

• Require a substantial emergency response from one or more agencies
• Stretch resources beyond the normal level of activity
• Require special arrangements to be put in place, including requirement for additional resources
• Require a planned, coordinated multi agency approach in conjunction with command-and-control arrangements

Please refer to the Trust Major Incident Plan for further detail.

It is a mandatory requirement for all Tactical (Silver) on-call managers to attend the NHSE Principles of Health Command (Tactical) training. The sessions for 2023 are listed below:   

• 16 March 2023 from 12pm to 4pm
• 28 April 2023 from 10am to 2pm
• 16 May 2023 from 9am to 1pm
• 15 June 2023 from 12pm to 4pm
• 19 July 2023 from 10am to 2pm
• 15 August 2023 from 9am to 1pm
• 21 September 2023 from 12pm to 4pm
• 11 October 2023 from 10am to 2pm
• 15 November 2023 from 9am to 1pm
• 12 December 2023 from 12pm to 4pm

All NHS organisations have a duty to put in place continuity arrangements.

This means that services should be maintained to agreed standards during any disruption (e.g. loss of utilities, loss of staff, loss of estate etc.) or recovered to these standards as soon as possible. Business continuity management (BCM) gives Mersey Care a framework for identifying and managing risks that could disrupt normal service. The holistic process of business continuity management is an essential tool in establishing the organisation’s resilience.

All staff are responsible for

• Being aware of their role & responsibilities during incidents and emergencies ~ if in doubt, discuss with your line manager
• Ensure they are familiar with the contents and location of business continuity plan and action cards related to their team/ service.

Industrial action

Our response to the recent series of Industrial Action Days has been well managed by planning and preparation in the clinical divisions supported by an internal strategic (gold) command structure with timely communications and informative questions (FAQs).

Learning:

• Situation reports were required to provide the Integrated Care Board (ICB) with information during industrial action. These could have been shared by the ICB with the Trust earlier to ensure information can be prepared in a timely way for submission back to the ICB
• Improved understanding of where the communications team should forward relevant information to eg. to new strategic coordination centre (SCC) inbox
• The Royal College of Nursing (RCN), as part of their nationally agreed process, asked the Trust to complete derogation forms to request exemptions for staff to work whilst supporting industrial action to maintain patient safety and safe staffing. Some derogation outcomes were received late from the RCN impacting on the Trust’s ability to communicate these to staff. It was agreed by the Trust and the RCN that meetings to discuss and agree derogations should have started earlier
• The RCN Strike Committee would have benefited from the Trust providing them with an overview describing the role, function and location of each of its services
• It would be helpful if the derogation form templates are simplified to ensure that the interpretation of the information required in relation to staffing numbers is consistent across all Services.

Lost network connection

On 23 November 2022 4pm, through network monitoring, Informatics Merseyside was made aware that several sites had lost network connectivity. This was due to a fault with third party suppliers, Virgin Media.

Learning:

• Strategic (gold) and tactical (silver) on call managers will be telephoned by switchboard if they need to join Microsoft (MS) Teams meetings; the time of the incident, 5pm to 6pm meant not all staff were active on emails at the time
• GigaCubes (portable wireless routers) will be installed across the Trust, in areas which don’t currently have them, as part of business continuity plans, this will enable internet connectivity for access to electronic patient records and the Electronic Prescribing Medicines Administration (EPMA) system.

Fire at another trust

On 10 August 2022 a major incident was declared due to a fire at Aintree Hospital Accident and Emergency Department.  The Trust’s internal operational (bronze), tactical (silver) and strategic (gold) on call management escalation process worked well, and the Trust’s strategic (gold) on call manager ensured the deputy chief executive of clinical services and chief nurse was briefed throughout the incident response period.

Good Practice:

• Mental Health Care division placed nurse co-ordinators at the other responding hospitals to help manage and minimise the impact on their services
• The Trust process for co-ordinating incident response meetings and recording actions/ decisions was well received by strategic (gold) command

Learning:

• It is important to make sure that the correct Mersey Care managers are notified of an emerging incident in a local hospital in a timely manner
• It is beneficial to have a defined and agreed system wide process for informing Trust on-call managers of an incident happening in another Trust
• The strategic (gold) on call manager would benefit from being invited to the relevant ICB/NHS England (NHSE) incident response meetings
• It is imperative that communications on call is notified when an incident is emerging / occurs, in hours and out of hours.

Disruption to phlebotomy supplies

During the period 1 to 11 August 2022 the Trust was made aware of disruptions to the availability of essential phlebotomy supplies.

Good practice:

• Based on previous incidents of this nature, the Trust was able to confirm the stock levels required to meet demand, using business intelligence team analysis.  This enabled a forecast of how many appointments the Trust could undertake and plan accordingly
• Due to learning from previous similar incidents, the clinical divisions had up to date knowledge of stock levels and activity per team and were able gather the information quickly.

Learning:

• It was identified that supplier contracts were long standing and needed to be reviewed to ensure stock is readily available
• Actions have now been put in place for stock to be ordered centrally, allowing for robust monitoring of stock numbers and delivery dates
• It was noted that having one person or driver managing the distribution was not sustainable and going forward this would be taken into consideration to develop and improved process
• It would be helpful if a list of affected teams is created in the event of a similar incident occurring, to ensure a timely and collaborative incident response.

If you would like to discuss any of the incident responses or learning contained within this update, please email Emergency.Planning@merseycare.nhs.uk

• Major Incident Plan
• Trust-wide Incident Response Plans
• Business Continuity Policy
• Useful templates and guidance for the development of Business Continuity plans