We continue to refine our response to industrial action which continued as follows:
13 to 16 March
BMA Junior Doctor, British Dental Associate Trainees and Hospital Consultants & Specialists Association
15 to 16 March
Strike action in England and Wales Schools
11 to 15 April
BMA Junior Doctor Members
30 t0 1 May May
RCN Industrial Action
We learnt the following:
- Early planning was essential, and the Divisions prioritised their service provision ready for the strike action period
- Having Divisional spreadsheets detailing planned staffing numbers for each day gave assurance although it was acknowledged that this could change on the day. It was identified during the debrief that it would be useful to hold a ‘real time’ staffing dashboard to capture staff on duty to complement the E Roster system, which our Information Department is now looking into
- Having real time capacity and demand reports available proved essential in being able to monitor and respond to the situation
- The receiving of timely and accurate information from external stakeholders is essential in supporting the prioritisation of service delivery and the maintenance of staff relationships.
Do you review your Business Continuity Plan after a Business Continuity Incident?
When you or your team have been involved in a business continuity incident, do you review your Team’s Business Continuity Plan and update it based on any learning identified? It is good practice to hold a meeting with your team to review the incident response including what went well and what didn’t go so well. Any learning identified should then be written into your business continuity action cards so you are even more prepared the next time it happens.
When planning for an event that may potentially disrupt the delivery of Trust critical services, did you know that you can discuss it with the emergency planning team who will support with ensuring that relevant stakeholders are warned and informed about your contingency arrangements during the disruptive period.
If you would like to discuss any of the incident responses or you have identified any lessons from business continuity incidents that others could learn from, please email: Emergency
Planning any maintenance works that might cause disruption to services?
When maintenance work takes place there is always the potential that it might impact on systems or equipment which may disrupt the delivery of services. When planning maintenance work the right people need to be notified at least 14 days in advance of the works to make sure there is time to consider the any impact and risks and plan associated contingencies. Divisional contacts are as follows:
- Emergency Planning: emergency
Do you notify your Operational (Bronze) On Call Manager when Business Continuity Incidents Occur?
When an incident occurs in your team which affects the delivery of patient services and could cause potential harm to patients, staff or which may come to the attention of the media, please notify your Operational (Bronze) On Call Manager so they can offer support and consider if the incident needs to be escalated through to the Tactical (Silver) On Call Manager for further support.
Do you have any critical equipment/systems that you rely on to deliver an essential service?
Do you have critical equipment, including telephone linesor systems, that are essential to providing a service to patients?
What would you do if the phone line or equipment suddenly failed? How would you carry on with the critical service?
Have a think about any critical equipment you are reliant on and whether there is a contingency action card in place in the event of failure. If you don’t have one, consider how you would continue to deliver that service in the event of failure and add the action card to your local business continuity plan.
If you need more advice on how to complete a business continuity plan for your service, come and join an informal Business Continuity Workshop. Further details are avaliable on YourSpace.
Planning for Industrial Action:
We have refined our response to industrial action, be it RCN, GMB, Northwest Ambulance Service or Junior Doctors. Key Learning is as follows:
- Joint planning with the Trade Unions is essential
- Any derogation requests need to be agreed sooner rather than later
- A clinical cell with a Doctor available for advice was found to be helpful in offering support during ambulance delays
- Industrial action planning meetings were essential and should be established early in the planning stages
- Staff found timely communication updates helpful
- Ensuring there are split shifts for on call managers and those responding to the incidents.
- Teamwork - During every incident debrief, collaboration and support provided by staff responding to each incident has been a key theme, which really does make the whole process much easier.
Creating Teams Channels during impacting works - During recent IT works, an Microsoft Teams channel was set up for On Call Managers so that IT colleagues could provide live updates on progress. The On Call Managers found this very helpful and enabled the impact and risks to be managed safely.
Giga Cubes – A silent contingency - In the event of a network failure, the GigaCube (a portable wireless router that transforms 4G and 5G networks into WiFi) will provide mobile wireless internet access, allowing the Trust laptops to continue to access IT systems such as EPMA (electronic prescribing system). Informatics Merseyside currently have a rolling program to deploy GigaCubes across the Trust in order to enhance network resilience. Once they are implemented in your building, don’t forget to reference them in your business continuity action card for loss of IT.
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).
- 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.
- 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.
- 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
- 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.
- 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.
- 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