Wolverhampton CCG
Major Incident Response Plan
Wolverhampton Clinical Commissioning Group – Major Incident Response Plan V2
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Wolverhampton Clinical Commissioning Group – Major Incident Response Plan V2
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Contents
Contents
PART 1 – GENERAL INFORMATION .................................................................................. 6
1.1
STRATEGIC AIM .................................................................................................... 6
1.2
STRATEGIC OBJECTIVES .................................................................................... 6
1.3
LEGAL FRAMEWORK ............................................................................................ 7
1.4
JOINT EMERGENCY SERVICES INTEROPERABILITY PROGRAM (JESIP) ........ 7
1.5
DEFINING A MAJOR INCIDENT ............................................................................ 8
1.6
RISK ....................................................................................................................... 9
1.7
ROLES AND RESPONSIBILITIES.......................................................................... 9
PART 2 – NOTIFICATION, MANAGEMENT, CONTROL, CO-ORDINATION AND
ESCALATION..................................................................................................................... 11
2.1
METHANE ............................................................................................................ 11
2.2
ROLES and RESPONSIBILITIES OF THE CCG .................................................. 11
2.3
INCIDENT LEVELS .............................................................................................. 12
2.4
COMMAND AND CONTROL ............................................................................... 15
2.4.1
Strategic (Gold).............................................................................................. 15
2.4.2
Tactical (Silver) .............................................................................................. 15
2.4.3
Operational (Bronze) ...................................................................................... 15
PART 3: TRIGGERS, ALERTING PROCESS & ACTIVATION .......................................... 16
3.1
Notification ............................................................................................................ 16
3.2
ONWARD ALERTING ........................................................................................... 16
PART 4: LOGISTICS .......................................................................................................... 17
4.1
Logging and Records management ...................................................................... 17
4.2
Shift arrangements................................................................................................ 17
PART 5: STAND-DOWN .................................................................................................... 18
5.1
INITIAL “STAND DOWN” ...................................................................................... 18
5.2
ADMINISTRATION ............................................................................................... 18
5.3
RECORDS MANAGEMENT ................................................................................. 18
5.4
DEBRIEFS AND REPORTS ................................................................................. 18
5.5
LESSONS IDENTIFIED PROCESS ...................................................................... 19
ACTION CARDS ................................................................................................................ 20
APPENDIX 1:INCIDENT MANAGEMENT TEAM AGENDA ............................................... 31
APPENDIX 2:MAJOR INCIDENT SITUATION REPORT – SITREP TEMPLATE ............... 32
APPENDIX 3:BATTLE RHYTHM TEMPLATE ................................................................... 34
APPENDIX 4:INFORMATION RECODING TEMPLATE .................................................... 35
Wolverhampton Clinical Commissioning Group – Major Incident Response Plan V2
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APPENDIX 5:BRIEFING TOOL .......................................................................................... 36
APPENDIX 6:KEY CONTACTS ......................................................................................... 37
APPENDIX 7:PLAN HOLDER RECORD............................................................................ 38
Wolverhampton Clinical Commissioning Group – Major Incident Response Plan V2
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Foreword
Wolverhampton Clinical Commissioning Group has a significant role in preparing for,
responding to and managing major incidents. The objective of WCCG‟s Emergency
Preparedness, Resilience and Response (EPRR) framework is:
To ensure that Wolverhampton Clinical Commissioning Group is capable of
responding to incidents, major or otherwise, in a way that delivers optimum care and
assistance to people affected, that maintains, wherever possible, “business as
uisual”, minimises the consequential disruption to NHS services and that brings
about a speedy return to normality. It will endeavour to do this by enhancing both its
own, and its commissioned services, capabilities to respond in addition to ensuring it
is prepared to work within a multi-agency response across organisational and
geographic boundaries.
The purpose of this document is to provide a brief summary of how „major incidents‟ are
managed both within the CCG, wider NHS and in a multi-agency environment, and to give
some guidance as to roles and responsibilities in a major incident.
It must be borne in mind that all incidents are different. This can best be illustrated by recent
incidents such as Swine Flu, Carvers Fire and Civil Disorder This guidance must be read in
that light: it contains general principles and suggestions, but due account must be taken of
the circumstances of the particular incident and any other extenuating circumstances.
In addition the appendices contain an escalation flowchart, action cards and details of the
core competencies expected of anyone undertaking a Director, or senior manager, on call
role on behalf of Wolverhampton Clinical Commissioning Group.
Please take the time and trouble to familiarise yourself with the information contained within
this guide AND to complete the on call checklist found at Appendix 3. This should be used to
identify training needs to ensure that both you, and the CCG, are prepared and equipped to
manage whatever may arise in the best interests of the City of Wolverhampton and its
residents.
Dr Helen Hibbs
Accountable Officer
Wolverhampton Clinical Commissioning Group – Major Incident Response Plan V2
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PART 1 – GENERAL INFORMATION
1.1
STRATEGIC AIM
The strategic aims of Wolverhampton Clinical Commissioning Group (WCCG)1 , and of its
commissioned services, with respect to a major incidents and disruptive challenges are:



Save lives
Minimise ill health
Mitigate the adverse impacts of major incidents that cause (or have the potential
to cause) significant disruption to the health of the population and/or normal NHS
business
The aim of this plan is to provide a framework for WCCG to respond to local incidents,
support the NHS England (NHSE) West Midlands and, where necessary, co-ordinate the
local NHS in the event of an emergency or major incident.
1.2
STRATEGIC OBJECTIVES
The above aims will be achieved through the following objectives:








Provide strong, local leadership and organisational co-ordination with clear lines of
communication during preparedness; response; and recovery phases
Coordinate provision of swift and effective health care to those affected escalating as
necessary in light of subsidiary and mutual aid needs
Provide a local supporting role for NHS England West Midlands in the event of a
“level 22 or above” incident
Maintain critical business functions and core service delivery through dynamic
business continuity management
Restore NHS services to “normality‟ as soon as possible
Contribute appropriately to the overall multi-agency effort
Work with partners to mitigate disruption to society
Provide a robust EPRR contractual process to ensure that all commissioned services
achieve appropriate capability.
The objectives of this plan are to:

Establish when the plan should be activated

Define what the WCCG incident management structure should be in relation to:

1
2
o
A locally managed incident
o
An NHS England West Midlands managed incident
Define what a major incident is and outline the types of emergency that the local
NHS might be expected to respond to;
WCCG means Wolverhampton Clinical Commissioning Group
See Fig 2 – Incident Response Levels – Page 10
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1.3

Outline the command, control and co-ordination arrangements internally, within in
the local NHS and in the multi-agency context by identifying stakeholders and
operational plans, including the decision making process;

Establish a framework within which the AT‟s roles and responsibilities can be fulfilled
through the CCG during the response to a major incident;

Identify the arrangements for communicating information to staff, patients and
stakeholders both prior to, during and after a major incident;

Outline the process for recovery from a major incident.
LEGAL FRAMEWORK
The Civil Contingencies Act 2004 (CCA) establishes a statutory framework of roles and
responsibilities for local responders and is supported by Regulations (The CCA 2004
(Contingency Planning) Regulations) and statutory guidance (Emergency Preparedness).
NHS organisation specific responsibilities are set out in section 46 (9, 10) of the Health and
Social Care Act 2012, NHS CB Core Standards for EPRR and NHS CB EPRR Framework.
The Health and Social Care Act 2012 provides that the Secretary of State for Health (and
thus Public Health England) and NHSE will be Category 1 responders under the Civil
Contingencies Act. CCGs are Category 2 responders. Category 2 responders are cooperating bodies and generically, their roles will be to co-operate and share relevant
information with Category 1 responders. In this instance however CCGs are also required to
have business continuity plans in place in addition to considerable responsibilities contained
within the NHS England EPRR Core Standards.
Given the large footprint of the NHS England West Midlands, and the limited staffing,
the AT may at times request support from the CCGs to become part of the initial
health response. This will be through agreement between the AT and the CCG on-call
who will act on behalf of NHSE locally during the initial stages of an incident. Under
any such agreement NHSE is still responsible for ensuring an effective response is
delivered and, if the AT EPRR MoU is invoked, will have command and control of all
NHS resources.
1.4
JOINT EMERGENCY SERVICES INTEROPERABILITY PROGRAM (JESIP)
This plan has been written in line with JESIP principles now codified in the JESIP Joint
Doctrine - Interoperability Framework.
(http://www.jesip.org.uk/wp-content/uploads/2013/07/JESIP-Joint-Doctrine.pdf)
The Joint Doctrine focuses on the interoperability of Police, Fire and Ambulance services in
the early stages of a response to a major or complex emergency. It is also acknowledged
that emergency response is a multi-agency activity and the resolution of an emergency will
usually involve collaboration with other Category 1 and 2 responders.
The Joint Doctrine sets out what responders should do and how they should do it in a multiagency working environment to achieve a successful joint response.
Wolverhampton Clinical Commissioning Group – Major Incident Response Plan V2
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The Joint Doctrine and the principles contained within it are equally applicable to the wider
range of Category 1 & 2 response organisations. The Joint Doctrine has been designed so
that it can be applied to smaller scale incidents, wide-area emergencies and pre-planned
operations
1.5
DEFINING A MAJOR INCIDENT
The CCA defines an emergency as:
An event or a situation which threatens serious damage to human welfare in a place
in the UK, the environment of a place in the UK, or war or terrorism which threatens
serious damage to the security of the UK.
For the NHS however the following definitions are detailed by the NHS England EPRR
Framework:
A significant incident or emergency can be described as any event that cannot be managed
within routine service arrangements. Each require the implementation of special procedures
and may involve one or more of the emergency services, the wider NHS or a local authority.
A significant incident or emergency may include;
a. Times of severe pressure, such as winter periods, a sustained increase in demand
for services such as surge or an infectious disease outbreak that would necessitate
the declaration of a significant incident however not a major incident;
b. Any occurrence where the NHS funded organisations are required to implement
special arrangements to ensure the effectiveness of the organisations internal
response. This is to ensure that incidents above routine work but not meeting the
definition of a major incident are managed effectively.
c. An event or situation that threatens serious damage to human welfare in a place in
the UK or to the environment of a place in the UK, or war or terrorism which
threatens serious damage to the security of the UK. The term „„major incident‟‟ is
commonly used to describe such emergencies. These may include multiple casualty
incidents, terrorism or national emergencies such as pandemic influenza.
d. An emergency is sometimes referred to by organisations as a major incident. Within
NHS funded organisations an emergency is defined as the above for which robust
management arrangements must be in place.
It therefore follows that a significant or major incident is any event where the impact
CANNOT be handled within routine service arrangements.
What is a major incident to the NHS may not be a major incident for other responding
agencies. The NHS, or any part of it, can therefore declare a major incident when its own
facilities and/or resources or those of partner organisations are overwhelmed.
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1.6
RISK
Risks are assessed at national, regional and locals levels and are used to direct specific
planning, where appropriate.
This plan is a generic, all risks plan to enable WCCG to respond to, and/or support NHSE
AT in responding to, any significant incident or emergency at a local, regional or national
level.
In the event of a specific risk being identified then a sub-plan or process may be prepared
however the major incident management and response process outlined in this plan will
overarch any response. Examples are Mass casualty, fuel, severe weather
A copy of the West Midlands Conurbation Community Risk Register can be accessed at the
following link:
https://www.wmfs.net/sites/default/files/CRR%20Publication%2004082014.pdf
1.7
ROLES AND RESPONSIBILITIES
During the planning phase, CCGs are required to:

Co-operate and share relevant information with Category 1 responders;

Engage in discussions (including at the Local Health Resilience Partnership (LHRP))
where this will add value;

Maintain robust business continuity plans for their own organisations;

Test and update their own business continuity plans to ensure they are able to
maintain business resilience during any disruptive event or incident.
Support the NHS CB in discharging its EPRR functions and duties locally, ensuring
representation on the LHRP.



Provide their commissioned providers with a route of escalation on a 24/7 basis – the
CCGs maintain a shared rota of senior managers;
Include relevant EPRR elements (including business continuity planning) in
contracts with provider organisations in order to:

Ensure that resilience is “commissioned-in” as part of standard provider contracts
and to reflect local risks identified through wider, multi-agency planning;

Reflect the need for providers to respond to routine operational pressures, e.g.
winter, failure of providers to continue to deliver high quality patient care, provider
trust internal major incidents;

Enable NHS-funded providers to participate fully in EPRR exercise and testing
programmes as part of NHS CB EPRR assurance processes.
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During the response phase, CCGs will therefore:

Respond to reasonable requests to assist and co-operate. This will include
supporting the NHS CB Area Team (AT) should any emergency require local NHS
resources to be mobilised;

Have a mechanism in place to mobilise all applicable providers that support primary
care services should the need arise;

Support providers to maintain service delivery across the local health economy (LHE)
to prevent business as usual pressures and minor incidents from becoming
significant incidents or emergencies;

Have systems to manage their provider organisations to effectively coordinate
increases in activity across the local health economy;

Escalate significant incidents and emergencies to the AT.
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PART 2 – NOTIFICATION, MANAGEMENT, CONTROL, COORDINATION AND ESCALATION
2.1
METHANE
In the event you receive a call regarding a potential incident then it is critical that you record
as much information as possible. The accepted mnemonic used is as follows:
M
E
T
H
A
N
E
Major Incident – Has major incident, or standby, been declared and by whom?
Exact location Type – e.g. mass casualty; CBRN; terrorism; infectious disease outbreak etc.
Hazards – e.g. fire, plume, flooding, contamination etc.
Access – Access and egress routes to scene or rendezvous points
Number of casualties, and type (estimated)
Emergency services – At scene or required
There is a further information gathering template that can be used in addition to the
above at Appendix 1.
2.2
ROLES and RESPONSIBILITIES OF THE CCG
This section describes the roles and responsibilities required to deliver the response to a
significant health related incident/emergency. For full details of the responsibilities and
associated actions, please refer to the action cards in Appendix 1.
Incident Manager (1st On Call in or out of hours)
1. Assess the initial information received in respect of a potential or actual significant /
major incident and escalate to the on call Director/2nd on call as indicated.
2. Manage the incident as tasked by the Incident Director (when activated).
Incident Director (CCG Incident Lead)
1. In liaison with the CCG On Call Incident Manager/1st on call, assess the initial
information received in respect of a potential or actual significant / major incident and
determine the appropriate initial course of action to be taken.
2. Direct all subsequent actions including stand-down decisions.
3. Coordinate the local NHS response as appropriate.
4. The Incident Director/2nd on call has full authority to respond to the incident on
behalf of the CCG Accountable Officer or Accountable Emergency Officer.
Incident Management Team
1. To provide WCCG with a
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2. provide support to both providers and NHSE AT, as required, in addition to collating
information regarding the operational/tactical response across the local NHS. This
will include gathering intelligence from wider sources relating to the incident and
ensuring the efficient flow of information between the chain of command and partner
agencies.
Incident Coordination Centre (ICC)
The ICC serves as a focal point for the CCGs response and all liaison with NHS and partner
agencies regarding the incident, and is established in the Boardroom. Alternatively, it could
be co-located through mutual aid agreements with another organisation if required. The ICC
will be staffed by the Incident Management Team, and other relevant personnel.
Refer to the flow chart at Fig. 1 below and the ACTION CARD in Appendix A.
2.3
INCIDENT LEVELS
Incidents require management at different levels according to the exact nature, scale or
location involved and the first underlying principle for the NHS England EPRR Framework
2013 is as follows:
The management of an incident should be at the level closest to the people affected by the
incident as is practical
In the event of an incident requiring additional resources the route of escalation will be to the
NHS England West Midlands Director on-call who will consider whether to assume
command and control of the incident. Equally West Midlands Incident Manager may contact
the CCG on-call to mobilise, respond or coordinate the local NHS response. The AT will
determine at what point command of the incident passes to the NHS.
This is illustrated in Fig 2 below
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Fig 1: Incident Activation Flowchart
INCIDENT
CCG on-call (in or out of hours)
Verify information and complete
METHANE.
Consider possible impact on local
NHS.
Is this a potential/actual Major
Incident?
No
Maintain
watching
brief
Yes
Level 1
CCG
Action Card
Notify
appropriate
personnel
Level 2
Notify AT
Incident
Manager
Jointly assess information received:
 Consider/agree action
 Agree command & control with
NHSE West Midlands
 Determine in Major Incident stand-by
or implement should be declared
 Activate Plan
 Notify appropriate personnel
 Establish ICR / IMT
Reassess situation as
further information
becomes available
No further
action
required
Implement local
response
measures
⃰ Refer to Fig 2 – Incident Response Levels (below)
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Fig 2: Incident Response Levels
Response
Level
1
Definition and Description of Level



2



3



4



A health related incident that can be responded to and managed
by single local health provider organisations within their
respective business as usual capabilities.
Local lead arrangements are in place, however the Director in
charge at this level needs to contact the NHS England West
Midlands Incident Director and agree the incident is to be dealt
with at this level.
Escalation of the incident will be agreed between the local lead
and the NHS England West Midlands Incident Director
A health related incident which requires the response of a
number of health provider organisations across the
Birmingham, Solihull & Black Country Locality boundary and
will require NHS England Response Arrangements coordinate
local NHS support and respond accordingly.
The On Call NHS England West Midlands Incident Director will
lead the NHS response to the incident within the Locality and
wider NHS England West Midlands sub region boundary and
take responsibility for directing NHS resources.
The NHS England West Midlands Incident Director will be
responsible for contacting the On Call Regional Incident
Director to agree the level at which the incident will be dealt with
and therefore who is in command
A health related incident that requires the response of a number
of health provider organisations that spans across the
boundaries of several NHS England WMidlands- Sub Regions
that requires NHS England – Midlands & East Region will require
NHS England regional coordination to meet the demands of the
incident
The On call Regional Incident Director will lead the NHS
response to the incident and be responsible for directing the
resources of NHS England – Midlands & East.
The Regional Incident Director will be responsible for notifying
all other On Call within the NHS England – Midlands & East
region that an incident has happened and at what level the
incident is being managed. They are also responsible for
notifying neighbouring NHS England regions as well as NHS
England – national.
A health related incident that requires NHS England national
coordination to support the NHS and NHS England response
The On call National Incident Director will lead the NHS
response to the Incident and be responsible for directing the
national NHS resources.
They are responsible for notifying all other NHS England regions
an incident has happened and at what level the incident is being
managed.
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2.4
COMMAND AND CONTROL
Command and control mechanisms within the NHS, and wider, are based upon the following
levels.
2.4.1 Strategic (Gold)
Refers to those responsible for determining the overall management, policy, and strategy for
the incident whilst maintaining normal services at an appropriate level. They should ensure
appropriate resources are made available to deliver the tactical plan and enable and
manage communications with the public and media. Additionally they will identify the longer
term implications and determine plans for the return to normality (recovery) once the incident
is brought under control or is deemed to be over. In complex, large scale incidents, there is a
need to co-ordinate and integrate the strategic, tactical and operational response of each
responder organisation.
The STRATEGIC CO-ORDINATING GROUP (SCG) is usually chaired by the Chief
Constable and ordinarily meets at either Lloyd House or Tally Ho. The NHS is usually
represented at SCG by NHSE AT.
2.4.2 Tactical (Silver)
Refers to those who are in charge of managing the incident on behalf of their organisation.
They are responsible for making tactical decisions, determining operational priorities,
allocating staff and physical resources and developing a tactical plan to implement the
agreed strategy.
2.4.3 Operational (Bronze)
Refers to those who provide the immediate „hands on‟ response to the incident, carrying out
specific operational tasks either at the scene, or at a supporting location such as a hospital,
as directed by tactical/silver.
NB: Not all these command levels are necessarily activated - depending on the scale
of incident and response. The general approach is to escalate the levels with the
increasing size and complexity of the response required.
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PART 3: TRIGGERS, ALERTING PROCESS & ACTIVATION
3.1
Notification
Notification of an incident can come from a variety of internal or external sources. The
WCCG major incident plan can be activated when a situation arises that meets either or both
of the following criteria;
3.2

Any occurrence that presents serious threat to the health of the community,
disruption to the service or causes (or is likely to cause) such numbers or types of
casualties as to require special arrangements to be implemented by hospitals,
ambulance trusts or primary care organisations; or

Where WCCG considers it necessary to act to prevent, reduce, control or mitigate
the effects of an emergency and would be unable to act without changing the normal
deployment of resources, including support to commissioned services
ONWARD ALERTING
The CCG on-call will be responsible for ensuring CCG staff, provider organisations and the
AT Director on-call are alerted in line with the ACTION CARD.
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PART 4: LOGISTICS
4.1
Logging and Records management
An essential element of any response to an incident is to ensure that all records and data
are captured and stored in a readily retrievable manner. These records will form the
definitive record of the response and may be required at a future date as part of an inquiry
process (judicial, technical, inquest or others). Such records are also invaluable in identifying
lessons that would improve future response. The Incident Director is formally responsible
for signing off the decision log, electronic or otherwise, and all briefing papers and
documents relating to the incident.
4.2
Shift arrangements
In the event of a significant/major incident or emergency having a substantial impact on the
population and health services, it may be necessary to continue operation of the Incident
Management Team for a number of days or weeks. In particular, in the early phase of an
incident, the Incident Management Team may be required to operate continuously 24/7.
Responsibility for deciding on the scale of response, including maintaining teams overnight,
rests with the Incident Director.
A robust and flexible shift system will need to be in place to manage an incident through
each phase. These arrangements will depend on the nature of the incident, may involve
deploying staff to provider trusts affected and must take into consideration any requirements
to support external meetings and activities. The Incident Manager is accountable for
ensuring appropriate staffing of all shifts. During the first two shift changes 1-2 hours of hand
over time is required.
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PART 5: STAND-DOWN
The CCG Incident Director will decide when an emergency or incident stand down should be
declared for the CCG, which may be long after the emergency services response is over. If
the AT are in command of NHS resources they will determine at what stage stand down
occurs and when command returns to local trusts. This could be either a full or partial stand
down with one or more individuals monitoring the situation.
5.1
INITIAL “STAND DOWN”
All response level changes need to be communicated both internally and externally as
appropriate. A brief description of the resource implications of the new level should be
included.
5.2
ADMINISTRATION
Once the decision has been taken, the CCG Incident Director will ensure that all appropriate
elements of the local response are stood down. This may be a staged process. It is
important to ensure that where communication channels have been specially created for the
incident, forwarding mechanisms are in place to ensure that no traffic is lost. This will also
ensure that people trying to contact the ICC, if established, have an alternative
communications route.
5.3
RECORDS MANAGEMENT
All logs, records and other details from the incident will be collected and secured from all
personnel involved and kept safe in line with CCG data retention protocol.
5.4
DEBRIEFS AND REPORTS
The aim of any debrief is not to apportion blame but to identify areas for improvement and
ensure that future responses benefit from lessons identified.
A hot debrief will be held within 24 hours of the close down of the incident. A full, internal
debrief will be held within 14 working days of the incident. The initial incident report will be
produced within 28 working days.
Structured debriefs should be held with involved staff as soon as possible after de-escalation
and stand down. Participants must be given every opportunity to contribute their
observations freely and honestly. The Incident Director must ensure that the full debriefing
process is followed.
As part of the debriefing process a post incident report will be produced to reflect the actual
events and actions taken throughout the response. Typically this will include:

Nature of incident;
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5.5

Involvement of the CCG;

Involvement of other responding agencies;

Implications for strategic management of the NHS;

Actions undertaken;

Future threats/forward look;

Chronology of events.
LESSONS IDENTIFIED PROCESS
A separate Lessons Identified report will focus on areas where response improvements can
be made in future. This report will include the following sections:

Introduction

Observations

Action Plan (detailing recommendations, actions, timescales and owner).
Throughout the incident at whatever level, there will need to be an agreed process in place
to evaluate the response and recovery effort and identify lessons. The Incident Director is
responsible for activating the lessons identified process and may delegate the responsibility
for lessons identified to the Emergency Planning Manager. The lessons identified process
will be implemented at the start of the response and continue during and after the incident
until all actions are completed.
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ACTION CARDS
Action Card
Number
1
2
3
4
5
6
7
8
9
Role
DIRECTOR or MANAGER ON CALL
INCIDENT DIRECTOR
LOGGIST
COMMUNICATIONS LEAD
OPERATIONS OFFICER
CRITICAL INFORMATION OFFICER
ICC ADMINISTRATOR
PROVIDER LIAISON OFFICER
TACTICAL ADVISER
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Page
20
21
22
23
24
25
26
27
28
ACTION CARD 1
Accountable to
DIRECTOR or MANAGER ON CALL
CHIEF EXECUTIVE/ACCOUNTABLE EMERGENCY
OFFICER
Responsible for: Assessing the initial information received, determining whether it constitutes a
major incident for the CCG, escalating to a Director (if manager on call) and instigating the initial
appropriate response.
Number Actions required
Time
Completed
1.
Gather relevant information by using the Information Template at
Appendix 2.
2.
If the incident fits, or is likely to fit, the Major Incident definition then:
 If Director - Declare Major Incident, or standby, and activate
major incident response plan
 If Manager – Escalate to Director
3.
Commence personal log.
4.
Continue to manage incident and on call until able to handover incident to
Incident Director (Action Card 2)
If it is NOT a potential or actual major incident for the CCG, or
doesn’t require a CCG response:

If no further action is required, complete the log recording the
information received and the action taken

If it can be dealt with using normal resources, notify the
appropriate personnel and maintain a watching brief

Continue to reassess the situation as further information becomes
available and determine if any additional action is required

In the event of any increase in the scale / impact of the incident
reassess the risk and escalate as needed.
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ACTION CARD 2
Accountable to
INCIDENT DIRECTOR
CHIEF EXECUTIVE/ACCOUNTABLE EMERGENCY OFFICER
Responsible for: assessing the initial information received, determining whether it constitutes a
major incident for the CCG and instigating the response.
Number Actions required
Time
Completed
1.
In the event of a potential or actual major incident, either complete the
Information Template at Appendix 2 or receive a briefing from the
Director on Call.
If not already declared determine whether it constitutes a major incident,
or standby, for the CCG and declare as appropriate.
2.
Start a personal log detailing information received and actions taken.
Ensure formal logging of your actions/decisions is in place as soon as
possible.
3.
Advise the NHS England Director on Call.
4.
Activate the Major Incident Response Plan and notify relevant personnel.
5.
Establish an initial CCG Incident Management Team (IMT) meeting (actual
or virtual) and provide an initial briefing. Consider activation of ICC.
A sample agenda is at Appendix 3
6.
If IMT and ICC activated contact identified staff and agree time of first
meeting. Ensure Loggist attends and documents decisions and rationales
7.
Determine the severity of the situation and consider the potential impact
of the incident on the local health economy. Appendix 4
8.
Establish liaison with the appropriate personnel from PHE, NHS Trusts and
partner agencies and confirm that the relevant command and control
structures have been implemented across the local health economy.
9.
If a level 2 Major incident confirm with the AT Incident Director the AT’s
strategy, aim and objectives for responding to the incident.
10.
If required deploy the Provider Liaison Officer (Action Card 8) to Provider
Gold to establish strategic support.
11.
Agree the Incident Battle Rhythm (Appendix 5) with all agencies and
ensure that reports/sitreps are submitted/received in a timely manner
12.
In the event that the incident is likely be over a prolonged period identify
appropriate replacement staff and agree staggered handovers
13.
Ensure that ALL actions tasked are completed and that reports are
submitted to IMT
14.
Continue to manage the incident, ensure sitrep updates are received and
review decisions taken accordingly
INCIDENT STAND DOWN
When the „Stand Down‟ is agreed locally (Level 1) or command is given by the AT (Level 2),
the Incident Director will:
1. Ensure a process is in place for an appropriate return to business as usual internally
and externally across the local NHS.
2. Support the multi-agency recovery phase if required.
3. Agree when staff involved in the incident should return to their normal duties.
4. Debrief the staff working in the incident room (“hot debrief”).
5. Complete and sign off the incident log and ensure all relevant documentation is
secured.
6. Ensure a formal report is prepared, highlighting any good practice or issues identified.
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ACTION CARD 3
Accountable to
LOGGIST
The person for whom they are logging: either Incident
Director or Incident Manager
Responsible for: Recording and documenting all issues/actions/decisions made by the Incident
Director, and reasons for that decision. If a member of IMT attends multi-agency meetings they will
be accompanied by a loggist if possible. Within the ICC, a loggist will always be present working to
the Incident Director.
Number Action
Time
Completed
1.
The loggist must use the log book, or electronic log, provided.
2.
Prior to IMT commencement the loggist must record who is present
and in what capacity.
3.
The log must be clearly written, dated and initialled by the loggist at
start of shift and include the location.
4.
The log must be a complete and continuous record of all decisions
taken, inclusive of the rationale for taking that decision, and actions
taken as directed by the Incident Director.
5.
Timings have to be accurate and recorded each time information is
received or transmitted. If individuals are tasked with a function or
role this must be documented and marked on the log when reported
as completed.
6.
If notes or maps are utilised these must be noted within the log.
7.
If the loggist changes this must be recorded within the log and
initialled by both the outgoing and incoming loggist
8.
At the end of each session in the log a score and signature to be
added underneath the documentation so no alterations can be made
at a later date.
9.
Where something is written in error changes must be made by a
single line scored through the word and the amendment made.
10.
All documentation is to be kept safe and retained for evidence for
any future proceedings.
The loggist MUST NOT:




Take minutes
Record for more than one decision maker
Keep a separate chronological log
Have responsibility for the decision/action
The log and all paper work becomes legal documentation and could be used at a later
date in a public enquiry or other legal proceedings.
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ACTION CARD 4
Accountable to
COMMUNICATIONS LEAD
Incident Director
Responsible for: Providing communication co-ordination, advice and support to the Incident Director
Number Action
Time
Completed
1.
Attend the initial IMT meeting and commence personal log
2.
Contact the provider (Level 1) or AT (Level 2) communications lead and
agree, with CCG Incident Director, who will be leading on media
communications on the incident.
3.
Invoke WCCG Crisis Communications Plan and, with Incident Director
approval, issue a holding statement or pre-arranged public health / safety
messages in conjunction with Public Health England, if appropriate, as
above.
4.
If leading on the incident media communications assume responsibility for
managing all public information and media communications.
If provider or NHS England is agreed as communications lead then liaise
and respond according, continually updating IMT.
*If an SCG is established, and it is likely that a media cell will be established
to lead on media and communication, then act as the conduit for IMT and
SCG
5.
If leading, rapidly formulate and implement an integrated media handling
strategy on behalf of the local NHS response, and agree approach with
IMT.
6.
Deal with all media enquiries/draft statements/organise press conferences
and interviews as agreed, with Incident Director, in media handling
strategy.
Identify and brief any “talking heads” and advise media (and stakeholders)
on the regularity and timing of future media updates
7.
Brief NHS 111 on the information / advice to be given to the public.
8.
Identify communications officer/ cell (based on incident requirements) to:
log media calls, monitor media and social media, update IMT, develop
rolling question and answer brief, develop comms for staff and undertake
on-going liaison with responding NHS comms leads and partners.
9.
On stand down, ensure that all original documentation (including notes,
flip charts, e-mails etc.) are kept. Close personal log.
10.
Attend Hot and Formal debriefs.
11.
Manage any on-going media interest in the NHS response, including social
media.
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ACTION CARD 5
Accountable to
OPERATIONS OFFICER
Incident Director
Responsible for: Supporting the Incident Director by undertaking, or delegating, tasks as determined
by the Incident Director.
In a smaller incident this role may be combined with the Critical Information Officer
Number Action
Time
Completed
1.
Attend the initial IMT meeting and commence personal log
2.
Establish document control.
Establish the required Battle Rhythm and ensure that requirements are
3.
met
Work in partnership with the Critical Information Officer to ensure IMT has
4.
sight of the latest information as required.
Action decisions and processes as tasked and ensure compliance with set
5.
time scales.
Assist in preparation of time critical documents including sitreps, CRIPS
6.
and other reporting or responding mechanisms such as Unify.
Establish rotas and call in staff as required by the incident Director specific
7.
to incident requirements.
8.
Ensure handover arrangements
9.
Ensure staff supported with beverages and food and appropriate breaks.
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ACTION CARD 6
Accountable to
CRITICAL INFORMATION OFFICER
Incident Director
Responsible for: Reviewing, prioritising informing information, confirming accuracy where required
and informing the Incident Director, and Incident management Team, of the same in a structured
form against agreed priorities to enable timely decisions to be made.
In a smaller incident this role may be combined with the Operations Officer
Number Action
Time
Completed
1.
Attend the initial IMT meeting and commence personal log
2.
Establish an information cell/officer to review incoming information (non
media), assign priority for action and update IMT accordingly
3.
Record all information received, using the template at Appendix 6, noting
time, from whom, information, expected actions and any timescales and
prioritise.
4.
Prepare briefing notes, as requested by the Incident Director using the
IIMARCH tool at Appendix 7
5.
Continue to review incoming information and review prioritisation against
IMT aims, objectives and risk factors agreed with the Incident Director
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ACTION CARD 7
Accountable to
ICC ADMINISTRATOR
Incident Director (Operations Officer if present)
Responsible for: Providing comprehensive administration support to the Incident Coordination
Centre.
Number
Action
Time
Completed
Set up Incident Coordination Centre as directed by the Incident
1.
Director (or Operations Officer if present).
Maintain a record of who is in the ICC at all times, including of arrivals
2.
and departures.
3.
Maintain a record of queries/documents and responses.
4.
Minute any meetings or teleconferences.
Work with the Operations Officers to ensure robust rotas are in place
5.
and appropriate rest breaks are scheduled.
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ACTION CARD 8
Accountable to
PROVIDER LIAISON OFFICER
Incident Director
Responsible for: Providing on-going strategic liaison and support at Provider Gold, operating within
agreed levels of authority and acting as the Incident Director’s representative.
Number Action
Time
Completed
1.
As directed by the Incident Director, attend Provider Gold as the WCCG
strategic representative.
2.
Agree levels of responsibility and authority for allocating resources with
the WCCG Incident Director and receive a briefing of strategic aims and
objectives.
3.
Commence personal log.
4.
Provide WCCG support to the provider within agreed brief limits. Refer
back to IMT in the event of a decision being required that exceeds agreed
authority
5.
Adhere to the WCCG battle rhythm providing strategic
updates/CRIPS/Sitreps from Provider to WCCG IMT via either the Critical
Information Officer or direct to the Incident Director
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ACTION CARD 9
Accountable to
TACTICAL ADVISER
Incident Director
Responsible for: Providing tactical advice, knowledge and support to the Incident Director or other
strategic or tactical command roles as directed. In the event of a significant major incident a tactical
adviser may also be deployed with the provider liaison Officer or the SCG.
Number Action
Time
Completed
1.
As directed by the Incident Director, attend the initial IMT.
2.
Commence personal log.
3.
Provide support to the Incident Director, and IMT, in terms of invoking the
MIRP, risk assessment, horizon scanning, multi-agency context and
strategy.
4.
Establish liaison between established IMTs, and other tactical advisers, and
support the Critical Information Officer in establishing the initial
CRIP/Sitrep
5.
Provide on-going advice and support to the IMT
6.
As directed, provide support to IMT staff deployed to the Provider or SCG.
7.
Assist all staff in providing strategic oversight in that action cards are
followed, strategic aims addressed, decisions logged, documents are
controlled and that major incident process is adhered to.
8.
At incident Stand Down, ensure that all documentation is retained,
including decisions logs, and lead of arranging debriefs (hot and cold)
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APPENDIX 2: Information Template
M
E
T
H
A
N
E
Major Incident – Has major incident, or standby, been declared and by whom?
Exact location – where has the incident occurred?
Type – e.g. mass casualty; CBRN; terrorism; infectious disease outbreak etc.
Hazards – e.g. fire, plume, flooding, contamination etc.
Access – Access and egress routes to scene or rendezvous points
Number of casualties, and type (estimated)
Emergency services – At scene or required
Information
Collected?*
Questions to consider
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
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APPENDIX 3:
INCIDENT MANAGEMENT TEAM AGENDA
Time/Date
Venue/Teleconference Details
1. Current situation report
2. Impact on the NHS
3. Current multi-agency command arrangements
4. Communications

Reporting arrangements (NHSE AT; DH; SCG; DPH)

Public information and media strategy

Internal NHS communications and staff briefings
5. Staff and other resources required
6. Authorisation of expenditure
7. Horizon scanning
8. AGREED

NHS command arrangements

NHS Strategy and/or objectives (depending on level of incident)

NHS Actions

NHS Battle Rhythm (linked to AT/ SCG/ national rhythm if established)
9. Meeting Schedule
A signed attendance sheet must be completed for every meeting detailing who was
present and which role they performed.
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APPENDIX 4:
MAJOR INCIDENT SITUATION REPORT – SITREP TEMPLATE
Note: Please complete all fields. If there is nothing to report, or the information request is not
applicable, please insert NIL or N/A.
Organisation:
Date:
Name (completed by):
Time:
Telephone number:
Email address:
Authorised for release by (name
& title):
Type of Incident (Name)
Organisations reporting serious
operational difficulties
Impact/potential impact of
incident on services / critical
functions and patients
Impact on other service providers
Mitigating actions for the above
impacts
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Impact of business continuity
arrangements
Media interest expected/received
Mutual Aid Request Made (Y/N)
and agreed with?
Additional comments
Other issues
NHS CB Regional Incident
Coordination Centre contact
details:
Name:
Telephone number:
Email:
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APPENDIX 5: Battle Rhythm Template
Strategic
Time
Meeting
Activity
Tactical
Output
Meeting
Activity
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Operational
Output
Meeting
Activity
Output
APPENDIX 6: information Recording Template
Date/Time
Who From
Information Received
Priority Rating
Choose an item.
Choose an item.
Choose an item.
Choose an item.
Choose an item.
Choose an item.
Choose an item.
Choose an item.
Choose an item.
Choose an item.
Choose an item.
Choose an item.
Choose an item.
Choose an item.
Choose an item.
Choose an item.
Choose an item.
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Action Taken
Date/Time
APPENDIX 7: Briefing Tool
Information
Intention
Method
Administration
Risk Assessment
Communications
Human Rights
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APPENDIX 8: Key Contacts
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APPENDIX 9: Plan Holder record
Plan
Number
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
Name
Organisation
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