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NHS Grampian Board Report

Civil Contingencies Annual Report

2014 / 2015

(Including 2013-2014 highlights)

Susan Webb Interim Director of Public Health Executive Lead for Civil Contingencies

Isabelle Laing Head of Civil Contingencies

Civil Contingencies Report 2014/2015

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Contents 1 Executive Summary ................................................................................................ 5

2 Introduction ............................................................................................................. 7

3 Legislation and Guidance Framework ..................................................................... 7

4 Governance, Responsibility and Accountability....................................................... 8

5 Civil Contingencies Unit (CCU) ............................................................................. 10

6 Incidents and Responses ...................................................................................... 11

7 Glasgow Commonwealth Games 2014 ................................................................. 15

8 Business Continuity - Internal Audit ...................................................................... 16

9 CONTEST ............................................................................................................. 17

10 Partnership Working - Resilience Partnerships ..................................................... 20

11 NHSG Compliance with the Civil Contingencies Act 2004 .................................... 21

12 Civil Contingencies Unit Priorities 2015 – 2016..................................................... 25

13 Looking Ahead 2015 – 2016 ................................................................................. 26

14 Appendix 1: Business Continuity Audit Action Plan ............................................... 29

15 Appendix 2: Training and Exercises ...................................................................... 32


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1 Executive Summary Health Boards need to plan for and be able to respond to a wide range of incidents that could affect the smooth running of services, or impact patient care and the health of the public. We need to ensure that we have, and maintain, health service resilience and have robust health emergency planning and business continuity planning across the whole system to allow us to continue to provide a comprehensive healthcare service delivery to the people of Grampian, even in adverse circumstances or in the event of incidents that may threaten the wellbeing of the community and may put us under severe pressure. This report is intended to assure the Board that Civil Contingencies arrangements are in place, and that Civil Contingencies work underway at all levels across the organisation, (supported by the Civil Contingencies Unit, Civil Contingencies Group and Sector Resilience groups, and with the engagement and support of staff at all levels) contributes to organisational compliance with the Civil Contingencies Act 2004 and discharge of organisational duties under the Act, associated legislation and related guidance. It summarises the key Civil Contingencies activities and achievements over the period of this report, and provides an overview of incidents and significant events. There were no major incidents although a number of smaller incidents tested both NHS Grampian’s direct response and our response as part of the Grampian Resilience Partnership which was convened, on a precautionary principle, in pre-response mode. Continuity of NHS Grampian services was sustained over the period of the report. Two national priorities set the direction and pace of a significant element of preparedness work for this period and influenced the Civil Contingencies objectives for the organisation: Scotland’s hosting of the Commonwealth Games 2014, and the largest and deadliest Ebola outbreak in history, in West Africa, that resulted in a global effort to contain and deal with the outbreak, and a significant programme of communication and preparedness across the UK to identify and manage possible cases and to prevent the spread of the disease should it arrive on these shores. The impact of these on resilience priorities was felt across all partner agencies. As part of the 2014/2015 internal audit plan PwC conducted a Business Continuity review of 3 Sectors in NHS Grampian: the organisation was commended for a number of areas of good practice. The audit also identified areas for improvement and these were incorporated into an action plan. NHS Grampian values working on a multi-agency basis and continued to actively participate in and support the Resilience Partnership at Regional and Local levels as the new Scottish Resilience structures bedded in over the period of the report. We recognise the good work that has been done, but also acknowledge there is more yet to do: we continue to work towards compliance with the NHS Scotland Resilience Preparing for Emergencies guidance and continue to manage several risks under the Civil Contingencies Risk Register. The Look Ahead shows a national level focus on Pandemic Flu preparedness as well as the introduction of NHS Scotland Standards for


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Organisational Resilience against which NHS Boards will be assessed. There is a need for continued organisational support for Civil Contingencies matters and focus on areas of work that help ensure NHS Grampian is both a resilient organisation, and one that is able deliver response capacity and capability. In times of financial pressure and growing demand for services, and at a time of significant organisational change with the integration of health and social care, it is essential that we continue to drive towards robust organisational resilience and preparedness to ensure that NHS Grampian is able to remain ‘open for businesses’ in the event of a disruptive event. Susan Webb Interim Director of Public Health Executive Lead for Civil Contingencies October 2015


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2 Introduction This document is the NHS Grampian Civil Contingencies Annual Report for 2014-2015 with additional information covering the period April 2013 to March 20141. The purpose of the report is to:

Provide assurance to the Board that NHS Grampian fulfils its statutory duties under the Civil Contingencies Act 2004 (CCA 2004), and has arrangements to meet requirements under the associated regulations2;

Provide the Board with an overview of resilience activities over the period;

Highlight key elements of the Civil Contingencies work programme to meet the requirements of the framework of Scottish guidance, including Preparing Scotland and NHS Scotland’s Preparing for Emergencies: Guidance for Health Boards in Scotland (2013).

The report includes: a summary of significant incidents over 2013/2015; the planning, training and exercising that have taken place over the period; and highlights the Civil Contingencies/Resilience priorities for 2015/2016; and provides a high level overview of partnership working under the new Resilience Partnership arrangements in Scotland.

3 Legislation and Guidance Framework The Civil Contingencies Act 2004 outlined a single framework for civil protection in the United Kingdom. Part 1 of the Act established a clear set of roles and responsibilities for specified organisations involved in emergency preparedness and response at local level (known as Category 1 responders). As a Category 1 responder NHS Grampian is subject to the following civil protection duties to:

1. Assess the risk of emergencies occurring and use this to inform contingency planning;

2. Put in place emergency plans; 3. Put in place business continuity management arrangements to sustain critical

functions in the event of disruption or emergency situation; 4. Put in place arrangements to make information available to the public about civil

protection matters and maintain arrangements to warn, inform and advise the public in the event of an emergency;

5. Share information with other local responders to enhance coordination; 6. Co-operate with other local responders to enhance coordination and efficiency.

Additional duties specified under The Civil Contingencies Act 2004 (Contingency Planning) (Scotland) Regulations 2005 include:

The requirement to carrying out exercises for the purpose of ensuring that plans that the organisation maintains are effective;

1 No annual report was issued in 2013-2014 due to a loss of operational capacity within the Civil

Contingencies Unit concurrent with competing national priorities (see Section 5 for further information). 2 The Civil Contingencies Act 2004 (Contingency Planning) (Scotland) Regulations 2005


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The provision of training for an appropriate number of suitable staff to ensure that those persons can carry out plans effectively.

Scottish Government’s Preparing Scotland resilience guidance sets out how we "do" resilience in Scotland. It provides a good practice guide around regulatory duties under the Civil Contingencies Act and establishes a "hub and spokes” model of guidance with a core that describes the doctrine, principles, integrated emergency management, structures, role of Scottish Government and (UK) emergency powers, and "spokes" that provide detailed guidance on specific resilience matters such as Mass Fatalities, Business Continuity, Care for People etc. NHS Scotland’s Preparing for Emergencies: Guidance for Health Boards in Scotland (2013) provides the strategic guidance to Chief Executives and other senior health service leaders on what should be done by NHS Boards to enhance organisational resilience and capability in order that the NHS in Scotland can respond effectively in a major incident, remain ‘open for business during major incidents and respond to disruptive challenges with confidence’3.

4 Governance, Responsibility and Accountability Figure 1 below shows the Civil Contingencies governance framework in NHS Grampian (period up to and including March 2015).

NHS Grampian Civil Contingencies Group: the main governance group for Civil Contingencies is the NHS Grampian Civil Contingencies Group (CCG) Chaired by the Chief Executive with Deputy Chief Executive as Vice Chair. Membership of the CCG includes representation from all Sectors and key Directorates. The business of the

3 Preparing for Emergencies: Guidance for Health Boards in Scotland (2013)


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CCG is managed by the Civil Contingencies Unit (CCU) on behalf of the Chair. The NHS Grampian CCG met quarterly, as scheduled, over the period of this report. (As of 1 April 2015 Chair of NHSG CCG transferred to the Director of Public Health). Sector Civil Contingencies Leads: Sector/Directorate resilience and preparedness is the responsibility of the relevant Director/General Manager. A Sector Civil Contingencies Lead, appointed by the Director/General Manager, is responsible for acting as the point of contact for the Sector/Directorate and for driving forward all matters relating to Civil Contingencies and resilience within the Sector, working through and supported by a Sector Civil Contingencies/Resilience Group (where these have been established). Detailed operational planning is owned and conducted at service and sector level. Sector Civil Contingencies/Resilience Groups: these are currently established in the following areas:

Aberdeen City CHP Civil Contingencies Group

Aberdeenshire CHP Resilience Group

Acute Sector CCG (ASCCG)

GMHS Contingency Planning Steering Group

Moray Civil Contingencies Group

Work will be taken forward in 2015-2016 to review arrangements in other key areas of the organisation e.g. Facilities & Estates and Public Health, and where appropriate to establish Directorate/corporate support service resilience groups.

Sector Civil Contingencies/Resilience Groups in the Community Healthcare Partnerships (CHPs) and Grampian Mental Health & Learning Disability Services (GMH&LDS) are well established and met regularly throughout 2013-2015.

The Acute Sector Civil Contingencies Group (ASCCG) was not convened during this period although significant hospital response planning and preparedness work was taken forward by the Acute Sector Civil Contingencies lead: a key objective for the Acute Sector in 2015-2016 will be the re-constitution and re-invigoration of the ASCCG.

Civil Contingencies planning and preparedness in Public Health and Facilities & Estates were taken forward by the Sector Civil Contingencies Leads working directly with service leads in their areas.

Governance review: a review of Civil Contingencies governance reporting arrangements will be undertaken in 2015-2016, as part of a wider governance review, to ensure that reporting and assurance mechanisms are effective and fit for purpose.


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5 Civil Contingencies Unit (CCU)

5.1 Role

The role of the Civil Contingencies Unit is to support NHS Grampian build resilience and meet the challenges of compliance with the Civil Contingencies Act 2004 and associated legislation, and Scottish Government guidance, by providing specialist expertise, leadership and guidance to the organisation and by working with others, both internally across Sectors and Directorates, and externally with partner responders, to anticipate, assess, prevent, prepare, respond to and recover from disruptive challenge.

5.2 Line management

Throughout April 2013 – March 2015 the Civil Contingencies Unit continued as part of the Delivery Unit with line management reporting direct to the Deputy Chief Executive. (As of 1 April 2015 this transferred to the Director of Public Health).

5.3 CCU Staffing

April 2013 – March 2014: the temporary arrangements for Unit staffing, put in place in 2011, continued through 2013-2014.

Civil Contingencies Manager (Full time seconded role)

Civil Contingencies Support Officer (Full time fixed term appointment – maternity leave from October 2013 without backfill)

The Head of Civil Contingencies remained on secondment to ARI Reconfiguration Project until February 2014 when the staff member resigned from the substantive post of Head of Civil Contingencies. March 2014 – March 2015: ‘normal’ CCU posts were re-established although the Civil Contingencies Support Officer role remained part of the Unit (due to maternity leave requirements) until October 2014.

The Head of Civil Contingencies (new appointment - full time secondment from March 2014)

Civil Contingencies Advisor (from June 2014 - full time fixed term appointment)

Civil Contingencies Support Officer (maternity leave to October 2014 then re-deployed)

5.4 Civil Contingencies Unit (CCU) Capacity Challenges

Over the 24 month period, April 2013 – March 2015, Unit operational capacity was reduced due to staff maternity leave (Civil Contingencies Support Officer) and a reshaping of the Unit following the resignation in February 2014 of the substantive post holder for Head of Civil Contingencies: for the majority (75%) of the period April 2013 – March 2015 CCU capacity was below normal, and 9 months of this was at 50% of establishment (i.e. 1 x Whole Time Equivalent (WTE)).


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This significant reduction in operational capacity within the CCU, which coincided with national preparations for Glasgow to host the Commonwealth Games 2014, led to a requirement to adjust and re-prioritise the CCU work-plan. This was done in discussion with, and approval of, the Deputy Chief Executive on behalf of the Chief Executive (Accountable Resilience Officer): a number of specific objectives, including the Civil Contingencies Annual Report 2013-2014, were deferred, and some core activities re-scoped.

6 Incidents and Responses There were no major incidents declared in Grampian during 2013/2015. A number of smaller incidents however involved NHS Grampian both in terms of direct response as well as in support of the multi-agency partnership, Grampian Local Resilience Partnership (LRP), activated under the Grampian LRP Generic Response and Recovery Framework. As in previous years, there were several meetings of the LRP Tactical Coordinating Group, convened in pre-response mode, as a precautionary measure in response to local incidents with the potential to have wider impacts: these meetings were supported by the Civil Contingencies Unit as part of normal operational business. 5 November 2013 Royal Cornhill Hospital - fire within the derelict building at Royal

Cornhill Hospital, no-one injured. Scottish Fire and Rescue Service and Police Scotland attended. Grampian Mental Health Services (GMHS) Control Room activated and used to coordinate response between the emergency services and the GMHS team. During the response, and as the derelict building was made safe afterwards, there was disruption to the traffic flow on Royal Cornhill Hospital (RCH) site and public roads adjoining the site.

5 December 2013 Winter Storm - the LRP Tactical Coordinating Group convened to coordinate the response to the storm. Impacts were short in duration and included 9000 properties without power, including health premises e.g. Glen O' Dee hospital in Banchory, drivers stranded in flood water and rescued by emergency services, and flooding in coastal areas including Banff where some commercial properties were affected. The same event resulted in fallen trees and extensive debris on rail lines which completely disrupted the rail network and led to delays numbers of stranded passengers.

19 December 2013 Spey Bay flood Warning: LRP Tactical Coordinating Group convened in response to a flood warning issued for Spey Viaduct to Spey Bay. A moderate surge was predicted to cause high tides along the Moray coast which, combined with high river levels along the River Spey, had the potential to result in localised flooding in the area around Garmouth and Kingston. In the event, some road flooding cut off Kingston for a short period. No properties known to be evacuated. LRP multi-agency response not required, normal operational response dealt with the incident.


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16 April 2014 Gas Leak – Persley Bridge: a major gas leak was reported around midnight, on Persley Bridge, A90 Parkway, Aberdeen. Incident resulted in local diversions impacting the Parkway and A90 north and south bound. A teleconference meeting of the Grampian LRP Public Communication Local Group was held to determine public messaging and information. The leak was dealt with and roads opened by lunchtime of the following day.

14 May 2014 HMP Grampian – Prison riot: HMP Grampian, the first purpose built community facing prison within Scotland, opened on 3rd March 2014. Health care services are provided on site by NHS Grampian staff. On 14th May 2014 there was a disturbance at the prison: 40 adult inmates barricaded themselves inside a cell block within the jail’s Ellon Hall. During the 14-hour siege inmates caused £150,000 of damage. The incident did not require an LRP response and was dealt with by HM Prison Service (HMPS) and Police Scotland. There was no impact on NHS Grampian.

10 – 12 August 2014 Severe Weather – North East: Severe weather event across North East Scotland: heavy and persistent rainfall across much of Moray and Aberdeenshire combined with high winds gusting 50-60 mph. Rivers Deveron, Lossie and Don flooded with residential properties affected and residents evacuated, and businesses and agricultural land affected also. Residents evacuated from Meadows Nursing Home and Pine View and Rowan Avenue in Huntly, and approximately 200 properties in the East area of Elgin were also evacuated. Rest centres were stood up across affected areas of Grampian. No major incident was declared but LRP Tactical Coordinating Group was activated to coordinate the multi-agency response and met by teleconference 10 times over the period. Some minor impacts on NHS Grampian estate were dealt with operationally.

24 August 2014 Suspect Ebola at Aberdeen Airport: 10 year old passenger arrived at Aberdeen airport suspected as possibly suffering from Ebola infection and transferred for clinical assessment to Royal Aberdeen Children’s Hospital (RACH) Accident and Emergency Department. Following assessment the patient was sent home as not at risk of Ebola Virus Disease (EVD).

30 December 2014 Suspect Ebola – Torridon: On the 29 December 2014 a Category 2 returning healthcare worker from Oxford became unwell while staying in a youth hostel in Torridon in the Scottish Highlands. Following clinical risk assessment the healthcare worker was categorised as high possibility/low probability for Ebola and transferred by Scottish Ambulance Service (SAS), under Police Scotland escort, to the Infectious Diseases Unit of ARI on the 30 December. Blood samples were taken at Inverness stopover and flown to Edinburgh to reduce testing times. Test results were negative for Ebola.


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6.1 West Africa Ebola Outbreak (March 2014 – ongoing)

The Ebola outbreak in West Africa was first reported in March 2014 and over the course of 2014-2015 became the largest and deadliest Ebola Virus Disease (EVD) outbreak in history. The outbreak, at the date of this report is ongoing although at a much reduced rate. Details of the outbreak can be found at http://www.who.int/csr/disease/ebola/en/. All of NHS Scotland responded to the West Africa outbreak and the risk of imported cases of EVD into the UK with a significant programme of communication and preparedness to identify and manage possible cases and to prevent the spread of the disease should it arrive in Scotland. In addition to the measures put in place to protect the UK, numbers of NHS volunteers from across the country travelled to West Africa to be part of the international response effort to help those affected and bring the outbreak under control. National protocols were put in place to deal with the risk from returning health care workers. NHS Grampian put in place a local strategy for Ebola preparedness and response and convened two groups to take forward the necessary programme of work.

The Ebola Preparedness Working Group chaired by Dr Anne-Marie Karcher led the planning and preparedness at an operational level across acute and primary care;

The Ebola Preparedness Core Group chaired by Susan Webb, Interim Director of Public Health and Executive Lead for Ebola, supported and oversaw the implementation of the local strategy.

A key area of focus for Boards, including NHS Grampian, was personal protective equipment (PPE) for staff: an enhanced level of protective equipment, including FFP3 mask, was required to allow staff to safely manage a potential, or actual, EVD patient. Challenges included:

Delays to sourcing of appropriate PPE: availability of enhanced PPE stock was adversely impacted in the early stages by simultaneous demands on suppliers by NHS Boards and NHS England Health Trusts at a time that suppliers were being asked, at a UK level, to provide equipment to support the international response effort in Africa;

Ability to rapidly increase capacity to support face-fit testing of large numbers of staff for FFP3 masks;

Release of hospital staff to undertake enhanced level PPE training in the face of the operational pressures on Acute services in 2014.

The work on Ebola preparedness served to highlight the issue of FFP3 face-fit testing in a wider context of general respiratory protection, including for Pandemic Flu response, and the challenges of maintaining up-to-date face-fit-tests and records of tests for staff across NHS Grampian. A project to address this will be taken forward in 2015-2016 by the Head of Health & Safety. NHS Grampian did not have any confirmed cases of EVD however did successfully deal with a small number of suspect EVD cases which live-tested local arrangements.


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Debriefs of the incidents on 24 August and 30 December (noted in Section 6, p10) identified learning points that helped to refine the local Ebola response. At the date of this report, the risk of cases being imported into the UK is now assessed by Public Health England as being ‘very low’ however the screening and monitoring of workers returning from the affected West African countries continues in all UK countries while other returning travellers are being asked to self-refer to healthcare services if they develop symptoms. Protocols for the risk assessment of symptomatic returning travellers who present to local healthcare services remain in place.

6.2 Queen’s Baton Relay: Grampian 29 June – 4 July 2014

The Queen’s Baton Relay (QBR) travelled through Grampian on 29 and 30 June and then again 2, 3 and 4 July 2014 in the run up to the opening of the 2014 Commonwealth Games in Glasgow on 23 July 2014. The experience and learning from the passage of the Olympic Torch Relay (OTR) in 2012 informed and positively contributed to the arrangements put in place in Grampian during the passage of the Baton. As a Local Resilience partner NHS Grampian supported the multi-agency LRP Resilience

Room which was set up for the Public Communications Cell which managed local public communications while the QBR was in Aberdeen City, Aberdeenshire and Moray. The passage of the QBR was planned, and timed, to have minimal impact on main commuter routes and there was no requirement for NHS Grampian to put in place measures to mitigate potential disruptive effects of the Relay through the area. The QBR, and associated events, were very successful.

6.3 Winter Weather

Grampian has been fortunate over the last 2 years to have experienced generally mild, but wet, winters with few major winter weather impacts. Other areas however, over the same period, experienced extreme weather events with significant impacts. It is predicted that climate change and increases in global temperatures will lead in future to more frequent extreme weather events. UK Climate Projections (UKCP09) indicate the changes that can be expected, and for Scotland these are that Scotland will get warmer, wetter winters and hotter, drier summers. These changes will have a variety of impacts, including increased flood risk, longer growing seasons and new pests and diseases. Winter 2013/2014

NE Scotland had a relatively mild, wet, winter. On the whole the region experienced little in way of major winter weather impacts however a winter storm with extremely strong winds, combined with heavy rain and tidal surges, led to a number of incidents across the Grampian area on 5 December 2015 (as noted above). On 18/19 December a notification of potential flooding in the Spey Bay area led to a meeting of the LRP Tactical Coordinating Group however the incident did not develop further and initial precautionary actions were sufficient for the situation.


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It is worth noting that over this same winter period other parts of the country were very badly affected by weather including almost continuous severe storms along the West Coast of Scotland throughout December and January, and severe storms, flooding and continuous rain across large parts of South West England leading to wide area flooding lasting for weeks (e.g. Somerset Levels) with thousands of homes without power and numbers of people evacuated from their homes. In February 2014 the South East was flooded resulting in flood warnings at the highest level (danger to life) issued along the River Thames. The impact on communities, damage to infrastructure and cost to the economy was significant: recovery from events of this magnitude take years.

Winter 2014/2015:

This was again relatively mild for NE Scotland with little snow/ice and most localised impacts in Grampian were minor, arising from wet/stormy weather. By comparison, severe weather events in December & January badly affected the Highlands and Western Isles and led to a number of power outages over the period across large areas of the West of Scotland and a declaration by Police of a major incident in the Western Isles.

While winter weather was not an issue for NHS Grampian, services experienced sustained pressure over the winter period and a higher than anticipated number of respiratory illnesses admissions.

As part of the range of activities across NHS Grampian in preparation for winter, including support for the Scottish Government Ready Winter campaigns, NHS Grampian renewed, for a further 2 years to 2016, its Memorandum of Understanding with Community Off Road Transport Action Group (COTAG) 4x4 Response and operational protocols were updated and disseminated across the organisation accompanied by an article in UPFRONT. COTAG offers logistical and transport support to assist NHS Grampian staff to carry out their duties, particularly during periods of extreme weather or civil emergency.

7 Glasgow Commonwealth Games 2014 Glasgow hosted the Commonwealth Games (CWG) in July/August 2014. As part of Scotland’s delivery of a ‘successful, safe and secure Games’, NHS Scotland’s commitments were:

• Free medical care for Games Family members • Ambulance provision for Games venues • NHS volunteers to support the delivery of medical services • Capability to respond in the event of an incident (public health or other type of

attack). • Provide appropriate contingency for health resilience for security threats during

Games • Ability to deliver business as usual for health services


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The approach by NHS Scotland was to ensure readiness for the Games through planning and preparedness whilst at the same time acknowledging the need for proportionality and differing levels of NHS involvement during Games Time. No Games events were held in Grampian however the Cameroon team training camp was hosted in Aberdeen. NHS Scotland’s ‘Games Readiness’ included a preparedness assurance exercise with NHS Boards in the months preceding the Games, both for host Boards and non-host Boards. The assurance process involved NHS Scotland tracking Health Board’s progress against specific requirements in relation to planning and preparedness at three stages: December 2013, January 2014 and March 2014. The final element of the assurance process was the Chief Executive’s Assurance of Health Board Preparedness statement, by letter, to Scottish Government on 4 June 2014. To support NHS Grampian’s preparedness work, a Commonwealth Games Planning Group (CGPG) was convened, chaired by Civil Contingencies Manager and supported by Sector leads for Games preparedness. The group took forward the CWG 2014 assurance work from late 2013 to May 2014 and provided assurance submissions to Scottish Government’s NHS Scotland Resilience Unit as required, and to the expected timetable. During Games Time NHS Grampian put in place special arrangements to support Scottish Government Games Operations and the NHS Scotland Resilience Unit Concept of Operations (CONOPS) for Glasgow 2014 Commonwealth Games.

8 Business Continuity - Internal Audit In late autumn 2014 PwC conducted a Business Continuity review of NHS Grampian as part of the 2014/2015 internal audit plan approved by the Audit Committee. The review assessed NHS Grampian’s Business Continuity Management (BCM) arrangements (BCM) and Business Continuity plans with a specific focus on processes and controls within the areas of governance, planning, embedding and exercising. Three Sectors were selected for review: Aberdeen City CHP, Moray CHP and Facilities & Estates. Public Health was specifically excluded under the audit terms of reference. Interviews were held in October 2014 with management and staff responsible for business continuity across NHS Grampian. A number of areas of good practice were identified and NHS Grampian commended for these. Areas for improvement were also identified and recommendations were made to help NHS Grampian more effectively govern, and embed, business continuity across the organisation. The impact of the unavailability of the organisation’s Business Continuity Lead, through secondment to other roles, since 2011, was acknowledged in the report. The final report was issued in December 2014 and is available on request through the Civil Contingencies Unit. An action plan to address the areas for improvement and take forward the Audit recommendations was drawn up and approved by the Civil Contingencies Group in


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February 2015 (See Appendix 1) and included in the CCU work-plan. A number of actions were progressed as a priority, including the development of a Business Continuity Policy: actions will continue to be taken forward in 2015-2016.

9 CONTEST CONTEST is the UK's Counter-terrorism strategy, organised around four principal work-streams:

Pursue: aims to stop terrorist attacks; Prevent: aims to stop people who are at risk of radicalisation4 from becoming

terrorists or supporting terrorism; Protect: aims to strengthen our defence against terrorist attack; Prepare: aims to mitigate the impact of a terrorist incident where it cannot be

stopped The NHS has a role in supporting the strategy under the Prevent, Protect and Prepare work-streams. Through 2013-2015 NHS Grampian continued to support CONTEST through organisational planning and preparedness work, as described in this report, and through:

Head of Civil Contingencies participation, at a national level, in the Scottish Government (SG) Prevent Sub Group;

Active membership and participation in the Aberdeen City, Aberdeenshire and Moray multi-agency CONTEST Groups, working with partners to deliver the local CONTEST Group plan;

Work with partner agencies to continue the roll-out of staff training and awareness-raising sessions: Project Argus and Project Griffin delivered by local Counter Terrorism and Security Advisors (CTSAs); Workshops to Raise Awareness to Prevent (WRAP) by the local Prevent Delivery Unit.

Piloting of a centrally administered NHS Grampian programme of CONTEST training events;

Internal delivery of CONTEST and Prevent awareness-raising sessions by Civil Contingencies Manager/Head of Civil Contingencies to management groups:

o 18/06/2013 - Acute Sector Divisional General Manager + Unit Operational Managers

o 02/10/2013 - HR Managers o 30/01/2014 - Senior Workforce Directorate o 12/03/2014 - Facilities Managers CPD (12 March 2014) o 03/07/2014 – Executive Team briefing

4 Radicalisation is a form of exploitation whereby extremists seek to groom and recruit vulnerable

individuals to their cause leading ultimately to those individuals harming themselves and others. Individuals who may be vulnerable to radicalisation could be staff, patients or carers.


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9.1 CONTEST Sessions held in 2013 and 2014

Date Event Type Audience Attendees

19.04.13 Project Revise NHS Lab Staff 18

26.04.13 Project Argus NHS Moray 6

30.05.13 Project Griffin (c) NHS Staff (Elgin) 23

12.06.13 Project Griffin (c) NHS Dental 27



07.08.13 Project Griffin (c) NHS Physio (Elgin) 31

11.11.13 Project Argus NHS Staff Woodend Hospital 7

10.03.14 Crowded Places CTSA visit ARI -

11.03.14 Crowded Places CTSA visit Dr Gray’s Hospital -

11.03.14 Project Griffin (c) NHS Dr Gray's 9

12.03.14 Prevent Briefing NHS Facilities & Estates Mgt 4

05.09.14 Prevent Briefing ARI Mosque Committee unknown

(c=condensed version)

9.2 Pilot of NHS Grampian CONTEST Training Programme

In late 2013 to mid 2014 NHS Grampian trialled a revised approach to CONTEST training with the introduction of a centrally administered programme of training events, available to staff across all Sectors/Teams. While Sectors were still free to arrange single-sector training sessions, the NHSG programme was available to staff on a self-booking basis: the aim was to provide staff with an opportunity for cross-sector discussion and sharing of learning during training sessions, with the added benefit of reducing the administrative overhead for Sectors. After 9 months the pilot was discontinued due to poor uptake of places leading to the cancellation of several programmed sessions: responsibility for arranging CONTEST training for staff was returned to individual Sectors/Teams. Informal feedback indicated that although there was support for the principle of a centrally administered and managed programme, staff availability, and willingness to self-book, was impacted by competing operational priorities and other training commitments.

9.3 CONTEST - PREVENT

In 2014-2015 there was an increased focus at UK level on Prevent with a new Act of Parliament, The Counter-Terrorism and Security Act 2015 (CT&S Act 2015), that placed Prevent duties on a statutory footing for specified authorities, including NHS Scotland Boards. “A specified authority must, in the exercise of its functions, have due regard to the need to Prevent people from being drawn into terrorism.” Part 5, Chapter 1: Preventing people being drawn into terrorism, CT&S Act 2015.


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National and international incidents, combined with high profile instances of British citizens travelling to conflict areas, such as Syria, to fight or join violent extremist groups such as the so-called Islamic State group, also raised general public awareness to issues around radicalisation and extremism. On the 20 January 2015 NHS Scotland published Playing Our Part – Implementing the Prevent Strategy – Guidance for Health Boards, guidance that formally set out how Health Boards in Scotland should engage with and support Prevent and thereby meet the new statutory duty under the Counter-Terrorism and Security Act 2015 (CT&S Act 2015). NHS Grampian developed a Board Prevent Implementation Plan and submitted this to NHS Scotland Resilience Unit in April 2015, as did all NHS Scotland Boards, along with named leads for Prevent in NHS Grampian:

Executive Prevent Lead: Director of Public Health

Prevent Lead: Adult Support and Protection Lead

9.4 Update on 2012-2014 NHS Grampian Prevent Programme

A number of actions from the 2012-2014 NHS Grampian Prevent Programme, delayed in agreement with Scottish Government pending outputs from national level work, were incorporated into the new Implementation Plan and will be reported to the Board by the Prevent Lead as part of the Prevent Implementation reporting. The remaining balance of £5k ring-fenced Scottish Government funding was transferred from Civil Contingencies to the NHSG Prevent Lead. The Final Project Contract Evaluation of the NHS Grampian Prevent Programme 2012-2014 was submitted to the Scottish Government on 31 January 2014. The report is available on request from the Civil Contingencies Unit.


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10 Partnership Working - Resilience Partnerships 1 November 2013 marked a change to Scotland's multi-agency resilience structures. The eight Strategic Coordinating Groups (SCGs) were replaced by three Regional Resilience Partnerships (RRPs - North, East and West) each comprised of a number of Local Resilience Partnerships (LRPs – 3 each in the North and East, 7 in the West). NHS Grampian is part of the Grampian Local Resilience Partnership (GLRP) which along with Tayside LRP and Highlands & Islands LRP forms the North of Scotland RRP. Throughout the period of this report the new structures have become established, embedded, and more familiar: partner organisations have come together under the local and regional partnership arrangements to take forward risk assessment, planning and preparedness activities. Support is provided to Grampian LRP by the Grampian Resilience Coordinator with a North RRP Learning and Development Coordinator providing shared support across the 3 LRPs. Resilience Partnership Activity NHS Grampian is an active member of the Grampian LRP and North RRP and engages and supports the work of the partnership (Local and Regional) at all levels of activity both in planning and preparation and in response and recovery. NHS Grampian participates in key areas of work undertaken by local and regional level multi-agency Resilience Partnership planning groups in order to ensure a proactive health input and coordinated approach to planning, preparedness and response activities. This includes for example work on mass fatalities, public communications, Care for People and security. As noted earlier in this report cooperation with other responders and joint working was clearly demonstrated during LRP activations and pre-activations over the period of this report.


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11 NHSG Compliance with the Civil Contingencies Act 2004 NHS Grampian, as a Category 1 responder under the Civil Contingencies Act 2004, has legal responsibilities in six specific areas as noted at Section 3. In order to respond to these duties the Board has undertaken a number of activities during 2013/2014/2015: where these are a continuation of activities previously reported this report does not seek to repeat detail but highlights specific points for noting.

11.1 Assessing the Risk of Emergencies

NHS Grampian continued its arrangements, both internally and as part of the Local and Regional Resilience Partnerships, to assess the risks of emergencies occurring, and to use this to inform contingency planning.

North of Scotland RRP adopted a revised Risk assessment methodology as laid out in the new Scottish Government Risk and Preparedness Assessment (2014): NHS Grampian contributed to the multi-agency risk assessment work under the RRP Risk Capability Group, led by Scottish Fire and Rescue Service, leading to the development of the North of Scotland RRP Community Risk Register, expected publication date in 2015-2016.

Civil Contingencies Risk Register was fully reviewed at a workshop held on 14 January 2015, supported by the Risk Management Advisor and attended by Executive Directors and Senior Sector managers. Outcomes were presented to CCG on 26 February 2015.

11.2 Emergency Planning

NHS Grampian is required, under legislation and guidance, to have in place emergency plans to deal with the consequences of an emergency in the Grampian Region, to ensure that plans are validated and exercised, that appropriate senior command, control and coordination (C3) arrangements are in place, and appropriate incident control centre facilities to control and coordinate the response to an emergency are in place, and that appropriate numbers of staff receive training to allow them to can carry out plans effectively. Plans and Planning NHS Grampian has a suite of emergency plans in place, or under development, to deal with the consequences of an emergency in the Grampian Region. These include for example:

NHS Grampian Major Incident Plan including Board Control Centre;

Foresterhill Health Campus Major Incident Plan (incorporating RACH);

Dr Gray’s Hospital Major Incident Plan;

NHS Grampian Major Infectious Diseases Plan;

Sector Business Continuity Response and Recovery Plans;

Surge Capacity Plans (Pandemic Influenza & Winter Planning);

Corporate Communications Major Incident Plan;


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A new, restricted, plan was developed in 2014 and added to the above suit of plans – ‘Operation Unicorn’. NHS Grampian plans are in the maintenance cycle of review and update. All SCG plans were reviewed and brought into line with the new Local and Regional Resilience Partnership (LRP/RRP) arrangements. Work to assess the requirement for North of Scotland regional level plans, in place of Local Resilience Partnership plans, was undertaken over the course of 2013/2014 and where necessary a RRP group was tasked with developing a Regional plan. Until such time as the Regional RRP plans are fully developed, the local LRP plans remain in place. Exercising NHS Grampian engaged in both internal and external exercises throughout 2013 – 2015 including: Hospital Major Incident exercises using the Emergo-Train system for ARI and Dr Gray’s Hospital; national mass casualties exercise ‘Safe Hands’; Care for People exercise; communications test; control room exercise; CBRN/decontamination exercise; Ebola response exercise. Appendix 2 provides detail of the exercises undertaken in 2013-2015 run by, involving, or made known to the Civil Contingencies Unit. NHS Grampian continues to work towards achieving a level and frequency of testing and exercising of its plans to align with current guidance: this is an area of focus for the CCG and Sector Resilience Groups and remains a risk on the Civil Contingencies Risk Register. Training NHS Grampian must train staff to provide them with the competencies and confidence to undertake their designated roles within plans. Appendix 2 details training provided as part of the CCU 2013/2014/2015 programme of training including: Loggist training; Control Centre operations; Hospital Decontamination; Business Continuity; Exercising of Plans; Crisis Management; Tactical Training; and STAC. Training delivery is via a mixture of internal delivery, external trainers and ScoRDS5 training delivered to support the multi-agency partnership. In addition to this, Sectors and Services undertook sector specific training sessions for staff e.g. Sector Control Room operations, Hospital Major Incident training and awareness, decontamination training for Emergency Department (ED) staff. Staff competency remains a risk on the Civil Contingencies Risk Register and will continue to be a challenge for the organisation as we transition to new Integrated Joint Board (IJB) structures, staff move roles, new staff are recruited, and Sectors and Services re-organise. There continue to be gaps between staff competency

5 ScoRDS is the Scottish Resilience Development Service, a division of Scottish Resilience that supports

the resilience community by providing learning and development to enhance the knowledge, skills and behaviours required for effective multi-agency emergency planning, response and recovery.


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requirements, training opportunities, staff time to engage with training provision in the face of multiple competing priorities, and the availability of resources to support training. Command, Control and Coordination Arrangements (C3) NHS Grampian has in place Director-level C3 arrangements for the Board Major Incident response at tactical or strategic level, supported by a dedicated Board Control Centre facility maintained at operational readiness, in case of an emergency. Sectors have or are in the process of developing Sector Control Room functions to provide Sector level command, control and coordination.

Trial of revised arrangements April 2014: the Executive Management Team requested and agreed to trial a revised arrangement for the provision of an NHS Grampian Duty Director/Executive incident response out with office hours. Instead of the formal duty rota for an Executive Manager on Call (EMoC), a new system of Executive Incident Response (EIR) was implemented whereby any Executive Manager could be contacted out of office hours to undertake the NHS Grampian strategic or tactical response role. The revised arrangements were implemented in April 2014 and ran for 11 months at which time a review determined that the EMoC duty rota should be re-instated, at an enhanced level of cover, supported by a training programme and an agreed competency framework. A Short Life Working Group has been tasked to progress this in first quarter 2015-2015.

11.3 Business Continuity Management

NHS Grampian has a legal duty to put in place business continuity management arrangements which would help the organisation to maintain critical functions in the event of a significant disruption or major emergency. All Sectors continued their work under the auspices of their Sector Civil Contingencies/Resilience Groups to develop, maintain and where necessary enhance BCM arrangements. PwC undertook an internal audit of NHS Grampian’s Business Continuity Management in October 2014: see Section 8. The audit identified areas for improvement in NHS Grampian’s BCM and these are noted at Appendix 1 along with the action plan to take forward the recommendations. The ongoing secondment of the NHS Grampian BC lead to other roles in the organisation, without replacement, was noted in the PwC report and the impact of that loss of resource acknowledged. (See Section 5 for details).

11.4 Public Information, Warning and Informing

NHS Grampian has in place, and maintains, arrangements to make information available to the public about civil protection matters and to warn, inform and advise the public in the event of an emergency. These arrangements cover NHS Grampian as a single responder organisation (for example the Corporate Communications Major Incident Plan) and as a partner in the


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RRP arrangements for multi-agency public communications in response to an emergency. Public information, warning and informing is a key component of NHS Grampian and Resilience Partnership major incident response and is explicitly incorporated into plans. The local Resilience Public Communications plan has been replaced by a North of Scotland Public Communications Plan agreed at RRP level.

11.5 Sharing information with Local Responders

Information sharing is an integral part of civil protection and interagency cooperation. NHS Grampian shares information with partner responders during planning and preparedness activities as well as during responses to incidents.

Partnership Working: NHS Grampian participates at all levels of multi-agency partnership groups (LRP and RRP) to ensure a proactive and coordinated approach to emergency preparedness in terms of planning, response and recovery. (See Section 10 for details).

In response mode, shared situational awareness and sharing of information is achieved through the Resilience Partnership situation reporting mechanisms. These mechanisms were well supported and tested under the SCG structures and the facilitation of information sharing and situational awareness under the Resilience Partnership support arrangements have been tested during pre-response mode of the LRP.

Resilience Direct is the UK’s secure platform for multi-agency partnerships to share information in both emergency response and in planning, launched in March 2014. The SCG website was run in parallel with Resilience Direct until February 2015 when it was stood down. NHS Grampian has engaged with Resilience Direct and will, over the course of 2015-2016, develop its use of, and presence on, Resilience Direct.

11.6 Co-operating with Local Responders

NHS Grampian is an active member of the Grampian LRP and the North RRP and continues to engage and support the work of the partnership at all levels of activity both in planning and preparation, and response and recovery. Cooperation with other responders and joint working, mainly under the auspices of the LRP, was also clearly demonstrated during multiple LRP activations and pre-activations in 2013/15 as noted earlier in this report.


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12 Civil Contingencies Unit Priorities 2015 – 2016 The key emergency planning and business continuity priorities for NHS Grampian in 2015-2016 are outlined below with associated Civil Contingencies Unit objectives:

Compliance: continue to ensure that NHS Grampian fulfils its statutory duties under the CCA 2004 and has arrangements to enable requirements of accompanying legislation and guidance to be met.

Compliance: ensure NHS Grampian compliance with Organisational Resilience Standards published by NHS Scotland (expected late 2015).

Multi-Agency Cooperation and Coordination - to continue to support, at all levels, the Resilience Partnership through: active participation in LRP/RRP governance, planning and preparedness groups; participation in exercises and training events; and support of the Resilience Partnership in response mode.

Major Incident planning:

o Review and update of the NHS Grampian Major Incident plan to reflect resilience partnership arrangements, organisational change, new guidance, and the NHS Scotland Mass Casualty Incident plan (MCI) Response Plan.

o Reinforcement of the NHS Grampian level tactical and strategic support to a major incident through: reinstatement of EMoC, at an enhanced level; development of a core competencies framework; development of an enhanced supporting training programme.

o Development of NHS Grampian mass casualties response protocols to support the coordination and management of a Mass Casualty Incident (MCI) as part of the NHS Scotland Mass Casualty Incident Response Plan.

o Review and rewrite of the VIP/Protected Persons protocol for ARI

Training: Development of formal training programme for training across tactical, strategic and operational levels with delivery of the following specific modules:

o CCU delivery of training modules to enhance incident support arrangements e.g. Control Centre operations and loggists

o Strategic/Tactical leadership in a Crisis training

o Public Inquiry training for EMoCs and Chief Executive

o Major Incident training and workshop for EMoCs and managers with tactical responsibilities at Sector level.

o Embedding Initial Operational Response (IOR) principles in hospital and health facility response to a hazardous materials event.

Exercising: testing of emergency plans at local and multi-agency level, and engagement with appropriate national exercises.

o Silver Swan national Pandemic Influenza Exercise

o NHS Grampian major incident exercise


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o Exercise of Board Control Centre

o Exercise of Hospital Centre

o Exercising of Winter plans under Winter Planning lead

o LRP activation exercise as part of COMAH site exercise

o Participation in the Aberdeen International Airport annual exercise

o Exercise North Explorer – multi-agency exercise via the LRP

Planning for VIP/Protected Persons: re-write of the VIP/Protected Persons protocol for ARI.

Strengthening Business Continuity Management – take forward the measures recommended in the PwC report to better embed and more effectively govern business continuity across the organisation, including the development of a BC Policy.

Civil Contingencies Unit (CCU) Core Activities – continued delivery of CCU core activities, including support for Civil Contingencies governance arrangements. Full details of CCU core activities can be requested from CCU and have been detailed in previous reports.

Prevent – support for Prevent implementation by delivery of a Prevent e-learning module for roll-out to NHS Grampian and for potential adoption by NHS Scotland.

13 Looking Ahead 2015 – 2016

Scotland has, for the first time, a dedicated Minister with responsibility for Resilience, Mr John Swinney, Deputy First Minister and Cabinet Secretary for Finance, Constitution and Economy. The Resilience agenda is one which is important and relevant to individuals, organisations and communities, and will continue to gain profile at the highest level of Government with a corresponding interest and scrutiny in the work of responder organisations such as the NHS. NHS Grampian must maintain its commitment to, and support of, Resilience/Civil Contingencies work across the organisation both in terms of preparedness of the organisation to deal with shocks but also in encouraging a resilient culture in the organisation.

Key areas for the next 12-18 months include:

Health and Social Care Integration: the Public Bodies (Joint Working) (Scotland) Act 2014 paved the way for the creation of new organisations - Integrated Joint Boards (IJBs) - which formally integrate health and social care services and budgets. The integration of health and social care is a significant reform of service delivery: throughout 2015-2016 the design of jointly delivered adult health and social care services across Aberdeen City, Aberdeenshire and Moray Health & Social Care Partnerships (H&SCPs) will be progressed along with re-alignment of budgets to IJBs, ready for full implementation in 2016. It is important that there is clarity regarding roles, responsibilities and accountabilities, with regard to Resilience (emergency planning and response and business continuity planning


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and response), under the new IJB and H&SCPs structures. NHS Grampian and the Local Authorities have separate approaches to emergency response and business continuity therefore it is proposed that a jointly agreed (NHS and local authority) resilience framework be developed that will provide the necessary clarity.

NHS Scotland - Standards for Organisational Resilience: the publication of the NHS Scotland Standards for Organisational Resilience is anticipated for late autumn 2015. The standards will set out the minimum requirements for business continuity and emergency preparedness for Boards, set in the context of Preparing for Emergencies-Guidance for Health Boards in Scotland published by Scottish Government (SG) in 2013 and the 2015 Prevent guidance Playing Our Part – Implementing the Prevent Strategy – Guidance for Health Boards. Assurance of compliance with these standards will be sought from Boards as part of the NHS Scotland assurance and performance management process.

National Pandemic Flu Exercise – Silver Swan: Scottish Government, in partnership with Resilience Partnerships, Health Boards and other partners, plans to deliver a programme of events in 2015 to exercise Scotland’s response to a Pandemic Influenza outbreak: exercise ‘Silver Swan’. Silver Swan will be comprised of four elements:

1. Business Continuity questionnaire – June 2015 2. Excess Deaths event – September 2015 3. Health and Social Care response event – September 2015 4. National coordination tabletop exercise – November 2015

NHS Grampian, along with other Boards and partner organisations, will participate in the exercise and, in advance of the exercise, will, through the Major Infectious Disease Group, review both NHS Grampian, and Local Resilience Partnership, Major Infectious Diseases (MID) plans for a response to a pandemic flu.

PREVENT: new Prevent duties under the Counter-Terrorism and Security Act 2015 came into force on 1 July 2015. The NHS, along with other public sector organisations (designated ‘specified authorities’) are now required by statute to “have due regard (in the exercise of its functions) to the need to Prevent people from being drawn into terrorism”. 2015-2016 will see a focus by Scottish Government (NHS Scotland Resilience Unit) on the successful implementation by Boards of NHS Scotland’s guidance, ‘Playing Our Part – Implementing the Prevent Strategy – Guidance for Health Boards’.

At the time of writing of this report numbers of individuals, including whole families, have left the UK to travel to conflict areas like Syria to fight or to join extremist groups such as Islamic State group. The threat to the UK from international terrorism remains at SEVERE (an attack is highly likely) and the threat of attack at home and aboard increasingly from ‘lone actors’. The recent, terrible, events of 2015 (see below) highlight how important it is, now more than ever, that we acknowledge the threats posed by radicalisation and extremism, and understand the importance of Prevent work as an integral part of the UK


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Counter Terrorism Strategy, and that we play our part in stopping people who are at risk of radicalisation from becoming terrorists, or supporting terrorism, before they put themselves, or others, at risk of harm.

o 7 January 2015 - Charlie Hebdo attack, Paris o 7 January 2015 - siege on a Paris kosher supermarket o 18 March 2015 - attack on the Bardo museum in Tunis, targeting tourists; o 26 June 2015 – attack on a beach in Port El Kantaoui, north of Sousse in

Tunisia, targeting tourists; o 21 August 2015 - foiled attack of a gunman on a high-speed train

travelling from Amsterdam to Paris, which, but for the bravery of a few passengers, would have resulted in a massacre.


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14 Appendix 1: Business Continuity Audit Action Plan Approved CCG February 2015. (Note: target dates were subsequently adjusted to take account of policy development procedures and associated timeframes, and wider Civil Contingencies priorities.)

ID Area Rating Recommendation

Action Target Date

1. Policy and procedures

– control design

High A business continuity policy (with

underlying procedures) should be

developed and rolled out across NHS

Grampian. The policy should define roles

and responsibilities, escalation route, and

timelines for reviewing plans and

performing exercises.

IL to draft an overarching NHSG

Civil Contingencies Policy, to

include Business Continuity.

Policy to be developed under

auspices of NHSG Policies Sub-

group.

Draft to be circulated to CCG

members for comment (May

meeting) prior to submission to

16 June meeting of Policies Sub-

group.

28 May 2015

16 June 2015

2. Review process–

Control design

Medium The Civil Contingencies Unit should

develop a performance score card to

assess each sector on key business

continuity practices. This should include

timely review of plans, performing

exercises, and use of standard

documentation. The results could be

presented to the Civil Contingencies

Group on an annual basis.

CCU to develop Sector

performance measures for key BC

practices (to be detailed in the

Civil Contingencies Policy) to

include review of plans,

exercising, training for staff and

use of standard documentation.

Performance measures to be put

to May CCG meeting for

endorsement.

Sector Civil Contingencies Groups

to manage Sector performance

against measures. Scoring

against Performance measures to

31 March 2015

28 May 2015

June 2015

onwards.


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Action Target Date

be reported as part of Sector

update report to quarterly NHSG

CCG meeting.

3. Training and

resource– control

design

Medium A formal training needs assessment

should be developed centrally by the

Civil Contingencies Unit and issued to

sectors for self-evaluation.

CCU to develop a self-assessment

form.

Sector self-assessments to be

completed by 28 May CCG

meeting.

31 March 2015

28 May 2015

Training gaps should be identified and

appropriate training developed.

3 year Civil Contingencies training

programme to be developed to

include BC training sessions: draft

programme for 2015-16 to be

discussed at CCG 26 Feb 2015.

Initial tranche of BC training

(including BC cycle, BIA and

exercising) scheduled for 23 – 26

March 2015.

31 March 2015

Training should be recorded and

completion monitored centrally. The

annual review process (as noted in finding

3.o1) should evaluate the training

programme and the scorecard could

highlight completion rates.

Training module outlines to be

developed and uploaded to AT

learning.

CCU to record attendance at CCU

arranged training sessions.

Staff training records to be

updated through AT learning, as

per current operational practice,

after attendance at training

courses.

Implement an annual evaluation

of the training programme to help

Initial tranche of

modules by 31

March 2015.

In place

In place

First annual

evaluation to be


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Action Target Date

identify priority training needs for

the following year’s programme.

held: Feb 2016

CCG

In light of the recommendations coming

from this review, management

should assess the resource dedicated to

business continuity and determine

if it is appropriate.

Sector General Managers/Chief

Officers IJBs to review resources

supporting Sector Civil

Contingencies workplans

(including Business Continuity) to

determine if levels are

appropriate to achieve

organisational objectives.

Review outcomes

to be reported to

CCG May 2015

meeting.

4. Risk Register–

operating

effectiveness

Medium The Head of Civil Contingencies should

work with the Risk Management Advisor to

ensure the business continuity risk

register is up to date and appropriately

documented. We have been informed that

a review meeting is scheduled for 14

January 2015.

Civil Contingencies Risk Register

review workshop held on 14

January 2015. Outcomes

presented to CCG on 26 February

2015.

Completed.


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15 Appendix 2: Training and Exercises Exercises and training sessions noted below are both LRP multi-agency events and those sessions directly involving, or supported by, Civil Contingencies Unit. Exercises are identified by the shading.

Date Exercise Name / Details Type Description

2 May 2013 STAC training ScoRDS seminar for Grampian LRP

Training for Scientific and Technical Advice Cell (STAC) participants to work together in a multi-agency setting and explore the challenges for a STAC.

5 Jun 2013 Board Control Centre Comms cascade Test of Board Control Centre (BCC) communications cascade and call-out.

20 Jun 2013 Exercise Skyward Tabletop exercise Tabletop exercise of GMH&LDS response to a fire in a building on Royal Cornhill Site. Exercise of control room arrangements.

20 Jun 2013 Tactical Training ScoRDS seminar for Grampian LRP

Multi-agency emergency response training session run by ScoRDS aimed at tactical level managers.

3 Jul 2013 Exercise Water Water Tabletop exercise and workshop

Aberdeenshire CHP – tabletop exercise of Aberdeenshire CHP response to severe flooding event.

23 Aug 2013 Exercise Power Ranger Tabletop exercise Aberdeen City CHP - tabletop exercise focussing on Aberdeen City CHP’s Management response to a significant Business Continuity disruption: denial of access to premises event resulting from a fire in Foresterhill Health Centre.

2 Sept 2013 Board Control Centre training

Internal training Board control centre (BCC) operations training: knowledge and skills to support major incidents response as part of BCC.

6 Sept 2013 GMH&LD Exercise Tabletop exercise Re-run of Exercise Skyward scenario for Support Managers

19 Sept 2013 Exercise Blue Lagoon Tabletop exercise (external)

Airport Licensing Exercise - multi-agency tabletop exercise supported by Grampian Hospital Emergency Medical Service (GHEMS) members representing pre-hospital and hospital response to the incident.

22 Oct 2013 Exercise Safe Hands National tabletop exercise (external)

National mass casualties exercise – part of Scottish Government national exercise programme


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30 Oct 2013 Exercise Artemis Tabletop exercise (external)

Multi-agency Care for People tabletop and workshop to test LRP and local authority major incident response involving Care for People issues.

31 Oct 2013 Winter planning tabletop exercise

Tabletop exercise Moray CHP and Dr Gray’s Hospital joint winter planning and preparedness exercise to test the joint Moray response to winter weather and service pressures.

7 Nov 2013 Staff prophylaxis Exercise

Tabletop exercise Tabletop exercise to test the newly developed Staff Prophylaxis Protocol for response to an infectious disease incident in an NHS health care setting.

12 Nov 2013 Loggist Training Internal training Training for Loggist role: knowledge and skills training to fulfil the role of Decision Loggist in an emergency response.

13 Nov 2013 Exercise Apache COMAH site live exercise (external)

Live exercise at St Fergus under COMAH regulations – multi-agency response supported by members of Grampian Hospital Emergency Medical Service (GHEMS)

20 Nov 2013 SWHP - Scottish Waterborne Hazard Plan and WPI-RMG - Wastewater Pollution Incidents – Risk Management Guidance

Workshop and tabletop exercise (external)

Scottish Water workshop and tabletop exercise, aimed at NHS and Local Authorities, to raise awareness of, and scenario test, the updated Scottish Waterborne Hazards Plan and the Wastewater Pollution Incidents Risk Management Guidance.

26 Nov 2013 STAC Seminar ScoRDS seminar for Grampian LRP

Training for Scientific and Technical Advice Cell (STAC) participants to work together in a multi-agency setting and explore the challenges for a STAC.

26 Nov 2013 Major Incident Symposium

Symposium Major Incident symposium arranged and hosted by Aberdeen Royal Infirmary on Civilian Mass Casualties with guest speakers presenting on London 7/7 bombings and the two sequential lone actor terrorist attacks in Norway on 22 July 2011.

12 Feb 2014 Exercise Open Channel Tabletop exercise NHS Grampian communications exercise to test the initial phases of a major incident activation and call-out cascade including test activation of the major incident telephone call routing procedures and IVR system.


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12 Feb 2014 Aberdeen City CHP Control Room Exercise

Live exercise Live activation of Aberdeen City CHP control room – linked to Exercise Open Channel

30 April 2014 Exercise Compass Hospital Emergo exercise

Hospital major incident exercise for ARI using the Emergo-Train system. This was the first of this type of exercise run in NHS Scotland. The Emergo-Train System is a major incident simulation tool which allows hospitals to carry out a real-time training exercise without impacting on the hospital’s daily business. Emergo is used internationally and is regarded as an acceptable alternative to ‘Live play’ exercise.

1 May 2014 Hospital Decontamination Live exercise Live exercising of the ARI hospital decontamination response with live set up of equipment and decon team deployment.

4 Jul 2014 Pharmacy CBRN response exercise

Tabletop exercise Exercise of Pharmacy emergency response to a CBRN incident.

15 Jul 2014 Integrated Emergency Management (IEM)

ScoRDS training for Grampian LRP

Multi-agency training providing introduction to the principles of integrated emergency management.

15 Jul 2014 Introduction to Preparing Scotland Guidance


Multi-agency workshop introducing the Preparing Scotland national guidance.

16 Jul 2014 Social Media for Resilience Partners


Multi-agency workshop introducing Preparing Scotland guidance on using social media in emergencies and social media briefing for resilience partners.

10 Sep 2014 CBRN/Hazmat response - IOR workshop

Workshop Workshop for hospital and community settings to raise awareness to new CBRN/Hazmat response guidance – Immediate Operational Response (IOR) and dry decontamination.

19 Nov 2014 Exercise Double Vision Live exercise (external)

Airport Licensing Exercise - Multi-agency live play exercise supported by Grampian Hospital Emergency Medical Service (GHEMS) members providing hospital site medical response to the incident.

20 Nov 2014 Airport - Ebola Tabletop exercise LRP multi-agency tabletop exercise of the Aberdeen International Airport port health function and response to an infectious disease incident. The tabletop exercise was combined with a debrief of the Suspect Ebola incident of 24 August 2014.


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26 Nov 2014 Crisis Management: Part 1 - Founding Principles


New course developed by ScoRDS providing multi-agency training in crisis management.

28 Nov 2014 Project Griffin Training (external) Hosted at Aberdeen Health Village for NHS and local authority staff: one of the suite of training modules offered under CONTEST: Project Griffin is an event to advise and familiarise managers, security officers and employees of large public and private sector organisations on security, counterterrorism and crime prevention issues.

10 Dec 2014 Exercise Pithos Tabletop exercise Ebola tabletop exercise delivered as part of NHS Grampian’s programme of training and exercising to support the organisation’s preparations to deal with a potential case of EVD. The exercise tested the operational response in a Primary Care/Community setting and in an Acute hospital setting.

10 Feb 2015 Decontamination Operator Training

Training course Dr Gray’s Hospital decontamination response training for decon operators: classroom combined with practical training in protective suits.

17 Feb 2015 Loggist Training Internal training Training for Loggist role: knowledge and skills training to fulfil the role of Decision Loggist in an emergency response.

3 March 2015 Crisis Management: Part 1 - Founding Principles



18 March 2015 Exercise Benromach Hospital Emergo exercise

Hospital major incident exercise for Dr Gray’s Hospital using the Emergo-Train system.

23 Mar 2015 Business Continuity Workshop/Training Introduction to Business Continuity – principles and practice. Including Business Impact Analysis and development of Business Continuity plans.

24 Mar 2015 Exercising Your Plans Training Training course to develop knowledge and skills in how to design and deliver exercises to validate business continuity and emergency plans.

Loggist training Training Training for Loggist role: knowledge and skills training to fulfil the role of Decision Loggist in an emergency response.

Crisis Management: Part 2 - Decision Making




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Under Pressure

25 Mar 2015 Business Continuity Workshop/Training Introduction to Business Continuity – principles and practice. Including Business Impact Analysis and development of Business Continuity plans.

26 Mar 2015 Exercising Your Plans Training Training course to develop knowledge and skills in how to design and deliver exercises to validate business continuity and emergency plans.

31 Mar 2015 Airwave Train the Trainer Training Training delivered by SAS for new cohort of NHSG Airwave trainers and to refresh existing trained trainers.

civil contingencies unit - nhs grampian · provide the board with an overview of resilience...

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