To receive presentations from emergency planning officers at Barts Health NHS Trust and Barking, Havering and Redbridge University Hospitals NHS Trust on how local hospitals would deal with major emergency incidents.
Minutes:
1. Barking, Havering and Redbridge University Hospitals NHS Trust (BHRUT)
BHRUT covered two acute sites at Queen’s and King George Hospitals. It was noted however that King George was not a receiving hospital for major incidents.
The Trust used a series of emergency manuals and an on-call system that was the same as that used by the Local Authority. There was also an emergency planning and business continuity system in place at Queen’s.
In case of a major incident, a series of hospitals (usually four) were nominated by the London Ambulance Service to respond to an incident. A nominated hospital would assess the impact of an incident and decide if this was a major incident that required a more coordinated response. Specific stocks of burns treatments dressings and other equipment were carried in case of a major incident.
If there was a major incident, discharges from Queen’s Hospital would be accelerated but this would be done in conjunction with NELFT or North East London Community Services (NELCS). Some existing patients could also be transferred to King George if necessary.
In cases of e.g. severe weather, guidance was sought from the Met Office in the same way as Councils did. There were also plans to deal with industrial action or fuel shortages. Should there be an incident on a hospital site, evacuation plans were available.
Other health links used in emergency planning included NHS England (who would coordinate responses to a major incident) primary care and Council adult social care departments.
2. Barts Health NHS Trust
Barts Health was the largest Hospital Trust in the country, controlling six hospitals including Newham and Whipps Cross. For external incidents, the Trust would be informed by London Ambulance Service or NHS England. In internal incidents, the Trust itself would advise doctors and nurses in the relevant hospital.
Incident response saw staff alerts cascaded down and this covered approximately 250 staff at Barts. Additional doctors could be alerted to come in to assist the discharge of existing patients would also be accelerated. Some elective surgery would also be cancelled in order to free up space for emergency surgery. Arriving relatives would be looked after and hospital staff would also be supported. Support would by Barts and the London Chest Hospital in case of a major incident.
There would also need to be a recovery period following an incident. In the case of the July 2005 London bombings, all casualties were received within a three hour period but the recovery period while victims continued to be treated lasted for around three months.
The Trust also had a number of event-specific plans to cover issues such as the decontamination of patients or an influenza pandemic. There was also a hospital evacuation plan in case of an incident such as the fire at the Royal Marsden Hospital. Plans were also available to deal with fuel disruption, extreme weather etc. Business continuity plans would deal with situations such as the loss of key staff or the non-availability of utilities.
All emergency plans underwent a cycle of audit and review. Barts Health also planned its responses in conjunction with the wider environment such as Local authorities and other emergency services.
A recent incident had seen the trauma centre at the Royal London Hospital put on standby for the building collapse at the Apollo Theatre. The Trust also planned the health response for large scale events such as the Olympic Games and London Marathon.
3. Questions and Discussion
In the case of a major incident occurring in the West Essex area, hospitals would be nominated by the East of England Ambulance service. Notifications would also be received from the Essex or East of England health resilience structure.
If multiple hospitals were required to respond to an incident, NHS England would lead on coordinating the response. Hospitals would advise NHS England if e.g. their emergency department had become full and could not take any further admissions. The grading of incidents was based upon a four-stage scale set up by NHS England:
0 – Incidents affects the Trust only
1 – Incident dealt with within normal major incident procedures
2 – All hospitals in the area respond
3 - All hospitals in the region respond
High levels of A&E patient activity could be managed by the Trusts and A&E departments worked closely on this with the London Ambulance Service. Confirmation had recently been received of funding levels to deal with winter pressures on hospitals.
Barts Health confirmed that accelerated discharge would be planned with Councils and discharge people into community settings would also be supported.
The Committee NOTED the presentations.