Joint Committee on Draft Civil Contingencies Bill Minutes of Evidence

Examination of Witnesses (Questions 300-319)


21 OCTOBER 2003

Q300  Mr Llwyd: Such as?

  Mr Williams: Possibly the National Blood Service, medical gas supply companies or NHS supply companies. The reason is we have to be confident in our response, in our planning arrangements, that those services behind us can support us in the event of a long-term destructive challenge.

  Mr Kealy: From my perspective all of the duties that would be imposed on category 1 responders are undertaken by NHS organisations through general emergency preparedness working at the moment, to a greater or lesser extent obviously, so I certainly agree there is a case for categorisation as category 1. I am not sure whether it would make that much difference to the engagement of the response though because, as I say, it is already being undertaken perhaps through permissive powers at the moment, but the case would be I suppose that it provides a more formal statutory basis for undertaking those duties. That sounds a bit woolly, I am afraid—I am a bit ambivalent on this. I can see the case for it but I am not sure in practical circumstances how much difference it would make.

  Mr Pullin: As a footnote, if I may, I think it is worth pointing out the role and remit of foundation trusts when they come on-line, something that needs not to be forgotten in terms of emergency planning and statutory responsibilities.

Q301  Mr Llwyd: Is that if or when they come on-line?

  Mr Pullin: I am not in a position to comment on that!

Q302  Patrick Mercer: How far do you think the NHS already undertakes the duties required of category 1 responders under the draft Bill?

  Mr Kealy: To a large extent that already does happen. The work around risk assessment and planning, information sharing and actual incident response is all part of general major incident planning and emergency preparedness in SHAs, NHS trusts and PCTs. I suppose the issue is whether there is a uniform standard of engagement in those activities at the moment, and I suspect the answer is perhaps not right across the board but it is a formal part of the internal controls arrangements for NHS organisations to undertake each of those function.

Q303  Patrick Mercer: What contingency plans does the NHS already have in place?

  Mr Pullin: It covers a wide variety of headings. In terms of emergency planning, all acute hospitals, PCTs, strategic health authorities and ambulance services in general have a responsibility to have an emergency plan with escalation triggered within those plans, not only to look at health and safety within the community but in wider fields as well. So it is something we already have on board and we are revising those plans on a regular basis and we test them on a regular basis, not only with desk-top but with real exercises. You are probably aware of the recent exercise on London Underground which was just part of the system of exercises, and we are co-ordinating those across multi agency now, and that is the important development. So we have quite a lot of work already on board.

Q304  Patrick Mercer: Are there plans to carry out similar exercises—not table top, not command post exercises but like the Bank exercise that we saw?

  Mr Pullin: Absolutely.

Q305  Patrick Mercer: And outside London, or purely within?

  Mr Williams: Across the whole of the UK. From what I understand the Fire Brigade are leading a lot of these exercises but certainly in Wales we are taking part in a lot of similar exercises.

  Mr Pullin: The Bank Underground exercise received a lot of publicity, but a lot of exercises take place without public knowledge which are desk-top and real in terms of co-ordinating active services together in a unified approach. That is something that is often hidden from the public and may be a reassuring message to give out—that, in fact, exercises take place on a regular basis.

Q306  Baroness Ramsay of Cartvale: Could you tell us something about what you thought the role of the Mental Health Trusts might be in emergencies?

  Mr Kealy: I previously worked in a Mental Health Trust in Leeds and had emergency planning as part of my responsibilities there, so perhaps I could give a personal perspective on that. There are two main roles for mental health organisations: first, its own business continuity in the event of a large scale disaster affecting a whole community and I would expect mental health trusts to prepare for those eventualities and to have appropriate business continuity arrangements. A more specific duty for them is their role in post-incident response, rather than immediate response; it is about providing counselling and support to victims or those affected by major incidents in the aftermath. There is a developing expertise in mental health organisations around that function which focuses on not descending on the immediate aftermath of an incident but being available to provide more structured and co-ordinated support for the weeks and months after something has occurred, once psychological problems are becoming more apparent. That function of providing that psychological counselling and support is something that they undertake in concert with social services authorities, and probably voluntary sector organisations as well.

  Mr Williams: I agree with what Anthony says. It is difficult to think of a scenario whereby mental health would be involved directly as the consequence of an incident unless the incident was centred upon themselves, but in support of that incident they would be absolutely vital.

  Mr Pullin: The mental health trusts have quite a large estate in terms of opportunity for enhancing the capacity for the NHS to utilise, and there is also a very clear remit about the transfer of cases like forensic cases to ensure appropriate security of people who are actually patients within mental health institutions, and that is something that is part of the day-to-day responsibility of all mental health trusts anyway, but during a significant major incident those issues become very real because it might involve the transfer of patients from one side to another in pretty quick time, and that is something that mental health trusts are dealing with currently.

Q307  Mr Bailey: I believe in a reply to an earlier question Mr Williams said he thought the United Kingdom blood service should be incorporated in categories 1 and 2. Could you just confirm that in outline, and also whether the Health Protection Agency should be included as well?

  Mr Williams: Absolutely. As far as the blood service is concerned, we must be confident in our response that the support agencies behind the NHS, the main category 1 bodies as we have suggested, in their planning assumptions can rely upon and be confident that the blood service, for example, can support us. In terms of the Health Protection Agency within Wales and the National Public Health Service, the NPHS absolutely should be a category 1 responder, to my mind. Their role is vital in response to incidents that involve chemicals, biological agents and that type of incident, and if they are not included in that planning risk assessment phase, the initial requirements and duties placed upon the category 1 responders, I would suggest that if we had an incident possibly at a COMAH site then they would not be as well informed as they should be, and they would be possibly lacking in some knowledge or response.

  Mr Kealy: Picking up on the Health Protection Agency question in relation to England, we would see the HPA very much as an advisory body providing advice and expertise to the NHS organisations such as SHAs, primary care trusts and acute trusts who are in the operational line of control, and in that advisory capacity I am not sure it would be necessary for the HPA to be categorised as a formal category 1 or category 2 responder.

  Mr Pullin: Yes. I agree with Anthony's point. It is important to note that by this time next year the HPA will not be part of the NHS and their role and responsibilities need to be clearly defined as a consequence of that transfer.

Q308  Lord Lucas of Crudwell and Dingwall: I think you have covered the next question mostly which is to what extent outside organisations, particularly pharmaceutical companies, should be involved as category 2 responders if we get into a situation of a bio terrorist incident with some new infectious organism, and the French decide they really do not want us travelling abroad much, and presumably we will have to find resources in this country and the wherewithal to deal with the creation and manufacture of vaccines and the provision within this country of necessary medical supplies. Can you do that on your own, or do you need to have the active involvement of pharmaceutical companies to do that?

  Mr Kealy: I think it would certainly help to have the major pharmaceutical companies included as category 2 organisations. The difficulty I have is where do you draw the boundaries, which organisations would be included and which would not. That is an issue for the drafting of the Bill, of course, but I think there would be debate about who really needed to be included as a supplier with risks attached to the NHS and who would not. There is certainly a case for it.

  Mr Pullin: Yes, I agree. I think the problem is that the category 2 list would become neverending as a consequence, and I think it is worth noting also that there are emergency stores of mainline drugs around the country, both with the Ministry of Defence and the Ministry of Health, and it is something that the Department has access to on an as-required basis.

  Mr Williams: I support what my colleagues have said.

Q309  Lord Brooke of Alverthorpe: Do you think that central and regional tiers of government should be included as category 1 or 2 responders, and are there any organisations other than those you have mentioned already which you think should be included in category 1 or 2 and, if so, why?

  Mr Kealy: On the central government point, I do not think that would be necessary. Certainly from a health perspective in England we would be looking for the Department of Health to be providing direction and control and operational co-ordination in a very major incident at a regional or national level anyway, and whether or not that was covered by the statute I suspect would not make an awful lot of difference at all to the way we engage with them. As far as Department of Health is concerned, and probably other regional arms of government, it would not be necessary to categorise them.

  Mr Williams: Personally I do not feel well-informed enough to make a complete decision.

  Mr Pullin: We have to question the added value to adding people and organisations to categories 1 and 2. Certainly within London the NHS is part of the London resilience team and that is proving a useful forum on a multi-agency basis. The resilience organisations are mentioned in the Bill already and would work on the back of that, I would have thought.

Q310  Lord Brooke of Alverthorpe: Are there any startling omissions from the category 2 responders that you thought might have been there?

  Mr Kealy: Other than the ones we have discussed already, the possibility of drug companies and types of NHS organisation we have talked about, those are the only ones I would want to have a debate about in any further depth, but no major omissions.

Q311  Kali Mountford: From those responses, unless I have misunderstood, can I take it that you are not supportive of the idea of a national forum of emergency planning, and can you not see any circumstances where national planning would be useful in a major incident? We are thinking of the sorts of unthinkable incidents that perhaps would need co-operation across all sorts of boundaries, or are you absolutely confident that it can be maintained within the sector, with the lead group being in the department?

  Mr Kealy: I am sorry; it sounds as though I may have given the wrong impression.

Q312  Kali Mountford: I may have misunderstood you. Please correct me.

  Mr Kealy: I certainly feel there is a place for national co-ordination and national involvement in planning. I think the question I was answering was around whether government departments needed to be formally categorised as category 1 or 2 responders. That is a slightly different issue to whether there is a role for national organisations. I certainly feel there is definitely a national role for government departments in co-ordinating and planning and, as you say, perhaps even organising national forums for the sharing of best practice and ideas.

Q313  Kali Mountford: Is that where you see the limit, sharing best practice?

  Mr Pullin: Not at all. I think there is a real opportunity for multi-agency working along the lines of training programmes, for example. We have already mentioned exercise and testing on plans, and we realise that the NHS cannot and will not work in isolation in a major emergency and we need the co-operation and support of all the agencies, both the blue light services and beyond, and if there was a generic national structure to work within that could field it down to a regional level then I would be very supportive of that approach. Certainly that is something I know the Department of Health is working towards and all the other agencies are as well.

  Kali Mountford: I apologise for not listening properly!

Q314  Lord Bradshaw: In a hypothetical case where there are casualties in several places, does a mechanism exist for new emergency services to work together, and who is in charge of that sort of situation?

  Mr Pullin: The Department of Health has a director of operations remit and would co-ordinate on a national level as required, and probably through the Cabinet Office briefing room as well into multi-agency, if it was needed at that sort of level. Also, certainly within a pan London environment, the Metropolitan Police takes a very strong lead in co-ordinating the services, and there are well-established and developing mutual aid agreements across the country from organisation to service to organisation, which is bringing this together.

Q315  David Wright: At present can a strategic health authority or primary care trust call on resources from outside the affected area, or from the private sector, and who is in charge of the money needed to deal with an emergency? Could you particularly think about whether the current structures, the fairly new structures in terms of PCTs and strategic health authorities, are robust enough at present to tackle the issues that come up through this proposed bill.

  Mr Kealy: I think the new strategic health authority arrangements do provide for very clear command and control arrangements to mobilise and deploy NHS assets and resources to respond to a major incident or emergency. There are very clear mechanisms for co-ordination across SHA boundaries and that would be done with the support of regional directors of public health, for example, and very likely under the co-ordination of the Department of Health operations room. There is certainly clarity about who is in charge from an NHS perspective, and that does provide the ability to call on resources from outside an affected area, and I would envisage the Department of Health playing a very central role in facilitating that.

  Mr Pullin: The NHS has a very good history of mutual aid across regions anyway in terms of bringing equipment and staff in support; it is something we are particularly good at. Some of the boundaries may feel as though they are brick walls but in fact, when the incident is there, the walls do not exist and we do cross the boundaries very clearly in mutual aid.

  Mr Williams: From a Wales perspective we have been very active in catering for these arrangements. Across the six local health boards covering the North Wales area we have the overarching regional office. Should we have an incident that requires the co-ordination of those six LHBs the regional office would obviously take the lead and there are mutual aid arrangements in place to co-ordinate an arrangement.

Q316  Mr Allan: Could you tell the Committee how much organisations currently spend on contingency planning?

  Mr Kealy: That is a most difficult question to answer, as I am sure you will not be surprised to hear!

Q317  Mr Allan: What kind of resources are dedicated to it?

  Mr Kealy: If I can speak to my own SHA, the main resource commitment is in opportunity cost, the time of senior managers and other members of staff who contribute to emergency preparedness arrangements—that is people's time spent in table-top exercises, in live exercises, in training and in general discussion and normal management activity related to this area. I think the indicative costs outlined in the regulatory impact assessment that was published with the Bill are in the right ballpark as far as we are concerned. Actual expenditure is probably only really visible in ambulance trusts and acute trusts in their role around dealing with de-contamination and that kind of thing, so it is the opportunity cost that I think we are looking at mainly at the moment.

  Mr Williams: From the ambulance service perspective, the Welsh ambulance service is a national organisation and it is very difficult to pinpoint how much we spend. It is soaked up into normal operational streams, but a rough estimate would be in excess of £150,000 a year based on three full time emergency planning officers, and takes into account all the exercises and the other activities we get involved in.

  Mr Pullin: As director of emergency planning for London I think I am obliged to say "not enough", which would be the obvious answer! Certainly there is a history of emergency planning being an add-on extra to people's general day jobs. That has changed over the last couple of years and since we have been trying to mainstream this has meant planning more and more into organisations. Trying to find the money to support that is proving difficult, but it is a case of re-allocating resources within the baseline appropriately, and that is something taxing all financing directors across the NHS. Certainly within London I am fortunate; my post has been funded through the five strategic health authorities to bring it together, and that is something we are hoping to bring out on a strategic health authority basis to ensure there is at least a full-time officer pulling together the strategy enabling it to be put into operational practice. But we certainly need to spend more time on this.

Q318  Mr Allan: And the regulatory impact assessment with the Bill suggests that policy objectives will be achieved without imposing any significant new burdens on private or public sector organisations. Looking at Part 1 of the Bill and the contingency planning requirements contained within it, could you take on those new duties without significant additional resources?

  Mr Pullin: I think that would be a challenge.

  Mr Williams: Absolutely, I have to agree. We would find it very difficult.

  Mr Kealy: I agree it is challenging, although I do not feel it would necessarily be a major additional burden on the strategic health authority or primary care trusts or NHS trusts in the area I work in.

Q319  Mr Allan: You would have to be creative?

  Mr Kealy: Absolutely.

  Chairman: Thank you very much indeed. You have given us very disciplined responses.

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