Examination of Witnesses (Questions 300-319)|
21 OCTOBER 2003
Q300 Mr Llwyd: Such
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 afraidI 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 exercisesnot table
top, not command post exercises but like the Bank exercise that
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 outthat, 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
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
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
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
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
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 arrangementsthat 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
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
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.