The Regular forces
- A question not answered by the discussion document on the role of the Reserves is whether in fact regular forces would be deployed if a call was made on a Reserve Reaction Force when suitable regular forces were available. We find it hard to believe that, in the event of a major terrorist incident, the regular army would remain in barracks while a force of Reserves assisted the emergency services.
- We accept that a commitment that a comparable number of regular forces would also be available in each region would impact on military planning and training. A requirement to be available at short notice would be, at least, an inconvenience to the troops concerned. On the other hand to be placed in a situation where in a crisis a reserve force was called on ahead of them might prove even more frustrating. And, if it turns out that the Reserve Reaction Forces are in fact only called upon when there are no regular forces available, that could be equally demoralising to those who have volunteered, and trained, for those forces.
- The Secretary of State in his response to the Public Spending Review announcement, said
Before the summer recess, I will publish a White Paper, on the New Chapter to the Strategic Defence Review, setting out how we plan to adjust defence capability in the light of the sorts of threats that we saw on 11 September.
We believe that this should include a commitment to making available, in the context of a terrorist incident, certain capabilities from the regular Armed Forces. These might include specific capabilitiesfor example in the CBRN fieldon a national basis as well as more general assistance at a regional level. The commitments from the Reserves and Regulars taken together should meet as far as possible the skills and capabilities required by the civil authorities, who should be closely involved by the MoD in identifying those skills and capabilities.
- These forces should not only be land-based. A major disaster on the scale discussed in this report could seriously obstruct surface transport, either by its direct action or as a consequence of large numbers of people trying to leave the area. We recommend that the MoD identify what provision of airlift capacity, both fixed-wing and rotary, can be committed to the response to a major terrorist incident. Tasks could include casualty evacuation, moving of heaving lifting equipment, insertion of civilian and military reinforcing personnel and the provision of medical and other supplies. The geographical location of these assets, their guaranteed availability and response times should be made available to the relevant civil authorities so that they can plan for their effective and co-ordinated use in times of crisis.
Military civil liaison
- The arrangements for military-civil liaison at the regional level were set out in the MoD's memorandum
MoD Joint Contingency Planning and liaison with the relevant emergency services and local authorities is the responsibility of the Army Regional Brigade Commander. He fulfils his liaison responsibilities through a Joint Services Coordination Group, which meets regularly to consider issues relating to emergency planning and the provision of military assistance (from all three Services) to the civil authorities. This group includes representative from members of the following organisations:
- The Army Regional Brigade
- The Royal Air Force (Regional Liaison Officer)
- The Royal Navy
- The Fire Service
- The Police
- Local Authorities (emergency planning teams)
- Although we have had some evidence that in the past these liaison arrangements have not been consistently applied, we were assured that the system 'got a wake-up call because of foot-and-mouth and has received another wake-up call in the aftermath of 11 September'. Nonetheless the MoD's Director-General, Operational Policy, still did not believe that all the arrangements for local liaison were satisfactory. It was, he said, 'an area where there needs to be improvement.' We note, for example, that there seems to be no provision for regular attendance by the ambulance service.
- Neither the MoD nor the Armed Forces are mentioned in the emergency planning review and the MoD did not contribute to the consultation process, although seven other government departments did. We were told that the MoD was consulted before the document was published and were content with the document as it emerged. They had not contributed to the consultation because 'the consultation exercise was aimed principally at local authorities, to seek their views on their greater involvement in the emergency planning process rather than being aimed at the MoD or any other organ of central government.' This is nonsense, as is demonstrated by the breakdown of responses to the consultation published in the Cabinet Office's Results of the Consultation. We regret the absence of any reference to the contribution of Armed Forces in the Emergency Planning Review consultation paper and the failure of the MoD to engage in the consultation process.
- If arrangements for local liaison are to improve there must be greater engagement by the MoD and the Armed Forces with the local agencies. We are aware that the Armed Forces exercise jointly with the emergency services already. We welcome this and believe such exercises should be increased and should include other agencies as well.
Chemical, Biological, Radiological and Nuclear
- In the Threat from Terrorism we concluded
There is also an increased risk that terrorists may turn to weapons of mass destruction. We have inquired into the possibility that they might obtain chemical, biological or nuclear or radiological weapons. There is evidence that terrorist organisations, including al Qaeda, have been trying to obtain such materials. We can see no reason to believe that people who are prepared to fly passenger planes into tower blocks would balk at using such weapons. The risk that they will do so cannot be ignored.
- Events since then have reinforced this view. We have particularly noted the evidence of US Secretary of State for Defense, Donald Rumsfield to a Senate Subcommittee
...we have to recognise that terrorist networks have relationships with terrorist states that have weapons of mass destruction, and that they are inevitably going to get their hands on them, and they would not hesitate in using them. That's the world we live in.
- In our earlier report we discussed some of the routes by which terrorists might obtain such weapons and some of the specific agents which they might use. It is important to recognise that the characteristics of terrorist attacks using chemical, biological or radiological agents respectively could each be very different. A radiological release from a dirty bomb would, initially, have many of the characteristics of a conventional explosion. It might be some time before radiological contamination became apparent. An attack with a chemical weapon might be identified by the smell of the agent, if any. Otherwise the appearance of symptoms might be the first evidence. The sarin attack by the Aum Shinrikyo cult on the Tokyo underground demonstrated how much panic can be caused by even a relatively unsuccessful chemical attack. A biological attack might be rapidly identifiedif for example a visible agent was used, such as the anthrax spores sent through the post in the United States. On the other hand it might only become apparent over time in the same way as a naturally occurring epidemic would be identified.
- Consequently the first response to a CBRN attack may not rest with the usual emergency services
If we think of the CBRN response, if you talk about an explosion, yes, the Ambulance Service is the frontline service, but if we are talking about an infectious disease it is not the Ambulance Service, it may be the Primary Care Sector, it may be the Accident and Emergency Department, it may be the infectious disease consultant. Similarly with chemical and radiological incidents, there are a number of different players who might be the front-line response.
This unpredictability reinforces the need for effective co-ordination amongst all those who might be involved.
- Dr Pat Troop, Deputy Chief Medical Officer, stressed the need for co-ordination across the health service. She described two major structural developments which she believed would contribute positively to this. Firstly the creation of a new Health Protection Agency through the amalgamation of the Public Health Laboratory Service, the National Radiological Protection Board, the Centre for Applied Microbiology and Research, and the National Focus for Chemical Incidents and secondly, the reorganisation of the health service under which responsibility for emergency planning would fall to the new Primary Care Trusts.
- In January 2002 the Chief Medical Officer's report Getting Ahead of the Curve: A strategy for combatting infectious diseases was published. The focus of the report was on the natural occurrence of infections, but it did also address the prospect of the deliberate release of infectious agents. In its section on terrorism, the report described the position before 11 September
By the middle of 2001, most planning to protect the public health against the deliberate release of biological or chemical agents or radioactivity had:
- Included consideration of the use of such agents in warfare which could affect both troops and civilians.
- Assessed the challenge of creating an infectious agent for deliberate release as an aerosol as technically very difficult
- Acknowledged the possibility of an attempt to infect or poison large numbers of people by the deliberate release of such agents but considered it unlikely to be successful.
It went on
The terrorist attacks on the World Trade Center in New York City and the Pentagon in Washington DC on September 11th 2001 and the cases of anthrax amongst office and postal workers in the USA during the autumn of 2001 have led to revisiting of these assumptions.
The possibility of a much more extensive terrorist operation, the absence of a specific warning, the deployment of terrorists who have no fear for their personal safety or survival, and the use of multiple simultaneous points of attack must now form part of the planning for countermeasures to protect the health of the population against deliberate release.
This planning is taking place and will need to become increasingly sophisticated as vulnerabilities are identified and countermeasures designed.
Health Protection Agency
- The principal recommendation of Getting Ahead of the Curve was the creation of the new Health Protection Agency referred to above. The agency will have a number of functions. It will be the centrepiece of 'an integrated health protection infrastructure.' Its expertise will extend beyond infectious diseases to include responding also to chemical and radiological releases. In the words of the consultation document on its creation published on 12 June this year
The Government believes that a unified agency will be able to provide more effective services for health protection and health emergency planning than can be achieved under the current, more fragmented arrangement.
- The principal functions of the four bodies being brought together in the new agency, which are relevant to the response to a terrorist incident, include
Public Health Laboratory Service
- infectious disease surveillance, co-ordinated by the Communicable Disease Surveillance Centre, which also provides support to local services for threatening outbreaks of infectious disease.
Centre for Applied Microbiology and Research
- expertise in handling infectious disease and in research, development and manufacture of related products for human use (eg vaccines).
- the development of a strategic response capability to provide a mechanism to identify, assess and respond to the threat from emerging and re-emerging infectious diseases as well as outbreaks arising from deliberate release.
National Focus for Chemical Incidents
- an on-call service for collecting, collating and integrating data from chemical incidents; NFCI also promotes best practice on handling chemical incidents.
National Radiological Protection Board
- advice to government and others on the protection of people against radiation hazards and co-operation with a variety of organisations to ensure emergency preparedness in case of radiological or nuclear accidents and incidents.
The new Agency's core functions will be:
- surveillance of infectious disease and of chemical and radiation hazards
- support for services provided at local level, principally through assistance to the primary care trust
- advice and support at the national level, for example on health emergency planning policy.
One of the benefits of bringing together the existing bodies will be to provide 'some read-across particularly in terms of emergency response where there is a horizontal issue that the radiation area is working very closely with chemical and with micro-biological.'
- Emergency planning in the CBRN field has been given a much higher profile and an increased urgency by the attacks of 11 September and the subsequent anthrax incidents in the United States. That has been reinforced by evidence from the military campaign in Afghanistan that al Qaeda was seeking to develop capabilities in these areas. But whereas in other areas the scale of 11 September has required fundamental re-appraisal of emergency response arrangements, that has not been the case in the same way in the CBRN field. As Dr Troop told us
We have emergencies of all sorts all the time, we have a lot of chemical incidents to which we have to respond and we have infectious disease outbreaks. We have to plan for a flu pandemic which would be just as devastating.
Consequently they believed that the efforts which they were already engaged upon before 11 September were reinforced rather than challenged by 11 September.
- We understand the validity of this approach in respect of the biological incidents and, also largely in respect of chemical incidents, but we are less convinced in the nuclear and radiological fields (see paragraph 127 above).
- We welcome the proposed creation of the Health Protection Agency. We have noted, however, that there are no proposals to provide any additional resources. Dr Troop told us, 'when we put these agencies together there will be some significant savings ... and that ... additional funding will be re-deployed to front-line services.' The consultation document stated 'we expect the changes to be neutral in terms of public expenditure overall ... We expect the creation of the agency to make it possible to use the funds already spent on these services more effectively.' We support the effective use of resources, but we also note that the new Agency's functions are likely to expand as it builds on the best practice of each of the component bodies. We also note the role expected of Agency staff in glueing together the different tiers of emergency planning responsibility in the health service and in providing expert advice and, when required, additional surge capacity to local services.
Local health services
- Previously emergency planning responsibilities rested with the health authorities, but the National Health Service Reform and Health Care Professionals Act 2002 provides that the existing 99 Health Authorities will be merged into around 30 Strategic Health Authorities. Responsibility for emergency planning will be devolved to the Primary Care Trusts. We were concerned that the Primary Care Trusts, having many other new responsibilities, might not be in a position to focus immediately on emergency planning matters without some outside assistance. Dr Troop told us
We have written to all the Primary Care Trusts, advising them that they are taking over the responsibility for emergency planning, but ... as the Primary Care Trusts are in a state of developmentmost of them have got their chief executives but not all of them have appointed their Directors of Public Healthin the next few months the strategic health authorities and the Regional Directors of Public Health must ensure that there are plans in place in each health economy... and will be handing it over but ... in an orderly way to those Primary Care Trusts.
- Additional responsibilities are likely to require additional funding. In his Budget Statement in April 2002 the Chancellor of the Exchequer announced a five-year financial settlement for the health service under which cash spending would grow from £65.4 billion to £105.6 billion in 2007-08. The Chancellor described this as 'even after inflation, a 43 per cent rise over five years.' These increases, however, are tied to the delivery of the NHS Plan, which the Secretary of State for Health announced the day after the Budget Statement. Dr Troop told us
... the NHS was allocated a large volume of resources, but it will be up to ministers to decide precisely how that is deployed. We have set out the framework of all the guidance and the requirement of the NHS, and we have had a number of discussions with ministers about the relevance of different resources. We have received some additional resources over the last few months and we hope that that will continue over the following months.
- If all Primary Care Trusts are to have emergency plans in place by October, they will need considerable assistance not only from the strategic health authorities and the Regional Directors of Public Health but also from other agencies. If those plans are to be effective they must be co-ordinated with the plans of local authorities, the emergency services and others. In particular they must be prepared in close liaison with the local ambulance trust. We understand that the NAO is currently conducting an inquiry into emergency planning in the NHS. We look forward to their report. We recommend that the Government report progress on the PCTs' preparation of emergency plans and the arrangements for including the ambulance service in that process in their response to this report.
Personal protection and mass decontamination
- The Ambulance Service Association identified staff protection and the provision of personal protective equipment as areas of major concern. The London Ambulance Service, for example, aims to have 150 staff trained 'to deal with the front end of a CBRN incident' by July/August this year. Lessons learnt from the 1996 sarin attack on the Tokyo underground have meant that London is further ahead in its preparations than other parts of the country. The Chief Executive of the London Ambulance Service believed that their remaining weaknesses related to sustaining a response to 'a large long term incident.'
- Elsewhere, the picture is more variable. The Ambulance Service Association told us that after 11 September
One of the things we are clear needs to change is our approach to major incidents, which was very locally based ... Particularly for a chemical incident, any mass decontamination, we are going to have to rely much more on a national doctrine, national standards, national commonality of equipment, so teams from Essex can come into London after 40, 45 minutes to take over the decontamination, because people can only work in equipment for 30 minutes or so.
Currently ambulance service personal protective equipment allows working in what is known as the 'warm zone' (ie not the highly contaminated centre of the incident which is the 'hot zone'). It affords general protection against most contaminants (ie chemicals) but not biological agents.
- In December 2001 a Memorandum of Understanding was agreed between the Departments of Health and of Transport, Local Government and the Regions (as it then was) which set out the arrangements for co-operation between the Fire Service and the Ambulance Service if mass decontamination of the public was required. When we took evidence from Chief Fire Officers in April work was still in progress to design a system for mass decontamination. Funding had been allocated by the DTLR (some £53 million). An additional bid for £217 million had been made to the Capital Modernisation Fund. This bid included the provision of the equipment and training necessary to fulfil the Fire Services new mass decontamination responsibilities; protective equipment for fire fighters who might be called upon to respond to a CBRN incident; search and rescue equipment; and some specific additional requirements for London. In April the messages which the Fire Service was 'getting back from the Treasury [were] not positive'.
- If ambulance and fire crew are expected to respond to a CBRN incident, they must have the necessary training and protective equipment. Now that there is a real threat of a CBRN attack on a scale not previously planned for, the Government must provide the additional resources needed. We were pleased to hear that progress was being made with the introduction of properly constructed decontamination facilities. We look to the Government to ensure that the resources are available to build on this beginning.
- The Deputy Chief Medical Officer described the Government's policy on providing information on the countermeasures which it might have taken against the CBRN threat as follows
The approach we have had all the time with our countermeasures, before and since 11 September, is to always indicate that we do have a range of medical countermeasures and that they are kept under review. The details of the volume and the place of those we have not indicated. It was considered that was information which would be of help to those who might wish to do us harm.
The Government's decision to procure stocks of smallpox vaccine earlier this year, however, found its way into the public domain.
- Principally this was because the Department of Health, instead of openly tendering for the vaccine, made confidential approaches to five companies. This procurement seems then to have entered the public domain in part because some of those involved were unhappy at the conduct of the negotiations for the contract. One of the companies involved told us that it was 'prevented from commenting on the detail of the UK procurement of smallpox vaccine as it is bound by confidentiality agreements with both the Ministry of Defence and the Department of Health'.
- In the event much of the detail of the contract has become public. The two matters which the Government seem to have particularly wanted to have kept confidential were firstly the price of the vaccines on the grounds that it was commercially confidential and secondly the number of vaccines procured. We understand that the National Audit Office is conducting an inquiry into how the Department of Health conducts procurements of this sort. We await the outcome of that inquiry with interest.
- We believe, however, that the Government should reconsider its policy of not providing information on countermeasures. The United States Government conducted a similar procurement exercise through open tender. It may be that precise stock levels should not be published but we believe that the public has a right to know, to an indicative level at least, what provisions the Government has made for its protection. We are not persuaded that such information would materially assist terrorists.
- To manage the successful co-ordination of the response to a major disaster or emergency is by no means straightforward. Recent examples in the UK have all demonstrated the difficulties. Deficiencies in central Government's capabilities in this area were a major factor in the Prime Minister's decision to establish the CCS.
- We have discussed the arrangements that are in place between the emergency services and we have looked at the role of central government. We have examined the need to clarify the responsibilities of the many agencies who have a role. The Government, however, also envisages a greater role for a regional tier. The White Paper, Your Region, Your Choice: Revitalising the English Regions states
It would be appropriate for elected assemblies to take on the main co-ordination role in regional contingency planning, working closely with the Government offices [of the Regions]. This will be reflected in the work being undertaken in the Emergency Planning Review to define an enhanced role for the Government offices in the regions without an elected assembly.
- According to the Cabinet Office's analysis of the consultation process on the emergency planning review
Many respondents with experience of wide area emergencies say they would welcome a greater, predictable and pre-planned role for GORs [Government Offices of the Regions] and central government departments in response arrangementsparticularly in supplying physical resources and expertise when necessary.
The analysis does not, however, indicate what proportion of respondents were of this view, nor who they were.
- We have discussed the moves by the Department of Health, which is transferring responsibility for emergency planning to the primary care trusts (PCTs), to place a co-ordinating responsibility on the Regional Directors of Public Health, particularly in the transitional period of the next few months. Additionally the Department of Health is introducing 'strong regional public health groups, co-located in the Government Offices of the Regions [which] will have important functions in ensuring protection of health across each region including emergency and disaster planning and management'. There are also Regional Emergency Planning Advisers who will be able to provide advice and assistance to PCTs putting together their emergency plans.
- These arrangements appear complex and overlapping. They might suggest that the Department of Health is not entirely convinced that giving the principal responsibility for emergency planning in the health service to the PCTs will naturally lead to a seamless and effective provision. And as we have previously noted, we are not clear how the ambulance service will be involved in the preparation of the plans.
- The next few months will be a time of considerable flux in the health service as the wide-ranging re-organisation introduced by the National Health Service Reform and Health Care Professions Act is implemented. A major responsibility will fall on the Regional Directors of Public Health to ensure that PCTs have adequate emergency plans in place by October 2002, and that these have been prepared in co-ordination with other agencies, including in particular the ambulance service.
- The MoD's proposal for Reserve Reaction Forces envisages those forces being structured on a regional basis and includes enhancements to regional headquarters in a crisis. In most of the country army regions are coterminous with GOR boundaries. Where they are not, in one case, one army region covers two government regions and, in the other, two army regions cover one government region.
- Taken together these developments clearly indicate that the Government expects the regional tier to play a significant role in co-ordinating emergency planning and consequence management. What is not clear is to what extent that co-ordinating role might develop into directing or leading the response to a wide-spread or large scale emergency. That role may also be different where there is an elected regional assembly (ERA). The emergency planning role for ERAs 'reflects and will build on the key responsibilities ERAs will have for taking a stratetgic lead for the region, for ensuringthrough their executive and influencing rolesthat strategies are implemented, and for joining up the many partnerships which have already developed at regional level'.
- A strong regional tier with clear responsibility for co-ordination would potentially bring many benefits. It was supported by CACFOA in their response to the emergency planning review. In Your Region, Your Choice, the Government states
We recognise that decisions made at the regional level can take better account of the unique opportunities and challenges faced by an individual region. This can lead to improvements both for the region in question and the country as a whole.
- ACPO, on the other hand, was more sceptical. Their response to the emergency planning review stated
It is difficult to see a valid role for regions; to date any attempt by regional offices to become involved in emergency events has led to confusion and another step in a communication process which can be managed better if direct from local to central government. Roles and responsibilities can be clearly defined and included in legislation.
- Deputy Chief Constable Goldsmith also argued that 'regions can perhaps be too large'. That view was supported by the LGA: 'some of the regions are relatively large and may start to suffer some of the diseconomies of scale, and they suffer some of the difficulties in understanding local circumstances'.
- We have already recommended a strengthening of central government's role. Elected regional assemblies are still some years off. In the meantime the Government Offices of the Region will continue to be seen as part of central government. There may be a role for a regional tier in assisting with the co-ordination of the response to a civil emergency of wide geographical extent. But we believe that a major terrorist incident will require the direct and continuing involvement of central government including direct and close communication with the local agencies. If the Government believes that its contribution can be best delivered through GORs or other regional agencies it must ensure that their efforts are co-ordinated with and supportive of the work of local and emergency agencies.
336 Ev 36 Back
337 Q 390 Back
338 Q 391 Back
339 Q 410-2 Back
340 Q 410 Back
341 Op cit Appendix A Back
342 Op cit summary Back
343 Testimony at Defense Subcommittee of Senate Appropriations Committee, 21 May 2002 Back
344 Q 1017 Back
345 Q 1030 Back
346 Op cit, para 1.6 Back
347 Q 1041 Back
348 Q 1030 Back
349 Q 1034 Back
350 Op cit, paras 6.3 and 6.4 Back
351 Q 1042 Back
352 Q 1017 Back
353 The 2002 Spending Review did not add further resources for health previously announced in the Budget. As with all departments, however, the Spending Review set out budgets in resource terms, and for the NHS the Budget figures on a resource basis were £109.4 billion by 2007-08 from £68.1 billion in 2002-03-a similar percentage increase as for the increase in cash provision (see 2002 Spending Review, Cm 5570, p69). Back
354 HC Deb 17 April 2002, Col 592 Back
355 Q 1028 Back
356 Ev 174 Back
357 Q 922 and Q 925 Back
358 Q 925 Back
359 Q 930 Back
360 Q 972 Back
361 Q 1125 Back
362 Q 1128 Back
363 Q 1127 Back
364 Q 1065 Back
365 Ev 310 Back
366 Q 1074 Back
367 Q 1076-7 Back
368 Op cit para 4.56 Back
369 The Future of Emergency Planning in England and Wales: Results of the Consultation, para 33 Back
370 Ev 201 Back
371 Ev 284 Back
372 Q 1120 Back
373 Op cit, p 9 Back
374 ACPO comments on "The Future of Emergency Planning in England and Wales", p 8 Back
375 Q 1160 Back
376 Q 572 Back