Resource Escalation Action Plan - REAP · PDF fileResource Escalation Action Plan - REAP ... numerical escalation levels referred to in other agency documents throughout the

NWAS Resource Escalation Action Plan (REAP) Page 1 of 34

Author: Service Delivery Version: 5.0

Date of Approval: 23/10/13 Status: Approved

Date of Issue: 24/10/13 Date of Review: 30/09/14

Resource Escalation Action Plan - REAP

VERSION 5.0





Recommended by Service Delivery

Approved by Executive Management Team

Approval Date 23/10/13

Version Number 5.0

Review Date 30/09/14

Responsible Director Acting Director of Operations

Responsible Manager (Sponsor) Director of Resilience

For use by All Trust Employees and NHS Partners





CHANGE RECORD FORM

Version Date of change

Date of release

Changed by Reason for change

4.0 14/03/12 14/03/12 P. Kudray Approved

x4.1 12/06/13 19/06/13 D. Winchester Annual Review

X4.2 27/08/13 27/08/13 P. Kudray Continuing annual review

X4.3 08/10/13 08/10/13 P. Kudray Final Draft

5.0 24/10/13 24/10/13 P. Kudray EMT Approved





Contents

Foreword .................................................................................................................................... 5

Introduction ............................................................................................................................... 6

Background ................................................................................................................................ 6

Intention..................................................................................................................................... 6

Links to Associated Plans ........................................................................................................... 7

NHS North of England ................................................................................................................ 7

NWAS Regional Operational Coordinating Centre (ROCC) ........................................................ 8

NWAS Major Incident/Operational Management Suites (formally AOCC’s)............................. 8

National Considerations ............................................................................................................. 8

National Ambulance Coordination Centre (NACC) .................................................................... 8

Actions ....................................................................................................................................... 8

Key Triggers ................................................................................................................................ 9

Executive decisions .................................................................................................................. 13

Intelligence gathering .............................................................................................................. 13

Co-ordination and Assessment of Information ....................................................................... 14

Structure .................................................................................................................................. 14

Schedule of Meetings .............................................................................................................. 15

Directorate/Department Business Continuity Situation Report (Sitrep)................................. 15

Appendix 1 - Resource Escalation Action Plan – Level Cards .................................................. 17

Appendix 2 - REAP Trigger Matrix Summary ........................................................................... 33

Appendix 3 - REAP ACTION CARD





Foreword

The NWAS Resource Escalation Action Plan - REAP (hereafter ‘the Plan’) provides the Trust with a structured set of considerations and arrangements to assist in Business Continuity Management (BCM).

The Plan is based on a national formulation and has been in place in NWAS since early 2008 in line with a staged roll out across the Ambulance Services in England; each Trust having its own local triggers in their own plan but common escalation indicators.

Lessons identified and subsequently learned since the introduction of this plan and experiences of its invocation have been incorporated into this current version of the NWAS REAP.

Effective BCM and associated Business Impact Assessments (BIA) enable the identification of key critical functions and the supporting, dependent structures to deliver those activities. In doing so, it allows all Trust staff to be aware of the hazards, threats and risks to the critical functions and supporting structures, in terms of how to respond to and recover from, ‘disruptive challenges’, such as a significant loss of staff, buildings and resources.

The Plan is directly linked with similar arrangements in all other Ambulance Services across England and it is designed to ‘be informed’ by any disruptive challenges and ‘to inform’ the Trust and wider NHS of the pressures applied to the organisation at any time. The considerations and actions contained within ‘the Plan’ are designed to assist in protecting staff, patients and the organisation and should be viewed as guidance in challenging situations.

Individual considerations should be applied in terms of their relevance to the disruptive challenge with, where practicable, the relevant elements being acted upon to enable the Trust to deliver core functions and recover within the time period stipulated within the organisations relevant business continuity plan or another agreed period of time.

Any changes to ‘the Plan’ levels will be communicated across the Trust and to relevant stakeholder agencies through existing and established processes in addition to Trust wide alerting notices placed on all stations and other core sites. The REAP Action Card which has been developed to assist in mitigating any associated risks of escalation requirements and actions, is based around the National Decision Model (NDM) enabling a consistent and evidence based record of all decisions and actions made to continue core services during disruptive challenges.

The NWAS REAP was developed in conjunction with the Trust and Staff Side representatives and will be subject to annual audit and review under the Trust’s Resilience Programme.





1. Introduction

1.1 This Plan has been developed to provide NWAS with a structured set of arrangements and guidance when ‘normal’ operating functions are challenged, either through loss of staff, resources or external operational pressures.

1.2 The Plan was originally developed with the assistance of individuals with a wide range of expertise and is subject to periodic peer review as part of its annual update process.

2. Background

2.1 The REAP arrangements are designed to support the principles of whole system resilience (NHS) against disruptive challenges and both internal and external operating pressures. It will enable the processes of mitigation, preparedness, response and recovery to take place alongside supporting plans and arrangements through effective and appropriate consequence management steps.

2.2 The potential for significant service or business disruption in the modern world is ever present and the Trust as part of the wider NHS is required to ensure that it has suitable, robust arrangements in place to cope with disruptive challenges that may affect the core business delivery and functions.

2.3 The Civil Contingencies Act 2004 (CCA) provides legislation to ensure robust emergency preparedness, including BCM. The Health and Social Care Act (2012) and the more recent introduction of the NHS England, Emergency Preparedness, Resilience and Response (EPRR) Framework have both changed the landscape of health services in England and it is within these structures that this plan operates.

2.4 Through the increasing use and reliance on technology and complex systems to deliver core business functions, the risk of ‘system failure’ or overload augments the need to ensure adequate and reflective escalation procedures are established, to enable the Trust to respond to such challenges whilst having supporting plans in place to facilitate suitable recovery to a ‘new normality’.

3. Intention

3.1 It is the intention of NWAS to maintain a commitment to the provision of the highest level of safe patient care to the public of North West including times when it is experiencing capacity pressures and periods of high demand. The Trust core value of delivering the right care, at the right time, in the right place underpins the rationale of this plan.

3.2 This commitment is critical for the Trust to maintain public confidence and the good reputation of the Service. During periods of challenge to performance, quality or safety, NWAS will consider a variety of strategic and tactical options that are most





suitable to deal with the situation.

3.3 It is recognised that the organisation is measured against many other performance targets outside of response times and the requirement to achieve these has to be managed and balanced against each other. Consideration of the potential impact on performance in other areas will be made during the implementation phase of this plan.

3.4 To assist in the effective management and implementation of this plan for a given period of pressure, a sample NWAS Gold Commander ‘Statement of Intent’ (Appendix 4) outlines the key strategic considerations to be taken.

4. Links to Associated Plans

4.1 The Resource Escalation Action Plan is intrinsically linked to the following plans and arrangements:

NWAS Major Incident Response Plan

NWAS Business Continuity Departmental Plans

NWAS Pandemic Influenza Plan

Five Local Area Teams (LAT) - Contingency Planning and Recovery Arrangements

NHS England (North) - Contingency Planning and Recovery Arrangements

Five Local Resilience Forum Contingency Planning Arrangements

DCLG Resilience & Emergencies Division (Northern) Planning and Recovery Arrangements

NHS England Emergency Preparedness, Response and Recovery (EPRR) arrangements

National NHS Contingency Planning and Recovery Arrangements

National Ambulance Contingency Planning and Recovery Arrangements 5. NHS North of England

5.1 This REAP will feed into the existing and developing NHS North of England escalation policies and procedures to enable the assessment of current and predicted pressure levels. Equally, in escalating the NWAS Plan, consideration should be given to the pressure levels experienced across the region such as bed capacity.

5.2 In considering the content of this plan, recognition should also be given to the escalation arrangements of each LAT and individual Acute Hospital Trusts. The numerical escalation levels referred to in other agency documents throughout the wider health economy are not necessarily indicative of similar levels of pressure as the internally set criteria are likely to differ from the National Ambulance REAP levels.

5.3 Individual NWAS Gold and Silver Commanders should ensure that they are familiar with the different escalation arrangements which may exist in those Trusts that they deal with on a regular basis.





6. NWAS Regional Operational Coordinating Centre (ROCC)

6.1 The NWAS ROCC will provide oversight and scrutiny on a day by day basis of both regional and national challenges; this includes assessment and appropriate communication cascade of such information as national changes in other Ambulance Service REAP reporting.

6.2 The coordination and communication of NWAS Command & Control resources may be facilitated and supported through the ROCC; ensuring that a timely, accurate, resilient and robust response is provided and BCM arrangements are considered as early into the incident or event as possible.

7. NWAS Major Incident/Operational Management Suites (formally

AOCC’s)

7.1 The NWAS Major Incident Suites are located within EOC’s facilities – separate to the main Dispatch and Call Centres. They will be established when EOC’s require Operational Management support during an incident, event or challenge.

7.2 The facility will be resourced from within the cadre of staff utilised for command role functions. They will be responsible for ensuring that the tactical coordination of the response is managed effectively; allowing EOC staff to focus on core responsibilities.

8. National Considerations

8.1 Information and intelligence from a national perspective (such as Pandemic Influenza, significant challenges and mutual aid requests) will also require assessment during escalation considerations.

9. National Ambulance Coordination Centre (NACC)

9.1 The Ambulance Services of England, in partnership with the Devolved Administrations of Scotland and Wales have developed the capacity to operate a National Ambulance Coordination Centre (NACC) to both collate data and inform early warning systems in terms of pressures across the UK and to assist in the provision and delivery of mutual aid requests to support extreme demands. This facility proved to be a particularly significant resource during the Olympic Games period in 2012 and can be stood up on request to meet specific challenges.

10. Actions

10.1 The options that may be considered are identified in Appendix 1. These considerations provide guidance to the command structure and teams when taking appropriate actions to support service delivery and general ‘critical’ business functions.

10.2 In assessing potential actions to mitigate pressure which are covered under the NWAS REAP, it is essential that the National Decision Model (NDM) is used and the REAP Action Card is followed. This will ensure consistency in the decision making





process and allow the risks of any action or suspension of activity to be considered. 11. Key Triggers

11.1 The triggers below will apply; each trigger has several elements. When sufficient elements exist, the trigger is activated (See Section 6). Each trigger causes an escalating level of ‘the Plan’ to be activated.

11.2 Some of the elements are measured against statistical data and is activated when the data differs considerably from the ‘normal’ accepted value.

11.3 In addition to the key elements, any failure of mission-critical or support infrastructure/departments may also trigger any of ‘the Plan’ levels. When taking action in this Plan, senior managers must refer to the Trust’s Business Continuity arrangements and follow the NDM linked to the REAP Action Card.

11.4 The key trigger points will be subject to regular review and associated to changes in national policy, service structure and business operation and external factors.

11.5 The Gold Commander is responsible for escalating ‘the Plan’. However, in some circumstances the escalation of ‘the Plan’ maybe initiated through the Trust’s Executive Management Team (EMT) on a week by week basis following a review of previous, current and predicted pressures.

11.6 Pressures should also be considered by EOC Managers, ROCC Managers, Urgent Care Desks and the Regional Health Control Desk and concerns relayed to the relevant on-call senior manager.

11.7 Consultation should take place between the Gold Commander and if necessary, the Executive on Call, and (where appropriate) Staff Side representatives when considering plan escalation and the associated actions.

11.8 De-escalation triggers must also be considered as a staged return to normal operations is vital in ensuring that any changes are managed carefully.





11.8 Sliding Scale The following table may be used to assess and determine the necessary triggers for escalating ‘the Plan’: The REAP Action Card should also be used

Impacted Element

Descriptor Period of Disruption

Across a 4 week period or more Comments Responsibility

Performance

Any challenges to operational (national) performance targets. This includes commissioned performance

1. Red calls < 3% below target

2. Red calls 3– 5% below target

3. Red calls 5 -10% below target

4. Red calls 10 – 15% below target

5. Red calls >15% below target

Suggested (REAP Level 2) Suggested (REAP Level 3) Suggested (REAP Level 4) Suggested (REAP Level 5) Suggested (REAP Level 6)

Service Delivery senior

managers

or

On call Gold

or

EMT

Production

Any challenges to the production processes including fleet, operations, control centres.

Rising tide situations (developing challenges) over any identified or predicted period of time Any unplanned interruption to any control functions including CAD (over and above scheduled down time).

Should be assessed against all other factors, including seasonal, external or internal pressures. Indicators for period of disruption can be found within each level but should be used as guidance. Consideration must always be given to all factors that may influence the escalation, its duration and the risks to the Trust.

Capacity

Any challenges to the capacity capabilities of the Trust (or wider health) including loss of resources, staff and equipment.

Rising tide situations (developing challenges) over any identified or predicted period of time.

Should be assessed against all other factors, including seasonal, external or internal pressures. Indicators for periods of disruption can be found within each level but should be used as guidance. Consideration must always be given to all factors that may influence the escalation, its duration and the risks to the Trust.

Demand

Any challenges or unscheduled (short, mid-term or sustained) demand on the Trust that may be generated externally or internally.

Rising tide situations (developing challenges) over any identified or predicted period of time.

Should be assessed against all other factors, including seasonal, external or internal pressures. Indicators for periods of disruption can be found within each level but should be used as guidance. Consideration must always be given to all factors that may influence the escalation, its duration and the risks to the Trust.





11.9 Resource Escalation Action Plan – Trigger Points

Level 1 Level 2 Level 3 Level 4 Level 5 Level 6* 1 Acceptable Operating Level Red call below target by >< 1%-2.99%

across 4 week period Red call below target by >< 3%-4.99% across 4 week period

Red call below target by > 5% across 4 week period

Red call below target by > 5% across 4 week period

Assumption that performance standards are suspended by the Department of Health

2 Resources satisfactory 10% activity increase for 7 consecutive days

15% activity increase across 4 week period



Wholesale NHS problem – assume Acute Trust and Primary Care also affected.

3 No Excessive demands Turnaround delay avg >30mins for 7 consecutive days

Hospital A&E deflections/diverts in place at up to 25% or more of Acute Trusts (area or NWAS)

Hospital A&E deflections/diverts in place at up to 50% of Acute Trusts (area or NWAS)

Hospital A&E deflections/diverts in place affecting all Acute Trusts (NWAS)

Hospital handovers/deflections are causing major disruption to ambulance resourcing with no resolution expected within the immediate future.

4 Trust meeting key performance targets Resource levels across EOC’s or Operations >95%

Resource levels across EOC’s or Operations >90%



5 Delivering safe and quality service EA, RRV or PTS resources fall ><1%-2.99% across a 4 week period

EA, RRV or PTS resources fall ><3%-4.99% across a 4 week period

EA, RRV or PTS resources fall ><5%-6.99% across a 4 week period

Extraordinary depletion of resources for reasons unknown.

All possible options available to ambulance services to uplift operational and control resources have been exhausted.

6 EOC resource levels fall between ><1%-2.99% across 4 week period

EOC resource levels fall between ><3%-4.99% across 4 week period

EOC resource levels fall reduced by 7% across 4 week period

7 Support Services business interruption for 7 consecutive days, i.e. loss of staff, access to buildings, disruption to supply chain, critical systems (IM&T)

Disruption to supply chain for up to 4 weeks.

Loss of Business Critical Functions for more than 1 hour.

Catastrophic failure of critical department; i.e. CAD, Payroll – please refer to departmental BCM Plan via esecurus.

Restricting service provision to those critically ill patients or those patients that may become critical if hospital treatment were not to be received.

8 Weather conditions causing concern Deterioration in weather conditions – or severe weather forecast/warnings; flash floods, snow, ice, heat wave.

Extended period of severe weather causing widespread disruption – at least 7 days without change forecast.

Extended period of severe weather causing widespread disruption to an area for 30 days

9 Unplanned loss of operational fleet for 24hrs or more, i.e. result of defects/manufacturing recalls or accidents.

Unplanned loss of operational fleet for 24hrs or more, i.e. result of defects/manufacturing recalls or accidents.

Unplanned loss of 25% of Operational fleet for more than 24hrs.



10 Increase in National Threat Assessment Level to SUBSTANTIAL (Refer to RESTRICTED NWAS CT Annex)

Increase in National Threat Assessment Level to SEVERE (Refer to RESTRICTED NWAS CT Annex)

Increase in National Threat Assessment Level to CRITICAL (Refer to RESTRICTED NWAS CT Annex)

Acts of Terrorism have occurred in the UK – NWAS providing Mutual Aid. Potential of reduced resilience within Trust area. (Refer to RESTRICTED NWAS CT Annex)

Acts of Terrorism have occurred in the NWAS area - requesting Mutual Aid. Confirmed reduction of resilience within Trust area. (Refer to RESTRICTED NWAS CT Annex)

11 Declared Major Incident in a neighbouring service

Declared Major Incident by NWAS Prolonged Major Incident declared – in excess of 24hrs.

Catastrophic Incident or multiple Major Incidents declared.

Uncompensated Major Incident.

12 Sustained Major Incident in neighbouring service.

Threat to or breakdown of national infrastructure; i.e. electricity, gas, water or transport.

13 Mutual Aid for up to 2 weeks; including pre-planned, i.e. Olympics 2012.

Mutual Aid in excess of 2 weeks (prolonged) or more than 20 vehicles (extensive)

14 Actual staff absence across Service Delivery exceeds expected levels by 10% for up to 14 consecutive days.

Actual staff absence across Service Delivery exceeds expected levels by 10% for up to 21 consecutive days.



15 Increase in risk impact of infectious disease spread, i.e. Pandemic Influenza – resulting in both internal and external demand pressures.

Increase in risk impact of infectious disease spread, i.e. Pandemic Influenza – resulting in both internal and external demand pressures.

Intel from DH advising imminent disease outbreak or pandemic from overseas could impact significantly on Service Delivery.

Sustained national impact of infectious disease spread, such as Pandemic Influenza.

16 Widespread industrial action or civil unrest causing significant pressure.

Sustained impact of infectious disease spread; such as Pandemic Influenza.

17 Prolonged failure of the GRS system.

*NB – Please see the below assumptions relating to Level 6.





11.10 Level 6 Assumptions

Level 6 Assumptions

Increase in ‘activations’, based upon the % increase above the level experienced at REAP level 5:

Stage 1 (Green) 25-35%

Stage 2 (Amber) 35-45%

Stage 3 (Red) 45-55%

Increase in call volume based upon the % increase above the level experienced at REAP level 5:




Actual Human Resource absence for each discipline (e.g. Fleet, procurement, stores, Resource Scheduling etc), within Service Delivery exceeds expected levels by:




Actual Human Resource absence for each discipline (e.g. Fleet, procurement, stores, Resource Scheduling etc), within Service Delivery exceeds expected levels by:




Production against plan for on operational staff falls below:




Production against plan for the EOC staff falls below:








12. Executive decisions

12.1 The actions contained within each level of ‘the Plan’ may require Executive support (and where appropriate) some levels of authorisation. However, where practicable, delegated authority to make decisions on the actions included within ‘the Plan’ should be given to the appropriate Gold Commander.

12.2 Executive engagement may include:

12.2.1 Consideration of use of staff to undertake suitable work that is not their current job role. Discussion with HR and Staff Side representatives may be required.

12.2.2 Consideration and authorisation for temporary accommodation for staff if Appropriate; NB Gold Commanders have authority to use NWAS Credit Cards.

12.2.3 Deferral of commissioned work during significant recovery strategies.

12.2.4 Engagement with NHS England or the Department of Health during significant service interruption.

12.2.5 Engagement with stakeholders regarding the deferral of scheduled external reporting process during significant service interruption (i.e. reporting returns for audit purposes).

13. Intelligence gathering

13.1 The key to dealing with the triggers in Section 5 is early warning systems and identification of problems arising.

13.2 Any of the relevant departments or disciplines of the service will provide evidence of capacity breach. These may include the following:

Chief Executive or Deputy Chief Executive

Executive Management Team (EMT)

Gold Command

Directors of Emergency Services, Resilience, and Head of PTS

Healthcare Governance

Sector Managers

Resilience Team

Local Service Delivery Managers

Emergency Operations Control Centres

ROCC

Regional Health Control Desk

Service Delivery Support Directorates

Communications Team

Staff Side representatives





13.3 External sources may include:

The Department of Health

NHS England (North Region)

Public Health England

Ambulance Service Networks

Police and Security Services

Clinical Commissioning Groups

Acute hospitals

Non-health organisations

Local Resilience Fora (LRF)

The media

Health and Safety Executive

Meteorological Office

Environment Agency

13.4 This list should not be viewed as exhaustive so it is essential that all departments and managers within NWAS are alert and receptive to the collection of information/intelligence that could indicate a threat to the capacity and function of the service.

14. Co-ordination and Assessment of Information

14.1 The Gold Commander will declare changes to the REAP level, which will then be notified across the Trust via pager messages, email, via the EOCs and on the NWAS intranet site. This will be followed up when possible by an internal communications bulletin outlining the reason for the escalation.

14.2 It is the responsibility of all local managers/supervisors to ensure that the current REAP level is displayed on the status boards on all of their sites.

14.3 It is the responsibility of the Regional Health Control Desk and the ROCC to inform the wider NHS (via NHS England – North Region), of the current REAP level within NWAS. This reporting should also encompass the Clinical Commissioning Groups.

15. Structure

15.1 Having been made aware of the developing/deteriorating situation, Gold on call (or equivalent) will consider the need to convene a meeting or teleconference at the necessary level, to take action.

15.2 Dependent on the nature and level of the event, the Gold commander may convene a meeting of relevant directorates/departments and other key stakeholders for information and planning purposes.

15.3 Gold will lead the recovery effort, supported by all departments. Gold (or equivalent) will re-convene meetings, as required, to review progress and





determine any necessary further actions/activity.

16. Schedule of Meetings

16.1 The following schedule/frequency of meetings is suggested in order to ensure the appropriate actions are applied and reviewed:

Level Lead Frequency

1 Head of Service or Gold on Call Weekly

2 Head of Service or Gold on Call Daily/Weekly

3 Head of Service or Gold on Call 8 Hourly

4 Head of Service or Gold on Call 4 Hourly

5 Executive 4 Hourly

6 Executive 4 Hourly

17. Directorate/Department Business Continuity Situation Report

(Sitrep)

17.1 Each directorate/department should make an assessment of their respective Business Continuity Plans/arrangements when there has been a change in the Trusts Escalation level.

17.2 This will ensure that a Common Recognised Information Picture (CRIP) is formulated and allows the Trust Command Team/Executive Management Team to assess the current capacity options.

17.3 The SITREP should be completed by the Directorate/Departments Leads and submit the report to the ROCC within 2 hours of the REAP Level being changed or at the earliest practical opportunity.





NWAS Resource Escalation Action Plan

BUSINESS CONTINUITY SITUATION REPORT (SITREP)

DIRECTORATE/ DEPARTMENT NAME

NAME OF PERSON COMPLETING SITREP INCLUDING DATE & TIME

REAP LEVEL

Current staff availability including

staff absence (By Grade)

Brief list of current (active) critical projects that your department is

working on

Can any of these projects be reduced or stopped for a period of time to support the response and recovery

actions of the new REAP level? (This should be reflected in your existing BC Plan with identified

recovery time objectives for each project)

Capacity to increase/supply resources.

YES/NO

Include the level (of staff) and for how long?

NB: please submit this SITREP to the ROCC: [email protected]

mailto:[email protected]





Appendix 1 - Resource Escalation Action Plan – Level Cards





Resource Escalation Action Plan Levels

1. INTRODUCTION

1.1 The REAP is designed to increase operational resource in line with demand; this will assist the service in coping with periods of high pressure and maintain the quality of patient care.

1.2 The plan is in operation at all times. In general it will indicate pressure level one, when the Service is operating within normal parameters. There are varying levels reflecting increasing pressure on the Service, up to level six, where there is the potential of Service failure. Each level has been colour coded to make recognition of current operating pressures, easier to identify.

1.3 The Pressure levels are:

REAP Level 6 Potential Service Failure

REAP Level 5 Critical

REAP Level 4 Severe Pressure

REAP Level 3 Pressure

REAP Level 2 Concern

REAP Level 1 Normal Service

1.4 Each level is triggered by intelligence from inside the Service or from the external environment. The triggers are detailed within ‘the Plan’.

1.5 The REAP and the ‘pressure’ levels apply to the whole of NWAS. The current level will be widely publicised by EOC and managers will be alerted to changes in level as and when they occur.

1.6 The current level will be displayed on the intranet and via a physical alert sign located at all Trust sites. The signs can be found at Appendix 3.

1.7 Every manager has a responsibility to know the current level. Department Heads outside of Service Delivery will be informed of the levels via the intranet/email or telephone. This will be undertaken by the on call team.

1.8 Each manager and head of department has a responsibility to understand the





plan and to have a corresponding implementation plan for their area of operation. All areas of the Service are required to take meaningful action, with the appropriate urgency, as the plan escalates.

1.9 REAP is aimed at ensuring the right care for our patients whilst also protecting our staff and maintenance of quality throughout the service through robust governance arrangements. Consequently, actions taken under the plan should be taken through a formal process (the NDM) to be considered as being in line with the Trusts scheme of delegation.

1.10 The Plan is geared for ‘front end’ delivery and therefore mainly focused on Emergency Services however there are clear benefits in considering Patient Transport Services needs in addition to all other departments across the Trust. In conjunction with the NDM this will enable a full impact assessment of how the organisation will respond to and recover from adverse ‘operating’ pressures and the suspension of some activities.

2. THE PLAN

2.1 The following tables explain the actions that will be taken at different levels of ‘the Plan’. For ‘the Plan’ to work it is imperative that these actions are followed, this will assist in maintaining the best possible service to our patients.

2.2 The Plan relies on data values for the various escalation levels to be activated therefore an accurate assessment of management information is essential to inform the decision making process.

2.3

Each decision made under the plan must follow a formal progression and the rationale should be clear and unambiguous. Records of decisions made either by and individual or by EMT should be logged or minuted to form part of the subsequent evidence chain. The risks of conducting any particular action should be considered not only in instigating a particular action but also in relation to how long any given strategy should remain in place.





Intentionally Blank

RESOURCE ESCALATION ACTION PLAN





Consultation should take place between the Gold Commander and if necessary, the Executive on Call, and (where appropriate) Staff Side representatives when considering plan escalation and the associated actions.

LEVEL 1 LE

VEL

ON

E

ACTION DECISION RESPONSIBLE IMPACT REVIEW SUPPORT DEPT COST

PRESSURE 1. Ensure staff who are absent due to sickness

are made aware that they should maintain regular contact with their line manager and ensure RTW is completed ASAP following return

RO

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2. Ensure maximum cover of core fleet Service Delivery

3. Ensure RRV’s are at their agreed designated standby points

EOC

4. Actively liaise with EOC on ambulance station cover

Service Delivery

5. Actively engage local Staff Side Representatives

Service Delivery

6. Monitor and manage annual leave Service Delivery

7. Monitor and manage mobilisation times Service Delivery/ EOC/

8. Monitor and manage job cycle times Service Delivery/EOC

9. Monitor and manage activation times EOC

10. Monitor and manage staff hours Service Delivery

11. Utilisation of overtime as required

12. Monitor and manage predicted staffing Service Delivery

13. Ensure routine management/ALO presence at hospitals as required

Service Delivery

14. Monitor and manage EOC staffing EOC Manager

15. Monitor and manage PTS and Intermediate Tier staffing and deployment

Service Delivery

Be prepared for actions at level 2






Consultation should take place between the Gold Commander and if necessary, the Executive on Call, and (where appropriate) Staff Side

representatives when considering plan escalation and the associated actions. USE THE REAP ACTION CARD!

LEVEL 2

LEV

EL T

WO

ACTION LEAD RESPONSIBLE IMPACT REVIEW SUPPORT DEPT COST

PRESSURE

RISK

ALL LEVEL 1 ACTIONS PLUS THE FOLLOWING

1. Consider opening Area Major Incident Suites (Formerly known as AOCC)

Gold on Call Service Delivery High Daily GENERAL

Yes (only outside normal

business hours)

Low

2. Increase local monitoring at Area level to ensure efficiency

Gold on Call Service Delivery Med Weekly/daily

Ensure that your teams are aware of the current REAP status Consider how to cover gaps in your team if seconded clinical staff is recalled. Review priorities of workload to assess what might offer a quick operational gain. Proactively offer support to the Operations management team.

No Low

3. Look at predicted solo staff and pair up in advance. (this includes staff moving location)

Gold on Call Service Delivery Med Daily No Low

4. Review non-essential training and consider re-schedule options

Gold on Call Service Delivery Med Weekly No Low

5. Review predicted RRV cover and fill in all gaps. Use solos as necessary.

Gold on Call Service Delivery High Daily No Low

6. Increase focus on Control staffing ensuring adequate ratio of call takers and dispatchers.

Gold on Call EOC Manager High Daily No Low

7. Review all seconded clinical and non-clinical staff and consider recalling

Gold on Call Service Delivery Med Daily No Medium

8. Consider allocating shifts to all non-operational staff (e.g. non-operational Clinical Practice Trainers)

Gold on Call Service Delivery Med Weekly No Medium






9. Consider the role of Urgent Care Service/PTS and how they can assist with Red calls.

Gold on Call Executive Team Med Daily

Increase monitoring of own performance measures that support operational performance. Review work locations of key personnel & consider relocating.

No Low

10. Monitor all planned events and resource requirements and available intra area assistance

Gold on Call Service Delivery Low Weekly Yes Low

11. Consideration of existing BCM plans; Review Directorate/Department BCM SitRep (submitted following Escalation Change) and ensure recovery actions are identified and in place.

Gold on Call

Head of Services (All Depts)

All Directorates/ Departments

Med/High Weekly Yes Low

12. Control to routinely contact all CFR schemes and request their availability

Gold on Call Control Low Weekly No Low

13. Consider issuing message to the media about inappropriate use of service

Gold on Call HOS Communications High 6 Hourly Communications No Medium

14. Inform all stakeholders of any changes in Trust Escalation Plan levels so assessments of their own needs/pressures can be identified as part of the early warning systems

Gold on Call HOS Communications High 6 Hourly Communications No Low

Be prepared for actions at level 3, or return to level 1








LEVEL 3

LEV

EL T

HR

EE


PRESSURE

RISK

ALL LEVEL 1 AND 2 ACTIONS PLUS THE FOLLOWING 1. Establish GOLD command team to manage recovery

& declare ‘Major Incident Standby’ and implement relevant business continuity arrangements

Gold on Call GOLD High Daily GENERAL No Low

2. Identify the number and location of PTS resources required to support the A&E operation – PTS management to provide resources where possible

Gold on Call Service Delivery Med Weekly

Recognise the need to prioritise REAP linked requests over planned work Brief teams to expect and act on short notice, urgent requests from OP’s Brief teams to expedite processes wherever feasibly possible Brief teams to expect cancellations of planned meetings Make active plans to release any clinically trained staff Cancel new meeting requests Prepare suppliers and contractors for increased demand

No Low

3. Station Management Teams to establish list of staff available for overtime and use appropriately

Gold on Call Service Delivery Med Daily Yes Low

4. Consider providing appropriate clinical training staff for operational shifts

Gold on Call

Head of ETD/ Head of Service – Service

Delivery High Weekly Yes Low

5. Cancel non-essential meetings

Gold on Call ALL Low Weekly No Medium

6. Non Ops CPTs and Service Delivery Managers to staff vehicles where possible (Ambulance or RRV)

Gold on Call Service Delivery High Weekly Yes Low

7. PTS Managers who can be released without generating a negative impact on PTS core activity to be deployed to busy A&E Departments as Ambulance Liaison Officers (ALO’s)

Gold on Call Service Delivery

/HCD Med Daily No Low






LEV

EL T

HR

EE

ACTION DECISION RESPONSIBLE IMPACT REVIEW SUPPORT

DEPT COST

PRESSURE RISK

ALL LEVEL 1 AND 2 ACTIONS PLUS THE FOLLOWING 8. Establish GOLD command team to manage recovery

& declare ‘Major Incident Standby’ and implement relevant business continuity arrangements

Gold on Call GOLD High Daily GENERAL No Medium

9. Identify the number and location of PTS resources required to support the A&E operation – PC management to provide resources where possible


Recognise the need to prioritise REAP linked requests over planned work Brief teams to expect and act on short notice, urgent requests from Op’s Brief teams to expedite processes wherever feasibly possible Brief teams to expect cancellations of planned meetings Make active plans to release any clinically trained staff Cancel new meeting requests Prepare suppliers and contractors for increased demand

No Low

10. Station Management Teams to establish list of staff available for overtime and use appropriately

Gold on Call Service Delivery Med Daily Yes Low

11. Consider providing appropriate clinical training staff for operational shifts

Gold on Call

Head of ETD/ Head of Service – Service

Delivery High Weekly Yes Low

12. Cancel non-essential meetings

Gold on Call ALL Low Weekly No Medium

13. Non Ops CPTs and Service Delivery Managers to staff vehicles where possible (Ambulance or RRV)

Gold on Call Service Delivery High Weekly Yes Low

14. PTS Managers who can be released without generating a negative impact on PC core activity to be deployed to busy A&E Departments as Ambulance Liaison Officers (ALO’s)


/HCD Med Daily No Low

15. Review resource cover at external events

Gold on Call Service Delivery Med Weekly Finance Yes Low

16. Consider extended hours of Fleet Support Services


Support Low Weekly Fleet Yes Medium

17. Control to rigidly maintain RRV deployment to standby points and monitor re-deployment following meal.

Gold on Call Control

High Daily Staff Side/HR No Low






LEV

EL T

HR

EE

ACTION DECISION RESPONSIBLE IMPACT REVIEW SUPPORT

DEPT COST

PRESSURE RISK

18. Issue message to the media, key stakeholders and service users.

Gold on Call HoS Communications High 6 Hourly Communications No Medium

19. Consider Operational Managers deploying to AS1 incidents

Gold on Call

Head of Service – Service Delivery

Low Daily N/A No Medium

20. Stringent local monitoring of all instances causing vehicle downtime e.g. VOR, Medicine issues, meal breaks.

Gold on Call Service Delivery Med Daily

Trust

No Low

21. Consider placing operational management liaison in Control


N/A Yes Low

22. Consider staffing additional RRVs

Gold on Call Service Delivery High Weekly N/A

Yes Medium

23. Ensure health control desk liaise with ALOs and feed information into the MI Suites and ROCC

Gold on Call Head of Service – Service

Delivery Med Hourly

Executive / CCGs

No Low

24. Consider appropriate clinical staff for operational cover Cat A cover

Gold on Call Head of Service – Service

Delivery /Control Med Weekly

Trust

No Medium

25. Inform CCGs/NHS England – North Region of current service delivery pressure level

Gold on Call Control High Hourly

Executives No Low

26. Consider requesting intra area mutual aid

Gold on Call Control High Hourly Yes Low

27. Consider providing accommodation for personnel/finance requirements

Gold on Call Gold/Finance High Daily Executives Yes Medium

28. Consider relocating vulnerable key assets/functions (vehicles/personnel) in line with relevant BCM plans

Gold on Call Heads of Depts High Daily All Yes Medium

Be prepared for actions at level 4, or return to level 2 or less if possible








LEVEL 4

LEV

EL F

OU

R


PRESSURE RISK

ALL LEVEL 1 – 3 ACTIONS PLUS THE FOLLOWING

1. Consider Declaration of a ‘Major Incident’. Advise NHS England & Trust Board

Gold on Call ALL High Hourly

All Teams are to be briefed that supporting REAP related activity becomes the immediate priority Directors to support and action the release of clinical staff Directors to support and communicate a philosophy of ‘do it now and catch up later’ Maximum number of support staff/mangers to be released to assist operations

No (Initially) High

2. Appropriate Clinical Training staff to be re-deployed to staff vehicles

Gold on Call

Head of Service – Service Delivery /ETD

High Weekly Yes Medium

3. Review planned leave and negotiate rescheduling with staff

Gold on Call Service Delivery Med Weekly No Medium

4. Defer all operational training days for existing staff but ensure consideration of mandatory training requirements in line with BCM Plans (including recovery strategies where appropriate)

Gold on Call Head of Service –

Service Delivery /ETD High Weekly No High

5. Defer all non-escalation plan related meetings

Gold on Call ALL Med Weekly All Departments No Medium

6. Consider deploying all clinically trained non Operational staff (e.g. HCG, Community Liaison Officer etc)

Gold on Call EMT Med Weekly All Departments Yes Medium

7. Consider recalling all externally seconded staff

Gold on Call EMT High Weekly All Departments Yes Medium

8. All non – essential vehicle maintenance/repair to be re-scheduled


Support Med Weekly Fleet No Medium







PRESSURE RISK

9. All staff deficiencies and projected resources to be reported to the Area Major Incident Suite (formerly known as the AOCC).

Gold on Call Service Delivery Low Daily All Departments No

Low

10. A&E Operational Managers to be allocated shifts in a staff support role covering 24 hours. Request support from PTS Management in supporting this capability.

Gold on Call Head of Service – Service Delivery

Med Weekly All Departments Yes Medium

11. Consider contacting Acute Trusts with a view to reducing planned clinics in conjunction with PTS

Gold on Call Service Delivery High Daily GENERAL Yes Medium

12. Liaison with CCG’s to explore options for additional support

Gold on Call Service Delivery Low Weekly

All Departments

Yes Low

13. Consider sending a Silver level liaison to Police controls to review police requests and provide advice.


Med Weekly POLICE Yes High

14. Reinforce messages to the media about pressures and using the service wisely

Gold on Call

Service Delivery /HoS Communications

High Daily Communications No Medium

15. Consider requesting other agencies to act as co-responders

Gold on Call


Med Weekly Executive No High

16. Consider Mutual Aid options

Gold on Call EMT Med Daily Executive Yes

Low

17. Where appropriate consider contacting voluntary agencies for additional resources.

Medium

Be prepared for actions at level 5, or return to level 3 or less if possible








LEVEL 5

LEV

EL F

IVE


PRESSURE RISK

ALL LEVELS 1 – 4 ACTIONS PLUS THE FOLLOWING

1. Consider implementing a no send policy

Gold/NHS ENGLAND

GOLD/NHS ENGLAND High Daily HCG No High

2. Request mutual aid and support National Ambulance Coordination Centre

Gold on Call EOC/ROCC High Daily Executive Yes Medium

3. Consider extending clinically based telephone triage for all incidents

Gold/Medical Director


High Daily

Executive

No Medium

4. In conjunction with PTS Commissioners, cancel by agreement all PTS and non-essential work and redeploy resources to support PES Ops

Gold/Medical Director/Head of

Service PTS

Director/Heads of Service

High Daily Yes Medium

5. Cancel all event cover


High Daily Yes High

6. High profile media campaign to discourage inappropriate use

Gold/Comms

Communications Team

High Daily Communications Yes High

7. Use trainees to support operations

Gold/Medical Director

Head of ETD High Daily ETD No High

8. Open workshops at night to increase daytime fleet

Gold/Director Finance and

Facilities

AD Service Delivery Support

High Weekly Fleet Yes Medium

9. All non-operational Managers with a lease vehicle to ‘book on’ with Control each morning and make themselves available to support operations

Gold Managers High Weekly All Departments No

Medium






10. Carry cash float/Procurement Card to allow quick solutions

Gold

Dir Finance/Head of Finance

High Weekly Finance Yes Medium

Be prepared for actions at Level 6 or return to level 5 or less if possible






Consultation should take place between the Gold Commander, the Executive on Call, NHS North of England, the National Ambulance Coordination Centre, and (where appropriate) Staff Side representatives when considering plan escalation and the associated actions.

LEVEL 6 USE THE REAP ACTION CARD!

LEV

EL S

IX


PRESSURE RISK

ALL LEVELS 1 – 5 ACTIONS PLUS THE FOLLOWING

1. In conjunction with Department of Health, NHS North and National Ambulance Coordination Centre, ensure appropriate and common response and recovery strategies are effective and deliverable.

Executive Gold High Hourly All Yes High

2. Ensure effective and coordinated communication messages are cascaded and updated to reflect the situation.

Executive Gold High Hourly All Yes Low

3. Ensure safety and integrity of all staff is maintained to assist recovery needs.

Executive Gold High Hourly All Yes Medium

4. Ensure support to National Mutual Aid Requirements are balanced against needs and capability across NWAS region

Executive Gold High Hourly All Yes High

Consultation should take place between the Gold Commander, the Executive on Call, NHS England, Commissioners and stakeholders, the National Ambulance Coordination Centre, and (where appropriate) Staff Side representatives when considering plan de-escalation and the associated actions.

Return to level 5 or less if possible






GENERIC DE-ESCALATION CONSIDERATIONS AND ACTIONS - USE THE REAP ACTION CARD!

NOTE: De-escalation should be considered when the identified pressures which triggered the initial ‘step up’ have started to reduce in impact. These may be internal or external in origin but should be easily recognised through the Trust’s existing reporting processes. Early consideration for de-escalation should be made in conjunction with the Business Continuity Plans in terms of recovery time objectives for critical functions.

DE-

ESC

ALA

TIO

N A

CTI

ON

S


PRESSURE RISK

1. Review current projects/ contracts with partners and stakeholders for any phased recovery (switch back on)

Executive Gold High Weekly All Yes Low

2. Re-establish new timelines where appropriate

Executive Gold High

Weekly All Yes Low

3. Ensure staff welfare screening and monitoring is in place where applicable following significant events

Gold/Director HR Director HR High

Weekly

All Yes Medium

4. Ensure recruitment processes are established where required

Executive Director HR High

Monthly All Yes Low

5. Consider any issues such as remembrance/anniversary of events and potential impacts on staff.

Executive Director HR High

Annually

All Yes Medium






Appendix 2 - REAP Trigger Matrix Summary

RED CALL

PERFORMANCE DEMAND

HOSPITAL CAPACITY

STAFFING (Service Delivery)

SICKNESS (Service Delivery)

OTHER FACTORS

LEVEL ONE (Normal)

OVER 75% FOR THE YEAR

Based on Call Connect

NORMAL NO DELAYS FULLY STAFFED 4-6%

Normal Service

CONSIDER OPENING THE AREA MAJOR INCIDENT SUITES (FORMERLY KNOWN AS AOCC)

LEVEL TWO (Concern)

Fall below target (or trajectory) by between

1% and 2.99% across a 4 week period

Sustained increase of 10% over predicted activations and call

volume for more than 7 days

Capacity at A&E hospitals causing crews

inordinate delays in excess of norms

threatening both patient care and service

performance

Staffing reduced by 1% - 2.99% across 4 week

period

EOC staff reduced by 3-4.99% across 4 week

period

Actual absence (Service Delivery) exceeds

expected levels by 10% for 14 consecutive days

CAD/Airwave failure for less than 1 hour.

Severe weather

Warnings affecting the entire county.

Unplanned loss of 5% of Operational fleet for 24 hours or more

LEVEL THREE (Pressure)

Fall below target (or trajectory) by between

3% and 4.99% across a 4 week period

increase of 15% over predicted activations

and call volume across 4 week period

Hospital deflections or treat and transfer

policies in place at 25% or more A&E Departments

Increased transport requests between

hospitals

Staffing reduced by 3% - 4.99% across 4 week

period

EOC staff reduced by 5-6.99% across 4 week

period


expected levels by 10% for up to 21 consecutive

days

CAD/Airwave Failure for more than 1 hour

Loss of 10% of Operational fleet for 24 hours or

more

Severe weather across the county affecting response times

LEVEL FOUR (Severe

Pressure)

Fall below target (or trajectory) by 5% or

more across a 1 week period

>20% in activations and call volume across

4 week period


policies in place at 50% or more A&E Departments

Staffing reduced by 5% or more across 4 week

period EOC staff reduced by

7% across 4 week period



days

CAD/Airwave failure for more than 4 hours and up to 12 hours.

Loss of 15% of Operational fleet for 24 hours or more

LEVEL FIVE (Critical)

<5% below targets/trajectory for more than 4 weeks

>25% in activations and call volume across

4 week period


policies in place at 75% or more of A&E Departments

Staffing reduced by 5% or more across 4 week

period

EOC staff reduced by 7% across 4 week

period



days

CAD/Airwave failure for more than 12 hours

Total MDT failure in all PES vehicles for 24 hours or

more

Loss of 30% of Operational fleet for 24 hours or more

LEVEL SIX (Potential

Service Fail

Performance Standards suspended

Increased activations and call volume above

level 5

Major disruptions with no resolution in immediate

future

Increased abstractions above Level 5

Increased abstractions above Level 5

Total loss of Command and Control

Up to 50% fleet loss






REAP Level notification boards

Trust Level 1 – White

Trust Level 4 – Red

NWAS is currently operating at:

Level 1 (Normal Service)


Level 4 (Severe Pressure)

Trust Level 2 – Green

Trust Level 5 - Purple


Level 2 (Concern)


Level 5 (Critical)

Design C - Trust Level 3 – Amber

Trust Level 6 - Black


Level 3 (Pressure)


Level 6 (Potential Service Failure)

Documents

Resource Escalation Action Plan - REAP · PDF fileResource Escalation Action Plan - REAP ... numerical escalation levels referred to in other agency documents throughout the