It is early January 2021 and I am sitting in a room with over 100 senior staff from across Solihull, Coventry and Warwickshire.
Over the last month, we have had regular drops in our in-box, giving us the latest situation report from a fictious pandemic which started small but grew quickly. And today, we are all in a room playing through an increasingly worse scenario with mounting casualties and staff absences. Two months later, we were doing it for real.
As integrated care systems (ICS) work through a long pre-go-live to do list, many will be starting to get to grips with their new Civil Contingencies responsibilities. While the precise details of what this will look like are still being finalised, there is a lot we already know and some key points for us to reflect on.
First, as COVID’s taught us, resilience and emergency planning is everyone’s business. Of course, you need great plans, but the plan is only as good as the people executing it. So, if you are going to be the person getting the call at 2am on a Sunday morning, would you know what to do? If your technology goes down, would you know what to do? (Clue: ask your emergency planner).
Testing and exercising is at the heart of good emergency planning and response. You don’t want to be doing this for the first time in the heat of battle. And the scenario, however far-fetched, could be one you need to live (and possibly lead) through.
Second, good decision-making structures and credible, jargon-free plans keep you safe, particularly when the scenario you had planned for turns out to be much more complicated or much longer than you had anticipated.
Third, one of the key responsibilities for Category 1 responders is to co-operate with other local responders. Local relationships are essential to mounting a strong incident response. It is much easier to work efficiently and effectively in a high-pressure situation with people you have on speed-dial. This will not always be possible, but cultivating relationships and using exercises to get to know people from different worlds to you is really important.
Fourth, ICSs should take time to understand the current system. At local level, NHS Trusts have highly expert emergency planners as do local councils. This gives a rich starting point for ICS.
As the new UK Health Security Agency takes shape, making sure that health protection expertise through regional health protection teams and local authority public health teams is built in is also crucial.
Understanding the wider resilience system, including the local resilience forums and local health resilience partnerships also needs to be on the task list.
What are the risks in the system? First, anyone who is working in resilience or emergency planning – whoever they work for – will have been running flat out for two years. They have been part of an often unseen army that has helped keep the show on the road but don’t always get the recognition they deserve. Talented though they are at debriefing and managing the impact of incidents on the people involved in them, like many in the public sector, they need recovery too.
Like any other skilled workforce, we need to think carefully about workforce planning and development.
Emergency planning is a specialist skill and needs people who have been trained for the job.
In a world of geo-political uncertainty with major challenges such as climate change, this workforce is unfortunately going to be in demand. Therefore, ‘building resilience into resilience’ needs to be at the forefront of our minds. This function needs to be adequately resourced: the impact of a poor response can be catastrophic on our communities.
At a time of constrained budgets, we need to think carefully about how we create critical mass and co-ordinate our emergency planning capacity across agencies to get maximum bang for buck.
Locally, we have benefitted from a shared resilience function across three councils, including staff with expertise in health. During COVID, managing concurrent events has been a reality, not a planning scenario, but having flexible capacity has enabled us to firefight on more than one front.
We have also deployed these councils’ excellent scenario planning and exercising skills to do rapid systems tests across local government and the NHS, including the management of concurrent COVID and flu outbreaks in care homes, and planning for virus evolution scenarios developed by SAGE.
Looking back to January 2021, I still remember the words of a colleague: ‘I hope it’ll never happen. I don’t see how we’ll cope’. We did, but we will have to again in the future.
Ruth Tennant is DPH Solihull, leads the joint Coventry, Solihull and Warwickshire Resilience Team, is the co-chair of the West Midlands Local Health Resilience Partnership, a member of the West Midlands Resilience Forum and is on the board of the Association of Directors of Public Health