Health and social care - surge preparedness: national planning priorities and principles

Section 5: Pandemic and Major Incident Preparedness

Purpose

While local arrangements for managing seasonal pressures and surges in demand underpin resilience, health and social care systems must also be prepared to respond to exceptional events that place significant and sustained pressure on services. These may include pandemics, infectious disease outbreaks, severe weather, major accidents, cyber incidents, infrastructure failures and other civil emergencies. Effective preparedness requires arrangements that support anticipation, response and recovery across a wide range of risks and scenarios.

The Covid-19 pandemic highlighted the importance of scalable capacity, effective decision-making and strong partnership working across health, social care, local government and communities. Learning from the pandemic, operational experience, and recommendations emerging from the Covid-19 inquiries reinforce the need for arrangements that support both routine resilience and large-scale emergency response.

NHS Health Boards and Local Authorities have statutory responsibilities as responders under the Civil Contingencies Act 2004. Pandemic preparedness, resilience and surge planning should therefore be considered as part of wider Emergency Preparedness, Resilience and Response (EPRR) arrangements, alongside emergency planning, business continuity management, exercising and organisational learning.

While this Framework has a particular focus on supporting resilience during winter and other periods of increased pressure, the principles and expectations set out within it are equally relevant to broader preparedness and resilience activities. Health and social care systems should use these arrangements to strengthen readiness for a range of hazards and threats, while supporting continuity of safe, effective and person-centred care during disruption.

This section supports wider Emergency Preparedness, Resilience and Response (EPRR) guidance and complements existing emergency planning, business continuity and pandemic preparedness arrangements. It does not replace statutory responsibilities, local emergency plans or requirements under the Civil Contingencies Act 2004.

Maintaining Preparedness for Exceptional Events

Local systems should maintain arrangements that support a timely and coordinated response to pandemics, major incidents, severe weather, cyber incidents and other civil emergencies.

Plans should reflect local risks and enable rapid escalation, mobilisation of resources and maintenance of essential services where required.

Pandemic Preparedness

Pandemics and large-scale infectious disease outbreaks can place sustained pressure across health, social care and community services. Local systems should maintain arrangements that support:

• Early identification and assessment of emerging threats.
• Rapid escalation and decision-making.
• Workforce mobilisation and redeployment.
• Maintenance of essential and critical services.
• Coordination across partner organisations.
• Effective communication with staff, partners and the public.
• Recovery and organisational learning.

Planning should be sufficiently flexible to respond to a range of scenarios and levels of impact.

Surge Capacity and Service Expansion

Where pressures exceed normal operating levels, local systems should be able to expand capacity while protecting essential and time-critical services wherever possible. Planning should consider:

Workforce Capacity

• Redeployment arrangements.
• Workforce surge models.
• Mutual aid arrangements.
• Emergency recruitment processes.
• Training, competency and supervision requirements.
• Workforce wellbeing and fatigue management.

Hospital and Inpatient Capacity

• Additional inpatient capacity.
• Expansion of assessment and treatment capacity.
• Escalation arrangements to support increased demand.
• Infrastructure and estate requirements.
• Access to essential equipment and supplies.

Critical Care Preparedness

• Critical care expansion capability.
• Specialist workforce requirements.
• Equipment and supply resilience.
• Access to mutual aid arrangements where required.

Infrastructure and System Dependencies

• Oxygen resilience arrangements.
• Digital and technology infrastructure.
• Pharmaceutical and supply chain resilience.
• Business continuity requirements for essential services.

Command, Control and Coordination

Preparedness arrangements should include clear governance, command, control and coordination structures that support timely decision-making and effective leadership. Local systems should ensure that:

• Roles, responsibilities and decision-making arrangements are clearly understood.
• Escalation processes are documented and routinely reviewed.
• Communication arrangements support coordination between organisations and partners.
• Resilience structures align with local, regional and national arrangements.
• Leaders have access to timely intelligence and situational awareness.

Strong partnership working and shared situational awareness are essential to coordinated response across health, social care and community services.

Assurance, Testing and Continuous Improvement

Regular assurance activity helps ensure plans remain practical, understood and capable of supporting an effective response to exceptional demand or disruption. Local systems should:

• Test preparedness and surge arrangements regularly.
• Participate in multi-agency exercises where appropriate.
• Review lessons identified from exercises, incidents and periods of pressure.
• Update plans to reflect emerging risks, evidence and good practice.
• Support organisational readiness through training and development.
• Share learning across organisations and systems to strengthen resilience.

Key Expectations

Local systems should:

• Maintain readiness to respond to pandemics, major incidents and civil emergencies.
• Maintain workforce mobilisation, mutual aid and service escalation arrangements.
• Maintain plans for inpatient and critical care expansion, including infrastructure and oxygen resilience.
• Ensure command, control and escalation arrangements remain current and understood.
• Align resilience arrangements with Emergency Preparedness, Resilience and Response (EPRR) guidance.
• Undertake regular testing, exercising and assurance activity.
• Use learning from incidents, exercises and operational experience to strengthen future resilience.

Preparedness for pandemics, major incidents and other civil emergencies should be embedded within wider resilience planning, ensuring health and social care systems can respond rapidly, maintain essential services and protect the people who rely on them during periods of exceptional demand or disruption.