Preparing for Emergencies- Guidance For Health Boards in Scotland

The document provides strategic guidance for Health Board Chief Executives and NHS Senior Managers on fulfilling their obligations under the Civil Contingencies 2004 and other key legislation underpinning emergency preparedness, response and recovery.

Section 1 Introduction

This section sets out the context of this guidance, explains its purpose and the process of producing it.


1.1 Everyone expects the NHS to be there, functioning normally and safely when they need it. This expectation is constant despite an increasing number of disruptive challenges facing health services. These include severe weather, utilities failures, industrial action, public health and other types of major incidents and acts of terrorism. All carry with them short and long term consequences for operating business as usual.

1.2 The NHS in Scotland continues to operate in a changing environment with new and increasing demands: new health and social care policy and legislation (the integration of health and social care services); the redesign of health services; the development of new healthcare environments and facilities and a greater number of large-scale, major public entertainment and sporting events.

1.3 These changes create new opportunities but also presents potential risks and threats for health services that were previously unrecognised. Relevant Health Boards will also be involved in new arrangements for inter-agency civil contingencies planning and coordination in the form of Regional Resilience Partnerships (RRP) and Local Resilience Partnerships (LRP) in place of the Strategic Coordinating Groups.

1.4 This guidance takes account of the changes facing the NHS and builds on progress that Health Boards have made to date in implementing the Civil Contingencies Act 2004. It replaces National Health Service in Scotland Manual of Guidance: Responding to Emergencies, 2005.

Purpose of the guidance

1.5 The purpose of this guidance is to:

  • enhance the resilience of NHSScotland and ensure there is a consistent and coordinated approach to resilience planning across the NHS;
  • enable NHSScotland Chief Executives, Executive Directors and resilience-planning leads to understand both their own and their Board's roles and responsibilities under the Civil Contingencies Act 2004[1] and other key legislation;
  • ensure Health Boards comply with the relevant duties in preparing for, and recovering from major incidents and emergencies;
  • ensure consistent approaches and standards of practice across NHSScotland in relation to responding to major incidents and emergency situations; and
  • promote continuous improvement of emergency preparedness across NHSScotland.

About the guidance

1.6 The guidance recommends a framework and general principles for Health Boards to develop and maintain their capability to respond to major incidents and a range of disruptive events.

1.7 The guidance is:

  • strategic in focus;
  • set in the context of the Civil Contingencies Act 2004 (CCA) and associated regulations, which place statutory duties on some Health Boards regarding emergency capabilities;
  • intended for all Health Boards as it is relevant to the full range of healthcare services, not only acute emergency care; and
  • set in a 3-year timeframe. It will be reviewed mid-term to ensure that it reflects changes in policy and new developments.

1.8 It should be read in conjunction with Preparing Scotland[2], which provides broader guidance on fulfilling CCA duties, and within the context of other legislation, policy and guidance applicable to NHSScotland.

1.9 Preparing for Emergencies has been prepared with advice and support from a multidisciplinary working group (see appendix 1).


1.10 Although the term emergency is used in the CCA, it is often used interchangeably with major incident in civil contingencies planning documents and guidance. The term major incident is used predominantly in this guidance. In the NHS context it is defined as:

Any occurrence that presents serious threat to the health of the community, disruption to the service or causes (or is likely to cause) such numbers or types of casualties as to require special arrangements to be implemented by one or more territorial and/or special health boards simultaneously or in support of each other. It requires considerable resources and strategic input as it potentially threatens the survival of an organisation.

1.11 The term is deliberately broad so that potential incidents are not missed. It describes events that require special procedures and arrangements to be implemented and the involvement of one or more emergency planning partners. Further, it recognises the fundamental importance of public confidence and trust in the NHS response to any incident.

1.12 A major incident may present as a variety of different scenarios (see Glossary, Appendix 9 for definitions of major incident scenarios). What constitutes a major incident for a Health Board may not be one for another organisation, or vice-versa.

1.13 Some of the terms used in this document are defined in the Glossary.

Health Inequalities Impact Assessment (HIIA)

1.14 This guidance has been subjected to an HIIA scoping which highlighted three key points that need to be considered by Health Boards (category 1 and 2 responders) when preparing for emergencies and deploying resources in emergency situations:

Communication: The most effective and appropriate means of communication should be used to convey important and timely information to staff, patients and the general public. It should include a combination of different methods and approaches so that everyone is given appropriate information.

Access to services: During major incidents or emergencies some services may be disrupted or experience a surge in demand. NHS Bodies should identify services likely to be affected and prepare plans to mitigate the impact on the users of critical services.

Staff training: Staff should have appropriate equalities and human rights training so that they are aware of and are sensitive to the needs of different population groups. This will help staff understand how procedures followed and decisions taken in emergency situations may impact on injured patients and their relatives, particularly in the recovery phase of an emergency.

1.15 The points from the HIIA have been incorporated into and generally underpin this guidance.

Who this guidance is aimed at

This strategic national guidance is principally aimed at NHSScotland Chief Executives, Executive Directors, senior managers and staff responsible for resilience and emergency planning of health services.

NHSScotland includes NHS Bodies, Special and other Health Bodies, including the Common Services Agency (commonly known as NHS National Services Scotland). In this guidance they are collectively referred to as 'Health Boards'.

The terms 'Territorial Health Boards' and 'Special Health Boards' are used when specific advice, information or guidance is directed at particular organisations within NHSScotland.

Health Boards should ensure that primary care contractors are aware of this guidance and, where appropriate, engage them in the relevant major incident planning processes.


Email: NHSScotland Resilience Unit

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