Facing The Challenge: NHS Emergency Planning in England Public Accounts Committee 27 Nov 2002

Examination of Witnesses

Mr Steinberg When I read this report I did not know whether to take it seriously because I thought if there is a nuclear attack on Durham or somebody dropped a bomb it would not matter whether a hospital was prepared or not really, would it? We appear to come from the region least prepared and not only are we least prepared for a nuclear attack or a biological attack or a radiological attack, whatever that is; we are also not prepared for a major incident. If you look at the traffic light graph, north and Yorkshire health authorities were the least prepared for a major, general incident. You seem to concentrate on the fact that we are talking about decontamination. I am not sure you need to be decontaminated if you have been in a rail crash or not. That is irrelevant. Then we look at the acute trusts and again they are the least prepared all over the country for a general, major incident. What does that mean to my constituents?

Mr Crisp These are pointing us to issues that we now need to look at, to find out why people have said that. I do not know if Mr Doran can comment on the general, major incidents, because that is clearly the one that is the lowest.

Mr Steinberg That is the most likely, I would have thought. For example, the main coast east line railway coming through and there are two viaducts in the constituency which could be used for a terrorist attack. Are you saying that the health authorities and the acute trusts in my areas are not prepared for such an incident?

Mr Crisp I am not saying they are not prepared. They are not well prepared and that is their self-assessment. It is an entirely appropriate question that you and we should ask: why people are saying they are not well prepared.

Mr Steinberg In the west Midlands, they are tip-top, 100 per cent at everything. What different treatment would my constituents get than the constituents of an MP for the west Midlands get if there was a major incident?

Mr Crisp The NHS has dealt with emergencies, with its partners in the other emergency services, very well over recent years. You all know examples, happily not everywhere in the country because we have not had them everywhere in the country. This is building on strength. Where this report has identified that people are saying to us they do not think they are as well prepared as they would want to be, we have to ask them the question and we have to resolve it.

Mr Steinberg What should the PCTs and the acute trusts in my area and Jon Trickett's area do?

Mr Crisp Firstly, provided we have the names of people who are saying they are not well prepared, they should tell us why they are saying they are not well prepared for a general incident, because this is not about decontamination equipment and the roll out of that. Then they should tell us what they are going to do about that and we should work together on that.

Mr Steinberg What also tickled my fancy a little bit was the fact that, when I looked at the ambulance trusts, I see in the north and Yorkshire we are performing very well indeed, 100 per cent on general, major incidents. Are we saying that if there was a general, major incident in my constituency the ambulance would get them to hospital but once they got to hospital they would be knackered?

Mr Crisp No. We only had this information relatively recently and we do not know the answer to your question. I am very happy to try and find out the answer, provided we hear from the NAO which trusts we are talking about.

Mr Steinberg Perhaps the NAO could answer this question because they are the ones who produced the report. Are they saying that in Durham, if there was a major incident, you found our ambulances would get them to the hospital but the hospitals could not cope?

Mr Robertson We are not saying that. It is very difficult to speculate about any given incident. When we looked at individual health authorities, some were better than others. When we looked at acute trusts, some were better than others. When we looked at ambulance trusts, some were better than others. It is a question of taking all that response together on the day. As Mr Crisp has said, the performance to date has been good. What we are pointing out is that there need to be improvements in all these organisations.

Mr Steinberg This report when it hit the press a fortnight ago was one of the biggest splashes I have seen for an NAO report. Not only was it national news; I think it even led the news on the day. People regard this as very serious but you seem to be saying that, yes, this is very serious but we do not know what the problem is or how to put it right.

Mr Crisp We do not see the information on the trusts involved in that until after the report is published and when we see that we then need to follow it up and investigate. Particularly for general incidents, the NHS has an exemplary record and it has been improving, as this report says. There has been an enormous amount of work going on, but we need to continue and keep improving on this. We need to know if there is a problem and we need to sort it out.

Mr Steinberg Paragraphs 3.12 and 3.13 deal with not all health authorities' staff being adequately trained to deal with major incidents. Even before September 11, 33 per cent of health authorities believed their training was insufficient. What has been done to rectify that?

Mr Crisp There were training programmes underway then. There are further training programmes following 11 September and we have now appointed a new co-ordinator for the training programme to make sure that we are rolling that out in a consistent way around the country, because one of the points made here is about the consistency of that training and the point was made earlier by Mr Trickett about the consistency of training across boundaries and so on.

Mr Steinberg What struck me was that I thought if the authorities who were not satisfied were the same authorities who were ill prepared for major incidents, at least we know and can do something about it. What if it was the ones who were insufficiently trained; yet, they believed they were able to handle a major incident? What is the situation there?

Mr Crisp That is again why we are going through the training programme consistency across the country and also the audit which I mentioned earlier, and also making sure that, for the first time, we have the Health Protection Agency which comes into existence in April next year, which will pull all this together in a tighter way across the country as a whole.

Mr Steinberg Will you be able to know if it was those authorities who were not up to scratch who were not fully trained as well?

Mr Crisp In future, absolutely.

Mr Steinberg The only way in which the plans of any authority or acute hospital can be tested is if there is an incident. The next best thing is, I assume, to regularly test those plans. I thought it was quite worrying to see that in paragraph 3.15 only 60 per cent of health authorities ensured that their trusts exercised their plans regularly. 71 acute trusts and 32 ambulance trusts were unable to tell whether a major incident plan had been tested or not. That seems absolutely ludicrous: that they have a plan there and 72 trusts and 32 ambulance trusts did not know whether the plan would work or not because they had never tested it. It is absolutely crazy.

Mr Crisp You are quite right that the best way to test it is in reality. One thing this report does not bring out is that since 11 September we have had many hundreds of white powder incidents, including one in the Department of Health, which have been handled very effectively by some of the people who say they are not well prepared. We are dealing with highly professional people trained to make decisions on the spot. This is taken extraordinarily seriously. On the second point about testing, I agree with you. However, I ought to point out that this survey took place one month before the health authorities were abolished. If in that month a health authority said it was unable to tell you whether 72 of the trusts had tested or not, there may be lots of reasons. That is not an excuse for not testing, but we have to be a little cautious about how we treat that. We need to make sure that people test; we need more scenario testing, more table top exercises, particularly for the even more worrying things than train crashes. Your point is entirely well made, but these are people who are delivering these services with a lot of experience.

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Mr Steinberg It would be easy to name each one of those hospitals on the graph so that we knew which ones we were talking about and then we would know exactly which hospitals were performing and which were not. Perhaps you are not allowed to do that.

Sir John Bourn We are allowed to do it. We chose not to do it because we wanted to focus on the general issue.

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Mr Molan We just had a spending review which was concluded this summer. Like all departments, the plans which have been set for the next three years have been set at a level which should allow the DoH and other departments to plan accordingly for incidents like this.

Mr Steinberg That is rubbish, is it not, to be honest? If we had a major incident in Durham and 300 people were injured in a major incident are you saying that no extra money would be made available because the spending plan said there could not be? That is crazy. How can the Health Authority fund something like that?

Mr Molan I think if there was a particular incident -----

Mr Steinberg That is what we are talking about.

Mr Molan ----- there would be an issue as to whether DoH could find initial resources. If they could not there would be a possibility of the Treasury providing money from the contingency reserve depending on the local need, the Department of Health's overall spare resources. For example, the Department of Health does have an allocated reserve so there is some spare capacity for special incidents. If it was a very pressing matter and money had to be spent to help people locally then obviously the Treasury would engage with the Department to provide resources as necessary from the contingency reserve.

Chairman So although Mr Crisp has done a lot more work and spent a lot more money after September 11, you are saying he just has got to find that from within his budget. That begs the question, Mr Crisp, what else are you going to cut to make up for the shortfall, or is there sufficient leeway?

Mr Crisp There are two points, are there not? The first bit is what we did last year we managed to fund within our overall expenditure. The Treasury is quite right. We have then subsequently had a spending review which was settling our allocation for the next five years and which was meant to deal with everything.

Chairman. And you can reassure us of course that it does? You can remain silent and take the fifth amendment. We do not mind.

Mr Crisp I think we are extremely grateful for a very healthy settlement within the NHS which will enable us to make very significant improvements in this area and in our health services over the next few years, and that is what we are going to use it for.

Chairman: Thank you very much, gentlemen, for appearing in front of us. As Mr Steinberg said, this report did get a huge amount of national publicity a few weeks ago. I think it has shown, following the Prime Minister's statement, just how seriously the public take these matters. We do not want to alarm the public. We have to do our duty to try and encourage better and greater efforts and I think you yourself have acknowledged it and are now moving it further up the agenda in your evidence today and, whilst there may be shortcomings, we look for some major improvements. Thank you very much for appearing before us. We are very grateful.