In England, the Civil Contingencies Act 2004 (CCA), National Health Service (NHS) Standard Contract Service Conditions, and NHS England Emergency Preparedness, Resilience, and Response (EPRR) Framework require NHS-funded organizations to be able to respond to emergencies for the provision of health care. ^{1 - 3} The CCA defines an emergency as “an event or situation which threatens serious damage to human welfare in a place in the United Kingdom … if it involves, causes or may cause … loss of human life, human illness or injury, … or disruption of services relating to health.” ^{1 (s.1)}

The NHS England EPRR Framework “describes how the NHS in England will go about its duty to be properly prepared for dealing with emergencies”. ^{3 (p.4)} It states “Category 1 responders are those organisations at the core of emergency response” and that Category 1 responders for health care include NHS Trusts which provide “hospital accommodation and services in relation to accidents or emergencies.” ^{3 (p.12)}

The CCA requires Category 1 responders to “maintain plans for the purpose of ensuring, so far as is reasonably practicable, that if an emergency occurs the person or body is able to continue to perform his or its functions.” ^{1 (s.2(1)(c))} The Civil Contingencies Act (Contingency Planning) Regulations 2005 require that “[e]very plan maintained by a general Category 1 responder … must include provision for the carrying out of exercises for the purpose of ensuring that the plan is effective.” ^{4 (s.25(a))} The NHS England EPRR Framework states “Learning from exercises is central to developing a method that supports personal and organisational goals and must be part of an annual plan validation and maintenance programme.” ^{3 (p.31)}

The NHS England EPRR Framework also states that if an organization activates its plan or Incident Command Centre in response to a live incident then this replaces the need to run a live play or command post exercise, respectively, “providing lessons are identified and logged and an action plan developed.” ^{3 (pp.31-32)} However, the Framework does not override the Contingency Planning Regulations’ requirement to carry out exercises.

Results

The types of exercises and minimum frequencies of exercises required by the NHS England EPRR Framework, ³ and the number of Trusts having a record of their most recent exercises in accordance with the minimum frequencies are shown in Table 1.

Table 1.

NHS Trust EPRR exercise frequencies

There were 122 applicable Trusts. ⁵

Regarding live play and command post exercises, some Trusts stated that activating their plan or Incident Command Centre in response to a live incident satisfied their statutory requirements.