What journey led to you being Head of NHS EPRR?
In 1978 I started as a cadet nurse at Hartlepool hospital and then went on to train as a registered general nurse, specialising in A&E. My career aspiration was always to become a charge nurse in A&E and when I got there I thought, what do I do next?
The hospital I was working in at that time (North Tees in Stockton) didn’t have a good working relationship with its local ambulance service and one of my objectives was to improve it. So I made some contacts in what was then Cleveland Ambulance Service and went out with them on a couple of shifts.
The hospital was one of those in the catchment area for 38 top tier COMAH sites and by that time I was the manager of the A&E department and I was given responsibility for the major incident plan. So I started working much more closely with the ambulance service and emergency planning really grabbed my interest. I then got involved in teaching on some of the pre-hospital paediatric emergency care courses before becoming involved with the Cleveland Emergency Planning Unit and the Local Resilience Forum.
As a result, I was offered a secondment to the Health Protection Agency in the North East which led to working at the SHA. A secondment at the DH (into EP) followed and then my current post was advertised and luckily I got it. I want to stay in post for as long as I can make a difference.
What particularly interests you about the world of EPRR?
The unpredictability! I like planning for events but I like being involved in the response too – whether it is an emergency at a local airport or an urgent ministerial question relating to Hepatitis C! No two days are the same.
Can you describe the structure of the wider team you manage?
At present there are six of us in the corporate team. There’s myself, Paul Dickens (Senior Officer), Hazel Gleed (Senior Officer), Kristel McDevitt and Mark Sewell (EPRR Officers) and Julie Fisher (EPRR Support Officer). We are part of the wider Operations and Delivery Team but we also work very closely with the regional heads of EPRR – so we work in tandem with them and this support is vital.
What are your department’s three key objectives for the year?
(1) Making sure that the new EPRR system is fit for purpose. (2) Producing new guidance for the NHS in the event of pandemic influenza and (3) making sure the team is embedded and people know what we do and where we are.
What are your overall impressions of the NHS Ambulance Service?
The ambulance services do a fantastic job. I think they’ve got a very challenging role in terms of the threats, opportunities and challenges they face – winter pressures, demand on services and the public’s expectation is so high. I have a great deal of respect for the services the ambulance service provides.
I do think we can do better from an EPRR viewpoint, we always can. For example, the way we train ambulance officers to do their role is very different to the rest of the NHS. I recognise ambulance staff have to work with other responders like the fire service and police, but we still need to make sure we are training people to the same level across the health service, of which the ambulance service is a key part.
What have your first impressions of NARU been?
Initially I didn’t fully understand what NARU did, however having worked very closely with the team since I started my job I can see it’s a very valuable unit that does a broad variety of EP work. I think we now need to communicate that to the wider NHS – what NARU can bring to the party and what expertise they’ve got.
When you look at some of the streams of work that individual members of the team are doing, most members of the NHS wouldn’t know about that and wouldn’t know that they could go to NARU for specific pieces of advice and assistance. So I think NARU could do a lot more to get the specific messages across to the wider NHS about what NARU can deliver. I want to see NARU being successful and I want to see it work, I want to see it being almost the professional representative of the ambulance service’s Emergency Preparedness leads.
I have been keen to get to know the NARU people as they are doing their job and have been travelling around meeting people to see what they do. Part of my role is being a conduit between the practitioners and the policy lead at the Department and it’s about trying to bring a sense of proportion to what the Department – and ultimately ministers – want, against what the NHS is able to deliver.
What are your priorities for how the NARU resource is best utilised in future?
We don’t control the funding for NARU but it is my job to make sure the NARU budget is spent wisely and being used appropriately. It is about making sure that NARU sticks to its business plan and is appropriately represented at things like JESIP and on the IOR groups.
We have some excellent expertise in NARU and going forward I would like to build up some confidence in NHS Trusts that we will get deliverables from NARU that we can provide to the rest of the NHS. NARU is not fully proven yet and we need to prove we can deliver a high quality product. And if we can do it through NARU – and we will need the support of the regional heads of emergency planning and ultimately the Trusts in doing this – we can say to Trusts, for example, “What product do you want that will help us deliver safe and effective decontamination in an acute hospital setting? What does that response look like and how do we deliver it in the most cost effective way?” This is where NARU can help and where I hope to see it heading.
Do you see a potential role for NARU in wider NHS training and exercising programmes?
Yes I do and I think it is really important that the NHS participates fully in exercises – ideally using expertise from across the service. We have money for training and exercises and I would like to see Public Health England working more closely with NARU to share expertise and knowledge to deliver even better exercising products. I found out recently about the TrainStation product (developed by the NARU Training and Education Faculty) and what a great piece of kit that is, allowing all people to genuinely participate in desk top exercises. This is an example of something I could see being rolled out across the whole NHS.
How important is interoperability and how does it affect your work?
It is very, very important. We can’t stress enough about the need to be able to talk to our partners and share information that affects the response we can deliver to patients from Health and Social Care. We cannot deliver an effective response on our own.
What have your biggest challenges been so far?
Travelling – I definitely underestimated the impact of how much travel would be involved in this job! I was on the train last week and had an important discussion to have and the signal dropped out ten times, which must have been so disruptive for the person I was talking to.
But to balance these frustrations out, I have been overwhelmed at how helpful and friendly everybody has been, especially in the ambulance world. They have been genuinely keen to help us make things better for the wider healthcare system.
What are your main messages for NHS EPRR professionals?
My biggest message is that we have to work together better. We have to break down this artificial barrier between the NHS and the ambulance service where we talk about the ambulance service separately. When we talk about the NHS we need to include the ambulance service. We need to help each other, work together and support each other.
At the end of the day we are all there for the patients’ benefit and the patient wants to receive a high standard of care from the NHS. That starts from the scene of an incident or being picked up at home, to their point of discharge. The patient sees the NHS not as separate units but as one whole service and they have a right to expect a certain standard of care.
What I want to try and do is make sure that from our point of view, when we talk about emergency preparedness, that there is a greater degree of consistency. There hasn’t been consistency thus far, we have a huge opportunity now with NHS England, with the way we are starting to work with NARU and with ambulance colleagues to improve things.
So for example we are looking to put out a template incident response plan for acute hospitals. Most hospitals in England have got their own major incident plan and there is no consistency. I know the ambulance services have worked on that and I would like to see where we have a tertiary centre or a regional trauma centre that we have a template plan that describes what a trauma centre would do differently and that we have common terminology and names.
So if you ring the ambulance service and ask for an Incident Director you know what capability, what skill set that individual is going to bring. You also know what that person’s role is going to be. If you ring an acute hospital and ask for the Incident Director you should have the same expectation that you will get a person of a particular standing in the organisation who has a particular skill set that they can bring to the management of an event.
Another example is I want common terminology across the NHS where we refer to the Incident Co-ordination Centre across England. So if I phone an acute hospital switchboard I don’t ask for the command centre, the operations centre or whatever, I ask for the Incident Co-ordination Centre and we start to get a common language agreed.
And then in the event mutual aid is invoked and I have to come from Hexham to support a hospital down in London or wherever I am familiar with the role I am being asked to do, because the role is the same. Geographically there is a difference and the people I am talking to are different people, but the competencies and the skill set are exactly the same – the action card should be fundamentally the same, why should it be different?
For me if there was a single measure of success going forward, it’s that we would have a greater degree of consistency across our plans, our planning and our response. I certainly don’t see this happening in six, or 12 months – but maybe in 18 months’ time.
Anything else to add?
I genuinely want us all to work together and I see myself as an enabler bringing people together to improve the system. For me, once we stop talking about patients and the benefit to patients it’s time to pack up and go home. We must remember that all of the planning, exercising and training is about making sure we get this right for patients, and that we are maintaining a safe secure system for patients to be cared for in.