There were 14 monitored recommendations in the report (14-27). The following is a brief summary of that progress. The full transcript is available to read on the inquiry website.
Recommendation 14 – North West Ambulance Service should review its Major Incident Response Plan to consider whether it should be updated to include a pre-determined attendance (PDA) for Major Incidents.
- Our Major Incident Plan has been updated six times since May 2017.
- The PDA was incorporated into the plan in January 2021. It provides a realistic and minimum response NWAS should implement on two levels for “major incident standby” and for “major incident”.
- The major incident plan continues to be reviewed on an ongoing basis.
Recommendation 15 – North West Ambulance Service should review its Major Incident Response Plan to consider whether, in order to speed up mobilisation, it should provide pre-determined attendances for the Hazardous Area Response Team (HART), Ambulance Intervention Team (AIT) and Special Operations Response Team (SORT) crews for Major Incidents.
- The introduction of PDA has improved the identification and mobilisation of resources, including HART and SORT, to major incidents.
- AIT functions have now been absorbed into SORT capabilities.
- The Major incident plan and action plan clearly identifies the specialist resources available within NWAS.
- NWAS has appointed a full-time Marauding Terror Attack training manager.
- We have more than the nationally mandated level of 290 SORT staff.
Recommendation 16 – North West Ambulance Service should ensure that it has up-to-date site-specific plans for all large, complex or high-risk locations within its area.
- A guidance document has been developed for the management of complex sites, for example, large shopping centres, sports stadia, arenas, transport hubs and high-security sites.
- Plans are developed after sites visits and include information including:
– Exact Location
– 24/7 contact details
– any code words
– overview of the site
– access and egress routes
– potential rendezvous points (RVP)
– maps and floors plans
- They have been shared with other Category 1 responders for comment.
- Site specific plans continue to be developed as sites change or as information is agreed upon between agencies.
- We have enhanced our internal Mass Gatherings Register (a record of events in the region), which now link site-specific plans and other operational plans.
Recommendation 17 – North West Ambulance Service should ensure that all its site-specific plans are multi-agency and that all Category 1 responders operating in the areas it serves have contributed to them.
- All site-specific plans are shared with partners agencies.
- We have written to all six Local Resilience Forums to support the sharing of multi-agency plans.
- This work is ongoing.
Recommendation 18 – North West Ambulance Service should ensure that it has a policy that sets out the circumstances in which an Operational Commander may be relieved and how that should occur and be communicated to the outgoing Operational Commander and beyond.
Recommendation 19 – North West Ambulance Service should train its Operational Commanders on the appropriate practice for relieving another of command and being relieved of command.
- The current version of the NWAS major incident plan has been updated to include a section on handover and/or relieving of command.
- Training began in 2023 to assist commanders in the decision-making process.
Recommendation 20 – North West Ambulance Service should ensure that non-specialist ambulance personnel are involved in multi-agency exercising.
- All staff are mandated to watch the JESIP video, which covers aspects of multi-agency working and JESIP principles.
- A further Marauding Terrorist Attack (MTA) awareness video has been made mandatory.
- Non-specialist staff have always been involved in multi-agency training, but the trust has aspirations to include more. Due to the size of the organisations, this does remain a significant challenge.
Recommendation 21 – North West Ambulance Service should review its Major Incident Response Plan to make clear that the first resource on scene should assume the role of Operational Commander only once they have achieved situational awareness.
- The current major incident plan and the actions cards now reflect the first resources on the scene are likely to be in the best position to assess the scale of the incident and the potential need for a wider response.
- Visual prompts have been installed within all ambulances.
- First response on scene is part of current mandatory training for all front-line staff.
Recommendation 22 – North West Ambulance Service should ensure that its commanders are adequately trained in the use of operational discretion.
- It has been identified that there may be exceptional circumstances where policies and procedures are unable to offer adequate options to those in a command role.
- The major incident has been updated to include a new section on the use of operational discretion.
- Commander training is being enhanced – and a bespoke training package is being used in this year’s annual training.
Recommendation 23 – North West Ambulance Service should review its policies for mobilising the Hazardous Area Response Team (HART) resource, to ensure that this team is available as soon as possible for an emergency where its specialist skills are required.
- HART continues to be part of the trust PDA.
- It’s now policy that the second HART team are informed of the activation of the other team in the case of a critical or major incident and moved to a designated location to provide backup if required.
Recommendation 24 – North West Ambulance Service should review how it rosters Tactical Advisors and National Interagency Liaison Officers (NILO) so as to ensure that there is adequate geographical coverage enabling those on duty to arrive promptly at the scene of any Major Incident.
Recommendation 25 – North West Ambulance Service should review the number of Tactical Advisors and National Interagency Liaison Officers it has, and whether the number of such specialists, both generally and on call, should be increased.
- We have committed to increasing and maintaining 21 NILOS. This will mean 3 NILOs can remain on call 24/7 and have the flexibility to cover sickness and annual leaves.
- NWAS currently has 12 fully trained NILOs.
- It will take approximately 2 years to reach the level of 21, due the availability of training.
- A review of the roster has been undertaken to ensure the optimal mix of skills is available in the meantime.
Recommendation 26 – North West Ambulance Service should review its procedures with local NHS trusts to ensure that it has effective policies in place for quickly dispatching patients injured in a Major Incident to an appropriate hospital.
- A Mass Casualty Distribution plan has been finalised and is under ongoing review.
- We have introduced improved training and frontline staff in incident management
- New equipment purchased to enhance the response to significant incidents where multi casualty triage is required.
Recommendation 27 – North West Ambulance Service should reflect on its approach to record-making during and immediately following a Major Incident, with a view to improving the current practice.
- Policy now states notes and decision-making logs should be completed within 24 hours of an incident reduced from 72 hours.
- Dictaphones have been issued to all incident commanders.
- Logging training is being given to commanders and SORT staff.
- We are undertaking a pilot of body-worn cameras for staff.