COVID-19, Collaboration and Challenges Ahead for the Emergency Services

At the time of writing, it has been a year since the UK government held its first meeting of the emergency committee Cobra to discuss the coronavirus, following the appearance of the first COVID-19 cases in the UK in January 2020.

One year later and 3.7m people in the UK have had coronavirus, and sadly over 100k people have died. The pandemic has impacted everyone, but particularly in the NHS and our emergency services; and the pressure has not subsided.

In this post, we’ll be reviewing the herculean task our emergency services have faced and still face, how they have collaborated to ensure the health and safety of the public and a look at some of the challenges they will face in the weeks and months to come.

Emergency Services COVID-19 Response

Ambulance Services

The ambulance sector began receiving its first COVID-19 related NHS111 and 999 calls towards the end of February 2020 and attended its first COVID-19 incidents in March. Throughout March and April, demand on services across the country escalated out of all known proportion, particularly for our NHS111 services.

These were evidently unprecedented times, not just for the ambulance service but for the whole of the NHS, Government, and life in general.

Ambulance services, at the forefront of caring for patients within the pandemic setting, had to take rapid and significant steps in order to manage the extreme levels of demand placed on the 999 service, NHS111 and Patient Transport Services as the crisis unfolded.

Operating models were transformed, digital solutions were implemented, workforce numbers were temporarily swelled, and processes and pathways that had once seemed frustratingly unattainable, suddenly became achievable – all at great speed.

Many of the changes that were implemented were already identified as objectives in ambulance trusts’ strategies for delivering against the NHS Long Term Plan (LTP). Most of them comprise solutions that are not just about ambulance operations, but form co-designed, integrated models working with partner providers in the NHS and in other sectors.

Members of the Association of Ambulance Chief Executives (AACE) swiftly worked together to provide national coordination and consistency in the response to COVID-19, supported by the central AACE team.

Police Forces

In normal circumstances, a crisis in policing, however acute, is typically at a local level and limited in duration to a few days or weeks. As we enter 2021, with the whole country in a third lockdown, policing across the UK has been responding to Covid for 11 months and will still be enforcing the coronavirus laws well beyond the one year anniversary of the first lockdown in March 2020.

The pandemic has challenged the way policing views its role as custodians of public safety. Traditionally, officers run towards danger on our behalf, equipped with powers, training and kit to eliminate the threat. But dealing with a virus is very different to handling a crime or terrorist incident. When the pandemic first struck, there were no stocks of PPE and almost no time to prepare for new laws which the government expected the police to enforce. Neither was there any sense of when or how the situation would be resolved.

The Covid-19 outbreak has presented policing in the UK with an unprecedented challenge. Enforcing restrictions never placed on the public in peacetime, adjusting to major shifts in crime, and ensuring the safety of officers and staff are among the many operational changes forces are responding to.

Fire and Rescue Services

To support their communities during the pandemic, fire and rescue services have done much  more than their ‘business as usual’ activities. Whilst maintaining their ability to respond to fires and other emergencies they have been supporting communities in ways that extended far beyond their statutory duties, with firefighters and staff stepping up to take on a range of pandemic activities, including driving ambulances, and delivering essential items to the most vulnerable and personal protective equipment (PPE) to those working in healthcare.

The pandemic was a catalyst for many fire and rescue services to transform, modernising some of their working practices to become more effective and efficient. All services put in place extra measures to support and protect their staff.

COVID-19 Collaboration

The COVID-19 pandemic has seen our public and private sector services collaborate on a scale never before seen in peacetime. Everyone has pulled together in the fight against this pandemic and this continues with the huge logistical effort of rolling out of the first vaccine.

Managing outbreaks of coronavirus is very dynamic. The overarching aim of government has been to empower local decision-makers to act at the earliest stage for local incidents, and ensure swift national support is readily accessible where needed. Continuous improvement and communication has been critical as more has been learnt about managing the virus alongside existing infectious disease and emergency response arrangements.

With the NHS under extreme pressure during the most critical stage of the COVID-19 pandemic, the Local Resilience Forums (LRFs) have sought to provide assistance where possible to assist health colleagues on the frontline.

LRFs, which are made up of emergency services, local authorities, NHS organisations, armed forces planners and other key agencies – have been meeting at least once a week during the pandemic to provide additional resources to tackle the health emergency and keep the public safe. These range from offering extra staff to tackling logistical challenges as part of the vaccine roll-out.

In certain instances, decision-making will be referred back up to the national level. This includes cases where:

• local leaders request an intervention from government

• multiple outbreaks require resource prioritisation by Ministers (for example where an outbreak requires more resources than local decision-makers can access through their own systems or mutual aid, including supplies of items such as PPE or additional staff)

• outbreaks raise issues of national importance (for example impact on critical infrastructure, major parts of the economy or on wider sectors such as food or energy production); or

• local capabilities and controls are exceeded (for example local community protection actions are not effective, or the scale of the outbreak calls for the use of wider or more intrusive powers)

A multi-agency national incident resource will be deployed to significantly bolster local resources to respond to incidents such as these. This team will include epidemiological resources, health protection experts, logisticians and general managers, communications specialists and other resources as needed depending on the scale and type of incident in question.

Every local authority has a published local outbreak plan covering the following themes:

• Healthcare and education settings – planning for local outbreaks in health, care and education settings (for example defining monitoring arrangements, potential scenarios and planning the required response).

• High-risk workplaces, communities and locations – identifying and planning how to manage high-risk workplaces, communities of interest and locations (for example defining preventative measures and outbreak management strategies).

• local testing deployment – ensuring readiness to deploy mobile testing units to high risk locations (for example defining how to prioritise and manage deployment).

• Contact tracing in complex settings – assessing local and regional contact tracing capability in complex settings (for example identifying specific local complex communities, developing assumptions to estimate demand and options to scale capacity).

• Data integration – integrating national and local data and scenario planning (for example data management planning, including data security).

• Vulnerable people and diverse communities – supporting vulnerable local people to get help to self-isolate (for example encouraging neighbours to support identifying relevant community groups etc) and ensuring services meet the needs of diverse communities.

• Local boards – establishing governance structures led by existing COVID-19 health protection boards and supported by existing ‘gold’ command forums and a new member-led board to communicate with the general public.

Challenges Ahead for the Emergency Services

There is no doubt that we will be living with coronavirus for some time to come. However, the vaccination programme appears to be progressing well across the UK, giving everyone hope of some easing of personal and professional restrictions within the next few months, but as we have seen repeatedly over the last year, nothing is certain.

The UK government have committed to carrying out a full review of how the pandemic has been handled in the future, although no date has yet been committed to as to when this will happen. It is expected that both the public sector and private sector will be doing the same.

In fact, many organisations that have implemented news ways of working during 2020, have actually accelerated plans to work more digitally and improve systems and processes.

There is no doubt that cross-organisation collaboration and shared learnings at a local, regional and national level will stand us in much better stead for future major societal disruptions.

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