When Worst Case Scenarios Happen

As an NHS manager for over 30 years Jeremy Millar has had his share of Major Incident Planning and, from an NHS management perspective, has been directly involved in several, culminating last July in the London terrorist bombings. Here he tells how management can gain from experience honed in adversity.

In 1984 I worked in Brighton, the year when the Grand Hotel was bombed, and like many other managers since, I carried the experience of that event to future NHS jobs, making sure Major Incident Planning was given a high priority, and that the management process in connection with these sudden and disruptive events was improved from year to year.

Later that decade, after moving to South Staffordshire as UGM, the Burton Hospitals were involved with the Colwich train crash, a major chemical spillage, and were on standby for the Kegworth air crash. And on each occasion, the plans worked.

Many other managers over the years will have shared my experiences. Moorgate, Kings Cross, the Birmingham pub bombings, the Paddington rail crash – each one tested the quality of local hospitals’ incident planning, and enabled systems and procedures to be reviewed and improved.

None of these events, however, came near the scale of the multiple incidents on July 7th when dozens died and hundreds were injured. Hospitals across London were put on alert, and then coped with not just the events themselves, but also the aftermath. Staff access was disrupted, media interest almost unavoidable, and routine patient care inevitably delayed. So it is a testament to the managers of those hospitals throughout the city, that their plans worked – and if they didn’t in small ways, the rest of us didn’t see that. It is the mark of good planning – detailed planning which has been taking place in London for some considerable time – that this was the case.

None of this takes away from the dangerous and truly awful tasks for either the emergency services, or the clinical staff directly involved, but equally, it is the planning, the arranging, the testing, and the maintenance of Major Incident Plans which ensured those front-line staff had the best opportunity to do their jobs well – in unprecedented circumstances for the UK.

NHS managers, many of whom are members of the Institute of Health Management (IHM), will have been behind the scenes in July, ensuring systems, supplies and staff were available. They have shown once again that they can deliver. And as a result, the public can have confidence in NHS emergency arrangements. It is sad that managers, so often the subject of negative publicity, are so rarely thanked when things go well.

The IHM is grateful to all those managers, many of whom would have had disruption and personal trauma to deal with, for the professional way their work was done, both before, and in the aftermath of those events. The NHS will again learn from these experiences. Plans will be reviewed, revised, and where necessary rewritten – in order that the country’s hospitals are ready, and even better able to deal with any future disaster.

Jeremy Millar is Interim Chief Executive of the Institute of Health Management.

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