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CHAPTER FOUR STAGE TWO FINDINGS

Introduction

4.1 This chapter describes the main findings from stage 2 of research. These findings were derived from focus group discussions conducted in the 8 strategic coordinating group areas late in 2005 where 'hypothetical' scenarios were utilised to elicit data. With the research objectives in mind the data was examined, firstly, for emerging themes that could provide an indication of the issues that could affect capability in Scotland. Next the data was cross referenced against the capability workstreams to capture any issues that had not emerged in the first examination. Finally an adaptation of the FEMA/ CAR matrix was used to provide an overview of the results by analysing each SCG and capability workstream against the Emergency Management Functions ( EMF) on a scale of high, medium and low. It is important to note here that as the results from stage 2 were qualitative a row for evidence that appears in the original FEMA matrix has been excluded. It is our intention that future research using this methodology would allow for quantitative data to be incorporated into the matrix via a row for evidence.

4.2 It is also important to note that these results are in the main qualitative and as such are the respondents'/participants' interpretations of the situation as they see it for their particular SCG area. There is however, a small section in this chapter that details results from a training and experience questionnaire which are largely quantitative in nature.

Emerging themes

4.3 It was apparent from the data that there were a number of themes emerging that could compromise capability and thus have a detrimental effect on the development of Scotland's resilience to major disaster. It should be borne in mind that this data was collected as a result of discussions surrounding 'hypothetical' scenarios and as such relates to a response to given situations. Nevertheless the themes discussed below are generic in nature and extremely relevant to Scotland's response capability to any major event but particularly so to wide area (cross-border) emergencies and those that are beyond the 'normal'.

Integrated emergency management

4.4 Whilst it is recognised and evidenced by the discussion at the exercises that single agency planning capabilities across all of the SCG areas was high (see also the EMF matrix at the end of this chapter) there were a number of issues with regard to the exercising of plans and multi-agency co-ordination both horizontally and vertically. In the majority of SCG areas (5 out of the 8) it was stated that emergency plans for a major incident have never been put to the test but these SCGs were 'confident' that the plans will work. This is of major concern as research and experience show that plans should never be 'signed off' until they have been tested and validated. We are of the opinion that this is a misplaced confidence.

4.5 Comments were made at some of the exercises regarding the vertical integration of emergency management in Scotland and in some cases a lack of trust in the ability of the SE and ultimately Whitehall to deal with wide area emergencies was displayed. There was a perception amongst some of the SCGs that the SE had limited resources and that they needed to enhance their cooperation with and coordination of all strata of the emergency management system. Fife SCG mentioned that there "needed to be formal procedures in place for a national approach". This view of government by practitioners is not wholly unexpected and is demonstrated in other parts of the UK.

4.6 Conversely, there was the assumption present in most SCGs that the SE would play a substantial role in the event of a major emergency by providing guidance, management objectives, policy directives and resources for emergency operations. Given that the ethos that underpins emergency management in Scotland and the UK is primarily one of local response this was a disturbing theme. The idea that "someone else will rescue us" could suggest that preparedness might be compromised when a major emergency occurred.

4.7 It was clear from the exercises that SCGs like the Northern area SCG had long established and well embedded cooperation and coordination procedures in place indeed this was a very definite strength of the system in Scotland. However there were some comments regarding horizontal coordination particularly with regard to the Health boards. Comments such as "not cross multi-agency" and "single agency plan" were mentioned in regard to pandemic flu. Here again there was emphasis on the SE taking the lead in such a situation.

4.8 What was of concern was the emphasis being placed on the notion that a major event like a flu pandemic would result in public order issues. It is mildly alarming that participants at the exercises seemed to focus on such a crisis as being one of public order rather than a public health crisis. Such a focus could act as a decoy allowing planning and resources to be channelled in the wrong direction thus compromising the ability to effectively deal with the real crisis. Further to this the possibility of requesting military aid was also raised. Here there seemed to be some lack of knowledge with regard to the procedures for such a request with one participant remarking that "there were no plans in the UK to ask for military aid".

Communications

4.9 Communication is of major importance in emergency management and a number of issues in this regard were raised during the exercises. These issues on several different levels ranged from the delivery of public information to the standardising of systems used by emergency services. All agencies across all SCGs reported that they had PR and media plans in place and access to PR and media officers. They did indicate however, that in the event of a wide area emergency like a pandemic that they would depend upon the SE for reliable information and assumed that the SE would ensure that the information being distributed was accurate. It was felt there was a need for a national and local integrated approach to the distribution of public information in wide area emergencies and that the SE would take the lead on this.

4.10 Local authorities and the emergency services felt that it could be extremely difficult to comply fully with the statutory requirements of the CCA 2004 to warn and inform the public in the event of a major emergency. Striking a balance can be difficult and problems were envisaged in delivering timely, accurate information that is understood and acted upon to multi-racial communities, particularly when the diversity of languages spoken in a community may not be catered for by interpreting agencies. Here also the difficulties with informing tourists must be taken into account in almost all areas of Scotland along with the consideration of the time of year an event may occur.

4.11 The ability of the casualty bureaux to handle large numbers of enquiries was also highlighted. It was felt that arrangements and mechanisms, including communications equipment, facilities and trained staff to allow for large numbers of people to contact local authorities for information and advice during a major event should be further developed. Here again the SE was seen as taking the lead in setting up help lines and providing the necessary resources.

4.12 With regard to 'hard' communications systems the advice from the scenarios was for all the emergency services to have access to one universal communication system. Lack of such a system was a weakness that was acknowledged during the Kings Cross Inquiry in 1988 and again during the events of July 2005 in London and is of particular concern. It was suggested that a more integrated approach to the various command and control systems be adopted using the police system already in place as a basis for the whole of Scotland. There was also a suggestion that the relevant software to enable the integration be developed by and directed from the SE to allow for uniformity across all of the SCG areas. In some SCG areas there was compatibility across the services (but in one case not with the council) but in others the police and fire services had different systems, which was seen as being a gap in their ability to operate effectively

4.13 Finally, and of concern, is the issue of network coverage for mobile phones. Comments were made in all SCG areas with regard to the reliance of agencies, particularly the local authority and voluntary organisations, on mobile phones as a means of communication. We were advised (and it was experienced by us on a number of occasions) that there were many areas where network coverage is limited or is not available at all. We recognise that for network providers coverage is largely dependent upon population and centres of population rather than square miles or geographical location. However such a means of communication can be a lifeline to responders working in remote or isolated communities and all SCG areas were anxious that this gap be filled. The caveat to this is New Zealand (a country comparable to Scotland in many ways) where network coverage is treated as an essential lifeline by government. Consequently network providers have established coverage irrespective of population or terrain.

Business continuity

4.14 As one of the new duties under the CCA 2004 business continuity ( BC) figured highly in all of the discussions at the exercises. Many comments were made regarding the development of BC programmes and plans as being "work in progress" and of the requirement to develop the skill sets needed for this. Other discussions related to being able to provide essential services with a reduced workforce of up to 50%. However, it is our opinion and a cause for some concern, that the process of BC is not fully understood by those who have been tasked with implementing it.

4.15 The CCA 2004 requires responder organisations to be resilient in the event of a major emergency and to develop that resiliency by implementation of BC programmes to ensure the provision of essential everyday services during a disruption. Fundamental to developing resiliency is developing an understanding of the organisation, its critical activities and dependencies and interdependencies. Comments like "we can cope with only 50% of our workforce'" and "we would have to suspend normal activities" suggest to us that some responders have got very little understanding of where their critical points of failure might lie or what their minimum resource requirement might be to continue operating. Furthermore, when one responder in Lothian & Borders mentioned that they had updated their Y2K plan alarm bells began ringing. Y2K planning was concerned with the loss of IT systems, a small part of BC. BC should be a holistic management process that encompasses the whole of the organisation from people issues through facilities, systems, support functions, the supply chain and internal and external stakeholders, it is not simply a case of just writing a plan.

4.16 We are concerned that the lack of understanding is a very real gap in Scotland's capability and will seriously compromise the development Scotland's resilience. It is obvious to us that there is a major training gap here and suggest that steps should be taken as a matter of some urgency to ensure that affordable training and education in understanding the BC process is made available to all responders. We further suggest that the SE oversee the training to ensure that it complies with the Statutory Guidance.

Funding and resources

4.17 The allocation of funds to the SCGs for the delivery of emergency management and services appeared to be a contentious and divisive issue for all participants. This was particularly so for local authority representatives who see the delivery of the new statutory duties contained in the CCA 2004 without significantly improved budgets as difficult. Those arguing for a change in the funding regime which is currently based on the size of the population suggested that the system would be improved if funds were allocated according to the hazards and risks faced (i.e. based on the risk registers). The counter to this of course is that some SCG areas are more advantaged by the present system than others and would consequently lose resources as a result of any reallocation. We recognise that the funding of emergency management is a controversial issue that has always generated much debate but wish to highlight and suggest that the basis on which funds are allocated needs to be discussed at the SE level with the SCGs and category one responders

4.18 Non-payment for non public servants was a major issue in Fife but less so in other SCG areas. Where voluntary organisations were present, they expressed funding as an issue as they have limited resources. It would appear from the discussions that the SE and the local authorities were in dispute over who should fund these organisations when they are called upon to assist in a major event and that a solution needs to be determined as such disputes compromise the reliance placed on such organisation and further stretch the already limited resources of local authorities.

4.19 The lack of resources and the stresses imposed generally on emergency management services were of major concern across the whole of Scotland, comments such as "We lack the resources to deal with what the Scottish Executive may want" were typical This perceived 'lack' appeared to encompass all types of resources both human and physical. Only one fire service participant said that their funding resources had increased and that was felt to be due to 9/11. In all SCG areas the impact of the CCA 2004 was obvious with the appeal being for more money and resources to be available to allow for expansion and to meet the new demands from government. The difficulties were expressed by one local authority representative as being that they now have to carry out tasks that were mandatory rather than voluntary and this meant they were unable to prioritise the various tasks allowing those of lesser importance to be placed aside until later. Much of the call for more resources came from the local government participants but all participants felt their resources were being stretched as they endeavoured to meet the new requirements of the CCA.

4.20 The limited number of emergency planning practitioners in post was of major concern in a number of SCG areas. It was suggested that the depth of knowledge was disappearing through retirement and employees moving elsewhere. Here again the demands of the CCA 2004 were stretching existing resources to the limit whilst lack of adequate funding was limiting expansion of the profession. Reliance on just one or 2 practitioners in some organisations has serious implications for delivery of service over prolonged time periods and for resilience in general (a lesson learnt in London in July 2005). It was suggested that training of non practitioners was needed so that the system did not break down if the key individuals are absent. Statements such as "we're more vulnerable than ever before" and "we have no resources to meet the new demands" are a reflection of the responses we received. The CCA 2004 and the ramifications for the various human resource services were of particular concern in the areas beyond the 2 major cities and, even there, problems of stress on staff were noted.

4 21 With regard to voluntary organisations, members present expressed concern that the membership was growing older and that there is a difficulty in attracting younger members and particularly in the more rural areas where the youth were moving out to the cities. As so many services are reliant on volunteers this could have serious resource implications over the next decade with the rapidly ageing populations.

4.22 From responses to prompting by the moderators, it was apparent that while the usual voluntary agencies were drawn upon during an emergency, a ready source of volunteers appears to go largely ignored and this is the service/business clubs such as Rotary, the Lions and so on. Also underutilised are the churches and other faith based groups, although potential volunteers in both these areas may already be involved. It may be worth exploring these less than traditional sources for a renewed volunteer-base, which would be of particular use during the recovery phase of an event.

4.23 All SCG areas reported that they had the resources to enable them to deal with a 'normal' emergency (how this is defined is again based on local considerations). However if an event extended beyond the norm (i.e. producing a large number of casualties or fatalities or was multi SCG area) then resources would be stretched. All SCG areas apart from Strathclyde and Lothian & Borders would be reliant on informal cross-border mutual aid agreements for assistance. Mutual support was seen as being essential as the non-major city SCG areas expressed the view that they were under resourced for certain events such as a plane crash or chemical/fuel explosions. This lack of formal agreements presents a worrying picture if scenarios such as pandemic flu are realised.

Recovery

4.24 Information given at the various exercises indicated a very high level of preparedness for 'response' but less information could be obtained on the level of preparedness in the area of recovery: We understand that recovery has traditionally been the responsibility of the local authority and that emergency services participation generally ends after the immediate crisis had been dealt with. However true resilience comes from understanding how disaster can also promote sustainability and mitigation and that a comprehensive recovery strategy will help build resilience in communities.

4.25 Considering that those present at the exercises were nearly all category 1 and 2 responders it is likely that other persons not present may be dealing more with the recovery phase, but this could indicate that communication between key actors is lacking. However, planning for recovery and the need for resource allocation in this area would appear to be where one of the major gaps lies and further research is needed to allow the development of recovery strategies and to see that there is a seamless move from disaster/crisis to recovery.

Education and training

4.26 Data relating to the education and training aspects of emergency management in Scotland was elicited through both the scenario exercises and the use of a qualifications and experience assessment questionnaire. Qualifications, experience and the training of those tasked with emergency management are fundamental to resilience and capability. The research revealed that training needs varied between SCGs and responder organisations and were dependent on the experience and qualifications of those tasked with emergency management. All agreed however that it was essential for training and staff development to be a continuous process and that funding for training across all areas needs to be addressed.

4.27 Worth mentioning here was the discussion in the Lothian and Borders exercise regarding emergency management competencies. Responders commented that they needed to know what constituted the competencies (often referred to by the SE) so that they could identify the key skills needed to carry out their work. Nevertheless the following training needs, drawn from all the exercises, were specifically identified:

4.28 The Cabinet Office Emergency Planning College ( EPC) was the subject of some criticism in 3 of the exercises. The criticism levelled at the EPC was that it was very Englandcentric and that the content of courses was irrelevant for Scotland as it was based on the legislative and other requirements of England and Wales. Others commented that courses were expensive and their training budgets did not extend to sending delegates for training there. Conversely, 2 SCG areas thought the courses and training to be very good. Interpretations obviously differed on the value of the EPC's courses and training, however one solution might be for the SE to enter into discussion with the EPC regarding the tailoring of some courses to match Scotland's distinct needs.

4.29 The introduction of the CCA 2004 has increased the need for more training, specifically in understanding the Act and how it has impacted on responders and in what it means in terms of roles (both stated and un-stated) and responsibilities. One comment made was that training in this field be directed by the SE with a

"generic template, which could then be applied locally. In this way all of Scotland could work together in training. The police already do this".

The implications of the Act on training within the NHS were also raised and this too has funding implications. "There is only one NHS person to train 15,000". If this is the case then the training programs will be less than effective.

Qualifications and experience assessment exercise

4.30 In addition to the scenario findings a qualifications and experience assessment exercise (as outlined in the methodology) was used to elicit data regarding the qualifications, experience and competencies of incumbent emergency management practitioners. It is important to point out here that this was an opportunistic exercise that was carried out at the Scottish Emergency Planning Society Annual Conference in order to supplement and add some weight to the research project as a whole.

4.31 It is our opinion that the experience, qualifications and competencies of those tasked with emergency planning responsibilities are important and as much a part of a Scottish national capability as any of the designated workstreams. Indeed in other parts of the world the need for such qualifications and competencies are enshrined in emergency planning/civil defence law (see for example Stuart-Black et al 2005). It was disappointing then to only receive 17 responses from the 100 delegates attending the conference. Nevertheless these responses do give a valuable 'snap-shot' of experience in Scotland and as such provide some useful, if not representative, findings.

4.32 The main findings from the qualifications and experience assessment exercise are summarised as follows ( see Appendix 6 for data tables):

• All the strategic coordinating groups, except Fife, were represented in the exercise, with a high proportion (35%) of responses from delegates working in the Strathclyde SCG region.
• The participants were predominantly Local Authority Emergency Planning professionals (8/47%) and, interestingly, (6/38%) of respondents were from non-category one organisations (there were no submissions from the industrial sector, the Ambulance Service, SEPA or the Coastal & Maritime Agency).
• Just under half (8/47%) of respondents had only been in the profession for 5 years or less which does bear out some of the evidence regarding experience gathered during the focus groups.
• There was a variety of experience recorded ranging from the Lockerbie disaster, flooding, train crashes, murder, Foot and Mouth disease ( FMD), and the Dunblane tragedy to typhoons.
• Only 25% (4) of respondents were full time emergency planning professionals - additional responsibilities carried out ranged from human resource management, training and policy/electoral duties to more emergency planning related work. The amount of time these respondents spent on emergency planning duties covered a wide range from as little as only 5% to as much as 95%.
• 47% (9) of respondents said they had been previously employed by either the military (Army and Navy) or the emergency services (police and fire).
• Academic qualifications held by professionals in emergency planning ranged from CSE/ GCSE to Masters Degree level. Only one respondent had an academic qualification in emergency planning. One respondent had no academic qualifications at all, 77% (12) had CSE/ GCSE, 30% (5) had 'A' levels, 18% (3) had NVQ/ GNVQs, 35% (6) had HNC/ HND, 18% (3) had a Bachelors degree, 41% (7) had a postgraduate Diploma and 12% (2) had a Masters degree. Other qualifications mentioned were from the military.
• As would be expected, the majority of the respondents were members of the Emergency Planning Society (15/88%). There was also a number of other professional bodies mentioned.

4.33 Taken together, these findings would suggest that the role of emergency planning officer is still seen by some organisations as an additional role that does not warrant too much investment. While this supports previous UK-wide research (Coles 1998) it is still surprising in light of the Civil Contingencies Act.

Remoteness and service delivery

4.34 The ability to reach some of the more remote regions of Scotland and in particular the islands and oil rigs were mentioned in all exercises where there was a responsibility for services to these areas. Problems can arise particularly during poor weather conditions and where there are no doctors on the islands or in the more remote parts of a SCG area.

4.35 The observation was made that the situations in these remote areas would be exacerbated if a flu pandemic were to occur. The oil rigs would be at risk where the flu could spread rapidly as they operate in confined spaces. We were advised that quarantining of workers might have to occur. The health workers present indicated, though without providing evidence, that in the case of a pandemic, coupled with extreme weather conditions the delivery of emergency medical services from outside the area would be limited.

Population, tourism and service delivery

4.36 The logistics of dealing with a major event in the tourist season or when students were in University was also raised. Seasonal variations need to be taken into account when dealing with emergencies and mass evacuation. Contingency plans need to be developed with the local SCG working with the SE to enable some of the numerically smaller SCG areas to be able to deal with the massive increase in the numbers of people who are situated within their boundaries during the tourist season and who may be affected by a disaster.

General issues relating to the data gathered during the scenarios

4.37 What was evident from the scenario responses was the need for the SCG areas and SE to draw out some of the variables in capability and to assess their significance. These variables would include: remoteness, isolation (and not just those areas on the mainland or islands where they are quite isolated from services but the 25,000 workers on the oil rigs), diurnal factors, annual factors, tourism, ethnic backgrounds and transient populations.

4.38 Testing for system breakdown, human and also organisational behaviour also needs to be accounted for. All of these variables were raised to some degree during the scenarios in each of the SCG areas and we were advised that they were dealt with as best as was possible but were often placed in the "to be addressed later basket". While such prioritisation can be seen as being a valid management tool in emergencies, the observation made across the SCG areas was that resources were already stretched to the limit and a pandemic would stretch their capability to deliver services across the board.

Capabilities programme: functional workstreams

4.39 The purpose of this secondary analysis of the data was to cross reference the information gathered at the focus group exercises against the 9 functional workstreams listed in chapter one and to build, where possible, on the findings from stage one of the research. The difference here is that the CBRN (including mass evacuation) workstream has been added to the research.

4.40 Interestingly, the only focus group that specifically mentioned the capabilities programme and the workstreams was the Lothian and Borders SCG exercise and here the perception was that the workstreams would address many of the issues being raised in the scenarios. However, there was much discussion relating to the functional workstreams at all of the exercises.

Mass fatalities

4.41 The capacity to deal with mass fatalities was highlighted in stage one of the research and is dealt with in summary ( see chapter 3) in this report. It appears that the issues raised in 2004 were still very much the same in 2005, indeed it was frequently mentioned during the exercises that overall, mass casualties and mass fatalities were the most difficult areas to deal with and that SCGs could ' cope' with and were ' geared up' for a major incident but not a pandemic or a major disaster where many lives were lost and many casualties resulted from the event.

4.42 A number of issues were raised with regard to this workstream including

• legal requirements, which includes the capacity to deal with large numbers of inquests and the release of bodies for burial; the capacity and cooperation of undertakers (and the lack of any formal planning in this regard); and
• the capacity of crematoria to deal with large numbers.

The ability of the casualty bureaux to deal with the consequences of mass fatalities event was also called into question.

4.43 Most of the SCGs stated that their body holding capacity (even allowing for temporary mortuary arrangements) would need to be supplemented by the use of mobile refrigerated units. Tayside, for example, suggested that " they only had storage for 50 bodies so would use mobile mortuaries or empty hospital wards". They further suggested that the " NHS should prioritise staff to deal with bodies".

4.44 More importantly however, there was a perception that the SE would have plans in place to deal with such eventualities and that they would provide guidance where necessary and temporary facilities for body holding. If this was indeed the case then there was also need expressed for stronger links to be developed between the SE and the local authorities in particular.

Mass casualties

4.45 Capability with regard to mass casualties is seen by all SCGs as a difficult issue. In remote communities for instance (and this was raised by local authorities and health representatives alike) there was a perceived problem associated with isolation and a lack of doctors on site, a situation that could quite easily exacerbate the outcomes of a major event. Furthermore, we were advised that apart from facilities in Edinburgh and Glasgow the SCG areas lacked resources to deal with major numbers of casualties, e.g. there are only 6 pressure beds in Tayside . "We could deal with 100s but not 1,000s" was the general comment. However the point was made regarding the definition of the word casualty as " with a pandemic many of the people could be treated at home and in this or in other circumstances, beds would be made available to meet particular needs".

4.46 Issues were raised in Grampian with regard to offshore oil rig workers and what would happen if they became infected while working offshore. The need for carers or volunteer staff from hospitals was also discussed at some exercises. Here the issues were to do with the training of such staff and their identification as key workers.

4.47 All SCG areas stated they could deal with a normal emergency, though some would be reliant on mutual aid from surrounding SCG areas. This of course would pose a major problem if an event extends beyond borders to neighbouring SCG areas that would normally assist with the provision of resources. The need was stated for more cooperation across the SCG borders a gap which the Scottish Executive could provide oversight on.

Chemical, biological, radiological & nuclear ( CBRN)

4.48 The discussions regarding CBRN did not yield a large amount of salient information with respect to the assessment of emergency management capabilities. Fife, for example, see themselves as being ahead of the game, yet they don't have a CBRN scheme for ambulances on site. Plans for CBRN would appear to be in place in all SCG areas but again, in all SCG areas, resources would be stretched when an event went beyond a normal incident. It was suggested at the Fife exercise that one gap may be that many local authorities who are involved in the plans have no actual experience in this area and thus this need should be addressed. A series of major field exercises like those that have been conducted in England and Wales could satisfy this need and go much of the way to providing some experience for those tasked with writing such plans.

4.49 One belief held by the participants at another SCG area was that CBRN planning, particularly concerning decontamination, should be conducted or facilitated at the Scottish national level where knowledge and resources already exist. This would be a more efficient use of resources and would enable all 8 SCGs to have uniform plans which would enable greater cross-border cooperation where needed.

Mass evacuation

4.50 CBRN issues have been prominent in emergency management since 9/11 so we were mildly surprised and somewhat concerned that there are no plans in any SCG area to test for mass evacuation. Further no SCG area had exercised a mass evacuation in the past and Lothian and Borders stated they had no plans to do so. A situation that could have major consequences as such an event could almost certainly be wide area (cross border) if not Scotland wide. We acknowledge that it is difficult and costly to test such plans in live exercises however if the situation experienced in the southern US in 2005 is to be avoided the SCG table-top exercises in respect of mass evacuation should be encouraged.

4.51 Generally, and this is a major gap, there were no emergency management plans for mass evacuation with Tayside being typical in saying they could only deal with a few hundred evacuees. The problem was identified as not having suitable facilities and thus not being able to accommodate large numbers of evacuees. The assumption appeared to be that the SE would have the plans for a mass evacuation and its consequences.

4.52 There was the general assumption, evident at all focus group exercises that tourists would self-evacuate. It was stated that contingency plans for dealing with large numbers of foreign tourists are required as there seems to be no priority for action by the tourism industry for warning tourists of a disaster or for evacuation during an emergency. These issues become particularly relevant during such events as the Edinburgh Festival or large open air pop festivals like T in the Park. Without such plans it was noted the capacity of emergency services to 'cope' during the tourist season is an unknown.

Human disease

4.53 Stage one of the research in 2004 revealed that very little had been done with regard to identifying who were the key workers and how many there were. It appears that when stage 2 of the research was conducted in 2005 the same issues were present in some of the SCG areas. Fife and Tayside for instance noted that they had identified their key workers and priority lists had been built into the plan, Dumfries & Galloway have noted all health workers as key workers, whereas the police in Strathclyde still had identify their key workers. Following on from the issue of key workers was that of vaccinations (" a big issue is anti-virals"), in particular stocks of vaccines and how long they would last, who would be vaccinated and when and how such a programme would be organised and coordinated. Many of the SCGs again expected the SE to take the lead on these types of issues and comments were made regarding the lack of clear information and direction. For instance "distribution of vaccine would be a SE decision' and ' SE would determine who got the vaccine".

4.54 In the planning for a pandemic all agreed that such an emergency would be a public health issue and therefore health services would take the lead in dealing with it. However, there did not seem to a consistent and standard approach across the SCG areas. In Tayside for instance they had established a Pandemic Committee while at the same time commenting that "interagency cooperation needs to be achieved". In Strathclyde there was much discussion regarding single agency plans with the ambulance commenting that they had "plans for all types of outbreak". In Dumfries & Galloway the perception was that a flu pandemic would not be as bad as a smallpox outbreak whilst Lothian & Borders consider they have all their planning in place and if any gaps exist then they are in the national plans not the local ones.

4.55 It was evident from the scenario discussions in all areas that the lack of negative-pressure isolation rooms across Scotland could be a problem if a flu pandemic struck. There would not be sufficient numbers of beds available for treatment of the seriously ill and those with pre-existing chronic ailments and contemporaneous complaints. It was stated that to cope with an emergency, you may need to

"…release patients early, not deal with electives, treat people at home, but this means that electives will still later need to be done and other foregone treatment carried out".

Other suggestions included the use of care/nursing homes and similar facilities for treating the sick or the setting up of emergency clinics.

4.56 With regard to communication during a pandemic, all expected the SE, the NHS including HPS and the SCGs to work cooperatively together with the SE taking responsibility for reliably informing the public about the symptoms of a flu pandemic and how to deal with it. This would mitigate against public fear and would take some pressure off the local health staff. Clear information should also be provided to staff and the public on the strategies being employed to combat the flu and what is available to whom, where it is available and when it will be available. All SCGs stated that they had good relations with the media who could be used as a medium to transfer information. Any fear shown by the public has to be dealt with through the provision of timely and accurate information. This information should also come from the SE via the various forms of media so that a uniform approach can be adopted across the whole of Scotland to save confusion.

Animal and plant disease

4.57 The manner in which foot and mouth disease was dealt with has left a number of SCG areas suspicious regarding how an outbreak of avian flu will be approached. There was fear of a 'knee-jerk reaction and that all chickens would be culled unnecessarily. The perception was that "not much had been taken on board following the uproar over foot and mouth". Again, the common belief was that clear information from the SE needs to be made available and strategies for working with vets and government departments need to also be developed at the national (Scotland wide) level.

4.58 Concern was also raised over planning to dispose of larger numbers of chickens and the economic impact the large scale culling of birds would have on communities. This was particularly so in Fife where the most birds in the UK are farmed. Memories of burning cattle at the side of roads and images in newspapers during the FMD crisis have resulted in suspicion and a perception that plans at SE level are not well developed and a lack of understanding regarding where the SE and Whitehall would be involved. Other issues raised included the availability of protective clothing for those who were disposing of birds and the need (yet again) for accurate information.

Warning and informing the public

4.59 As warning and informing the public is one of the 6 duties of the CCA 2004 much discussion took place in the exercises with regard to this. In Grampian comments were made about the lack of strategies and facilities in that area to allow for large numbers of people to contact local authorities during a major event. These types of problems were alluded to in other SCG areas and can be seen as a major gap in provision which in our opinion could compromise Scottish resilience if not dealt with in a timely fashion. There was also mention of the procedures in place that would utilise the resources of the SE.

4.60 The public require information regardless of the type of event although with public health emergencies this becomes crucial, for example in a pandemic information regarding flu symptoms will be needed. There was much discussion regarding the best way to achieve the dissemination of the information. Radio and television, newspapers, word of mouth through meals on wheels deliverers and through the voluntary agencies, leaflets at surgeries were all mentioned as ways of getting the messages into the public domain. One problem mentioned was that some of the communities in the southern SCG areas receive their 'local' television news from Carlisle which can be a problem in an emergency.

4.61 In all SCG areas there was an assumption that the SE would play a major role in disseminating timely and accurate messages to the public in situations such as a pandemic. However SCGs also believed that restrictions on information should only be used with caution and that getting the balance right was of the utmost importance as reassurance was the major aim in working to inform the public.

CAR emergency management functions

4.62 The final part of the analysis of the stage 2 research data is presented below in Tables 4.6 and 4.7. Here the data is cross referenced against the EMFs described in the methodology in order to give an indication of the readiness capability of both the SCGs and the functional workstreams.

4.63 A scale of high, medium and low has been used to indicate levels of readiness. Criteria for each level is as follows;

Table 4.6 EMFs by Strategic Coordinating Groups

Table 4.7 CAR Emergency Management Function by Work stream

Summary

This chapter has presented the findings of stage 2 of the research. Key findings are:

• There was a high level of trust and capacity in planning and working relationships between SCG areas.
• Business continuity processes are not fully understood.
• General emergency plans have not been exercised giving cause for concern.
• Long term recovery arrangements were under developed which gave cause for concern.
• There were no plans to test mass evacuation arrangements in any of the SCG areas.
• Mutual aid agreements were mostly of an informal nature across nearly all of the SCGs.
• Health care provision and mortuary facilities could be stretched beyond limits in a wide area emergency such as pandemic flu.
• Warning and informing the public could prove difficult if diverse languages are not catered for and communication facilities are not in place.
• Training and development of emergency managers should be continuous and funding for such activities needs addressing.
• The allocation of funds for delivering emergency management in local authorities needs some consultation.
• SCGs assumed that the SE would play a substantial role in major emergencies.

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