• Alexander Thompson

From Integration to Coordination

Somehow it is now June 2022 and it seems a long time since I first talked about the impact of the latest legislative change to Emergency Preparedness, Resilience and Response (EPRR) on the NHS in England.


It was within this article here that I reviewed the contents of the Government's ICS White Paper and tried to identify what this might mean for emergency preparedness in the NHS as it was brought through to implementation. Well, much time has now passed and we are but one month away from the legal creation of Integrated Care Boards (ICBs) as statutory entities to replace Clinical Commissioning Groups (CCGs). The transition for leadership arrangements of EPRR at a local level should be well underway and the last two-years experience of CCGs being at the front-line of response will hopefully have aided this process of understanding. That said, the provision of central guidance and expectations will be important to ensuring we all collectively land in the right place.


Simultaneously we are seeing the national development of a series of Operations Centres across the NHS landscape, although at different levels of pace and scale. These Operations Centres are purposed at maintaining the synergistic 'command and control' mechanisms that have been developed though having Incident Coordination Centres (ICCs) open for over two years. The robust and rigorous coordination that ICCs bring to incident response has been a huge benefit to the ease at which the national body can push communications and instructions out to the entire NHS - a benefit that nationally the organisation would like to maintain. To that end a National Operations Centre (NOC) is in development with a series of 7 Regional Operations Centres (ROCs) picking up this work and generating a network of operational coordination and situational awareness across England. Once again the imapct for ICBs and local systems is not simple to quantify and relatively open to interpretation depending on each Region's translation of flexible national guidance.


I have spent the last 9 months, in a new role as Head of the ROC in the South West, developing our function and strategy for delivery as a novel team in a busy and complex regional environment. There is still a long way to go on our journey but it is in my mind very clear the role and value that generating these quasi-COO/Operations Offices have brought to supporting the enduring response to both COVID and it's interactions with the significant challenges of non-elective pressures.

The image on the right is probably what I wished, and many envisage, such an Ops Centre looks like - but alas not, we work almost entirely virtually.


Ops Centres, ICCs and EOCs are of course not a novel concept to the world of EPRR or wider civil protection space, and it is not long since Whitehall themselves splashed a modest £9m on their new control room.


Has this £9m spend brought about better crisis decision making and coordination over the past year? I will leave that one to you all to ponder... I am pleased to let the tax payer know that our ROC is, in my humble opinion, significantly better value for money.


In other NHS news, at the end of May the NHS in England signalled a move from 'response to recovery' with a downward shift in the NHS Incident Level from 4 (nationally-led) to 3 (regionally-led). Communications around this change were clear in portraying a need for recovery to be led on a regional-footprint as it is clearly not uniform across England. It outlined three clear priorities for the health service in England:

  • Delivering timely urgent and emergency care and discharge

  • Providing more routine elective and cancer tests and treatments

  • Improving patient experience

Despite this shift in framing to recovery the NHS continues to be in problem-solving-response-mode both for the significant challenges facing urgent and emergency care provision as well as continued COVID pressures, the support to Ukraine, and the growing impacts of Monkey Pox Virus outbreaks. This is giving me flashbacks to one of my first ever posts on concurrent incident preparedness.


All of the above combined with the transition and implementation arrangements of ICBs leave the health service with an array of complex priorities to navigate over the next year(s). This will all need close coordination and support through a lens of regional and national situational awareness about local-level pressures and challenges, something I am confident the generation of our operations centres will be able to contribute towards.








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