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Emerald Group Publishing Limited
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Business continuity management in healthcare: an interview with Tony Hallett
Article Type: Talking Heads From: Leadership in Health Services, Volume 23, Issue 4
Interview by Alistair Craven
Tony Hallett currently works as an Assistant Director Resilience at Guy’s and St Thomas’ National Health Service (NHS) Foundation Trust.
On joining the NHS, Tony took the lead in emergency planning and continued this role when he moved into Primary Care Trusts, both in a secondary role to his performance management and IT function, then took extra responsibility for emergency planning for the South East London sector. During this period, and supported by the Health Protection Agency and the Emergency Planning College, Tony worked with colleague Alex Haynes to produce the original modular course; this is now the Diploma in Health Emergency Planning.
Prior to working for the NHS, Tony started his career in the military, working as a Unit Defence Officer in South West England and regional lead for a regional Nuclear Accident Response team. Tony was responsible for visiting and training a number of civilian organisations (fire brigade, local police, etc.) and later was a Unit Fire Officer for two large Royal Air Force bases in Germany and the UK. Throughout his career in the military, Tony’s work preparing for aircraft incidents or other large events and planning to defend a substantial air base all built towards a level of expertise in managing disasters and understanding the potential complexity of any given incident.
Since leaving the military and armed with this experience and expertise in contingency planning, Tony has been employed primarily as a specialist in performance management and held the role of an Assistant Director of Performance and IT at Lambeth PCT. Tony moved from there to Ealing PCT as a Director of IT, before arriving at his present post at Guy’s and St Thomas’ NHS Foundation Trust.
AC: Hello and welcome. Can you start by telling us about your day-to-day role?
I am the Assistant Director of Resilience for an Acute Foundation Trust within the NHS. I am responsible for all aspects of emergency planning for both internal and external events. I am also responsible for all aspects of business continuity management (BCM) for the whole Trust. I also have management responsibility for the occupational health service and the H&S Service.
AC: Can you give us a brief introduction to BCM from an NHS perspective?
BCM plans are required to sustain normal service delivery in the event of some disruption to the organization, where maintenance of key services is essential and return to normality is required. In a similar vein to other organizations, relocation is usually not an option, so plans need to identify how service delivery can be sustained. With exacting national targets and tight financial constraints to meet, BCM has never been more important to the NHS.
Where the NHS differs from other non-health-related organizations is the requirement to change its function in the event of a major incident. In this case, the whole organization’s purpose is switched from delivery of a general or normal health-related service to become a specialist unit providing high-level trauma care for the casualties created by the incident. The organization’s focus changes to reception of casualties, immediate treatment in A&E, and their move to theatres or intensive care. In parallel to this, teams are clearing beds within the general hospital environment to take the casualties treated. This switch of focus requires a completely different set of BCM plans to sustain these new patient pathways. This shift presents unique problems for senior managers within the organization.
As priorities will shift, there will be a demand for rapid and effective command and control with little time for detailed debate. BCM planning within this environment has to cover the shift in function, the maintenance of that function, the delivery of new functions, and the eventual return to normality.
AC: What are the core elements of a typical business continuity plan?
The generic plan should contain:
purpose and scope;
roles and responsibilities;
exercise history; and
Detail of the plans might contain all or some of the following:
tasks and contacts;
incident management location;
incident management activities;
communications (internal and external); and
information and checklists, etc.
AC: Why is BCM becoming such a hot topic in the NHS?
As mentioned above, the requirement for organizations to meet national targets within a very tight financial environment means sustaining delivery is ever more important. This delivery needs to continue to be of the highest quality. The advent of the Care Quality Commission accreditation process has added a further layer of pressure to sustain quality services. The pandemic flu outbreak of 2009 (swine flu) highlighted the potential pressures on service delivery. Whilst most NHS organizations managed to support the requirements of the pandemic without a huge impact on service delivery, it did successfully highlight the importance of effective and comprehensive BCM plans for ordinary NHS managers.
AC: According to the Business Continuity Institute, there has been no funding drive to support the implementation of a broader BCM programme within the NHS, and so adoption comes down to the importance and priority placed on resilience by individual trusts. What is your take on this situation? Is it likely to lead to big gaps in performance across the country?
There will always be variation in performance in any large organization, and the NHS is no different. Much will depend on the individual within each organization and their knowledge and skill. The Department of Health has provided clear guidance and supported individuals with the provision of 12 months contract with BSI by providing a copy of the BS25999 standard and a link to an online self-assessment tool for all NHS organizations. This tool will allow all leads to achieve a common level of assessment and therefore have a common starting point for their BCM planning process.
Generally, NHS organizations have had BCM plans in place for a number of years. The fact that the plans were not called “BCM” plans and perhaps do not conform to the exact specification for structured BCM plans does not remove their value in achieving resilience. These plans provide an excellent start point for the development of more formal BCM plans.
AC: You have said that it is impossible to write a single Business Continuity Plan for a whole NHS trust. What do you mean by this?
I think this applies for a large organization. Certainly, I have taken the approach that producing a clear BCM policy on how to create a BCM plan means that BCM planning will be achieved in a consistent fashion across the whole trust. There will be a central repository for all BCM plans, so the trust management team can assure themselves that the planning is comprehensive and effective. There are some plans which are trust wide (such as flooding and evacuation), although individual parts of the organization also have to produce their own local plans for dealing with these eventualities.
AC: One provider of BCM consultancy services to the NHS notes that plans will often look at threats first and then work on the response. A potential weakness in this approach is that an organization may fail to look at what makes the service deliverable. How would you comment on this?
We have very much taken the approach of “what do we have to deliver” in service terms. Each part of the organization is then asked to assess which of those services are critical or core, and then we build our planning around that. We obviously do look at the risks, but they are identified risks to the services we have identified we should be delivering.
AC: On the subject of consultancy, what are your thoughts on the amount of BCM advice provided to the NHS versus the amount of skill and knowledge available in-house, so to speak?
As with any other large organization, there will always be a tension between available in-house skills and the extra dimension that can be provided by external consultants. The judicious use of external consultants to support in-house delivery can be hugely helpful, particularly if the BCM programme has stalled. Some of the full-time BCM managers currently employed within the NHS are highly skilled, but knowledge levels do vary.
AC: The Business Continuity Institute states that implementing an effective BCM programme “can be made easier with the use of software tools.” Many businesses have been stung in the past with IT systems that promised the earth but failed to deliver it. What are your general thoughts on this?
I think it is very true and not just in BCM software, but in all other areas. Software can have many attractions but generally it requires a huge amount of effort to load the data on to get it up and running. There is an increased return for reduced input as time progresses. Unfortunately, this can take a long time, so realizing the full benefit should be measured over a sensible period and instant results should not be expected.
My advice would be to test all the potential systems once you have a clear vision for what you want to achieve. If you look for a system without this vision, you will end up modifying how you do things to suit the software rather than having software that supports your systems.
AC: Finally, are there any closing comments you wish to make?
BCM is the next big challenge for many NHS organizations. Pressure to deliver targets against a very restrictive financial picture will demand effective BCM plans to ensure downtime is reduced to a minimum and restoration of systems is efficient and timely.