Key lessons learned dealing with a deluge

Lessons from Hull and East Yorkshire

First incident
On Friday 15 June 2007, unusually high rainfall resulted in localised flooding. The area worst hit was north-east Lincolnshire, and the Multi Agency Command Centre for Humberside was in place for that day. Hull Teaching PCT, the lead PCT for the Humber area, has responsibilities both for coordination of the NHS response and for its population’s non-emergency healthcare.

To its credit, the PCT undertook a debriefing exercise within one week of this first incident, which had left the ground saturated. Previous planning exercises with the Environment Agency had covered testing of rivers over-topping and coastal flooding arrangements, but had not considered such a volume of local rainwater.

Second incident
On Monday 25 June 2007, a huge quantity of rainwater fell across the whole of the already saturated Humberside area; Hull City being worst hit. In the morning there were local radio reports of flooding to homes and properties across the area, causing staff concerns. Additionally, significant problems were being experienced by the emergency services, resulting in a major incident being declared and the Multi Agency Silver Command being convened at police HQ.

The fire service had primacy in the first 48 hours, and organisations represented included the Environment Agency, the local authority, and water and electricity companies.

Hull and East Yorkshire Hospitals NHS Trust

Hull and East Yorkshire Hospitals NHS Trust effectively provide services from three major sites – the Hull Royal Infirmary (HRI) and Princess Royal Hospital (PRH),both in the City of Hull, and Castle Hill Hospital (CHH) in Cottingham to the north. Following the setting up of the Silver command at around 11 am, no particular action took place other than the director of operations being advised of the multi-agency Silver Command’s activation. By mid-afternoon there was rainfall let-up, and further reports were being received regarding flood water damage to homes, and of a number of staff becoming “emergency carers”, as most schools had already closed. There were growing concerns staff might not be able to attend work. While the whole of Hull and the surrounding area is below sea level, and thus requires pumping out of flood and surface water to avoid flooding, the situation was described as “surreal”; localised flooding “popped up” all over the city area, with certain parts under several feet of water, while parts of the city centre continued functioning with relatively little effect.

There were a number of flooding issues associated with the Trust’s estate and facilities services, with three major areas of concern:

Subsequently, the fire and rescue services attended and, with the Army’s help, pumped the floodwater away from the sub-station, thereby maintaining supply.

Trust medical staff had reviewed overnight cover, and accommodation was made available to allow key staff to take up residence to provide this. Following discussion it was agreed that activating the major incident plan would not be appropriate, since the Trust was not receiving numerous casualties from any incident sites. While the declaration of an “internal” major incident, as detailed in Section 17 of the Trust’s major incident plan, was instead perceived as most appropriate, this was never activated.

At around 5.30 pm the Yorkshire Ambulance Service representative advised that YAS had declared a major incident due to flooded roads. Concerns were raised over perceived staffing problems for the night shift and the following day, as staff realised the extent of the flood damage to their properties and might choose to remain at home.

Additionally, it was thought many would not be able to attend work due to transport problems and being unable to arrange the necessary childcare (due to school closures). Subsequently, the Trust cancelled all outpatient clinics for the following day and utilised the outpatient nursing staff to offset any nursing staff shortages. It was acknowledged it would probably be too late to inform the media of the outpatient clinical cancellations, and therefore many people might attempt to attend sites.

By 8.30 pm the electrical substation risk at the PRH site had been resolved. However there was a continuing flooding problem with the boiler house, although this was being brought under control via the use of pumping sets, and the site’s fire alarm system had failed, with a repair not possible at this stage. A fire watch procedure was therefore implemented. At the HRI site the service tunnel flooding had been resolved and theatres were declared available again. As the situation appeared to be improving, it was decided not to declare an internal major incident.

By 8 am the following day the extreme rainfall had ceased. Nevertheless, the devastation to both residential and commercial property was considerable. At HRI, outpatient nursing staff continued to be used to support areas with staffing problems, enabling clinical services to continue. At PRH, staff reported the boiler house issue resolved. However the fire alarm system remained inoperable and the fire watch procedure was being maintained. This lasted until Friday 29 June, when the PRH site fire alarm system was repaired and returned to service.

Hull Teaching Primary Care Trust
Despite the unprecedented levels of flooding generally, services were maintained. Two GP practices were flooded, but it has been decided to accelerate the NHS LIFT programme within the PCT, and these premises will not be repaired. The joint PCT/local authority control system worked well and liaised regularly with hospital and ambulance control system centres. Additionally, an evacuation centre was set up and used for seven days at Hull City Hall. The organisation was fortunate that the operations centre had available 24-hour nursing cover and already houses the GP out-of-hours service. For those residents needing to be evacuated, the local authorities utilised the university accommodation as an option, as school premises were effectively deemed unavailable.

The planning process adopted to date, for example for a major incident response, was recognised as inadequate to meet the flooding experience. It is now recognised that business continuity, in conjunction with a major incident plan, is essential to cover such issues as flooding, heatwave and epidemic. The issues faced by patients in the community – for example 60 were on ventilators and many required portable oxygen supplies – posed different challenges when many of the roads proved to be impassable. The message was that healthcare needs to be managed more flexibly, with a prioritisation role to ensure essential services are maintained and that sessions can be moved to other facilities if a building is placed out of use.

Organisational preparedness
Both Trusts felt reasonably well prepared based on the testing regimes employed. However, the plans and processes in place were not adequate to meet the experience associated with this flooding, and it is testament to the staff involved that services were maintained throughout, with minimal disruption to clinical services.

Other patient services
The transport services around Hull and East Yorkshire were disrupted on the day and in the immediate aftermath, but sufficient supplies of catering and other services were held on various sites. Additionally, adequate waste storage facilities were available such that waste disposal was not particularly problematic. Decontamination services are provided offsite from premises near the river Humber, and therefore there were issues about how long such services could have been maintained had the situation been further prolonged. Communication systems, except the mobile phone networks, which were “down” for around two hours, worked well.

Summary of the Hull and East Yorkshire experience
The incidents have raised a number of issues, including: