MAJOR INCIDENTS

Published: 11/08/2005, Volume II5, No. 5967 Page 31

Training helped a London trust cope during the London bombings and the day's events are now shaping training for the future, writes David Amos

How staff perform and practise on any given day is the result of a whole series of interventions and actions stretching back years. For the classic hospital workforce, every day is a test of training and skills levels, team resilience and individual tenacity. This test applies in spades when the 'major incident policy' is put into action. This was the case at University College London Hospital and right across London on 7 July.

'Team NHS' has been widely credited for how it delivered - within organisations, across healthcare sectors and alongside other emergency services (news, page 9, 14 July). Lives were saved and top care given because of the expertise and leadership of individuals, underpinned by the support and confidence that comes from teamwork.

At UCLH our staff had been in their new hospital less than a month when the bombs went off. All those working in the new hospital had received retraining in our major incident policy.

Creating the capacity to deal with the injured began as soon as word reached those who could help. The extended team which made these decisions was invented during the crisis of the day itself. Some of this was planned - GPs agreed with the request from primary care trusts to keep referrals to their local hospital to an absolute minimum.

Others were spontaneous and offers of help came from far and wide - one to me from a former colleague running a hospital in New York, volunteering staff and equipment. Self-responders - bystanders who treated and attended victims - have featured prominently in the descriptions of Team NHS.

In general, the capacity created within the first hour of the bombs to treat across London and the South East was the result of extensive planning, management and workforce development. The design of buildings, the recruitment of certain staff and the production of special management systems were not invented overnight. Previous experience, new ideas and the vital contribution of frontline staff formed the bedrock of those policies tested on and after 7 July.

Hospitals are learning from what went well and what needs to improve. Staff are reflecting on how capacity can be created faster, deeper and more efficiently. A common theme is how best to enhance communications across teams within organisations and with those working externally.

The London Deanery has noted in its promotion of further changes to medical education that shorter hours help reduce post-traumatic stress disorder. Based on research carried out after the Omagh bombing in Northern Ireland, posttraumatic stress disorder is lower among those working for 11 hours or less.

Support for staff is now a priority for hospitals that were active on the front line. They are ensuring occupational health and counselling services are available when staff need it. It would be too late to invent this after the event.

This is the ultimate chance for the Improving Working Lives infrastructure to prove itself. As ever, the quality of line management is fundamental, and we should not forget that line managers will need support, too.

David Amos is director of workforce at University College London Hospitals foundation trust and is former DoH deputy director of human resources.