NHS organisations have been warned not to use contingency plans designed to cope with incidents like terrorist attacks as a way to tackle other pressures in the system.

NHS organisations have been warned not to use contingency plans designed to cope with incidents like terrorist attacks as a way to tackle other pressures in the system.

A consultation launched last week by the Department of Health advises on contingency planning following an emergency where the number of patients exceeds normal critical care capacity.

The consultation acknowledges that critical care units routinely run at high capacity levels and says NHS organisations must agree plans to maximise efficient use, including protocols for cancelling elective surgery and extending staff roles. But it warns: 'Under no circumstances should any NHS organisation seek to initiate or adapt these to respond to a problem arising from staff shortages, waiting list pressures, management failures or other local institutional deficiency.'

The guidance shows how the NHS should respond to emergencies arising from infectious epidemic, natural disaster, freak weather, utilities failure or a hostile act which results in significant numbers needing critical care.

For example, trusts are advised to identify staff with the skills to care for critically ill patients, including those who work in other hospital areas or who have recently retired.

Employers are asked to look at how far staff travel to work and to consider arrangements with neighbouring organisations so staff can work at facilities nearer home.

They are also advised to consider the needs of patients' relatives, including whether visiting is appropriate (for example, where there is high-infection risk) and to consider alternatives to visiting such as video links