146. This inquiry has not attempted to assess the adequacy of the emergency response as such. Nevertheless, we have been keen to determine how well the response has been informed by science and technology and how this has been coordinated and disseminated. The Government's Dealing with Disaster publication contains guidance on the handling of emergencies, although it is not intended as the vehicle for specific guidance on the response to a CBRN emergency.[158] A forthcoming fourth edition will pay more attention to CBRN incidents.[159] The current outlines the role of different services during an emergency:

• The Ambulance Service
• Hospitals
• Public Health
• The Police Service
• The Fire Service
• HM Coroner
• Maritime and Coastguard Agency
• Local authorities
• Central Government
• Environment Agency
• Commercial organisations
• Volunteers
• The Military

These organisations are to greater or lesser extent dependent on science and technology for their response.

Medical

147. Shifting the Balance of Power: The Next Steps states that primary care trusts (PCTs) will become responsible for the delivery of the vast majority of health authority functions, including emergency planning.[160]

148. Dr Nathanson from the BMA expressed concerns about this. She questioned whether PCTs have the skills, resources and time to take on this extra responsibility. The only advantage she could see was that at present GPs do not know the local disaster plan because it is so secret; the involvement of PCTs would at least provide access to this information. Dr Nathanson felt that emergency planning would be better dealt with on a local geographical basis.[161] On a more positive note, Mr John Harrop from Salford Royal Hospital Trust reported that he liaised with his equivalent in his local PCT and there had been good continuity of personnel with the PCT and its predecessor organisations, and that there were established major incident plans that had not altered dramatically since the formation of the PCT.[162]

149. Dr Maureen Baker from the Royal College of General Practitioners (RCGP) said that primary care teams were "starting to get a very little support in terms of funding to organise the training".[163] RCGP has agreed with the DoH to begin a training programme for trainers. It will "pull in people from the various regions … support them with resource packs and then … franchise these individuals to run that training".[164]

150. The UK national stockpile of countermeasures was established before Christmas 2001. "Pods", a range of pre-packed consignments of emergency equipment and pharmaceutical products, are accessible by the NHS on a 24-hour basis for rapid deployment in the event of a mass casualty incident, which may or may not be associated with deliberate release of hazardous material.[165]

151. An NAO report into NHS emergency planning in England published in November 2002 concluded:

"The quality of plans and preparedness improved after September 11, but coverage of chemical, biological and radioactive incidents was mixed, some plans were still out of date and there was scope to improve arrangements for working with other emergency organisations, such as the police and fire services. Importantly, one third of health authorities considered post September 11 that they did not test their plans frequently enough and nearly a fifth considered that their testing was not effective".[166]

The problems were particularly bad for radiological incidents, with 20% of health authorities unprepared; 80% had not tested their response. These concerns were echoed by a Public Accounts Committee report, which concluded that "parts of the NHS are not well prepared to handle the emerging threats from nuclear, chemical, biological and radiological incidents".[167]

AMBULANCE SERVICE

152. Ambulance services have responsibility for co-ordinating the on-site NHS response and determining the hospital(s) to which injured persons should be taken, which may depend on the types of injuries received. The ambulance service, in conjunction with the medical incident officer and medical teams, endeavours to sustain life through effective emergency treatment at the scene, to determine the priority for release of trapped casualties and decontamination in conjunction with the fire service, and to transport the injured in order of priority to receiving hospitals.

153. The Fire Service takes the lead in identifying any threat. Peter Bradley from the London Ambulance Service said that the Fire Service is usually first on the scene and that this arrangement is appropriate. What happens at a potential CBRN incident if the ambulance service is first on the scene is not clear. Without an assessment of the risk they are at danger and potentially a threat to others. Mr Bradley said "There is talk of ambulance staff having access to pagers which can detect certain types of chemical incidents, but again we have got a very good arrangement with the Fire Service around the country and that has never failed us so far so I think we rely on the Fire Brigade with their access scientists to do that".[168] We are pleased to hear there has been "talk" of a detection capability for ambulance crews as we are concerned that they may become too reliant on the Fire Service in this respect and will need some capability. We recommend that it should become a medium term aim to provide the ambulance service with a basic level of detector technology for CBRN incidents in high risk areas, along with the necessary training and access to scientific expertise.

154. We were told by Mr Bradley that small ambulance services are having trouble releasing staff for training: "The pressures on the day to day activities are such that they have difficulty, both in terms of getting equipment and getting the staff released".[169] The Ambulance Service Association told the Defence Committee in May 2003 that ambulance services "have not received any additional resources to deal with the new and emerging threats. This compares unfavourably with colleagues in the other blue light services who seemingly have received substantial additional funding".[170] This is a concern to us. We recommend that the Government provide the means for all ambulance services to get access to CBRN training, regardless of their size.

COMMUNICATION

155. The Deputy Chief Medical Officer updated doctors in October 2001, through the "Public Health Link" message cascade system, in response to the anthrax attacks in the USA.[171] Despite this, Vivienne Nathanson from the BMA said that "most GPs would tell you that they feel starved of knowledge, starved of information. They have not been given a lot of information, they are not certain what their role will be and they are not certain when they will get information if there is a suspected attack". She said that following the ricin arrests in north London, GPs local to that area were getting their information from BBC Online and news programmes, which she said was not good enough.[172] Dr David Harper from the DoH told us that they had "a technical problem that has been rectified, which held up some of the information for a relatively short time … since then we have improved the system. There is now an option for an automated e-mail system from PCTs to GPs specifically and to community pharmacists as well".[173] Dr Harper said the system needed continual refinement and that it was a real challenge to match the speed of the media. We wonder whether this may be a case of joining rather than beating. Unless GPs are able to give authoritative information the health service risks being overwhelmed by concerned members of the public. The Government should work with the media to feed information to the public about counter-terrorist activity.

156. The HPA website contains information on potential biological agents.[174] The BMA's Vivian Nathanson said the site was good but that awareness was poor. This highlights the limits of using the internet: it is largely a passive medium. It is a shame that such a good resource is not more widely appreciated. We recommend that the Health Protection Agency take steps to disseminate information on potential biological agents through other channels or employ means to improve awareness of its website.

SKILLS

157. There are short-and long-term skills issues. There is the long-term shortage of specialists in certain fields, such as microbiology, particularly in virology and mycology, and also pathology and toxicology. The Committee heard that the situation was worst at the top end with few consultant medical microbiologists.[175]

158. Dr Nicholas Beeching, a consultant in infectious diseases, told us that there is a shortage of diagnostic and clinical capacity. There are only about 90 clinical infectious disease specialists in England, half of which are academic appointees. Dr Beeching said that with the amount of time needed for training and preparation, let alone in actually responding in the event of something happening, he and his colleagues were "stretched to the limit".[176]

159. We are content that the Government recognises the problems of skill shortages in some areas but less confident that the measures being taken are sufficient.[177] The problem is particularly pressing in the case of microbiology and infectious diseases in light of the global outbreak of SARS. The House of Lords Science and Technology Committee report on Fighting Infection also identified concerns over training. It recommended "that the Government, in conjunction with relevant Royal Colleges and the Joint Committee on Infection and Tropical Medicine, address the shortage of expertise in clinical infectious disease, clinical microbiology and communicable disease epidemiology by increasing numbers of fully funded consultant posts and ensuring that there are available training posts".[178] We endorse the findings of the House of Lords Committee report on Fighting Infection that action is needed to tackle the shortages is several clinical specialties and urge the Government to address them promptly.

160. A second problem is the skills in the current cohort of practitioners. There are concerns that GPs will struggle to recognise diseases such as anthrax and smallpox, having never seen a case. Dr Hans-Christian Raabe, a GP in Lancashire, is concerned that healthcare staff are unaware of the procedures and the facilities in response to a terrorist attack.[179] As we reported above, the Royal College of General Practitioners has secured funding from the DoH to develop training for GP trainers on biological agents and perhaps chemical and radiological threats.[180] Mr Hutton says that "Since 11 September 2001, training to spot outbreaks of infectious diseases caused by the deliberate release of biological agents has increased. This has included educational articles in national and international medical journals, authoritative and up-to-date advice on the Department of Health and Health Protection Agency's websites and seminars/conferences for specific groups of healthcare workers".[181]

161. Dr Vivienne Nathanson at the BMA told the Committee that we have got to get GPs to think not only, "Is this the common thing that I see every day?" which it is likely to be, but also, "Could it just be something really peculiar?".[182] The PHLS says there is concern as to how much those working at the routine coal-face in the NHS are aware of, and able to respond to, documents containing information and policies on the deliberate release of pathogens. It notes that the capability of the front line NHS diagnostic laboratories to recognise potential BT [biological and toxin] agents is only now being tested for smallpox. "This means there remains a considerable task of awareness raising and training".[183]

162. CAMR is developing a series of training courses to address these needs for health professionals. The first course in March 2003 concentrated on specialist medical personnel, but this will be followed by other practical courses for first line laboratory staff and accident and emergency staff. It plans to build on this programme to provide basic introductions to biological emergencies for NHS managers and planners, for leaders in the emergency service and Government and for the media if required. The HPA's Corporate Plan reports that "Training [has been] delivered to general practitioners, A&E staff and support staff, medical microbiologists, lead Primary Care Trust (PCTs) and Strategic Health Authority (SHAs)."[184]

163. There are no easy answers to the problem of improving awareness of potential biological agents, particularly in general practice. Training will help but there is a danger that, unless it is regularly reinforced, it will be hard to condition GPs and other front-line health professionals to recognise and deal with the unexpected. We recommend that the Government make sufficient resources available to achieve this.

Police

164. Dealing with Disaster states that police will normally co-ordinate all the activities of those responding at and around the scene of a land-based emergency. Where terrorist action is suspected, the police will normally take measures to protect the scene. These include establishing cordons under the Prevention of Terrorism Act and carrying out searches for secondary devices. They also take initial responsibility for safety management at such incidents for those working within cordons.[185] The police response has focused on training and protective equipment. The Home Office has provided funding for the provision of personal protective equipment to all officers trained in CBRN procedures. Brian Coleman, Director of the PSDB, told us that "There is no doubt that a lot of work remains to be done in these new areas and changed areas of threat that have developed over the last 18 months but I believe that we are very well placed to do this because we are a sophisticated requirements driven organisation for science and technology in law enforcement".[186]

165. The Home Office, in liaison with the Association of Chief Police Officers and MoD, set up a national Police Training Centre at Winterbourne Gunner near Porton Down, in October 2001. Here police officers from all forces are trained in CBRN response procedures. In a House of Lords Written Answer Baroness Scotland of Asthal said that 3,700 officers would be trained to deal with a CBRN incident by July 2003 and this would rise to 6000 next year.[187] This is a facility we would have wished to have examined.[188] Unfortunately, the Home Office refused our request for a witness to appear, even in private. This decision is curious since a member of our Committee, Mr Robert Key, in whose constituency Winterbourne Gunner lies, was invited to the facility and we understand that the media have been offered briefings. It is in everybody's interest that the House is well-informed by its Committees. The Home Office's decision defies logic.

166. We were interested in the comments of David Veness, Assistant Commissioner of Specialist Operations at Scotland Yard, who has outlined his "wish list" for the emergency services. These were:

• Better detection and identification methods on the chemical and biological field;
• Personal protection for emergency service workers; and
• "Post bucket" decontamination technology.[189]

167. We are particularly interested in his first point. As we described above, Dealing with Disaster states that if terrorist action is suspected, the police will carry out searches for secondary devices and take initial responsibility for safety management. It is hard to see how they can fulfil this role unless they are equipped with detection devices which can, at the very least, reveal if there some sort of agent that may be cause for particular concern. In a letter to the Defence Committee in June 2003, Mr Raynsford reported that "There are two systems [for biological agent identification and monitoring] currently under evaluation by PSDB and Dstl which will test for a range of agents … User handling trials are being undertaken by BTP, City of London Police, and the Metropolitan Police Force".[190] Information published by the Government on the exercise held at Bank Underground Station in London on 7 September 2003 states that "London's Fire Brigade and Police Services now have new chemical, biological and radiation detection and identification equipment with further equipment due".[191] We are pleased that police are being supplied with CBRN detection equipment. The Government should be moving to a situation where police officers in high risk areas have at least a primary level of detection capability.

Fire Service

168. The primary role of the fire service in a major emergency, according to Dealing with Disaster, is the rescue of people trapped by fire, wreckage or debris.

169. A key technological requirement for the Fire Service is detection. The Service operates in the "hot zone" and it has primary responsibility for the safety of people at the scene of the incident.[192] Mr Morphew told us that "detection will influence the way we go about our business, the level of protection, how speedily we must operate and the distances involved from the incident". We gather that the CBRN Resilience Committee, led by the Home Office, has set up a special task group to look at detection apparatus. Mr Morphew said "It is not an area that the Fire Service is particularly skilled at. It is very much on the edges of technology and we have been reliant on that particular team to inform all the emergency services, the police, the ambulance and ourselves, on what is the best way of detecting what we call biohazards".[193] This is troubling. Mr Pete Bradley of the London Ambulance Service told us that "We rely on the Fire Brigade, who are usually there before us in any case, to establish what sort of incident it is, what the agents are involved".[194] The Fire Service says it does not have the skills to work with biohazard detection equipment yet the other emergency services are relying on its expertise. If this arrangement is to remain in place then the Government must move rapidly to provide the Fire Service with effective detection and identification technology and the skills to use it.

170. Mr Dobson told us that all Fire Service personnel are trained to deal with hazardous material (e.g. CBRN) incidents: "We train at a number of levels together with the police and … we do have a Fire Service representation at Winterbourne Gunner and we send Fire Service principal managers there to understand and learn about joint emergency service operations within a CBRN incident.[195]

Military

171. The Ministry of Defence has "an operational role in prevention and consequence management". MOD says it has developed some of the world's best counter terrorist expertise and capabilities.[196] The provision of military aid to the civil power (MACP) is set out in an MoD booklet. One of the three categories of aid is "Assistance to the civil authorities in dealing with an emergency such as a natural disaster or major incident".[197]

172. In its evidence to the Defence Committee inquiry on Defence and Security in the UK, the Chief and Assistant Chief Fire Officers Association said that: "the MACP scheme does not constitute a guarantee and that the level of assistance will be dependent on current military commitments in the UK and abroad. However, the benefits to responding agencies, including the military, of planning, training and exercising together are well recognised and include allowing all parties to identify gaps in liaison, operational procedure and policy".[198]

173. During our visit to Dstl Porton Down, we were briefed on its MACP provision. This included the deployment of scientists through immediate response teams. These provide advice and practical assistance to Police and Military Bronze and Silver Commanders on all chemical and biological weapon-related matters. Their capabilities include detection, identification, sampling and decontamination.

174. The military, and in particular Dstl Porton Down, provide a potentially valuable resource in the response to a real or suspected CBRN incident. Nevertheless, it should be recognised that Dstl's priority is the support of the military. We therefore recommend that the deployment of scientists to a suspected CBRN incident through immediate response teams should come under the control of and be financed by our proposed Centre for Home Defence.

Decontamination

175. The Home Office leads a cross-Government CBRN Decontamination Programme. Initiated in July 2001, it aims to draw together all the strands of work relevant to decontamination - from detection to decontamination of the environment - and ensure inter-Departmental coordination.[199] It has issued Strategic National Guidance on the Decontamination of People Exposed to CBRN Substances. The method it outlines is "soap and water, rinse-wipe-rinse", which we understand is state-of-the-art.[200]

176. We have outlined the moves taken by the Fire Service to procure decontamination. We have no reason to doubt their assertion that they have got the best technology available. Mr Peter Morphew considers their provision to be "cutting edge".[201] He should note the comments of David Veness of Scotland Yard, however, who has professed a wish to move beyond this basic technology. It is no use having cutting edge technology if it is still not good enough. The problems faced by the Americans in clearing up after the anthrax letters is evidence of the technological deficiencies in this area. A further problem is the wide range of environments requiring decontamination. According to Steris, "there is no single solution for treating chemical or biological contamination. Successful remediation requires the selective use of multiple technologies".[202] Sir David King also stated that decontamination was a big issue and the subject of major research.[203] We recommend that one of the first steps for our proposed Centre for Home Defence is to conduct or commission new research into decontamination processes and procedures.

Coordination

177. We were keen to establish if there is a national standard operating procedure as to who goes in as the first responder in a suspected CBRN incident. We were told that there is, but it is a "mixture".[204] Mr Morphew from the Fire Service told us that "All local authorities will have some arrangements for the management of joint emergency services incidents. They will have a committee that meets quarterly or monthly, depending on the area and the amount of tension that there is. These committees will plan the response, who does what and what support will be needed… The police will have a role. They will secure the site. The Fire Service will have a role in the sense of protective equipment. There will be anti-terrorist branch personnel who will also have a role and ambulance personnel will be standing by to take away anybody who is injured. It is a combined operation".[205] In other words, it depends.

178. These arrangements have no doubt been developed over many years and we do not doubt their clarity and effectiveness at a local level. We have discussed the New Dimension programme with respect to the Fire Service. This has marked a shift to national procurement. This step has much to commend it, provided that it is compatible with local need. It is no use supplying equipment to the Fire Service if it would be more appropriately employed by the police. We recommend that the Government consider providing a national template for the procurement of CBRN countermeasures for the emergency services as a whole. Its most appropriate deployment could then be established at a local level.

Planning and exercises

179. Exercises play a valuable role in testing out response plans. The Home Secretary said in July that "A series of live counter-terrorist exercises takes place each year".[206] In the past these have generally been conducted in private but in the future there would be "more complex, larger scale exercises, with greater public involvement".[207] We were pleased to learn that the UK will be undertaking a joint exercise with the US in 2005.

180. We also read reports of the exercise held in London on 7 September with great interest. The "Bank" exercise was planned by a multi-agency team, coordinated by the Metropolitan Police Service, in conjunction with the London Resilience Team and "designed to test the co-ordinated responses of the emergency services to a chemical release on a train in the London Underground".[208] After the exercise, the Minister of State for Local Government and the Regions, Nick Raynsford, stated that "we would hope where appropriate to publish the major findings".[209] We are pleased to learn that the Government plans to be more open about counter-terrorist exercises in the future. While some of their findings will be sensitive, we hope the Government is able release some information to the public.

181. We understand that the findings of the exercise were due to be circulated during October 2003 to senior representatives of the agencies involved in the exercise with relevant elements reported to the London Resilience Forum and Ministers through the relevant committees.[210] As this inquiry had demonstrated, most departments will need to learn lessons from the findings of anti-terrorist exercises. We therefore urge that detailed findings are disseminated throughout Government.

182. The London exercise tested the response to a chemical incident. The response to a radiological or biological will require different responses. We therefore recommend that the "more complex, larger scale exercises" conducted in the future test such scenarios.

159   Home Office, Dealing with Disaster, Revised Third Edition, June 2003 Back

160   Department of Health, Shifting the Balance of Power: The Next Steps, February 2002 Back

161   Qq 111-112 Back

162   Q 142 Back

163   Q 117 Back

164   Q 122 Back

165   Ev 121 Back

166   Report by the Comptroller and Auditor General, Facing the Challenge: NHS Emergency Planning in England, HC 36 Session 2002-2003, November 2002, para 9 Back

167   Eleventh Report of the Public Accounts Committee Facing the Challenge: NHS Emergency Planning in England, 16 April 2003 HC 545 Back

168   Q 151 Back

169   Q 161 Back

170   Seventh Report of the Defence Committee, Session 2002-03, Draft Civil Contingencies Bill, HC 557, Ev 59 Back

171   Ev 121 Back

172   Q 105 Back

173   Q 714 Back

174   www.hpa.org.uk, see paragraph 14 above Back

175   Q 56 Back

176   Q 115 Back

177   Q 704 Back

178   House of Lords Fourth Report of the Select Committee on Science and Technology, Session 2002-03, Fighting Infection, HL Paper 138, para 7.5 Back

179   Ev 237-238 Back

180   Ev 200 Back

181   HC Deb, 8 September 2003, Col 5W Back

182   Q 124 Back

183   Ev 191 Back

184   Health Protection Agency, Corporate Plan 2003-2008, p 29 Back

185   Home Office, Dealing with Disaster, Revised Third Edition, June 2003, p 8 Back

186   Q 263 Back

187   HL Deb, 3 July 2003, Col 124WA Back

188   Q 806 Back

189   David Veness, Anticipating an enduring threat, FST Journal (Vol17, No10), July 2003, pp 5-6 Back

190   Seventh Report of the Defence Committee, Session 2002-03, Draft Civil Contingencies Bill, HC 557, Ev 60 Back

191   www.ukresilience.info Back

192   Q 147; Home Office, Dealing with Disaster, Revised Third Edition, June 2003,p 8 Back

193   Q 652 Back

194   Q 149 Back

195   Q 638 Back

196   Ev 115 Back

197   Ministry of Defence, Military Aid to the Civil Community-A Pamphlet for the Guidance of Civil Authorities and Organisations (Third Edition), 1989 Back

198   Sixth Report of the Defence Committee, Session 2001-02, Defence and Security in the UK, HC 518-II; Ev 206 Back

199   Ev 118 Back

200   Ev 118-119 Back

201   Q 615 Back

202   Ev 168 Back

203   Q 733 Back

204   Q 635 Back

205   Q 635 Back

206   Home Office press release 190/2003, 3 July 2003 Back

207   HC Deb, 3 July 2003, Col 27WS Back

208   Ev 261 Back

209   End of Exercise Statement by Nick Raynsford, Minister For Civil Resilience. www.ukresilience.info Back

210   Ev 261 Back