What does declaring a major incident really mean?

As a new, more transmissible variant of the coronavirus has swept across parts of England, a string of areas have been forced to declare major incidents because of fears their health services will be overwhelmed, with London being the latest.

Greater Manchester declared a major incident back in August, North Yorkshire did so in September, and more recently the Thames Valley, Essex, Buckinghamshire, Sussex and Surrey have also done so.

Crucially, declaring a major incident enables local leaders – usually from councils, police, the health and fire services – to request extra support from the government and to better coordinate action between emergency services.  

But it might also involve prioritising resources in services, which could mean cancelling planned surgery; discharging medically fit patients; moving staff, including managers, to other duties; preparing in detail for extra, urgent workloads and making more use of volunteer help.

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Major incidents have previously been declared in the UK for terror attacks, floods, infernos, street stabbings and gas leaks, including the Grenfell Tower fire in 2017 and the terror attacks at Westminster Bridge and London Bridge.

Hospitals and health trusts have also done so during the Covid-19 pandemic.

London’s mayor, Sadiq Khan, said he took the action because the situation in the capital was now “critical, with the spread of the virus out of control”.

According to the Joint Emergency Services Interoperability Programme (Jesip), major incidents are declared at the discretion of local services to manage emergencies “with a range of serious consequences which require special arrangements implemented by one or more emergency responder agency”. 

Jesip, which was established in 2012 to improve how the police, fire and ambulance services work together at major or complex incidents, helps ensure that any multi-agency response to incidents is better organised.

It defines a major incident as one that is “beyond the scope of business-as-usual operations, and is likely to involve serious harm, damage, disruption or risk to human life or welfare, essential services, the environment or national security”.

In addition, “the severity of the consequences associated with a major incident are likely to constrain or complicate the ability of responders to resource and manage the incident”.

Major incidents require emergency responders to put into effect special plans to deal with a crisis. Police, health or council chiefs may be put in charge, depending on the circumstances.

In most areas that have already declared a major incident, it was done so by the local resilience forum, which comprises managers from the emergency services, local authorities, the NHS and others. Environment Agency staff are also on the forum and will help take a judgement in the case of flooding.

They will consider issues such as NHS critical care and bed capacity, sickness and self-isolation levels among health staff and how many patients can safely be sent home quickly.

In 2013 the East Kent Hospitals Trust cancelled doctors' study leave and clinic appointments, and outpatient staff were redeployed to help with patient care on hospital wards when it put into place "major incident procedures”.

In some cases, public service chiefs are already co-ordinating their work even before a major incident is declared.  

Surrey resilience forum chairman Steve Owen-Hughes said hospitals, GPs, social care, emergency services and councils were already working together but would now reprioritise their approach to focus on public safety and redeploying staff and expertise.

Deputy Assistant Commissioner Matt Twist, who leads the Metropolitan Police response to the pandemic, said: "The announcement that London has declared a major incident in the battle against coronavirus is a stark reminder of the critical point we are at.

"Our health service colleagues are fighting this virus every day on the front line, but the case rate continues to increase and the number of people affected in London is alarming. Now more than ever is the moment for people to stick to the rules, and stay at home.”