It is unfortunate that a very important discussion about NHS Trusts declaring a major incident has become a political football. Not only is this an important issue for the NHS but, more generally, defining a process for invoking contingency plans is a crucial, but often neglected, part of any business continuity management system.
By and large, procedures for dealing with conventional external major incidents (eg mass-casualty scenarios) appear to be well embedded within NHS organisations, and Trusts are confident in invoking these when required. By contrast, invocation of plans to deal with internal major incidents (eg IT failures) seems to be much more controversial, perhaps because there is the implication that the organisation itself is at fault. The current problem of very high seasonal demand, particularly for A&E, doesn’t fit neatly into either category so maybe some clarification was actually overdue.
In reality, this is just one specific example of a more general problem of defining a process for a smooth transition between business-as-usual and managing a disruption. Our experience is that, even when organisations have developed and exercised their plans, there is considerable hesitation to actually invoke them; perhaps for fear of being criticised for over-reacting. We would strongly encourage a no-blame culture where the appropriate individuals feel empowered to invoke plans when necessary, even if only as a precautionary measure, without fear of criticism from those who enjoy the benefit of hindsight. We would also recommend structuring plans in a flexible manner so as individual elements can be invoked as required, without having to make an emotionally-charged decision to formally declare a crisis.