Review into major incident triage

Dear Leo Pritchard, 

NHS England has assessed your communications as requests under the Freedom
of Information (FOI) Act 2000. Your request is being dealt with under the
terms of the FOI Act and will be answered within twenty working days. Your
reference number is FOI-2408-2130736.

Please note that the three requests you have sent regarding triage tools
have, under the terms of the FOI Act been aggregated into one single case.
These will all be responded to under the same case reference
FOI-2408-2130736.

For further information regarding the FOI Act, please refer to the website
of the [1]Information Commissioner’s Office (ICO). For further information
regarding NHS England, and the information we publish, please visit [2]our
website.

If you have any queries about this request or wish to contact us again,
please email [3][NHS England request email] and the message will be
forwarded appropriately. Please remember to quote the above reference
number in any future communications.

Yours sincerely,

Freedom of Information

NHS England
PO Box 16738
REDDITCH
B97 9PT

Tel: 0300 311 22 33
Email: [4][NHS England request email] 

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Dear Leo Pritchard,

We refer to your email of 06 August 2024 in which you requested
information under the Freedom of Information Act from NHS England. As your
requests were received close together and were of a very similar nature,
we have under the terms of the Freedom of Information Act, aggregated them
into one single request.

Your request

You made the following request:

To whom it may concern,

I am writing to request information under the Freedom of Information Act
2000 regarding the review conducted by NHS England into major incident
triage that led to the development of the Major Incident Triage Tool.

Please can you provide the following information on this review:

 1. The title and start and end dates of the review.
 2. The personnel and groups who took part in the review and their roles
within it.
 3. The motivations and reasoning for carrying out the review.
 4. The aims and objectives of the review.
 5. The subjects and topics examined in the review, its specific areas of
focus, and its scope.
 6. The methodology used in each stage of the review.
 7. The nature of the review's output (e.g. a report with findings, a
presentation, a journal article, etc.).
 8. A list of the findings of the review, if applicable.
 9. A list of the recommendations of the review, if applicable.
10. A list of all other conclusions of the review, if applicable.
11. How and when the review's findings and recommendations have been, are
being, or will be implemented.
12. A list and copies of all held documents created during or as output
from the review (e.g. meeting minutes, presentations, a final report,
etc.).
13. A list of public resources with information on the review.

AND

I am writing to request information under the Freedom of Information Act
2000 regarding the relationship between the review of major incident
triage conducted by NHS England and the subsequent development of the
Major Incident Triage Tool (MITT).

Please can you provide the following information:

14. The ways in which the MITT and the review are connected in general.
15. How the findings and recommendations of the review motivated and
informed the development of the MITT.
16. The process by which the review's recommendations were translated into
specific requirements for the MITT.

AND

I am writing to request information under the Freedom of Information Act
2000 regarding the development of the Ten Second Triage (TST) tool.

Please provide the following information:

17. A detailed description of the process used to develop the TST.
18. The specific individuals or organizations responsible for the
development of the TST.
19. The timeframe for the development of the TST, including start and end
dates.
20. Whether the development of the TST was linked to the major incident
triage review conducted by NHS England.
21. If the TST’s development was linked to the major incident triage
review, please provide details on how the review informed or motivated
the development of the TST.
22. If the TST’s development was not linked to the major incident triage
review, please outline what motivated and informed its development.
23. A list and copies of all held documents created as part of the project
to develop the TST.

Decision

NHS England holds the information you have requested but has decided to
withhold some information under section 12 of the Freedom of Information
Act (FOIA).
 

 1. An EPRR Task and Finish Group was created for this purpose. The review
approximately started in February 2020 until October 2022 when it was
announced that the outcomes had resulted in the development of the NHS
MITT to be introduced into UK practice from April 2023.

 

 2. Personnel and groups involved: NHS England, the organisation formerly
known as National Ambulance Resilience Unit, Defence Medical Services,
Advanced Life Support Group (ALSG) and Behavioural Science and
Insights Unit at UKHSA. Membership is listed in the article below and
was based on clinical and/ or EPRR subject matter expertise in this
area.

3 – 10 and 13.

The response is covered by the FOIA exemption, Section 21 – information
accessible by other means.

The [1]New NHS Prehospital Major Incident Triage Tool: from MIMMS to MITT
article published in the Emergency Medicines Journal in November 2022
describes the output from this review, the changes being undertaken to UK
major incident triage and the introduction of the new NHS Major Incident
Triage Tool from April 2023 which has now been implemented.

This exemption is not subject to the public interest test. This response
therefore acts as a refusal notice under section 17 of the FOIA. 
 

12. NHS England holds the information you have requested but has decided
to withhold the information under section 12 of the Freedom of
Information Act (FOIA).

Section 12 of the Freedom of Information Act 2000 allows a public
authority to refuse a request if the cost of providing the information to
the applicant would exceed the ‘appropriate limit’ as defined by the
Freedom of Information and Data Protection (Appropriate Limit and Fees)
Regulations 2004: 
 
“Section 12 Exemption where cost of compliance exceeds appropriate
limit.  
 
(1) Section 1(1) does not oblige a public authority to comply with a
request for information if the authority estimates that the cost of
complying with the request would exceed the appropriate limit”. 
 
The Regulations states that the appropriate limit to be applied to
requests received by local authorities is £450 (equivalent to 2.5 days of
work) for the purposes of the estimate the costs of performing these
activities should be estimated at a rate of £25 per hour (£25 x 18hours =
£450). 
 
In estimating the cost of complying with a request for information, an
authority can only take into account any reasonable costs incurred in: 
 
(a) determining whether it holds the information, 
 
(b) locating the information, or a document which may contain the
information, 
 
(c) retrieving the information, or a document which may contain the
information, and 
 
(d) extracting the information from a document containing it”. 
 
We have carried out a reasonable and proportionate search to locate all of
the documents that relate to the above request for information and outline
how this was carried out. 

Section 12 of the FOI Act allows a public authority to refuse to deal with
a request where it estimates that it would exceed the appropriate limit
to:
 

• Either, comply with the request in its entirety or;
• Confirm or deny whether the requested information is held.

For NHS England to complete this request, we need to first identify all
relevant documents.  As such, we would need to search several systems
including archive and current folders and individual mailboxes, as this is
where information would be stored and recorded. NHS England has so far
spent a total of 3 hours determining whether the information requested is
held, and 2.5 hours reviewing materials. A total of 5.5 hours has been
spent working on this FOI.
It is NHS England’s estimate that the following activities would need to
be undertaken to extract the information:
 

• Location and identification of the information. There are 11 folders
within the document store between 2 - 10 documents per file, which
could take up to 30 minutes per folder to review contents, a minimum
of further 5.5 hours in total. To ascertain whether it is in scope of
this FOI request would require a staff member to open and review each
document in turn. This doesn’t include the need to review documents
held in individual mailboxes. An initial search on triage has resulted
in 900 emails which could take anywhere between 2 – 5 minutes to
review the contents, a maximum of 75 hours. Additionally, the
information may not be easily searchable.
• For the reasons described above it would not be possible to verify
that the requested information had been retrieved in full.

 
Due to the nature of the development process which took place over several
years and the number of people involved outside the organisation itself,
it would be very difficult for this request to be refined in such a way as
to bring it in under the 18 hour deadline. We have provided such
information as we feel can be given within the timeframe.

14. The response is covered by Section 21 – information accessible by
other means.

The [2]New NHS Prehospital Major Incident Triage Tool: from MIMMS to MITT
article published in the Emergency Medicines Journal in November 2022
describes the relationship between the review and the development of the
NHS Major Incident Triage Tool.

15.  As above

 

16.  As above

 

17. The response is covered by Section 21 – information accessible by
other means.

The [3]Ten Second Triage: A novel and pragmatic approach to major incident
triage published in the Sage Journals in March 2023 provides an overview
of the process to develop the TST and describes its rationale ahead of
introduction into practice.

18. The development of the TST represents a collaborative approach
incorporating academics and clinicians involved in pre-hospital care
and incident management. Organisations involved: NHS England, the
organisation formerly known as National Ambulance Resilience Unit, and
Defence Medical Services. Individuals are listed in the article.

 

19. Casualty care was highlighted as an issue during the Manchester Arena
Inquiry. The NARU Medical Director gave evidence to the Inquiry
stating that the TST was under development at the time. Addressing
this issue became a priority during this period.

 

20. Whilst both tools were formally launched at the same time, they have
different purposes. The NHS MITT is for clinicians; the TST has been
recommended for use by all organisations (typically responders) who
may be at the scene of or required to respond to a major incident.

 

21.  This was answered as part of Question 17.

 

22.  This was answered as part of Question 17.

 

23. As for question 11, to answer this question would exceed 18 hours and
is thus exempt under section 12 of the FOIA.

For NHS England to complete this request, we need to first identify all
relevant documents.  As such, we would need to search several systems
including archive and current folders and individual mailboxes, as this is
where information would be stored and recorded. NHS England has so far
spent a total of 3 hours determining whether the information requested is
held, and 2.5 hours reviewing materials. A total of 5.5 hours has been
spent working on this FOI.
It is NHS England’s estimate that the following activities would need to
be undertaken to extract the information:

• Location and identification of the information. There are 11 folders
within the document store between 2 - 10 documents per file, which
could take up to 30 minutes per folder to review contents, a minimum
of further 5.5 hours in total. To ascertain whether it is in scope of
this FOI request would require a staff member to open and review each
document in turn. This doesn’t include the need to review documents
held in individual mailboxes. An initial search on triage has resulted
in 900 emails which could take anywhere between 2 – 5 minutes to
review the contents, a minimum of 75 hours. Additionally, the
information may not be easily searchable.
• For the reasons described above it would not be possible to verify
that the requested information had been retrieved in full.

Due to the nature of the development process which took place over several
years and the number of people involved outside the organisation itself,
it would be very difficult for this request to be refined in such a way as
to bring it in under the 18 hour deadline. We have provided such
information as we feel can be given within the timeframe.

If you would like to resubmit a refined request please do so on the
following link: [4][NHS England request email].   Please note, we cannot
guarantee that Section 12(1) or any exemptions will not apply to any
further information requested.

Copyright

NHS England operates under the terms of the Open Government Licence (OGL).
Terms and conditions can be found on the following link:

[5]http://www.england.nhs.uk/terms-and-cond...

Review rights
If you consider that your request for information has not been properly
handled or if you are otherwise dissatisfied with the outcome of your
request, you may seek an internal review within NHS England of the issue
or the decision. A senior member of NHS England’s staff, who has not
previously been involved with your request, will undertake that review.

If you are dissatisfied with the outcome of any internal review, you may
complain to the Information Commissioner for a decision on whether your
request for information has been dealt with in accordance with the FOI
Act.

A request for an internal review should be submitted in writing to:

[6][NHS England request email]

Yours sincerely,

Freedom of Information

NHS England
 

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