The Start of Silver Command

What is Silver Command?

Gold, Silver or Bronze Commands
are different levels of emergency
self-management protocols.
Each command signifies a different level of severity

On 4 January 2016 there was an unusually high demand for NHS services, particularly acute and mental health. This resulted in a major incident being declared and Silver Command was established at The Harbour. The higher than usual demand for mental health beds and the number of patients that we were able to discharge being minimal led to a lack of available beds. We immediately linked in with our partners, including the Acute Trusts and Clinical Commissioning Groups (CCGs) to put in place a number of measures to create capacity and ensure the continuity of care. 

Our Response

In order to ensure that the services under the most pressure were resourced and fully supported, staff from community services were temporarily re-deployed and the decision was taken to suspend all planned or non-urgent appointments until Friday 8 January, some elements of our community services continued with these arrangements until 15 January. Staff contacted patients to re-arrange appointments at the earliest opportunity and to signposted them to alternative support if this was required.

Network Directors and Clinical Directors were fully briefed and supported staff to enable effective coordination and deployment to support all frontline services both within our organisation and externally to acute trusts. 

Our focus during this period was to ensure that those people that were the most unwell or vulnerable were cared for appropriately and as little disruption as possible was caused. 

Some of the other things we did as a Trust included:

  • Working with CCGs and external providers to create additional capacity for accommodation to avoid admission/assist with a quicker discharge process 
  • The OATs review team was significantly increased with Specialist Services psychiatrists physically visiting OATs patients and psychiatrists to review treatment and discharge plans to facilitate discharge or repatriation
  • Internal discharge meetings with clinicians increased to daily on wards

Where are we now?

We would like to say a massive thank you to everyone involved in supporting the Trust in managing the increased pressure within our services. Due to your hard work and dedication, we are now in a position to move the escalation level down to amber. 

The table below shows our improving OATs position and where we are as of today:

 Date

 OATs

Declaration Status

4 January

94

 Purple

8 January

70

 Red

11 January

68

 Amber

12 January

57

 Amber

We are continuing to make changes and improvements that will support us with admissions and discharges going forward. An example of this is the Crisis Support Unit which opened in December and is supporting people stay well in the community where possible without the need to be admitted.

As a Trust we will undertake a comprehensive review of the actions we have taken and lessons we have learnt. We will be talking to teams and sharing this learning, but in the meantime if you have any concerns or issues you want to discuss with us, please contact us.

See also: