The four REAP levels correspond to Opel (Operational Pressures Escalation Levels) used by other NHS organisations. They provide a framework to maintain an effective and safe operational and clinical response for patients.

Level one/two is our normal state, rising to level four which indicates a potential for failures within our service.

Every manager has a responsibility to know the current REAP level and understand the implications. It is the responsibility of all local managers to ensure that the current REAP level is displayed on the status boards on all primary sites.

During periods of high demand on our services, the communications team and senior management will ensure the latest situation is shared appropriately with our patients, the public and key stakeholders.

These messages will explain that patients with urgent and immediately life-threatening conditions are our priority and those with less serious conditions are being advised that there may be a delayed response or, if it is safe to do so, they should seek alternative care. We apologise in advance to anyone experiencing delays.

There are specific triggers that govern escalation/de-escalation from one REAP level to another. These triggers do not mean that we will automatically move from one level to the next – this will be decided by the strategic commander during each incident, based on information from across the health and emergency sectors.

The strategic commander has the authority to implement a range of decisions and actions.

This may include:

  • Setting up of a command and control cell.
  • Doctor cover in our Emergency Operations Centre to support our Clinical Assessment Team.
  • When safe to do so, patients are being advised to make their own way to hospital to allow our crews to respond to patients who are in a serious and immediately life-threatening condition.
  • Alternative use of some Community First Responder Schemes (CFR) and Non-emergency Patient Transport.
  • Reviewing whether training and clinical education can be rearranged to provide additional support.
  • Considering use of staff to undertake work that is not their current job role.
  • Considering and authorising temporary accommodation for staff, if appropriate.
  • Deferral of commissioned work during significant recovery strategies.
  • Engagement with the NHS England Area Teams, Clinical Commissioning Groups or the Department of Health during significant service interruption.
  • Engagement with stakeholders regarding the deferral of scheduled external reporting processes during significant service interruption (ie reporting returns for audit purposes).