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Mobilising a “Gold Command Room” to ease system pressure

We set up a “Gold Command Room” in collaboration with partners from across the Lancashire and South Cumbria health system, to provide tactical and analytical support and ease system pressures due to the COVID-19 pandemic and the winter season.

In October 2020, increasing and extreme system pressures in the Lancashire and South Cumbria Integrated Care System (ICS) caused by the COVID-19 pandemic and then upcoming challenging winter period, highlighted the need for dedicated tactical support. A “Gold Command Room” was mobilised at pace to provide resilience by helping to manage daily operational activities. It reported to the ICS Hospital Cell with involvement of key stakeholder groups from CCGs, trusts, NHS England and Improvement (NHSEI) and ICS executives.

Midlands and Lancashire CSU led the development and mobilisation process, provides business intelligence expertise and also hosts the function.

The Gold Command Room operates with the delegated authority of the ICS; it directs the full range of providers, including acute trusts, ambulance, GPs and nursing homes.

We monitor and analyse pressure on individual trusts and organisations – number of people in A&E, COVID-19 cases, people who cannot be admitted because they are waiting for a COVID-19 test result, and other issues such as staff sickness, lack of beds, discharge delays, ambulances queueing up, and so on. Data is looked at from a system perspective and capacity redistributed to where it is needed most.

It is supported by a full MLCSU-led business intelligence function, using data and insight to support robust and agile decision-making and actions.


The Gold Command Room provided visibility of information and robust oversight to serve as an urgent care system-level decision-making function. It has been integral to the step-change improvement in system coordination and to effectively managing the significant pressures brought by COVID-19 and Winter 2020/21.

The Gold Command Room has:

  • Supported improved linkages of the wider provider system
  • Generated cross provider mitigation proposals for apparent and emerging pressures
  • Provided assurance, coordination and communication to the ICS Hospital Cell and NHSEI
  • Provided support and early operational decision-making and forward-facing planning
  • Provided operational advice to integrated care partnerships at all levels.
  • Encouraged proactive working via early warning of issues and facilitation of mutual aid.