Health Protection in Scotland - A Consultation Paper
Executive Summary
Introduction
In broad terms, health protection means protecting each of us from hazards which can damage our health, whether from disease or from biological, chemical, radiation and physical processes. Protecting health is an individual and collective responsibility. This consultation paper focuses on the latter and seeks views on the future direction of health protection in Scotland.
There are a number of compelling reasons for reviewing health protection arrangements in Scotland, including the proposals set out in "Getting Ahead of the Curve - A Strategy for combating infectious diseases", which the Chief Medical Officer in England published on 10 January 2002. The rationale for that strategy is that the co-location of responsibilities in a Health Protection Agency (HPA) will enhance the capability to tackle health protection issues in England , including, infectious disease, and chemical and radiation hazards.
What is health protection?
The 2001 Review of the Public Health Function in Scotland defined health protection as activities that protect health and prevent ill health. These include communicable disease control; control of environmental hazards to health; management of public health emergencies; and population immunisation and screening programmes. However, other health problems are wholly or partly related to exposure to hazards such as injuries and cancers. We need to consider whether these other health problems should be brought within the scope of any new arrangements for health protection, and how we can best continue our commitment to working within a UK and increasingly international context on health protection issues.
The key functions involved in health protection are: surveillance; investigation; risk assessment, management and communication; and planning for and managing emergencies. In Scotland, within the policy and legislative framework set by the Scottish Executive and, as appropriate the UK Government, these functions are at present the responsibility of a variety of national, and local agencies. It is proposed that the scope for alternative organisational arrangements in Scotland should be limited to the functions discharged by the following bodies: National Radiological Protection Board; National Focus for Chemical Incidents; Scottish Centre for Infection and Environmental Health; Information and Statistics Division (the health surveillance elements); Scottish Poisons Information Bureau; Scottish National Reference Laboratories; and NHS Boards (health protection functions especially those delivered by communicable disease and environmental health teams). It is also proposed that the scope and shape of any re-organisation in Scotland should mainly be determined by the major health problems caused by exposure to hazards and how well alternative arrangements will help protect the public from them.
Major issues for health protection in Scotland
" Our National Health, a plan for action, a plan for change" recognised three clinical priorities: coronary heart disease and strokes, cancer and mental health. Other major issues for health protection in Scotland are: injuries in children and young people; healthcare associated infections, and anti-microbial resistance; infections in childhood; infections associated with injecting drug use; sexually transmitted infections; respiratory illnesses associated with exposure to airborne hazards; intestinal infections caused by organisms of animal origin; falls in older people; cancers linked with exposure to radiation; emerging and "re-emerging" infections; incidents and outbreaks caused by the deliberate release of biological, chemical or radiological agents; and climate change. A key outcome from this consultation process will be to determine whether there are any other health problems, which should be considered major issues for health protection, and why.
Strengthening health protection services
Surveillance
The effectiveness of surveillance depends upon: professional awareness of the value of the early recognition of actual and potential hazards and their notification to relevant protection agencies; accurate clinical and laboratory diagnosis of illness linked to hazards; a strong system of fully accredited diagnostic and reference laboratory services; information systems which permit the rapid transfer, processing and dissemination of data; and the ability to link surveillance data from different sources to develop an overall picture of the risk presented to the public from exposure to a hazard.
Against this background, the consultation aims to determine whether there is a need for health protection surveillance to be strengthened in the following areas: monitoring unusual illnesses; integrating different surveillance systems; modernising the system for notifying communicable diseases; improving information technology for data transfer.
Investigation
There are two approaches to health protection investigations. The first is the investigation of an outbreak or incident; the second is specifically commissioned research. The consultation aims to determine whether health protection investigations should be developed by: improving capability to carry out investigations into outbreaks or incidents; defining strategic priorities for research into health protection issues; making better use of findings from investigation and research.
Risk
Risk assessment, management and communication are distinct but inter-related elements of health protection measures. The consultation aims to determine whether there is a need for these to be strengthened by: developing guidance on good practice in risk assessment in health protection agencies, particularly those working within the NHS; ensuring that all policies developed to protect the public are formally founded on a rigorous approach to risk assessment; promoting partnership working on health protection; improving education on hygiene; developing indicators to assess the performance of NHS agencies with health protection responsibilities and the impact of risk reduction measures on health; developing guidance on risk communication for NHS agencies involved in health protection to be used in establishing communication plans and procedures; commissioning research into understanding how certain risks become amplified and how the public can develop better means of comparing and contrasting risks which affect their personal life (risk literacy).
Emergency response and management
The importance of this function has been given added priority after the events of 11 September 2001. Extensive planning and guidance have already been put in place, including detailed guidance to health and local authority and other emergency services, raising clinical awareness and producing guidelines on the recognition and management of infections and exposures to chemical agents which give rise to unusual clinical presentations. The multi-agency response to an emergency involving the deliberate release of a biological, chemical or radiological agent is in most ways the same as one arising accidentally or naturally. The key aim is to reduce to a minimum the number of cases of illness by recognising promptly the outbreak of the incident, defining how cases have been exposed and identifying and controlling the source of the exposure.
Experience suggests that emergency response and management could be strengthened by: carrying out more regular joint exercises in all relevant types of incidents and improving the sharing of lessons learnt from them; continuing to develop and improve the reporting of outbreaks and incident management and the collation of the key lessons learnt from them; developing standards to audit the performance of organisations in managing outbreaks and incidents; and developing on-going training for frontline staff.
The contribution of microbiology services to health protection
Except for Reference Laboratories, the Scottish Executive sees no need to alter the organisational arrangements for microbiology services, which are the cornerstone of the surveillance of communicable disease. However, in line with progress being made in other UK countries, there is a requirement to improve the effectiveness and quality of NHS microbiology services' input to health protection, by, for example: identifying a lead microbiologist in each NHS Board area; establishing a standing sub-group of the Advisory Group on Infection; participating appropriately in two proposed UK initiatives (the adoption of standard operating procedures, and establishing an Inspector of Microbiology).
In addition, views are sought on: whether the current network of microbiology reference laboratories should be extended to deal with other micro-organisms and if so which; if their remit should be extended to test isolates from non-human samples; the scope for centralising all, or the majority of, reference laboratories in one NHS Trust or other appropriate service unit.
Options
The primary aim of this consultation is to assess the relative merits of 6 options for change summarised in the following table. Each option will have advantages and disadvantages. In judging them and framing a view on which is the best for Scotland, it will be important to consider whether and how each one:
- could improve the co-ordination and implementation of the required range of health protection measures;
Figure 1
OPTIONS FOR NEW ORGANISATIONAL ARRANGEMENTS FOR HEALTH PROTECTION IN SCOTLAND
- could improve the effectiveness and efficiency of the key health protection functions of surveillance, investigation, risk assessment, management and communication and managing emergencies.
- could enhance the accountability of health protection services in Scotland by more closely aligning policy, resource allocation and performance management functions.
- could facilitate collaboration with UK, European and international counterparts in protecting health, especially in securing the best possible specialist advice and in recognising and responding promptly to emerging infections and the deliberate release of biological and chemical agents.
- could provide incentives for people working in health protection to improve their individual and collective performance through a continuing process of personal, professional and organisational development.
Conclusion
More detailed, specific questions relating to all these themes are collated in Chapter 7.